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Hiki M, Kasai T, Sato A, Ishiwata S, Yatsu S, Matsumoto H, Shitara J, Shimizu M, Murata A, Kato T, Suda S, Iwata H, Takagi A, Daida H. Effects of Worsening Renal Function and Changes in Blood Urea Nitrogen Level During Hospitalization on Clinical Outcome in Patients with Acute Decompensated Heart Failure. Biomedicines 2025; 13:977. [PMID: 40299659 PMCID: PMC12024774 DOI: 10.3390/biomedicines13040977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2025] [Revised: 03/22/2025] [Accepted: 04/15/2025] [Indexed: 05/01/2025] Open
Abstract
Background/Objectives: Worsening renal function (WRF) during hospitalization for acute decompensated heart failure (ADHF) is associated with poor clinical outcomes. Data on the impact of WRF on clinical outcomes, considering blood urea nitrogen (BUN) level and its changes in patients with ADHF, are scarce. This study aimed to investigate the effects of BUN and its changes during hospitalization on the relationship between WRF during hospitalization and post-discharge clinical outcomes in patients with ADHF. Methods: A total of 509 patients with ADHF, hospitalized between 2007 and 2011, were included. WRF was defined as an absolute increase in serum creatinine level of >0.3 mg/dL, with a >25% increase during hospitalization. The risk of WRF for post-discharge clinical events, including death and rehospitalization, considering BUN levels, was assessed using three multivariable Cox regression models. Results: WRF was observed in 55 (10.8%) patients. The cumulative event-free survival was significantly worse in patients with WRF (p = 0.039). In Model 1 (excluding BUN changes), WRF was associated with a greater risk of post-discharge clinical events. In Model 2, which included both WRF and BUN changes, WRF was not a significant predictor. In Model 3, patients were subdivided according to WRF or BUN increase, and the subgroups were included instead of isolated WRF and BUN changes; only WRF with increased BUN level was associated with an increased risk of post-discharge clinical events. Conclusions: In patients with ADHF, WRF was associated with poor post-discharge clinical outcomes when accompanied by increased BUN levels during hospitalization.
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Affiliation(s)
- Masaru Hiki
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo 113-8421, Japan; (M.H.); (A.S.); (S.I.); (S.Y.); (H.M.); (J.S.); (M.S.); (A.M.); (T.K.); (S.S.); (H.I.); (A.T.); (H.D.)
| | - Takatoshi Kasai
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo 113-8421, Japan; (M.H.); (A.S.); (S.I.); (S.Y.); (H.M.); (J.S.); (M.S.); (A.M.); (T.K.); (S.S.); (H.I.); (A.T.); (H.D.)
- Cardiovascular Respiratory Sleep Medicine, Juntendo University Graduate School of Medicine, Tokyo 113-8421, Japan
- Sleep and Sleep-Disordered Breathing Center, Juntendo University Hospital, Tokyo 113-8421, Japan
- Department of Cardiovascular Management and Remote Monitoring, Juntendo University Graduate School of Medicine, Tokyo 113-8421, Japan
| | - Akihiro Sato
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo 113-8421, Japan; (M.H.); (A.S.); (S.I.); (S.Y.); (H.M.); (J.S.); (M.S.); (A.M.); (T.K.); (S.S.); (H.I.); (A.T.); (H.D.)
- Cardiovascular Respiratory Sleep Medicine, Juntendo University Graduate School of Medicine, Tokyo 113-8421, Japan
| | - Sayaki Ishiwata
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo 113-8421, Japan; (M.H.); (A.S.); (S.I.); (S.Y.); (H.M.); (J.S.); (M.S.); (A.M.); (T.K.); (S.S.); (H.I.); (A.T.); (H.D.)
- Cardiovascular Respiratory Sleep Medicine, Juntendo University Graduate School of Medicine, Tokyo 113-8421, Japan
| | - Shoichiro Yatsu
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo 113-8421, Japan; (M.H.); (A.S.); (S.I.); (S.Y.); (H.M.); (J.S.); (M.S.); (A.M.); (T.K.); (S.S.); (H.I.); (A.T.); (H.D.)
| | - Hiroki Matsumoto
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo 113-8421, Japan; (M.H.); (A.S.); (S.I.); (S.Y.); (H.M.); (J.S.); (M.S.); (A.M.); (T.K.); (S.S.); (H.I.); (A.T.); (H.D.)
| | - Jun Shitara
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo 113-8421, Japan; (M.H.); (A.S.); (S.I.); (S.Y.); (H.M.); (J.S.); (M.S.); (A.M.); (T.K.); (S.S.); (H.I.); (A.T.); (H.D.)
| | - Megumi Shimizu
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo 113-8421, Japan; (M.H.); (A.S.); (S.I.); (S.Y.); (H.M.); (J.S.); (M.S.); (A.M.); (T.K.); (S.S.); (H.I.); (A.T.); (H.D.)
| | - Azusa Murata
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo 113-8421, Japan; (M.H.); (A.S.); (S.I.); (S.Y.); (H.M.); (J.S.); (M.S.); (A.M.); (T.K.); (S.S.); (H.I.); (A.T.); (H.D.)
| | - Takao Kato
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo 113-8421, Japan; (M.H.); (A.S.); (S.I.); (S.Y.); (H.M.); (J.S.); (M.S.); (A.M.); (T.K.); (S.S.); (H.I.); (A.T.); (H.D.)
- Sleep and Sleep-Disordered Breathing Center, Juntendo University Hospital, Tokyo 113-8421, Japan
| | - Shoko Suda
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo 113-8421, Japan; (M.H.); (A.S.); (S.I.); (S.Y.); (H.M.); (J.S.); (M.S.); (A.M.); (T.K.); (S.S.); (H.I.); (A.T.); (H.D.)
- Cardiovascular Respiratory Sleep Medicine, Juntendo University Graduate School of Medicine, Tokyo 113-8421, Japan
- Sleep and Sleep-Disordered Breathing Center, Juntendo University Hospital, Tokyo 113-8421, Japan
| | - Hiroshi Iwata
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo 113-8421, Japan; (M.H.); (A.S.); (S.I.); (S.Y.); (H.M.); (J.S.); (M.S.); (A.M.); (T.K.); (S.S.); (H.I.); (A.T.); (H.D.)
| | - Atsutoshi Takagi
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo 113-8421, Japan; (M.H.); (A.S.); (S.I.); (S.Y.); (H.M.); (J.S.); (M.S.); (A.M.); (T.K.); (S.S.); (H.I.); (A.T.); (H.D.)
| | - Hiroyuki Daida
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo 113-8421, Japan; (M.H.); (A.S.); (S.I.); (S.Y.); (H.M.); (J.S.); (M.S.); (A.M.); (T.K.); (S.S.); (H.I.); (A.T.); (H.D.)
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Abstract
Cardiovascular diseases (CVD) remain a leading cause of death worldwide. In the past years new biomarkers have drawn the clinician's attention for their use in primary prevention and in the identification of individuals at cardiovascular risk. Biomarkers also provide information on the progression and possible recurrence of cardiovascular events, and include inflammatory markers (C-reactive protein and interleukin-18), endothelial dysfunction markers (intercellular adhesion molecule-1 and vascular cell adhesion molecule-1), neurohormonal markers (brain natriuretic peptide and copeptine), ischemia biomarkers (apolipoprotein J) and necrosis markers (troponins). Although biomarkers provide utility for predicting cardiovascular risk, the identification and characterization of new biomarkers to achieve increasing diagnosis and prognostic efficiency in CVD prevention is of high clinical interest. In this review we will discuss on recently discovered biomarkers and their clinical applications.
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Affiliation(s)
- L Badimon
- Cardiovascular Research Center, CSIC-ICCC, Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau, Barcelona, Spain.
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Abstract
The non-peptide vasopressin antagonists (VPA), called vaptans, were developed in the 1990s to antagonize both the pressor and antidiuretic effects of vasopressin. There are three subtypes of VPA receptors: V1a, V1b and V2. V1a receptors are widely distributed in the body, mainly the blood vessels and myocardium. The V1b receptors are located mainly in the anterior pituitary gland and play a role in ACTH release. V2 receptors are located in the collecting tubular renal cells. Both V1a and V1b receptors act through the intracellular phosphoinositol signalling pathway, Ca(++) being the second messenger. V2 receptors work through AMPc generation, which promotes aquaporin 2 (AQP2) trafficking and allows water to enter the cell. The vaptans act competitively at the AVP receptor. The most important are mozavaptan, lixivaptan, satavaptan and tolvaptan, all of which are selective V2 antagonists and are administered through the oral route. In contrast, conivaptan is a dual V1 and V2 antagonist administered through the endovenous route. The main characteristics of vaptans are their effect on free water elimination without affecting electrolyte excretion. There are several studies on the effects of these drugs in hypervolemic hyponatremia (heart failure, hepatic cirrhosis) as well as in normovolemic hyponatremia (inappropriate secretion of ADH [SIADH]). Current studies show that the vaptans are effective and well tolerated, although knowledge of these drugs remains limited. There are no studies of the use of vaptans in severe hyponatremia. Osmotic demyelination syndrome due to excessively rapid correction of hyponatremia has not been described.
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Affiliation(s)
- Carles Villabona
- Servicio de Endocrinología y Nutrición, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
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Clozel JP, Ertel EA, Ertel SI. Voltage-gated T-type Ca2+ channels and heart failure. PROCEEDINGS OF THE ASSOCIATION OF AMERICAN PHYSICIANS 1999; 111:429-37. [PMID: 10519164 DOI: 10.1111/paa.1999.111.5.429] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
In the cardiovascular system, two types of voltage-gated Ca2+ channels are present: the L-type and the T-type. Under normal conditions, T-type Ca2+ channels are involved in the maintenance of vascular tone and cardiac automaticity but, since they are not present in contractile myocardial cells, they do not contribute significantly to myocardial contraction. In experimental models of cardiac hypertrophy, myocardial T-type Ca2+ channels are upregulated, which could contribute to the increased incidence of ventricular arrhythmia. In addition, T-type Ca2+ channels participate in the regulation of cell proliferation and neurohormonal secretion; through these pathways, T-type Ca2+ channels might participate in myocardial remodeling. The pathophysiological role of T-type Ca2+ channels in heart failure has been investigated using mibefradil, a Ca2+ antagonist that is 10-50 times more potent at blocking T-type than L-type Ca2+ channels. In contrast with classic L-type Ca2+ channel antagonists, miberfradil appears beneficial in many animal models of heart failure; in particular, it does not exert negative inotropic effects nor does it stimulate the neurohormonal system. Furthermore, in the Pfeffer rat model, blockade of T-type Ca2+ channels with mibefradil is associated with an improved survival rate. In humans, however, major metabolic drug interactions independent of T-type Ca2+ channel blockade made it impossible to determine the efficacy of mibefradil in treating heart failure; indeed, these interactions led to the withdrawal of the drug from the market.
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Affiliation(s)
- J P Clozel
- Actelion Ltd, Innovation Center, Allschwil, Switzerland
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Abstract
Our evolving understanding of how psychosocial and behavioral factors affect health and disease processes has been marked by investigation of specific relationships and mechanisms underlying them. Stress and other emotional responses are components of complex interactions of genetic, physiological, behavioral, and environmental factors that affect the body's ability to remain or become healthy or to resist or overcome disease. Regulated by nervous, endocrine, and immune systems, and exerting powerful influence on other bodily systems and key health-relevant behaviors, stress and emotion appear to have important implications for the initiation or progression of cancer, HIV, cardiovascular disease, and other illnesses. Health-enhancing and health-impairing behaviors, including diet, exercise, tobacco use, and protection from the sun, can compromise or benefit health and are directed by a number of influences as well. Finally, health behaviors related to being ill or trying to avoid disease or its severest consequences are important. Seeking care and adhering to medical regimens and recommendations for disease surveillance allow for earlier identification of health threats and more effective treatment. Evidence that biobehavioral factors are linked to health in integrated, complex ways continues to mount, and knowledge of these influences has implications for medical outcomes and health care practice.
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Affiliation(s)
- A Baum
- University of Pittsburgh Cancer Institute, Pennsylvania 15213, USA.
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