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Sasmita BR, Zhao Y, Gong M, Luo S, Huang B. Edema Index Predicts Mortality in Patients with Chronic Heart Failure: A Prospective, Observational Study. Glob Heart 2024; 19:5. [PMID: 38250704 PMCID: PMC10798169 DOI: 10.5334/gh.1287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 12/18/2023] [Indexed: 01/23/2024] Open
Abstract
Introduction Chronic fluid accumulation or congestion is considered an important pathophysiologic mechanism in heart failure, leading to cardinal symptoms such as dyspnea, pulmonary congestion, and pitting edema. Edema index (EI) recently emerged as a surrogate for extracellular volume status and has been proven to be able to reflect one's congestion status. In this study, we aimed to evaluate the prognostic value of EI in patients with chronic heart failure (CHF). Methods A total of 401 consecutive patients with CHF between August 2019 and October 2021 were prospectively enrolled. EI was obtained by InBody S10. The primary endpoint was long-term all-cause and cardiovascular mortality. Results Patients with high EI (>0.397) tended to be older, presented with atrial fibrillation, have higher N-terminal brain natriuretic peptide, and have higher creatinine (all p < 0.05). During a median follow-up of 1200 days, the all-cause and cardiovascular mortality rate was significantly higher in the high EI group compared to the low EI group (all-cause mortality rate 43.8% vs. 30.3%, p < 0.001, and cardiovascular mortality rate 17.5% vs. 13.0%, p < 0.001, respectively). In the multivariate Cox proportional hazard analysis, EI > 0.397 was an independent predictor for both all-cause mortality (HR 1.959; 95% CI 1.304, 2.944; p = 0.001) and cardiovascular mortality (HR 2.051; 95% CI 1.276, 3.296; p = 0.003). Conclusions Admission EI could be used as a marker for predicting long-term mortality in patients with CHF, and higher EI was associated with an increased risk of all-cause and cardiovascular mortality. Furthermore, EI-guided management could be a promising therapy in patients with CHF.
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Affiliation(s)
- Bryan Richard Sasmita
- Department of Cardiology, the First Affiliated Hospital of Chongqing Medical University, 400016, Chongqing, China
| | - Yuhe Zhao
- Department of Cardiology, the First Affiliated Hospital of Chongqing Medical University, 400016, Chongqing, China
- Department of Cardiology, Chongqing Seventh People’s Hospital, Chongqing, China
| | - Ming Gong
- Department of Cardiology, the First Affiliated Hospital of Chongqing Medical University, 400016, Chongqing, China
| | - Suxin Luo
- Department of Cardiology, the First Affiliated Hospital of Chongqing Medical University, 400016, Chongqing, China
| | - Bi Huang
- Department of Cardiology, the First Affiliated Hospital of Chongqing Medical University, 400016, Chongqing, China
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Chen J, Jiang C, Guo M, Zeng Y, Jiang Z, Zhang D, Tu M, Tan X, Yan P, Xu X, Long Y, Xu Y. Effects of SGLT2 inhibitors on cardiac function and health status in chronic heart failure: a systematic review and meta-analysis. Cardiovasc Diabetol 2024; 23:2. [PMID: 38172861 PMCID: PMC10765651 DOI: 10.1186/s12933-023-02042-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 10/22/2023] [Indexed: 01/05/2024] Open
Abstract
PURPOSE Numerous clinical studies have explored sodium-glucose cotransporter 2 inhibitor (SGLT2i) in patients with chronic heart failure (CHF), with or without type 2 diabetes mellitus (T2DM), and SGLT2i were proved to significantly reduce CHF hospitalization, cardiovascular death, cardiovascular mortality, all-cause mortality and myocardial infarction in patients with or without T2DM. However, only a limited few have investigated the effects of SGLT-2i on HF disease-specific health status and cardiac function. This meta-analysis aims to assess the effects of SGLT2i on disease-specific health status and cardiac function in CHF patients. METHODS A comprehensive search was conducted of trials by searching in PubMed, EMBASE, CENTRAL, Scopus, and Web of Science, and two Chinese databases (CNKI and Wanfang), Clinical Trials ( http://www. CLINICALTRIALS gov ) were also searched. RESULTS A total of 18 randomized controlled trials (RCTs) involving 23,953 participants were included in the meta-analysis. The effects of SGLT2 inhibitors were compared with control or placebo groups in CHF with or without T2DM. The SGLT2 inhibitors group exhibited a significant reduction in pro b-type natriuretic peptide (NT-proBNP) levels by 136.03 pg/ml (95% confidence interval [CI]: -253.36, - 18.70; P = 0.02). Additionally, a greater proportion of patients in the SGLT2 inhibitors group showed a ≥ 20% decrease in NT-proBNP (RR = 1.45, 95% CI [0.92, 2.29], p = 0.072). However, no statistically significant difference was observed for the effects on B-type natriuretic peptide (BNP). The use of SGLT-2 inhibitors led to a noteworthy improvement in LVEF by 2.79% (95% CI [0.18, 5.39];P = 0.036). In terms of health status, as assessed by the Kansas City Cardiomyopathy Questionnaire (KCCQ) and 6-minute walk distance, SGLT2 inhibitors led to a significant improvement in KCCQ clinical summary (KCCQ-CS) score (WMD = 1.7, 95% CI [1.67, 1.73], P < 0.00001), KCCQ overall summary (KCCQ-OS) score (WMD = 1.73, 95% CI [0.94, 2.52], P < 0.00001), and KCCQ total symptom (KCCQ-TS) score (WMD = 2.88, 95% CI [1.7, 4.06], P < 0.00001). Furthermore, the occurrence of KCCQ-CS and KCCQ-OS score increases ≥ 5 points had relative risks (RR) of 1.25 (95% CI [1.11, 1.42], P < 0.00001) and 1.15 (95% CI [1.09, 1.22], P < 0.00001), respectively. Overall, SGLT2 inhibitors increased the 6-minute walk distance by 23.98 m (95% CI [8.34, 39.62]; P = 0.003) compared to control/placebo from baseline. CONCLUSIONS The SGLT2 inhibitors treatment offers an effective strategy for improving NT-proBNP levels, Kansas City Cardiomyopathy Questionnaire scores and 6-minute walk distance in CHF with or without T2DM. These findings indicate that SGLT2i improve cardiac function and health status in CHF with or without T2DM, and provide valuable guidance for clinicians making treatment decisions for patients with CHF.
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Affiliation(s)
- Jiao Chen
- Department of Endocrinology and Metabolism, the Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China
- Department of Endocrinology, The Third Hospital of Mianyang, Sichuan Mental Health Center, Mianyang, Sichuan, China
- Sichuan Clinical Research Center for Nephropathy, Luzhou, Sichuan, China
- Metabolic Vascular Disease Key Laboratory of Sichuan Province, Luzhou, China
| | - Chunxia Jiang
- Department of Endocrinology and Metabolism, the Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China
- Sichuan Clinical Research Center for Nephropathy, Luzhou, Sichuan, China
- Metabolic Vascular Disease Key Laboratory of Sichuan Province, Luzhou, China
- State Key Laboratory of Quality Research in Chinese Medicine, Macau University of Science and Technology, Macao, China
- Faculty of Chinese Medicine, Macau University of Science and Technology, Macao, China
| | - Man Guo
- Department of Endocrinology and Metabolism, the Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China
- Sichuan Clinical Research Center for Nephropathy, Luzhou, Sichuan, China
- Metabolic Vascular Disease Key Laboratory of Sichuan Province, Luzhou, China
| | - Yan Zeng
- Department of Endocrinology and Metabolism, the Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China
- Sichuan Clinical Research Center for Nephropathy, Luzhou, Sichuan, China
- Metabolic Vascular Disease Key Laboratory of Sichuan Province, Luzhou, China
| | - Zongzhe Jiang
- Department of Endocrinology and Metabolism, the Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China
- Sichuan Clinical Research Center for Nephropathy, Luzhou, Sichuan, China
- Metabolic Vascular Disease Key Laboratory of Sichuan Province, Luzhou, China
| | - Dongmin Zhang
- Department of Endocrinology, The Third Hospital of Mianyang, Sichuan Mental Health Center, Mianyang, Sichuan, China
| | - Mengqin Tu
- Department of Endocrinology and Metabolism, the Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China
- Sichuan Clinical Research Center for Nephropathy, Luzhou, Sichuan, China
- Metabolic Vascular Disease Key Laboratory of Sichuan Province, Luzhou, China
| | - Xiaozhen Tan
- Department of Endocrinology and Metabolism, the Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China
- Sichuan Clinical Research Center for Nephropathy, Luzhou, Sichuan, China
- Metabolic Vascular Disease Key Laboratory of Sichuan Province, Luzhou, China
| | - Pijun Yan
- Department of Endocrinology and Metabolism, the Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China
- Sichuan Clinical Research Center for Nephropathy, Luzhou, Sichuan, China
- Metabolic Vascular Disease Key Laboratory of Sichuan Province, Luzhou, China
| | - XunMei Xu
- Department of Endocrinology, The Third Hospital of Mianyang, Sichuan Mental Health Center, Mianyang, Sichuan, China.
| | - Yang Long
- Department of Endocrinology and Metabolism, the Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China.
- Sichuan Clinical Research Center for Nephropathy, Luzhou, Sichuan, China.
- Metabolic Vascular Disease Key Laboratory of Sichuan Province, Luzhou, China.
| | - Yong Xu
- Department of Endocrinology and Metabolism, the Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China.
- Sichuan Clinical Research Center for Nephropathy, Luzhou, Sichuan, China.
- Metabolic Vascular Disease Key Laboratory of Sichuan Province, Luzhou, China.
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Millogo GRC, Thiam Tall A, Seghda TAA, Kambiré Y, Nongkouni E, Dabiré YE, Kagambéga LJ, Kologo JK, Yaméogo VN, Marcaggi X, Zabsonré P. [Contribution of the 6-minutes walking test and the plasma NT-proBNP at admission and discharge to the prognostic evaluation of patients with NYHA class II-III Heart Failure.]. Ann Cardiol Angeiol (Paris) 2023; 72:101639. [PMID: 37717311 DOI: 10.1016/j.ancard.2023.101639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 08/08/2023] [Accepted: 08/08/2023] [Indexed: 09/19/2023]
Abstract
OBJECTIVE To study the 6MWT and NT-proBNP contribution to the prognosis evaluation of patients with NYHA class II-III heart failure in the Yalgado Ouédraogo Teaching Hospital. METHODS We carried out a nine months prospective observational cohort from the 1st February to the 31st October 2020. Patients with NYHA class II-III HF who consented to participate were included in the study. We identified two variables of interest: death and readmission. RESULTS We included 50 patients with congestive heart failure representing 37.3% of heart failure. The average follow up time of patients was 154.58 ± 74.8 days. Twelve patients (24%) were readmited and 11 passed away with five during hospitalisation. On admission, The average distance on the 6MWT (194.6 ± 85.5 m) on admission and average NT-proBNP (5812.1±4729.4 ng/L) measured on admission and before discharge wasn't significantly correlated to the risk of death and re-hospitalisation. The average distance on the 6MWT before discharge (306.2±84.6) was significantly correlated to an increase risk of death and re-hospitalisation. Patients with an increase in NT-proBNP superior to 30% from measurement on admission to the one before discharge had a high risk of re-hospitalisation and death compare to those with a decrease of more than 30% with a moderate to good correlation coefficient of 0.6 between the two. CONCLUSION 6MWT and NT-proBNP variations from admission to discharge have been necessary to evaluate the prognosis of patients with CHF.
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Affiliation(s)
- G R C Millogo
- Service de cardiologie centre hospitalier Universitaire Yalgado Ouédraogo, Ouagadougou, Burkina Faso.
| | - A Thiam Tall
- Service de cardiologie centre hospitalier Universitaire Yalgado Ouédraogo, Ouagadougou, Burkina Faso
| | - T A A Seghda
- Service de cardiologie centre hospitalier Universitaire de Bogodogo, Ouagadougou, Burkina Faso
| | - Y Kambiré
- Service de cardiologie centre hospitalier Universitaire de Tengandogo, Ouagadougou, Burkina Faso
| | - E Nongkouni
- Service de cardiologie centre hospitalier Universitaire Yalgado Ouédraogo, Ouagadougou, Burkina Faso
| | - Y E Dabiré
- Service de cardiologie centre hospitalier Universitaire Yalgado Ouédraogo, Ouagadougou, Burkina Faso
| | - L J Kagambéga
- Service de cardiologie centre hospitalier Universitaire Yalgado Ouédraogo, Ouagadougou, Burkina Faso
| | - J K Kologo
- Service de cardiologie centre hospitalier Universitaire Yalgado Ouédraogo, Ouagadougou, Burkina Faso
| | - V N Yaméogo
- Service de cardiologie centre hospitalier Universitaire Yalgado Ouédraogo, Ouagadougou, Burkina Faso
| | | | - P Zabsonré
- Service de cardiologie centre hospitalier Universitaire Yalgado Ouédraogo, Ouagadougou, Burkina Faso
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Guan Z, Chen J, Wang L, Hao M, Dong X, Luo T, Jiang J, Lin Z, Li X, Chen P, Yang Z, Ye X, Wang L, Xian S, Chen Z. Nuanxinkang prevents the development of myocardial infarction-induced chronic heart failure by promoting PINK1/Parkin-mediated mitophagy. Phytomedicine 2023; 108:154494. [PMID: 36279758 DOI: 10.1016/j.phymed.2022.154494] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Revised: 09/27/2022] [Accepted: 10/05/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Mitochondrial dysfunction is an important pathological feature of chronic heart failure (CHF). Regulation of mitophagy can effectively maintain mitochondrial homeostasis and energy metabolism, thereby inhibiting the development of CHF. Nuanxinkang (NXK), a Chinese herbal compound preparation, has significant cardioprotective effects on CHF; however, its underlying mechanism on mitophagy has not been completely clarified. This research intended to investigate the mechanism of NXK in treating myocardial infarction (MI)-induced CHF. METHODS The left anterior descending coronary artery (LAD) ligation surgery was performed to establish an MI-induced CHF model in male C57BL/6 mice. From 1 day after surgery, mice were given NXK (0.41, 0.82 or 1.65 g/kg/d), Perindopril (PDPL, 0.607 mg/kg/d), or an equivalent amount of sterile water by gavage for 28 continuous days. Then, mice were examined for cardiac function, myocardial fibrosis, cardiomyocyte apoptosis, mitochondrial structure and mitophagy levels of cardiomyocytes, etc. In addition, a hypoxic injury model was created using HL-1 cardiomyocytes from wild-type (WT) mice. HL-1 cells were pretreated with or without NXK-containing serum. Mitochondrial function and mitophagy levels were examined in HL-1 cells. RESULTS In MI-induced CHF mice, cardiac dysfunction, severe cardiac remodeling, elevated levels of oxidative stress, reduced ATP levels, and inhibition of PINK1/Parkin-mediated mitophagy were observed. High-dose NXK treatment (1.65 g/kg/d) significantly improved myocardial energy metabolism, inhibited cardiac remodeling, improved cardiac function, and restored cardiac PINK1/Parkin-mediated mitophagy levels to some extent in MI mice. In vitro, elevated levels of mitochondrial reactive oxygen species (ROS) with impaired mitochondrial membrane potential (ΔΨm) were observed in hypoxic HL-1 cells. While NXK treatment significantly protected cardiomyocytes from hypoxia-induced mitochondrial dysfunction, which is consistent with the in vivo results. Further studies showed that NXK could increase PINK1/Parkin-mediated mitophagy levels in cardiomyocytes, which could be blocked by the mitophagy inhibitor Mdivi-1. CONCLUSION In conclusion, NXK could prevent cardiac mitochondrial dysfunction and improve cardiac function against MI-induced CHF by promoting Pink1/Parkin-mediated mitophagy, which represents a very prospective strategy for the treatment of CHF.
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Affiliation(s)
- Zhuoji Guan
- Dongguan Hospital, Guangzhou University of Chinese Medicine, Dongguan 523005, China; Guangzhou University of Chinese Medicine, Guangzhou 510405, China; The First Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou 510405, China; Lingnan Medical Research Center, Guangzhou University of Chinese Medicine, Guangzhou 510405, China; Guangzhou Key Laboratory of Chinese Medicine for Prevention and Treatment of Chronic Heart Failure, Guangzhou 510405, China
| | - Jie Chen
- Guangzhou University of Chinese Medicine, Guangzhou 510405, China; The First Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou 510405, China; Lingnan Medical Research Center, Guangzhou University of Chinese Medicine, Guangzhou 510405, China; Guangzhou Key Laboratory of Chinese Medicine for Prevention and Treatment of Chronic Heart Failure, Guangzhou 510405, China
| | - Linhai Wang
- Guangzhou University of Chinese Medicine, Guangzhou 510405, China; The First Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou 510405, China; Lingnan Medical Research Center, Guangzhou University of Chinese Medicine, Guangzhou 510405, China; Guangzhou Key Laboratory of Chinese Medicine for Prevention and Treatment of Chronic Heart Failure, Guangzhou 510405, China
| | - Mengjiao Hao
- Guangzhou University of Chinese Medicine, Guangzhou 510405, China; Sun Yat-sen University, Guangzhou 510006, China
| | - Xin Dong
- Guangzhou University of Chinese Medicine, Guangzhou 510405, China; The First Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou 510405, China; Lingnan Medical Research Center, Guangzhou University of Chinese Medicine, Guangzhou 510405, China; Guangzhou Key Laboratory of Chinese Medicine for Prevention and Treatment of Chronic Heart Failure, Guangzhou 510405, China
| | - Tong Luo
- Guangzhou University of Chinese Medicine, Guangzhou 510405, China; The First Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou 510405, China; Lingnan Medical Research Center, Guangzhou University of Chinese Medicine, Guangzhou 510405, China; Guangzhou Key Laboratory of Chinese Medicine for Prevention and Treatment of Chronic Heart Failure, Guangzhou 510405, China
| | - Jialin Jiang
- Guangzhou University of Chinese Medicine, Guangzhou 510405, China; The First Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou 510405, China; Lingnan Medical Research Center, Guangzhou University of Chinese Medicine, Guangzhou 510405, China; Guangzhou Key Laboratory of Chinese Medicine for Prevention and Treatment of Chronic Heart Failure, Guangzhou 510405, China
| | - Zhijun Lin
- Guangzhou University of Chinese Medicine, Guangzhou 510405, China; The First Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou 510405, China; Lingnan Medical Research Center, Guangzhou University of Chinese Medicine, Guangzhou 510405, China; Guangzhou Key Laboratory of Chinese Medicine for Prevention and Treatment of Chronic Heart Failure, Guangzhou 510405, China
| | - Xuan Li
- Guangzhou University of Chinese Medicine, Guangzhou 510405, China; The First Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou 510405, China; Lingnan Medical Research Center, Guangzhou University of Chinese Medicine, Guangzhou 510405, China; Guangzhou Key Laboratory of Chinese Medicine for Prevention and Treatment of Chronic Heart Failure, Guangzhou 510405, China
| | - Pinliang Chen
- Guangzhou University of Chinese Medicine, Guangzhou 510405, China; The First Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou 510405, China; Lingnan Medical Research Center, Guangzhou University of Chinese Medicine, Guangzhou 510405, China; Guangzhou Key Laboratory of Chinese Medicine for Prevention and Treatment of Chronic Heart Failure, Guangzhou 510405, China
| | - Zhongqi Yang
- Guangzhou University of Chinese Medicine, Guangzhou 510405, China; The First Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou 510405, China; Lingnan Medical Research Center, Guangzhou University of Chinese Medicine, Guangzhou 510405, China; Guangzhou Key Laboratory of Chinese Medicine for Prevention and Treatment of Chronic Heart Failure, Guangzhou 510405, China
| | - Xiaohan Ye
- Dongguan Hospital, Guangzhou University of Chinese Medicine, Dongguan 523005, China; Guangzhou University of Chinese Medicine, Guangzhou 510405, China; The First Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou 510405, China; Lingnan Medical Research Center, Guangzhou University of Chinese Medicine, Guangzhou 510405, China; Guangzhou Key Laboratory of Chinese Medicine for Prevention and Treatment of Chronic Heart Failure, Guangzhou 510405, China.
| | - Lingjun Wang
- Guangzhou University of Chinese Medicine, Guangzhou 510405, China; The First Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou 510405, China; Lingnan Medical Research Center, Guangzhou University of Chinese Medicine, Guangzhou 510405, China; Guangzhou Key Laboratory of Chinese Medicine for Prevention and Treatment of Chronic Heart Failure, Guangzhou 510405, China.
| | - Shaoxiang Xian
- Guangzhou University of Chinese Medicine, Guangzhou 510405, China; The First Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou 510405, China; Lingnan Medical Research Center, Guangzhou University of Chinese Medicine, Guangzhou 510405, China; Guangzhou Key Laboratory of Chinese Medicine for Prevention and Treatment of Chronic Heart Failure, Guangzhou 510405, China.
| | - Zixin Chen
- Guangzhou University of Chinese Medicine, Guangzhou 510405, China; The First Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou 510405, China; Lingnan Medical Research Center, Guangzhou University of Chinese Medicine, Guangzhou 510405, China; Guangzhou Key Laboratory of Chinese Medicine for Prevention and Treatment of Chronic Heart Failure, Guangzhou 510405, China.
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Piccirillo G, Moscucci F, Carnovale M, Corrao A, Di Diego I, Lospinuso I, Caltabiano C, Mezzadri M, Rossi P, Magrì D. Short-Period Temporal Dispersion Repolarization Markers in Elderly Patients with Decompensated Heart Failure. Clin Ter 2022; 173:356-361. [PMID: 35857054 DOI: 10.7417/ct.2022.2446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
OBJECTIVES Aging and chronic heart failure (CHF) are responsible for the temporal inhomogeneity of electrocardiogram (ECG) repolarization phase. In the past, short period repolarization-dispersion parameters were used as makers of mortality risk in different heart diseases, yet. Aim of this work was to evaluate risk of mortality or worsening condition in CHF elderly subjects by mean of these repo-larization variables. METHOD An observational, prospective cohort study was performed, collecting 5 minutes ECG recordings to assess the mean and standard deviation (SD) of the following variables: QT end (QTe), QT peak (QTp) and T peak to T end (Te) in 117 decompensated CHF (age range: from 49 to 103 years). 30-day mortality and high levels of NT-pro BNP (<75 percentile) were considered markers of decompensated CHF. RESULTS A total of 27 patients (23%) died during the 30-day follow-up (overall mortality rate 23%). Te mean (odd ratio (OR): 1.04, 95% confidence limit (Cl 7u): 1.02-1.09, p<0.01), NT-pro BNP (OR: 1.00, 95% cl: 1.00-1.00, p<0.01) and LVMI (OR : 0.98, 95% cl: 0.96-0.10, p<0.05) were associated to risk of mortality at the multivariable logistic analysis. On the contrary, the same statistical analysis selected TeSD (OR: 1.36, 95% cl: 1.16-1.59, p<0.001) and LVEF (OR: 0.91, 95% cl: 0.87-0.95, p<0.001) as marker of decompensated CHF. CONCLUSION In decompensated CHF elderly subjects, Te mean seem be associated to mortality and TeSD could be considered a risk factor for CHF worsening and complications. These evidences could provide useful tools for telemonitoring CHF elderly patients, amelio-rating treatments and outcomes.
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Affiliation(s)
- G Piccirillo
- Department of Clinical and Internal Medicine, Anesthesiology and Cardiovascular Sciences, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
| | - F Moscucci
- Policlinico Umberto I, DAI Internal Medicine and Medical Specialties, Rome, Italy
| | - M Carnovale
- Department of Clinical and Internal Medicine, Anesthesiology and Cardiovascular Sciences, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
| | - A Corrao
- Department of Clinical and Internal Medicine, Anesthesiology and Cardiovascular Sciences, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
| | - I Di Diego
- Department of Clinical and Internal Medicine, Anesthesiology and Cardiovascular Sciences, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
| | - I Lospinuso
- Department of Clinical and Internal Medicine, Anesthesiology and Cardiovascular Sciences, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
| | - C Caltabiano
- Department of Clinical and Internal Medicine, Anesthesiology and Cardiovascular Sciences, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
| | - M Mezzadri
- Department of Clinical and Internal Medicine, Anesthesiology and Cardiovascular Sciences, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
| | - P Rossi
- Cardiology Division, Arrhythmology Unit, S. Giovanni Calibita, Isola Tiberina, Rome, Italy
| | - D Magrì
- Department of Clinical and Molecular Medicine, S. Andrea Hospital, "Sapienza" University of Rome, Rome, Italy
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Nalesso F, Garzotto F, Gobbi L, Cattarin L, Calò LA. In vitro use of standard fluid infusion central venous catheter for Slow Continuous Ultrafiltration feasibility assessment. Artif Organs 2022; 46:1695-1700. [PMID: 35403263 DOI: 10.1111/aor.14253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 03/19/2022] [Accepted: 03/30/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Slow Continuous Ultrafiltration (SCUF) by Central Venous Catheter (CVC) for hemodialysis is a simple extracorporeal ultrafiltration that can reduce and control fluid overload in patients with chronic or acute on chronic heart failure unresponsive to medical therapy. In order to avoid complications and risks related to the catheterization with a standard CVC for hemodialysis to provide the SCUF, considering that hospitalized patients affected by congestive heart failure commonly undergo CVC placement for medications delivering, we tested an in vitro model to use a standard CVC for infusion to perform SCUF. METHODS We performed an in vitro SCUF experimental model through two different lumens of a triple (8Fr x 20 cm Tri-lumen catheter Kit - Envans Extra) and a quad-lumen CVC (8.5Fr x 20 cm Quad-lumen catheter kit - Benefis Medical Devices) commonly used in our Intensive Care Unit for fluids and medications infusions. We used Prismaflex with HF-20 set (Baxter, IL, USA) to perform the SCUF treatment. RESULTS Our in vitro data confirm the technical feasibility of the use of standard CVC for fluid infusion to perform a SCUF treatment with a theoretical weight loss up to 200 mL/h by a blood flow ranging from 30 to 45 mL/min. CONCLUSIONS The use of standard infusion CVC could be utilized in Intensive Care Unit to perform SCUF not exposing patients to the risks and complications related to the placement and permanence of CVC for hemodialysis.
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Affiliation(s)
- Federico Nalesso
- University of Padua, Department of Medicine, Nephrology, Dialysis and Transplant Unit, Padova, Italy
| | | | - Laura Gobbi
- University of Padua, Department of Medicine, Nephrology, Dialysis and Transplant Unit, Padova, Italy
| | - Leda Cattarin
- University of Padua, Department of Medicine, Nephrology, Dialysis and Transplant Unit, Padova, Italy
| | - Lorenzo A Calò
- University of Padua, Department of Medicine, Nephrology, Dialysis and Transplant Unit, Padova, Italy
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Yun S, Enjuanes C, Calero-Molina E, Hidalgo E, José N, Calvo E, Verdú-Rotellar JM, Garcimartín P, Chivite D, Formiga F, Jiménez-Marrero S, Garay A, Alcoberro L, Moliner P, Corbella X, Comín-Colet J. Effectiveness of telemedicine in patients with heart failure according to frailty phenotypes: Insights from the iCOR randomised controlled trial. Eur J Intern Med 2022; 96:49-59. [PMID: 34656406 DOI: 10.1016/j.ejim.2021.09.021] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 09/02/2021] [Accepted: 09/14/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND The potential impact of telemedicine (TM) in the monitoring of patients with heart failure (HF) is still uncertain particularly in the frailest patients. The aim of this study was to define the efficacy of a TM-based managed care solution across different HF patient frailty phenotypes. METHODS We performed a clustering analysis on the basis of 8 frailty-related dimensions to the HF-patients included in the 'insuficiència Cardíaca Optimització Remota' (iCOR) randomised study comparing TM vs. usual care (UC) in HF patients. The primary study endpoint was the incidence of a non-fatal HF event after 6 months of inclusion. The healthcare-related costs in each study group and cluster were also evaluated. The event rates of primary and secondary study endpoints were calculated for each cluster. Cox proportional-hazards regression models were used to evaluate the effect of cluster, treatment group and the interaction term cluster by treatment group on study endpoints. RESULTS 5 different frailty phenotypes were identified. The positive effect of TM compared to UC strategy was consistent across all frailty phenotypes (p-value for interaction 0.711). The risk of experiencing a primary event was significantly lower in patients that underwent allocation to the TM arm compared to UC (p-value = 0.016). Ultimately, the healthcare costs were significantly reduced in patients allocated to the TM compared to UC in all 5 frailty phenotypes (all p-value < 0.05). CONCLUSIONS Non-invasive TM-based follow-up tools are effective compared to UC follow-up in preventing HF events in the early post-discharge period, regardless of the 5 frailty phenotypes.
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Affiliation(s)
- Sergi Yun
- Community Heart Failure Program, Departments of Cardiology and Internal Medicine, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain; Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain; Department of Internal Medicine, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Cristina Enjuanes
- Community Heart Failure Program, Departments of Cardiology and Internal Medicine, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain; Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain; Department of Cardiology, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Esther Calero-Molina
- Community Heart Failure Program, Departments of Cardiology and Internal Medicine, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain; Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain; Department of Cardiology, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Encarnación Hidalgo
- Community Heart Failure Program, Departments of Cardiology and Internal Medicine, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain; Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain; Department of Cardiology, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Núria José
- Community Heart Failure Program, Departments of Cardiology and Internal Medicine, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain; Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain; Department of Cardiology, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Elena Calvo
- Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain; Department of Cardiology, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain; Faculty of medicine and Health Sciences, School of Nursing, University of Barcelona (UB), Barcelona, Spain
| | - José María Verdú-Rotellar
- Heart Diseases Biomedical Research Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain; School of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain; Jordi Gol Primary Care Research Institute, Catalan Institute of Heath, Barcelona, Spain
| | - Paloma Garcimartín
- Heart Diseases Biomedical Research Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain; Outpatient Clinics, Hospital del Mar, Parc de Salut Mar, Barcelona, Spain; Escuela Superior de Enfermería del Mar, Parc de Salut Mar, Barcelona, Spain
| | - David Chivite
- Department of Internal Medicine, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain; Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Francesc Formiga
- Department of Internal Medicine, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain; Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Santiago Jiménez-Marrero
- Community Heart Failure Program, Departments of Cardiology and Internal Medicine, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain; Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain; Department of Cardiology, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain; Department of Cardiology, Cardio-Oncology Unit, Bellvitge University Hospital and Catalan Institute of Oncology, L'Hospitalet del Llobregat, Barcelona, Spain
| | - Alberto Garay
- Community Heart Failure Program, Departments of Cardiology and Internal Medicine, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain; Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain; Department of Cardiology, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain; Department of Cardiology, Cardio-Oncology Unit, Bellvitge University Hospital and Catalan Institute of Oncology, L'Hospitalet del Llobregat, Barcelona, Spain
| | - Lídia Alcoberro
- Community Heart Failure Program, Departments of Cardiology and Internal Medicine, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain; Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain; Department of Cardiology, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Pedro Moliner
- Community Heart Failure Program, Departments of Cardiology and Internal Medicine, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain; Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain; Department of Cardiology, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain; Department of Cardiology, Cardio-Oncology Unit, Bellvitge University Hospital and Catalan Institute of Oncology, L'Hospitalet del Llobregat, Barcelona, Spain
| | - Xavier Corbella
- Department of Internal Medicine, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain; Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain; Hestia Chair in Integrated Health and Social Care, School of Medicine, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Josep Comín-Colet
- Community Heart Failure Program, Departments of Cardiology and Internal Medicine, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain; Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain; Department of Cardiology, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain; Department of Clinical Sciences, School of Medicine, University of Barcelona (UB), Barcelona, Spain.
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Tsabedze N, Kinsey JH, Mpanya D, Mogashoa V, Klug E, Manga P. The prevalence of depression, stress and anxiety symptoms in patients with chronic heart failure. Int J Ment Health Syst 2021; 15:44. [PMID: 33980322 DOI: 10.1186/s13033-021-00467-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 05/02/2021] [Indexed: 12/19/2022] Open
Abstract
Background Mental health illnesses are associated with frequent hospitalisation and an increased risk of all-cause mortality. Despite the high prevalence of depression in patients with chronic heart failure (CHF), there is a paucity of data on this subject from low and middle-income countries (LMIC). The aim of this study was to determine the prevalence of depression, anxiety, and stress symptoms in patients attending a dedicated CHF clinic. Methods A prospective study was conducted at an outpatient heart failure clinic in a tertiary academic centre. The study participants completed a Depression, Anxiety and Stress (DASS-21) questionnaire to screen for the presence and severity of depression, anxiety and stress symptoms. Furthermore, the Minnesota Living with Heart Failure Questionnaire (MLHFQ) was completed and used to evaluate the impact of CHF on health-related quality of life (QoL). Descriptive statistics were used to describe patients' characteristics and logistic regression analysis to identify predictors of symptoms of depression. Results The study population comprised of 103 patients, predominantly female (62.1%) with a median age of 53 (interquartile range 38–61) years. Symptoms of depression were reported by 52.4%, with 11.6% reporting symptoms suggestive of extremely severe depression. Anxiety was diagnosed in 53.4% of patients and extremely severe anxiety was reported by 18.4% of patients. Fifty patients were classified as stressed, and only 7.7% had extremely severe stress. More than half of the patients (54.4%) were in New York Heart Association functional class I. The mean left ventricular ejection fraction in the entire cohort was 30% (SD = ± 11.1%). In the multivariable logistic regression model, the MLHFQ score [odds ratio (OR) 1.04, 95% CI:1.02–1.06, p = 0.001] and the six-minute walk test [OR 0.99, 95% CI: 0.98–0.99, p = 0.014] were identified as independent predictors of depression. Conclusion Depression and anxiety symptoms were found in over half of patients attending the CHF clinic. We recommend that mental health screening should be routinely performed in patients with CHF. Prospective, adequately powered, multicentre studies from LMIC investigating the impact of depression, anxiety and stress on CHF outcomes such as health-related QoL, hospitalisation and mortality are required.
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Slawik J, Dederer J, Kindermann I, Böhm M. Management of hyperkalaemia in acute kidney injury in a heart failure patient with patiromer. ESC Heart Fail 2020; 7:3161-3164. [PMID: 32840030 PMCID: PMC7524130 DOI: 10.1002/ehf2.12711] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 03/09/2020] [Accepted: 04/01/2020] [Indexed: 12/28/2022] Open
Abstract
AIMS One prevalent comorbidity of chronic heart failure (CHF) is chronic kidney disease(CKD). Hyperkalemia is associated with both CHF and CKD, which often leads to withdrawal of heart failure medications in clinical praxis. METHODS AND RESULTS A patient is presented who suffered from acute kidney injury with pre-existing CKD as heart failure comorbidity and a history of hyperkalemia. CONCLUSIONS This case shows that potassium levels remained stable in acute kidney injury under ongoing heart failure medications, including an MRA, with the use of the potassium binder patiromer.
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Affiliation(s)
- Jonathan Slawik
- Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Universität des Saarlandes, Kirrberger Straße 100, 66421, Homburg, Saar, Germany
| | - Juliane Dederer
- Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Universität des Saarlandes, Kirrberger Straße 100, 66421, Homburg, Saar, Germany
| | - Ingrid Kindermann
- Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Universität des Saarlandes, Kirrberger Straße 100, 66421, Homburg, Saar, Germany
| | - Michael Böhm
- Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Universität des Saarlandes, Kirrberger Straße 100, 66421, Homburg, Saar, Germany
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Revuelta-López E, Lupón J, Lax A, Pascual-Figal DA, Bayés-Genís A. Differences in the Interleukin-1β/Soluble ST2 Interplay Between Acute and Chronic Heart Failure. J Cardiovasc Transl Res 2020; 13:864-6. [PMID: 31970669 DOI: 10.1007/s12265-020-09958-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 01/16/2020] [Indexed: 12/19/2022]
Abstract
Recently, novel findings about the interleukin 1β (IL-1 β) axis in acute decompensated heart failure (ADHF) have been published. There is a positive correlation between IL-1 β and interleukin-1 receptor like 1 (sST2) in ADHF patients. Is there also a correlation between the values of IL-1 β and sST2 in chronic heart failure patients?
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11
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Gunton JE, Nandal S, Jones J, Chew DP, Marwick TH, De Pasquale CG. Validation of the "Doorbell Test": A Novel Functional Test of Frailty and Clinical Status After Acute Decompensated Heart Failure. Heart Lung Circ 2020; 29:1054-62. [PMID: 31594721 DOI: 10.1016/j.hlc.2019.08.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2019] [Revised: 07/24/2019] [Accepted: 08/17/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Acute decompensated heart failure (ADHF) carries a high event rate following discharge. The complex interplay between age, frailty and decongestion may lend itself to a functional test. METHODS In the doorbell test the patient simulates answering the doorbell. They are timed rising from a recumbent position, bending over twice and walking 10 metres, this time is added to the change in respiratory rate. We aimed to determine if the doorbell test was associated with post ADHF events (death or readmission). The test was performed at hospital discharge, with follow up at 30-days and 1-year. RESULTS In 74 patients at 30-days there was a 14% event rate. At 1-year there were 40 (54%) events (9 deaths and 31 readmissions, 28 were cardiovascular of which 14 were [heart failure] HF). Amongst those who had an event at 30-days only doorbell test scores were different (58 [36,72] vs 32 [26,53] p < 0.05). One-year (1-year) events were associated with doorbell test scores (47 [29,62] vs 30 [26,42] p < 0.05), body weight (78 kg [68,94] vs 95 [76,105] (p < 0.05), creatinine (134 mmol/L [114, 173] vs 99 [82, 133] p < 0.01) and age (76 years [61,86] vs 67 [53, 73] p < 0.01). Heart failure readmissions were associated with doorbell test scores (56 [46,68] vs 30 [26,47] p < 0.001). Death was associated with body weight (74 kg [69,81] vs 88 [72,101] p < 0.05) and age (83 years [78,86] vs 69 [55,77] p < 0.01). After age stratification, the hazard ratio for heart failure readmission associated with a high doorbell test score was 11.08 (95%C.I. 2.01-61.17 p = 0.006), while the hazard ratio for 1-year cardiovascular readmission was 4.62 (95%C.I. 1.71-12.51 p = 0.003). There was no association with 1-year mortality. CONCLUSION The doorbell test represents a novel test of multiple domains of the ADHF pre-discharge state and demonstrates an association with 30-day and 1-year rehospitalisation.
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Ghimire R, Dhungana SP. Evaluation of drugs used in chronic heart failure at tertiary care centre: a hospital based study. J Cardiovasc Thorac Res 2019; 11:79-84. [PMID: 31384400 PMCID: PMC6669424 DOI: 10.15171/jcvtr.2019.15] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Accepted: 06/19/2019] [Indexed: 02/04/2023] Open
Abstract
Introduction: There is lack of data on pattern of use of drugs in patients with chronic heart failure (CHF) from Nepalese population. This study was conducted to explore the trends of evidence based medications used for CHF in our population.
Methods: This is a cross-sectional study on 200 consecutive patients with New York Heart Association (NYHA) class II to IV symptoms of CHF who attended cardiology clinic or admitted from September 2017 to August 2018 at Nobel Medical College Teaching Hospital, Biratnagar, Nepal.
Results: Mean age of patients was 54 (range 15-90) years. Ischemic cardiomyopathy, rheumatic heart disease, dilated cardiomyopathy, hypertensive heart disease, peripartum cardiomyopathy were common etiologies of CHF. Analysis of drugs used in CHF revealed that 85% patients were prescribed diuretics, 58.5% angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs), 53% mineralocorticoid receptor antagonists (MRAs), 38% beta-blockers (BBs) and 24% digoxin. Digoxin was mainly used as add on therapy for patients with atrial fibrillation (24% of all patients). Antithrombotics (warfarin or aspirin), inotropic agents (dopamine, dobutamine or noradrenaline), antiarrhythmic agent (amiodarone) and nitrates (intravenous glyceryl trinitrate or oral isosorbide dinitrate) were prescribed for 48%, 28%, 5% and 6% patients respectively. All CHF patients with preserved or mid-range ejection fraction (25% of all patients) were prescribed diuretics along with antihypertensive drugs for hypertensive patients.
Conclusion: CHF is associated with significant morbidity and mortality due to associated co-morbidities and underuse of proven therapy like BBs, ACEIs or ARBs and MRAs. Careful attention to optimization of different drugs therapy in patients with CHF may help to improve patient outcomes.
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Affiliation(s)
- Rinku Ghimire
- Department of Pharmacology, Nobel Medical College Teaching Hospital, Nepal
| | - Sahadeb Prasad Dhungana
- Cardiology Unit, Department of Internal Medicine, Nobel Medical College Teaching Hospital, Nepal
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Gorjipour F, Hosseini-Gohari L, Alizadeh Ghavidel A, Hajimiresmaiel SJ, Naderi N, Darbandi Azar A, Pazoki-Toroudi H. Mesenchymal stem cells from human amniotic membrane differentiate into cardiomyocytes and endothelial-like cells without improving cardiac function after surgical administration in rat model of chronic heart failure. J Cardiovasc Thorac Res 2019; 11:35-42. [PMID: 31024670 PMCID: PMC6477105 DOI: 10.15171/jcvtr.2019.06] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Accepted: 12/27/2018] [Indexed: 12/18/2022] Open
Abstract
Introduction: Human amnion-derived mesenchymal stem cells (hAMSCs) have been used in the treatment of acute myocardial infarction. In the current study, we investigated the efficacy of hAMSCs for the treatment of chronic model of myocardial ischemia and heart failure (HF) in rats. Methods: Male Wistar rats weighing between 250 to 350 g were randomized into three groups: sham, HF control and HF+hAMSCs. For HF induction, animals were anesthetized and underwent left anterior descending artery ligation. In HF+hAMSCs group, 2×106 cells were injected into the left ventricular muscle four weeks post ischemia in the border zone of the ischemic area. Cardiac function was studied using echocardiography. Masson's trichrome staining was used for studying tissue fibrosis. Cells were transduced with green fluorescent protein (GFP) coding lentiviral vector. Immunohistochemistry was used for detecting GFP, vascular-endothelial growth factor (VEGF) and troponin T markers in the tissue sections. Results: Assessment of the cardiac function revealed no improvement in the myocardial function compared to the control HF group. Moreover, tissue fibrosis was similar in two groups. Immunohistochemical study revealed the homing of the injected hAMSCs to the myocardium. Cells were stained positive for VEGF and troponin T markers. Conclusion: injection of hAMSCs 4 weeks after ischemia does not improve cardiac function and cardiac muscle fibrosis, although the cells show markers of differentiation into vascular endothelial cells and cardiomyocytes. In sum, it appears that hAMSCs are effective in the early phases of myocardial ischemia and does not offer a significant advantage in patients with chronic HF.
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Affiliation(s)
- Fazel Gorjipour
- Cellular and Molecular Research center, Iran University of Medical Sciences, Tehran, Iran
| | - Ladan Hosseini-Gohari
- Cellular and Molecular Research center, Iran University of Medical Sciences, Tehran, Iran
| | - Alireza Alizadeh Ghavidel
- Rajaie Cardiovascular and Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | | | - Nasim Naderi
- Rajaie Cardiovascular and Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Amir Darbandi Azar
- Rajaie Cardiovascular and Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Hamidreza Pazoki-Toroudi
- Department of Physiology and Physiology Research Center, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran
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Curbelo J, Aguilera M, Rodriguez-Cortes P, Gil-Martinez P, Suarez Fernandez C. Usefulness of inferior vena cava ultrasonography in outpatients with chronic heart failure. Clin Cardiol 2018; 41:510-517. [PMID: 29664116 DOI: 10.1002/clc.22915] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Revised: 01/25/2018] [Accepted: 01/30/2018] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Inferior vena cava (IVC) ultrasonography has been used for the diagnosis and prognosis of acute heart failure (HF). Its usefulness in chronic HF is less known. HYPOTHESIS IVC ultrasonography is a useful tool in the care of patients with chronic HF. METHODS For this prospective cohort study, 95 patients with chronic HF were included consecutively as they attended scheduled medical visits. Ultrasound was done with a 5-MHz convex probe device, calculating IVC collapse index (IVCCI). Follow-up time was 1 year. Outcome events were worsening HF, hospital admission for HF, HF mortality, and all-cause mortality. RESULTS Worsening HF occurred in 70.9% of patients with IVCCI <30% and 39.1% of patients with IVCCI >50%, with a hazard ratio (HR) of 2.8 (95% CI: 1.3-6.2) adjusted by multivariable analysis. Regarding hospitalization, 45.3% of patients with IVCCI <30% required admission, compared with 5.9% of patients with IVCCI >50%; the adjusted HR was 13.9 (95% CI: 1.7-113.0). Mortality was higher in the IVCCI <30% group, with 25.7% all-cause mortality and 18.6% HF mortality, whereas in the IVCCI >50% group these values were 13% and 4.7%, respectively. However, these differences did not reach statistical significance. ROC analysis was performed and the AUC for IVCCI was not higher than that for NTproBNP for any of the outcomes studied. CONCLUSIONS IVC ultrasonography is a useful tool in follow-up of patients with chronic HF, allowing identification of patients at high risk of worsening and hospitalization. However, its usefulness is not higher than that of NTproBNP.
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Affiliation(s)
- Jose Curbelo
- Internal Medicine Department, Instituto de Investigación Sanitaria, Hospital Universitario La Princesa, Madrid, Spain.,Medicine Department, Universidad Autónoma de Madrid, Madrid, Spain
| | - Maria Aguilera
- Internal Medicine Department, Instituto de Investigación Sanitaria, Hospital Universitario La Princesa, Madrid, Spain.,Medicine Department, Universidad Autónoma de Madrid, Madrid, Spain
| | - Pablo Rodriguez-Cortes
- Internal Medicine Department, Instituto de Investigación Sanitaria, Hospital Universitario La Princesa, Madrid, Spain.,Medicine Department, Universidad Autónoma de Madrid, Madrid, Spain
| | - Paloma Gil-Martinez
- Internal Medicine Department, Instituto de Investigación Sanitaria, Hospital Universitario La Princesa, Madrid, Spain.,Medicine Department, Universidad Autónoma de Madrid, Madrid, Spain
| | - Carmen Suarez Fernandez
- Internal Medicine Department, Instituto de Investigación Sanitaria, Hospital Universitario La Princesa, Madrid, Spain.,Medicine Department, Universidad Autónoma de Madrid, Madrid, Spain
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McAloon CJ, Ali D, Hamborg T, Banerjee P, O'Hare P, Randeva H, Osman F. Extracellular cardiac matrix biomarkers in patients with reduced ejection fraction heart failure as predictors of response to cardiac resynchronisation therapy: a systematic review. Open Heart 2017; 4:e000639. [PMID: 28878953 PMCID: PMC5574440 DOI: 10.1136/openhrt-2017-000639] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2017] [Revised: 06/26/2017] [Accepted: 07/13/2017] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE Cardiac resynchronisation therapy (CRT) is an effective therapy for selected patients with heart failure (HF); however, a significant non-response rate exists. We examined current evidence on extracellular cardiac matrix (ECM) biomarkers in predicting response following CRT. METHODS Complete literature review of PubMed, Ovid SP MEDLINE, Cochrane Library and TRIP, reference lists, international cardiology conferences and ongoing studies between December 1999 and December 2015 conducted according to prospectively registered study selection and analysis criteria (PROSPERO:CRD42016025864) was performed. All observational and randomised control trials (RCT) were included if they tested prespecified ECM biomarkers' ability to predict CRT response. Risk of bias assessment and data extraction determined pooling of included studies was not feasible due to heterogeneity of the selected studies. RESULTS A total of 217 studies were screened; six (five prospective cohort and one RCT substudy) were included in analysis with 415 participants in total. Study sizes varied (n=55-260), cohort characteristics contrasted (male: 67.8%-83.6%, ischaemic aetiology: 40.2%-70.3%) and CRT response definitions differed (three clinical/functional, three echocardiographic). Consistent observation in all ECM biomarker behaviour before and after CRT implantation was not observed between studies. Lower type I and type III collagen synthesis biomarkers (N-terminal propeptides of type I and III procollagens) expression demonstrated replicated ability to predict reverse left ventricular remodelling. CONCLUSION Collagen synthesis biomarkers offer the most potential as ECM biomarkers for predicting CRT response. Heterogeneity between these studies was large and limited the ability to pool and compare results numerically. Use of different response definitions was one of the biggest challenges.
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Affiliation(s)
- Christopher J McAloon
- Department of Cardiology, University Hospital Coventry, Coventry, UK
- Department of Medicine, Warwick Medical School, University of Warwick, Coventry, UK
| | - Danish Ali
- Department of Cardiology, University Hospital Coventry, Coventry, UK
- Department of Medicine, Warwick Medical School, University of Warwick, Coventry, UK
| | - Thomas Hamborg
- Department of Medicine, Warwick Medical School, University of Warwick, Coventry, UK
| | - Prithwish Banerjee
- Department of Cardiology, University Hospital Coventry, Coventry, UK
- Department of Medicine, Warwick Medical School, University of Warwick, Coventry, UK
- Department of Life Sciences, Coventry University, Coventry, UK
| | - Paul O'Hare
- Department of Medicine, Warwick Medical School, University of Warwick, Coventry, UK
| | - Harpal Randeva
- Department of Medicine, Warwick Medical School, University of Warwick, Coventry, UK
| | - Faizel Osman
- Department of Cardiology, University Hospital Coventry, Coventry, UK
- Department of Medicine, Warwick Medical School, University of Warwick, Coventry, UK
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Murase K, Ono K, Yoneda T, Iguchi M, Yokomatsu T, Mizoguchi T, Izumi T, Akao M, Miki S, Nohara R, Ueshima K, Mishima M, Kimura T, White DP, Chin K. Adaptive servoventilation versus oxygen therapy for sleep disordered breathing in patients with heart failure: a randomised trial. Open Heart 2016; 3:e000366. [PMID: 27099761 PMCID: PMC4823544 DOI: 10.1136/openhrt-2015-000366] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Accepted: 02/24/2016] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Both adaptive servoventilation (ASV) and nocturnal oxygen therapy improve sleep disordered breathing (SDB), but their effects on cardiac parameters have not been compared systematically. METHODS AND RESULTS 43 patients with chronic heart failure (CHF; left ventricular ejection fraction (LVEF) ≤50%) with SDB were randomly assigned to undergo ASV (n=19, apnoea hypopnoea index (AHI)=34.2±12.1/h) or oxygen therapy (n=24, 36.9±9.9/h) for 3 months. More than 70% of SDB events in both groups were central apnoeas or hypopnoeas. Although nightly adherence was less for the ASV group than for the oxygen group (4.4±2.0 vs 6.2±1.8 h/day, p<0.01), the improvement in AHI was larger in the ASV group than in the oxygen group (-27.0±11.5 vs -16.5±10.2/h, p<0.01). The N-terminal pro-brain natriuretic peptide (NT-proBNP) level in the ASV group improved significantly after titration (1535±2224 to 1251±2003 pg/mL, p=0.01), but increased slightly at follow-up and this improvement was not sustained (1311±1592 pg/mL, p=0.08). Meanwhile, the level of plasma NT-proBNP in the oxygen group did not show a significant change throughout the study (baseline 1071±1887, titration 980±1913, follow-up 1101±1888 pg/mL, p=0.19). The significant difference in the changes in the NT-proBNP level throughout the study between the 2 groups was not found (p=0.30). Neither group showed significant changes in echocardiographic parameters. CONCLUSIONS Although ASV produced better resolution of SDB in patients with CHF as compared with oxygen therapy, neither treatment produced a significant improvement in cardiac function in the short term. Although we could not draw a definite conclusion because of the small number of participants, our data do not seem to support the routine use of ASV or oxygen therapy to improve cardiac function in patients with CHF with SDB. TRIAL REGISTRATION NUMBER NCT01187823 (http://www.clinicaltrials.gov).
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Affiliation(s)
- Kimihiko Murase
- Department of Respiratory Medicine , Graduate School of Medicine, Kyoto University , Kyoto , Japan
| | - Koh Ono
- Department of Cardiovascular Medicine , Graduate School of Medicine, Kyoto University , Kyoto , Japan
| | - Tomoya Yoneda
- Clinical Laboratory Medicine , Kyoto University Hospital , Kyoto , Japan
| | - Moritake Iguchi
- Department of Cardiovascular Medicine , Kyoto Medical Centre , Kyoto , Japan
| | - Takafumi Yokomatsu
- Department of Cardiovascular Medicine , Kyoto Mitsubishi Hospital , Kyoto , Japan
| | - Tetsu Mizoguchi
- Department of Cardiovascular Medicine , Kyoto Mitsubishi Hospital , Kyoto , Japan
| | - Toshiaki Izumi
- Department of Cardiovascular Medicine , Kitano Hospital , Osaka , Japan
| | - Masaharu Akao
- Department of Cardiovascular Medicine , Kyoto Medical Centre , Kyoto , Japan
| | - Shinji Miki
- Department of Cardiovascular Medicine , Kyoto Mitsubishi Hospital , Kyoto , Japan
| | - Ryuji Nohara
- Department of Cardiovascular Medicine , Kitano Hospital , Osaka , Japan
| | - Kenji Ueshima
- Department of EBM Research , Institute for Advancement of Clinical and Translational Research, Kyoto University Hospital , Kyoto , Japan
| | - Michiaki Mishima
- Department of Respiratory Medicine , Graduate School of Medicine, Kyoto University , Kyoto , Japan
| | - Takeshi Kimura
- Clinical Laboratory Medicine , Kyoto University Hospital , Kyoto , Japan
| | - David P White
- Division of Sleep Medicine , Brigham and Women's Hospital and Harvard Medical School , Boston, Massachusetts , USA
| | - Kazuo Chin
- Department of Respiratory Care and Sleep Control Medicine , Graduate School of Medicine, Kyoto University , Kyoto , Japan
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Correale M, Totaro A, Ferraretti A, Musaico F, Passero T, De Rosa F, Abruzzese S, Ieva R, Di Biase M, Brunetti ND. Additional Prognostic Value of EAS index in predicting the occurrence of rehospitalizations in chronic heart failure: data from the Daunia Heart Failure Registry. Eur J Clin Invest 2015; 45:1098-105. [PMID: 26255786 DOI: 10.1111/eci.12514] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Accepted: 08/04/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Tissue Doppler imaging (TDI) may be useful in identifying subjects at higher risk among patients with chronic heart failure (CHF). The clinical role of newly developed TDI parameters, however, still needs to be documented. METHODS A total of 287 consecutive patients with CHF enrolled in the Daunia Heart Failure Registry underwent echocardiography assessment and were followed prospectively for a median 255 (204-316) days. Conventional echocardiography and TDI parameters were calculated. We also quantified by TDI a combined index (EAS index) of diastolic and systolic performance E'/(A'xS') and assessed its possible additional prognostic role in combination with 'traditional' parameters such as left ventricular ejection fraction (LVEF) and myocardial performance index (MPI). RESULTS Subjects readmitted for worsening HF were characterized by higher levels of EAS index (median 0·14 (95% C.I. 0·12-0·21) vs. 0·11 (0·10-0·12, P < 0·05)). Increased rates of rehospitalization were found in subjects with EAS index >median (0·115) (21% vs. 10%, P < 0·05); higher EAS index values predicted the incidence of readmissions for worsening HF during follow-up, even at multivariable analysis. The assessment of EAS index in addition to LVEF and MPI showed an adjunctive prognostic value (log-rank P < 0·001 and P < 0·05, respectively). CONCLUSIONS EAS index assessed by TDI may be helpful in predicting the risk of rehospitalizations in subjects with CHF. EAS index may represent an independent adjunctive tool for the risk stratification of patients with CHF in addition to 'traditional' tools such as LVEF or MPI.
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Affiliation(s)
| | - Antonio Totaro
- Cardiology Department, University of Foggia, Foggia, Italy
| | | | | | | | | | | | - Riccardo Ieva
- Cardiology Department, University of Foggia, Foggia, Italy
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Berezin AE, Kremzer AA, Martovitskaya YV, Samura TA, Berezina TA. The Association of Subclinical Hypothyroidism and Pattern of Circulating Endothelial-Derived Microparticles Among Chronic Heart Failure Patients. Res Cardiovasc Med 2015; 4:e29094. [PMID: 26528453 PMCID: PMC4623383 DOI: 10.5812/cardiovascmed.29094] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Revised: 05/09/2015] [Accepted: 06/07/2015] [Indexed: 12/28/2022] Open
Abstract
Background: Subclinical hypothyroidism (SH) is diagnosed biochemically by the presence of normal serum free thyroxine concentration, in conjunction with an elevated serum thyroid-stimulating hormone level. Recent studies have demonstrated the frequent association between SH and cardiovascular diseases and risk factors. Objectives: To evaluate the impact of SH on patterns of circulating endothelial-derived microparticles, (EMPs) among chronic heart failure (CHF) patients Patients and Methods: This is a retrospective study involving a cohort of 388 patients with CHF. Fifty-three CHF subjects had SH and 335 patients were free from thyroid dysfunction. Circulating levels of N-terminal-pro brain natriuretic peptide (NT-proBNP), high-sensitivity C-reactive protein (hs-CRP), thyroid-stimulating hormone (TSH), total and free thyroxine (T4), and triiodothyronine (T3), and endothelial apoptotic microparticles (EMPs), were measured at baseline. SH was defined, according to contemporary clinical guidelines, as a biochemical state associated with an elevated serum TSH level of greater 10 μU/L and normal basal free T3 and T4 concentrations. Results: Circulating CD31+/annexin V+ EMPs were higher in patients with SH compared to those without SH. In contrast, activated CD62E+ EMP numbers were not significantly different between both patient cohorts. Using uni (bi) variate and multivariate age- and gender-adjusted regression analysis, we found several predictors that affected the increase of the CD31+/annexin V+ to CD62E+ ratio in the patient study population. The independent impact of TSH per 6.5 μU/L (odds ratio [OR] = 1.23, P = 0.001), SH (OR = 1.22, P = 0.001), NT-proBNP (OR = 1.19, P = 0.001), NYHA class (OR = 1.09, P = 0.001), hs-CRP per 4.50 mg/L (OR = 1.05, P = 0.001), dyslipidemia (OR = 1.06, P = 0.001), serum uric acid per 9.5 mmol/L (OR = 1.04, P = 0.022) on the increase in the CD31+/annexin V+ to CD62E+ ratio, was determined. Conclusions: We believe that the SH state in CHF patients may be associated with the impaired pattern of circulating EMPs, with the predominantly increased number of apoptotic-derived microparticles.
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Affiliation(s)
- Alexander E. Berezin
- Consultant of Therapeutic Unit, Internal Medicine Department, State Medical University, Zaporozhye, Ukraine
- Corresponding author: Alexander E. Berezin, Consultant of Therapeutic Unit, Internal Medicine Department, State Medical University, Zaporozhye, Ukraine. Tel: +38-0612894585, E-mail:
| | | | | | - Tatyana A. Samura
- Clinical Pharmacology Department, State Medical University, Zaporozhye, Ukraine
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Abstract
BACKGROUND Among the indices able to replace invasive central venous pressure (CVP) measurement for patients with acute decompensated heart failure (ADHF) the diameters of the inferior vena cava (IVC) and their respiratory fluctuations, so-called IVC collapsibility index (IVCCI), measured by echocardiography, have recently gained ground as a quite reliable proxy of CVP. OBJECTIVES The aims of our study were to compare three different ways of evaluating cardiac overload by using the IVC diameters and/or respiratory fluctuations and by calculating the inter-method agreement. PATIENTS AND METHODS Medical records of patients hospitalized for right or bi-ventricular acute decompensated heart failure from January to December 2013 were retrospectively evaluated. The predictive significance of the IVC expiratory diameter and IVC collapsibility index (IVCCI) was analyzed using three different methods, namely a) the criteria for the indirect estimate of right atrial pressure by Rudski et al. (J Am Soc Echocardiogr. 2010); b) the categorization into three IVCCI classes by Stawicki et al. (J Am Coll Surg. 2009); and c) the subdivision based on the value of the maximum IVC diameter by Pellicori et al. (JACC Cardiovasc Imaging. 2013). RESULTS Among forty-seven enrolled patients, those classified as affected by persistent congestion were 22 (46.8%) using Rudski's criteria, or 16 (34%) using Stawicki's criteria, or 13 (27.6%) using Pellicori's criteria. The inter-rater agreement was rather poor by comparing Rudski's criteria with those of Stawicki (Cohen's kappa = 0.369; 95% CI 0.197 to 0.54), as well as by comparing Rudski's criteria with those of Pellicori (Cohen's kappa = 0.299; 95% CI 0.135 to 0.462). Further, a substantially unsatisfactory concordance was also found for Stawicki's criteria compared to those of Pellicori (Cohen's kappa= 0.468; 95% CI 0.187 to 0.75). CONCLUSIONS The abovementioned IVC ultrasonographic criteria for hemodynamic congestion appear clearly inconsistent. Alternatively, a sequential or simultaneous combination of clinical scores of congestion, IVC ultrasonographic indices, and circulating levels of natriuretic peptides could be warranted.
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Affiliation(s)
- Renato De Vecchis
- Cardiology Unit, Presidio Sanitario Intermedio “Elena d’Aosta”, Naples, Italy
- Corresponding author: Renato De Vecchis, MD, Cardiology Unit, Presidio Sanitario Intermedio “Elena d’Aosta”, ASL Napoli 1 Centro, Naples, Italy. Tel: +393483313530; Fax: +390812543144; E-mail:
| | - Cesare Baldi
- Heart Department, Interventional Cardiology, A.O.U. “San Giovanni di Dio e Ruggi D’Aragona”, Salerno, Italy
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Berezin AE, Kremzer AA, Samura TA, Berezina TA, Martovitskaya YV. Serum uric Acid predicts declining of circulating proangiogenic mononuclear progenitor cells in chronic heart failure patients. J Cardiovasc Thorac Res 2014; 6:153-62. [PMID: 25320662 PMCID: PMC4195965 DOI: 10.15171/jcvtr.2014.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Accepted: 09/03/2014] [Indexed: 12/22/2022] Open
Abstract
INTRODUCTION Serum uric acid (SUA) is considered a marker for natural progression of chronic heart failure (CHF) mediated cardiovascular remodelling. CHF associates with declining of circulating mononuclear progenitor cells (MPCs). The objective of this study was to evaluate the interrelationship between SUA concentrations and proangiogenic MPCs in ischemic CHF patients. METHODS The study population was structured retrospectively after determining the coronary artery disease (CAD) by contrast-enhanced spiral computed tomography angiography in 126 subjects with symptomatic ischemic mild-to-severe CHF and 128 CAD subjects without CHF. Baseline biomarkers were measured in all patients. Cox proportional multivariate hazard ratio was calculated for predictors of MPCs declining in both CHF and non-CHF patient population predictors of MPCs declining in CHF subjects were examined in stepwise logistic regression. C-statistics, integrated discrimination indices (IDI) and net-reclassification improvement were utilized for prediction performance analyses. RESULTS Cox proportional adjusted hazard ratio analyses for CD14(+)CD309(+) and CD14(+)CD309(+)Tie2(+) MPCs by SUA has shown that the higher quartiles (Q3 and Q4) of SUA compared to the lower quartiles (Q1 and Q2) are associated with increased risks of depletion of both CD14(+)CD309(+) and CD14(+)CD309(+)Tie2(+) MPCs. The addition of Q4 SUA to the ABC model improved the relative IDI by 13.8% for depletion of CD14(+)CD309(+) MPCs and by 14.5% for depletion of CD14(+)CD309(+)Tie2(+) MPCs. CONCLUSION Circulating levels of proangiogenic MPCs are declined progressively depending on the levels of SUA in the HF subjects with CHF. We suggest that even mild elevations of SUA might be used to predict of relative depletion of proangiogenic MPCs among chronic HF patients.
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Affiliation(s)
| | - Alexander A Kremzer
- State Medical University, Clinical Pharmacology Department, Zaporozhye, Ukraine
| | - Tatyana A Samura
- State Medical University, Clinical Pharmacology Department, Zaporozhye, Ukraine
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Jonkman NH, Westland H, Trappenburg JCA, Groenwold RHH, Effing-Tijdhof TW, Troosters T, van der Palen J, Bourbeau J, Jaarsma T, Hoes AW, Schuurmans MJ. Towards tailoring of self-management for patients with chronic heart failure or chronic obstructive pulmonary disease: a protocol for an individual patient data meta-analysis. BMJ Open 2014; 4:e005220. [PMID: 24860002 PMCID: PMC4039847 DOI: 10.1136/bmjopen-2014-005220] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2014] [Revised: 04/21/2014] [Accepted: 05/02/2014] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Self-management interventions in patients with chronic conditions have received increasing attention over the past few years, yet the meta-analyses encountered considerable heterogeneity in results. This suggests that the effectiveness of self-management interventions must be assessed in the context of which components are responsible for eliciting the effect and in which subgroups of patients the intervention works best. The aim of the present study is to identify condition-transcending determinants of success of self-management interventions in two parallel individual patient data meta-analyses of self-management trials in patients with congestive heart failure (CHF) and in patients with chronic obstructive pulmonary disease (COPD). METHODS AND ANALYSIS Investigators of 53 randomised trials (32 in CHF and 21 in COPD) will be requested to share their de-identified individual patient data. Data will be analysed using random effects models, taking clustering within studies into account. Effect modification by age, sex, disease severity, symptom status, comorbid conditions and level of education will be assessed. Sensitivity analyses will be conducted to assess the robustness of the findings. ETHICS AND DISSEMINATION The de-identified individual patient data are used only for the purpose for which they were originally collected and for which ethical approval has been obtained by the original investigators. Knowledge on the effective ingredients of self-management programmes and identification of subgroups of patients in which those interventions are most effective will guide the development of evidence-based personalised self-management interventions for patients with CHF and COPD as well as with other chronic diseases. TRIAL REGISTRATION NUMBER PROSPERO CRD42013004698.
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Affiliation(s)
- Nini H Jonkman
- Department of Rehabilitation, Nursing Science and Sports, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Heleen Westland
- Department of Rehabilitation, Nursing Science and Sports, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Jaap C A Trappenburg
- Department of Rehabilitation, Nursing Science and Sports, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Rolf H H Groenwold
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Tanja W Effing-Tijdhof
- Department of Respiratory Medicine, Repatriation General Hospital, Daw Park, South Australia, Australia
| | - Thierry Troosters
- Department of Rehabilitation Sciences, Catholic University of Leuven, Leuven, Belgium
| | - Job van der Palen
- Department of Research Methodology, Measurement and Data Analysis, University of Twente, Enschede, The Netherlands
| | - Jean Bourbeau
- Respiratory Epidemiology Unit, McGill University, Montreal, Quebec, Canada
| | - Tiny Jaarsma
- Department of Social and Welfare Studies, Linköping University, Linköping, Sweden
| | - Arno W Hoes
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Marieke J Schuurmans
- Department of Rehabilitation, Nursing Science and Sports, University Medical Center Utrecht, Utrecht, The Netherlands
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Christensen HM, Kistorp C, Schou M, Keller N, Zerahn B, Frystyk J, Flyvbjerg A, Faber J. Cross-talk between the heart and adipose tissue in cachectic heart failure patients with respect to alterations in body composition: a prospective study. Metabolism 2014; 63:141-9. [PMID: 24140097 DOI: 10.1016/j.metabol.2013.09.017] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2013] [Revised: 09/17/2013] [Accepted: 09/18/2013] [Indexed: 12/13/2022]
Abstract
OBJECTIVES Cardiac cachexia (CC) is associated with changes in body composition. Lipolysis and increased energy expenditure caused by A- and B natriuretic peptides (NPs) have been suggested to play a role in CC. We tested the hypothesis that neurohormones and adipokines are associated with body composition in CC and that a progressive loss of fat free mass (FFM) and fat mass (FM) takes place. METHODS Body composition with regard to FFM, FM, and body fat distribution was assessed by dual energy X-ray absorptiometry (DXA) in 19 non-diabetic patients with chronic heart failure (CHF) and CC and 38 controls (non-cachectic CHF and individuals with prior myocardial infarction-both n = 19) who were followed for 12 months. Biomarkers of neurohormonal stimulation, inflammation, and endothelial dysfunction were measured. RESULTS N-terminal proBNP (NT-proBNP), midregional proANP (MR-proANP), and total adiponectin were elevated in CHF (p<0.001) and correlated inversely to BMI and FM. An inverse correlation was observed between pro-adrenomedullin (MR-proADM) and FFM. During follow up body weight was unaltered in all groups even though FM increased by 1.35 kg (p<0.05) and FFM decreased by 0.5 kg (p<0.05) in CC patients. The latter correlated inversely to baseline NT-proBNP, MR-proANP, and MR-proADM (p<0.05). No correlation to changes in FM was found. CONCLUSIONS FM was associated with plasma NPs and total adiponectin at baseline; whereas changes in FM and FFM did not correlate to changes in NPs or adiponectin during follow up. Prospectively, FFM decreased but FM increased, despite stable body weight in CC.
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Affiliation(s)
- Heidi Marie Christensen
- Department of Endocrinology, Herlev University Hospital, Denmark; Department of Cardiology, Herlev University Hospital, Denmark.
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