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Cheng W, Huang R, Pu Y, Li T, Bao X, Chen J, Li G, Wu H, Wei Z. Association between the haemoglobin glycation index (HGI) and clinical outcomes in patients with acute decompensated heart failure. Ann Med 2024; 56:2330615. [PMID: 38513606 PMCID: PMC10962296 DOI: 10.1080/07853890.2024.2330615] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Accepted: 02/23/2024] [Indexed: 03/23/2024] Open
Abstract
BACKGROUND A growing number of studies show that people with similar blood glucose levels have different levels of glycosylated haemoglobin (HbA1c), and relying only on HbA1c may lead to clinical decision-making errors. The haemoglobin glycation index (HGI) quantifies the difference in HbA1c among individuals and is strongly linked to the risk of cardiovascular disease. However, the connection between this phenomenon and the poor outcomes of patients with acute decompensated heart failure (ADHF) is currently unknown. PATIENTS AND METHODS This retrospective, single-centre-based cohort study included 1531 hospitalized patients with ADHF from September 2010 to January 2020. The HGI is calculated from the difference between the observed and predicted HbA1c values [predicted HbA1c = 0.024 × fasting plasma glucose (FPG) (mg/dL)+3.1]. The endpoints examined in the study included all-cause death, cardiovascular (CV) death, and major adverse cardiac events (MACE). We fitted multivariable-adjusted Cox proportional hazard models to investigate the association between the HGI and clinical outcomes. RESULTS During the five-year follow-up, 427 (27.9%) patients died from all causes, 232 (15.6%) from CV death, and 848 (55.4%) from MACE. The restricted cubic spline analysis also showed that the cumulative risk of all-cause and CV deaths decreased linearly with increasing HGI. According to multivariate Cox proportional hazard models, the highest tertile of the HGI was associated with a lower incidence of all-cause and cardiovascular deaths [all-cause death, adjusted hazard ratio (HR): 0.720, 95% confidence interval (CI): 0.563-0.921, p = 0.009; CV death, adjusted HR: 0.619, 95% CI: 0.445-0.861, p = 0.004]. A 1% increase in the HGI was associated with a 12.5% reduction in the risk of all-cause death and a 20.8% reduction in the risk of CV death. CONCLUSIONS A high HGI was directly associated with a reduction in all-cause and CV deaths but was not associated with MACE. These findings may be helpful in the management of patients with ADHF.
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Affiliation(s)
- Weimeng Cheng
- Department of Cardiology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Jiangsu, Nanjing, China
| | - Rong Huang
- Department of Cardiology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Jiangsu, Nanjing, China
| | - Yue Pu
- Department of Cardiology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Jiangsu, Nanjing, China
| | - Tianyue Li
- Department of Cardiology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Jiangsu, Nanjing, China
| | - Xue Bao
- Department of Cardiology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Jiangsu, Nanjing, China
| | - Jianzhou Chen
- Department of Cardiology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Jiangsu, Nanjing, China
| | - Guannan Li
- Department of Cardiology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Jiangsu, Nanjing, China
| | - Han Wu
- Department of Cardiology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Jiangsu, Nanjing, China
| | - Zhonghai Wei
- Department of Cardiology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Jiangsu, Nanjing, China
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Shingu M, Matsumoto K, Hoshijima M, Kawasaki S, Nishisaki H. A peculiar "tetra-phasic transmitral flow": An unusual case of acute aortic regurgitation accompanied by mid- and late-diastolic mitral regurgitation. Eur Heart J Cardiovasc Imaging 2024:jeae104. [PMID: 38651682 DOI: 10.1093/ehjci/jeae104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2024] [Accepted: 04/13/2024] [Indexed: 04/25/2024] Open
Affiliation(s)
- Manami Shingu
- Division of Cardiovascular Medicine, Department of Internal Medicine, Hyogo Prefectural Tamba Medical Center, Tamba, Japan
| | - Kensuke Matsumoto
- Division of Cardiovascular Medicine, Department of Internal Medicine, Hyogo Prefectural Tamba Medical Center, Tamba, Japan
| | - Masahiko Hoshijima
- Division of Cardiovascular Medicine, Department of Internal Medicine, Hyogo Prefectural Tamba Medical Center, Tamba, Japan
| | - Satoru Kawasaki
- Division of Cardiovascular Medicine, Department of Internal Medicine, Hyogo Prefectural Tamba Medical Center, Tamba, Japan
| | - Hogara Nishisaki
- Division of Cardiovascular Medicine, Department of Internal Medicine, Hyogo Prefectural Tamba Medical Center, Tamba, Japan
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Bok RW, Lacoste JL, Fang W, Kido K. Impact of Outpatient Beta Blocker Therapy Adjustment on Tachyarrhythmias in Patients With Heart Failure With Reduced Ejection Fraction Admitted for Acute Decompensated Heart Failure. J Pharm Pract 2024:8971900241247932. [PMID: 38644362 DOI: 10.1177/08971900241247932] [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] [Indexed: 04/23/2024]
Abstract
Background: Limited data exists to evaluate the optimal management of outpatient beta blocker therapy when patients with heart failure with reduced ejection fraction (HFrEF) are admitted for acute decompensated heart failure (ADHF). Objective: This study aimed to compare the effects of holding or decreasing the dose of outpatient beta blocker therapy vs continuation of therapy on rates of tachyarrhythmias during admission for ADHF. Methods: This single-center, retrospective cohort study divided patients with HFrEF (left ventricular ejection fraction less than or equal to 40%) admitted for ADHF into two cohorts: one that had their outpatient beta blocker continued at the same dose upon admission and one that had it held or dose decreased. The primary outcome was a composite of non-sustained or sustained ventricular tachycardia, ventricular fibrillation, or atrial fibrillation or flutter with rapid ventricular response during the hospitalization. Secondary outcomes included the individual tachyarrhythmias in the primary outcome, in-hospital mortality, and 90-day re-admission for heart failure. Results: Of the 137 patients included, 82 were in the continuation cohort and 55 in the discontinuation/reduction cohort. The median length of stay was 5.3 days (interquartile range, 3.8-7.6). No significant difference in the primary composite outcome was found between the discontinuation/reduction and continuation cohorts (29.1% vs 22.0%; relative risk [95% confidence interval], 1.33 [.74-2.37]; P = .420). No significant differences were seen between the two cohorts for any of the secondary outcomes. Conclusion: Beta blocker therapy adjustment on admission for ADHF may not affect the occurrence of tachyarrhythmias in patients with HFrEF.
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Affiliation(s)
- Ryan W Bok
- Department of Pharmacy, West Virginia University Hospitals, Morgantown, WV, USA
| | - Jordan L Lacoste
- Department of Pharmacy, West Virginia University Hospitals, Morgantown, WV, USA
| | - Wei Fang
- West Virginia Clinical and Translational Science Institute, Morgantown, WV, USA
| | - Kazuhiko Kido
- West Virginia University School of Pharmacy, Morgantown, WV, USA
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González-Ruiz FJ, Encarnación-Martínez U, Gaytán-García CJ. The paradigm to overcome in acute decompensated heart failure. Am J Health Syst Pharm 2024:zxae069. [PMID: 38491935 DOI: 10.1093/ajhp/zxae069] [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: 03/13/2024] [Indexed: 03/18/2024] Open
Abstract
In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time.
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Chang CH, Lee CC, Chen YC, Fan PC, Chu PH, Chu LJ, Yu JS, Chen HW, Yang CW, Chen YT. Identification of Endothelial Cell Protein C Receptor by Urinary Proteomics as Novel Prognostic Marker in Non-Recovery Kidney Injury. Int J Mol Sci 2024; 25:2783. [PMID: 38474029 DOI: 10.3390/ijms25052783] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 02/19/2024] [Accepted: 02/20/2024] [Indexed: 03/14/2024] Open
Abstract
Acute kidney injury is a common and complex complication that has high morality and the risk for chronic kidney disease among survivors. The accuracy of current AKI biomarkers can be affected by water retention and diuretics. Therefore, we aimed to identify a urinary non-recovery marker of acute kidney injury in patients with acute decompensated heart failure. We used the isobaric tag for relative and absolute quantification technology to find a relevant marker protein that could divide patients into control, acute kidney injury with recovery, and acute kidney injury without recovery groups. An enzyme-linked immunosorbent assay of the endothelial cell protein C receptor (EPCR) was used to verify the results. We found that the EPCR was a usable marker for non-recovery renal failure in our setting with the area under the receiver operating characteristics 0.776 ± 0.065; 95%CI: 0.648-0.905, (p < 0.001). Further validation is needed to explore this possibility in different situations.
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Affiliation(s)
- Chih-Hsiang Chang
- Kidney Research Center, Department of Nephrology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan 333, Taiwan
- Graduate Institute of Clinical Medicine Science, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Cheng-Chia Lee
- Kidney Research Center, Department of Nephrology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan 333, Taiwan
- Graduate Institute of Clinical Medicine Science, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Yung-Chang Chen
- Kidney Research Center, Department of Nephrology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan 333, Taiwan
| | - Pei-Chun Fan
- Kidney Research Center, Department of Nephrology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan 333, Taiwan
- Graduate Institute of Clinical Medicine Science, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Pao-Hsien Chu
- Department of Cardiology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan 333, Taiwan
| | - Lichieh Julie Chu
- Molecular Medicine Research Center, Chang Gung University, Guishan, Taoyuan 333, Taiwan
- Graduate Institute of Biomedical Sciences, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Jau-Song Yu
- Molecular Medicine Research Center, Chang Gung University, Guishan, Taoyuan 333, Taiwan
- Graduate Institute of Biomedical Sciences, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Hsiao-Wei Chen
- Molecular Medicine Research Center, Chang Gung University, Guishan, Taoyuan 333, Taiwan
| | - Chih-Wei Yang
- Kidney Research Center, Department of Nephrology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan 333, Taiwan
| | - Yi-Ting Chen
- Kidney Research Center, Department of Nephrology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan 333, Taiwan
- Molecular Medicine Research Center, Chang Gung University, Guishan, Taoyuan 333, Taiwan
- Graduate Institute of Biomedical Sciences, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
- Department of Biomedical Sciences, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
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Yen CC, Hsiao PJ, Chu CM, Chen PL. The impact of COVID-19 pandemic on air particulate matter exposure and heart attacks: a 5-year retrospective cohort study in Taiwan (2017-2021). Front Public Health 2024; 12:1321129. [PMID: 38476499 PMCID: PMC10927788 DOI: 10.3389/fpubh.2024.1321129] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 02/12/2024] [Indexed: 03/14/2024] Open
Abstract
Background Heart attacks including acute ST-segment elevation myocardial infarction (STEMI) and acute decompensated heart failure (ADHF) caused from the particulate matter (PM) and air pollutant exposures are positively associated with regional air pollution severity and individual exposure. The exceptional coronavirus disease epidemic of 2019 (COVID-19) may enhance the air conditions in areas under COVID-19 pandemic. We sought to study the impact of COVID-19 pandemic on air particulate matter (PM) exposure and heart attacks in Taiwan. Methods This retrospective cohort study was conducted in one teaching hospital in Taichung, Taiwan. We examined emergency patients diagnosed with acute STEMI and ADHF from January 1, 2017, to March 31, 2020, (i.e., before the COVID-19 pandemic) and from April 1, 2020, to December 31, 2021, (after the COVID-19 pandemic). The effects of particulate matter with a diameter of less than 2.5 micrometers (PM2.5) and PM10 as well as temperature and humidity on environmental air pollutants were recorded. The analysis was performed with a unidirectional case-crossover research design and a conditional logistic regression model. Results Both PM2.5 and PM10 levels had a positive association with the risk of acute STEMI before the COVID-19 pandemic (PM2.5 adjusted odds ratio (OR): 1.016, 95% confidence interval (CI): 1.003-1.032 and PM10 adjusted OR: 1.009, 95% CI: 1.001-1.018) and ADHF (PM2.5 adjusted OR: 1.046, 95% CI: 1.034-1.067 and PM10 adjusted OR: 1.023, 95% CI: 1.027-1.047). Moreover, the results demonstrated that PM2.5 and PM10 were not associated with the risk of acute STEMI or ADHF after the COVID-19 pandemic. Reduction in PM2.5 and PM10 levels after the COVID-19 pandemic were noted. Hospital admissions for acute STEMI (7.4 and 5.8/per month) and ADHF (9.7 and 8.2/per month) also decreased (21.6 and 15.5%) after the COVID-19 pandemic. Conclusion In Taiwan, paradoxical reductions in PM2.5 and PM10 levels during the COVID-19 pandemic may decrease the number of hospital admissions for acute STEMI and ADHF. As the COVID-19 pandemic eases, the condition of air pollution may gradually become worse again. The governments should formulate better policies to improve the health of the public and the quality of the air.
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Affiliation(s)
- Chih-Chien Yen
- Department of Surgery, Division of Cardiovascular Surgery, Taoyuan Armed Forces General Hospital, Taoyuan, Taiwan
- Department of Surgery, Division of Cardiovascular Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
- Graduate Institute of Injury Prevention and Control, College of Public Health, Taipei Medical University, Taipei, Taiwan
| | - Po-Jen Hsiao
- Department of Internal Medicine, Division of Nephrology, Taoyuan Armed Forces General Hospital, Taoyuan, Taiwan
- Department of Internal Medicine, Division of Nephrology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
- Department of Life Sciences, National Central University, Taoyuan, Taiwan
| | - Chi-Ming Chu
- School of Public Health, National Defense Medical Center, Taipei, Taiwan
- Graduate Institute of Life Sciences, National Defense Medical Center, Taipei, Taiwan
- Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan
- Department of Public Health, School of Public Health, China Medical University, Taichung, Taiwan
| | - Ping-Ling Chen
- Graduate Institute of Injury Prevention and Control, College of Public Health, Taipei Medical University, Taipei, Taiwan
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Mirzai S, Sarnaik KS, Persits I, Martens P, Estep JD, Chen P, Tang WHW. Combined Prognostic Impact of Low Muscle Mass and Hypoalbuminemia in Patients Hospitalized for Heart Failure: A Retrospective Cohort Study. J Am Heart Assoc 2024; 13:e030991. [PMID: 38258654 PMCID: PMC11056110 DOI: 10.1161/jaha.123.030991] [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: 05/14/2023] [Accepted: 12/19/2023] [Indexed: 01/24/2024]
Abstract
BACKGROUND Sarcopenia and hypoalbuminemia have been identified as independent predictors of increased adverse outcomes, including mortality and readmissions, in hospitalized older adults with acute decompensated heart failure (ADHF). However, the impact of coexisting sarcopenia and hypoalbuminemia on morbidity and death in adults with ADHF has not yet been investigated. We aimed to investigate the combined effects of lower muscle mass (LMM) as a surrogate for sarcopenia and hypoalbuminemia on in-hospital and postdischarge outcomes of patients hospitalized for ADHF. METHODS AND RESULTS A total of 385 patients admitted for ADHF between 2017 and 2020 at a single institution were retrospectively identified. Demographic and clinical data were collected, including serum albumin levels at admission and discharge. Skeletal muscle indices were derived from semi-automated segmentation software analysis on axial chest computed tomography at the twelfth vertebral level. Our analysis revealed that patients who had LMM with admission hypoalbuminemia experienced increased diagnoses of infection and delirium with longer hospital length of stay and more frequent discharge to a facility. Upon discharge, 27.9% of patients had higher muscle mass without discharge hypoalbuminemia (reference group), 9.7% had LMM without discharge hypoalbuminemia, 38.4% had higher muscle mass with discharge hypoalbuminemia, and 24.0% had LMM with discharge hypoalbuminemia; mortality rates were 37.6%, 51.4%, 48.9%, and 63.2%, respectively. 1- and 3-year mortality risks were highest in those with LMM and discharge hypoalbuminemia; this relationship remained significant over a median 23.6 (3.1-33.8) months follow-up time despite multivariable adjustments (hazard ratio, 2.03 [95% CI, 1.31-3.16]; P=0.002). CONCLUSIONS Hospitalization with ADHF, LMM, and hypoalbuminemia portend heightened mortality risk.
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Affiliation(s)
- Saeid Mirzai
- Section on Cardiovascular Medicine, Department of Internal MedicineWake Forest University School of MedicineWinston‐SalemNCUSA
- Department of Internal MedicineCleveland ClinicClevelandOHUSA
| | | | - Ian Persits
- Department of Internal MedicineCleveland ClinicClevelandOHUSA
| | - Pieter Martens
- Kaufman Center for Heart Failure Treatment and Recovery, Heart Vascular and Thoracic Institute, Cleveland ClinicClevelandOHUSA
| | - Jerry D. Estep
- Department of CardiologyCleveland Clinic FloridaWestonFLUSA
| | - Po‐Hao Chen
- Section of Musculoskeletal Imaging, Imaging Institute, Cleveland ClinicClevelandOHUSA
| | - W. H. Wilson Tang
- Kaufman Center for Heart Failure Treatment and Recovery, Heart Vascular and Thoracic Institute, Cleveland ClinicClevelandOHUSA
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Schumacher KR, Vitale C. It Is Shocking How Little We Have Talked About Cardiogenic Shock in Pediatrics. J Am Coll Cardiol 2024; 83:609-610. [PMID: 38296405 DOI: 10.1016/j.jacc.2023.11.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 11/28/2023] [Indexed: 02/15/2024]
Affiliation(s)
- Kurt R Schumacher
- Congenital Heart Center, C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, Michigan, USA.
| | - Carolyn Vitale
- Congenital Heart Center, C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, Michigan, USA. https://twitter.com/DoctorVitale
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Schupp T, Abumayyaleh M, Weidner K, Lau F, Schmitt A, Reinhardt M, Abel N, Forner J, Akin M, Ayoub M, Mashayekhi K, Bertsch T, Akin I, Behnes M. Diagnostic and Prognostic Value of Aminoterminal Prohormone of Brain Natriuretic Peptide in Heart Failure with Mildly Reduced Ejection Fraction Stratified by the Degree of Renal Dysfunction. J Clin Med 2024; 13:489. [PMID: 38256622 PMCID: PMC10816452 DOI: 10.3390/jcm13020489] [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: 12/12/2023] [Revised: 12/31/2023] [Accepted: 01/07/2024] [Indexed: 01/24/2024] Open
Abstract
Limited data concerning the diagnostic and prognostic value of blood-derived biomarkers in heart failure with mildly reduced ejection fraction (HFmrEF) is available. This study investigates the diagnostic and prognostic value of aminoterminal prohormone of brain natriuretic peptide (NT-proBNP) in patients with HFmrEF, stratified by the estimated glomerular filtration rate (eGFR). Consecutive patients with HFmrEF were retrospectively included at one institution from 2016 to 2022. First, the diagnostic value of NT-proBNP for acute decompensated heart failure (ADHF) was tested. Thereafter, the prognostic value of NT-proBNP levels was tested for 30-months all-cause mortality in patients with ADHF. From a total of 755 patients hospitalized with HFmrEF, the rate of ADHF was 42%. Patients with ADHF revealed higher NT-proBNP levels compared to patients without (median 5394 pg/mL vs. 1655 pg/mL; p = 0.001). NT-proBNP was able to discriminate ADHF with an area under the curve (AUC) of 0.777 (p = 0.001), with the highest AUC in patients with eGFR ≥ 60 mL/min (AUC = 0.800; p = 0.001), and no diagnostic value was seen in eGFR < 30 mL/min (AUC = 0.576; p = 0.210). Patients with NT-proBNP levels > 3946 pg/mL were associated with higher rates of all-cause mortality at 30 months (57.7% vs. 34.4%; HR = 2.036; 95% CI 1.423-2.912; p = 0.001), even after multivariable adjustment (HR = 1.712; 95% CI 1.166-2.512; p = 0.006). In conclusion, increasing NT-proBNP levels predicted the risk of ADHF and all-cause mortality in patients with HFmrEF and preserved renal function; however, NT-proBNP levels were not predictive in patients with HFmrEF and eGFR < 30 mL/min.
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Affiliation(s)
- Tobias Schupp
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, 68167 Mannheim, Germany
| | - Mohammad Abumayyaleh
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, 68167 Mannheim, Germany
| | - Kathrin Weidner
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, 68167 Mannheim, Germany
| | - Felix Lau
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, 68167 Mannheim, Germany
| | - Alexander Schmitt
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, 68167 Mannheim, Germany
| | - Marielen Reinhardt
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, 68167 Mannheim, Germany
| | - Noah Abel
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, 68167 Mannheim, Germany
| | - Jan Forner
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, 68167 Mannheim, Germany
| | - Muharrem Akin
- Department of Cardiology, St. Josef-Hospital, Ruhr-Universität Bochum, 44791 Bochum, Germany
| | - Mohamed Ayoub
- Division of Cardiology and Angiology, Heart Center University of Bochum, 32545 Bad Oeynhausen, Germany
| | - Kambis Mashayekhi
- Department of Internal Medicine and Cardiology, Mediclin Heart Centre Lahr, 77933 Lahr, Germany
| | - Thomas Bertsch
- Institute of Clinical Chemistry, Laboratory Medicine and Transfusion Medicine, Nuremberg General Hospital, Paracelsus Medical University, 90419 Nuremberg, Germany
| | - Ibrahim Akin
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, 68167 Mannheim, Germany
| | - Michael Behnes
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, 68167 Mannheim, Germany
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Appleby S, Frampton C, Holdaway M, Chew-Harris J, Liew OW, Chong JPC, Lewis L, Troughton R, Ooi SBS, Kuan WS, Ibrahim I, Chan SP, Richards AM, Pemberton CJ. Circulating erythroferrone has diagnostic utility for acute decompensated heart failure in patients presenting with acute or worsening dyspnea. Front Cardiovasc Med 2024; 10:1195082. [PMID: 38259307 PMCID: PMC10800458 DOI: 10.3389/fcvm.2023.1195082] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 12/20/2023] [Indexed: 01/24/2024] Open
Abstract
Objectives In dyspneic patients with atrial fibrillation (AF) or obesity, the diagnostic performance of NT-proBNP for acute heart failure is reduced. We evaluated the erythroblast derived protein erythroferrone (ERFE) as an ancillary biomarker for the diagnosis of acute decompensated heart failure (ADHF) in these comorbid subgroups in both Western and Asian populations. Methods The diagnostic performance of ERFE (Intrinsic Lifesciences) and NT-proBNP (Roche Cobas e411) for ADHF was assessed in 479 New Zealand (NZ) and 475 Singapore (SG) patients presenting with breathlessness. Results Plasma ERFE was higher in ADHF, compared with breathlessness from other causes, in both countries (NZ; 4.9 vs. 1.4 ng/ml, p < 0.001) and (SG; 4.2 vs. 0.4 ng/ml, p = 0.021). The receiver operating characteristic (ROC) areas under the curve (AUCs) for discrimination of ADHF were reduced in the NZ cohort compared to SG for ERFE (0.75 and 0.84, p = 0.007) and NT-proBNP (0.86 and 0.92, p = 0.004). Optimal cut-off points for ERFE yielded comparable sensitivity and positive predictive values in both cohorts, but slightly better specificity, negative predictive values and accuracy in SG compared with NZ. In patients with AF, the AUC decreased for ERFE in each cohort (NZ: 0.71, n = 105, SG: 0.61, n = 44) but increased in patients with obesity (NZ: 0.79, n = 150, SG: 0.87, n = 164). Conclusions Circulating ERFE is higher in patients with ADHF than in other causes of new onset breathlessness with fair diagnostic utility, performing better in Asian than in Western patients. The diagnostic performance of ERFE is impaired in patients with AF but not patients with obesity.
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Affiliation(s)
- Sarah Appleby
- Department of Medicine, Christchurch Heart Institute, University of Otago Christchurch, Christchurch, New Zealand
| | - Chris Frampton
- Department of Medicine, University of Otago Christchurch, Christchurch, New Zealand
| | - Mark Holdaway
- Department of Medicine, Christchurch Heart Institute, University of Otago Christchurch, Christchurch, New Zealand
| | - Janice Chew-Harris
- Department of Medicine, Christchurch Heart Institute, University of Otago Christchurch, Christchurch, New Zealand
| | - Oi Wah Liew
- Cardiovascular Research Institute, National University of Singapore, Singapore, Singapore
| | - Jenny Pek Ching Chong
- Cardiovascular Research Institute, National University of Singapore, Singapore, Singapore
| | - Lynley Lewis
- Department of Medicine, Christchurch Heart Institute, University of Otago Christchurch, Christchurch, New Zealand
| | - Richard Troughton
- Department of Medicine, Christchurch Heart Institute, University of Otago Christchurch, Christchurch, New Zealand
- Department of Cardiology, Te Whatu Ora, Christchurch, New Zealand
| | | | - Win Sen Kuan
- Emergency Department, National University Hospital, Singapore, Singapore
| | - Irwani Ibrahim
- Emergency Department, National University Hospital, Singapore, Singapore
| | - Siew Pang Chan
- Cardiovascular Research Institute, National University of Singapore, Singapore, Singapore
| | - A. Mark Richards
- Department of Medicine, Christchurch Heart Institute, University of Otago Christchurch, Christchurch, New Zealand
- Cardiovascular Research Institute, National University of Singapore, Singapore, Singapore
- Department of Cardiology, Te Whatu Ora, Christchurch, New Zealand
| | - Christopher J. Pemberton
- Department of Medicine, Christchurch Heart Institute, University of Otago Christchurch, Christchurch, New Zealand
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11
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Alevroudis I, Kotoulas SC, Tzikas S, Vassilikos V. Congestion in Heart Failure: From the Secret of a Mummy to Today's Novel Diagnostic and Therapeutic Approaches: A Comprehensive Review. J Clin Med 2023; 13:12. [PMID: 38202020 PMCID: PMC10779505 DOI: 10.3390/jcm13010012] [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: 11/10/2023] [Revised: 12/04/2023] [Accepted: 12/14/2023] [Indexed: 01/12/2024] Open
Abstract
This review paper presents a review of the evolution of this disease throughout the centuries, describes and summarizes the pathophysiologic mechanisms, briefly discusses the mechanism of action of diuretics, presents their role in decongesting heart failure in patients, and reveals the data behind ultrafiltration in the management of acutely or chronically decompensated heart failure (ADHF), focusing on all the available data and advancements in this field. Acutely decompensated heart failure (ADHF) presents a critical clinical condition characterized by worsening symptoms and signs of heart failure, necessitating prompt intervention to alleviate congestion and improve cardiac function. Diuretics have traditionally been the mainstay for managing fluid overload in ADHF. Mounting evidence suggests that due to numerous causes, such as coexisting renal failure or chronic use of loop diuretics, an increasing rate of diuretic resistance is noticed and needs to be addressed. There has been a series of trials that combined diuretics of different categories without the expected results. Emerging evidence suggests that ultrafiltration may offer an alternative or adjunctive approach.
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Affiliation(s)
- Ioannis Alevroudis
- Third Department of Cardiology, Ippokratio General Hospital, Aristotle University of Thessaloniki, 54642 Thessaloniki, Greece (V.V.)
- Intensive Care Medicine Clinic, Ippokratio General Hospital, Aristotle University of Thessaloniki, 54642 Thessaloniki, Greece;
| | | | - Stergios Tzikas
- Third Department of Cardiology, Ippokratio General Hospital, Aristotle University of Thessaloniki, 54642 Thessaloniki, Greece (V.V.)
| | - Vassilios Vassilikos
- Third Department of Cardiology, Ippokratio General Hospital, Aristotle University of Thessaloniki, 54642 Thessaloniki, Greece (V.V.)
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12
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Zhao K, Zheng Q, Zhou J, Zhang Q, Gao X, Liu Y, Li S, Shan W, Liu L, Guo N, Tian H, Wei Q, Hu X, Cui Y, Geng X, Wang Q, Cui W. Associations between serum electrolyte and short-term outcomes in patients with acute decompensated heart failure. Ann Med 2023; 55:155-167. [PMID: 36519243 PMCID: PMC9851236 DOI: 10.1080/07853890.2022.2156595] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION There is a dearth of comprehensive studies on the association between serum electrolyte and adverse short-term prognosis of Chinese patients with acute decompensated heart failure (ADHF). PATIENTS AND METHODS A total of 5166 patients with ADHF were divided into four serum electrolyte-related study populations (potassium (n = 5145), sodium (n = 5135), chloride (n = 4966), serum total calcium (STC) (n = 4143)) under corresponding exclusions. Different logistic regression models were utilized to gauge the association between these electrolytes or the number of electrolyte abnormalities and the risk of a composite of all-cause mortality or 30-day heart failure (HF) readmission. RESULTS In multivariable adjusted analysis, patients with potassium below 3.5 mmol/L (odds ratios (ORs) 1.45; 95% confidence interval (CI):1.07-1.95), 4.01-4.50 mmol/L (OR: 1.29, CI: 1.02-1.62), 4.51-5.00 mmol/L (OR: 1.43, CI: 1.08-1.90) and above 5.00 mmol/L (OR: 1.74, CI: 1.21-2.51) had an increased risk of outcome when compared with potassium at 3.50-4.00 mmol/L. Sodium levels were inversely related to the risk of a composite outcome (<130 mmol/L: OR: 2.73 (95% CI, 1.81-4.12); 130-134 mmol/L: OR, 1.97 (CI, 1.45-2.68); 135-140 mmol/L: OR, 1.45 (CI, 1.17-1.81); p for trend < 0.001) in comparison with sodium at 141-145 mmol/L. Chloride < 95 mmol/L corresponded to a higher risk of a composite outcome with an OR of 1.65 (95% CI, 1.16-2.37) in contrast to chloride levels at 101-105 mmol/L. In addition, the adjusted ORs (95% CI) for a composite outcome comparing the STC < 2.00 and 2.00-2.24 vs. 2.25-2.58 mmol/L were 0.98 (0.69-1.43) and 1.13 (0.89-1.44), respectively. Besides that, the number of electrolyte abnormalities was positively related to the risk of a composite outcome (N = 1, OR 1.40, 95% CI: 1.13-1.73; N = 2, OR 2.51, 95% CI: 1.85-3.42; N = 3, OR 2.47, 95% CI: 1.45-4.19; p for trend < 0.001) in comparison with N = 0. CONCLUSIONS A deviation of potassium levels from 3.50 to 4.00 mmol/L, lower sodium levels and hypochloremia were associated with poorer short-term prognosis of ADHF. Furthermore, the number of electrolyte abnormalities positively correlated with adverse short-term prognosis of patients with ADHF. Key MessagesADHF patients with baseline serum potassium at first half part of normal range (3.50-4.00 mmol/L) may herald the lowest risk of recent cardiovascular events.Serum sodium and chloride levels exhibit discrepancies in terms of risk of short-term adverse events of ADHF patients.The number of electrolyte abnormalities is a significant predictor of poor short-term prognosis in patients with ADHF. CLINICAL TRIAL REGISTRATION URL http://www.chictr.org.cn/showproj.aspx?proj=23139. Unique identifier: ChiCTR-POC-17014020.
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Affiliation(s)
- Kai Zhao
- Department of Cardiology, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Qun Zheng
- Department of Cardiology, Hengshui People's Hospital, Hengshui, China
| | - Jiang Zhou
- Department of Cardiology, Chengde Central Hospital, Chengde, China
| | - Qi Zhang
- Department of Cardiology, First Central Hospital of Baoding, Baoding, China
| | - Xiaoli Gao
- Department of Cardiology, Huabei Petroleum Administration Bureau General Hospital, Cangzhou, China
| | - Yinghua Liu
- Department of Cardiology, Huabei Petroleum Administration Bureau General Hospital, Cangzhou, China
| | - Senlin Li
- Department of Cardiology, First Hospital of Zhangjiakou, Zhangjiakou, China
| | - Weichao Shan
- Department of Cardiology, Affiliated Hospital of Chengde Medical University, Chengde, China
| | - Li Liu
- Department of Cardiology, First Hospital of Qinhuangdao, Qinhuangdao, China
| | - Nan Guo
- Department of Cardiology, Cangzhou Central Hospital, Cangzhou, China
| | - Hongsen Tian
- Department of Cardiology, Handan Central Hospital, Handan, China
| | - Qingmin Wei
- Department of Cardiology, Xingtai People's Hospital, Xingtai, China
| | - Xitian Hu
- Department of Cardiology, Shijiazhuang People's Hospital, Shijiazhuang, China
| | - Yingkai Cui
- Department of Cardiology, The 252nd Hospital of People's Liberation Army, Baoding, China
| | - Xue Geng
- Department of Cardiology, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Qian Wang
- Department of Cardiology, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Wei Cui
- Department of Cardiology, The Second Hospital of Hebei Medical University, Shijiazhuang, China
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13
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Harrison NE, Ehrman R, Pang P, Armitage S, Abidov A, Perkins D, Peacock J, Montelauro N, Gupta S, Favot MJ, Levy P. The significance of historical troponin elevation in acute heart failure: Not as reassuring as previously assumed. Acad Emerg Med 2023; 30:1223-1236. [PMID: 37641846 PMCID: PMC10863562 DOI: 10.1111/acem.14798] [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] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 08/21/2023] [Accepted: 08/22/2023] [Indexed: 08/31/2023]
Abstract
BACKGROUND Historical cardiac troponin (cTn) elevation is commonly interpreted as lessening the significance of current cTn elevations at presentation for acute heart failure (AHF). Evidence for this practice is lacking. Our objective was to determine the incremental prognostic significance of historical cTn elevation compared to cTn elevation and ischemic heart disease (IHD) history at presentation for AHF. METHODS A total of 341 AHF patients were prospectively enrolled at five sites. The composite primary outcome was death/cardiopulmonary resuscitation, mechanical cardiac support, intubation, new/emergent dialysis, and/or acute myocardial infarction (AMI)/percutaneous coronary intervention (PCI)/coronary artery bypass grafting (CABG) at 90 days. Secondary outcomes were 30-day AMI/PCI/CABG and in-hospital AMI. Logistic regression compared outcomes versus initial emergency department (ED) cTn, the most recent electronic medical record cTn, estimated glomerular filtration rate, age, left ventricular ejection fraction, and IHD history (positive, negative by prior coronary workup, or unknown/no prior workup). RESULTS Elevated cTn occurred in 163 (49%) patients, 80 (23%) experienced the primary outcome, and 29 had AMI (9%). cTn elevation at ED presentation, adjusted for historical cTn and other covariates, was associated with the primary outcome (adjusted odds ratio [aOR] 2.39, 95% confidence interval [CI] 1.30-4.38), 30-day AMI/PCI/CABG, and in-hospital AMI. Historical cTn elevation was associated with greater odds of the primary outcome when IHD history was unknown at ED presentation (aOR 5.27, 95% CI 1.24-21.40) and did not alter odds of the outcome with known positive (aOR 0.74, 95% CI 0.33-1.70) or negative IHD history (aOR 0.79, 95% CI 0.26-2.40). Nevertheless, patients with elevated ED cTn were more likely to be discharged if historical cTn was also elevated (78% vs. 32%, p = 0.025). CONCLUSIONS Historical cTn elevation in AHF patients is a harbinger of worse outcomes for patients who have not had a prior IHD workup and should prompt evaluation for underlying ischemia rather than reassurance for discharge. With known IHD history, historical cTn elevation was neither reassuring nor detrimental, failing to add incremental prognostic value to current cTn elevation alone.
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Affiliation(s)
| | - Robert Ehrman
- Indiana University School of Medicine, Department of Emergency Medicine
| | - Peter Pang
- Indiana University School of Medicine, Department of Emergency Medicine
| | - Sarah Armitage
- Wayne State University School of Medicine, Department of Emergency Medicine
| | - Aiden Abidov
- Wayne State University School of Medicine, Department of Medicine, Division of Cardiology
| | - Daniel Perkins
- Indiana University School of Medicine, Department of Emergency Medicine
| | - Johnathon Peacock
- Indiana University School of Medicine, Department of Emergency Medicine
| | | | - Sushane Gupta
- Wayne State University School of Medicine, Department of Emergency Medicine
| | - Mark J Favot
- Wayne State University School of Medicine, Department of Emergency Medicine
| | - Phillip Levy
- Wayne State University School of Medicine, Department of Emergency Medicine
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14
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Tume SC, Fuentes-Baldemar AA, Anders M, Spinner JA, Tunuguntla H, Imamura M, Razavi A, Hickey E, Stapleton G, Qureshi AM, Adachi I. Temporary ventricular assist device support with a catheter-based axial pump: Changing the paradigm at a pediatric heart center. J Thorac Cardiovasc Surg 2023; 166:1756-1763.e2. [PMID: 36681561 DOI: 10.1016/j.jtcvs.2022.11.039] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 08/10/2022] [Revised: 11/02/2022] [Accepted: 11/16/2022] [Indexed: 12/25/2022]
Abstract
OBJECTIVE We report the largest pediatric single-center experience with an Impella (Abiomed Inc) catheter-based axial pump support. METHODS We conducted a retrospective cohort study of all patients with acute decompensated heart failure or cardiogenic shock requiring catheter-based axial pump support between October 2014 and February 2022. The primary outcome per individual encounter (hospital admission) was defined as bridge-to-recovery, bridge-to-durable ventricular assist device support, bridge-to-cardiac transplantation, or death at 6 months after catheter-based axial pump explantation. Adverse events were defined according to the Pediatric Interagency Registry for Mechanical Circulatory Support criteria. RESULTS Our final study cohort included 37 encounters with 43 catheter-based axial pump implantations. A single catheter-based axial pump device was used for support in 33 encounters (89%), with 2 catheter-based axial pump devices used in 3 (8%) separate encounters and 3 catheter-based axial pump devices used in 1 (3%) encounter. The median [range] age, weight, and body surface area at implantation were 16.8 [6.9-42.8] years, 61.1 [23.1-123.8] kg, and 1.7 [0.8-2.5] m2, respectively. The predominant causes of circulatory failure were graft failure/rejection in 16 patients (43%), followed by cardiomyopathy in 7 patients (19%), arrhythmia refractory to medical therapies in 6 patients (16%), myocarditis/endocarditis in 4 patients (11%), and heart failure due to congenital heart disease in 4 patients (11%). Competing outcomes analysis showed a positive outcome with bridge-to-recovery in 58%, bridge-to-durable VAD support in 14%, and bridge-to-cardiac transplantation in 14% at 6 months. Fourteen percent of encounters resulted in death at 6 months. CONCLUSIONS We demonstrate that catheter-based axial pump support in children results in excellent 1- and 6-month survival with an acceptable adverse event profile.
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Affiliation(s)
- Sebastian C Tume
- Division of Pediatric Critical Care Medicine, Texas Children's Hospital, Baylor College of Medicine, Houston, Tex.
| | - Andres A Fuentes-Baldemar
- Division of Congenital Heart Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston, Tex
| | - Marc Anders
- Division of Pediatric Critical Care Medicine, Texas Children's Hospital, Baylor College of Medicine, Houston, Tex
| | - Joseph A Spinner
- Division of Pediatric Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, Tex
| | - Hari Tunuguntla
- Division of Pediatric Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, Tex
| | - Michiaki Imamura
- Division of Congenital Heart Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston, Tex
| | - Asma Razavi
- Division of Pediatric Critical Care Medicine, Texas Children's Hospital, Baylor College of Medicine, Houston, Tex
| | - Edward Hickey
- Division of Congenital Heart Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston, Tex
| | - Gary Stapleton
- Division of Pediatric Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, Tex
| | - Athar M Qureshi
- Division of Pediatric Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, Tex; The Lillie Frank Abercrombie Section of Cardiology, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, Tex
| | - Iki Adachi
- Division of Congenital Heart Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston, Tex
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15
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Sreekumar A, Sahu AK, Aggarwal P, Nayer J, Narang R. Assessment of Troponin I Levels as a Predictor of Mortality in Acute Decompensated Heart Failure. Cureus 2023; 15:e48760. [PMID: 38098927 PMCID: PMC10719076 DOI: 10.7759/cureus.48760] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/13/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND Acute decompensated heart failure (ADHF) is a highly prevalent diagnosis in the emergency department and is associated with high morbidity and mortality. As mortality remains high even in patients discharged from the emergency, it becomes mandatory to identify markers predictive of mortality in order to guide the disposition of such patients. No literature is available on the prognostic significance of Troponin I in ADHF patients in an emergency setting from an Indian standpoint. OBJECTIVES This study was aimed at identifying the ability of Troponin I levels at presentation to predict one-month mortality in patients with ADHF. METHODS The study was conducted in the emergency department of a tertiary healthcare center in north India. Serum cardiac Troponin I (cTnI) levels at presentation were assayed in 101 patients and a one-month follow-up was done. RESULTS cTnI levels were > 0.02 ng/mL in 51 patients (50.5%). ROC analysis showed an accuracy of 63% in predicting mortality (p < 0.05). Univariate and multivariate analysis showed an OR of 2.58 and 2.74, respectively (p - 0.037 and 0.047, respectively), suggesting cTnI to be a significant predictor of mortality in ADHF. N-terminal proBNP (NT-proBNP) (OR - 2.09; p - 0.229) and left ventricular ejection fraction (OR - 2.01; p - 0.157) were not found to be significant predictors of mortality on regression analysis. CONCLUSION cTnI levels at presentation are a significant predictor of short-term mortality in ADHF and can be used in an emergency setting to guide treatment, disposition, and follow-up plans of these patients.
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Affiliation(s)
- Aravind Sreekumar
- Emergency Medicine, All India Institute of Medical Sciences, New Delhi, New Delhi, IND
| | - Ankit K Sahu
- Emergency Medicine, All India Institute of Medical Sciences, New Delhi, New Delhi, IND
| | - Praveen Aggarwal
- Emergency Medicine, All India Institute of Medical Sciences, New Delhi, New Delhi, IND
| | - Jamshed Nayer
- Emergency Medicine, All India Institute of Medical Sciences, New Delhi, New Delhi, IND
| | - Rajib Narang
- Cardiology, All India Institute of Medical Sciences, New Delhi, New Delhi, IND
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16
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Cowger JA, Basir MB, Baran DA, Hayward CS, Rangaswami J, Walton A, Tita C, Minear S, Hakemi E, Klein L, Cheng R, Wu R, Mohanty BD, Heuring JJ, Neely E, Shah P. Safety and Performance of the Aortix Device in Acute Decompensated Heart Failure and Cardiorenal Syndrome. JACC Heart Fail 2023; 11:1565-1575. [PMID: 37804307 DOI: 10.1016/j.jchf.2023.06.018] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 06/06/2023] [Accepted: 06/07/2023] [Indexed: 10/09/2023]
Abstract
BACKGROUND Cardiorenal syndrome (CRS) complicates 33% of acute decompensated heart failure (ADHF) admissions, and patients with persistent congestion at discharge have high 30-day event rates. OBJECTIVES The purpose of this study was to evaluate a novel catheter-deployed intra-aortic entrainment pump (IAEP) in patients with ADHF with CRS and persistent congestion. METHODS A multicenter (n = 14), nonrandomized, single-arm, safety and feasibility study of IAEP therapy was conducted. Within patient changes (post-pre IAEP therapy) in fluid loss, hemodynamics, patient-reported dyspnea, and serum biomarkers were assessed using Wilcoxon signed-rank testing. RESULTS Of 21 enrolled patients, 18 received Aortix therapy. Mean ± SD patient age was 60.3 ± 7.9 years. The median left ventricular ejection fraction was 22.5% (25th-75th percentile: 10.0%-53.5%); 27.8% had a left ventricular ejection fraction ≥50%. Pre-therapy, patients received 8.7 ± 4.1 days of loop diuretic agents and 44% were on inotropes. Pump therapy averaged 4.6 ± 1.6 days, yielding net fluid losses of 10.7 ± 6.5 L (P < 0.001) and significant (P < 0.01) reductions in central venous pressure (change from baseline: -8.5 mm Hg [25th-75th percentile: -3.5 to -10.0 mm Hg]), pulmonary capillary wedge pressure (-11.0 mm Hg [25th-75th percentile: -5.0 to -14.0 mm Hg]), and serum creatinine (-0.2 mg/dL [25th-75th percentile: -0.1 to -0.5 mg/dL]) with improved estimated glomerular filtration rate (+5.0 mL/min/1.73 m2 [25th-75th percentile: 2.0-9.0 mL/min/1.73 m2]) and patient-reported dyspnea score (+16 [25th-75th percentile: 3-37]). Dyspnea scores, natriuretic peptides, and renal function improvements persisted through 30 days. CONCLUSIONS This pilot study of patients with ADHF, persistent congestion, and worsening renal function due to CRS supports the potential for safely achieving decongestion using IAEP therapy. These initial promising results provide the basis for future randomized clinical trials of this novel pump. (An Evaluation of the Safety and Performance of the Aortix System for Intra-Aortic Mechanical Circulatory Support in Patients with Cardiorenal Syndrome [The Aortix CRS Pilot Study]; NCT04145635).
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Affiliation(s)
- Jennifer A Cowger
- Henry Ford Health Heart and Vascular Institute, Detroit, Michigan, USA
| | - Mir B Basir
- Henry Ford Health Heart and Vascular Institute, Detroit, Michigan, USA
| | | | - Christopher S Hayward
- St. Vincent's Hospital, Sydney, Australia; Victor Chang Cardiac Research Institute, Sydney, Australia
| | | | | | - Cristina Tita
- Henry Ford Health Heart and Vascular Institute, Detroit, Michigan, USA
| | | | - Emad Hakemi
- Cleveland Clinic Florida, Weston, Florida, USA
| | - Liviu Klein
- University of California San Francisco, San Francisco, California, USA
| | - Richard Cheng
- University of California San Francisco, San Francisco, California, USA
| | - Robby Wu
- Tampa General Hospital and University of South Florida Heart and Vascular Institute, Tampa, Florida, USA
| | - Bibhu D Mohanty
- Tampa General Hospital and University of South Florida Heart and Vascular Institute, Tampa, Florida, USA
| | | | | | - Palak Shah
- Inova Heart and Vascular Institute, Falls Church, Virginia, USA.
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17
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Cox ZL, Siddiqi HK, Stevenson LW, Bales B, Han JH, Hart K, Imhoff B, Ivey-Miranda JB, Jenkins CA, Lindenfeld J, Shotwell MS, Miller KF, Ooi H, Rao VS, Schlendorf K, Self WH, Siew ED, Storrow A, Walsh R, Wrenn JO, Testani JM, Collins SP. Randomized controlled trial of urinE chemiStry guided aCute heArt faiLure treATmEnt (ESCALATE): Rationale and design. Am Heart J 2023; 265:121-131. [PMID: 37544492 PMCID: PMC10592235 DOI: 10.1016/j.ahj.2023.07.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 06/13/2023] [Revised: 07/24/2023] [Accepted: 07/25/2023] [Indexed: 08/08/2023]
Abstract
Diuresis to achieve decongestion is a central aim of therapy in patients hospitalized for acute decompensated heart failure (ADHF). While multiple clinical trials have investigated initial diuretic strategies for a designated period of time, there is a paucity of evidence to guide diuretic titration strategies continued until decongestion is achieved. The use of urine chemistries (urine sodium and creatinine) in a natriuretic response prediction equation accurately estimates natriuresis in response to diuretic dosing, but a randomized clinical trial is needed to compare a urine chemistry-guided diuresis strategy with a strategy of usual care. The urinE chemiStry guided aCute heArt faiLure treATmEnt (ESCALATE) trial is designed to test the hypothesis that protocolized diuretic therapy guided by spot urine chemistry through completion of intravenous diuresis will be superior to usual care and improve outcomes over the 14 days following randomization. ESCALATE will randomize and obtain complete data on 450 patients with acute heart failure to a diuretic strategy guided by urine chemistry or a usual care strategy. Key inclusion criteria include an objective measure of hypervolemia with at least 10 pounds of estimated excess volume, and key exclusion criteria include significant valvular stenosis, hypotension, and a chronic need for dialysis. Our primary outcome is days of benefit over the 14 days after randomization. Days of benefit combines patient symptoms captured by global clinical status with clinical state quantifying the need for hospitalization and intravenous diuresis. CLINICAL TRIAL REGISTRATION: NCT04481919.
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Affiliation(s)
- Zachary L Cox
- Department of Pharmacy, Lipscomb University College of Pharmacy, Nashville, TN; Department of Pharmacy, Vanderbilt University Medical Center, Nashville, TN.
| | - Hasan K Siddiqi
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Lynne W Stevenson
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Brian Bales
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Jin H Han
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN; Geriatric Research, Education and Clinical Center, Tennessee Valley Healthcare System, TN
| | - Kimberly Hart
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN
| | - Brant Imhoff
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN
| | - Juan B Ivey-Miranda
- Department of Internal Medicine, Yale University School of Medicine, New Haven, CT; Hospital de Cardiologia, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Cathy A Jenkins
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN
| | - JoAnn Lindenfeld
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Matthew S Shotwell
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN
| | - Karen F Miller
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Henry Ooi
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN; Department of Medicine, Veterans Affairs Tennessee Valley Healthcare System, TN
| | - Veena S Rao
- Department of Internal Medicine, Yale University School of Medicine, New Haven, CT
| | - Kelly Schlendorf
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Wesley H Self
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Edward D Siew
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Alan Storrow
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Ryan Walsh
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Jesse O Wrenn
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Jeffrey M Testani
- Department of Internal Medicine, Yale University School of Medicine, New Haven, CT
| | - Sean P Collins
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN; Geriatric Research, Education and Clinical Center, Tennessee Valley Healthcare System, TN
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18
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Nozaki K, Hamazaki N, Kamiya K, Uchida S, Noda T, Ueno K, Hotta K, Maekawa E, Matsunaga A, Yamaoka-Tojo M, Ako J. Association between walking speed early after admission and all-cause death and/or readmission in patients with acute decompensated heart failure. Eur J Cardiovasc Nurs 2023:zvad092. [PMID: 37672640 DOI: 10.1093/eurjcn/zvad092] [Citation(s) in RCA: 1] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 08/30/2023] [Accepted: 09/04/2023] [Indexed: 09/08/2023]
Abstract
AIM Patients with heart failure (HF) frequently experience decreased physical function, including walking speed. Slower walking speed is associated with poorer prognosis. However, most of these reports focused on patients with stable HF, and the relationship between walking speed in acute phase and clinical outcomes is unclear. Therefore, we aimed to investigate the associations between walking speed early after admission and clinical events in patients with acute decompensated HF (ADHF). METHODS AND RESULTS We reviewed consecutive 1391 patients admitted due to ADHF. We measured walking speed the first time to walk on the ward more than 10 m after admission, and the speed within four days after admission was included in this study. The primary outcome was combined events (all-cause death and/or readmission due to HF). The follow-up period was up to one year from the discharge. The study population had a median age of 74 years (interquartile range [IQR]: 65-80 years), and 35.9% of patients were females. The median walking speed was 0.70 m/s (IQR: 0.54-0.88 m/s). Combined events occurred in 429 (30.8%) patients. Faster walking speed was independently associated with lower rate of combined events (adjusted hazard ratio per 0.1 m/s increasing: 0.951, 95% confidence interval:0.912-0.992). CONCLUSION Faster walking speed within four days after admission was associated with favourable clinical outcomes in patients with ADHF. The results suggest that measuring walking speed in acute phase is useful for earlier risk stratification.
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Affiliation(s)
- Kohei Nozaki
- Department of Rehabilitation, Kitasato University Hospital, Kanagawa, Japan
| | - Nobuaki Hamazaki
- Department of Rehabilitation, Kitasato University Hospital, Kanagawa, Japan
| | - Kentaro Kamiya
- Department of Rehabilitation, School of Allied Health Sciences, Kitasato University, Kanagawa, Japan
- Department of Cardiovascular Medicine, Kitasato University Graduate School of Medical Sciences, Kanagawa, Japan
| | - Shota Uchida
- Department of Cardiovascular Medicine, Kitasato University Graduate School of Medical Sciences, Kanagawa, Japan
- Research Fellow of Japan Society for the Promotion of Science, Tokyo, Japan
| | - Takumi Noda
- Department of Cardiovascular Medicine, Kitasato University Graduate School of Medical Sciences, Kanagawa, Japan
- Exercise Physiology and Cardiovascular Health Lab, Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Canada
| | - Kensuke Ueno
- Department of Cardiovascular Medicine, Kitasato University Graduate School of Medical Sciences, Kanagawa, Japan
| | - Kazuki Hotta
- Department of Rehabilitation, School of Allied Health Sciences, Kitasato University, Kanagawa, Japan
- Department of Cardiovascular Medicine, Kitasato University Graduate School of Medical Sciences, Kanagawa, Japan
| | - Emi Maekawa
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Kanagawa, Japan
| | - Atsuhiko Matsunaga
- Department of Rehabilitation, School of Allied Health Sciences, Kitasato University, Kanagawa, Japan
- Department of Cardiovascular Medicine, Kitasato University Graduate School of Medical Sciences, Kanagawa, Japan
| | - Minako Yamaoka-Tojo
- Department of Rehabilitation, School of Allied Health Sciences, Kitasato University, Kanagawa, Japan
- Department of Cardiovascular Medicine, Kitasato University Graduate School of Medical Sciences, Kanagawa, Japan
| | - Junya Ako
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Kanagawa, Japan
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Keck C, Gregoski M, Litwin S, Borlaug BA, Fudim M, Tedford RJ, Houston BA. Decoupling of Hemodynamics and Congestive Symptoms in Obese Patients With Heart Failure. J Card Fail 2023; 29:1249-1256. [PMID: 36963608 DOI: 10.1016/j.cardfail.2023.02.016] [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] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 02/09/2023] [Accepted: 02/19/2023] [Indexed: 03/26/2023]
Abstract
BACKGROUND Prior studies indicate significant physiological differences between obese and nonobese patients with heart failure (HF), but none have evaluated differences in hemodynamic patterns in these patient populations during treatment for acute decompensated HF (ADHF). OBJECTIVES In this study, we assessed differences in hemodynamic trends between obese and nonobese patients during treatment for ADHF. METHODS Obese (body mass index (BMI) >30, n = 63) and nonobese (BMI < 25, n = 69) patients with ADHF in the Evaluation Study of Congestive Heart Failure and Pulmonary Artery Catheterization Effectiveness (ESCAPE) study who had pulmonary artery catheterization data available through the duration of treatment were evaluated. Hemodynamics were analyzed at baseline and optimal day. Changes in BNP levels, weight, creatinine, BUN, 6MWT, orthopnea and dyspnea scores were assessed. RESULTS Despite similar baseline hemodynamics, obese patients had significantly less absolute and relative pulmonary arterial wedge pressure (PAWP) reduction (-16 ± 28 vs -32 ± 29%; P = 0.03) during treatment. Obese patients also had higher PAWPs (19.9 + 8 vs 15.5 + 6.8 mmHg; P = 0.01) and PA pressures at optimization compared with nonobese patients. Obese and nonobese patients had similar relative improvements in weight, BNP, 6-minute walk test distance, dyspnea and orthopnea scores, and similar changes in creatinine and BUN levels. CONCLUSIONS Obese patients treated for ADHF display less reduction in invasively measured left heart filling pressures, despite similar improvements in symptoms, weight loss, and noninvasive surrogates of congestion. Our findings suggest a degree of decoupling between left heart filling pressures and congestive symptoms in obese patients undergoing treatment for ADHF.
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Affiliation(s)
- Carson Keck
- Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, SC
| | - Mathew Gregoski
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC
| | - Sheldon Litwin
- Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, SC
| | - Barry A Borlaug
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Marat Fudim
- Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, NC; Duke Clinical Research Institute, Duke University Medical Center, Durham, NC
| | - Ryan J Tedford
- Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, SC
| | - Brian A Houston
- Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, SC.
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20
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Capone F, Cipriani A, Molinari L, Noale M, Gusella B, Lucente F, Savino S, Bertomoro A, Saller A, Giannini S, Vettor R. Ferric Carboxymaltose in Patients with Acute Decompensated Heart Failure and Iron Deficiency: A Real-Life Study. J Pers Med 2023; 13:1250. [PMID: 37623500 PMCID: PMC10455601 DOI: 10.3390/jpm13081250] [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: 07/04/2023] [Revised: 07/28/2023] [Accepted: 08/02/2023] [Indexed: 08/26/2023] Open
Abstract
Background: The correction of iron deficiency (ID) with ferric carboxymaltose (FCM) is a recommended intervention in heart failure (HF) with reduced ejection fraction. Our aim is to evaluate, in a real-life setting, the clinical significance of ID screening and FCM treatment in acute decompensated HF (ADHF). Methods: In a cohort of ADHF patients, the prevalence of ID and FCM administration were investigated. Among the 104 patients admitted for ADHF, in n = 90 (median age 84, 53.5% with preserved left ventricular ejection fraction-LVEF), a complete iron status evaluation was obtained. ID was detected in n = 73 (81.1%), 55 of whom were treated with in-hospital FCM. The target dose was reached in n = 13. Results: No significant differences were detected in terms of age, sex, comorbidities, or LVEF between the FCM-supplemented and -unsupplemented patients. During a median follow-up of 427 days (IQR 405-466) among the FCM-supplemented patients, only 14.5% received FCM after discharge; the mortality and rehospitalizations among FCM-supplemented and -unsupplemented patients were similar (p = ns). In a follow-up evaluation, ID was still present in 75.0% of the FCM-supplemented patients and in 69.2% of the unsupplemented patients (p = ns). Conclusions: In this real-life ADHF cohort, FCM was administered at lower-than-prescribed doses, thus having no impact on ID correction. The significance of our findings is that only achieving the target dose of FCM and pursuing outpatient treatment can correct ID and produce long-term clinical benefits.
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Affiliation(s)
- Federico Capone
- Department of Medicine (DIMED), University of Padua, Via Giustiniani, 2, 35128 Padova, Italy
| | - Alberto Cipriani
- Department of Cardiac, Thoracic and Vascular Sciences, Padua University Hospital, 35128 Padua, Italy
| | - Leonardo Molinari
- Department of Medicine (DIMED), University of Padua, Via Giustiniani, 2, 35128 Padova, Italy
| | - Marianna Noale
- National Research Council (CNR), Neuroscience Institute, Aging Branch, 35128 Padua, Italy
| | - Beatrice Gusella
- Department of Medicine (DIMED), University of Padua, Via Giustiniani, 2, 35128 Padova, Italy
| | - Fabrizio Lucente
- Department of Medicine (DIMED), University of Padua, Via Giustiniani, 2, 35128 Padova, Italy
| | - Sandro Savino
- Department of Medicine (DIMED), University of Padua, Via Giustiniani, 2, 35128 Padova, Italy
| | - Antonella Bertomoro
- Department of Medicine (DIMED), University of Padua, Via Giustiniani, 2, 35128 Padova, Italy
| | - Alois Saller
- Department of Medicine (DIMED), University of Padua, Via Giustiniani, 2, 35128 Padova, Italy
| | - Sandro Giannini
- Department of Medicine (DIMED), University of Padua, Via Giustiniani, 2, 35128 Padova, Italy
| | - Roberto Vettor
- Department of Medicine (DIMED), University of Padua, Via Giustiniani, 2, 35128 Padova, Italy
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21
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Marcus G, Kofman N, Maymon SL, Asher E, Loberman D, Pereg D, Fuchs S, Minha S. Marital status impact on the outcomes of patients admitted for acute decompensation of heart failure: A retrospective, single-center, analysis. Clin Cardiol 2023; 46:914-921. [PMID: 37309080 PMCID: PMC10436802 DOI: 10.1002/clc.24053] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 05/07/2023] [Accepted: 05/13/2023] [Indexed: 06/14/2023] Open
Abstract
BACKGROUND Conflicting evidence exists regarding the association between marital status and outcomes in patients with heart failure (HF). Further, it is not clear whether type of unmarried status (never married, divorced, or widowed) disparities exist in this context. HYPOTHESIS We hypothesized that marital status will be associated with better outcomes in patients with HF. METHODS This single-center retrospective study utilized a cohort of 7457 patients admitted with acute decompensated HF (ADHF) between 2007 and 2017. We compared baseline characteristics, clinical indices, and outcomes of these patients grouped by their marital status. Cox regression analysis was used to explore the independency of the association between marital status and long-term outcomes. RESULTS Married patients accounted for 52% of the population while 37%, 9%, and 2% were widowed, divorced, and never married, respectively. Unmarried patients were older (79.8 ± 11.5 vs. 74.8 ± 11.1 years; p < 0.001), more frequently women (71.4% vs. 33.2%; p < 0.001), and less likely to have traditional cardiovascular comorbidities. Compared with married patients, all-cause mortality incidence was higher in unmarried patients at 30 days (14.7% vs. 11.1%, p < 0.001), 1 year, and 5 years (72.9% vs. 68.4%, p < 0.001). Nonadjusted Kaplan-Meier estimates for 5-year all-cause mortality by sex, demonstrated the best prognosis for married women, and by marital status in unmarried patients, the best prognosis was demonstrated in divorced patients while the worst was recorded in widowed patients. After adjustment for covariates, marital status was not found to be independently associated with ADHF outcomes. CONCLUSIONS Marital status is not independently associated with outcomes of patients admitted for ADHF. Efforts for outcomes improvement should focus on other, more traditional risk factors.
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Affiliation(s)
- Gil Marcus
- Cardiology, Shamir Medical CenterBe'er‐YaakovIsrael
- Sackler School of MedicineTel‐Aviv UniversityRamat‐AvivIsrael
| | - Natalia Kofman
- Cardiology, Shamir Medical CenterBe'er‐YaakovIsrael
- Sackler School of MedicineTel‐Aviv UniversityRamat‐AvivIsrael
| | - Shiri L. Maymon
- Sackler School of MedicineTel‐Aviv UniversityRamat‐AvivIsrael
| | - Elad Asher
- The Jesselson Integrated Heart Center, Shaare Zedek Medical Center, Faculty of MedicineHebrew UniversityJerusalemIsrael
| | - Dan Loberman
- Cape Cod Hospital, Brigham and Women's Hospital, Harvard Medical SchoolDivision of Cardiac SurgeryBostonMassachusettsUSA
| | - David Pereg
- Sackler School of MedicineTel‐Aviv UniversityRamat‐AvivIsrael
- Cardiology DepartmentMeir Medical CenterKfar‐SabaIsrael
| | - Shmuel Fuchs
- Cardiology, Shamir Medical CenterBe'er‐YaakovIsrael
- Sackler School of MedicineTel‐Aviv UniversityRamat‐AvivIsrael
| | - Sa'ar Minha
- Cardiology, Shamir Medical CenterBe'er‐YaakovIsrael
- Sackler School of MedicineTel‐Aviv UniversityRamat‐AvivIsrael
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22
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Kang N, Zheng S. Commentary: The efficacy of ginseng-containing traditional Chinese medicine in patients with acute decompensated heart failure: a systematic review and meta-analysis. Front Pharmacol 2023; 14:1180944. [PMID: 37593180 PMCID: PMC10427918 DOI: 10.3389/fphar.2023.1180944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 07/10/2023] [Indexed: 08/19/2023] Open
Affiliation(s)
- Niansong Kang
- Department of Traditional Chinese Medicine, Yuyao Hospital of Traditional Chinese Medicine, Yuyao, Zhejiang, China
| | - Sihui Zheng
- Department of Gastroenterology, The First Clinical Medical College of Zhejiang Chinese Medicine University, Hangzhou, Zhejiang, China
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23
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Karan A, Maaliki N, Kogler WM, Esmail K. Acute Decompensated Heart Failure and Cardiogenic Shock Following Propofol Infusion: A Report and Review of Pathophysiology. Cureus 2023; 15:e41815. [PMID: 37575769 PMCID: PMC10422935 DOI: 10.7759/cureus.41815] [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: 04/09/2023] [Accepted: 07/13/2023] [Indexed: 08/15/2023] Open
Abstract
Propofol is a widely used general anesthetic agent with a generally familiar and predictable adverse effect profile. Severe left ventricular dysfunction to an ejection fraction of < 35% is a rare adverse effect of propofol, with a scarcity of data in the literature. In this case, we report a 36-year-old female at 36 weeks gestation with a prior remote history of peripartum cardiomyopathy, who, while receiving propofol for general anesthesia during a C-section, developed severe left ventricular dysfunction with an ejection fraction of 20-25%, flash pulmonary edema, and cardiogenic shock. She required initiation of inotropic support and, following weaning of propofol, gradually recovered her ejection fraction over the next 24 hours to 40-45% and to 50-55% at follow-up two weeks after discharge. This case highlights a unique adverse effect of propofol with scarce pre-existing literature and no guidelines on appropriate management. It is essential for clinicians to be familiar with this uncommon complication, particularly as propofol use continues to rise worldwide.
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Affiliation(s)
- Abhinav Karan
- Internal Medicine, University of Florida College of Medicine, Jacksonville, USA
| | - Naji Maaliki
- Cardiology, University of Florida College of Medicine, Jacksonville, USA
| | - William M Kogler
- Cardiology, University of Florida College of Medicine, Jacksonville, USA
| | - Khadeeja Esmail
- Cardiology, University of Florida College of Medicine, Jacksonville, USA
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24
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Kim HN, Yang DH, Park BE. Acute decompensated heart failure after transcatheter aortic valve implantation: A case report. Clin Case Rep 2023; 11:e7597. [PMID: 37484748 PMCID: PMC10362099 DOI: 10.1002/ccr3.7597] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 06/02/2023] [Accepted: 06/07/2023] [Indexed: 07/25/2023] Open
Abstract
Transcatheter aortic valve implantation (TVAI) is a widely used treatment modality for severe aortic stenosis. The complication rates of the procedure have gradually decreased over time, owing to the improvements in procedural skills and development of TVAI devices. However, several rare but serious complications can still occur after TAVI. We recently encountered acute decompensated heart failure as a rare and fatal complication of TAVI and would like to share our experience.
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Affiliation(s)
- Hong Nyun Kim
- Division of Cardiology, Department of Internal MedicineKyungpook National University HospitalDaeguKorea
- Division of Cardiology, Department of Internal MedicineKyungpook National University Chilgok HospitalDaeguKorea
- Department of Internal Medicine, School of MedicineKyungpook National UniversityDaeguKorea
| | - Dong Heon Yang
- Division of Cardiology, Department of Internal MedicineKyungpook National University HospitalDaeguKorea
- Department of Internal Medicine, School of MedicineKyungpook National UniversityDaeguKorea
| | - Bo Eun Park
- Division of Cardiology, Department of Internal MedicineKyungpook National University HospitalDaeguKorea
- Department of Internal Medicine, School of MedicineKyungpook National UniversityDaeguKorea
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25
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Koikai J, Khan Z. The Effectiveness of Self-Management Strategies in Patients With Heart Failure: A Narrative Review. Cureus 2023; 15:e41863. [PMID: 37581125 PMCID: PMC10423403 DOI: 10.7759/cureus.41863] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/14/2023] [Indexed: 08/16/2023] Open
Abstract
Heart failure (HF) is a common condition with high morbidity and mortality. Self-management strategies for heart failure can be effective in improving patients' quality of life and reducing mortality and hospitalization for heart failure. These self-management strategies are also cost-effective. A complex interplay between various factors related to patients, therapy, healthcare, and socioeconomic factors influences the effectiveness of self-management strategies. The primary aim of this study is to determine the effectiveness of self-management strategies in patients with heart failure in reducing mortality, hospitalization for heart failure, and healthcare cost savings at six months and one year. The secondary aim is to determine adherence to self-management strategies in patients with HF. The current study is a narrative review of studies evaluating the effectiveness of self-management strategies in heart failure. A literature search was done in PubMed, Embase, Google Scholar, ScienceDirect, and the Cochrane Library for studies published in the English language between 2012 and 2022. Descriptive statistics were used to summarize the characteristics of studies and interventions. We calculated odds ratios, risk ratios, or mean differences to calculate the effect of self-management strategies on mortality, hospitalization for HF, and healthcare costs between patient groups. We included a total of 30 studies in our narrative review: eight cross-sectional studies and 22 randomized controlled trials. These studies showed a significant effect of self-management strategies on mortality at six- and 12-month follow-ups. Studies on the effectiveness of self-management strategies on hospitalization for heart failure showed benefits at six and 12 months. Self-management strategies are cost-effective and feasible with improved disability-adjusted life years (DALY). One study showed higher costs associated with self-management strategies and only a slight decrease in DALY. Overall, adherence to self-management strategies was inadequate in these studies. Novel and innovative self-management interventions improve therapy adherence. There was a lack of uniformity in using tools to assess self-management across studies. There was a lack of ethnic diversity in the individual studies, limiting the generalization of these studies' findings. Our review showed that self-management strategies are beneficial for heart failure-related hospitalization, reduce mortality and hospitalization for heart failure, and are cost-effective. The use of innovative approaches like smartphone applications improves adherence.
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Affiliation(s)
- Josephine Koikai
- Internal Medicine, Kenyatta National Hospital/ University of Nairobi (KNH/UoN), Nairobi, KEN
| | - Zahid Khan
- Acute Medicine, Mid and South Essex NHS Foundation Trust, Southend-on-Sea, GBR
- Cardiology, Barts Heart Centre, London, GBR
- Cardiology and General Medicine, Barking, Havering and Redbridge University Hospitals NHS Trust, London, GBR
- Cardiology, Royal Free Hospital, London, GBR
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26
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Makmal N, Silbermintz N, Faierstein K, Raphael R, Moeller C, Canetti M, Maor E, Kuperstein R, Hai I, Butnaru A, Oren D, Barbash IM, Guetta V, Fefer P. Transcatheter edge-to-edge mitral valve repair in patients with acute decompensated heart failure due to severe mitral regurgitation. Cardiol J 2023; 31:45-52. [PMID: 37345364 PMCID: PMC10919568 DOI: 10.5603/cj.a2023.0042] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 04/20/2023] [Accepted: 05/12/2023] [Indexed: 06/23/2023] Open
Abstract
BACKGROUND Transcatheter edge-to-edge mitral valve repair (TEER) has been established as a therapy for severe symptomatic mitral regurgitation (MR) in stable patients, and it has recently emerged as a reasonable option for acutely ill patients. The aim of this study was to evaluate the safety and efficacy of TEER in hospitalized patients with acute decompensated heart failure (ADHF) and severe MR that was deemed to play a major role in their deterioration. METHODS We included 31 patients who underwent emergent TEER for MR ≥ 3+ from 2012 to 2022 at Sheba Medical Center. Outcomes included procedural safety, procedural success, all-cause mortality, heart failure readmission, and functional improvement. Outcomes were evaluated at 3 months and at 1 year. Data were obtained retrospectively by chart review. RESULTS Implantation of a TEER device was achieved in 97% of patients, and reduction in MR severity of at least two grades and final MR ≤ 2+ at discharge was achieved in 74%. No intra-procedural mortality or life-threatening complications were noted. Mortality at 30 days was 23%. No excess mortality occurred beyond 6 months, with a total mortality of 41%. At 1 year all survivors had MR ≤ 2+, all were free of heart failure hospitalizations, and 88% were at New York Heart Association class ≤ II. CONCLUSIONS Mitral valve TEER for patients with ADHF and significant MR is safe, feasible, and achieves substantial reduction in MR severity. Despite high early mortality, procedural success is associated with good long-term clinical outcomes for patients surviving longer than 6 months.
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Affiliation(s)
- Noam Makmal
- Leviev Heart Center, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | - Neta Silbermintz
- Leviev Heart Center, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | - Kobi Faierstein
- Leviev Heart Center, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
- Internal Medicine Department E, Sheba Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Roy Raphael
- Internal Medicine Department E, Sheba Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Cathrine Moeller
- Columbia University Irving Medical Center, New York, United States
| | - Michal Canetti
- Leviev Heart Center, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | - Elad Maor
- Leviev Heart Center, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | - Rafi Kuperstein
- Leviev Heart Center, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | - Ilan Hai
- Leviev Heart Center, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | - Adi Butnaru
- Leviev Heart Center, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | - Daniel Oren
- Columbia University Irving Medical Center, New York, United States
- New York-Presbyterian Brooklyn Methodist Hospital, Weill Cornell Medicine, New York, United States
| | - Israel M Barbash
- Leviev Heart Center, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | - Victor Guetta
- Leviev Heart Center, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | - Paul Fefer
- Leviev Heart Center, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel.
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27
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Okada T, Miyoshi T, Oka A, Tsushima R, Sudo Y, Seiyama K, Takagi W, Kawaguchi T, Ozaki M, Sogo M, Ugawa S, Nosaka K, Takahashi M, Okawa K, Doi M. Prognostic Impact of the Early Use of Tolvaptan in Elderly Patients with Acute Decompensated Heart Failure. J Clin Med 2023; 12:jcm12093105. [PMID: 37176546 PMCID: PMC10179179 DOI: 10.3390/jcm12093105] [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: 03/27/2023] [Revised: 04/21/2023] [Accepted: 04/23/2023] [Indexed: 05/15/2023] Open
Abstract
The number of elderly patients with acute decompensated heart failure (ADHF) is increasing, and it is often difficult to treat. This study aimed to evaluate the efficacy and safety of using tolvaptan early after hospitalization in elderly patients with ADHF and the prognosis one year after hospitalization. This study enrolled 185 patients with ADHF who were admitted for the first time. Tolvaptan was administered within 24 h after admission. These patients were assigned to two groups: over 80 years old (n = 109) and under 80 years old (n = 76). There were no significant differences between the two groups in the occurrence of MACCE within one year (25% vs. 20%, p = 0.59). All-cause mortality was significantly higher in the over-80 group (12% vs. 2%, p = 0.01). There were no significant differences in the incidence of worsening renal failure (11% vs. 7%, p = 0.46) and hypernatremia (5% vs. 9%, p = 1.0), and in the duration of hospitalization (19.2 days vs. 18.8 days, p = 0.8). Tolvaptan might be effective and safe in elderly patients with ADHF, and there was no difference in the incidence of MACCE within one year.
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Affiliation(s)
- Tomoaki Okada
- Department of Cardiology, Kagawa Prefectural Central Hospital, 1-2-1 Asahi-machi, Takamatsu 760-8557, Japan
| | - Toru Miyoshi
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Okayama 700-8558, Japan
| | - Akihiro Oka
- Department of Cardiology, Kagawa Prefectural Central Hospital, 1-2-1 Asahi-machi, Takamatsu 760-8557, Japan
| | - Ryu Tsushima
- Department of Cardiology, Kagawa Prefectural Central Hospital, 1-2-1 Asahi-machi, Takamatsu 760-8557, Japan
| | - Yuya Sudo
- Department of Cardiology, Kagawa Prefectural Central Hospital, 1-2-1 Asahi-machi, Takamatsu 760-8557, Japan
| | - Kosuke Seiyama
- Department of Cardiology, Kagawa Prefectural Central Hospital, 1-2-1 Asahi-machi, Takamatsu 760-8557, Japan
| | - Wataru Takagi
- Department of Cardiology, Kagawa Prefectural Central Hospital, 1-2-1 Asahi-machi, Takamatsu 760-8557, Japan
| | - Tomohiro Kawaguchi
- Department of Cardiology, Kagawa Prefectural Central Hospital, 1-2-1 Asahi-machi, Takamatsu 760-8557, Japan
| | - Masatomo Ozaki
- Department of Cardiology, Kagawa Prefectural Central Hospital, 1-2-1 Asahi-machi, Takamatsu 760-8557, Japan
| | - Masahiro Sogo
- Department of Cardiology, Kagawa Prefectural Central Hospital, 1-2-1 Asahi-machi, Takamatsu 760-8557, Japan
| | - Satoko Ugawa
- Department of Cardiology, Kagawa Prefectural Central Hospital, 1-2-1 Asahi-machi, Takamatsu 760-8557, Japan
| | - Kazumasa Nosaka
- Department of Cardiology, Kagawa Prefectural Central Hospital, 1-2-1 Asahi-machi, Takamatsu 760-8557, Japan
| | - Masahiko Takahashi
- Department of Cardiology, Kagawa Prefectural Central Hospital, 1-2-1 Asahi-machi, Takamatsu 760-8557, Japan
| | - Keisuke Okawa
- Department of Cardiology, Kagawa Prefectural Central Hospital, 1-2-1 Asahi-machi, Takamatsu 760-8557, Japan
| | - Masayuki Doi
- Department of Cardiology, Kagawa Prefectural Central Hospital, 1-2-1 Asahi-machi, Takamatsu 760-8557, Japan
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Korotaeva AA, Samoilova EV, Zhirov IV, Mindzaev DR, Nasonova SN, Tereschenko SN. Dynamics of the Levels of Interleukin 6, Its Soluble Receptor, and Soluble Glycoprotein 130 in Patients with Chronic Heart Failure and Preserved or Reduced Ejection Fraction. Bull Exp Biol Med 2023; 174:666-669. [PMID: 37046116 DOI: 10.1007/s10517-023-05765-7] [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: 08/09/2022] [Indexed: 04/14/2023]
Abstract
The features of IL-6 trans-signaling were studied in patients with heart failure with reduced (n=74) and preserved (n=31) ejection fraction (EF) during acute decompensation of HF (ADHF) and after 1 year. Patients with ADHF with reduced EF demonstrated higher levels of IL-6 and soluble glycoprotein 130 in comparison with those in patients with preserved EF: 10.18 (7.07; 16.14) pg/ml vs 6.35 (3.52; 11.00) pg/ml and 543.46 (455.37; 634.43) ng/ml vs 498.50 (408.16; 632.23) ng/ml, respectively. The levels of soluble IL-6 receptor little differed in these groups: 57.82 (47.55; 79.85) ng/ml vs 61.30 (44.97; 78.08) ng/ml. After 1 year, the levels of IL-6 in HF patients with reduced EF significantly decreased (5.36 (3.35; 8.35) pg/ml), while in patients with preserved EF, the decrease in this parameter was less pronounced (5.86 (4.05; 7.32) pg/ml), and the difference between groups disappeared. The levels of soluble glycoprotein 130 increased in both groups: 448.06 (357.74; 550.67) ng/ml vs 385.35 (344.29; 523.72) ng/ml. It should be noted that after 1 year (in stable patients), the levels of soluble IL-6 receptor increased in both groups: 65.75 (54.84; 75.39) ng/ml vs 70.81 (57.51; 82.25) ng/ml. Thus, despite the high levels of IL-6 in HF patients with reduced EF, the potential limiting IL-6 trans-signaling in these patients is higher than in patients with preserved EF.
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Affiliation(s)
- A A Korotaeva
- E. I. Chazov National Medical Research Center of Cardiology, Ministry of Health of the Russian Federation, Moscow, Russia
| | - E V Samoilova
- E. I. Chazov National Medical Research Center of Cardiology, Ministry of Health of the Russian Federation, Moscow, Russia.
| | - I V Zhirov
- E. I. Chazov National Medical Research Center of Cardiology, Ministry of Health of the Russian Federation, Moscow, Russia
| | - D R Mindzaev
- E. I. Chazov National Medical Research Center of Cardiology, Ministry of Health of the Russian Federation, Moscow, Russia
| | - S N Nasonova
- E. I. Chazov National Medical Research Center of Cardiology, Ministry of Health of the Russian Federation, Moscow, Russia
| | - S N Tereschenko
- E. I. Chazov National Medical Research Center of Cardiology, Ministry of Health of the Russian Federation, Moscow, Russia
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29
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Inoue T, Matsunaga K, Kobayashi W, Minamino T. Successful treatment with ivabradine in a β-blocker-refractory patient with acute decompensated heart failure with reduced ejection fraction. Clin Case Rep 2023; 11:e6890. [PMID: 36879680 PMCID: PMC9984869 DOI: 10.1002/ccr3.6890] [Citation(s) in RCA: 1] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 12/12/2022] [Accepted: 01/03/2023] [Indexed: 03/06/2023] Open
Abstract
Ivabradine is an established treatment for chronic heart failure with reduced ejection fraction (HFrEF); however, it is not used for acute heart failure treatment. Negative inotropic effects (NIE) often limit the up-titration of β-blockers. Contrarily, ivabradine has no NIE, and enables β-blockers usage for treating patients with acute decompensated HFrEF.
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Affiliation(s)
- Tomoko Inoue
- Department of Cardiorenal and Cerebrovascular Medicine Faculty of Medicine Kagawa University Kagawa Japan
| | - Keiji Matsunaga
- Department of Cardiorenal and Cerebrovascular Medicine Faculty of Medicine Kagawa University Kagawa Japan
| | - Waki Kobayashi
- Department of Cardiorenal and Cerebrovascular Medicine Faculty of Medicine Kagawa University Kagawa Japan
| | - Tetsuo Minamino
- Department of Cardiorenal and Cerebrovascular Medicine Faculty of Medicine Kagawa University Kagawa Japan
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30
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Alalawi H, Fida HL, Bokhary OA, Alhuzali MA, Alharbi AF, Alhodian FY, Alsahari MR, Siddiqui AM. Demographics and Characteristics of Acutely Decompensated Heart Failure (ADHF) Patients in a Tertiary Care Center in Saudi Arabia. Cureus 2023; 15:e35724. [PMID: 37016652 PMCID: PMC10066922 DOI: 10.7759/cureus.35724] [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] [Accepted: 03/03/2023] [Indexed: 03/06/2023] Open
Abstract
BACKGROUND Acute decompensated heart failure (ADHF) has been defined as the gradual or rapid change in heart failure (HF) signs and symptoms resulting in a need for urgent therapy. Patients with ADHF usually have multiple comorbidities that contribute to the severity of exacerbation at admission, including diabetes mellitus and chronic kidney disease. The prognosis for these individuals is generally poor, with a high risk of readmission and death after discharge. Unfortunately, there are limited studies in Saudi Arabia reporting the characteristics of such patients. We aim to study the demographics and characteristics of ADHF patients admitted to King Abdulaziz University Hospital (KAUH) and analyze gender discrepancies and in-hospital mortality. METHODS This retrospective record review was conducted at KAUH. The study included 425 patients diagnosed with ADHF. The New York Heart Association (NYHA) classification, underlying etiology of HF, comorbidities, left ventricular ejection fraction (LVEF), vital signs, comprehensive metabolic panel at admission, and in-hospital mortality were evaluated and analyzed. RESULTS The majority of the patients were males (52.5%), and the average age was 63 ± 13.75 years. The most prevalent etiology of HF was hypertensive heart disease (51.8%), followed by ischemic heart disease (42.8%). The most common comorbidity was diabetes mellitus (73.6%), and the most common medication administered was diuretics (95.5%). The mean LVEF was 37.9% ± 16.0. In-hospital mortality occurred in 10.4% of patients. The mean length of hospitalization was 16.7 ± 86.2 days. The mean blood urea nitrogen (BUN) (17.18 ± 11.16) and creatinine (243.34 ± 222.27) were higher in patients with in-hospital mortality. The mean difference was statistically significant (P = 0.003 and P = 0.014). A higher length of hospitalization was significantly associated with in-hospital mortality (P = 0.036). CONCLUSION We found more than half of our sample to be males and diabetes mellitus to be common among ADHF patients. Elevated BUN and creatinine levels at the time of presentation, as well as patients who had been in the hospital for a more extended period of time, were found to be associated with an increased risk of in-hospital mortality.
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Affiliation(s)
- Hassan Alalawi
- Medicine and Surgery, King Abdulaziz University Faculty of Medicine, Jeddah, SAU
| | - Hamza L Fida
- Medicine and Surgery, King Abdulaziz University Faculty of Medicine, Jeddah, SAU
| | - Omar A Bokhary
- Medicine and Surgery, King Abdulaziz University Faculty of Medicine, Jeddah, SAU
| | - Majed A Alhuzali
- Medicine and Surgery, King Abdulaziz University Faculty of Medicine, Jeddah, SAU
| | - Abdullah F Alharbi
- Medicine and Surgery, King Abdulaziz University Faculty of Medicine, Jeddah, SAU
| | - Faisal Y Alhodian
- Medicine and Surgery, King Abdulaziz University Faculty of Medicine, Jeddah, SAU
| | - Mohammed R Alsahari
- Medicine and Surgery, King Abdulaziz University Faculty of Medicine, Jeddah, SAU
| | - Aisha M Siddiqui
- Internal Medicine, King Abdulaziz University Hospital, Jeddah, SAU
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31
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Ono M, Mizuno A, Kohsaka S, Shiraishi Y, Kohno T, Nagatomo Y, Goda A, Nakano S, Komiyama N, Yoshikawa T. Geriatric Nutritional Risk Index at Hospital Admission or Discharge in Patients with Acute Decompensated Heart Failure. J Clin Med 2023; 12:jcm12051891. [PMID: 36902677 PMCID: PMC10003647 DOI: 10.3390/jcm12051891] [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: 12/18/2022] [Revised: 02/08/2023] [Accepted: 02/21/2023] [Indexed: 03/08/2023] Open
Abstract
Geriatric Nutritional Risk Index (GNRI) is known both as a reliable indicator of nutritional status and a predictor of long-term survival among patients with acute decompensated heart failure (ADHF). However, the optimal timing to evaluate GNRI during hospitalization remains unclear. In the present study, we retrospectively analyzed patients hospitalized with ADHF in the West Tokyo Heart Failure (WET-HF) registry. GNRI was assessed at hospital admission (a-GNRI) and discharge (d-GNRI). Out of 1474 patients included in the present study, 568 (40.1%) and 796 (57.2%) patients had lower GNRI (<92) at hospital admission and discharge, respectively. After the follow-up (median 616 days), 290 patients died. The multivariable analysis showed that all-cause mortality was independently associated with d-GNRI (per 1 unit decrease, adjusted hazard ratio [aHR]: 1.06, 95% confidence interval [CI]: 1.04-1.09, p < 0.001), but not with a-GNRI (aHR: 0.99, 95% CI: 0.97-1.01, p = 0.341). The predictability of GNRI for long-term survival was more pronounced when evaluated at hospital discharge than at hospital admission (area under the curve 0.699 vs. 0.629, DeLong's test p < 0.001). Our study suggested that GNRI should be evaluated at hospital discharge, regardless of the assessment at hospital admission, to predict the long-term prognosis for patients hospitalized with ADHF.
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Affiliation(s)
- Masafumi Ono
- Department of Cardiovascular Medicine, St. Luke’s International Hospital, Tokyo 104-8560, Japan
| | - Atsushi Mizuno
- Department of Cardiovascular Medicine, St. Luke’s International Hospital, Tokyo 104-8560, Japan
- Correspondence:
| | - Shun Kohsaka
- Department of Cardiology, Keio University School of Medicine, Tokyo 108-8345, Japan
| | - Yasuyuki Shiraishi
- Department of Cardiology, Keio University School of Medicine, Tokyo 108-8345, Japan
| | - Takashi Kohno
- Department of Cardiovascular Medicine, Kyorin University Faculty of Medicine, Tokyo 181-8611, Japan
| | - Yuji Nagatomo
- Department of Cardiology, National Defense Medical College, Tokorozawa 359-8513, Japan
| | - Ayumi Goda
- Department of Cardiovascular Medicine, Kyorin University Faculty of Medicine, Tokyo 181-8611, Japan
| | - Shintaro Nakano
- Department of Cardiology, International Medical Center, Saitama Medical University, Saitama 350-1298, Japan
| | - Nobuyuki Komiyama
- Department of Cardiovascular Medicine, St. Luke’s International Hospital, Tokyo 104-8560, Japan
| | - Tsutomu Yoshikawa
- Department of Cardiology, Sakakibara Heart Institute, Tokyo 183-0003, Japan
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Abulimiti A, Naito R, Kasai T, Ishiwata S, Nishitani-Yokoyama M, Sato A, Suda S, Matsumoto H, Shitara J, Yatsu S, Murata A, Shimizu M, Kato T, Hiki M, Daida H, Minamino T. Prognostic Value of Cheyne-Stokes Respiration and Nutritional Status in Acute Decompensated Heart Failure. Nutrients 2023; 15. [PMID: 36839321 DOI: 10.3390/nu15040964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 02/02/2023] [Accepted: 02/09/2023] [Indexed: 02/17/2023] Open
Abstract
Malnutrition frequently coexists with heart failure (HF), leading to series of negative consequences. Cheyne-Stokes respiration (CSR) is predominantly detected in patients with HF. However, the effect of CSR and malnutrition on the long-term prognosis of patients with acute decompensated HF (ADHF) remains unclear. We enrolled 162 patients with ADHF (median age, 62 years; 78.4% men). The presence of CSR was assessed using polysomnography and the controlling nutritional status score was assessed to evaluate the nutritional status. Patients were divided into four groups based on CSR and malnutrition. The primary outcome was all-cause mortality. In total, 44% of patients had CSR and 67% of patients had malnutrition. The all-cause mortality rate was 26 (16%) during the 35.9 months median follow-up period. CSR with malnutrition was associated with lower survival rates (log-rank p < 0.001). Age, hemoglobin, albumin, lymphocyte count, total cholesterol, triglyceride, low-density lipoprotein cholesterol, creatinine, estimated glomerular filtration rate, B-type natriuretic peptide, administration of loop diuretics, apnea-hypopnea index and central apnea-hypopnea index were significantly different among all groups (p < 0.05). CSR with malnutrition was independently associated with all-cause mortality. In conclusion, CSR with malnutrition is associated with a high risk of all-cause mortality in patients with ADHF.
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Karedath J, Asif A, Tentu N, Zahra T, Batool S, Sathish M, Sandhu QI, Khan A. Continuous Infusion Versus Bolus Injection of Loop Diuretics for Patients With Congestive Heart Failure: A Meta-Analysis. Cureus 2023; 15:e34758. [PMID: 36909062 PMCID: PMC10005852 DOI: 10.7759/cureus.34758] [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] [Accepted: 02/07/2023] [Indexed: 02/10/2023] Open
Abstract
Loop diuretics continue to be a crucial component of pharmacological treatment, to eliminate extra fluid and enhance symptom control in acute decompensated heart failure (ADHF). Understanding the loop diuretics' more efficient form of administration would be very beneficial in improving the management of people's ADHF, resulting in a quicker resolution of symptoms and a notable decrease in morbidity. To assess the outcomes of intravenous continuous infusion with bolus injection of loop diuretics for patients with ADHF, this meta-analysis was carried out. The current meta-analysis was conducted as per the Cochrane Collaboration guidelines and the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension (PRISMA) guidelines. A search was carried out on PubMed and EMBASE databases for studies comparing continuous infusion with intermittent bolus injection of furosemide in patients with congestive heart failure without restriction on the language of publication from 1 January 2001 to 31 July 2022. The primary outcome of the meta-analysis was all-cause mortality and loss of body weight (kg). Pre-defined secondary outcomes included length of hospital stay (LOS) in days, brain natriuretic peptide (BNP) reduction (pg/ml), number of patients with hypokalemia, and urine output at 24 hours (ml). A total of nine articles were included in this meta-analysis enrolling 713 patients. No significant difference was reported between patients who received intermittent bolus injections and continuous infusion of furosemide in regards to all-cause mortality, LOS, total urine output, the incidence of hypokalemia, and change in BNP. However, the reduction of body weight was greater in the continuous infusion group compared to bolus administration. In conclusion, in the current meta-analysis of nine randomized controlled trials (RCTs), continuous infusion of furosemide seemed to have a greater reduction of body weight. However, no significant difference was there in 24-hrs urine output. However, we cannot conclude that intravenous continuous infusion has a better diuretic effect compared to bolus administration.
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Affiliation(s)
- Jithin Karedath
- Internal Medicine, James Cook University Hospital, Middlesbrough, GBR
| | - Anim Asif
- Medicine, Fauji Foundation, Rawalpindi, PAK
| | - Niharika Tentu
- Internal Medicine, Liaquat National Hospital, Karachi, PAK
| | - Tafseer Zahra
- Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Saima Batool
- Internal Medicine, Hameed Latif Hospital, Lahore, PAK
| | - Meenakshi Sathish
- Surgery, Caribbean Medical University School of Medicine, Chicago, USA
| | - Qudsia I Sandhu
- Medicine, Dera Ghazi Khan Medical College, Dera Ghazi Khan, PAK
| | - Areeba Khan
- Critical Care Medicine, United Medical and Dental College, Karachi, PAK
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Chen X, Ma Y, Li J, Yao L, Gui M, Lu B, Zhou X, Wang M, Fu D. The efficacy of ginseng-containing traditional Chinese medicine in patients with acute decompensated heart failure: A systematic review and meta-analysis. Front Pharmacol 2023; 13:1083001. [PMID: 36703755 PMCID: PMC9871309 DOI: 10.3389/fphar.2022.1083001] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 12/21/2022] [Indexed: 01/12/2023] Open
Abstract
Objective: To evaluate the efficacy of ginseng-containing traditional Chinese medicine (TCM) for acute decompensated heart failure (ADHF). Methods: Seven databases were included from establishment until 10 July 2022. Pooled data were analyzed with random-effects model. The risk of bias was measured by the risk of bias tool for randomized trials (RoB 2). Modified Jadad scale score was used to assess the quality of including studies. The meta-analysis was performed with RevMan 5.3. Trial sequential analysis was assessed to avoid type I errors. We have registered our protocol in PROSPERO (CRD42021267742). Results: Twenty-eight articles were included. The results demonstrated that compared with conventional western therapy (WT), ginseng-containing TCM combined with WT further improved clinical efficacy (RR: 1.25, 95% CI: 1.20-1.29, p < 0.00001, I2 = 8%), left ventricular ejection fraction (LVEF) (MD: 5.80, 95% CI: 4.86-6.74, p < 0.00001, I2 = 89%), stroke volume (MD: 13.80, 95% CI: 12.66-14.95, p < 0.00001, I2 = 93%), 6-min walk test (MD: 53.03, 95% CI: 20.76-85.29, p = 0.001, I2 = 97%), decreased 6-month rehospitalization (RR: 0.44, 95% CI: 0.18-1.11, p = 0.08, I2 = 0%), brain natriuretic peptide (MD: 188.12, 95% CI: 248.13 to -128.11, p < 0.00001, I2 = 94%), N-terminal pro-B-type natriuretic peptide (MD = -503.29; 95% CI: 753.18 to -253.40, p < 0.0001, I2 = 89%) and Minnesota living heart failure questionnaire scores (MD: 9.68, 95% CI: 13.67 to -5.70, p < 0.00001, I2 = 83%). The ROB2 assessment and modified Jaded scores showed most studies included were with some concerns. Conclusion: Compared with WT alone, ginseng-containing TCM is a possible way to benefit ADHF patients. However, limited by the quality of including trials, more high-quality studies are needed to provide reliable evidence.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Deyu Fu
- Department of Cardiology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
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35
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Lee HW, Huang CC, Yang CY, Leu HB, Huang PH, Wu TC, Lin SJ, Chen JW. Renal function during hospitalization and outcome in Chinese patients with acute decompensated heart failure: A retrospective study and literature review. Clin Cardiol 2023; 46:57-66. [PMID: 36345665 PMCID: PMC9849437 DOI: 10.1002/clc.23934] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 08/10/2022] [Accepted: 09/29/2022] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND The heart and kidneys had demonstrated a bidirectional interaction that dysfunction of the heart or kidneys can induce dysfunction in the other organ. HYPOTHESIS Renal function and its decline during hospitalization may have impact on cardiovascular outcomes in patients with acute decompensated heart failure (ADHF). METHODS A total of 119 consecutive Chinese patients admitted for ADHF were prospectively enrolled. The course of renal function was presented with estimated glomerular filtration rate (eGFR), calculated by the four-variable equation proposed by the Modification of Diet in Renal Disease (MDRD) Study. Worsening renal function (WRF) was defined as eGFR decline between admission (eGFRadmission ) and predischarge (eGFRpredischarge ). Clinical outcomes were defined as 4P-major adverse cardiovascular events (4P-MACE), including the composition of cardiovascular death, nonfatal myocardial infarction, nonfatal stroke, and nonfatal HF hospitalization. RESULTS During an average 2.6 ± 3.2 years follow-up, 66 patients (55%) experienced 4P-MACE. Patients with impaired eGFRpredischarge (<60 ml/min/1.73 m2 ) had more 4P-MACE than those with preserved eGFRpredischarge (64.7% vs. 43.1%, p = .019). The Kaplan-Meier survival curves showed significantly higher incidence of 4P-MACE in patients with impaired eGFRpredischarge than those with preserved eGFRpredischarge (p = .002). Cox regression analysis revealed that impaired eGFRpredischarge was significantly correlated with the development of 4P-MACE (hazard ratio, 2.003; 95% confidence interval, 1.072-3.744; p = .029). In contrast, outcomes would be similar with regard to eGFR on admission and eGFR decline during hospitalization. CONCLUSIONS Impaired renal function before discharge, but not impaired renal function on admission or WRF, is a significant risk factor for poor outcomes in patients with ADHF.
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Affiliation(s)
- Hao-Wei Lee
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chin-Chou Huang
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Institute of Pharmacology, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Cardiovascular Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Chih-Yu Yang
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Hsin-Bang Leu
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Cardiovascular Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Healthcare and Services Center, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Po-Hsun Huang
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Cardiovascular Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Department of Critical Care Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Tao-Cheng Wu
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Cardiovascular Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Shing-Jong Lin
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Cardiovascular Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Taipei Heart Institute, Taipei Medical University, Taipei, Taiwan
| | - Jaw-Wen Chen
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Institute of Pharmacology, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Cardiovascular Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Healthcare and Services Center, Taipei Veterans General Hospital, Taipei, Taiwan
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36
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Ozasa N, Kato T, Morimoto T, Yaku H, Yamamoto E, Inuzuka Y, Tamaki Y, Kitai T, Washida K, Seko Y, Yoshikawa Y, Sato Y, Motoki H, Kuwahara K, Kimura T. Polypharmacy and Clinical Outcomes in Hospitalized Patients With Acute Decompensated Heart Failure. J Cardiovasc Nurs 2023; 38:33-43. [PMID: 35030108 DOI: 10.1097/JCN.0000000000000885] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [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] [Indexed: 12/15/2022]
Abstract
BACKGROUND Polypharmacy is a common problem among patients with acute decompensated heart failure (ADHF) who often have multiple comorbidities. OBJECTIVE The aim of this study was to define the number of medications at hospital discharge and whether it is associated with clinical outcomes at 1 year. METHODS We evaluated the number of medications in 2578 patients with ADHF who were ambulatory at hospital discharge in the Kyoto Congestive Heart Failure Registry and compared 1-year outcomes in 4 groups categorized by quartiles of the number of medications (quartile 1, ≤ 5; quartile 2, 6-8; quartile 3, 9-11; and quartile 4, ≥ 12). RESULTS At hospital discharge, the median number of medications was 8 (interquartile range, 6-11) with 81.5% and 27.8% taking more than 5 and more than 10 medications, respectively. The cumulative 1-year incidence of a composite of death or rehospitalization (primary outcome measure) increased incrementally with an increasing number of medications (quartile 1, 30.8%; quartile 2, 31.6%; quartile 3, 39.7%; quartile 4, 50.3%; P < .0001). After adjusting for confounders, the excess risks of quartile 4 relative to those of quartile 1 remained significant ( P = .01). CONCLUSIONS In the contemporary cohort of patients with ADHF in Japan, polypharmacy at hospital discharge was common, and excessive polypharmacy was associated with a higher risk of mortality and rehospitalizations within a 1-year period. Collaborative disease management programs that include a careful review of medication lists and an appropriate deprescribing protocol should be implemented for these patients.
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37
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Hu T, Liu Y, Lou Y. Sacubitril-valsartan versus enalapril for the treatment of acute decompensated heart failure in Chinese settings: A cost-effectiveness analysis. Front Pharmacol 2023; 14:925375. [PMID: 36937882 PMCID: PMC10018029 DOI: 10.3389/fphar.2023.925375] [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: 04/21/2022] [Accepted: 02/20/2023] [Indexed: 03/06/2023] Open
Abstract
Background: The episode of acute decompensated heart failure (ADHF) is the main cause of hospitalization for heart failure (HF). Sacubitril-valsartan has been proven to be effective in reducing the risks of hospitalization for HF in ADHF. When to initiate sacubitril-valsartan in ADHF to make it the most cost-effective in China remains unclear. Methods: A lifetime Markov model with a 1-month cycle length was developed to evaluate the cost-effectiveness of early or late initiation of sacubitril-valsartan versus enalapril in ADHF. Early initiation of sacubitril-valsartan meant that it was initiated after stabilization from ADHF, and late initiation of sacubitril-valsartan meant that it was initiated after stabilization from HF, which includes no hospitalization for at least three consecutive months. The primary outcome was the incremental cost-effectiveness ratio (ICER), expressed as the ratio of incremental cost to incremental effectiveness. The secondary outcomes were total costs and total effectiveness. Three times of per capita GDP of China in 2021 was set as the willingness-to-pay threshold. One-way sensitivity analysis and probabilistic sensitivity analysis were employed to test the robustness of the results. Results: The early initiation of sacubitril-valsartan treatment resulted in an ICER of 3,662.4 USD per quality-adjusted life year, lower than the willingness-to-pay threshold, and the late initiation of sacubitril-valsartan treatment gained an ICER of 4,444.4 USD/QALY, still lower than the willingness-to-pay threshold. One-way sensitivity analysis showed that our results were robust, and probabilistic sensitivity analysis suggested that early initiation of sacubitril-valsartan in ADHF was cost-effective under a 97.4% circumstance. Conclusion: Early initiation of sacubitril-valsartan after stabilization of ADHF is highly cost-effective compared with the use of enalapril; late initiation of sacubitril-valsartan after stabilization of HF is still cost-effective but not as cost-effective as early initiation of sacubitril-valsartan in ADHF. For Chinese ADHF patients, the time to initiate sacubitril-valsartan should be when the patient is stabilized from ADHF rather than when stabilized from HF, from the perspective of economic evaluation.
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Affiliation(s)
- Tianyang Hu
- Precision Medicine Center, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yiting Liu
- Department of Critical Care Medicine, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yake Lou
- Department of Cardiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
- *Correspondence: Yake Lou,
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Rao M. Bedside Prognostication in Decompensated Heart Failure: No "Easy Button". J Am Heart Assoc 2022; 12:e028500. [PMID: 36583434 PMCID: PMC9973607 DOI: 10.1161/jaha.122.028500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- Madhumathi Rao
- University of Kentucky, Albert B. Chandler Medical CenterLexingtonKY
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Ye F, Nelson MB, Bertoni AG, Ditzenberger GL, Duncan P, Mentz RJ, Reeves G, Whellan D, Chen H, Upadhya B, Kitzman DW, Pastva AM. Severity of functional impairments by race and sex in older patients hospitalized with acute decompensated heart failure. J Am Geriatr Soc 2022; 70:3447-3457. [PMID: 36527410 PMCID: PMC9759671 DOI: 10.1111/jgs.18006] [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] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 06/17/2022] [Accepted: 07/16/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Older patients hospitalized with acute decompensated heart failure (ADHF) have marked functional impairments, which may contribute to their delayed and incomplete recovery and persistently poor outcomes. However, whether impairment severity differs by race and sex is unknown. METHODS REHAB-HF trial participants (≥60 years) were assessed just before discharge home from ADHF hospitalization. Physical function [Short Physical Performance Battery; 6-min walk distance (6MWD)], frailty (Fried criteria), cognition [Montreal Cognitive Assessment (MoCA)], quality-of-life [Kansas City Cardiomyopathy Questionnaire, Short-Form-12, EuroQol-5D-5L], and depression [Geriatric Depression Scale (GDS)] were examined by race and sex. RESULTS This prespecified subgroup cross-sectional analysis included 337 older adults (52% female, 50% Black). Black participants were on average younger than White participants (70.3 ± 7.2 vs. 74.7 ± 8.3 years). After age, body mass index, ejection fraction, comorbidity, and education adjustment, and impairments were similarly common and severe across groups except: Black male and Black and White female participants had more severely impaired walking function compared with White male participants [6MWD (m) 187 ± 12, 168 ± 9170 ± 11 vs. 239 ± 9, p < 0.001]; gait speed (m/s) (0.61 ± 0.03, 0.56 ± 0.02, 0.55 ± 0.02 vs. 0.69 ± 0.02, p < 0.001); White female participants had the highest frailty prevalence (72% vs. 47%-51%, p = 0.007); and Black participants had lower MoCA scores compared with White participants (20.9 ± 4.5 vs. 22.8 ± 3.9, p < 0.001). Depressive symptoms were common overall (43% GDS ≥5), yet underrecognized clinically (18%), especially in Black male participants compared with White male participants (7% vs. 20%). CONCLUSION Among older patients hospitalized for ADHF, frailty and functional impairments with high potential to jeopardize patient HF self-management, safety, and independence were common and severe across all race and sex groups. Impairment severity was often worse in Black participant and female participant groups. Formal screening across frailty and functional domains may identify those who may require greater support and more tailored care to reduce the risk of adverse events and excess hospitalizations and death.
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Affiliation(s)
- Fan Ye
- Section on Cardiovascular Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - M. Benjamin Nelson
- Section on Cardiovascular Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Alain G. Bertoni
- Department of Epidemiology and Prevention, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Grace L. Ditzenberger
- Department of Orthopaedic Surgery, Physical Therapy Division, Duke University School of Medicine, Durham, North Carolina, USA
| | - Pamela Duncan
- Departments of Neurology, Sticht Center on Aging, Gerontology, and Geriatric Medicine (P.W.D.), Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Robert J. Mentz
- Department of Medicine, Cardiology Division, Duke University School of Medicine, Durham, North Carolina, USA
| | - Gordon Reeves
- Novant Health Heart & Vascular Institute, Charlotte, North Carolina, USA
| | - David Whellan
- Department of Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Haiying Chen
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Bharathi Upadhya
- Department of Epidemiology and Prevention, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Dalane W. Kitzman
- Section on Cardiovascular Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Amy M. Pastva
- Department of Orthopaedic Surgery, Physical Therapy Division, Duke University School of Medicine, Durham, North Carolina, USA
- Claude D. Pepper Older Americans Independence Center, Duke University School of Medicine, Durham, North Carolina, USA
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Zhao HL, Hu HJ, Zhao XJ, Chi WW, Liu DM, Wang Q, Cui W. Urine N-terminal pro-B-type natriuretic peptide and plasma proenkephalin are promising biomarkers for early diagnosis of cardiorenal syndrome type 1 in acute decompensated heart failure: a prospective, double-center, observational study in real-world. Ren Fail 2022; 44:1486-1497. [PMID: 36000917 PMCID: PMC9423828 DOI: 10.1080/0886022x.2022.2114367] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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] [Indexed: 11/25/2022] Open
Abstract
Background Patients with acute decompensated heart failure (ADHF) show cardiorenal syndrome type 1 (CRS-1) are more likely to have a poor outcome. However, the current criteria often lead to delayed CRS-1 diagnosis. Therefore, we evaluated the predictive value of plasma proenkephalin (pPENK) and urine NT-proBNP (uNT-proBNP) for early diagnosis of CRS-1 and vulnerable-phase prognosis in ADHF patients. Methods The plasma NT-proBNP (pNT-proBNP), pPENK, and uNT-proBNP were measured in 121 ADHF patients on admission. The plasma neutrophil gelatinase-associated lipocalin (pNGAL) was chosen as the reference. Logistic regression was used to determine the predictors of CRS-1. The area under the receiver operating curves (ROCs) was calculated to assess the early diagnostic value of pNGAL, pPENK, and uNT-proBNP/uCr for CRS-1. To evaluate the prognostic risk of factors for the 90-d outcomes of all ADHF patients, the Cox regression was performed and the cumulative risk curve was plotted. Results We found that pPENK [OR 1.093 (95% CI 1.022–1.169), p = 0.010; AUROC = 0.899 (95% CI 0.831–0.946)] and uNT-proBNP/uCr ratio [OR 1.015 (95% CI 1.003–1.028), p = 0.012; AUROC = 0.934 (95% CI 0.874–0.971)] could independently predict the occurrence of CRS-1 in hospitalized patients with ADHF. The pPENK [HR 1.014 (95% CI 1.000–1.042), p = 0.044] and uNT-proBNP/uCr ration [HR 0.998 (95% CI 0.997–1.000), p = 0.045] were also independent predictors of the risk of HF readmission or all-cause death 90 d after discharge in ADHF patients. Conclusions The newly found pPENK and noninvasive test of uNT-proBNP/uCr ratio (pg/nmol) on admission may be two promising novel predictive biomarkers for early diagnosis of CRS-1 occurrence and vulnerable-phase outcomes in ADHF patients.
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Affiliation(s)
- Hong-Liang Zhao
- Department of Cardiology, The Second Hospital of Hebei Medical University, Shijiazhuang, PR China.,Department of Cardiology, The First Hospital of Hebei Medical University, Shijiazhuang, PR China
| | - Hai-Juan Hu
- Department of Cardiology, The Second Hospital of Hebei Medical University, Shijiazhuang, PR China
| | - Xiu-Jie Zhao
- Department of Cardiology, The First Hospital of Hebei Medical University, Shijiazhuang, PR China
| | - Wei-Wei Chi
- Biobank, The First Hospital of Hebei Medical University, Shijiazhuang, PR China
| | - De-Min Liu
- Department of Cardiology, The Second Hospital of Hebei Medical University, Shijiazhuang, PR China
| | - Qian Wang
- Department of Cardiology, The Second Hospital of Hebei Medical University, Shijiazhuang, PR China
| | - Wei Cui
- Department of Cardiology, The Second Hospital of Hebei Medical University, Shijiazhuang, PR China
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Zhao K, Zhou J, Guo JT, Wu CH, Li SL, Zhang Q, Tian X, Shan WC, Ding ZJ, Yuan LS, Zheng Q, Gao XL, Guo N, Tian HS, Wei QM, Hu XT, Cui YK, Geng X, Wang Q, Cui W. Association between tricuspid annular systolic velocity and poor short-term prognosis in patients with acute decompensated heart failure. Ann Med 2022; 54:2898-2908. [PMID: 36259612 PMCID: PMC9624254 DOI: 10.1080/07853890.2022.2134585] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND There is scant data on the association of the Pulsed wave-Doppler tissue imaging (PW-DTI)-derived tricuspid lateral annular peak systolic velocity (S') and poor short-term prognosis of patients with acute decompensated heart failure (ADHF). PATIENTS AND METHODS A total number of 732 participants from the Heb-ADHF registry in China were divided into three groups according to the corresponding status of tricuspid S'. Demographic characteristics, comorbidities, physical examinations, lab tests, and medications were compared among the different groups. Different logistic regression models were utilized to gauge the relationship between S' and the risk of a composite of short-term all-cause mortality or 30-day heart failure (HF)-related rehospitalization. RESULTS The number of composite outcome events identified in the study population was 85, with the short-term all-cause death coupled with 30-day HF readmission events reaching 23 and 62, respectively. As per the multivariable adjusted analysis, S' was inversely related to the risk of a composite outcome [<10 cm/s odds ratios (OR) 2.90, 95% confidence interval (CI):1.33-6.31; 10-11 cm/s OR 2.18, 95% CI: 1.10-4.33; p for trend = 0.006] in comparison with S' at >11 cm/s. When S' was analysed as a continuous variable, per 1 cm/s increase, the OR (95% CI) for a composite outcome was [0.87 (0.77-0.99), p = 0.028]. Area under curve (AUC) of S' for predicting outcome of ADHF was 0.631 (95%CI: 0.573-0.690, p < 0.01). Significant inverse association was also observed in left ventricular ejection fraction (LVEF) ≥40% subgroup. CONCLUSIONS Inspite of the potential confounders, a more impaired tricuspid annular peak systolic velocity is associated with a poorer short-term prognosis of patients with ADHF.
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Affiliation(s)
- Kai Zhao
- Department of Cardiology, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Jiang Zhou
- Department of Cardiology, Chengde Central Hospital, Chengde, China
| | - Jing Tao Guo
- Department of Cardiology, Chengde Central Hospital, Chengde, China
| | - Cai Hong Wu
- Department of Cardiology, First Hospital of Zhangjiakou, Zhangjiakou, China
| | - Sen Lin Li
- Department of Cardiology, First Hospital of Zhangjiakou, Zhangjiakou, China
| | - Qi Zhang
- Department of Cardiology, First Central Hospital of Baoding, Baoding, China
| | - Xiang Tian
- Department of Cardiology, First Central Hospital of Baoding, Baoding, China
| | - Wei Chao Shan
- Department of Cardiology, Affiliated Hospital of Chengde Medical University, Chengde, China
| | - Zhen Jiang Ding
- Department of Cardiology, Affiliated Hospital of Chengde Medical University, Chengde, China
| | - Lan Suo Yuan
- Department of Cardiology, Hengshui People's Hospital, Hengshui, China
| | - Qun Zheng
- Department of Cardiology, Hengshui People's Hospital, Hengshui, China
| | - Xiao Li Gao
- Department of Cardiology, Huabei Petroleum Administration Bureau General Hospital, Cangzhou, China
| | - Nan Guo
- Department of Cardiology, Cangzhou Central Hospital, Cangzhou, China
| | - Hong Sen Tian
- Department of Cardiology, Handan Central Hospital, Handan, China
| | - Qing Min Wei
- Department of Cardiology, Xingtai People's Hospital, Xingtai, China
| | - Xi Tian Hu
- Department of Cardiology, Shijiazhuang People's Hospital, Shijiazhuang, China
| | - Ying Kai Cui
- Department of Cardiology, The 252nd Hospital of People's Liberation Army, Baoding, China
| | - Xue Geng
- Department of Cardiology, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Qian Wang
- Department of Cardiology, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Wei Cui
- Department of Cardiology, The Second Hospital of Hebei Medical University, Shijiazhuang, China
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Muacevic A, Adler JR, Muthanna SI, Menon SR, Vithani V, Sutariya B, Montenegro DM, Chukwu M, Penumetcha SS. Sodium-Glucose Co-transporter 2 Inhibitors/Gliflozins: A New Miracle Therapy for Heart Failure Patients Irrespective of Diabetes Status? Cureus 2022; 14:e31777. [PMID: 36579255 PMCID: PMC9780697 DOI: 10.7759/cureus.31777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Accepted: 11/13/2022] [Indexed: 11/23/2022] Open
Abstract
Despite the existence of effective medicines, heart failure continues to be the largest cause of illness and death worldwide. As a prospective family of drugs with potential cardiovascular advantages in non-diabetic patients, sodium-glucose co-transporter 2 inhibitors (SGLT2-I) have recently come to the forefront. In this comprehensive study, we assessed the favorable cardiovascular outcomes of SGLT2-I in three sizable, randomized trials with both diabetic and non-diabetic populations. The results from these studies revealed a substantial reduction in heart failure hospitalizations and cardiovascular and all-cause deaths. To further support our assertion that SGLT2-I has the potential to be a novel addition to the standard treatment plan for heart failure, we also tried to assemble several post hoc and prespecified studies of the Dapagliflozin and Prevention of Adverse Outcomes in Heart Failure (DAPA-HF) study. The details of two clinical investigations that supported their use in acute decompensated heart failure were also examined, along with the most plausible mechanism of action generating their cardioprotective effects. Additionally, positive cardiovascular advantages were addressed in chronic heart failure with both preserved and reduced ejection fractions. The role of SGLT2-I in ST-elevation myocardial infarction (STEMI) and hypertrophic cardiomyopathy (HOCM) patients is currently being studied, and this research has the potential to be revolutionary. The purpose of this systematic review is to compile all information that supports the use of this life-saving drug in patients who do not have diabetes so that cardiac care can be improved globally.
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Tokonami Y, Tawarahara K, Kanda T, Ishibashi H, Kato H, Nakamura N, Aoshima H, Matsukura G, Ozek M, Ukigai H, Takeuchi R, Yamaguchi R, Yamamoto M, Koide M. Emergency Transcatheter Aortic Valve Implantation in a Surgical Aortic Bioprosthetic Valve for Acute Decompensated Heart Failure Caused by Sudden Progression of Structural Valve Deterioration. Intern Med 2022; 62:1513-1519. [PMID: 36171127 DOI: 10.2169/internalmedicine.0459-22] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Bioprosthetic aortic valves have limited durability. We herein report sudden progression of structural valve deterioration (SVD) and a successful case of emergency transcatheter aortic valve (TAV) implantation for acute decompensated heart failure (ADHF) caused by SVD. A 79-year-old man who had undergone a Bentall operation 11 years prior was diagnosed with ADHF due to suddenly progressive SVD. Emergency TAV implantation in the surgical bioprosthetic valve was selected based on the surgical risk. Ours and previous case reports suggest that SVD can progress suddenly, even after months of stability, and that emergency TAV implantation is effective.
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Affiliation(s)
- Yuki Tokonami
- Department of Cardiology, Hamamatsu Red Cross Hospital, Japan
| | - Kei Tawarahara
- Department of Cardiology, Hamamatsu Red Cross Hospital, Japan
| | - Takahiro Kanda
- Department of Cardiology, Hamamatsu Red Cross Hospital, Japan
| | | | - Haruta Kato
- Department of Cardiology, Hamamatsu Red Cross Hospital, Japan
| | - Naoki Nakamura
- Department of Cardiology, Hamamatsu Red Cross Hospital, Japan
| | | | - Gaku Matsukura
- Department of Cardiology, Hamamatsu Red Cross Hospital, Japan
| | - Mariko Ozek
- Department of Cardiology, Hamamatsu Red Cross Hospital, Japan
| | - Hiroshi Ukigai
- Department of Cardiology, Hamamatsu Red Cross Hospital, Japan
| | | | - Ryo Yamaguchi
- Department of Cardiology, Toyohashi Heart Center, Japan
| | | | - Masaaki Koide
- Department of Cardiovascular Surgery, Seirei Hamamatsu General Hospital, Japan
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Zisis G, Yang Y, Huynh Q, Whitmore K, Lay M, Wright L, Carrington MJ, Marwick TH. Nurse-Provided Lung and Inferior Vena Cava Assessment in Patients With Heart Failure. J Am Coll Cardiol 2022; 80:513-523. [PMID: 35902175 DOI: 10.1016/j.jacc.2022.04.064] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [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: 12/20/2021] [Revised: 04/01/2022] [Accepted: 04/25/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Residual congestion detected using handheld ultrasound may be associated with increased risk of readmission and death after hospitalization for acute decompensated heart failure (ADHF). However, effective application necessitates routine use by nonexperts delivering clinical care. OBJECTIVES The objective of this study was to determine the ability of heart failure (HF) nurses to deliver a predischarge lung and inferior vena cava (IVC) assessment (LUICA) to predict 90-day outcomes. METHODS In this multisite, prospective, observational study, HF nurses scanned 240 patients with ADHF (median age: 77 years; 56% men) using a 9-zone LUICA protocol. Obtained images were reviewed by independent nurses who were blinded to clinical characteristics and outcomes. Based on a B-line cut-off of 10, patients were dichotomized as congested (n = 115) or not congested (n = 125). RESULTS Congested patients were more likely to have previous cardiac operations, long-standing HF (>6 months), and renal impairment. At 90 days, HF readmission or mortality occurred in 42 congested patients (37%) compared with 18 noncongested patients (14%). Pulmonary congestion increased at 30-day (OR: 3.86; 95% CI: 1.65-8.99; P < 0.01) and 90-day (OR: 3.42; 95% CI: 1.82-6.4; P < 0.01) HF readmission or mortality risk and 90-day mortality (OR: 5.18; 95% CI: 1.44-18.69; P < 0.01). Pulmonary congestion increased the 90-day odds of HF readmission and/or death by 3.3- to 4.2-fold (P < 0.01), independent of demographics, HF characteristics, comorbidities, and event risk score. Over 90 days, days alive out of hospital were fewer (78.3 ± 21.4 days vs 85.5 ± 12.4 days; P < 0.01) in congested patients. CONCLUSIONS LUICA can be a powerful tool for detection of predischarge residual congestion. HF nurses can obtain images and provide diagnostic reports that are predictive of ADHF outcomes.
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Affiliation(s)
- Georgios Zisis
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia; The University of Melbourne, Baker Department of Cardiometabolic Health, Melbourne, Victoria, Australia; Western Health, Melbourne, Victoria, Australia; The University of Melbourne, Faculty of Medicine, Dentistry and Health Sciences, Melbourne, Victoria, Australia
| | - Yang Yang
- Western Health, Melbourne, Victoria, Australia; Monash University, Melbourne, Victoria, Australia; Eastern Health, Melbourne, Victoria, Australia
| | - Quan Huynh
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia; The University of Melbourne, Baker Department of Cardiometabolic Health, Melbourne, Victoria, Australia
| | - Kristyn Whitmore
- Menzies Institute for Medical Research, Hobart, Tasmania, Australia
| | - Maria Lay
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Leah Wright
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia; Western Health, Melbourne, Victoria, Australia
| | - Melinda J Carrington
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia; The University of Melbourne, Baker Department of Cardiometabolic Health, Melbourne, Victoria, Australia
| | - Thomas H Marwick
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia; The University of Melbourne, Baker Department of Cardiometabolic Health, Melbourne, Victoria, Australia; Western Health, Melbourne, Victoria, Australia; The University of Melbourne, Faculty of Medicine, Dentistry and Health Sciences, Melbourne, Victoria, Australia; Monash University, Melbourne, Victoria, Australia; Menzies Institute for Medical Research, Hobart, Tasmania, Australia.
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Wiley BM, Borlaug BA, Kane GC. Lung Ultrasound in Heart Failure: Envisioning Handheld Ultrasound to Empower Nurses and Transform Health Care. J Am Coll Cardiol 2022; 80:524-6. [PMID: 35902176 DOI: 10.1016/j.jacc.2022.05.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 05/02/2022] [Indexed: 11/21/2022]
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Lee WC, Wu PJ, Fang HY, Fang YN, Chen HC, Tong MS, Sung PH, Lee CH, Chung WJ. Levosimendan Administration May Provide More Benefit for Survival in Patients with Non-Ischemic Cardiomyopathy Experiencing Acute Decompensated Heart Failure. J Clin Med 2022; 11:jcm11143997. [PMID: 35887759 PMCID: PMC9322737 DOI: 10.3390/jcm11143997] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 06/23/2022] [Accepted: 07/08/2022] [Indexed: 11/26/2022] Open
Abstract
Background: Acute decompensated heart failure (ADHF) is a life-threatening condition with a high mortality rate. Levosimendan is an effective inotropic agent used to maintain cardiac output and a long-lasting effect. However, only few studies have compared the clinical outcomes, after levosimendan therapy, among etiologies of ADHF. Methods: Between July 2014 and December 2019, 184 patients received levosimendan therapy for ADHF at our hospital. A total of 143 patients had ischemic cardiomyopathy (ICM), and 41 patients had non-ICM (NICM). Data on comorbidities, echocardiographic findings, laboratory findings, use of mechanical devices, consumption of other inotropic or vasopressor agents, frequency of HF hospitalization, cardiovascular (CV) mortality, and all-cause mortality were compared between the ICM and NICM groups. Results: Patients with ICM were older with higher prevalence of diabetes mellitus when compared to patients with NICM. Patients with NICM had a poorer left ventricular ejection fraction (LVEF) and higher left ventricular end-systolic volume when compared to patients with ICM. At the 30 day follow-up period, a lower CV mortality (ICM vs. NICM: 20.9% vs. 5.1%; log-rank p = 0.033) and lower all-cause mortality (ICM vs. NICM: 28.7% vs. 9.8%; log-rank p = 0.018) was observed in the NICM patients. A significantly lower all-cause mortality was noted at 180 day (ICM vs. NICM: 39.2% vs. 22.0%; log-rank p = 0.043) and 1 year (ICM vs. NICM: 41.3% vs. 24.4%; log-rank p = 0.046) follow up in the NICM subgroup. NICM (hazard ratio (HR): 0.303, 95% confidence interval (CI): 0.108–0.845; p = 0.023) and ECMO use (HR: 2.550, 95% CI: 1.385–4.693; p = 0.003) were significant predictors of 30 day all-cause mortality. Conclusions: In our study on levosimendan use for ADHF patients, better clinical outcomes were noted in the NICM population when compared to the ICM population. In the patients with cardiogenic shock or ventilator use, significantly lower incidence of 30 day mortality presented in the NICM population when compared with the ICM population.
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Affiliation(s)
- Wei-Chieh Lee
- Division of Cardiovascular Medicine, Chi-Mei Medical Center, Tainan 71004, Taiwan
- Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan 70101, Taiwan
- Correspondence: ; Tel.: +886-6-281-2811; Fax: +886-6-282-8928
| | - Po-Jui Wu
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan; (P.-J.W.); (H.-Y.F.); (Y.-N.F.); (H.-C.C.); (M.-S.T.); (P.-H.S.); (C.-H.L.); (W.-J.C.)
| | - Hsiu-Yu Fang
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan; (P.-J.W.); (H.-Y.F.); (Y.-N.F.); (H.-C.C.); (M.-S.T.); (P.-H.S.); (C.-H.L.); (W.-J.C.)
| | - Yen-Nan Fang
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan; (P.-J.W.); (H.-Y.F.); (Y.-N.F.); (H.-C.C.); (M.-S.T.); (P.-H.S.); (C.-H.L.); (W.-J.C.)
| | - Huang-Chung Chen
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan; (P.-J.W.); (H.-Y.F.); (Y.-N.F.); (H.-C.C.); (M.-S.T.); (P.-H.S.); (C.-H.L.); (W.-J.C.)
| | - Meng-Shen Tong
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan; (P.-J.W.); (H.-Y.F.); (Y.-N.F.); (H.-C.C.); (M.-S.T.); (P.-H.S.); (C.-H.L.); (W.-J.C.)
| | - Pei-Hsun Sung
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan; (P.-J.W.); (H.-Y.F.); (Y.-N.F.); (H.-C.C.); (M.-S.T.); (P.-H.S.); (C.-H.L.); (W.-J.C.)
| | - Chieh-Ho Lee
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan; (P.-J.W.); (H.-Y.F.); (Y.-N.F.); (H.-C.C.); (M.-S.T.); (P.-H.S.); (C.-H.L.); (W.-J.C.)
| | - Wen-Jung Chung
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan; (P.-J.W.); (H.-Y.F.); (Y.-N.F.); (H.-C.C.); (M.-S.T.); (P.-H.S.); (C.-H.L.); (W.-J.C.)
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Emara AN, Mansour NO, Elnaem MH, Wadie M, Dehele IS, Shams MEE. Efficacy of Nondiuretic Pharmacotherapy for Improving the Treatment of Congestion in Patients with Acute Heart Failure: A Systematic Review of Randomised Controlled Trials. J Clin Med 2022; 11:jcm11113112. [PMID: 35683505 PMCID: PMC9181246 DOI: 10.3390/jcm11113112] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 05/22/2022] [Accepted: 05/26/2022] [Indexed: 11/16/2022] Open
Abstract
Diuretic therapy is the mainstay during episodes of acute heart failure (AHF). Diuretic resistance is often encountered and poses a substantial challenge for clinicians. There is a lack of evidence on the optimal strategies to tackle this problem. This review aimed to compare the outcomes associated with congestion management based on a strategy of pharmacological nondiuretic-based regimens. The PubMed, Cochrane Library, Scopus, and ScienceDirect databases were systematically searched for all randomised controlled trials (RCTs) of adjuvant pharmacological treatments used during hospitalisation episodes of AHF patients. Congestion relief constitutes the main target in AHF; hence, only studies with efficacy indicators related to decongestion enhancement were included. The Cochrane risk-of-bias tool was used to evaluate the methodological quality of the included RCTs. Twenty-three studies were included; dyspnea relief constituted the critical efficacy endpoint in most included studies. However, substantial variations in dyspnea measurement were found. Tolvaptan and serelaxin were found to be promising options that might improve decongestion in AHF patients. However, further high-quality RCTs using a standardised approach to diuretic management, including dosing and monitoring strategies, are crucial to provide new insights and recommendations for managing heart failure in acute settings.
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Affiliation(s)
- Abdelrahman N. Emara
- Clinical Pharmacy and Pharmacy Practice Department, Faculty of Pharmacy, Mansoura University, Mansoura 35516, Egypt; (A.N.E.); (N.O.M.); (M.E.E.S.)
| | - Noha O. Mansour
- Clinical Pharmacy and Pharmacy Practice Department, Faculty of Pharmacy, Mansoura University, Mansoura 35516, Egypt; (A.N.E.); (N.O.M.); (M.E.E.S.)
| | - Mohamed Hassan Elnaem
- Department of Pharmacy Practice, Faculty of Pharmacy, International Islamic University Malaysia, Kuantan 25200, Pahang, Malaysia
- Quality Use of Medicines Research Group, Faculty of Pharmacy, International Islamic University Malaysia, Kuantan 25200, Pahang, Malaysia
- Correspondence:
| | - Moheb Wadie
- Cardiology Department, Faculty of Medicine, Mansoura University, Mansoura 35516, Egypt;
| | | | - Mohamed E. E. Shams
- Clinical Pharmacy and Pharmacy Practice Department, Faculty of Pharmacy, Mansoura University, Mansoura 35516, Egypt; (A.N.E.); (N.O.M.); (M.E.E.S.)
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48
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Heidenreich PA, Bozkurt B, Aguilar D, Allen LA, Byun JJ, Colvin MM, Deswal A, Drazner MH, Dunlay SM, Evers LR, Fang JC, Fedson SE, Fonarow GC, Hayek SS, Hernandez AF, Khazanie P, Kittleson MM, Lee CS, Link MS, Milano CA, Nnacheta LC, Sandhu AT, Stevenson LW, Vardeny O, Vest AR, Yancy CW. 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation 2022; 145:e895-e1032. [PMID: 35363499 DOI: 10.1161/cir.0000000000001063] [Citation(s) in RCA: 548] [Impact Index Per Article: 274.0] [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] [Indexed: 01/04/2023]
Abstract
AIM The "2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure" replaces the "2013 ACCF/AHA Guideline for the Management of Heart Failure" and the "2017 ACC/AHA/HFSA Focused Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure." The 2022 guideline is intended to provide patient-centric recommendations for clinicians to prevent, diagnose, and manage patients with heart failure. METHODS A comprehensive literature search was conducted from May 2020 to December 2020, encompassing studies, reviews, and other evidence conducted on human subjects that were published in English from MEDLINE (PubMed), EMBASE, the Cochrane Collaboration, the Agency for Healthcare Research and Quality, and other relevant databases. Additional relevant clinical trials and research studies, published through September 2021, were also considered. This guideline was harmonized with other American Heart Association/American College of Cardiology guidelines published through December 2021. Structure: Heart failure remains a leading cause of morbidity and mortality globally. The 2022 heart failure guideline provides recommendations based on contemporary evidence for the treatment of these patients. The recommendations present an evidence-based approach to managing patients with heart failure, with the intent to improve quality of care and align with patients' interests. Many recommendations from the earlier heart failure guidelines have been updated with new evidence, and new recommendations have been created when supported by published data. Value statements are provided for certain treatments with high-quality published economic analyses.
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Affiliation(s)
| | | | | | | | | | | | - Anita Deswal
- ACC/AHA Joint Committee on Clinical Practice Guidelines Liaison
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49
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Heidenreich PA, Bozkurt B, Aguilar D, Allen LA, Byun JJ, Colvin MM, Deswal A, Drazner MH, Dunlay SM, Evers LR, Fang JC, Fedson SE, Fonarow GC, Hayek SS, Hernandez AF, Khazanie P, Kittleson MM, Lee CS, Link MS, Milano CA, Nnacheta LC, Sandhu AT, Stevenson LW, Vardeny O, Vest AR, Yancy CW. 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: Executive Summary: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation 2022; 145:e876-e894. [PMID: 35363500 DOI: 10.1161/cir.0000000000001062] [Citation(s) in RCA: 103] [Impact Index Per Article: 51.5] [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] [Indexed: 11/16/2022]
Abstract
AIM The "2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure" replaces the "2013 ACCF/AHA Guideline for the Management of Heart Failure" and the "2017 ACC/AHA/HFSA Focused Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure." The 2022 guideline is intended to provide patient-centric recommendations for clinicians to prevent, diagnose, and manage patients with heart failure. METHODS A comprehensive literature search was conducted from May 2020 to December 2020, encompassing studies, reviews, and other evidence conducted on human subjects that were published in English from MEDLINE (PubMed), EMBASE, the Cochrane Collaboration, the Agency for Healthcare Research and Quality, and other relevant databases. Additional relevant clinical trials and research studies, published through September 2021, were also considered. This guideline was harmonized with other American Heart Association/American College of Cardiology guidelines published through December 2021. Structure: Heart failure remains a leading cause of morbidity and mortality globally. The 2022 heart failure guideline provides recommendations based on contemporary evidence for the treatment of these patients. The recommendations present an evidence-based approach to managing patients with heart failure, with the intent to improve quality of care and align with patients' interests. Many recommendations from the earlier heart failure guidelines have been updated with new evidence, and new recommendations have been created when supported by published data. Value statements are provided for certain treatments with high-quality published economic analyses.
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Affiliation(s)
| | | | | | | | | | | | - Anita Deswal
- ACC/AHA Joint Committee on Clinical Practice Guidelines Liaison
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50
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Leahova-Cerchez X, Berthelot E, Genet B, Hanon O, Jourdain P. Estimation of the plasma volume status of elderly patients with acute decompensated heart failure using bedside clinical, biological, and ultrasound parameters. Clin Cardiol 2022; 45:379-385. [PMID: 35233791 DOI: 10.1002/clc.23791] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 01/17/2022] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVE Assessment of intravascular volume status to ensure optimization before hospital discharge could significantly reduce readmissions. It is difficult to evaluate congestion on clinical signs during an episode of acute heart failure (ADHF) in elderly patients. HYPOTHESIS There is an association between various volume overload parameters in patients older than 75 years. METHODS We performed a single-center prospective longitudinal study of patients older than 75 years hospitalized for acute heart failure. We analyzed the association between congestion assessment based on clinical signs, inferior vena cava (IVC) diameter measured by ultrasound, biological evaluation with N terminal pro brain natriuretic peptide (NT-proBNP), and estimated plasma volume (EPV) during decongestive therapy. We also monitored changes in renal function. RESULTS Fifty consecutive ADHF patients (85.2 ± 5.9 years, 68% female) were included in the study. At admission, a dilated, noncompliant IVC was found in all patients. The strongest correlations between different parameters of volume overload estimation were found between IVC and jugular vein distention (r = .8; p < .001), then IVC and oedema (r = .6; p < .001), IVC and crackles (r = .3; p < .036), then IVC and NT-proBNP (r = .3; p = .02). There was no correlation between EPV and signs of congestion. Patients who had no congestive signs on clinical or IVC examination at Day 2, more often presented with acute renal failure. CONCLUSION In ADHF patients older than 75 years, clinical and IVC evaluation of intravascular congestion correlate well. The concomitant assessment of clinical signs and IVC may prevent depletion-related renal failure.
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Affiliation(s)
- Xenia Leahova-Cerchez
- Hôpital Broca, Service de Gérontologie, Assistance Publique-Hôpitaux de Paris and EA 4468, Université de Paris, Paris, France
| | - Emmanuelle Berthelot
- Department of Cardiology, Université Paris-Saclay, AP-HP, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
| | - Bastien Genet
- Department of Biostatistics, Université Paris Sud, Le Kremlin-Bicêtre, France.,Department of Statistics and Methodology in Biomedical Research, Paris-Saclay University, Gif-sur-Yvette, France
| | - Olivier Hanon
- Hôpital Broca, Service de Gérontologie, Assistance Publique-Hôpitaux de Paris and EA 4468, Université de Paris, Paris, France
| | - Patrick Jourdain
- Department of Cardiology, Université Paris-Saclay, AP-HP, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
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