Influence of influenza vaccination on recurrent hospitalization in patients with heart failure

BACKGROUND

The current study aimed to evaluate the influence of regular annual influenza vaccinations on cardiovascular (CV) death and heart failure-related hospitalizations (HFrH) in stable outpatients with heart failure with reduced ejection fraction.

METHODS

The Turkish research team-HF (TREAT-HF) is a network undertaking multicenter, observational cohort studies in HF. This study is a subgroup analysis of TREAT-HF outpatient cohorts who completed a questionnaire on influenza vaccination status and for whom follow-up data were available. A total of 656 patients with available follow-up data for CV death and HFrH including recurrent hospitalization were included in the study. Patients were classified into two groups: those who received regular influenza vaccination (40 %) and those who did not receive vaccination.

RESULTS

During a mean follow-up of 15 ±6 months, 113 (18 %) patients had CV death and 471 (72 %) patients had at least one HFrH. The CV death rate was similar in both groups of patients (16 vs. 19 %, p = 0.37), whereas, HFrH and recurrent HFrH were significantly less frequently encountered in patients who received regular influenza vaccination than in those who did not receive vaccination (43 vs. 92 % and 16 vs. 66 %, p < 0.001, respectively). In a multivariate Cox proportional hazards model - in addition to a few clinical factors - vaccination status (HR = 0.30, 95 % CI = 0.17-0.51, p < 0.001) and graduation from university (HR = 0.35, 95 % CI = 0.17-0.72, p = 0.004) remained independently associated with the risk of recurrent HFrH.

CONCLUSION

Regular influenza vaccination does not influence CV deaths; however, it decreases HFrH including recurrent episodes of HFrH in outpatients with heart failure with reduced ejection fraction.

A cost effective parameter for predicting the troponin elevation in patients with carbon monoxide poisoning: red cell distribution width

OBJECTIVE

Carbon monoxide (CO) poisoning is very common worldwide. Despite the fact that CO is known to have cardiotoxic effects, as it has non-specific symptoms; cardiotoxicity could easily be overlooked, especially when troponin is not measured. The present study aimed to evaluate the association between troponin I levels and red cell distribution width (RDW) levels, which can be measured rapidly, easily, and affordably in the Emergency Room (ER).

PATIENTS AND METHODS

This single-center observational study included a total of 504 consecutive patients, who presented to the ER due to CO poisoning between January 2011 and June 2015. The diagnosis of CO poisoning was made according to the medical history and carboxyhemoglobin (COHb) level of >5%. Elevated troponin test levels, which measure >0.04 ng/ml for our laboratory, were accepted as positive.

RESULTS

Patients (mean age 37±14) were classified into two groups: those who had positive troponin levels (38%) and those that did not. Patients with positive troponin, who were older, had longer CO exposure time and higher creatinine, COHb and RDW levels at the index admission following CO poisoning than patients with negative troponin. In a multivariate logistic regression model with forward stepwise method, age, COHb level, CO exposure time, and RDW (HR=1.681, 95% CI: 1.472-1.934, p<0.001) remained associated with an increased risk of troponin positivity following adjustment for the variables that were statistically significant in the univariate analysis and correlated with RDW.

CONCLUSIONS

In patients presenting to the ER with CO poisoning, RDW can be helpful for the risk stratification of troponin positivity.

Early and late aortic propagation velocity values in STEMI patients after successful primary PCI and their relationship with neutrophil to lymphocyte ratio

OBJECTIVE

Atherosclerosis leads to increased arterial resistance through thickening and stiffening of the arterial wall, a phenomenon largely known as arterial stiffness. M-mode propagation velocity of the descending thoracic aorta, named aortic velocity propagation (AVP) is a novel method for the measurement of the aortic stiffness. We aimed to investigate the difference between early and late values of AVP after successful primary percutaneous coronary intervention (PCI) in ST-elevation myocardial infarction (STEMI) patients.

PATIENTS AND METHODS

A total of 103 (70 male, 67.9%) consecutive patients without a previous history of coronary artery disease, who presented with STEMI without hemodynamic compromise and underwent successful primary PCI were enrolled. Transthoracic echocardiography was performed in all patients after primary PCI at 12-24 hour in Intensive Care Unit (early measurements) and three months after the discharge during follow-up (late measurements). Doppler echocardiography, 2D and aortic M-mode propagation velocity measurements were recorded. Haematological and serum biochemical parameters of the study group were recorded.

RESULTS

There were no statistically significant differences in 2D echocardiography measurements between early and late evaluations. AVP values increased during 3 months follow-up in all patients. Mean AVP values were 33.7± 11.6 cm/sn and 44.4±10.5 cm/sn at early and late measurements, respectively (p<0.001). There were significant correlations between differences of AVP and neutrophil-lymphocyte ratio between early and late measurements.

CONCLUSIONS

We demonstrated for the first time that AVP values could improve after successful treatment in STEMI patients. The increment in AVP values was closely correlated with a decrement in neutrophil lymphocyte ratio. It can be postulated that AVP has strong correlations with the inflammatory markers.

Management of atrial fibrillation in the Emergency Department: current approach and future expectations

Atrial fibrillation (AF) is the most common cardiac dysrhythmia and occurs in 3.3%-10% of emergency admissions. It is frequently quoted for people over the age of 75, but the cases of AF in young subjects without structural heart disease are also increasing, therefore, leading to the evaluation of "lonely atrial fibrillation" as a new challenge for the clinician. The first diagnosis and treatment often occur in the emergency room and the emergency physician has therefore to evaluate the initial step towards the therapeutic decisions. Although international standard guidelines are available, AF treatment in the Emergency Department (ED) is still heterogeneous in terms of the management strategy chosen. There are two main strategies for the management of AF: rate and rhythm control. Moreover, antithrombotic treatment is pivotal in AF to prevent cardioembolic stroke and it is considered a primary objective after an accurate assessment of antithrombotic treatment risks and benefits. The introduction of innovative echocardiographic approach, directly in ED, seems to improve the management and risk stratification of patients with AF. This review aims to provide an overview about the current approach and the future expectations in the management of AF in ED. This manuscript represents a synopsis of the lectures on AF management in the ED of the Third Italian GREAT Network Congress, that was hold in Rome, 15-19 October 2012. We decided to use only the most relevant references for each contribution as suggested by each participant at this review.