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Ceriello A, Catrinoiu D, Chandramouli C, Cosentino F, Dombrowsky AC, Itzhak B, Lalic NM, Prattichizzo F, Schnell O, Seferović PM, Valensi P, Standl E. Heart failure in type 2 diabetes: current perspectives on screening, diagnosis and management. Cardiovasc Diabetol 2021; 20:218. [PMID: 34740359 PMCID: PMC8571004 DOI: 10.1186/s12933-021-01408-1] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 10/25/2021] [Indexed: 02/06/2023] Open
Abstract
Type 2 diabetes is one of the most relevant risk factors for heart failure, the prevalence of which is increasing worldwide. The aim of the review is to highlight the current perspectives of the pathophysiology of heart failure as it pertains to type 2 diabetes. This review summarizes the proposed mechanistic bases, explaining the myocardial damage induced by diabetes-related stressors and other risk factors, i.e., cardiomyopathy in type 2 diabetes. We highlight the complex pathology of individuals with type 2 diabetes, including the relationship with chronic kidney disease, metabolic alterations, and heart failure. We also discuss the current criteria used for heart failure diagnosis and the gold standard screening tools for individuals with type 2 diabetes. Currently approved pharmacological therapies with primary use in type 2 diabetes and heart failure, and the treatment-guiding role of NT-proBNP are also presented. Finally, the influence of the presence of type 2 diabetes as well as heart failure on COVID-19 severity is briefly discussed.
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Affiliation(s)
- Antonio Ceriello
- IRCCS MultiMedica, Via Gaudenzio Fantoli, 16/15, 20138 Milan, Italy
| | - Doina Catrinoiu
- Faculty of Medicine, Clinical Center of Diabetes, Nutrition and Metabolic Diseases, Ovidius University of Constanta, Constanta, Romania
| | - Chanchal Chandramouli
- Duke-NUS Medical School, Singapore, Singapore
- National Heart Research Institute, National Heart Centre, Singapore, Singapore
| | - Francesco Cosentino
- Unit of Cardiology, Karolinska Institute, Karolinska University Hospital Solna, Stockholm, Sweden
| | | | - Baruch Itzhak
- Clalit Health Services and Technion Faculty of Medicine, Haifa, Israel
| | - Nebojsa Malić Lalic
- School of Medicine, Clinic for Endocrinology, Diabetes and Metabolic Diseases, University of Belgrade, Belgrade, Serbia
| | | | - Oliver Schnell
- Forschergruppe Diabetes e. V. at Helmholtz Centre Munich GmbH, Munich, Germany
| | - Petar M. Seferović
- School of Medicine, University of Belgrade, Belgrade University Medical Center, Belgrade, Serbia
| | - Paul Valensi
- Unit of Endocrinology, Diabetology, Nutrition, Jean Verdier Hospital, AP-HP, CRNH-IdF, CINFO, Paris 13 University, Bondy, France
| | - Eberhard Standl
- Forschergruppe Diabetes e. V. at Helmholtz Centre Munich GmbH, Munich, Germany
| | - the D&CVD EASD Study Group
- IRCCS MultiMedica, Via Gaudenzio Fantoli, 16/15, 20138 Milan, Italy
- Faculty of Medicine, Clinical Center of Diabetes, Nutrition and Metabolic Diseases, Ovidius University of Constanta, Constanta, Romania
- Duke-NUS Medical School, Singapore, Singapore
- National Heart Research Institute, National Heart Centre, Singapore, Singapore
- Unit of Cardiology, Karolinska Institute, Karolinska University Hospital Solna, Stockholm, Sweden
- Sciarc GmbH, Baierbrunn, Germany
- Clalit Health Services and Technion Faculty of Medicine, Haifa, Israel
- School of Medicine, Clinic for Endocrinology, Diabetes and Metabolic Diseases, University of Belgrade, Belgrade, Serbia
- Forschergruppe Diabetes e. V. at Helmholtz Centre Munich GmbH, Munich, Germany
- School of Medicine, University of Belgrade, Belgrade University Medical Center, Belgrade, Serbia
- Unit of Endocrinology, Diabetology, Nutrition, Jean Verdier Hospital, AP-HP, CRNH-IdF, CINFO, Paris 13 University, Bondy, France
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152
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Novikova TN. [Features of anticoagulant therapy of atrial fibrillation in combination with impaired renal function]. KARDIOLOGIIA 2021; 61:81-88. [PMID: 34763642 DOI: 10.18087/cardio.2021.10.n1767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 07/27/2021] [Indexed: 06/13/2023]
Abstract
This review focuses on issues of anticoagulant therapy in patients with atrial fibrillation (AF) associated with chronic kidney disease (CKD). Such patients are at high risk of stroke whereas the choice of an anticoagulant is difficult. A wealth of information about a negative effect of warfarin on the kidney function has accumulated. A need for an alternative therapy to warfarin for patients with stage 3-4 CKD has become imminent. In this regard, rivaroxaban seems to be an appropriate replacement for warfarin in such patients. In randomized, controlled studies that evaluated the efficacy of direct oral anticoagulants in comparison with warfarin, the efficacy and safety profile of a "kidney" dose in moderate disorders of kidney function has been studied only for rivaroxaban. Moreover, both randomized, controlled studies and studies performed in the conditions of clinical practice, have demonstrated a more favorable effect of rivaroxaban on kidney function compared to warfarin. Patients with AF associated with CKD require a comprehensive protection, which, according to results of clinical studies, may be provided by rivaroxaban.
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Affiliation(s)
- T N Novikova
- I.I. Mechnikov North-Western State Medical University, Saint Petersburg
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153
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Matsue Y, Sama IE, Postmus D, Metra M, Greenberg BH, Cotter G, Davison BA, Felker GM, Filippatos G, Pang P, Ponikowski P, Severin T, Gimpelewicz C, Voors AA, Teerlink JR. Association of Early Blood Pressure Decrease and Renal Function With Prognosis in Acute Heart Failure. JACC-HEART FAILURE 2021; 9:890-903. [PMID: 34627724 DOI: 10.1016/j.jchf.2021.07.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 06/30/2021] [Accepted: 07/01/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVES The aim of this study was to investigate the association between systolic blood pressure (SBP) drop, worsening renal function (WRF), and prognosis in patients with acute heart failure (AHF). BACKGROUND A large drop in SBP early after hospital admission for AHF might be associated with increased risk for WRF and prognosis. However, there is a paucity of data regarding the interaction between WRF and a drop in SBP on clinical outcomes. METHODS A post hoc analysis among 6,544 patients with AHF enrolled in the RELAX-AHF-2 (Relaxin in Acute Heart Failure-2) trial was performed. Blood pressure was uniformly and repetitively measured. Peak SBP drop was defined as the difference between baseline SBP and lowest SBP documented during the first 48 hours. WRF was defined by an increase in serum creatinine of ≥0.3 mg/dL from baseline to day 5. RESULTS Peak SBP drop was independently associated with a higher risk for WRF (HR: 1.11 per 10 mm Hg SBP drop; P < 0.001), 5-day worsening heart failure (HR: 1.12 per 10 mm Hg SBP drop; P = 0.006), and 180-day cardiovascular death (HR: 1.09 per 10 mm Hg SBP drop; P = 0.026) after adjustment for potential confounders including baseline SBP. There was no interaction between the prognostic value of early SBP drop according to the presence or absence of WRF. CONCLUSIONS In patients hospitalized for AHF, a greater early drop in SBP was associated with a higher incidence of WRF, worsening heart failure, and an increased risk for 180-day cardiovascular death. However, the association between SBP drop and prognosis was not influenced by WRF. (Efficacy, Safety and Tolerability of Serelaxin When Added to Standard Therapy in AHF [RELAX-AHF-2]; NCT01870778).
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Affiliation(s)
- Yuya Matsue
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Iziah E Sama
- University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Douwe Postmus
- University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Marco Metra
- Cardiology, ASST Civil Hospitals, and Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Barry H Greenberg
- Division of Cardiology, University of California-San Diego, San Diego, California, USA
| | - Gad Cotter
- Momentum Research, Durham, North Carolina, USA; Inserm U-942 MASCOT, Paris, France
| | - Beth A Davison
- Momentum Research, Durham, North Carolina, USA; Inserm U-942 MASCOT, Paris, France
| | - G Michael Felker
- Division of Cardiology, Duke University School of Medicine, Durham, North Carolina, USA
| | | | - Peter Pang
- Department of Emergency Medicine, Indiana University School of Medicine, and the Regenstrief Institute, Indianapolis, Indiana, USA
| | - Piotr Ponikowski
- Department of Heart Diseases, Medical University, Military Hospital, Wroclaw, Poland
| | | | | | - Adriaan A Voors
- University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
| | - John R Teerlink
- Section of Cardiology, San Francisco Veterans Affairs Medical Center and School of Medicine, University of California-San Francisco, San Francisco, California, USA
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154
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Scicchitano P, Iacoviello M, Passantino A, Guida P, De Palo M, Piscopo A, Gesualdo M, Caldarola P, Massari F. The Prognostic Impact of Estimated Creatinine Clearance by Bioelectrical Impedance Analysis in Heart Failure: Comparison of Different eGFR Formulas. Biomedicines 2021; 9:1307. [PMID: 34680423 PMCID: PMC8533548 DOI: 10.3390/biomedicines9101307] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Revised: 09/15/2021] [Accepted: 09/20/2021] [Indexed: 01/11/2023] Open
Abstract
The estimation of glomerular filtration rate (eGFR) provides prognostic information in patients with heart failure (HF). Bioelectrical impedance analysis may calculate eGFR (Donadio formula). The aim of this study was to evaluate the impact of the Donadio formula in predicting all-cause mortality in patients with HF as compared to Cockroft-Gault, MDRD-4 (Modification of Diet in renal Disease Study), and Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formulas. Four-hundred thirty-six subjects with HF (52% men; mean age 75 ± 11 years; 42% acute HF) were enrolled. Ninety-two patients (21%) died during the follow-up (median 463 days, IQR 287-669). The area under the receiver operator characteristic curve for eGFR, as estimated by Cockroft-Gault formula (AUC = 0.75), was significantly higher than those derived from Donadio (AUC = 0.72), MDRD-4 (AUC = 0.68), and CKD-EPI (AUC = 0.71) formulas. At multivariate analysis, all eGFR formulas were independent predictors of death; 1 mL/min/1.73 m2 increase in eGFR-as measured by Cockroft-Gault, Donadio, MDRD-4, and CKD-EPI formulas-provided a 2.6%, 1.5%, 1.2%, and 1.6% increase, respectively, in mortality rate. Conclusions. eGFR, as calculated with the Donadio formula, was an independent predictor of mortality in patients with HF as well as the measurements derived from MDRD4 and CKD-EPI formulas, but less accurate than Cockroft-Gault.
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Affiliation(s)
- Pietro Scicchitano
- Cardiology Section, Hospital “F. Perinei”, 70022 Altamura, Italy; (A.P.); (M.G.); (F.M.)
| | - Massimo Iacoviello
- Cardiology Unit, Department of Medical and Surgical Science, University of Foggia, 71122 Foggia, Italy;
| | - Andrea Passantino
- Division of Cardiology and Cardiac Rehabilitation, Scientific Clinical Institutes Maugeri, IRCCS Institute of Bari, 70124 Bari, Italy;
| | - Piero Guida
- Regional General Hospital “F. Miulli”, 70021 Acquaviva delle Fonti, Italy;
| | - Micaela De Palo
- Cardiac Surgery Section, Policlinico University Hospital, 70124 Bari, Italy;
| | - Assunta Piscopo
- Cardiology Section, Hospital “F. Perinei”, 70022 Altamura, Italy; (A.P.); (M.G.); (F.M.)
| | - Michele Gesualdo
- Cardiology Section, Hospital “F. Perinei”, 70022 Altamura, Italy; (A.P.); (M.G.); (F.M.)
| | | | - Francesco Massari
- Cardiology Section, Hospital “F. Perinei”, 70022 Altamura, Italy; (A.P.); (M.G.); (F.M.)
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McDonagh TA, Metra M, Adamo M, Gardner RS, Baumbach A, Böhm M, Burri H, Butler J, Čelutkienė J, Chioncel O, Cleland JGF, Coats AJS, Crespo-Leiro MG, Farmakis D, Gilard M, Heymans S, Hoes AW, Jaarsma T, Jankowska EA, Lainscak M, Lam CSP, Lyon AR, McMurray JJV, Mebazaa A, Mindham R, Muneretto C, Francesco Piepoli M, Price S, Rosano GMC, Ruschitzka F, Kathrine Skibelund A, de Boer RA, Christian Schulze P, Abdelhamid M, Aboyans V, Adamopoulos S, Anker SD, Arbelo E, Asteggiano R, Bauersachs J, Bayes-Genis A, Borger MA, Budts W, Cikes M, Damman K, Delgado V, Dendale P, Dilaveris P, Drexel H, Ezekowitz J, Falk V, Fauchier L, Filippatos G, Fraser A, Frey N, Gale CP, Gustafsson F, Harris J, Iung B, Janssens S, Jessup M, Konradi A, Kotecha D, Lambrinou E, Lancellotti P, Landmesser U, Leclercq C, Lewis BS, Leyva F, Linhart A, Løchen ML, Lund LH, Mancini D, Masip J, Milicic D, Mueller C, Nef H, Nielsen JC, Neubeck L, Noutsias M, Petersen SE, Sonia Petronio A, Ponikowski P, Prescott E, Rakisheva A, Richter DJ, Schlyakhto E, Seferovic P, Senni M, Sitges M, Sousa-Uva M, Tocchetti CG, Touyz RM, Tschoepe C, Waltenberger J, Adamo M, Baumbach A, Böhm M, Burri H, Čelutkienė J, Chioncel O, Cleland JGF, Coats AJS, Crespo-Leiro MG, Farmakis D, Gardner RS, Gilard M, Heymans S, Hoes AW, Jaarsma T, Jankowska EA, Lainscak M, Lam CSP, Lyon AR, McMurray JJV, Mebazaa A, Mindham R, Muneretto C, Piepoli MF, Price S, Rosano GMC, Ruschitzka F, Skibelund AK. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab368 order by 1-- gadu] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/10/2023] Open
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2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab368 order by 1-- #] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/10/2023] Open
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157
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McDonagh TA, Metra M, Adamo M, Gardner RS, Baumbach A, Böhm M, Burri H, Butler J, Čelutkienė J, Chioncel O, Cleland JGF, Coats AJS, Crespo-Leiro MG, Farmakis D, Gilard M, Heymans S, Hoes AW, Jaarsma T, Jankowska EA, Lainscak M, Lam CSP, Lyon AR, McMurray JJV, Mebazaa A, Mindham R, Muneretto C, Francesco Piepoli M, Price S, Rosano GMC, Ruschitzka F, Kathrine Skibelund A, de Boer RA, Christian Schulze P, Abdelhamid M, Aboyans V, Adamopoulos S, Anker SD, Arbelo E, Asteggiano R, Bauersachs J, Bayes-Genis A, Borger MA, Budts W, Cikes M, Damman K, Delgado V, Dendale P, Dilaveris P, Drexel H, Ezekowitz J, Falk V, Fauchier L, Filippatos G, Fraser A, Frey N, Gale CP, Gustafsson F, Harris J, Iung B, Janssens S, Jessup M, Konradi A, Kotecha D, Lambrinou E, Lancellotti P, Landmesser U, Leclercq C, Lewis BS, Leyva F, Linhart A, Løchen ML, Lund LH, Mancini D, Masip J, Milicic D, Mueller C, Nef H, Nielsen JC, Neubeck L, Noutsias M, Petersen SE, Sonia Petronio A, Ponikowski P, Prescott E, Rakisheva A, Richter DJ, Schlyakhto E, Seferovic P, Senni M, Sitges M, Sousa-Uva M, Tocchetti CG, Touyz RM, Tschoepe C, Waltenberger J, Adamo M, Baumbach A, Böhm M, Burri H, Čelutkienė J, Chioncel O, Cleland JGF, Coats AJS, Crespo-Leiro MG, Farmakis D, Gardner RS, Gilard M, Heymans S, Hoes AW, Jaarsma T, Jankowska EA, Lainscak M, Lam CSP, Lyon AR, McMurray JJV, Mebazaa A, Mindham R, Muneretto C, Piepoli MF, Price S, Rosano GMC, Ruschitzka F, Skibelund AK. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab368 order by 8029-- -] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/10/2023] Open
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McDonagh TA, Metra M, Adamo M, Gardner RS, Baumbach A, Böhm M, Burri H, Butler J, Čelutkienė J, Chioncel O, Cleland JGF, Coats AJS, Crespo-Leiro MG, Farmakis D, Gilard M, Heymans S, Hoes AW, Jaarsma T, Jankowska EA, Lainscak M, Lam CSP, Lyon AR, McMurray JJV, Mebazaa A, Mindham R, Muneretto C, Francesco Piepoli M, Price S, Rosano GMC, Ruschitzka F, Kathrine Skibelund A, de Boer RA, Christian Schulze P, Abdelhamid M, Aboyans V, Adamopoulos S, Anker SD, Arbelo E, Asteggiano R, Bauersachs J, Bayes-Genis A, Borger MA, Budts W, Cikes M, Damman K, Delgado V, Dendale P, Dilaveris P, Drexel H, Ezekowitz J, Falk V, Fauchier L, Filippatos G, Fraser A, Frey N, Gale CP, Gustafsson F, Harris J, Iung B, Janssens S, Jessup M, Konradi A, Kotecha D, Lambrinou E, Lancellotti P, Landmesser U, Leclercq C, Lewis BS, Leyva F, Linhart A, Løchen ML, Lund LH, Mancini D, Masip J, Milicic D, Mueller C, Nef H, Nielsen JC, Neubeck L, Noutsias M, Petersen SE, Sonia Petronio A, Ponikowski P, Prescott E, Rakisheva A, Richter DJ, Schlyakhto E, Seferovic P, Senni M, Sitges M, Sousa-Uva M, Tocchetti CG, Touyz RM, Tschoepe C, Waltenberger J, Adamo M, Baumbach A, Böhm M, Burri H, Čelutkienė J, Chioncel O, Cleland JGF, Coats AJS, Crespo-Leiro MG, Farmakis D, Gardner RS, Gilard M, Heymans S, Hoes AW, Jaarsma T, Jankowska EA, Lainscak M, Lam CSP, Lyon AR, McMurray JJV, Mebazaa A, Mindham R, Muneretto C, Piepoli MF, Price S, Rosano GMC, Ruschitzka F, Skibelund AK. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab368 order by 8029-- #] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/10/2023] Open
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McDonagh TA, Metra M, Adamo M, Gardner RS, Baumbach A, Böhm M, Burri H, Butler J, Čelutkienė J, Chioncel O, Cleland JGF, Coats AJS, Crespo-Leiro MG, Farmakis D, Gilard M, Heymans S, Hoes AW, Jaarsma T, Jankowska EA, Lainscak M, Lam CSP, Lyon AR, McMurray JJV, Mebazaa A, Mindham R, Muneretto C, Francesco Piepoli M, Price S, Rosano GMC, Ruschitzka F, Kathrine Skibelund A. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J 2021; 42:3599-3726. [PMID: 34447992 DOI: 10.1093/eurheartj/ehab368] [Citation(s) in RCA: 5276] [Impact Index Per Article: 1758.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
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160
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McDonagh TA, Metra M, Adamo M, Gardner RS, Baumbach A, Böhm M, Burri H, Butler J, Čelutkienė J, Chioncel O, Cleland JGF, Coats AJS, Crespo-Leiro MG, Farmakis D, Gilard M, Heymans S, Hoes AW, Jaarsma T, Jankowska EA, Lainscak M, Lam CSP, Lyon AR, McMurray JJV, Mebazaa A, Mindham R, Muneretto C, Francesco Piepoli M, Price S, Rosano GMC, Ruschitzka F, Kathrine Skibelund A, de Boer RA, Christian Schulze P, Abdelhamid M, Aboyans V, Adamopoulos S, Anker SD, Arbelo E, Asteggiano R, Bauersachs J, Bayes-Genis A, Borger MA, Budts W, Cikes M, Damman K, Delgado V, Dendale P, Dilaveris P, Drexel H, Ezekowitz J, Falk V, Fauchier L, Filippatos G, Fraser A, Frey N, Gale CP, Gustafsson F, Harris J, Iung B, Janssens S, Jessup M, Konradi A, Kotecha D, Lambrinou E, Lancellotti P, Landmesser U, Leclercq C, Lewis BS, Leyva F, Linhart A, Løchen ML, Lund LH, Mancini D, Masip J, Milicic D, Mueller C, Nef H, Nielsen JC, Neubeck L, Noutsias M, Petersen SE, Sonia Petronio A, Ponikowski P, Prescott E, Rakisheva A, Richter DJ, Schlyakhto E, Seferovic P, Senni M, Sitges M, Sousa-Uva M, Tocchetti CG, Touyz RM, Tschoepe C, Waltenberger J, Adamo M, Baumbach A, Böhm M, Burri H, Čelutkienė J, Chioncel O, Cleland JGF, Coats AJS, Crespo-Leiro MG, Farmakis D, Gardner RS, Gilard M, Heymans S, Hoes AW, Jaarsma T, Jankowska EA, Lainscak M, Lam CSP, Lyon AR, McMurray JJV, Mebazaa A, Mindham R, Muneretto C, Piepoli MF, Price S, Rosano GMC, Ruschitzka F, Skibelund AK. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab368 order by 1-- -] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/10/2023] Open
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161
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McDonagh TA, Metra M, Adamo M, Gardner RS, Baumbach A, Böhm M, Burri H, Butler J, Čelutkienė J, Chioncel O, Cleland JGF, Coats AJS, Crespo-Leiro MG, Farmakis D, Gilard M, Heymans S, Hoes AW, Jaarsma T, Jankowska EA, Lainscak M, Lam CSP, Lyon AR, McMurray JJV, Mebazaa A, Mindham R, Muneretto C, Francesco Piepoli M, Price S, Rosano GMC, Ruschitzka F, Kathrine Skibelund A, de Boer RA, Christian Schulze P, Abdelhamid M, Aboyans V, Adamopoulos S, Anker SD, Arbelo E, Asteggiano R, Bauersachs J, Bayes-Genis A, Borger MA, Budts W, Cikes M, Damman K, Delgado V, Dendale P, Dilaveris P, Drexel H, Ezekowitz J, Falk V, Fauchier L, Filippatos G, Fraser A, Frey N, Gale CP, Gustafsson F, Harris J, Iung B, Janssens S, Jessup M, Konradi A, Kotecha D, Lambrinou E, Lancellotti P, Landmesser U, Leclercq C, Lewis BS, Leyva F, Linhart A, Løchen ML, Lund LH, Mancini D, Masip J, Milicic D, Mueller C, Nef H, Nielsen JC, Neubeck L, Noutsias M, Petersen SE, Sonia Petronio A, Ponikowski P, Prescott E, Rakisheva A, Richter DJ, Schlyakhto E, Seferovic P, Senni M, Sitges M, Sousa-Uva M, Tocchetti CG, Touyz RM, Tschoepe C, Waltenberger J, Adamo M, Baumbach A, Böhm M, Burri H, Čelutkienė J, Chioncel O, Cleland JGF, Coats AJS, Crespo-Leiro MG, Farmakis D, Gardner RS, Gilard M, Heymans S, Hoes AW, Jaarsma T, Jankowska EA, Lainscak M, Lam CSP, Lyon AR, McMurray JJV, Mebazaa A, Mindham R, Muneretto C, Piepoli MF, Price S, Rosano GMC, Ruschitzka F, Skibelund AK. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab368 and 1880=1880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/10/2023] Open
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McDonagh TA, Metra M, Adamo M, Gardner RS, Baumbach A, Böhm M, Burri H, Butler J, Čelutkienė J, Chioncel O, Cleland JGF, Coats AJS, Crespo-Leiro MG, Farmakis D, Gilard M, Heymans S, Hoes AW, Jaarsma T, Jankowska EA, Lainscak M, Lam CSP, Lyon AR, McMurray JJV, Mebazaa A, Mindham R, Muneretto C, Francesco Piepoli M, Price S, Rosano GMC, Ruschitzka F, Kathrine Skibelund A, de Boer RA, Christian Schulze P, Abdelhamid M, Aboyans V, Adamopoulos S, Anker SD, Arbelo E, Asteggiano R, Bauersachs J, Bayes-Genis A, Borger MA, Budts W, Cikes M, Damman K, Delgado V, Dendale P, Dilaveris P, Drexel H, Ezekowitz J, Falk V, Fauchier L, Filippatos G, Fraser A, Frey N, Gale CP, Gustafsson F, Harris J, Iung B, Janssens S, Jessup M, Konradi A, Kotecha D, Lambrinou E, Lancellotti P, Landmesser U, Leclercq C, Lewis BS, Leyva F, Linhart A, Løchen ML, Lund LH, Mancini D, Masip J, Milicic D, Mueller C, Nef H, Nielsen JC, Neubeck L, Noutsias M, Petersen SE, Sonia Petronio A, Ponikowski P, Prescott E, Rakisheva A, Richter DJ, Schlyakhto E, Seferovic P, Senni M, Sitges M, Sousa-Uva M, Tocchetti CG, Touyz RM, Tschoepe C, Waltenberger J, Adamo M, Baumbach A, Böhm M, Burri H, Čelutkienė J, Chioncel O, Cleland JGF, Coats AJS, Crespo-Leiro MG, Farmakis D, Gardner RS, Gilard M, Heymans S, Hoes AW, Jaarsma T, Jankowska EA, Lainscak M, Lam CSP, Lyon AR, McMurray JJV, Mebazaa A, Mindham R, Muneretto C, Piepoli MF, Price S, Rosano GMC, Ruschitzka F, Skibelund AK. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab368 order by 8029-- awyx] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/10/2023] Open
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163
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Jiang D, Younis MH, Lan X, Cai W. High-performance renal imaging with a radiolabeled, non-excretable chimeric fusion protein. Am J Cancer Res 2021; 11:9177-9179. [PMID: 34522233 PMCID: PMC8419045 DOI: 10.7150/thno.66417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 08/23/2021] [Indexed: 12/03/2022] Open
Abstract
Ideal nuclear imaging tracers should exhibit high target uptake and low background signal. Traditional renal scintigraphy and SPECT scans examine kidney function via static or dynamic tracing of radioactive probes in the kidneys. The lack of tracer affinity to specific biological processes and high background uptake from urinary excretion have added many difficulties to precision renal diagnosis. In this issue of Theranostics, Jin and colleagues innovatively devised a recombinant probe for preferential kidney imaging through targeting of tubular neonatal Fc receptor and proximal tubular basement membrane for sustained tubular reabsorption and accumulation. This work has broad implications regarding how an in depth understanding of physiology and pathology may be of service for tracer development, renal diagnosis, and disease theranostics.
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164
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Martens P, Tang WHW, Mullens W. Renal sodium avidity, the prevailing renal target in heart failure. Eur Heart J 2021; 42:4478-4481. [PMID: 34529790 DOI: 10.1093/eurheartj/ehab650] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Pieter Martens
- Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium.,Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - W H Wilson Tang
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Wilfried Mullens
- Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium.,Biomedical Research Institute, Faculty of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium
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165
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Biegus J, Niewinski P, Josiak K, Kulej K, Ponikowska B, Nowak K, Zymlinski R, Ponikowski P. Pathophysiology of Advanced Heart Failure: What Knowledge Is Needed for Clinical Management? Heart Fail Clin 2021; 17:519-531. [PMID: 34511202 DOI: 10.1016/j.hfc.2021.06.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Understanding of heart failure (HF) has evolved from a simple hemodynamic problem through a neurohormonally and proinflammatory-driven syndrome to a complex multiorgan dysfunction accompanied by inadequate energy handling. This article discusses the most important clinical aspects of advanced HF pathophysiology. It presents the concept of neurohormonal activation and its deleterious effect on cardiovascular system and reflex control. The current theories regarding the role of inflammation, cytokine activation, and myocardial remodeling in HF progression are presented. Advanced HF is a multiorgan syndrome with interplay between cardiovascular system and other organs. The role of iron deficiency is also discussed.
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Affiliation(s)
- Jan Biegus
- Department of Heart Diseases, Wrocław Medical University, ul. Borowska 213, 50-556 Wrocław, Poland; Centre for Heart Diseases, Wrocław University Hospital, ul. Borowska 213, 50-556 Wrocław, Poland
| | - Piotr Niewinski
- Department of Heart Diseases, Wrocław Medical University, ul. Borowska 213, 50-556 Wrocław, Poland; Centre for Heart Diseases, Wrocław University Hospital, ul. Borowska 213, 50-556 Wrocław, Poland
| | - Krystian Josiak
- Department of Heart Diseases, Wrocław Medical University, ul. Borowska 213, 50-556 Wrocław, Poland; Centre for Heart Diseases, Wrocław University Hospital, ul. Borowska 213, 50-556 Wrocław, Poland
| | - Katarzyna Kulej
- Department of Heart Diseases, Wrocław Medical University, ul. Borowska 213, 50-556 Wrocław, Poland; Centre for Heart Diseases, Wrocław University Hospital, ul. Borowska 213, 50-556 Wrocław, Poland
| | - Barbara Ponikowska
- Student Scientific Organization, Department of Heart Diseases, Wroclaw Medical University, ul. Borowska 213, 50-556 Wrocław, Poland
| | - Krzysztof Nowak
- Department of Heart Diseases, Wrocław Medical University, ul. Borowska 213, 50-556 Wrocław, Poland; Centre for Heart Diseases, Wrocław University Hospital, ul. Borowska 213, 50-556 Wrocław, Poland
| | - Robert Zymlinski
- Department of Heart Diseases, Wrocław Medical University, ul. Borowska 213, 50-556 Wrocław, Poland; Centre for Heart Diseases, Wrocław University Hospital, ul. Borowska 213, 50-556 Wrocław, Poland
| | - Piotr Ponikowski
- Department of Heart Diseases, Wrocław Medical University, ul. Borowska 213, 50-556 Wrocław, Poland; Centre for Heart Diseases, Wrocław University Hospital, ul. Borowska 213, 50-556 Wrocław, Poland.
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166
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Tomasoni D, Adamo M, Metra M. August 2021 at a glance: focus on cardiomyopathies, medical treatment and devices. Eur J Heart Fail 2021; 23:1247-1249. [PMID: 34405942 DOI: 10.1002/ejhf.1888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Affiliation(s)
- Daniela Tomasoni
- Cardiology and Cardiac Catheterization Laboratory, Cardio-Thoracic Department, Civil Hospitals; Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Marianna Adamo
- Cardiology and Cardiac Catheterization Laboratory, Cardio-Thoracic Department, Civil Hospitals; Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Marco Metra
- Cardiology and Cardiac Catheterization Laboratory, Cardio-Thoracic Department, Civil Hospitals; Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
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167
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Caraba A, Iurciuc S, Munteanu A, Iurciuc M. Hyponatremia and Renal Venous Congestion in Heart Failure Patients. DISEASE MARKERS 2021; 2021:6499346. [PMID: 34422137 PMCID: PMC8376441 DOI: 10.1155/2021/6499346] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 07/22/2021] [Accepted: 07/30/2021] [Indexed: 12/05/2022]
Abstract
OBJECTIVE The interrelationship between the heart and kidneys has a great importance in the homeostasis of the cardiovascular system. Heart failure patients present intrarenal arterial hypoperfusion and intrarenal venous congestion due to reduced left ventricle ejection fraction, which triggers numerous neurohormonal factors. The aim of this study was to investigate intrarenal vascularization (arterial and venous), as well as the links between it and systemic congestion and, on the other side, with the mortality in patients with heart failure. Material and Methods. This cross-sectional study was performed on a group of 44 patients with heart failure in different stages of evolution and 44 healthy subjects, matched for age and gender, as controls. Serum natremia, NT-proBNP, and creatinine analyses were performed in all patients and controls. Renal and cardiac ultrasonography was done in all patients and controls, recording intrarenal arterial resistive index (RRI), intrarenal venous flow (IRVF) pattern, renal venous stasis index (RVSI), and left ventricular ejection fraction (LVEF). Data are recorded and presented as mean ± standard deviation. Statistical analyses were performed using the Student t-test, ANOVA test, and the Pearson correlation. Differences were considered statistically significant at the value of p < 0.05. RESULTS Hyponatremia was identified in 47.72% of the HF patients. This study revealed correlations between serum natremia and LVEF, NT-proBNP, serum creatinine, interlobar venous RVSI (p < 0.00001), and interlobar artery RRI (p ≤ 0.002). Hyponatremia and renal venous congestion represent negative prognostic factors in HF patients. CONCLUSION In HF patients, hyponatremia was correlated with cardiac dysfunction and intrarenal venous congestion. Hyponatremia and renal venous congestion represented negative prognostic factors in HF patients.
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Affiliation(s)
- Alexandru Caraba
- Department of Internal Medicine, University of Medicine and Pharmacy “Victor Babeș” Timișoara, Romania
| | - Stela Iurciuc
- Department of Cardiology, University of Medicine and Pharmacy “Victor Babeș” Timișoara, Romania
| | - Andreea Munteanu
- Department of Internal Medicine, University of Medicine and Pharmacy “Victor Babeș” Timișoara, Romania
| | - Mircea Iurciuc
- Department of Cardiology, University of Medicine and Pharmacy “Victor Babeș” Timișoara, Romania
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168
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Tomasoni D, Adamo M, Metra M. July 2021 at a glance: focus on blood volume distribution, haemodynamics and adherence to therapy. Eur J Heart Fail 2021; 23:1059-1061. [PMID: 34291869 DOI: 10.1002/ejhf.1886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Affiliation(s)
- Daniela Tomasoni
- Cardiology and Cardiac Catheterization Laboratory, Cardio-Thoracic Department, Civil Hospitals; Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Marianna Adamo
- Cardiology and Cardiac Catheterization Laboratory, Cardio-Thoracic Department, Civil Hospitals; Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Marco Metra
- Cardiology and Cardiac Catheterization Laboratory, Cardio-Thoracic Department, Civil Hospitals; Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
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169
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Jíchová Š, Gawryś O, Kompanowska-Jezierska E, Sadowski J, Melenovský V, Hošková L, Červenka L, Kala P, Veselka J, Čertíková Chábová V. Kidney Response to Chemotherapy-Induced Heart Failure: mRNA Analysis in Normotensive and Ren-2 Transgenic Hypertensive Rats. Int J Mol Sci 2021; 22:8475. [PMID: 34445179 PMCID: PMC8395170 DOI: 10.3390/ijms22168475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 08/02/2021] [Accepted: 08/03/2021] [Indexed: 11/21/2022] Open
Abstract
The aim of the present study was to perform kidney messenger ribonucleic acid (mRNA) analysis in normotensive, Hannover Sprague-Dawley (HanSD) rats and hypertensive, Ren-2 renin transgenic rats (TGR) after doxorubicin-induced heart failure (HF) with specific focus on genes that are implicated in the pathophysiology of HF-associated cardiorenal syndrome. We found that in both strains renin and angiotensin-converting enzyme mRNA expressions were upregulated indicating that the vasoconstrictor axis of the renin-angiotensin system was activated. We found that pre-proendothelin-1, endothelin-converting enzyme type 1 and endothelin type A receptor mRNA expressions were upregulated in HanSD rats, but not in TGR, suggesting the activation of endothelin system in HanSD rats, but not in TGR. We found that mRNA expression of cytochrome P-450 subfamily 2C23 was downregulated in TGR and not in HanSD rats, suggesting the deficiency in the intrarenal cytochrome P450-dependent pathway of arachidonic acid metabolism in TGR. These results should be the basis for future studies evaluating the pathophysiology of cardiorenal syndrome secondary to chemotherapy-induced HF in order to potentially develop new therapeutic approaches.
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Affiliation(s)
- Šárka Jíchová
- Center for Experimental Medicine, Institute for Clinical and Experimental Medicine, 14021 Prague, Czech Republic; (Š.J.); (L.Č.); (P.K.)
| | - Olga Gawryś
- Department of Renal and Body Fluid Physiology, Mossakowski Medical Research Institute, Polish Academy of Sciences, PL02-106 Warsaw, Poland; (O.G.); (E.K.-J.); (J.S.)
| | - Elżbieta Kompanowska-Jezierska
- Department of Renal and Body Fluid Physiology, Mossakowski Medical Research Institute, Polish Academy of Sciences, PL02-106 Warsaw, Poland; (O.G.); (E.K.-J.); (J.S.)
| | - Janusz Sadowski
- Department of Renal and Body Fluid Physiology, Mossakowski Medical Research Institute, Polish Academy of Sciences, PL02-106 Warsaw, Poland; (O.G.); (E.K.-J.); (J.S.)
| | - Vojtěch Melenovský
- Department of Cardiology, Institute for Clinical and Experimental Medicine, 14021 Prague, Czech Republic; (V.M.); (L.H.)
| | - Lenka Hošková
- Department of Cardiology, Institute for Clinical and Experimental Medicine, 14021 Prague, Czech Republic; (V.M.); (L.H.)
| | - Luděk Červenka
- Center for Experimental Medicine, Institute for Clinical and Experimental Medicine, 14021 Prague, Czech Republic; (Š.J.); (L.Č.); (P.K.)
- Department of Pathophysiology, 2nd Faculty of Medicine, Charles University, 15006 Prague, Czech Republic
| | - Petr Kala
- Center for Experimental Medicine, Institute for Clinical and Experimental Medicine, 14021 Prague, Czech Republic; (Š.J.); (L.Č.); (P.K.)
- Department of Pathophysiology, 2nd Faculty of Medicine, Charles University, 15006 Prague, Czech Republic
- Department of Cardiology, University Hospital Motol and 2nd Faculty of Medicine, Charles University, 15006 Prague, Czech Republic;
| | - Josef Veselka
- Department of Cardiology, University Hospital Motol and 2nd Faculty of Medicine, Charles University, 15006 Prague, Czech Republic;
| | - Věra Čertíková Chábová
- Department of Nephrology, 1st Faculty of Medicine, Charles University, 12108 Prague, Czech Republic
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170
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Manca P, Nuzzi V, Cannatà A, Merlo M, Sinagra G. Contemporary etiology and prognosis of dilated non-ischemic cardiomyopathy. Minerva Cardiol Angiol 2021; 70:171-188. [PMID: 34338487 DOI: 10.23736/s2724-5683.21.05736-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Non-ischemic dilated cardiomyopathy (NI-DCM) represents a specific etiology of systolic heart failure that usually affect young individuals with a genetic background in up to 40% of cases. Behind the term NI-DCM there is a spectrum of different diseases, and an accurate etiological classification appears pivotal for the clinical management and prognostic stratification of these patients. EVIDENCE ACQUISITION In the last years the prognosis of NI-DCM patients dramatically improved thanks to the progresses in medical treatment/ device therapy and earlier diagnosis especially in familial context. In this review we summarize the actual state of art in the management of these patients. EVIDENCE SYNTHESIS In the era of precision medicine, a lot of progresses have been made to expand our knowledge on the management of NI-DCM patients. A complex interaction between genotype and external triggers is the main determinant of the clinical phenotype in NI-DCM, and a lot of efforts must be done by clinicians to systematically rule out all the possible causes involved in the pathogenesis. Progresses in cardiac imaging and familial screening led us to detect subtle abnormalities in the initial phase of the disease and also helped us to furtherly stratify the prognosis and arrhythmic risk of these patients. It is plausible that a more precise etiological classification will be needed in the near future. CONCLUSIONS NI-DCM contains a spectrum of different diseases. Proper etiological classification, early diagnosis and strict follow-up are essential to tailor care of these patients.
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Affiliation(s)
- Paolo Manca
- Department of Cardiology, Azienda Sanitaria Universitaria Integrata Giuliano Isontina (ASUGI), University of Trieste, Trieste, Italy
| | - Vincenzo Nuzzi
- Department of Cardiology, Azienda Sanitaria Universitaria Integrata Giuliano Isontina (ASUGI), University of Trieste, Trieste, Italy
| | - Antonio Cannatà
- Department of Cardiology, Azienda Sanitaria Universitaria Integrata Giuliano Isontina (ASUGI), University of Trieste, Trieste, Italy.,Department of Cardiovascular Science, Faculty of Life Science and Medicine, King's College London, London, UK
| | - Marco Merlo
- Department of Cardiology, Azienda Sanitaria Universitaria Integrata Giuliano Isontina (ASUGI), University of Trieste, Trieste, Italy -
| | - Gianfranco Sinagra
- Department of Cardiology, Azienda Sanitaria Universitaria Integrata Giuliano Isontina (ASUGI), University of Trieste, Trieste, Italy
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171
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Voors AA, Mulder H, Reyes E, Cowie MR, Lassus J, Hernandez AF, Ezekowitz JA, Butler J, O'Connor CM, Koglin J, Lam CS, Pieske B, Roessig L, Ponikowski P, Anstrom KJ, Armstrong PW. Renal function and the effects of vericiguat in patients with worsening heart failure with reduced ejection fraction: insights from the VICTORIA (Vericiguat Global Study in Subjects with HFrEF) trial. Eur J Heart Fail 2021; 23:1313-1321. [PMID: 33999486 PMCID: PMC8453520 DOI: 10.1002/ejhf.2221] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 05/11/2021] [Accepted: 05/11/2021] [Indexed: 12/15/2022] Open
Abstract
AIMS Vericiguat reduced the primary composite outcome of cardiovascular death or heart failure (HF) hospitalization in patients with worsening HF with reduced ejection fraction (HFrEF) and a lower limit of baseline estimated glomerular filtration rate (eGFR) of 15 mL/min/1.73 m2 . We evaluated the relationship between the efficacy of vericiguat and baseline and subsequent changes in renal function. METHODS AND RESULTS In VICTORIA, core laboratory serum creatinine was measured at baseline (n = 4956) and weeks 16, 32, and 48. Worsening renal function (WRF), defined as an increase ≥0.3 mg/dL in creatinine from baseline to week 16, was assessed via a Cox model with respect to subsequent primary events. Mean age was 69 years, 24% were female, and mean baseline eGFR was 61 mL/min/1.73 m2 . During 48 weeks of treatment, the trajectories in eGFR and creatinine with vericiguat were similar to placebo (P = 0.50 and 0.18). The beneficial effects of vericiguat on the primary outcome were not influenced by baseline eGFR (interaction P = 0.48). WRF occurred in 15% of patients and was associated with worse outcomes (adjusted hazard ratio 1.28, 95% confidence interval 1.11-1.47; P < 0.001), but the beneficial effects of vericiguat on the primary outcome were similar in patients with or without WRF (interaction P = 0.76). CONCLUSION Renal function trajectories were similar between vericiguat- and placebo-treated patients and the beneficial effects of vericiguat on the primary outcome were consistent across the full range of eGFR and irrespective of WRF.
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Affiliation(s)
| | - Hillary Mulder
- Duke Clinical Research InstituteDuke University School of MedicineDurhamNCUSA
| | - Eugene Reyes
- University of the PhilippinesCollege of MedicineManilaPhilippines
| | - Martin R. Cowie
- Royal Brompton Hospital & School of Cardiovascular Medicine & Sciences, Faculty of Life Sciences & Medicine, King's College LondonLondonUK
| | - Johan Lassus
- Helsinki University Central HospitalHelsinkiFinland
| | - Adrian F. Hernandez
- Duke Clinical Research InstituteDuke University School of MedicineDurhamNCUSA
| | | | - Javed Butler
- University of Mississippi Medical CenterJacksonMSUSA
| | | | | | - Carolyn S.P. Lam
- National Heart Centre Singapore & Duke‐National University of SingaporeSingapore
| | - Burkert Pieske
- Charité University MedicineGerman Heart CenterBerlinGermany
| | | | | | - Kevin J. Anstrom
- Duke Clinical Research InstituteDuke University School of MedicineDurhamNCUSA
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172
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Goffredo G, Barone R, Di Terlizzi V, Correale M, Brunetti ND, Iacoviello M. Biomarkers in Cardiorenal Syndrome. J Clin Med 2021; 10:jcm10153433. [PMID: 34362216 PMCID: PMC8348334 DOI: 10.3390/jcm10153433] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Accepted: 07/29/2021] [Indexed: 01/16/2023] Open
Abstract
Cardiorenal syndrome is a clinical manifestation of the bidirectional interaction between the heart and kidney diseases. Over the last years, in patients with cardiovascular diseases, several biomarkers have been studied in order to better assess renal function as well as to identify patients prone to experiencing chronic or acute worsening of renal function. The aim of this review is to focus on the possible clinical usefulness of the most recent biomarkers in the setting of cardiorenal syndrome.
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Affiliation(s)
- Giovanni Goffredo
- Department of Medical and Surgical Sciences, University of Foggia, Viale Luigi Pinto 1, 71122 Foggia, Italy; (G.G.); (R.B.); (V.D.T.); (M.C.); (N.D.B.)
- Cardiology Unit, University Policlinic Hospital Riuniti, Viale Luigi Pinto 1, 71122 Foggia, Italy
| | - Roberta Barone
- Department of Medical and Surgical Sciences, University of Foggia, Viale Luigi Pinto 1, 71122 Foggia, Italy; (G.G.); (R.B.); (V.D.T.); (M.C.); (N.D.B.)
- Cardiology Unit, University Policlinic Hospital Riuniti, Viale Luigi Pinto 1, 71122 Foggia, Italy
| | - Vito Di Terlizzi
- Department of Medical and Surgical Sciences, University of Foggia, Viale Luigi Pinto 1, 71122 Foggia, Italy; (G.G.); (R.B.); (V.D.T.); (M.C.); (N.D.B.)
- Cardiology Unit, University Policlinic Hospital Riuniti, Viale Luigi Pinto 1, 71122 Foggia, Italy
| | - Michele Correale
- Department of Medical and Surgical Sciences, University of Foggia, Viale Luigi Pinto 1, 71122 Foggia, Italy; (G.G.); (R.B.); (V.D.T.); (M.C.); (N.D.B.)
- Cardiology Unit, University Policlinic Hospital Riuniti, Viale Luigi Pinto 1, 71122 Foggia, Italy
| | - Natale Daniele Brunetti
- Department of Medical and Surgical Sciences, University of Foggia, Viale Luigi Pinto 1, 71122 Foggia, Italy; (G.G.); (R.B.); (V.D.T.); (M.C.); (N.D.B.)
- Cardiology Unit, University Policlinic Hospital Riuniti, Viale Luigi Pinto 1, 71122 Foggia, Italy
| | - Massimo Iacoviello
- Department of Medical and Surgical Sciences, University of Foggia, Viale Luigi Pinto 1, 71122 Foggia, Italy; (G.G.); (R.B.); (V.D.T.); (M.C.); (N.D.B.)
- Cardiology Unit, University Policlinic Hospital Riuniti, Viale Luigi Pinto 1, 71122 Foggia, Italy
- Correspondence:
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173
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Tersalvi G, Gasperetti A, Schiavone M, Dauw J, Gobbi C, Denora M, Krul JD, Cioffi GM, Mitacchione G, Forleo GB. Acute heart failure in elderly patients: a review of invasive and non-invasive management. J Geriatr Cardiol 2021; 18:560-576. [PMID: 34404992 PMCID: PMC8352772 DOI: 10.11909/j.issn.1671-5411.2021.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Acute heart failure (AHF) is a major cause of unplanned hospitalisations in the elderly and is associated with high mortality. Its prevalence has grown in the last years due to population aging and longer life expectancy of chronic heart failure patients. Although international societies have provided guidelines for the management of AHF in the general population, scientific evidence for geriatric patients is often lacking, as these are underrepresented in clinical trials. Elderly have a different risk profile with more comorbidities, disability, and frailty, leading to increased morbidity, longer recovery time, higher readmission rates, and higher mortality. Furthermore, therapeutic options are often limited, due to unfeasibility of invasive strategies, mechanical circulatory support and cardiac transplantation. Thus, the in-hospital management of AHF should be tailored to each patient's clinical situation, cardiopulmonary condition and geriatric assessment. Palliative care should be considered in some cases, in order to avoid unnecessary diagnostics and/or treatments. After discharge, a strict follow-up through outpatient clinic or telemedicine is can improve quality of life and reduce rehospitalisation rates. The aim of this review is to offer an insight on current literature and provide a clinically oriented, patient-tailored approach regarding assessment, treatment and follow-up of elderly patients admitted for AHF.
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Affiliation(s)
- Gregorio Tersalvi
- Department of Internal Medicine, Hirslanden Klinik St. Anna, Lucerne, Switzerland
| | - Alessio Gasperetti
- Cardiology Unit, ASST-Fatebenefratelli Sacco, Luigi Sacco University Hospital, Milan, Italy
| | - Marco Schiavone
- Cardiology Unit, ASST-Fatebenefratelli Sacco, Luigi Sacco University Hospital, Milan, Italy
| | - Jeroen Dauw
- Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium
- Doctoral School for Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium
| | - Cecilia Gobbi
- Institut Cardiovasculaire de Caen, Hôpital Privé Saint Martin, Caen, France
| | - Marialessia Denora
- Cardiology Unit, ASST-Fatebenefratelli Sacco, Luigi Sacco University Hospital, Milan, Italy
| | - Joel Daniel Krul
- Division of Cardiology, Fondazione Cardiocentro Ticino, Lugano, Switzerland
| | - Giacomo Maria Cioffi
- Division of Cardiology, Heart Center, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Gianfranco Mitacchione
- Cardiology Unit, ASST-Fatebenefratelli Sacco, Luigi Sacco University Hospital, Milan, Italy
| | - Giovanni B. Forleo
- Cardiology Unit, ASST-Fatebenefratelli Sacco, Luigi Sacco University Hospital, Milan, Italy
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Abdin A, Böhm M. Renal function and vericiguat in heart failure patients: light at the end of the tunnel! Eur J Heart Fail 2021; 23:1322-1324. [PMID: 34173701 DOI: 10.1002/ejhf.2280] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 06/23/2021] [Indexed: 12/28/2022] Open
Affiliation(s)
- Amr Abdin
- Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Saarland University, Homburg, Germany
| | - Michael Böhm
- Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Saarland University, Homburg, Germany
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175
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Sabouret P, Attias D, Beauvais C, Berthelot E, Bouleti C, Gibault Genty G, Galat A, Hanon O, Hulot JS, Isnard R, Jourdain P, Lamblin N, Lebreton G, Lellouche N, Logeart D, Meune C, Pezel T, Damy T. Diagnosis and management of heart failure from hospital admission to discharge: A practical expert guidance. Ann Cardiol Angeiol (Paris) 2021; 71:41-52. [PMID: 34274113 DOI: 10.1016/j.ancard.2021.05.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 05/07/2021] [Indexed: 10/20/2022]
Abstract
Heart failure (HF) has high event rates, mortality, and is challenging to manage in clinical practice. Clinical management is complicated by complex therapeutic strategies in a population with a high prevalence of comorbidity and general frailty. In the last four years, an abundance of research has become available to support multidisciplinary management of heart failure from within the hospital through to discharge and primary care as well as supporting diagnosis and comorbidity management. Within the hospital setting, recent evidence supports sacubitril-valsartan combination in frail, deteriorating or de novo patients with LVEF≤40%. Furthermore, new strategies such as SGLT2 inhibitors and vericiguat provide further benefit for patients with decompensating HF. Studies with tafamidis report major clinical benefits specifically for patients with ATTR cardiac amyloidosis, a remaining underdiagnosed and undertreated disease. New evidence for medical interventions supports his bundle pacing to reduce QRS width and improve haemodynamics as well as ICD defibrillation for non-ischemic cardiomyopathy. The Mitraclip reduces hospitalisations and mortality in patients with symptomatic, secondary mitral regurgitation and ablation reduces mortality and hospitalisations in patients with paroxysmal and persistent atrial fibrillation. In end-stage HF, the 2018 French Heart Allocation policy should improve access to heart transplants for stable, ambulatory patients and, mechanical circulatory support should be considered to avoid deteriorating on the waiting list. In the community, new evidence supports that improving discharge education, treatment and patient support improves outcomes. The authors believe that this review fills the gap between the guidelines and clinical practice and provides practical recommendations to improve HF management.
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Affiliation(s)
- P Sabouret
- Heart Institute, Cardiology department, La Pitié Salpetrière Hospital, Sorbonne University, Paris, France
| | - D Attias
- Cardiology department, Centre Cardiologique du Nord, Saint-Denis, France
| | - C Beauvais
- Cardiology department, La Riboisière Hospital, Inserm UMRS 942, University of Paris, Paris, France
| | - E Berthelot
- Cardiology department, Kremlin Bicêtre Hospital, Paris-Saclay University, Le Kremlin Bicêtre, France
| | - C Bouleti
- Cardiology department, Poitiers University Hospital, CIC INSERM 1402, Poitiers, France
| | - G Gibault Genty
- Cardiology department, André Mignot Hospital, Le Chesnay, France
| | - A Galat
- Cardiology department, University Hospital Henri Mondor, UPEC, Créteil, France
| | - O Hanon
- Geriatrics Department, Hospital Broca, Paris Descartes University, Paris, France
| | - J S Hulot
- Pharmacology Department, Georges-Pompidou European Hospital, INSERM, PARCC, CIC1418 Paris-Descartes University, Paris, France
| | - R Isnard
- Heart Institute, Cardiology department, La Pitié Salpetrière Hospital, Sorbonne University, Paris, France
| | - P Jourdain
- Cardiology department, Kremlin Bicêtre Hospital, Paris-Saclay University, Le Kremlin Bicêtre, France
| | - N Lamblin
- Cardiology Department, University Hospital, Lille, France
| | - G Lebreton
- Heart Institute, Cardiac Surgery department, La Pitié Salpêtrière Hospital, Sorbonne University, Paris, France
| | - N Lellouche
- Cardiology department, University Hospital Henri Mondor, UPEC, Créteil, France
| | - D Logeart
- Cardiology department, La Riboisière Hospital, Inserm UMRS 942, University of Paris, Paris, France
| | - C Meune
- Department of Cardiology, Avicenne Hospital, Paris 13 University, Bobigny, France
| | - T Pezel
- Cardiology department, La Riboisière Hospital, Inserm UMRS 942, University of Paris, Paris, France
| | - T Damy
- Cardiology department, University Hospital Henri Mondor, UPEC, Créteil, France.
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176
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Díez J, Navarro-González JF, Ortiz A, Santamaría R, de Sequera P. Developing the subspecialty of cardio-nephrology: The time has come. A position paper from the coordinating committee from the Working Group for Cardiorenal Medicine of the Spanish Society of Nephrology. Nefrologia 2021; 41:391-402. [PMID: 36165108 DOI: 10.1016/j.nefroe.2021.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 02/21/2021] [Indexed: 06/16/2023] Open
Abstract
Patients with the dual burden of chronic kidney disease (CKD) and cardiovascular disease (CVD) experience unacceptably high rates of morbidity and mortality, which also entail unfavorable effects on healthcare systems. Currently, concerted efforts to identify, prevent and treat CVD in CKD patients are lacking at the institutional level, with emphasis still being placed on individual specialty views on this topic. The authors of this position paper endorse the need for a dedicated interdisciplinary team of subspecialists in cardio-nephrology that manages appropriate clinical interventions across the inpatient and outpatient settings. There is a critical need for training programs, guidelines and best clinical practice models, and research funding from nephrology, cardiology and other professional societies, to support the development of the subspecialty of cardio-nephrology. This position paper from the coordinating committee from the Working Group for Cardiorenal Medicine of the Spanish Society of Nephrology (S.E.N.) is intended to be the starting point to develop the subspecialty of cardio-nephrology within the S.E.N.. The implementation of the subspecialty in day-to-day nephrological practice will help to diagnose, treat, and prevent CVD in CKD patients in a precise, clinically effective, and health cost-favorable manner.
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Affiliation(s)
- Javier Díez
- Departments of Nephrology and Cardiology, University of Navarra Clinic, Pamplona, Spain; Program of Cardiovascular Diseases, Center of Applied Medical Research, University of Navarra, Pamplona, Spain.
| | - Juan F Navarro-González
- Division of Nephrology and Research Unit, University Hospital Nuestra Señora de Candelaria, and Universitary Institute of Biomedical Technologies, University of La Laguna, Santa Cruz de Tenerife, Spain; Red de Investigación Renal (REDINREN), Madrid, Spain
| | - Alberto Ortiz
- Red de Investigación Renal (REDINREN), Madrid, Spain; Division of Nephrology IIS-Fundacion Jimenez Diaz, University Autonoma of Madrid, Madrid, Spain
| | - Rafael Santamaría
- Red de Investigación Renal (REDINREN), Madrid, Spain; Division of Nephrology, University Hospital Reina Sofia, Cordoba, Spain; Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Spain
| | - Patricia de Sequera
- Nephrology Department, Hospital Universitario Infanta Leonor, University Complutense of Madrid, Madrid, Spain
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177
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Slart RHJA, Tsoumpas C, Glaudemans AWJM, Noordzij W, Willemsen ATM, Borra RJH, Dierckx RAJO, Lammertsma AA. Long axial field of view PET scanners: a road map to implementation and new possibilities. Eur J Nucl Med Mol Imaging 2021; 48:4236-4245. [PMID: 34136956 PMCID: PMC8566640 DOI: 10.1007/s00259-021-05461-6] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 06/09/2021] [Indexed: 02/01/2023]
Abstract
In this contribution, several opportunities and challenges for long axial field of view (LAFOV) PET are described. It is an anthology in which the main issues have been highlighted. A consolidated overview of the camera system implementation, business and financial plan, opportunities and challenges is provided. What the nuclear medicine and molecular imaging community can expect from these new PET/CT scanners is the delivery of more comprehensive information to the clinicians for advancing diagnosis, therapy evaluation and clinical research.
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Affiliation(s)
- Riemer H J A Slart
- Medical Imaging Center, Department of Nuclear Medicine and Molecular, University of Groningen, University Medical Center Groningen, Hanzeplein 1, PO 9700 RB, Groningen, The Netherlands. .,Department of Biomedical Photonic Imaging, Faculty of Science and Technology, University of Twente, Enschede, The Netherlands.
| | - Charalampos Tsoumpas
- Medical Imaging Center, Department of Nuclear Medicine and Molecular, University of Groningen, University Medical Center Groningen, Hanzeplein 1, PO 9700 RB, Groningen, The Netherlands.,Leeds Institute of Cardiovascular and Metabolic Medicine, School of Medicine, University of Leeds, Leeds, UK
| | - Andor W J M Glaudemans
- Medical Imaging Center, Department of Nuclear Medicine and Molecular, University of Groningen, University Medical Center Groningen, Hanzeplein 1, PO 9700 RB, Groningen, The Netherlands
| | - Walter Noordzij
- Medical Imaging Center, Department of Nuclear Medicine and Molecular, University of Groningen, University Medical Center Groningen, Hanzeplein 1, PO 9700 RB, Groningen, The Netherlands
| | - Antoon T M Willemsen
- Medical Imaging Center, Department of Nuclear Medicine and Molecular, University of Groningen, University Medical Center Groningen, Hanzeplein 1, PO 9700 RB, Groningen, The Netherlands
| | - Ronald J H Borra
- Medical Imaging Center, Department of Nuclear Medicine and Molecular, University of Groningen, University Medical Center Groningen, Hanzeplein 1, PO 9700 RB, Groningen, The Netherlands
| | - Rudi A J O Dierckx
- Medical Imaging Center, Department of Nuclear Medicine and Molecular, University of Groningen, University Medical Center Groningen, Hanzeplein 1, PO 9700 RB, Groningen, The Netherlands
| | - Adriaan A Lammertsma
- Medical Imaging Center, Department of Nuclear Medicine and Molecular, University of Groningen, University Medical Center Groningen, Hanzeplein 1, PO 9700 RB, Groningen, The Netherlands
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178
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Caravaca Pérez P, Nuche J, Morán Fernández L, Lora D, Blázquez-Bermejo Z, López-Azor JC, de Juan Bagudá J, García-Cosío Carmena MD, Escribano Subías P, Salguero-Bodes R, Arribas Ynsaurriaga F, Delgado JF. Potential Role of Natriuretic Response to Furosemide Stress Test During Acute Heart Failure. Circ Heart Fail 2021; 14:e008166. [PMID: 34129364 DOI: 10.1161/circheartfailure.120.008166] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Poor natriuresis has been associated with a poorer response to diuretic treatment and worse prognosis in acute heart failure. Recommendations on how and when to measure urinary sodium (UNa) are lacking. We aim to evaluate UNa quantification after a furosemide stress test (FST) capacity to predict appropriate decongestion during acute heart failure hospitalization. METHODS Patients underwent an FST on day-1 of admission, and UNa was measured 2 hours after, dividing patients into low or high UNa based on the sample median value. A semiquantitative composite congestive score (CCS; 0-9) and NT pro-BNP (N-terminal pro-B-type natriuretic peptide) quantification were assessed before the FST and at day 5 after the FST. RESULTS Median UNa after FST in the 65 patients included was 113 (97-122) mmol/L. At day 5, a lower proportion of patients with a low UNa reached a 30% decrease in NT-proBNP levels (21 [66%] for low UNa versus 31 [94%] for high UNa; P=0.005) and an appropriate grade of decongestion (CCS<3) (20 [62%] for low UNa versus 32 [97%] for high UNa; P<0.001). A UNa>83 mmol/L 2 hours after FST had a 96% sensitivity to predict an NT-proBNP reduction ≥30% and 95% to predict a CCS<3 at day 5. Low UNa patients presented a lower cumulative diuresis and weight loss and presented more often with prolonged hospitalization, worsening heart failure, and readmission because of acute heart failure or death at 6 months. CONCLUSIONS Low natriuresis after an FST identified patients at a higher risk of an inadequate diuretic response and an inappropriate decongestion. FST-guided diuretic treatment might help to improve decongestion, shorten hospitalizations, and to reduce adverse outcomes.
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Affiliation(s)
- Pedro Caravaca Pérez
- Servicio de Cardiología, Hospital Universitario 12 de Octubre, Madrid, Spain (P.C.P., J.N., L.M.F., Z.B.-B., J.C.L.-A., J.d.J.B., M.D.G.-C.C., P.E.S., R.S.-B., F.A.Y., J.F.D.).,Centro de Investigaciones Biomédicas En Red de enfermedades CardioVasculares (CIBERCV), Spain (P.C.P., J.N., L.M.F., J.C.L.-A., J.d.J.B., M.D.G.-C.C., P.E.S., R.S.-B., F.A.Y., J.F.D.).,Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain (P.C.P., J.N., L.M.F., D.L., Z.B.-B., J.C.L-A., J.d.J.B., M.D.G.-C.C., P.E.S., R.S.-B., F.A.Y., J.F.D.)
| | - Jorge Nuche
- Servicio de Cardiología, Hospital Universitario 12 de Octubre, Madrid, Spain (P.C.P., J.N., L.M.F., Z.B.-B., J.C.L.-A., J.d.J.B., M.D.G.-C.C., P.E.S., R.S.-B., F.A.Y., J.F.D.).,Centro de Investigaciones Biomédicas En Red de enfermedades CardioVasculares (CIBERCV), Spain (P.C.P., J.N., L.M.F., J.C.L.-A., J.d.J.B., M.D.G.-C.C., P.E.S., R.S.-B., F.A.Y., J.F.D.).,Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain (J.N.).,Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain (P.C.P., J.N., L.M.F., D.L., Z.B.-B., J.C.L-A., J.d.J.B., M.D.G.-C.C., P.E.S., R.S.-B., F.A.Y., J.F.D.)
| | - Laura Morán Fernández
- Servicio de Cardiología, Hospital Universitario 12 de Octubre, Madrid, Spain (P.C.P., J.N., L.M.F., Z.B.-B., J.C.L.-A., J.d.J.B., M.D.G.-C.C., P.E.S., R.S.-B., F.A.Y., J.F.D.).,Centro de Investigaciones Biomédicas En Red de enfermedades CardioVasculares (CIBERCV), Spain (P.C.P., J.N., L.M.F., J.C.L.-A., J.d.J.B., M.D.G.-C.C., P.E.S., R.S.-B., F.A.Y., J.F.D.).,Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain (P.C.P., J.N., L.M.F., D.L., Z.B.-B., J.C.L-A., J.d.J.B., M.D.G.-C.C., P.E.S., R.S.-B., F.A.Y., J.F.D.)
| | - David Lora
- Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain (P.C.P., J.N., L.M.F., D.L., Z.B.-B., J.C.L-A., J.d.J.B., M.D.G.-C.C., P.E.S., R.S.-B., F.A.Y., J.F.D.)
| | - Zorba Blázquez-Bermejo
- Servicio de Cardiología, Hospital Universitario 12 de Octubre, Madrid, Spain (P.C.P., J.N., L.M.F., Z.B.-B., J.C.L.-A., J.d.J.B., M.D.G.-C.C., P.E.S., R.S.-B., F.A.Y., J.F.D.).,Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain (P.C.P., J.N., L.M.F., D.L., Z.B.-B., J.C.L-A., J.d.J.B., M.D.G.-C.C., P.E.S., R.S.-B., F.A.Y., J.F.D.)
| | - Juan Carlos López-Azor
- Servicio de Cardiología, Hospital Universitario 12 de Octubre, Madrid, Spain (P.C.P., J.N., L.M.F., Z.B.-B., J.C.L.-A., J.d.J.B., M.D.G.-C.C., P.E.S., R.S.-B., F.A.Y., J.F.D.).,Centro de Investigaciones Biomédicas En Red de enfermedades CardioVasculares (CIBERCV), Spain (P.C.P., J.N., L.M.F., J.C.L.-A., J.d.J.B., M.D.G.-C.C., P.E.S., R.S.-B., F.A.Y., J.F.D.).,Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain (P.C.P., J.N., L.M.F., D.L., Z.B.-B., J.C.L-A., J.d.J.B., M.D.G.-C.C., P.E.S., R.S.-B., F.A.Y., J.F.D.)
| | - Javier de Juan Bagudá
- Servicio de Cardiología, Hospital Universitario 12 de Octubre, Madrid, Spain (P.C.P., J.N., L.M.F., Z.B.-B., J.C.L.-A., J.d.J.B., M.D.G.-C.C., P.E.S., R.S.-B., F.A.Y., J.F.D.).,Centro de Investigaciones Biomédicas En Red de enfermedades CardioVasculares (CIBERCV), Spain (P.C.P., J.N., L.M.F., J.C.L.-A., J.d.J.B., M.D.G.-C.C., P.E.S., R.S.-B., F.A.Y., J.F.D.).,Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain (P.C.P., J.N., L.M.F., D.L., Z.B.-B., J.C.L-A., J.d.J.B., M.D.G.-C.C., P.E.S., R.S.-B., F.A.Y., J.F.D.)
| | - María Dolores García-Cosío Carmena
- Servicio de Cardiología, Hospital Universitario 12 de Octubre, Madrid, Spain (P.C.P., J.N., L.M.F., Z.B.-B., J.C.L.-A., J.d.J.B., M.D.G.-C.C., P.E.S., R.S.-B., F.A.Y., J.F.D.).,Centro de Investigaciones Biomédicas En Red de enfermedades CardioVasculares (CIBERCV), Spain (P.C.P., J.N., L.M.F., J.C.L.-A., J.d.J.B., M.D.G.-C.C., P.E.S., R.S.-B., F.A.Y., J.F.D.).,Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain (P.C.P., J.N., L.M.F., D.L., Z.B.-B., J.C.L-A., J.d.J.B., M.D.G.-C.C., P.E.S., R.S.-B., F.A.Y., J.F.D.)
| | - Pilar Escribano Subías
- Servicio de Cardiología, Hospital Universitario 12 de Octubre, Madrid, Spain (P.C.P., J.N., L.M.F., Z.B.-B., J.C.L.-A., J.d.J.B., M.D.G.-C.C., P.E.S., R.S.-B., F.A.Y., J.F.D.).,Centro de Investigaciones Biomédicas En Red de enfermedades CardioVasculares (CIBERCV), Spain (P.C.P., J.N., L.M.F., J.C.L.-A., J.d.J.B., M.D.G.-C.C., P.E.S., R.S.-B., F.A.Y., J.F.D.).,Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain (P.C.P., J.N., L.M.F., D.L., Z.B.-B., J.C.L-A., J.d.J.B., M.D.G.-C.C., P.E.S., R.S.-B., F.A.Y., J.F.D.).,Facultad de Medicina, Universidad Complutense de Madrid, Spain (P.E.S., R.S.-B., F.A.Y., J.F.D.)
| | - Rafael Salguero-Bodes
- Servicio de Cardiología, Hospital Universitario 12 de Octubre, Madrid, Spain (P.C.P., J.N., L.M.F., Z.B.-B., J.C.L.-A., J.d.J.B., M.D.G.-C.C., P.E.S., R.S.-B., F.A.Y., J.F.D.).,Centro de Investigaciones Biomédicas En Red de enfermedades CardioVasculares (CIBERCV), Spain (P.C.P., J.N., L.M.F., J.C.L.-A., J.d.J.B., M.D.G.-C.C., P.E.S., R.S.-B., F.A.Y., J.F.D.).,Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain (P.C.P., J.N., L.M.F., D.L., Z.B.-B., J.C.L-A., J.d.J.B., M.D.G.-C.C., P.E.S., R.S.-B., F.A.Y., J.F.D.).,Facultad de Medicina, Universidad Complutense de Madrid, Spain (P.E.S., R.S.-B., F.A.Y., J.F.D.)
| | - Fernando Arribas Ynsaurriaga
- Servicio de Cardiología, Hospital Universitario 12 de Octubre, Madrid, Spain (P.C.P., J.N., L.M.F., Z.B.-B., J.C.L.-A., J.d.J.B., M.D.G.-C.C., P.E.S., R.S.-B., F.A.Y., J.F.D.).,Centro de Investigaciones Biomédicas En Red de enfermedades CardioVasculares (CIBERCV), Spain (P.C.P., J.N., L.M.F., J.C.L.-A., J.d.J.B., M.D.G.-C.C., P.E.S., R.S.-B., F.A.Y., J.F.D.).,Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain (P.C.P., J.N., L.M.F., D.L., Z.B.-B., J.C.L-A., J.d.J.B., M.D.G.-C.C., P.E.S., R.S.-B., F.A.Y., J.F.D.).,Facultad de Medicina, Universidad Complutense de Madrid, Spain (P.E.S., R.S.-B., F.A.Y., J.F.D.)
| | - Juan F Delgado
- Servicio de Cardiología, Hospital Universitario 12 de Octubre, Madrid, Spain (P.C.P., J.N., L.M.F., Z.B.-B., J.C.L.-A., J.d.J.B., M.D.G.-C.C., P.E.S., R.S.-B., F.A.Y., J.F.D.).,Centro de Investigaciones Biomédicas En Red de enfermedades CardioVasculares (CIBERCV), Spain (P.C.P., J.N., L.M.F., J.C.L.-A., J.d.J.B., M.D.G.-C.C., P.E.S., R.S.-B., F.A.Y., J.F.D.).,Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain (P.C.P., J.N., L.M.F., D.L., Z.B.-B., J.C.L-A., J.d.J.B., M.D.G.-C.C., P.E.S., R.S.-B., F.A.Y., J.F.D.).,Facultad de Medicina, Universidad Complutense de Madrid, Spain (P.E.S., R.S.-B., F.A.Y., J.F.D.)
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179
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Bogaert J, Symons R, Rafouli-Stergiou P, Droogné W, Dresselaers T, Masci PG. Assessment of Right-Sided Heart Failure in Patients with Dilated Cardiomyopathy using Magnetic Resonance Relaxometry of the Liver. Am J Cardiol 2021; 149:103-111. [PMID: 33762175 DOI: 10.1016/j.amjcard.2021.03.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 03/01/2021] [Accepted: 03/05/2021] [Indexed: 02/07/2023]
Abstract
In non-ischemic dilated cardiomyopathy (DC) patients at risk of developing right heart failure (RHF), early depiction of congestive heart failure (CHF) is pivotal to inform about the hemodynamic status and tailor medical therapy. We hypothesized increased liver relaxation times measured at routine cardiovascular magnetic resonance (CMR), reflecting passive hepatic congestion, may be a valuable imaging biomarker to depict congestive heart failure. The study cohort consisted of DC patients with LV dysfunction (i.e., ejection fraction <35%) with (n = 48) and without (n = 46) right ventricular dysfunction (RVD), defined as a right ventricular ejection fraction <35%, and >45%, respectively, and a control group (n = 40). Native T1, T2, and extracellular volume (ECV) liver values were measured on routinely acquired cardiac maps. DC+RVD patients had higher C-reactive protein, troponin I and NT-pro BNP values, and worse LV functional parameters than DC-RVD patients (all p <0.001). T1, T2 and ECV Liver values were significantly higher in DC+RVD compared to DC-RVD patients and controls, that is, T1: 675 ± 88 ms verses 538 ± 39 ms and 540 ± 34 ms; T2: 54± 8 ms versus 45 ± 5 ms and 46 ± 4 ms; ECV: 36 ± 7% versus 29 ± 4% and 30 ± 3% (all p <0.001). Gamma-glutamyltranspeptidase (GGT) correlated moderately but significantly with native T1 (r2 = 0.34), T2 (r2 = 0.27), and ECV liver (r2 = 0.23) (all p <0.001). Using right atrial (RA) pressure, as surrogate measure of RHF (i.e., RA pressure >5 mm Hg), native T1 liver yielded at ROC analysis the highest area under the curve (0.906), significantly higher than ECV liver (0.813), GGT (0.806), T2 liver (0.797), total bilirubin (0.737) and alkaline phosphatase (0.561)(p = 0.04). A T1 value of 617 ms yielded a sensitivity of 79.5% and specificity of 91.0% to depict RHF. Excellent intra-/inter-observer agreement was found for assessment of native T1/T2/ECV liver values. In conclusion, in DC patients, assessment of liver relaxation times acquired on a cardiovascular magnetic resonance exam, may provide valuable information with regard to the presence of RHF.
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Affiliation(s)
- Jan Bogaert
- Department of Imaging and Pathology, KU Leuven and Dept of Radiology, University Hospitals Leuven, Leuven, Belgium.
| | - Rolf Symons
- Department of Imaging and Pathology, KU Leuven and Dept of Radiology, University Hospitals Leuven, Leuven, Belgium
| | - Pinelopi Rafouli-Stergiou
- Department of Imaging and Pathology, KU Leuven and Dept of Radiology, University Hospitals Leuven, Leuven, Belgium
| | - Walter Droogné
- Department of Cardiovascular Sciences, KU Leuven and Dept of Cardiovascular Diseases, University Hospitals Leuven, Leuven, Belgium
| | - Tom Dresselaers
- Department of Imaging and Pathology, KU Leuven and Dept of Radiology, University Hospitals Leuven, Leuven, Belgium
| | - Pier Giorgio Masci
- School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas Hospital, London, United Kingdom
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180
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Palazzuoli A, Tecson KM, Ronco C, McCullough PA. Nomenclature for Kidney Function from KDIGO: Shortcomings of Terminology Oversimplification. Cardiorenal Med 2021; 11:119-122. [PMID: 34091445 DOI: 10.1159/000516615] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 04/16/2021] [Indexed: 11/19/2022] Open
Abstract
The recent Kidney Disease: Improving Global Outcomes (KDIGO) consensus conference proposed a universal nomenclature calling for "Kidney Disease" (KD) to be applied to every form of kidney dysfunction, regardless of etiology. We recognize that the estimated glomerular filtration rate and urine albumin:creatinine ratio are limited in their application to the broad spectrum of KD. However, there are additional in vitro and advanced diagnostic options that can help identify the underlying cause of KD and inform about prognosis and management. While the overarching benefit of generalizing KD as a medical problem lies with screening and detection, the downsides attributable to a nonexact diagnosis (i.e., unclear prognosis and management strategy) are considerable. Finally, the terms "acute kidney injury" and "worsening renal function" are currently used interchangeably by nephrologists and cardiologists alike, and a universal adoption of one term will likely be a sizeable challenge. To be of greater benefit, we propose KD be used as a starting point and that the etiology and other epigenetic determinants of illness continue to be evaluated and characterized.
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Affiliation(s)
- Alberto Palazzuoli
- Department of Internal Medicine, Cardiovascular Diseases Unit, Le Scotte Hospital University of Siena, Siena, Italy
| | - Kristen M Tecson
- Baylor Heart and Vascular Institute, Baylor Scott & White Research Institute, Dallas, Texas, USA.,Department of Internal Medicine, Texas A&M University Health Science Center College of Medicine, Dallas, Texas, USA
| | - Claudio Ronco
- Department of Nephrology, San Bortolo Hospital and International Renal Research Institute of Vicenza (IRRIV), Vicenza, Italy
| | - Peter A McCullough
- Department of Internal Medicine, Texas A&M University Health Science Center College of Medicine, Dallas, Texas, USA
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181
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Bueno H, Moura B, Lancellotti P, Bauersachs J. The year in cardiovascular medicine 2020: heart failure and cardiomyopathies. Eur Heart J 2021; 42:657-670. [PMID: 33388764 DOI: 10.1093/eurheartj/ehaa1061] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 11/26/2020] [Accepted: 12/22/2020] [Indexed: 12/22/2022] Open
Affiliation(s)
- Héctor Bueno
- Multidisciplinary Translational Cardiovascular Research Group. Centro Nacional de Investigaciones Cardiovasculares (CNIC), Melchor Fernández Almagro, 3, Madrid 28029, Spain.,Cardiology Department, Hospital Universitario 12 de Octubre and Instituto de Investigación Sanitaria Hospital, 12 de Octubre (imas12), Madrid, Spain.,Centro de Investigación Biomédica en Red Enfermedades Cardiovaculares (CIBERCV), Madrid, Spain.,Facultad de Medicina, Universidad Complutense de Madrid, Plaza de Ramón y Cajal, s/n, 28040 Madrid, Spain
| | - Brenda Moura
- Cardiology Department, Military Hospital, Av. da Boavista S/N, 4050-115 Porto, Portugal.,CINTESIS-Center for Health Technology and Services Research, R. Dr. Plácido da Costa, 4200-450 Porto, Portugal
| | - Patrizio Lancellotti
- Department of Cardiology, CHU SartTilman, University of Liège Hospital, GIGA Cardiovascular Sciences, Avenue de L'Hôpital 1, 4000 Liège, Belgium.,Cardiology Departments, Gruppo Villa Maria Care and Research, Maria Cecilia Hospital, Cotignola Bari, Italy and Via Corriera, 1, 48033 Cotignola RA, Italy and Anthea Hospital, Via Camillo Rosalba, 35/37, 70124 Bari BA, Italy
| | - Johann Bauersachs
- Department of Cardiology and Angiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
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182
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Rosano GMC, Moura B, Metra M, Böhm M, Bauersachs J, Ben Gal T, Adamopoulos S, Abdelhamid M, Bistola V, Čelutkienė J, Chioncel O, Farmakis D, Ferrari R, Filippatos G, Hill L, Jankowska EA, Jaarsma T, Jhund P, Lainscak M, Lopatin Y, Lund LH, Milicic D, Mullens W, Pinto F, Ponikowski P, Savarese G, Thum T, Volterrani M, Anker SD, Seferovic PM, Coats AJS. Patient profiling in heart failure for tailoring medical therapy. A consensus document of the Heart Failure Association of the European Society of Cardiology. Eur J Heart Fail 2021; 23:872-881. [PMID: 33932268 DOI: 10.1002/ejhf.2206] [Citation(s) in RCA: 129] [Impact Index Per Article: 43.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 04/17/2021] [Accepted: 04/29/2021] [Indexed: 12/22/2022] Open
Abstract
Despite guideline recommendations and available evidence, implementation of treatment in heart failure (HF) is poor. The majority of patients are not prescribed drugs at target doses that have been proven to positively impact morbidity and mortality. Among others, tolerability issues related to low blood pressure, heart rate, impaired renal function or hyperkalaemia are responsible. Chronic kidney disease plays an important role as it affects up to 50% of patients with HF. Also, dynamic changes in estimated glomerular filtration rate may occur during the course of HF, resulting in inappropriate dose reduction or even discontinuation of decongestive or neurohormonal modulating therapy in clinical practice. As patients with HF are rarely naïve to pharmacologic therapies, the challenge is to adequately prioritize or select the most appropriate up-titration schedule according to patient profile. In this consensus document, we identified nine patient profiles that may be relevant for treatment implementation in HF patients with a reduced ejection fraction. These profiles take into account heart rate (<60 bpm or >70 bpm), the presence of atrial fibrillation, symptomatic low blood pressure, estimated glomerular filtration rate (<30 or >30 mL/min/1.73 m2 ) or hyperkalaemia. The pre-discharge patient, frequently still congestive, is also addressed. A personalized approach, adjusting guideline-directed medical therapy to patient profile, may allow to achieve a better and more comprehensive therapy for each individual patient than the more traditional, forced titration of each drug class before initiating treatment with the next.
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Affiliation(s)
| | - Brenda Moura
- Armed Forces Hospital, Porto, Portugal.,Faculty of Medicine, University of Porto, Porto, Portugal
| | - Marco Metra
- Department of Medical and Surgical Specialities, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | | | - Johann Bauersachs
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Tuvia Ben Gal
- Department of Cardiology, Rabin Medical Centre, Petah Tikva, Israel
| | | | - Magdy Abdelhamid
- Faculty of Medicine, Department of Cardiology, Cairo University, Giza, Egypt
| | - Vasiliki Bistola
- Department of Cardiology, Attikon University Hospital, University of Athens Medical School, Athens, Greece
| | - Jelena Čelutkienė
- Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, State Research Institute Centre for Innovative Medicine, Vilnius, Lithuania
| | - Ovidiu Chioncel
- University of Medicine Carol Davila, Bucharest, Romania.,Emergency Institute for Cardiovascular Diseases 'Prof. C.C. Iliescu', Bucharest, Romania
| | | | - Roberto Ferrari
- Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy.,Centro Cardiologico Universitario di Ferrara, University of Ferrara, Ferrara, Italy
| | - Gerasimos Filippatos
- National and Kapodistrian University of Athens, School of Medicine, University Hospital Attikon, Athens, Greece
| | - Loreena Hill
- School of Nursing and Midwifery, Queen's University Belfast, Northern Ireland, UK
| | - Ewa A Jankowska
- Department of Heart Diseases, Wroclaw Medical University and Center for Heart Diseases, University Hospital in Wroclaw, Wroclaw, Poland
| | - Tiny Jaarsma
- Department of Health, Medicine and Caring Sciences, Linkoping University, Linköping, Sweden.,Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Pardeep Jhund
- Institute of Cardiovascular and Medical Sciences, Glasgow, UK
| | - Mitja Lainscak
- Division of Cardiology, General Hospital Murska Sobota, Murska Sobota, Slovenia.,Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Yuri Lopatin
- Volgograd State Medical University, Regional Cardiology Centre Volgograd, Volgograd, Russian Federation
| | - Lars H Lund
- Department of Medicine, Karolinska Institutet, and Heart and Vascular Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Davor Milicic
- University of Zagreb School of Medicine, Zagreb, Croatia
| | - Wilfried Mullens
- Faculty of Medicine and Life Sciences, BIOMED - Biomedical Research Institute, Hasselt University, Diepenbeek, Belgium.,Department of Cardiology, Ziekenhuis Oost, Genk, Belgium
| | - Fausto Pinto
- Cardiology Department, University Hospital Santa Maria (CHULN), CAML, CCUL, Faculty of Medicine, University of Lisbon, Lisbon, Portugal
| | - Piotr Ponikowski
- Centre for Heart Diseases, Faculty of Health Sciences, Wroclaw Medical University, Wroclaw, Poland
| | - Gianluigi Savarese
- Department of Medicine, Karolinska Institutet, and Heart and Vascular Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Thomas Thum
- Hannover Medical School, Institute of Molecular and Translational Therapeutic Strategies, Hannover, Germany
| | | | - Stefan D Anker
- Department of Cardiology (CVK); and Berlin Institute of Health Center for Regenerative Therapies (BCRT); German Centre for Cardiovascular Research (DZHK) partner site Berlin; Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Petar M Seferovic
- Department Faculty of Medicine, University of Belgrade, Belgrade, Serbia.,Serbian Academy of Sciences and Arts, Belgrade, Serbia
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183
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Kataoka H. Arginine Vasopressin as an Important Mediator of Fluctuations in the Serum Creatinine Concentration Under Decongestion Treatment in Heart Failure Patients. Circ Rep 2021; 3:324-332. [PMID: 34136707 PMCID: PMC8180366 DOI: 10.1253/circrep.cr-21-0005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 04/05/2021] [Accepted: 04/11/2021] [Indexed: 11/25/2022] Open
Abstract
Background: The mechanism underlying serum creatinine (SCr) fluctuations in heart failure (HF) patients remains unclear. This study examined mediators of SCr fluctuations under diuretic treatment in HF patients. Methods and Results: Data from 26 HF patients were analyzed. Clinical tests included measurement of peripheral blood, blood urea nitrogen, SCr, serum and urinary electrolytes, B-type natriuretic peptide (BNP), and plasma neurohormones. Among the 26 patients recovering from worsening HF, changes in SCr were negatively correlated with changes in serum Cl, and positively correlated with changes in plasma arginine vasopressin (AVP). According to the median change in SCr, patients were divided into high (range 0.16-0.79 mg/dL; n=13) and low (range -0.35 to 0.14 mg/dL; n=13) change groups. Plasma AVP concentrations after treatment decreased in the low SCr change group and increased in the high SCr change group (-1.28±2.8 vs. 2.14±4.4 pg/mL, respectively; P=0.027). In both groups, there was no change in plasma volume, plasma BNP and norepinephrine concentrations decreased, and plasma renin activity increased after treatment. Multivariate logistic regression analysis showed a tendency towards an independent association between an increase in SCr and an increase or no change in the plasma AVP after decongestion (odds ratio 4.44; 95% confidence interval 0.81-24.3; P=0.086). Conclusions: Plasma AVP appears to be a physiologically important mediator of SCr fluctuations under decongestion treatment in HF patients.
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184
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Martens P, Ferreira JP, Vincent J, Abreu P, Busselen M, Mullens W, Tang WWH, Böhm M, Pitt B, Zannad F, Rossignol P. Serum sodium and eplerenone use in patients with a myocardial infarction and left ventricular dysfunction or heart failure: insights from the EPHESUS trial. Clin Res Cardiol 2021; 111:380-392. [PMID: 33893561 DOI: 10.1007/s00392-021-01853-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 04/01/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Sodium changes are common in myocardial infarction (MI) complicated with left ventricular systolic dysfunction (LVSD) and/or heart failure (HF). Sodium handling is fine-tuned in the distal nephron, were eplerenone exhibits some of its pleotropic effects. Little is known about the effect of eplerenone on serum sodium and the prognostic relevance of sodium alterations in patients with MI complicated with LVSD and/or HF. METHODS The EPHESUS trial randomized 6632 patients to either eplerenone or placebo. Hyponatremia and hypernatremia were defined as sodium < 135 mmol/L or > 145 mmol/L, respectively. Linear mixed models and time updated Cox regression analysis were used to determine the effect of eplerenone on sodium changes and the prognostic importance of sodium changes, respectively. The primary outcomes were all-cause mortality and a composite of cardiovascular (CV) mortality and CV-hospitalization. RESULTS A total of 6221 patients had a post-baseline sodium measurement, 797 patients developed hyponatremia (mean of 0.2 events/per patient) and 1476 developed hypernatremia (mean of 0.4 events/per patient). Patients assigned to eplerenone had a lower mean serum sodium over the follow-up (140 vs 141 mmol/L; p < 0.0001) and more often developed hyponatremia episodes (15 vs 11% p = 0.0001) and less often hypernatremia episodes (22 vs. 26% p = 0.0003). Hyponatremia, but not hypernatremia was associated with adverse outcome for all outcome endpoints in the placebo group but not in the eplerenone group (interaction p value < 0.05 for all). Baseline sodium values did not influence the treatment effect of eplerenone in reducing the various endpoints (interaction p value > 0.05 for all). Development of new-onset hyponatremia following eplerenone initiation did not diminish the beneficial eplerenone treatment effect. CONCLUSION Eplerenone induces minor reductions in serum sodium. The beneficial effect of eplerenone was maintained regardless of the baseline serum sodium or the development of hyponatremia. Sodium alterations should not refrain clinicians from prescribing eplerenone to patients who had an MI complicated with LVSD and/or HF. TRAIL REGISTRY ClinicalTrials.gov identifier: NCT00232180. Serum sodium and eplerenone use in patients with a myocardial infarction and left ventricular dysfunction or heart failure: insights from the EPHESUS trial.
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Affiliation(s)
- Pieter Martens
- Department of Cardiology, Ziekenhuis Oost Limburg, Genk, Belgium.,Department of Medicine and Life Sciences, University Hasselt, Hasselt, Belgium
| | - João Pedro Ferreira
- Centre d'Investigation Clinique 1433 module Plurithematique, Institut Lorrain du Coeur et des Vaisseaux Louis Mathieu, F-CRIN INI-CRCT Network, Universite de Lorraine, Inserm U1116, 4 rue du Morvan, 54500, Vandoeuvre les Nancy, France
| | | | | | | | - Wilfried Mullens
- Department of Cardiology, Ziekenhuis Oost Limburg, Genk, Belgium.,Department of Medicine and Life Sciences, University Hasselt, Hasselt, Belgium
| | - Wilson W H Tang
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Michael Böhm
- Klinik Für Innere Medizin III, Saarland University, Saarbrücken, Germany
| | | | - Faiez Zannad
- Centre d'Investigation Clinique 1433 module Plurithematique, Institut Lorrain du Coeur et des Vaisseaux Louis Mathieu, F-CRIN INI-CRCT Network, Universite de Lorraine, Inserm U1116, 4 rue du Morvan, 54500, Vandoeuvre les Nancy, France
| | - Patrick Rossignol
- Centre d'Investigation Clinique 1433 module Plurithematique, Institut Lorrain du Coeur et des Vaisseaux Louis Mathieu, F-CRIN INI-CRCT Network, Universite de Lorraine, Inserm U1116, 4 rue du Morvan, 54500, Vandoeuvre les Nancy, France.
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185
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Díez J, Navarro-González JF, Ortiz A, Santamaría R, de Sequera P. Developing the subspecialty of cardio-nephrology: The time has come. A position paper from the coordinating committee from the Working Group for Cardiorenal Medicine of the Spanish Society of Nephrology. Nefrologia 2021. [PMID: 33892978 DOI: 10.1016/j.nefro.2021.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
Patients with the dual burden of chronic kidney disease (CKD) and cardiovascular disease (CVD) experience unacceptably high rates of morbidity and mortality, which also entail unfavorable effects on healthcare systems. Currently, concerted efforts to identify, prevent and treat CVD in CKD patients are lacking at the institutional level, with emphasis still being placed on individual specialty views on this topic. The authors of this position paper endorse the need for a dedicated interdisciplinary team of subspecialists in cardio-nephrology that manages appropriate clinical interventions across the inpatient and outpatient settings. There is a critical need for training programs, guidelines and best clinical practice models, and research funding from nephrology, cardiology and other professional societies, to support the development of the subspecialty of cardio-nephrology. This position paper from the coordinating committee from the Working Group for Cardiorenal Medicine of the Spanish Society of Nephrology (S.E.N.) is intended to be the starting point to develop the subspecialty of cardio-nephrology within the S.E.N.. The implementation of the subspecialty in day-to-day nephrological practice will help to diagnose, treat, and prevent CVD in CKD patients in a precise, clinically effective, and health cost-favorable manner.
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Affiliation(s)
- Javier Díez
- Departments of Nephrology and Cardiology, University of Navarra Clinic, Pamplona, Spain; Program of Cardiovascular Diseases, Center of Applied Medical Research, University of Navarra, Pamplona, Spain.
| | - Juan F Navarro-González
- Division of Nephrology and Research Unit, University Hospital Nuestra Señora de Candelaria, and Universitary Institute of Biomedical Technologies, University of La Laguna, Santa Cruz de Tenerife, Spain; Red de Investigación Renal (REDINREN), Madrid, Spain
| | - Alberto Ortiz
- Red de Investigación Renal (REDINREN), Madrid, Spain; Division of Nephrology IIS-Fundacion Jimenez Diaz, University Autonoma of Madrid, Madrid, Spain
| | - Rafael Santamaría
- Red de Investigación Renal (REDINREN), Madrid, Spain; Division of Nephrology, University Hospital Reina Sofia, Cordoba, Spain; Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Spain
| | - Patricia de Sequera
- Nephrology Department, Hospital Universitario Infanta Leonor, University Complutense of Madrid, Madrid, Spain
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186
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Wettersten N, Horiuchi Y, van Veldhuisen DJ, Ix JH, Mueller C, Filippatos G, Nowak R, Hogan C, Kontos MC, Cannon CM, Müeller GA, Birkhahn R, Taub P, Vilke GM, Duff S, McDonald K, Mahon N, Nuñez J, Briguori C, Passino C, Maisel A, Murray PT. Decongestion discriminates risk for one-year mortality in patients with improving renal function in acute heart failure. Eur J Heart Fail 2021; 23:1122-1130. [PMID: 33788989 DOI: 10.1002/ejhf.2179] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 03/19/2021] [Accepted: 03/23/2021] [Indexed: 01/28/2023] Open
Abstract
AIMS Improving renal function (IRF) is paradoxically associated with worse outcomes in acute heart failure (AHF), but outcomes may differ based on response to decongestion. We explored if the relationship of IRF with mortality in hospitalized AHF patients differs based on successful decongestion. METHODS AND RESULTS We evaluated 760 AHF patients from AKINESIS for the relationship between IRF, change in B-type natriuretic peptide (BNP), and 1-year mortality. IRF was defined as a ≥20% increase in estimated glomerular filtration rate (eGFR) relative to admission. Adequate decongestion was defined as a ≥40% decrease in last measured BNP relative to admission. IRF occurred in 22% of patients who had a mean age of 69 years, 58% were men, 72% were white, and median admission eGFR was 49 mL/min/1.73 m2 . IRF patients had more severe heart failure reflected by lower admission eGFR, higher blood urea nitrogen, lower systolic blood pressure, lower sodium, and higher use of inotropes. IRF patients had higher 1-year mortality (25%) than non-IRF patients (15%) (P < 0.01). However, this relationship differed by BNP trajectory (P-interaction = 0.03). When stratified by BNP change, non-IRF patients and IRF patients with decreasing BNP had lower 1-year mortality than either non-IRF and IRF patients without decreasing BNP. However, in multivariate analysis, IRF was not associated with mortality [adjusted hazard ratio (HR) 1.0, 95% confidence interval (CI) 0.7-1.5] while BNP was (adjusted HR 0.5, 95% CI 0.3-0.7). When IRF was evaluated as transiently occurring or persisting at discharge, again only BNP change was significantly associated with mortality. CONCLUSION Improving renal function is associated with mortality in AHF but not independent of other variables and congestion status. Achieving adequate decongestion, as reflected by lower BNP, in AHF is more strongly associated with mortality than IRF.
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Affiliation(s)
- Nicholas Wettersten
- Division of Cardiovascular Medicine, Veterans Affairs San Diego Healthcare System, San Diego, CA, USA.,Division of Cardiovascular Medicine, University of California San Diego, La Jolla, CA, USA
| | - Yu Horiuchi
- Division of Cardiology, Mitsui Memorial Hospital, Tokyo, Japan
| | - Dirk J van Veldhuisen
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Joachim H Ix
- Division of Nephrology-Hypertension, Department of Medicine, University of California San Diego and Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
| | - Christian Mueller
- Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Gerasimos Filippatos
- Department of Cardiology, Athens University Hospital Attikon, University of Athens, Athens, Greece
| | - Richard Nowak
- Department of Emergency Medicine, Henry Ford Hospital System, Detroit, MI, USA
| | - Christopher Hogan
- Division of Emergency Medicine and Acute Care Surgical Services, VCU Medical Center, Virginia Commonwealth University, Richmond, VA, USA
| | - Michael C Kontos
- Division of Cardiology, VCU Medical Center, Virginia Commonwealth University, Richmond, VA, USA
| | - Chad M Cannon
- Department of Emergency Medicine, University of Kansas Medical Center, Kansas City, MO, USA
| | - Gerhard A Müeller
- Department of Nephrology and Rheumatology, University Medical Center Göttingen, University of Göttingen, Göttingen, Germany
| | - Robert Birkhahn
- Department of Emergency Medicine, New York Methodist, Brooklyn, NY, USA
| | - Pam Taub
- Division of Cardiovascular Medicine, University of California San Diego, La Jolla, CA, USA
| | - Gary M Vilke
- Department of Emergency Medicine, University of California San Diego, La Jolla, CA, USA
| | - Stephen Duff
- School of Medicine, University College Dublin, Dublin, Ireland
| | - Kenneth McDonald
- Department of Cardiology, Mater Misericordiae University Hospital, University College Dublin, Dublin, Ireland.,Department of Cardiology, St. Vincent's University Hospital, Dublin, Ireland
| | - Niall Mahon
- Department of Cardiology, Mater Misericordiae University Hospital, University College Dublin, Dublin, Ireland
| | - Julio Nuñez
- Department of Cardiology, Hospital Clínico Universitario Valencia, INCLIVA, University of Valencia, Valencia, Spain.,CIBER in Cardiovascular Diseases, Madrid, Spain
| | - Carlo Briguori
- Department of Cardiology, Interventional Cardiology, Mediterranea Cardiocentro, Naples, Italy
| | - Claudio Passino
- Department of Cardiology and Cardiovascular Medicine, Fondazione Gabriele Monasterio, Pisa, Italy
| | - Alan Maisel
- Division of Cardiovascular Medicine, University of California San Diego, La Jolla, CA, USA
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187
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Lainscak M, Omersa D, Rosano G, Farkas J, Böhm M. Pharmacotherapy adherence in patients with heart failure: Easier said than done. Int J Cardiol 2021; 332:135-137. [PMID: 33785392 DOI: 10.1016/j.ijcard.2021.03.051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Accepted: 03/22/2021] [Indexed: 12/28/2022]
Affiliation(s)
- Mitja Lainscak
- Division of Cardiology, General Hospital Murska Sobota, Murska Sobota, Slovenia; Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia; Faculty of Natural Sciences and Mathematics, University of Maribor, Maribor, Slovenia.
| | - Daniel Omersa
- Department of Research, General Hospital Murska Sobota, Murska Sobota, Slovenia; Department of Internal Medicine, General Hospital Jesenice, Jesenice, Slovenia
| | - Giuseppe Rosano
- Department of Medical Sciences, IRCCS San Raffaele Pisana, Rome, Italy
| | - Jerneja Farkas
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia; Department of Research, General Hospital Murska Sobota, Murska Sobota, Slovenia; National Institute of Public Health, Ljubljana, Slovenia
| | - Michael Böhm
- Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Homburg, Germany
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188
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Tomasoni D, Coats AJS. The Altmetric Attention Score: how science tries to meet social media. Eur J Heart Fail 2021; 23:693-697. [PMID: 33609070 DOI: 10.1002/ejhf.2136] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Affiliation(s)
- Daniela Tomasoni
- Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
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189
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Beldhuis IE, Myhre PL, Bristow M, Claggett B, Damman K, Fang JC, Fleg JL, McKinlay S, Lewis EF, O'Meara E, Pitt B, Shah SJ, Vardeny O, Voors AA, Pfeffer MA, Solomon SD, Desai AS. Spironolactone in Patients With Heart Failure, Preserved Ejection Fraction, and Worsening Renal Function. J Am Coll Cardiol 2021; 77:1211-1221. [PMID: 33663739 DOI: 10.1016/j.jacc.2020.12.057] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 12/23/2020] [Accepted: 12/28/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Treatment of heart failure with preserved ejection fraction (HFpEF) with spironolactone is associated with lower risk of heart failure hospitalization (HFH) but increased risk of worsening renal function (WRF). The prognostic implications of spironolactone-associated WRF in HFpEF patients are not well understood. OBJECTIVES The purpose of this study was to investigate the association between WRF, spironolactone treatment, and clinical outcomes in patients with HFpEF. METHODS In 1,767 patients randomized to spironolactone or placebo in the TOPCAT (Treatment of Preserved Cardiac Function Heart Failure With an Aldosterone Antagonist Trial)-Americas study, we examined the incidence of WRF (doubling of serum creatinine) by treatment assignment. Associations between incident WRF and subsequent risk for the primary study endpoint of cardiovascular (CV) death, HFH, or aborted cardiac arrest and key secondary outcomes, including CV death, HFH, and all-cause mortality according to treatment assignment, were examined in time-updated Cox proportional hazards models with an interaction term. RESULTS WRF developed in 260 (14.7%) patients with higher rates in those assigned to spironolactone compared to placebo (17.8% vs. 11.6%; odds ratio: 1.66; 95% confidence interval: 1.27 to 2.17; p < 0.001). Regardless of treatment, incident WRF was associated with increased risk for the primary endpoint (hazard ratio: 2.04; 95% confidence interval: 1.52 to 2.72; p < 0.001) after multivariable adjustment. Although there was no statistical interaction between treatment assignment and WRF regarding the primary endpoint (interaction p = 0.11), spironolactone-associated WRF was associated with lower risk of CV death (interaction p = 0.003) and all-cause mortality (interaction p = 0.001) compared with placebo-associated WRF. CONCLUSIONS Among HFpEF patients enrolled in TOPCAT-Americas, spironolactone increased risk of WRF compared with placebo. Rates of CV death were lower with spironolactone in both patients with and without WRF.
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Affiliation(s)
- Iris E Beldhuis
- Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts, USA; University of Groningen, University Medical Center Groningen, Department of Cardiology, Groningen, the Netherlands. https://twitter.com/iebeldhuis
| | - Peder L Myhre
- Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts, USA; Division of Medicine, Akershus University Hospital, Lorenskog, Norway. https://twitter.com/pmyhre
| | - Michael Bristow
- Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Brian Claggett
- Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Kevin Damman
- University of Groningen, University Medical Center Groningen, Department of Cardiology, Groningen, the Netherlands
| | - James C Fang
- University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Jerome L Fleg
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Sonja McKinlay
- New England Research Institutes, Watertown, Massachusetts, USA
| | - Eldrin F Lewis
- Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | | | - Bertram Pitt
- University of Michigan School of Medicine, Ann Arbor, Michigan, USA
| | - Sanjiv J Shah
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Orly Vardeny
- Minneapolis VA Center for Care Delivery and Outcomes Research, University of Minnesota, Minneapolis, Minnesota, USA
| | - Adriaan A Voors
- University of Groningen, University Medical Center Groningen, Department of Cardiology, Groningen, the Netherlands
| | - Marc A Pfeffer
- Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Scott D Solomon
- Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Akshay S Desai
- Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts, USA.
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190
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Rao VS, Ivey-Miranda JB, Cox ZL, Riello R, Griffin M, Fleming J, Soucier R, Sangkachand P, O'Brien M, LoRusso F, D'Ambrosi J, Churchwell K, Mahoney D, Bellumkonda L, Asher JL, Maulion C, Turner JM, Wilson FP, Collins SP, Testani JM. Natriuretic Equation to Predict Loop Diuretic Response in Patients With Heart Failure. J Am Coll Cardiol 2021; 77:695-708. [PMID: 33573739 DOI: 10.1016/j.jacc.2020.12.022] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 12/02/2020] [Accepted: 12/07/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND Most acute decompensated heart failure admissions are driven by congestion. However, residual congestion is common and often driven by the lack of reliable tools to titrate diuretic therapy. The authors previously developed a natriuretic response prediction equation (NRPE), which predicts sodium output using a spot urine sample collected 2 h after loop diuretic administration. OBJECTIVES The purpose of this study was to validate the NRPE and describe proof-of-concept that the NRPE can be used to guide diuretic therapy. METHODS Two cohorts were assembled: 1) the Diagnosing and Targeting Mechanisms of Diuretic Resistance (MDR) cohort was used to validate the NRPE to predict 6-h sodium output after a loop diuretic, which was defined as poor (<50 mmol), suboptimal (<100 mmol), or excellent (>150 mmol); and 2) the Yale Diuretic Pathway (YDP) cohort, which used the NRPE to guide loop diuretic titration via a nurse-driven automated protocol. RESULTS Evaluating 638 loop diuretic administrations, the NRPE showed excellent discrimination with areas under the curve ≥0.90 to predict poor, suboptimal, and excellent natriuretic response, and outperformed clinically obtained net fluid loss (p < 0.05 for all cutpoints). In the YDP cohort (n = 161) using the NRPE to direct therapy mean daily urine output (1.8 ± 0.9 l vs. 3.0 ± 0.8 l), net fluid output (-1.1 ± 0.9 l vs. -2.1 ± 0.9 l), and weight loss (-0.3 ± 0.3 kg vs. -2.5 ± 0.3 kg) improved substantially following initiation of the YDP (p < 0.001 for all pre-post comparisons). CONCLUSIONS Natriuretic response can be rapidly and accurately predicted by the NRPE, and this information can be used to guide diuretic therapy during acute decompensated heart failure. Additional study of diuresis guided by the NRPE is warranted.
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Affiliation(s)
- Veena S Rao
- Department of Internal Medicine, Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Juan B Ivey-Miranda
- Department of Internal Medicine, Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, Connecticut, USA; Department of Heart Failure, Hospital de Cardiologia, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Zachary L Cox
- Department of Pharmacy, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Ralph Riello
- Heart and Vascular Center, Yale New Haven Hospital, New Haven, Connecticut, USA
| | - Matthew Griffin
- Department of Internal Medicine, Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - James Fleming
- Department of Internal Medicine, Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Richard Soucier
- Department of Internal Medicine, Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Prasama Sangkachand
- Heart and Vascular Center, Yale New Haven Hospital, New Haven, Connecticut, USA
| | - Margaret O'Brien
- Heart and Vascular Center, Yale New Haven Hospital, New Haven, Connecticut, USA
| | - Francine LoRusso
- Heart and Vascular Center, Yale New Haven Hospital, New Haven, Connecticut, USA
| | - Julie D'Ambrosi
- Heart and Vascular Center, Yale New Haven Hospital, New Haven, Connecticut, USA
| | - Keith Churchwell
- Heart and Vascular Center, Yale New Haven Hospital, New Haven, Connecticut, USA
| | - Devin Mahoney
- Department of Internal Medicine, Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Lavanya Bellumkonda
- Department of Internal Medicine, Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Jennifer L Asher
- Department of Comparative Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Christopher Maulion
- Department of Internal Medicine, Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Jeffrey M Turner
- Department of Medicine, Division of Nephrology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - F Perry Wilson
- Clinical and Translational Research Accelerator, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Sean P Collins
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jeffrey M Testani
- Department of Internal Medicine, Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, Connecticut, USA.
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191
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Mareev VY, Garganeeva AA, Ageev FT, Arutunov GP, Begrambekova YL, Belenkov YN, Vasyuk YA, Galyavich AS, Gilarevsky SR, Glezer MG, Drapkina OM, Duplyakov DV, Kobalava ZD, Koziolova NA, Kuzheleva EA, Mareev YV, Ovchinnikov AG, Orlova YA, Perepech NB, Sitnikova MY, Skvortsov AA, Skibitskiy VV, Chesnikova AI. [The use of diuretics in chronic heart failure. Position paper of the Russian Heart Failure Society]. ACTA ACUST UNITED AC 2021; 60:13-47. [PMID: 33522467 DOI: 10.18087/cardio.2020.12.n1427] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 10/26/2020] [Indexed: 11/18/2022]
Abstract
The document focuses on key issues of diuretic therapy in CHF from the standpoint of current views on the pathogenesis of edema syndrome, its diagnosis, and characteristics of using diuretics in various clinical situations.
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Affiliation(s)
- V Yu Mareev
- Medical Research and Educational Center of the M. V. Lomonosov Moscow State University, Moscow, Russia Faculty of Fundamental Medicine, Lomonosov Moscow State University, Russia
| | - A A Garganeeva
- "Research Institute for Cardiology", Siberian State Medical University, Tomsk National Research Medical Center, Russian Academy of Sciences
| | - F T Ageev
- Scientific Medical Research Center of Cardiology, Russia
| | - G P Arutunov
- Russian National Research Medical University named after Pirogov, Moscow
| | - Yu L Begrambekova
- Medical Research and Educational Center of the M. V. Lomonosov Moscow State University, Moscow, Russia Faculty of Fundamental Medicine, Lomonosov Moscow State University, Russia
| | - Yu N Belenkov
- Sechenov Moscow State Medical University, Moscow, Russia
| | - Yu A Vasyuk
- Moscow State Medical and Dental University named after Evdokimov, Moscow, Russia
| | | | - S R Gilarevsky
- Russian Medical Academy of Postgraduate Education, Moscow, Russia
| | - M G Glezer
- Sechenov Moscow State Medical University, Moscow, Russia
| | - O M Drapkina
- National Medical Research Centre for Therapy and Preventive Medicine, Moscow, Russia
| | - D V Duplyakov
- Samara Regional Clinical Cardiological Dispensary, Russia
| | - Zh D Kobalava
- Russian State University of Peoples' Friendship, Moscow, Russia
| | - N A Koziolova
- Federal State Budgetary Institution of Healthcare of Higher Education "Perm State Medical University named after Academician E.A. Wagner ", Russia
| | - E A Kuzheleva
- "Research Institute for Cardiology", Siberian State Medical University, Tomsk National Research Medical Center, Russian Academy of Sciences, Russia
| | - Yu V Mareev
- National Medical Research Centre for Therapy and Preventive Medicine, Moscow, Russia Robertson Centre for Biostatistics, Glasgow, Great Britain
| | | | - Ya A Orlova
- Medical Research and Educational Center of the M. V. Lomonosov Moscow State University, Moscow, Russia Faculty of Fundamental Medicine, Lomonosov Moscow State University, Russia
| | | | - M Yu Sitnikova
- Almazov National Medical Research Center, St. Petersburg, Russia
| | - A A Skvortsov
- Scientific Medical Research Center of Cardiology, Russia
| | - V V Skibitskiy
- Kuban State Medical University" of the Ministry of Health of the Russian Federation, Russia
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192
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Miró Ò, Harjola P, Rossello X, Gil V, Jacob J, Llorens P, Martín-Sánchez FJ, Herrero P, Martínez-Nadal G, Aguiló S, López-Grima ML, Fuentes M, Álvarez Pérez JM, Rodríguez-Adrada E, Mir M, Tost J, Llauger L, Ruschitzka F, Harjola VP, Mullens W, Masip J, Chioncel O, Peacock WF, Müller C, Mebazaa A. The FAST-FURO study: effect of very early administration of intravenous furosemide in the prehospital setting to patients with acute heart failure attending the emergency department. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2021; 10:487-496. [PMID: 33580790 DOI: 10.1093/ehjacc/zuaa042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 12/16/2020] [Accepted: 12/30/2020] [Indexed: 11/14/2022]
Abstract
AIMS The effect of early administration of intravenous (IV) furosemide in the emergency department (ED) on short-term outcomes of acute heart failure (AHF) patients remains controversial, with one recent Japanese study reporting a decrease of in-hospital mortality and one Korean study reporting a lack of clinical benefit. Both studies excluded patients receiving prehospital IV furosemide and only included patients requiring hospitalization. To assess the impact on short-term outcomes of early IV furosemide administration by emergency medical services (EMS) before patient arrival to the ED. METHODS AND RESULTS In a secondary analysis of the Epidemiology of Acute Heart Failure in Emergency Departments (EAHFE) registry of consecutive AHF patients admitted to Spanish EDs, patients treated with IV furosemide at the ED were classified according to whether they received IV furosemide from the EMS (FAST-FURO group) or not (CONTROL group). In-hospital all-cause mortality, 30-day all-cause mortality, and prolonged hospitalization (>10 days) were assessed. We included 12 595 patients (FAST-FURO = 683; CONTROL = 11 912): 968 died during index hospitalization [7.7%; FAST-FURO = 10.3% vs. CONTROL = 7.5%; odds ratio (OR) = 1.403, 95% confidence interval (95% CI) = 1.085-1.813; P = 0.009], 1269 died during the first 30 days (10.2%; FAST-FURO = 13.4% vs. CONTROL = 9.9%; OR = 1.403, 95% CI = 1.146-1.764; P = 0.004), and 2844 had prolonged hospitalization (22.8%; FAST-FURO = 25.8% vs. CONTROL = 22.6%; OR = 1.189, 95% CI = 0.995-1.419; P = 0.056). FAST-FURO group patients had more diabetes mellitus, ischaemic cardiomyopathy, peripheral artery disease, left ventricular systolic dysfunction, and severe decompensations, and had a better New York Heart Association class and had less atrial fibrillation. After adjusting for these significant differences, early IV furosemide resulted in no impact on short-term outcomes: OR = 1.080 (95% CI = 0.817-1.427) for in-hospital mortality, OR = 1.086 (95% CI = 0.845-1.396) for 30-day mortality, and OR = 1.095 (95% CI = 0.915-1.312) for prolonged hospitalization. Several sensitivity analyses, including analysis of 599 pairs of patients matched by propensity score, showed consistent findings. CONCLUSION Early IV furosemide during the prehospital phase was administered to the sickest patients, was not associated with changes in short-term mortality or length of hospitalization after adjustment for several confounders.
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Affiliation(s)
- Òscar Miró
- Emergency Department, Hospital Clínic, "Emergencies: Processes and Pathologies" Research Group, IDIBAPS, University of Barcelona, Villarroel 170, 08036 Barcelona, Catalonia, Spain.,The GREAT (Global REsearch in Acute cardiovascular conditions Team) Network, Madrid, Spain
| | - Pia Harjola
- The GREAT (Global REsearch in Acute cardiovascular conditions Team) Network, Madrid, Spain.,Department of Emergency Medicine and Services, Emergency Medicine, University of Helsinki, Helsinki University Hospital, Helsinki, Finland, Emergency Department, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Xavier Rossello
- The GREAT (Global REsearch in Acute cardiovascular conditions Team) Network, Madrid, Spain.,Cardiology Department & Health Research Institute of the Balearic Islands (IdISBa), University Hospital Son Espases, Palma de Mallorca, Spain
| | - Víctor Gil
- Emergency Department, Hospital Clínic, "Emergencies: Processes and Pathologies" Research Group, IDIBAPS, University of Barcelona, Villarroel 170, 08036 Barcelona, Catalonia, Spain
| | - Javier Jacob
- Emergency Department, Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Spain
| | - Pere Llorens
- Emergency Department, Home Hospitalization and Short Stay Unit, Hospital General de Alicante, Alicante, Spain
| | - Francisco Javier Martín-Sánchez
- Emergency Department, Hospital Clínico San Carlos, Madrid, Instituto de Investigación Sanitaria San Carlos (IdISSC), Universidad Complutense de Madrid, Spain
| | - Pablo Herrero
- Emergency Department , Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Gemma Martínez-Nadal
- Emergency Department, Hospital Clínic, "Emergencies: Processes and Pathologies" Research Group, IDIBAPS, University of Barcelona, Villarroel 170, 08036 Barcelona, Catalonia, Spain.,The GREAT (Global REsearch in Acute cardiovascular conditions Team) Network, Madrid, Spain
| | - Sira Aguiló
- Emergency Department, Hospital Clínic, "Emergencies: Processes and Pathologies" Research Group, IDIBAPS, University of Barcelona, Villarroel 170, 08036 Barcelona, Catalonia, Spain
| | | | - Marta Fuentes
- Emergency Department, Hospital Universitario de Salamanca, Salamanca, Spain
| | | | | | - María Mir
- Emergency Department, Hospital Infanta Leonor, Madrid, Spain
| | - Josep Tost
- Emergency Department, Hospital de Terrassa, Barcelona, Catalonia, Spain
| | - Lluís Llauger
- Emergency Department, Hospital de Vic, Barcelona, Catalonia, Spain
| | - Frank Ruschitzka
- UniversitätsSpital Zürich, University Heart Center Zurich, Zurich, Switzerland
| | - Veli-Pekka Harjola
- The GREAT (Global REsearch in Acute cardiovascular conditions Team) Network, Madrid, Spain.,Department of Emergency Medicine and Services, Emergency Medicine, University of Helsinki, Helsinki University Hospital, Helsinki, Finland, Emergency Department, Hospital Universitario Central de Asturias, Oviedo, Spain
| | | | - Josep Masip
- The GREAT (Global REsearch in Acute cardiovascular conditions Team) Network, Madrid, Spain.,Cardiology Department, Hospital Sanitas CIMA, Barcelona, Catalonia, Spain
| | - Ovidiu Chioncel
- Emergency Institute for Cardiovascular Diseases 'Prof. C.C. Iliescu', University of Medicine Carol Davila, Bucharest, Romania
| | - W Frank Peacock
- The GREAT (Global REsearch in Acute cardiovascular conditions Team) Network, Madrid, Spain.,Department of Emergency Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Christian Müller
- The GREAT (Global REsearch in Acute cardiovascular conditions Team) Network, Madrid, Spain.,Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Basel, Switzerland
| | - Alexandre Mebazaa
- The GREAT (Global REsearch in Acute cardiovascular conditions Team) Network, Madrid, Spain.,Department of Anesthesiology and Critical Care Medicine, InsermU942-MASCOT, Saint Louis Lariboisière University Hospital, Université Paris Diderot, Paris, France
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193
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Mullens W, Martens P. Empagliflozin and renal sodium handling: an intriguing smart osmotic diuretic. Eur J Heart Fail 2021; 23:79-82. [PMID: 33372343 DOI: 10.1002/ejhf.2086] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 12/20/2020] [Indexed: 02/06/2023] Open
Affiliation(s)
- Wilfried Mullens
- Ziekenhuis Oost Limburg, Genk, Belgium.,Faculty of Medicine and Life Sciences, University Hasselt, Biomedical Research Institute, Hasselt, Belgium
| | - Pieter Martens
- Ziekenhuis Oost Limburg, Genk, Belgium.,Faculty of Medicine and Life Sciences, University Hasselt, Biomedical Research Institute, Hasselt, Belgium
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194
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Masarone D, Melillo E, Errigo V, Valente F, Pacileo G. Clinical relevance of transient worsening renal function after initiation of sacubitril/valsartan. Curr Med Res Opin 2021; 37:9-12. [PMID: 33210952 DOI: 10.1080/03007995.2020.1853509] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND The worsening of renal function after the start of valsartan therapy is relatively common in clinical practice. However, few data are available on the incidence of worsening renal function after the beginning of therapy with sacubitril/valsartan. METHODS We retrospectively enrolled 202 outpatients with HFrEF that started therapy with sacubitril/valsartan to evaluate the prevalence of worsening renal function and its clinical significance. RESULTS At 1 month, a worsening renal function (defined as a > 20% decrease in eGFR occurring after 1 month of ARNi therapy) was found in 68 patients (33%), however after a mean follow-up of 650 ± 80 days, Kaplan-Meier analysis showed no significant in terms of HF-related deaths, HF-related hospitalizations, and the need for renal replacement therapy (25.2 vs. 23.6%; p = .812). In addition, the renal function recovered in patients with early WRF at 3 months (62 + 9.3 ml/min/1.73 m2 vs. 63 ± 13.8 ml/min/1.73 m2; p < .05), with an improvement in estimated glomerular filtration rate at 1 year compared with baseline value (62 ± 9.3 ml/min/1.73 m2 vs. 69 ± 8.6 ml/min/1.73 m2; p < .01). CONCLUSIONS WRF occurs in nearly 30% of HFrEF patients without impacting clinical outcomes; HF specialists should be aware of these changes to avoid unnecessary discontinuation of sacubitril/valsartan therapy.
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Affiliation(s)
- Daniele Masarone
- Department of Cardiology, Heart failure Unit, AORN dei Colli-Monaldi Hospital, Naples, Italy
| | - Enrico Melillo
- Department of Cardiology, Heart failure Unit, AORN dei Colli-Monaldi Hospital, Naples, Italy
| | - Vittoria Errigo
- Department of Cardiology, Heart failure Unit, AORN dei Colli-Monaldi Hospital, Naples, Italy
| | - Fabio Valente
- Department of Cardiology, Heart failure Unit, AORN dei Colli-Monaldi Hospital, Naples, Italy
| | - Giuseppe Pacileo
- Department of Cardiology, Heart failure Unit, AORN dei Colli-Monaldi Hospital, Naples, Italy
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195
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Chen YL, Hang CL, Su CH, Wu PJ, Chen HC, Fang HY, Fang YN, Cheng CI, Fu M, Chen SM. Feature and impact of guideline-directed medication prescriptions for heart failure with reduced ejection fraction accompanied by chronic kidney disease. Int J Med Sci 2021; 18:2570-2580. [PMID: 34104088 PMCID: PMC8176167 DOI: 10.7150/ijms.55119] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 04/19/2021] [Indexed: 12/12/2022] Open
Abstract
Background: With respect to total mortality and cardiovascular mortality, the feature and impact of guideline-directed medication (GDM) prescriptions for heart failure with reduced ejection fraction (HFrEF) with chronic kidney disease (CKD) are unknown. Therefore, we aimed to determine these aspects. Methods: GDM prescriptions and their impact on discharged patients with and without CKD were analyzed. To analyze differences in one-year clinical outcomes, propensity score matching was conducted on a cohort of patients with concomitant HFrEF and CKD who received more and fewer GDM prescriptions. Results: A total of 1509 patients were enrolled in Taiwan's HFrEF registry from May 2013 to October 2014, and 1275 discharged patients with complete one-year follow-up were further analyzed. Of these patients, 468 (36.7%) had moderate CKD, whereas 249 (19.5%) had advanced CKD. Patients with advanced CKD received fewer prescribed GDMs than other patients. Multivariate analysis revealed that peripheral arterial occlusive disease, thyroid disorder, advanced HF at discharge, diastolic blood pressure, digoxin use, and fewer prescribed GDMs were independent predictors of one-year total mortality. After propensity score matching, patients with fewer prescribed GDMs had higher one-year total mortality rate than those with more prescribed GDMs (P=0.036). Conclusions: CKD at discharge from HF hospitalization was associated with fewer GDM prescriptions, particularly in patients with more advanced CKD. The propensity-matched analysis indicated that more GDM prescriptions led to better clinical outcomes in HFrEF patients with CKD. Careful interpretation of changes in renal function during HF hospitalization may improve GDM prescriptions.
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Affiliation(s)
- Yung-Lung Chen
- Section of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung City, Taiwan, Republic of China.,Chang Gung University College of Medicine, Taoyuan City, Taiwan, Republic of China
| | - Chi-Ling Hang
- Section of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung City, Taiwan, Republic of China
| | - Chien-Hao Su
- Department of Pharmacy, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung City, Taiwan, Republic of China
| | - Po-Jui Wu
- Section of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung City, Taiwan, Republic of China
| | - Huang-Chung Chen
- Section of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung City, Taiwan, Republic of China
| | - Hsiu-Yu Fang
- Section of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung City, Taiwan, Republic of China
| | - Yen-Nan Fang
- Section of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung City, Taiwan, Republic of China
| | - Cheng-I Cheng
- Section of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung City, Taiwan, Republic of China.,Chang Gung University College of Medicine, Taoyuan City, Taiwan, Republic of China
| | - Morgan Fu
- Section of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung City, Taiwan, Republic of China.,Chang Gung University College of Medicine, Taoyuan City, Taiwan, Republic of China
| | - Shyh-Ming Chen
- Section of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung City, Taiwan, Republic of China.,Chang Gung University College of Medicine, Taoyuan City, Taiwan, Republic of China
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196
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Yoshihisa A, Watanabe K, Sato Y, Ishibashi S, Matsuda M, Yamadera Y, Ichijo Y, Yokokawa T, Misaka T, Oikawa M, Kobayashi A, Takeishi Y. Intrarenal Doppler ultrasonography reflects hemodynamics and predicts prognosis in patients with heart failure. Sci Rep 2020; 10:22257. [PMID: 33335236 PMCID: PMC7746684 DOI: 10.1038/s41598-020-79351-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Accepted: 12/08/2020] [Indexed: 12/24/2022] Open
Abstract
We aimed to clarify clinical implications of intrarenal hemodynamics assessed by intrarenal Doppler ultrasonography (IRD) and their prognostic impacts in heart failure (HF). We performed a prospective observational study, and examined IRD and measured interlobar renal artery velocity time integral (VTI) and intrarenal venous flow (IRVF) patterns (monophasic or non-monophasic pattern) to assess intrarenal hypoperfusion and congestion in HF patients (n = 341). Seven patients were excluded in VTI analysis due to unclear imaging. The patients were divided into groups based on (A) VTI: high VTI (VTI ≥ 14.0 cm, n = 231) or low VTI (VTI < 14.0 cm, n = 103); and (B) IRVF patterns: monophasic (n = 36) or non-monophasic (n = 305). We compared post-discharge cardiac event rate between the groups, and right-heart catheterization was performed in 166 patients. Cardiac index was lower in low VTI than in high VTI (P = 0.04), and right atrial pressure was higher in monophasic than in non-monophasic (P = 0.03). In the Kaplan–Meier analysis, cardiac event rate was higher in low VTI and monophasic groups (P < 0.01, respectively). In the Cox proportional hazard analysis, the combination of low VTI and a monophasic IRVF pattern was a predictor of cardiac events (P < 0.01). IRD imaging might be associated with cardiac output and right atrial pressure, and prognosis.
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Affiliation(s)
- Akiomi Yoshihisa
- Department of Cardiovascular Medicine, Fukushima Medical University, 1 Hikarigaoka, Fukushima, 960-1295, Japan.
| | - Koichiro Watanabe
- Department of Cardiovascular Medicine, Fukushima Medical University, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Yu Sato
- Department of Cardiovascular Medicine, Fukushima Medical University, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Shinji Ishibashi
- Department of Clinical Laboratory Medicine, Fukushima Medical University, Fukushima, Japan
| | - Mitsuko Matsuda
- Department of Clinical Laboratory Medicine, Fukushima Medical University, Fukushima, Japan
| | - Yukio Yamadera
- Department of Clinical Laboratory Medicine, Fukushima Medical University, Fukushima, Japan
| | - Yasuhiro Ichijo
- Department of Cardiovascular Medicine, Fukushima Medical University, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Tetsuro Yokokawa
- Department of Cardiovascular Medicine, Fukushima Medical University, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Tomofumi Misaka
- Department of Cardiovascular Medicine, Fukushima Medical University, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Masayoshi Oikawa
- Department of Cardiovascular Medicine, Fukushima Medical University, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Atsushi Kobayashi
- Department of Cardiovascular Medicine, Fukushima Medical University, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Yasuchika Takeishi
- Department of Cardiovascular Medicine, Fukushima Medical University, 1 Hikarigaoka, Fukushima, 960-1295, Japan
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197
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Raja Shariff RE, Kasim S, Borhan MK, Yusoff MR. Acute heart failure – The ‘real’ Malaysian experience: An observational study from a single non-cardiac centre. PROCEEDINGS OF SINGAPORE HEALTHCARE 2020. [DOI: 10.1177/2010105820978664] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background: Cardiovascular care in Malaysia adopts a ‘spoke-and-hub’ model, leaving the majority of acute heart failure (AHF) care to non-cardiac centres. Granular data on AHF care are essential and yet remain scarce. Objectives: This study aimed to illustrate the baseline characteristics, management and outcome of AHF patients. Methods: A retrospective, cross-sectional study was conducted on 1307 AHF patients admitted between 1 January 2012 and 31 December 2016. Results: The younger and Malay-predominant population reflects the distribution of ischaemic heart disease in Malaysia, highlighting the need to tackle metabolic risks factors. The majority are precipitated by ischaemia (61.8%). Common co-morbidities include hypertension (70.9%), coronary artery disease (57.8%) and diabetes (62.2%). The majority were of New York Heart Association Class II (31.9%) and Class III (25.6%). A total of 14.5% required inotropes and vasopressors, 12.9% required intravenous nitrates and 8.6% required dialysis. A further 4.9% of patients required intubation and mechanical ventilation, and 25.9% required non-invasive ventilation. Readmission and mortality were extremely high in our population. Short inpatient stays, restricting optimisation of medication, and gaps in the provision of coronary intervention and stress testing are possible contributing factors. When compared to global and regional registries, disparities were noted specifically surrounding mortality rate and optimum use of guideline-directed medical therapy. Conclusion: Although smaller and single centred, our study provides a unique insight into a pure Malaysian-only cohort from a hospital with no cardiology services in-house, which is more reflective of the majority of hospitals in Malaysia, unlike previous studies and registries.
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198
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Núñez-Marín G, Martín-Sánchez FJ, Bonanad C. [Cardiorenal Syndrome in Elderly: An Endless Loop Between Heart and Kidneys]. Rev Esp Geriatr Gerontol 2020; 56:1-2. [PMID: 33280925 DOI: 10.1016/j.regg.2020.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 10/30/2020] [Indexed: 10/22/2022]
Affiliation(s)
- Gonzalo Núñez-Marín
- Servicio de Cardiología, Hospital Clínico Universitario de Valencia; INCLIVA, Valencia, España
| | - Francisco Javier Martín-Sánchez
- Servicio de Urgencias, Hospital Universitario Clínico San Carlos; Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC); Departamento de Medicina, Facultad de Medicina, Universidad Complutense, Madrid, España
| | - Clara Bonanad
- Servicio de Cardiología, Hospital Clínico Universitario de Valencia; INCLIVA, Valencia, España.
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199
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Biegus J, Zymliński R, Testani J, Marciniak D, Zdanowicz A, Jankowska EA, Banasiak W, Ponikowski P. Renal profiling based on estimated glomerular filtration rate and spot urine sodium identifies high-risk acute heart failure patients. Eur J Heart Fail 2020; 23:729-739. [PMID: 33190378 DOI: 10.1002/ejhf.2053] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 08/11/2020] [Accepted: 09/11/2020] [Indexed: 12/21/2022] Open
Abstract
AIMS In acute heart failure (AHF), assessment of renal function comprises estimation of glomerular filtration rate (eGFR), which does not provide any information about renal sodium/water handling. We describe the interactions between urinary sodium concentration and eGFR to better characterize AHF patients. METHODS AND RESULTS In 219 patients with AHF, spot urine sodium (UNa+ ) and eGFR were assessed on admission, day 1 and day 2 of hospitalization. We found no correlation between UNa+ and eGFR (calculated on each consecutive day, as an average of all three values, and as changes from baseline; all P > 0.05). The population was subsequently divided into four profiles based on eGFR (preserved vs. impaired; cutoff of 60 mL/min/1.73 m2 ) and UNa+ (sodium excreter vs. non-excreter; cutoff of 60 mmol/L). At day 1, there were 70 (31.9%) patients classified as preserved eGFR/sodium excreter, 37 (16.8%) as impaired eGFR/sodium non-excreter, 72 (32.9%) as impaired eGFR/sodium excreter, and 40 (18%) as preserved eGFR/sodium non-excreter. Both sodium non-excreter profiles were associated with an increased risk of in-hospital heart failure worsening [odds ratio (OR) 2.8, 95% confidence interval (CI) 1.3-6.4], inotrope use (OR 2.6, 95% CI 1.1-6.7) and rehospitalization due to AHF (OR 3.2, 95% CI 1.6-6.2; all P < 0.05). The preserved eGFR/sodium non-excreter profile was associated with highest 1-year mortality (52.5%) and remained an independent prognosticator after adjustment for other prognosticators (hazard ratio 2.9, 95% CI 1.7-5.2; P < 0.0005). CONCLUSIONS In AHF, values of spot UNa+ and eGFR are not interrelated. Concomitant assessment of eGFR and spot UNa+ may be useful for better clinical and therapeutic profiling of patients.
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Affiliation(s)
- Jan Biegus
- Department of Heart Diseases, Medical University, Wroclaw, Poland
| | - Robert Zymliński
- Department of Heart Diseases, Medical University, Wroclaw, Poland
| | | | - Dominik Marciniak
- Department of Drugs Form Technology, Faculty of Pharmacy, Medical University, Wroclaw, Poland
| | - Agata Zdanowicz
- Student Scientific Organization, Department of Heart Diseases, Medical University, Wroclaw, Poland
| | - Ewa A Jankowska
- Department of Heart Diseases, Medical University, Wroclaw, Poland
| | | | - Piotr Ponikowski
- Department of Heart Diseases, Medical University, Wroclaw, Poland
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200
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Zymliński R, Sierpiński R, Metra M, Cotter G, Sokolski M, Siwołowski P, Garus M, Gajewski P, Tryba J, Samorek M, Jankowska EA, Biegus J, Ponikowski P. Elevated plasma endothelin-1 is related to low natriuresis, clinical signs of congestion, and poor outcome in acute heart failure. ESC Heart Fail 2020; 7:3536-3544. [PMID: 33063475 PMCID: PMC7755016 DOI: 10.1002/ehf2.13064] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 09/24/2020] [Accepted: 09/25/2020] [Indexed: 02/06/2023] Open
Abstract
AIMS Endothelin-1 (ET-1) is a potent vasoconstrictor, which regulates renal and vascular function. We aimed to relate plasma levels of ET-1 with the clinical picture and outcomes in acute heart failure (AHF). METHODS AND RESULTS We studied 113 patients with AHF [mean age 65 ± 13 (years), median (upper and lower quartiles) N-terminal pro-B-type natriuretic peptide, 5422 (2689; 8582) (pg/mL)], in whom plasma levels of ET-1 were serially measured at admission (10.8 ± 5.2), Day 1 (9.5 ± 3.4), and Day 2 (8.9 ± 3.8) (pg/mL). The population was divided into tertiles across baseline ET-1 levels. Patients in the highest ET-1 tertile had predominant clinical signs of peripheral congestion; however, no difference was observed in pulmonary congestion and severity of dyspnoea. They also presented lower spot urine sodium at admission (75 ± 35 vs. 99 ± 43 vs. 108 ± 30), 6 h (84 ± 34 vs. 106 ± 43 vs. 106 ± 35), and Day 1 (75 ± 38 vs. 96 ± 36 vs. 100 ± 35) (mmol/L), when compared with the second and first tertile, respectively (all P < 0.05); furthermore, they received higher doses of intravenous furosemide from Day 2 and had longer intravenous diuretics, as median switch to oral furosemide was 4 (3; 4) vs. 3 (2; 4) vs. 2 (2; 3) (days), respectively, P < 0.05. There was no difference in serum creatinine, urea, and renal injury biomarkers (kidney injury molecule-1, serum cystatin C, and urine neutrophil gelatinase-associated lipocalin) between the ET-1 tertiles. Higher values of ET-1 measured at each time point were related with a higher risk of 1 year mortality. CONCLUSIONS Elevation of ET-1 is related to clinical signs of peripheral congestion, low urine sodium excretion, and poor outcome in AHF.
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Affiliation(s)
- Robert Zymliński
- Department of Heart DiseasesWroclaw Medical UniversityBorowska 213Wrocław50‐556Poland
| | | | - Marco Metra
- Cardiology, The Department of Medical and Surgical Specialties, Radiological Sciences and Public HealthUniversity of BresciaBresciaItaly
| | | | - Mateusz Sokolski
- Department of Heart DiseasesWroclaw Medical UniversityBorowska 213Wrocław50‐556Poland
| | | | - Mateusz Garus
- Department of Heart DiseasesWroclaw Medical UniversityBorowska 213Wrocław50‐556Poland
| | - Piotr Gajewski
- Department of Heart DiseasesWroclaw Medical UniversityBorowska 213Wrocław50‐556Poland
| | - Joanna Tryba
- Student Scientific Organization, Department of Heart DiseasesWroclaw Medical UniversityWrocławPoland
| | - Maria Samorek
- Student Scientific Organization, Department of Heart DiseasesWroclaw Medical UniversityWrocławPoland
| | - Ewa A. Jankowska
- Department of Heart DiseasesWroclaw Medical UniversityBorowska 213Wrocław50‐556Poland
| | - Jan Biegus
- Department of Heart DiseasesWroclaw Medical UniversityBorowska 213Wrocław50‐556Poland
| | - Piotr Ponikowski
- Department of Heart DiseasesWroclaw Medical UniversityBorowska 213Wrocław50‐556Poland
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