1
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Aguiló O, Castells X, Miró Ò, Mueller C, Chioncel O, Trullàs JC. The prognostic significance of bundle branch block in acute heart failure: a systematic review and meta-analysis. Clin Res Cardiol 2022:10.1007/s00392-022-02105-z. [DOI: 10.1007/s00392-022-02105-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Accepted: 09/06/2022] [Indexed: 11/03/2022]
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2
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Dong X, Tse G, Hao G, Du Y. Heterogeneities in Ventricular Conduction Following Treatment with Heptanol: A Multi-Electrode Array Study in Langendorff-Perfused Mouse Hearts. Life (Basel) 2022; 12:life12070996. [PMID: 35888085 PMCID: PMC9321110 DOI: 10.3390/life12070996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 06/21/2022] [Accepted: 06/30/2022] [Indexed: 11/26/2022] Open
Abstract
Background: Previous studies have associated slowed ventricular conduction with the arrhythmogenesis mediated by the gap junction and sodium channel inhibitor heptanol in mouse hearts. However, they did not study the propagation patterns that might contribute to the arrhythmic substrate. This study used a multi-electrode array mapping technique to further investigate different conduction abnormalities in Langendorff-perfused mouse hearts exposed to 0.1 or 2 mM heptanol. Methods: Recordings were made from the left ventricular epicardium using multi-electrode arrays in spontaneously beating hearts during right ventricular 8 Hz pacing or S1S2 pacing. Results: In spontaneously beating hearts, heptanol at 0.1 and 2 mM significantly reduced the heart rate from 314 ± 25 to 189 ± 24 and 157 ± 7 bpm, respectively (ANOVA, p < 0.05 and p < 0.001). During regular 8 Hz pacing, the mean LATs were increased by 0.1 and 2 mM heptanol from 7.1 ± 2.2 ms to 19.9 ± 5.0 ms (p < 0.05) and 18.4 ± 5.7 ms (p < 0.05). The standard deviation of the mean LATs was increased from 2.5 ± 0.8 ms to 10.3 ± 4.0 ms and 8.0 ± 2.5 ms (p < 0.05), and the median of phase differences was increased from 1.7 ± 1.1 ms to 13.9 ± 7.8 ms and 12.1 ± 5.0 ms by 0.1 and 2 mM heptanol (p < 0.05). P5 took a value of 0.2 ± 0.1 ms and was not significantly altered by heptanol at 0.1 or 2 mM (1.1 ± 0.9 ms and 0.9 ± 0.5 ms, p > 0.05). P50 was increased from 7.3 ± 2.7 ms to 24.0 ± 12.0 ms by 0.1 mM heptanol and then to 22.5 ± 7.5 ms by 2 mM heptanol (p < 0.05). P95 was increased from 1.7 ± 1.1 ms to 13.9 ± 7.8 ms by 0.1 mM heptanol and to 12.1 ± 5.0 ms by 2 mM heptanol (p < 0.05). These changes led to increases in the absolute inhomogeneity in conduction (P5−95) from 7.1 ± 2.6 ms to 31.4 ± 11.3 ms, 2 mM: 21.6 ± 7.2 ms, respectively (p < 0.05). The inhomogeneity index (P5−95/P50) was significantly reduced from 3.7 ± 1.2 to 3.1 ± 0.8 by 0.1 mM and then to 3.3 ± 0.9 by 2 mM heptanol (p < 0.05). Conclusion: Increased activation latencies, reduced CVs, and the increased inhomogeneity index of conduction were associated with both spontaneous and induced ventricular arrhythmias.
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Affiliation(s)
- Xiuming Dong
- Henan SCOPE Research Institute of Electrophysiology Co., Ltd., Kaifeng 475000, China; (X.D.); (G.H.)
| | - Gary Tse
- Cardiac Electrophysiology Unit, Cardiovascular Analytics Group, Hong Kong, China;
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin 300211, China
- Kent and Medway Medical School, Canterbury CT2 7FS, UK
| | - Guoliang Hao
- Henan SCOPE Research Institute of Electrophysiology Co., Ltd., Kaifeng 475000, China; (X.D.); (G.H.)
- Burdon Sanderson Cardiac Science Centre, BHF Centre of Research Excellence, Department of Physiology, Anatomy and Genetics, University of Oxford, Oxford OX1 3PT, UK
| | - Yimei Du
- Department of Cardiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
- Research Center of Ion Channelopathy, Institute of Cardiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
- Correspondence:
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3
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Trullàs J, Aguiló O, Mirò Ó, Díez-Manglano J, Carrera-Izquierdo M, Quesada-Simón M, Álvarez-Rocha P, Llorens P, González-Franco Á, Montero-Pérez-Barquero M. Prevalencia e impacto en el pronóstico del bloqueo de rama derecha en pacientes con insuficiencia cardíaca aguda: hallazgos del registro RICA. Rev Clin Esp 2022. [DOI: 10.1016/j.rce.2021.10.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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4
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Trullàs J, Aguiló O, Mirò Ó, Díez-Manglano J, Carrera-Izquierdo M, Quesada-Simón M, Álvarez-Rocha P, Llorens P, González-Franco Á, Montero-Pérez-Barquero M. Prevalence and impact on prognosis of right-bundle branch block in patients with acute heart failure: Findings from the RICA registry. Rev Clin Esp 2022; 222:272-280. [DOI: 10.1016/j.rceng.2021.10.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 10/08/2021] [Indexed: 10/18/2022]
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5
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Prevalence, Related Factors and Association of Left Bundle Branch Block With Prognosis in Patients With Acute Heart Failure: a Simultaneous Analysis in 3 Independent Cohorts. J Card Fail 2022; 28:1104-1115. [PMID: 34998702 DOI: 10.1016/j.cardfail.2021.11.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 11/13/2021] [Accepted: 11/19/2021] [Indexed: 11/21/2022]
Abstract
OBJECTIVES To determine the prevalence, characteristics and association with prognosis of left bundle branch block (LBBB) in 3 different cohorts of patients with acute heart failure (AHF). METHODS AND RESULTS We retrospectively analyzed 12,950 patients with AHF who were included in the EAHFE (Epidemiology Acute Heart Failure Emergency), RICA (National Heart Failure Registry of the Spanish Internal Medicine Society), and BASEL-V (Basics in Acute Shortness of Breath Evaluation of Switzerland) registries. We independently analyzed the relationship between baseline and clinical characteristics and the presence of LBBB and the potential association of LBBB with 1-year all-cause mortality and a 90-day postdischarge combined endpoint (Emergency Department reconsultation, hospitalization or death). The prevalence of LBBB was 13.5% (95% confidence interval: 12.9%-14.0%). In all registries, patients with LBBB more commonly had coronary artery disease and previous episodes of AHF, were taking chronic spironolactone treatment, had lower left ventricular ejection fraction and systolic blood pressure values and higher NT-proBNP levels. There were no differences in risk for patients with LBBB in any cohort, with adjusted hazard ratios (95% confidence interval) for 1-year mortality in EAHFE/RICA/BASEL-V cohorts of 1.02 (0.89-1.17), 1.15 (0.95-1.38) and 1.32 (0.94-1.86), respectively, and for 90-day postdischarge combined endpoint of 1.00 (0.88-1.14), 1.14 (0.92-1.40) and 1.26 (0.84-1.89). These results were consistent in sensitivity analyses. CONCLUSIONS Less than 20% of patients with AHF present LBBB, which is consistently associated with cardiovascular comorbidities, reduced left ventricular ejection fraction and more severe decompensations. Nonetheless, after taking these factors into account, LBBB in patients with AHF is not associated with worse outcomes.
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6
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Pranata R, Tondas AE, Yonas E, Vania R, Yamin M, Chandra A, Siswanto BB. Differences in clinical characteristics and outcome of de novo heart failure compared to acutely decompensated chronic heart failure - systematic review and meta-analysis. Acta Cardiol 2021; 76:410-420. [PMID: 32252602 DOI: 10.1080/00015385.2020.1747178] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Recent evidence showed that the characteristics and outcome of those with de novo heart failure (HF) and acutely decompensated chronic heart failure (ADCHF) were different. We aimed to perform a comprehensive search on the clinical characteristics and outcome of patients with de novo HF and ADCHF. METHODS We performed a comprehensive search on de novo/new onset acute HF vs ADCHF from inception up until December 2019. RESULTS There were 38320 patients from 15 studies. De novo HF were younger and, had less prevalent hypertension, diabetes mellitus, ischaemic heart disease, chronic obstructive pulmonary disease, atrial fibrillation, and history of stroke/transient ischaemic attack compared to ADCHF. Five studies showed a lower NT-proBNP in de novo HF patients, while one study showed no difference. Valvular heart disease as aetiology of heart failure was less frequent in de novo HF, and upon sensitivity analysis, hypertensive heart disease was more frequent in de novo HF. As for precipitating factors, ACS (OR 2.42; I2:89%) was more frequently seen in de novo HF, whereas infection was less frequently (OR 0.69; I2:32%) in ADCHF. De novo HF was associated with a significantly lower 3-month mortality (OR 0.63; I2:91%) and 1-year (OR 0.59; I2:59%) mortality. Meta-regression showed that 1-year mortality did not significantly vary with age (p = .106), baseline ejection fraction (p = .703), or HF reduced ejection fraction (p = .262). CONCLUSION Risk factors, aetiology, and precipitating factors of HF in de novo and ADCHF differ. De novo HF also had lower 1-year mortality and 3-month mortality compared to ADCHF.
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Affiliation(s)
- Raymond Pranata
- Faculty of Medicine, Universitas Pelita Harapan, Tangerang, Indonesia
| | - Alexander Edo Tondas
- Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Sriwijaya, Dr. Mohammad Hoesin General Hospital, Palembang, Indonesia
| | - Emir Yonas
- Faculty of Medicine, Universitas YARSI, Jakarta, Indonesia
| | - Rachel Vania
- Faculty of Medicine, Universitas Pelita Harapan, Tangerang, Indonesia
| | - Muhammad Yamin
- Division of Cardiology, Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia/Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia
| | - Alvin Chandra
- Cardiology Division, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Bambang Budi Siswanto
- Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Indonesia, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
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7
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Martins C, Machado da Silva J, Guimarães D, Martins L, Vaz da Silva M. MONITORIA: The start of a new era of ambulatory heart failure monitoring? Part I - Theoretical Rationale. Rev Port Cardiol 2021; 40:329-337. [PMID: 34187634 DOI: 10.1016/j.repce.2020.07.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Accepted: 07/28/2020] [Indexed: 10/21/2022] Open
Abstract
Heart failure (HF) is a multifactorial chronic syndrome with progressive increasing incidence causing a huge financial burden worldwide. Remote monitoring should, in theory, improve HF management, but given increasing morbidity and mortality, a question remains: are we monitoring it properly? Device-based home monitoring enables objective and continuous measurement of vital variables and non-invasive devices should be first choice for elderly patients. There is no shortage of literature on the subject, however, most studies were designed to monitor a single variable or class of variables that were not properly assembled and, to the best of our knowledge, there are no large randomized studies about their impact on HF patient management. To overcome this problem, we carefully selected the most critical possible HF decompensating factors to design MONITORIA, a non-invasive device for comprehensive HF home monitoring. MONITORIA stands for MOnitoring Non-Invasively To Overcome mortality Rates of heart Insufficiency on Ambulatory, and in this paper, which is part I of a series of three articles, we discuss the theoretical basis for its design. MONITORIA and its inherent follow-up strategy will optimize HF patient care as it is a promising device, which will essentially adapt innovation not to the disease but rather to the patients.
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Affiliation(s)
- Carla Martins
- Internal Medicine, Centro Hospitalar de Entre Douro e Vouga, Santa Maria da Feira, Portugal.
| | | | - Diana Guimarães
- Faculty of Engineering of the University of Porto, Porto, Portugal
| | - Luís Martins
- Cardiology, Centro Hospitalar de Entre Douro e Vouga, Santa Maria da Feira, Portugal
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8
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Raffaello WM, Henrina J, Huang I, Lim MA, Suciadi LP, Siswanto BB, Pranata R. Clinical Characteristics of De Novo Heart Failure and Acute Decompensated Chronic Heart Failure: Are They Distinctive Phenotypes That Contribute to Different Outcomes? Card Fail Rev 2021; 7:e02. [PMID: 33708417 PMCID: PMC7919682 DOI: 10.15420/cfr.2020.20] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 10/23/2020] [Indexed: 12/11/2022] Open
Abstract
Heart failure is currently one of the leading causes of morbidity and mortality. Patients with heart failure often present with acute symptoms and may have a poor prognosis. Recent evidence shows differences in clinical characteristics and outcomes between de novo heart failure (DNHF) and acute decompensated chronic heart failure (ADCHF). Based on a better understanding of the distinct pathophysiology of these two conditions, new strategies may be considered to treat heart failure patients and improve outcomes. In this review, the authors elaborate distinctions regarding the clinical characteristics and outcomes of DNHF and ADCHF and their respective pathophysiology. Future clinical trials of therapies should address the potentially different phenotypes between DNHF and ADCHF if meaningful discoveries are to be made.
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Affiliation(s)
| | - Joshua Henrina
- Siloam Heart Institute, Siloam Hospitals Kebon Jeruk Jakarta, Indonesia
| | - Ian Huang
- Faculty of Medicine, Universitas Pelita Harapan Tangerang, Indonesia.,Department of Internal Medicine, Faculty of Medicine, Universitas Padjadjaran, Hasan Sadikin General Hospital Bandung, Indonesia
| | | | | | - Bambang Budi Siswanto
- Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Indonesia, National Cardiovascular Center Harapan Kita Jakarta, Indonesia
| | - Raymond Pranata
- Faculty of Medicine, Universitas Pelita Harapan Tangerang, Indonesia
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9
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MONITORIA: The start of a new era of ambulatory heart failure monitoring? Part I - Theoretical Rationale. Rev Port Cardiol 2021; 40:329-337. [PMID: 33483175 DOI: 10.1016/j.repc.2020.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 05/22/2020] [Accepted: 07/28/2020] [Indexed: 11/23/2022] Open
Abstract
Heart failure (HF) is a multifactorial chronic syndrome with progressive increasing incidence causing a huge financial burden worldwide. Remote monitoring should, in theory, improve HF management, but given increasing morbidity and mortality, a question remains: are we monitoring it properly? Device-based home monitoring enables objective and continuous measurement of vital variables and non-invasive devices should be first choice for elderly patients. There is no shortage of literature on the subject, however, most studies were designed to monitor a single variable or class of variables that were not properly assembled and, to the best of our knowledge, there are no large randomized studies about their impact on HF patient management. To overcome this problem, we carefully selected the most critical possible HF decompensating factors to design MONITORIA, a non-invasive device for comprehensive HF home monitoring. MONITORIA stands for MOnitoring Non-Invasively To Overcome mortality Rates of heart Insufficiency on Ambulatory, and in this paper, which is part I of a series of three articles, we discuss the theoretical basis for its design. MONITORIA and its inherent follow-up strategy will optimize HF patient care as it is a promising device, which will essentially adapt innovation not to the disease but rather to the patients.
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10
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Miró Ò, García Sarasola A, Fuenzalida C, Calderón S, Jacob J, Aguirre A, Wu DM, Rizzi MA, Malchair P, Haro A, Herrera S, Gil V, Martín-Sánchez FJ, Llorens P, Herrero Puente P, Bueno H, Domínguez Rodríguez A, Müller CE, Mebazaa A, Chioncel O, Alquézar-Arbé A. Departments involved during the first episode of acute heart failure and subsequent emergency department revisits and rehospitalisations: an outlook through the NOVICA cohort. Eur J Heart Fail 2019; 21:1231-1244. [PMID: 31389111 DOI: 10.1002/ejhf.1567] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 06/02/2019] [Accepted: 06/30/2019] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVES We investigated the natural history of patients after a first episode of acute heart failure (FEAHF) requiring emergency department (ED) consultation, focusing on: the frequency of ED visits and hospitalisations, departments admitting patients during the first and subsequent hospitalisations, and factors associated with difficult disease control. METHODS AND RESULTS We included consecutive patients diagnosed with FEAHF (either with or without previous heart failure diagnosis) in four EDs during 5 months in three different time periods (2009, 2011, 2014). Diagnosis was adjudicated by local principal investigators. The clinical characteristics of the index event were prospectively recorded, and all post-discharge ED visits and hospitalisations [related/unrelated to acute heart failure (AHF)], as well as departments involved in subsequent hospitalisations were retrospectively ascertained. 'Uncontrolled disease' during the first year after FEAHF was considered if patients were attended at ED (≥ 3 times) or hospitalised (≥ 2 times) for AHF or died. Overall, 505 patients with FEAHF were included and followed for a mean of 2.4 years. In-hospital mortality was 7.5%. Among 467 patients discharged alive, 288 died [median survival 3.9 years, 95% confidence interval (CI) 3.5-4.4], 421 (90%) revisited the ED (2342 ED visits; 42.4% requiring hospitalisation, 34.0% AHF-related) and 357 (77%) were hospitalised (1054 hospitalisations; 94.1% through ED, 51.4% AHF-related). AHF-related hospitalisations were mainly in internal medicine (28.0%), short-stay unit (26.3%), cardiology (20.8%), and geriatrics (14.1%). Only 47.4% of AHF-related hospitalisations were in the same department as the FEAHF, and internal medicine involvement significantly increased with subsequent hospitalisations (P = 0.01). Uncontrolled disease was observed in 31% of patients, which was independently related to age > 80 years [odds ratio (OR) 1.80, 95% CI 1.17-2.77], systolic blood pressure < 110 mmHg at ED arrival (OR 2.61, 95% CI 1.26-5.38) and anaemia (OR 2.39, 95% CI 1.51-3.78). CONCLUSION In the present aged cohort of AHF patients from Barcelona, Spain, the natural history after FEAHF showed different patterns of hospital department involvement. Advanced age, low systolic blood pressure and anaemia were factors related to uncontrolled disease during the year after debut.
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Affiliation(s)
- Òscar Miró
- Emergency Department, Hospital Clínic, 'Emergencies: Processes and Pathologies' Research Group, IDIBAPS, University of Barcelona, Barcelona, Spain.,The GREAT (Global REsearch in Acute cardiovascular conditions Team) Network
| | - Ana García Sarasola
- Emergency Department, Hospital de la Santa Creu I Sant Pau, Barcelona, Spain
| | - Carolina Fuenzalida
- Emergency Department, Hospital Clínic, 'Emergencies: Processes and Pathologies' Research Group, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Sofía Calderón
- Emergency Department, Hospital Clínic, 'Emergencies: Processes and Pathologies' Research Group, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Javier Jacob
- Emergency Department, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Alfons Aguirre
- Emergency Department, Hospital del Mar, Barcelona, Spain
| | - Da M Wu
- Emergency Department, Hospital Clínic, 'Emergencies: Processes and Pathologies' Research Group, IDIBAPS, University of Barcelona, Barcelona, Spain.,San Juan Bautista School of Medicine, San Juan de Puerto Rico, Puerto Rico
| | - Miguel A Rizzi
- Emergency Department, Hospital de la Santa Creu I Sant Pau, Barcelona, Spain
| | - Pierre Malchair
- Emergency Department, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Antonio Haro
- Emergency Department, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Sergio Herrera
- The GREAT (Global REsearch in Acute cardiovascular conditions Team) Network
| | - Víctor Gil
- Emergency Department, Hospital Clínic, 'Emergencies: Processes and Pathologies' Research Group, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Francisco J Martín-Sánchez
- Emergency Department, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria San Carlos (IdISSC), Universidad Complutense de Madrid, Madrid, Spain.,Centro Nacionalde Investigaciones Cardiovasculares (CNIC), Madrid, Spain
| | - Pere Llorens
- Emergency Department, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Pablo Herrero Puente
- Emergency Department, Home Hospitalization and Short Stay Unit, Hospital General de Alicante, Alicante, Spain
| | - Héctor Bueno
- Centro Nacionalde Investigaciones Cardiovasculares (CNIC), Madrid, Spain.,Cardiology Department, Hospital 12 de Octubre, Universidad Complutense, Madrid, Spain
| | | | - Christian E Müller
- The GREAT (Global REsearch in Acute cardiovascular conditions Team) Network.,Cardiology Department, University Hospital of Basel, Basel, Switzerland
| | - Alexandre Mebazaa
- The GREAT (Global REsearch in Acute cardiovascular conditions Team) Network.,Department of Anesthesiology and Critical Care Medicine, Saint Louis Lariboisière University Hospital, Université Paris Diderot, Paris, France
| | - Ovidiu Chioncel
- Emergency Institute for Cardiovascular Diseases, Prof. C. C. Iliescu, University of Medicine Carol Davila, Bucharest, Romania
| | - Aitor Alquézar-Arbé
- Emergency Department, Hospital de la Santa Creu I Sant Pau, Barcelona, Spain
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11
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Lee JH, Park JJ, Cho Y, Oh IY, Yoo BS, Kim JJ, Kim KH, Kang SM, Baek SH, Jeon ES, Cho MC, Chae SC, Oh BH, Choi DJ. Prognostic Implication of Ventricular Conduction Disturbance Pattern in Hospitalized Patients with Acute Heart Failure Syndrome. Korean Circ J 2019; 49:602-611. [PMID: 30891964 PMCID: PMC6597449 DOI: 10.4070/kcj.2018.0290] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Revised: 12/03/2018] [Accepted: 01/23/2019] [Indexed: 11/11/2022] Open
Abstract
Background and Objectives Conflicting data exist regarding the prognostic implication of ventricular conduction disturbance pattern in patients with heart failure (HF). This study investigated the prognostic impact of ventricular conduction pattern in hospitalized patients with acute HF. Methods Data from the Korean Acute Heart Failure registry were used. Patients were categorized into four groups: narrow QRS (<120 ms), right bundle branch block (RBBB), left bundle branch block (LBBB), and nonspecific intraventricular conduction delay (NICD). The NICD was defined as prolonged QRS (≥120 ms) without typical features of LBBB or RBBB. The primary endpoint was the composite of all-cause mortality or rehospitalization for HF aggravation within 1 year after discharge. Results This study included 5,157 patients. The primary endpoint occurred in 39.7% of study population. The LBBB group showed the highest incidence of primary endpoint followed by NICD, RBBB, and narrow QRS groups (52.5% vs. 49.7% vs. 44.4% vs. 37.5%, p<0.001). In a multivariable Cox-proportional hazards regression analysis, LBBB and NICD were associated with 39% and 28% increased risk for primary endpoint (LBBB hazard ratio [HR], 1.392; 95% confidence interval [CI], 1.152–1.681; NICD HR, 1.278; 95% CI, 1.074–1.520) compared with narrow QRS group. The HR of RBBB for the primary endpoint was 1.103 (95% CI, 0.915–1.329). Conclusions LBBB and NICD were independently associated with an increased risk of 1-year adverse event in hospitalized patients with HF, whereas the prognostic impacts of RBBB were limited. Trial Registration ClinicalTrials.gov Identifier: NCT01389843
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Affiliation(s)
- Ji Hyun Lee
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Jin Joo Park
- Department of Cardiology, Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Youngjin Cho
- Department of Cardiology, Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Il Young Oh
- Department of Cardiology, Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Byung Su Yoo
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Jae Joong Kim
- Division of Cardiology, Heart Institute, Asan Medical Center, University of Ulsan, Seoul, Korea
| | - Kye Hun Kim
- Department of Internal Medicine, Heart Research Center of Chonnam National University, Gwangju, Korea
| | - Seok Min Kang
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Sang Hong Baek
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Eun Seok Jeon
- Department of Internal Medicine, Sungkyunkwan University College of Medicine, Seoul, Korea
| | - Myeong Chan Cho
- Department of Internal Medicine, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Shung Chull Chae
- Department of Internal Medicine, Kyungpook National University College of Medicine, Daegu, Korea
| | - Byung Hee Oh
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Dong Ju Choi
- Department of Cardiology, Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Korea.
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12
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Kim KH. Ventricular Conduction Disturbance in Acute Heart Failure Syndrome: Does It Matter for Prognosis? Korean Circ J 2019; 49:612-614. [PMID: 31165596 PMCID: PMC6597455 DOI: 10.4070/kcj.2019.0116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Accepted: 04/16/2019] [Indexed: 11/25/2022] Open
Affiliation(s)
- Kyung-Hee Kim
- Division of Cardiology, Cardiovascular Center, Sejong General Hospital, Bucheon, Korea
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13
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Tolppanen H, Javanainen T, Sans-Rosello J, Parenica J, Nieminen T, Pavlusova M, Masip J, Köber L, Banaszewski M, Sionis A, Spinar J, Harjola VP, Jurkko R, Lassus J. Prevalence, Temporal Evolution, and Impact on Survival of Ventricular Conduction Blocks in Patients With Acute Coronary Syndrome and Cardiogenic Shock. Am J Cardiol 2018; 122:199-205. [PMID: 29778237 DOI: 10.1016/j.amjcard.2018.04.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 03/24/2018] [Accepted: 04/02/2018] [Indexed: 10/17/2022]
Abstract
Changes in QRS duration and pattern are regarded to reflect severe ischemia in acute coronary syndromes (ACS), and ventricular conduction blocks (VCBs) are recognized high-risk markers in both ACS and acute heart failure. Our aim was to evaluate the prevalence, temporal evolution, association with clinical and angiographic parameters, and impact on mortality of VCBs in ACS-related cardiogenic shock (CS). Data of 199 patients with ACS-related CS from a prospective multinational cohort were evaluated with electrocardiogram data from baseline and day 3. VCBs including left or right bundle branch block, right bundle branch block and hemiblock, isolated hemiblocks, and unspecified intraventricular conduction delay were assessed. Fifty percent of patients had a VCB at baseline; these patients were older, had poorer left ventricular function and had more often left main disease compared with those without VCB. One-year mortality was over 2-fold in patients with VCB compared with those without VCB (68% vs 32%, p<0.001). All types of VCBs at baseline were associated with increased mortality, and the predictive value of a VCB was independent of baseline variables and coronary angiography findings. Interestingly, 37% of the VCBs were transient, i.e., disappeared before day 3. However, 1-year mortality was much higher in these patients (69%) compared to patients with persistent (38%) or no VCB (15%, p<0.001). Indeed, a transient VCB was a strong independent predictor of 1-year mortality. In conclusion, our findings propose that any VCB in baseline electrocardiogram, even if transient, identifies very early patients at particularly high mortality risk in ACS-related CS.
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Tolppanen H, Siirila-Waris K, Harjola VP, Marono D, Parenica J, Kreutzinger P, Nieminen T, Pavlusova M, Tarvasmaki T, Twerenbold R, Tolonen J, Miklik R, Nieminen MS, Spinar J, Mueller C, Lassus J. Ventricular conduction abnormalities as predictors of long-term survival in acute de novo and decompensated chronic heart failure. ESC Heart Fail 2015; 3:35-43. [PMID: 27774265 PMCID: PMC5061091 DOI: 10.1002/ehf2.12068] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2015] [Revised: 08/08/2015] [Accepted: 09/07/2015] [Indexed: 11/30/2022] Open
Abstract
Aims Data on the prognostic role of left and right bundle branch blocks (LBBB and RBBB), and nonspecific intraventricular conduction delay (IVCD; QRS ≥ 110 ms, no BBB) in acute heart failure (AHF) are controversial. Our aim was to investigate electrocardiographic predictors of long‐term survival in patients with de novo AHF and acutely decompensated chronic heart failure (ADCHF). Methods and Results We analysed the admission electrocardiogram of 982 patients from a multicenter European cohort of AHF with 3.9 years' mean follow‐up. Half (51.5%, n = 506) of the patients had de novo AHF. LBBB, and IVCD were more common in ADCHF than in de novo AHF: 17.2% vs. 8.7% (P < 0.001) and 20.6% vs. 13.2% (P = 0.001), respectively, and RBBB was almost equally common (6.9% and 8.1%; P = 0.5), respectively. Mortality during the follow‐up was higher in patients with RBBB (85.4%) and IVCD (73.7%) compared with patients with normal ventricular conduction (57.0%); P < 0.001 for both. The impact of RBBB on prognosis was prominent in de novo AHF (adjusted HR 1.93, 1.03–3.60; P = 0.04), and IVCD independently predicted death in ADCHF (adjusted HR 1.79, 1.28–2.52; P = 0.001). Both findings were pronounced in patients with reduced ejection fraction. LBBB showed no association with increased mortality in either of the subgroups. The main results were confirmed in a validation cohort of 1511 AHF patients with 5.9 years' mean follow‐up. Conclusions Conduction abnormalities predict long‐term survival differently in de novo AHF and ADCHF. RBBB predicts mortality in de novo AHF, and IVCD in ADCHF. LBBB has no additive predictive value in AHF requiring hospitalization.
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Affiliation(s)
- Heli Tolppanen
- Heart and Lung Center, Cardiology Helsinki University Hospital Finland
| | | | - Veli-Pekka Harjola
- Division of Emergency Care, Department of Medicine Helsinki University Hospital Finland
| | - David Marono
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB) University Hospital Basel Switzerland
| | - Jiri Parenica
- Cardiology DepartmentFaculty Hospital BrnoCzech Republic; International Clinical Research Center, Department of Cardiovascular DiseaseUniversity Hospital BrnoCzech Republic
| | - Philipp Kreutzinger
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB) University Hospital Basel Switzerland
| | - Tuomo Nieminen
- Heart and Lung Center, Cardiology Helsinki University Hospital Finland
| | | | | | - Raphael Twerenbold
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB) University Hospital Basel Switzerland
| | - Jukka Tolonen
- Department of Medicine Helsinki University Hospital Finland
| | - Roman Miklik
- Cardiology DepartmentFaculty Hospital BrnoCzech Republic; International Clinical Research Center, Department of Cardiovascular DiseaseUniversity Hospital BrnoCzech Republic
| | - Markku S Nieminen
- Heart and Lung Center, Cardiology Helsinki University Hospital Finland
| | - Jindrich Spinar
- Cardiology DepartmentFaculty Hospital BrnoCzech Republic; International Clinical Research Center, Department of Cardiovascular DiseaseUniversity Hospital BrnoCzech Republic
| | - Christian Mueller
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB) University Hospital Basel Switzerland
| | - Johan Lassus
- Heart and Lung Center, Cardiology Helsinki University Hospital Finland
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