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Watanabe Y, Kubota Y, Nishino T, Tara S, Kato K, Hayashi D, Matsuda J, Miyachi H, Tokita Y, Iwasaki Y, Asai K. Fractional excretion of urea nitrogen can identify true worsening renal function in patients with heart failure. ESC Heart Fail 2024; 11:2043-2054. [PMID: 38522427 PMCID: PMC11287315 DOI: 10.1002/ehf2.14755] [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: 12/23/2023] [Revised: 02/18/2024] [Accepted: 02/29/2024] [Indexed: 03/26/2024] Open
Abstract
AIMS Fractional excretion of urea nitrogen (FEUN), used to differentiate the cause of acute kidney injury, has emerged as a useful fluid index in patients with heart failure (HF). We hypothesized that FEUN could be useful in identifying worsening renal function (WRF) associated with poor outcomes in patients with acute HF (AHF). METHODS AND RESULTS Overall, 1103 patients with AHF (median age, 78 years; male proportion, 60%) were categorized into six groups according to the presence of WRF and FEUN values (low, ≤32.1%; medium, >32.1% and ≤38.0%; and high, >38.0%) at discharge. WRF was defined as an increase of ≥0.3 mg/dL in the serum creatinine level from admission to discharge. FEUN was calculated by the following formula: (urinary urea × serum creatinine) × 100/(serum urea × urinary creatinine). The cut-off values for low, medium, and high FEUN were based on a previous study. The primary outcome of this study was HF readmission after hospital discharge. During the 1 year follow-up, 170 HF readmissions occurred. Kaplan-Meier analysis revealed significantly higher HF readmission rates in patients with WRF than in those without WRF (log-rank test, P < 0.001). Additionally, among patients with WRF, HF readmission rates were lowest in those with medium FEUN values, followed by those with low FEUN values and those with high FEUN values. On multivariable analysis, the presence of WRF with low or high FEUN values was independently associated with increased HF readmission, as compared with the absence of WRF with medium FEUN values. Notably, no association was noted between WRF with medium FEUN values and HF readmission. CONCLUSIONS The prognostic impact of WRF was significantly mediated by the FEUN values and was associated with worse outcomes only when the FEUN values were either low or high. Our study suggests that FEUN can identify prognostically relevant WRF in patients with AHF.
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Affiliation(s)
- Yukihiro Watanabe
- Department of Cardiovascular MedicineNippon Medical SchoolTokyoJapan
| | - Yoshiaki Kubota
- Department of Cardiovascular MedicineNippon Medical SchoolTokyoJapan
| | - Takuya Nishino
- Department of Health Care AdministrationNippon Medical SchoolTokyoJapan
| | - Shuhei Tara
- Department of Cardiovascular MedicineNippon Medical SchoolTokyoJapan
| | - Katsuhito Kato
- Department of Hygiene and Public HealthNippon Medical SchoolTokyoJapan
| | - Daisuke Hayashi
- Department of Pharmaceutical ServiceNippon Medical School HospitalTokyoJapan
| | - Junya Matsuda
- Department of Cardiovascular MedicineNippon Medical SchoolTokyoJapan
| | - Hideki Miyachi
- Department of Cardiovascular MedicineNippon Medical SchoolTokyoJapan
- Division of Cardiovascular Intensive CareNippon Medical School HospitalTokyoJapan
| | - Yukichi Tokita
- Department of Cardiovascular MedicineNippon Medical SchoolTokyoJapan
| | - Yu‐ki Iwasaki
- Department of Cardiovascular MedicineNippon Medical SchoolTokyoJapan
| | - Kuniya Asai
- Department of Cardiovascular MedicineNippon Medical SchoolTokyoJapan
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Hirano Y, Fujikura T, Kono K, Yamaguchi T, Ohashi N, Yokoyama Y, Toda M, Yamauchi K, Yasuda H. Effect of rehabilitation on renal outcomes after acute kidney injury associated with cardiovascular disease: a retrospective analysis. BMC Nephrol 2024; 25:222. [PMID: 38997657 PMCID: PMC11242010 DOI: 10.1186/s12882-024-03666-z] [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: 03/13/2024] [Accepted: 07/05/2024] [Indexed: 07/14/2024] Open
Abstract
BACKGROUND Acute kidney injury (AKI) incidence is extremely high worldwide, and patients who develop AKI are at increased risk of developing chronic kidney disease (CKD), CKD progression, and end-stage kidney disease (ESKD). However, there is no established treatment strategy for AKI. Based on the idea that exercise has a stabilizing effect on hemodynamics, we hypothesized that rehabilitation would have beneficial renal outcomes in patients with AKI associated with cardiovascular disease. Therefore, the purpose of this study was to determine whether rehabilitation can stabilize hemodynamics and positively impact renal outcomes in patients with AKI associated with cardiovascular disease. METHODS In total, 107 patients with AKI associated with cardiovascular disease were enrolled in this single-center retrospective study and were either assigned to the exposure group (n = 36), which received rehabilitation at least once a week for at least 8 consecutive weeks, or to the control group (n = 71). Estimated glomerular filtration rate was assessed at baseline before admission, at the lowest value during hospitalization, and at 3, 12, and 24 months after enrolment. Trends over time (group × time) between the two groups were compared using generalized estimating equations. Moreover, congestive status was assessed by amino-terminal pro-B-type natriuretic peptide (NT-proBNP), and the effect of rehabilitation on congestion improvement was investigated using logistical regression analysis. RESULTS The time course of renal function after AKI, from baseline to each of the three timepoints suggested significant differences between the two groups (p < 0.01). However, there was no significant difference between the two groups at any time point in terms of percentage of patients who experienced a 40% estimated glomerular filtration rate reduction from that at baseline. The proportion of patients with improved congestion was significantly higher in the exposure group compared with that in the control group (p = 0.018). Logistic regression analysis showed that rehabilitation was significantly associated with improved congestion (p = 0.021, OR: 0.260, 95%CI: 0.083-0.815). CONCLUSION Our results suggest that rehabilitation in patients with AKI associated with cardiovascular disease correlates with an improvement in congestion and may have a positive effect on the course of renal function.
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Affiliation(s)
- Yuma Hirano
- Department of Rehabilitation Medicine, Hamamatsu University Hospital, Hamamatsu City Shizuoka, Japan.
| | - Tomoyuki Fujikura
- Internal Medicine 1, Hamamatsu University School of Medicine, Hamamatsu City Shizuoka, Japan
| | - Kenichi Kono
- Department of Physical Therapy, International University of Health and Welfare School of Health Science at Narita, Narita City Chiba, Japan
| | - Tomoya Yamaguchi
- Department of Rehabilitation Medicine, Hamamatsu University Hospital, Hamamatsu City Shizuoka, Japan
| | - Naro Ohashi
- Internal Medicine 1, Hamamatsu University School of Medicine, Hamamatsu City Shizuoka, Japan
| | - Yurina Yokoyama
- Department of Rehabilitation Medicine, Hamamatsu University Hospital, Hamamatsu City Shizuoka, Japan
| | - Masahiro Toda
- Department of Rehabilitation Medicine, Hamamatsu University Hospital, Hamamatsu City Shizuoka, Japan
| | - Katsuya Yamauchi
- Department of Rehabilitation Medicine, Hamamatsu University Hospital, Hamamatsu City Shizuoka, Japan
| | - Hideo Yasuda
- Internal Medicine 1, Hamamatsu University School of Medicine, Hamamatsu City Shizuoka, Japan
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Horiuchi Y, Wettersten N. Treatment strategies for diuretic resistance in patients with heart failure. J Cardiol 2024:S0914-5087(24)00122-9. [PMID: 38914279 DOI: 10.1016/j.jjcc.2024.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Revised: 06/13/2024] [Accepted: 06/18/2024] [Indexed: 06/26/2024]
Abstract
Improving congestion with diuretic therapy is crucial in the treatment of heart failure (HF). However, despite the use of loop diuretics, diuresis may be inadequate and congestion persists, which is known as diuretic resistance. Diuretic resistance and residual congestion are associated with a higher risk of rehospitalization and mortality. Causes of diuretic resistance in HF include diuretic pharmacokinetic changes, renal hemodynamic perturbations, neurohumoral activations, renal tubular remodeling, and use of nephrotoxic drugs as well as patient comorbidities. Combination diuretic therapy (CDT) has been advocated for the treatment of diuretic resistance. Thiazides, acetazolamides, tolvaptan, mineralocorticoid receptor antagonist, and sodium-glucose co-transporter-2 inhibitors are among the candidates, but none of these treatments has yet demonstrated significant diuretic efficacy or improved prognosis. At present, it is essential to identify and treat the causes of diuretic resistance in individual patients and to use CDT based on a better understanding of the characteristics of each drug to achieve adequate diuresis. Further research is needed to effectively assess and manage diuretic resistance and ultimately improve patient outcomes.
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Affiliation(s)
- Yu Horiuchi
- Division of Cardiology, Mitsui Memorial Hospital, Tokyo, Japan.
| | - Nicholas Wettersten
- Division of Cardiovascular Medicine, San Diego Veterans Affairs Medical Center, San Diego, CA, USA; Division of Cardiovascular Medicine, University of California, San Diego, La Jolla, CA, USA
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4
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Mughal HB, Majeed AI, Aftab M, Ubaid MF, Zahra S, Abbasi MSR, Qadir M, Ahmad M, Akbar A, Tasneem S, Jadoon SK, Tariq M, Hussain S, Khandker SS, Alvi S. Brain natriuretic peptide in acute heart failure and its association with glomerular filtration rate: A systematic review and meta-analysis. Medicine (Baltimore) 2024; 103:e36933. [PMID: 38394539 PMCID: PMC11309607 DOI: 10.1097/md.0000000000036933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 12/20/2023] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND Acute heart failure (AHF) is one of the most common cardiovascular diseases. Early diagnosis and prognosis are essential, as they can eventually lead to a fatal condition. Recently, brain natriuretic peptide (BNP) has been recognized as one of the most popular biomarkers for AHF. Changes in glomerular filtration rate (GFR) are often observed in AHF. METHODS We searched PubMed, Google Scholar, and ScienceDirect between March and June 2023. Original case control studies written in English that assessed levels oh BNP in AHF were included. Systematic reviews, letters to editor, correspondence, comprehensive reviews, and duplicated studies were excluded. Funnel plots were constructed to assess publication bias. RESULTS A total of 9 studies were selected and we obtained the mean difference (MD) of BNP level to be 2.57 (95% CI: 1.35, 3.78), and GFR to be -15.52, (95% CI: -23.35, -7.70) in AHF patients. Sensitivity analyses supported the robustness of the outcome. CONCLUSION Results indicated that BNP was a promising prognostic biomarker of AHF, whereas GFR was found to be negatively correlated with AHF.
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Affiliation(s)
- Hamdah Bashir Mughal
- Registered Medical Practitioner, Azad Jammu & Kashmir Medical College, Muzaffarabad, Azad Jammu and Kashmir, Pakistan
| | | | - Maria Aftab
- Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | | | - Sabahat Zahra
- Acute and General Medicine, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | | | - Mamoon Qadir
- Head of Cardiology Department Fed Govt Polyclinic and Kulsum International Hospital, Islamabad, Pakistan
| | - Mumtaz Ahmad
- Abbas Institute of Medical Sciences, Muzaffarabad AJK, Pakistan
| | - Amna Akbar
- District Headquarter Hospital Jhelum Valley, Muzaffarabad AJK, Pakistan
| | | | | | - Maham Tariq
- Gujranwala, Teaching Hospital, Gujranwala, Pakistan
| | | | | | - Sarosh Alvi
- Teaching Faculty, University of Khartoum, Khartoum, Sudan
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5
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Georges G, Fudim M, Burkhoff D, Leon MB, Généreux P. Patient Selection and End Point Definitions for Decongestion Studies in Acute Decompensated Heart Failure: Part 2. JOURNAL OF THE SOCIETY FOR CARDIOVASCULAR ANGIOGRAPHY & INTERVENTIONS 2023; 2:101059. [PMID: 39131062 PMCID: PMC11307977 DOI: 10.1016/j.jscai.2023.101059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 06/07/2023] [Accepted: 06/09/2023] [Indexed: 08/13/2024]
Abstract
Congestion is the most common manifestation of acute decompensated heart failure (ADHF). Residual congestion despite initial medical therapy is common and is recognized to be associated with worse outcomes; however, there are currently no standardized definition regarding decongestion end point. In the second part of this 2-part review, we provide a critical appraisal of decongestion definitions previously used in ADHF studies, review alternative metrics to define severity of volume overload, and propose a more granular 4-class congestion grading scheme and decongestion end point definitions that could potentially be included in future ADHF trials and consensus definitions.
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Affiliation(s)
- Gabriel Georges
- Quebec Heart and Lung Institute, Quebec City, Quebec, Canada
| | - Marat Fudim
- Division of Cardiology, Department of Internal Medicine, Duke University School of Medicine, Durham, North Carolina
| | | | - Martin B. Leon
- Division of Cardiology, Columbia University Irving Medical Center/NewYork-Presbyterian Hospital, New York, New York
| | - Philippe Généreux
- Gagnon Cardiovascular Institute, Morristown Medical Center, Morristown, New Jersey
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6
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Macedo E, Wettersten N. The Mounting Evidence for Permissive Hypercreatinemia in Acute Heart Failure: Adding Sodium Glucose Cotransporter Inhibitors to the List. KIDNEY360 2023; 4:1347-1349. [PMID: 37883999 PMCID: PMC10617792 DOI: 10.34067/kid.0000000000000266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Affiliation(s)
- Etienne Macedo
- Division of Nephrology, University of California, San Diego, La Jolla, California
| | - Nicholas Wettersten
- Division of Cardiovascular Medicine, San Diego Veterans Affairs Medical Center, San Diego, California
- Division of Cardiovascular Medicine, University of California, San Diego, La Jolla, California
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Kenneally LF, Lorenzo M, Romero-González G, Cobo M, Núñez G, Górriz JL, Barrios AG, Fudim M, de la Espriella R, Núñez J. Kidney function changes in acute heart failure: a practical approach to interpretation and management. Clin Kidney J 2023; 16:1587-1599. [PMID: 37779845 PMCID: PMC10539207 DOI: 10.1093/ckj/sfad031] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Indexed: 10/03/2023] Open
Abstract
Worsening kidney function (WKF) is common in patients with acute heart failure (AHF) syndromes. Although WKF has traditionally been associated with worse outcomes on a population level, serum creatinine concentrations vary greatly during episodes of worsening heart failure, with substantial individual heterogeneity in terms of their clinical meaning. Consequently, interpreting such changes within the appropriate clinical context is essential to unravel the pathophysiology of kidney function changes and appropriately interpret their clinical meaning. This article aims to provide a critical overview of WKF in AHF, aiming to provide physicians with some tips and tricks to appropriately interpret kidney function changes in the context of AHF.
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Affiliation(s)
- Laura Fuertes Kenneally
- Cardiology Department, General Hospital of Alicante, Dr Balmis. Alicante, Spain
- Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL). Alicante, Spain
| | - Miguel Lorenzo
- Cardiology Department, Hospital Clínico Universitario de Valencia, Universitat de Valencia, INCLIVA, Valencia, Spain
| | - Gregorio Romero-González
- Nephrology Department, University Hospital Germans Trias I Pujol, Badalona, Spain, International Renal Research Institute of Vicenza (IRRIV), Vicenza, Italy
| | - Marta Cobo
- CIBER Cardiovascular
- Cardiology Department, Hospital Universitario Puerta de Hierro Majadahonda (IDIPHISA), Madrid, Spain
| | - Gonzalo Núñez
- Cardiology Department, Hospital Clínico Universitario de Valencia, Universitat de Valencia, INCLIVA, Valencia, Spain
| | - Jose Luis Górriz
- Nephrology Department, Hospital Clínico Universitario de Valencia, Universitat de Valencia, Valencia, Spain
| | - Ana Garcia Barrios
- Cardiology Department, General Hospital of Alicante, Dr Balmis. Alicante, Spain
- Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL). Alicante, Spain
| | - Marat Fudim
- Cardiology Department, Duke University Medical Center. Durham, NC, USA
- Duke Clinical Research Institute, Durham, NC, USA
| | - Rafael de la Espriella
- Cardiology Department, Hospital Clínico Universitario de Valencia, Universitat de Valencia, INCLIVA, Valencia, Spain
| | - Julio Núñez
- Cardiology Department, Hospital Clínico Universitario de Valencia, Universitat de Valencia, INCLIVA, Valencia, Spain
- CIBER Cardiovascular
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8
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Song J, Chen L, Yuan Z, Gong X. Elevation of serum human epididymis protein 4 (HE4) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) as predicting factors for the occurrence of acute kidney injury on chronic kidney disease: a single-center retrospective self-control study. Front Pharmacol 2023; 14:1269311. [PMID: 37753112 PMCID: PMC10518407 DOI: 10.3389/fphar.2023.1269311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Accepted: 08/30/2023] [Indexed: 09/28/2023] Open
Abstract
Objectives: To evaluate whether novel biomarkers of renal injury, serum HE4 and NT-proBNP could predict acute kidney injury (AKI) on chronic kidney disease (CKD) (A on C) and assess the specificity and efficiency of serum creatinine (SCr), HE4 and NT-proBNP in identifying potential AKI. Meanwhile, the potential early-warning value of HE4 and NT-proBNP in CKD patients was explored. Methods: We performed a single-center, retrospective cohort study of 187 adult CKD patients. 32 AKI (grades 1-2) patients with pre-existing CKD (stages 3-5) were Group 1, 59 patients of CKD (stages 4-5) were Group 2. Another 96 patients of CKD (stages 1-3) were Group 3. All patients received general treatments, Group 1 patients received Chinese herb formulation (Chuan Huang Fang-Ⅱ, CHF-Ⅱ) simultaneously. These 155 CKD (stages 1-5) without AKI patients were observed for descriptive analysis. Results: HE4 in Group 1 (860.63 ± 385.40) was higher than that in Group 2 (673.86 ± 283.58) before treatments. BUN, SCr, UA, NGAL, IL18, HE4 and NT-proBNP in Group 1 were lower, while eGFR was higher (p < 0.01, after vs. before treatments). In Group 1, both HE4 and NT-proBNP were positively correlated with SCr (respectively r = 0.549, 0.464) before treatments. The diagnostic performance of serum HE4 and NT-proBNP for A on C was 351.5 pmol/L, 274.5 pg/mL as the optimal cutoff value Area Under Curve (AUC) 0.860 (95% CI: 0.808 - 0.913, p < 0.001), [AUC 0.775 (95% CI: 0.697 - 0.853, p < 0.001), with a sensitivity and specificity of 100% and 66.5%, 87.5% and 48.8%, respectively]. In Group 2, serum HE4 was correlated with SCr (r = 0.682, p < 0.01) before treatments. Serum HE4 and NT-proBNP were elevated in advanced CKD stages, and were increased as CKD stages progressed with statistical significance. Conclusion: This work indicated serum HE4 and NT-proBNP should elevate in A on C and CKD patients, HE4 is positively correlated with the disease severity, and patients with higher HE4 and NT-proBNP usually have poorer prognosis. Thus, serum HE4 and NT-proBNP are impactful predictors of A on C. Additionally, serum HE4 and NT-proBNP have the potential to evaluate clinical efficacy of A on C.
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Affiliation(s)
| | | | | | - Xuezhong Gong
- Department of Nephrology, Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
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Lorenzo M, Núñez G, Fuertes-Kenneally L, de la Espriella R, Villar S, Miró O, Llorens P, Santas E, Miñana G, Bodí V, Sanchis J, Carratalá A, Bayés-Genís A, Núñez J. Early glomerular filtration rates changes and risk of mortality in acute heart failure. The modifying role of admission renal function and decongestion. Eur J Intern Med 2023; 115:96-103. [PMID: 37316355 DOI: 10.1016/j.ejim.2023.05.037] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Revised: 05/26/2023] [Accepted: 05/29/2023] [Indexed: 06/16/2023]
Abstract
BACKGROUND The pathophysiology of changes in estimated glomerular filtration rate (eGFR) in acute heart failure (AHF) is complex and multifactorial. We evaluated the associated mortality risk of early changes in eGFR across baseline renal function on admission and early changes in natriuretic peptides in patients admitted with AHF. METHODS We retrospectively evaluated 2,070 patients admitted with AHF. Renal dysfunction on admission was defined as eGFR<60 ml/min/1.73m2 and successful decongestion as NT-proBNP decreased >30% from baseline. We assessed the mortality risk associated with eGFR changes from baseline at 48-72 h after admission (ΔeGFR%) according to baseline renal function, and NT-proBNP changes at 48-72 h through Cox regression analyses. RESULTS The mean age was 74.4 ± 11.2 years, and 930 (44.9%) were women. The proportion of admission eGFR<60 ml/min/1.73m2 and 48-72 h changes in NT-proBNP>30% were 50.5% and 32.8%, respectively. At a median follow-up of 1.75 years, 928 deaths were registered. In the whole sample, changes in renal function were not associated with mortality (p = 0.208). The adjusted analysis revealed that the risk of mortality related to ΔeGFR% was heterogeneous across baseline renal function and changes in NT-proBNP (p-value for interaction=0.003). ΔeGFR% was not associated with mortality in patients with baseline eGFR≥60 ml/min/1.73m2. In those with eGFR<60 ml/min/1.73m2, a decrease in eGFR was associated with higher mortality, particularly in those with a reduction in NT-proBNP<30%. CONCLUSION In patients with AHF, early ΔeGFR% was associated with the risk of long-term mortality only in patients with renal dysfunction on admission and no early decline in NT-proBNP.
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Affiliation(s)
- Miguel Lorenzo
- Cardiology Department, Hospital Clínico Universitario de Valencia, INCLIVA, Universitat de València, Valencia, Spain
| | - Gonzalo Núñez
- Cardiology Department, Hospital Clínico Universitario de Valencia, INCLIVA, Universitat de València, Valencia, Spain
| | | | - Rafael de la Espriella
- Cardiology Department, Hospital Clínico Universitario de Valencia, INCLIVA, Universitat de València, Valencia, Spain
| | - Sandra Villar
- Cardiology Department, Hospital Clínico Universitario de Valencia, INCLIVA, Universitat de València, Valencia, Spain
| | - Oscar Miró
- Emergency Department, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Pere Llorens
- Emergency Department, Hospital General Universitario de Alicante, Alicante, Spain
| | - Enrique Santas
- Cardiology Department, Hospital Clínico Universitario de Valencia, INCLIVA, Universitat de València, Valencia, Spain
| | - Gema Miñana
- Cardiology Department, Hospital Clínico Universitario de Valencia, INCLIVA, Universitat de València, Valencia, Spain
| | - Vicent Bodí
- Cardiology Department, Hospital Clínico Universitario de Valencia, INCLIVA, Universitat de València, Valencia, Spain
| | - Juan Sanchis
- Cardiology Department, Hospital Clínico Universitario de Valencia, INCLIVA, Universitat de València, Valencia, Spain; CIBER Cardiovascular, Madrid, Spain
| | - Arturo Carratalá
- Department of Clinical Chemistry, Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - Antoni Bayés-Genís
- CIBER Cardiovascular, Madrid, Spain; Cardiology Department, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Julio Núñez
- Cardiology Department, Hospital Clínico Universitario de Valencia, INCLIVA, Universitat de València, Valencia, Spain; CIBER Cardiovascular, Madrid, Spain.
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10
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Zhao D, Gu L, Wei W, Peng D, Yang M, Yuan W, Rong S. Impact of the degree of worsening renal function and B-type natriuretic peptide on the prognosis of patients with acute heart failure. Front Cardiovasc Med 2023; 10:1103813. [PMID: 37077744 PMCID: PMC10106778 DOI: 10.3389/fcvm.2023.1103813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 03/15/2023] [Indexed: 04/05/2023] Open
Abstract
BackgroundThe impact of the degree of worsening renal function (WRF) and B-type natriuretic peptide (BNP) on the prognosis of patients with acute heart failure (AHF) is still debatable. The present study investigated the influence of different degrees of WRF and BNP levels at discharge on 1-year all-cause mortality in AHF.MethodsHospitalized AHF patients diagnosed with acute new-onset/worsening of chronic heart failure (HF) between January 2015 and December 2019 were included in this study. Patients were assigned into high and low BNP groups based on the median BNP level at discharge (464 pg/ml). According to serum creatinine (Scr) levels, WRF was divided into non-severe WRF (nsWRF) (Scr increased ≥0.3 mg/dl and <0.5 mg/dl) and severe WRF (sWRF) (Scr increased ≥0.5 mg/dl); non-WRF (nWRF) was defined as Scr increased of <0.3 mg/dl). Multivariable cox regression was used to evaluate the association of low BNP value and different degrees of WRF with a all-cause death, as well as testing for an interaction between the two.ResultsAmong 440 patients in the high BNP group, there was a significant difference in WRF on mortality (nWRF vs. nsWRF vs. sWRF: 22% vs. 23.8% vs. 58.8%, P < 0.001). Yet, mortality did not significantly differ across the WRF subgroups in the low BNP group (nWRF vs. nsWRF vs. sWRF: 9.1% vs. 6.1% vs. 15.2%, P = 0.489). In multivariate Cox regression analysis, low BNP group at discharge (HR, 0.265; 95%CI, 0.162–0.434; P < 0.001) and sWRF (HR, 2.838; 95%CI, 1.756–4.589; P < 0.001) were independent predictors of 1-year mortality in AHF.There was a significant interaction between low BNP group and sWRF(HR, 0.225; 95%CI, 0.055–0.918; P < 0.05).ConclusionsnsWRF does not increase the 1-year mortality in AHF patients, whereas sWRF does. A low BNP value at discharge is associated with better long-term outcomes and mitigates the adverse effects of sWRF on prognosis.
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Rong Y, Wu D, Li M, Teng J. Efficacy and safety of Guipi Decoction in the treatment of chronic heart failure: A systematic review and meta-analysis of randomized controlled trials. Medicine (Baltimore) 2023; 102:e33181. [PMID: 36862873 PMCID: PMC9981397 DOI: 10.1097/md.0000000000033181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/04/2023] Open
Abstract
BACKGROUND Chronic heart failure (CHF) is the ultimate destination of most cardiovascular diseases and one of the leading causes of death for the elderly. Despite significant advances in the therapy of heart failure, the mortality and rehospitalization rates remain high. Guipi Decoction (GPD) has been reported to be significantly effective on patients with CHF, but it still lacks evidence-based medicine support. METHODS Two investigators systematically searched a total of 8 databases including PubMed, Embase, The Cochrane Library, Web of Science, Wanfang, China National Knowledge Infrastructure (CNKI), VIP, and CBM from construction to Nov 2022. Randomized controlled trials that compared GPD or in combination with conventional western medicine versus western medicine alone in the treatment of CHF were eligible for selection. The quality of included studies were evaluated and assigned data were extracted according to the method provided by Cochrane. All analyses used Review Manager 5.3 software. RESULTS The search identified 17 studies with a sample size of 1806 patients. Meta-analysis showed that GPD intervention was associated with an improvement in total clinical effective rate with a relative risk of 1.19 (95% confidence interval [CI] [1.15, 1.24]), P < .00001]. In terms of cardiac function and ventricular remodeling, GPT could improve left ventricular ejection fraction (mean difference [MD] = 6.41, 95% CI [4.32, 8.50], P < .00001), reduce left ventricular end diastolic diameter (MD = -6.22, 95% CI [-7.17, -5.28], P < .00001) and left ventricular end systolic diameter (MD = -4.92, 95% CI [-5.93, -3.90], P < .00001). In terms of hematological indices, GPD could decrease the levels of N-terminal pro-brain natriuretic peptide (standardized MD = -2.31, 95% CI [-3.05, -1.58], P < .00001) and C-reactive protein (MD = -3.51, 95% CI [-4.10, -2.92], P < .00001). And the analysis of safety revealed no significant differences in adverse effects between the 2 groups with a relative risk of 0.56 (95% CI [0.20, 0.89], P = .55). CONCLUSION GPD can improve cardiac function and inhibit ventricular remodeling with few adverse effects. However, more rigorous and high-quality randomized controlled trials are needed to verify the conclusion.
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Affiliation(s)
- Yuanhang Rong
- College of Traditional Chinese Medicine, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Di Wu
- College of Traditional Chinese Medicine, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Ming Li
- Office of Academic Affairs, Shandong University of Traditional Chinese Medicine, Jinan, China
- *Correspondence: Ming Li, Office of Academic Affairs, Shandong University of Traditional Chinese Medicine, No. 4655 Daxue Road, Changqing District, Jinan, Shandong Province 250000, China (e-mail: )
| | - Jing Teng
- The First Clinical Medical College, Shandong University of Traditional Chinese Medicine, Jinan, China
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12
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Horiuchi YU, Wettersten N, VAN Veldhuisen DJ, Mueller C, Filippatos G, Nowak R, Hogan C, Kontos MC, Cannon CM, Müeller GA, Birkhahn R, Taub P, Vilke GM, McDonald K, Mahon N, Nuñez J, Briguori C, Passino C, Duff S, Maisel A, Murray PT. Galectin-3, Acute Kidney Injury and Myocardial Damage in Patients With Acute Heart Failure. J Card Fail 2023; 29:269-277. [PMID: 36332898 DOI: 10.1016/j.cardfail.2022.09.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Revised: 09/28/2022] [Accepted: 09/28/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND Galectin-3, a biomarker of inflammation and fibrosis, can be associated with renal and myocardial damage and dysfunction in patients with acute heart failure (AHF). METHODS AND RESULTS We retrospectively analyzed 790 patients with AHF who were enrolled in the AKINESIS study. During hospitalization, patients with galectin-3 elevation (> 25.9 ng/mL) on admission more commonly had acute kidney injury (assessed by KDIGO criteria), renal tubular damage (peak urine neutrophil gelatinase-associated lipocalin [uNGAL] > 150 ng/dL) and myocardial injury (≥ 20% increase in the peak high-sensitivity cardiac troponin I [hs-cTnI] values compared to admission). They less commonly had ≥ 30% reduction in B-type natriuretic peptide from admission to last measured value. In multivariable linear regression analysis, galectin-3 was negatively associated with estimated glomerular filtration rate and positively associated with uNGAL and hs-cTnI. Higher galectin-3 was associated with renal replacement therapy, inotrope use and mortality during hospitalization. In univariable Cox regression analysis, higher galectin-3 was associated with increased risk for the composite of death or rehospitalization due to HF and death alone at 1 year. After multivariable adjustment, higher galectin-3 levels were associated only with death. CONCLUSIONS In patients with AHF, higher galectin-3 values were associated with renal dysfunction, renal tubular damage and myocardial injury, and they predicted worse outcomes.
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Affiliation(s)
- Y U Horiuchi
- Division of Cardiovascular Medicine, University of California San Diego, La Jolla, CA, USA; Division of Cardiology, Mitsui Memorial Hospital, Tokyo, Japan
| | - Nicholas Wettersten
- Division of Cardiovascular Medicine, University of California San Diego, La Jolla, CA, USA; Division of Cardiovascular Medicine, San Diego Veterans Affairs Medical Center, San Diego, CA
| | - Dirk J VAN Veldhuisen
- Department of Cardiology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Christian Mueller
- Cardiovascular Research Institute Basel, 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, KS, USA
| | - Gerhard A Müeller
- Department of Nephrology and Rheumatology, University Medical Centre Göttingen, University of Göttingen, Göttingen, Germany
| | - Robert Birkhahn
- Department of Emergency Medicine, New York Methodist Hospital, New York, 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
| | - Kenneth McDonald
- Department of Cardiology, School of Medicine, University College Dublin, Dublin, Ireland; Department of Cardiology, St Vincent's University Hospital, Dublin, Ireland
| | - Niall Mahon
- Department of Cardiology, School of Medicine, University College Dublin, Dublin, Ireland; Department of Cardiology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Julio Nuñez
- Department of Cardiology, Hospital Clínico Universitario, INCLIVA, Valencia, Spain; Centro de Investigación Biomédica en Red (CIBER) in Cardiovascular Diseases, Madrid, Spain
| | - Carlo Briguori
- Department of Cardiology, Mediterranea Cardiocentro, Naples, Italy
| | - Claudio Passino
- Department of Cardiology and Cardiovascular Medicine, Fondazione Gabriele Monasterio, Pisa, Italy
| | - Stephen Duff
- Department of Medicine, School of Medicine, University College Dublin, Dublin, Ireland
| | - Alan Maisel
- Division of Cardiovascular Medicine, University of California San Diego, La Jolla, CA, USA
| | - Patrick T Murray
- Department of Medicine, School of Medicine, University College Dublin, Dublin, Ireland.
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13
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Setoguchi N, Horiuchi Y, Kawakami T, Nakase M, Watanabe Y, Ishizawa T, Sekiguchi M, Nakajima M, Nonaka H, Asami M, Yahagi K, Komiyama K, Yuzawa H, Tanaka J, Aoki J, Tanabe K. Diuretic and renal effects of angiotensin receptor-neprilysin inhibitor in patients hospitalized for acute heart failure. Heart Vessels 2023:10.1007/s00380-023-02253-w. [PMID: 36854753 DOI: 10.1007/s00380-023-02253-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 02/16/2023] [Indexed: 03/02/2023]
Abstract
In patients hospitalized for acute decompensation of heart failure (HF), the impact of angiotensin receptor-neprilysin inhibitor (ARNI) on diuresis and renal function has not been fully investigated. Patients with HF and reduced ejection fraction who were hospitalized for acute decompensation and newly initiated ARNI after hemodynamic stabilization were enrolled. Changes in urine volume (UV), body weight, estimated glomerular filtration rate (eGFR), and urine N-acetyl-beta-d-glucosaminidase (uNAG) levels before and after ARNI initiation were investigated. Changes in the diuretic response [DR, calculated as urine volume/(intravenous furosemide volume/40 mg)], N-terminal pro-brain natriuretic peptide (NT-proBNP), hematocrit, and plasma volume (PV) were also evaluated. A total of 60 patients were enrolled. ARNI was initiated at a median of 6 [5, 7] days after hospitalization. After initiation of ARNI, body weight, NT-proBNP, and PV decreased. UV and DR increased only on the day of ARNI initiation (delta UV 400 ± 957 ml and delta DR 1100 ± 3107 ml/40 mg furosemide) and then decreased to baseline levels. In the multivariable linear regression analysis, younger age, higher BMI, and higher NT-proBNP levels were significantly associated with greater UV after ARNI initiation. eGFR and uNAG did not significantly change after the initiation of ARNI [delta eGFR -1.7 ± 12.0 mL/min/1.73 m2 and delta uNAG 2.0 (-5.6, 6.9) IU/L]. In patients hospitalized for HF, the initiation of ARNI was associated with a small and transient increase in UV and DR, and was not associated with worsening of renal function or tubular injury.
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Affiliation(s)
- Naoto Setoguchi
- Division of Cardiology, Mitsui Memorial Hospital, Kanda-Izumi-Cho 1, Chiyoda-Ku, Tokyo, 101-8643, Japan.,Department of Cardiovascular Medicine, The University of Tokyo, Hongo 7-3-1, Bunkyo-Ku, Tokyo, 113-8654, Japan
| | - Yu Horiuchi
- Division of Cardiology, Mitsui Memorial Hospital, Kanda-Izumi-Cho 1, Chiyoda-Ku, Tokyo, 101-8643, Japan.
| | - Toshiharu Kawakami
- Division of Cardiology, Mitsui Memorial Hospital, Kanda-Izumi-Cho 1, Chiyoda-Ku, Tokyo, 101-8643, Japan
| | - Masaaki Nakase
- Division of Cardiology, Mitsui Memorial Hospital, Kanda-Izumi-Cho 1, Chiyoda-Ku, Tokyo, 101-8643, Japan
| | - Yusuke Watanabe
- Division of Cardiology, Mitsui Memorial Hospital, Kanda-Izumi-Cho 1, Chiyoda-Ku, Tokyo, 101-8643, Japan
| | - Taiki Ishizawa
- Division of Cardiology, Mitsui Memorial Hospital, Kanda-Izumi-Cho 1, Chiyoda-Ku, Tokyo, 101-8643, Japan
| | - Masahiro Sekiguchi
- Division of Cardiology, Mitsui Memorial Hospital, Kanda-Izumi-Cho 1, Chiyoda-Ku, Tokyo, 101-8643, Japan
| | - Momoka Nakajima
- Division of Cardiology, Mitsui Memorial Hospital, Kanda-Izumi-Cho 1, Chiyoda-Ku, Tokyo, 101-8643, Japan.,Department of Cardiovascular Medicine, The University of Tokyo, Hongo 7-3-1, Bunkyo-Ku, Tokyo, 113-8654, Japan
| | - Hideaki Nonaka
- Division of Cardiology, Mitsui Memorial Hospital, Kanda-Izumi-Cho 1, Chiyoda-Ku, Tokyo, 101-8643, Japan
| | - Masahiko Asami
- Division of Cardiology, Mitsui Memorial Hospital, Kanda-Izumi-Cho 1, Chiyoda-Ku, Tokyo, 101-8643, Japan
| | - Kazuyuki Yahagi
- Division of Cardiology, Mitsui Memorial Hospital, Kanda-Izumi-Cho 1, Chiyoda-Ku, Tokyo, 101-8643, Japan
| | - Kota Komiyama
- Division of Cardiology, Mitsui Memorial Hospital, Kanda-Izumi-Cho 1, Chiyoda-Ku, Tokyo, 101-8643, Japan
| | - Hitomi Yuzawa
- Division of Cardiology, Mitsui Memorial Hospital, Kanda-Izumi-Cho 1, Chiyoda-Ku, Tokyo, 101-8643, Japan
| | - Jun Tanaka
- Division of Cardiology, Mitsui Memorial Hospital, Kanda-Izumi-Cho 1, Chiyoda-Ku, Tokyo, 101-8643, Japan
| | - Jiro Aoki
- Division of Cardiology, Mitsui Memorial Hospital, Kanda-Izumi-Cho 1, Chiyoda-Ku, Tokyo, 101-8643, Japan
| | - Kengo Tanabe
- Division of Cardiology, Mitsui Memorial Hospital, Kanda-Izumi-Cho 1, Chiyoda-Ku, Tokyo, 101-8643, Japan
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14
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Hou J, Zhang X, Wu Z, Liu Y, Zhang Y, Zhao J, Wang X, Chen H, Yang G, Ma Q, Cheng Q, Ao Q. Association of serum N-terminal pro-brain natriuretic peptide levels with survival and renal outcomes among elderly patients with acute kidney injury in chronic heart failure. Front Cardiovasc Med 2023; 10:1104787. [PMID: 36818349 PMCID: PMC9935602 DOI: 10.3389/fcvm.2023.1104787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 01/20/2023] [Indexed: 02/05/2023] Open
Abstract
Background Elderly patients exhibit a higher incidence of chronic heart failure (CHF). Patients with CHF can develop acute kidney injury (AKI) during follow-up, which can result in poor prognosis. This relationship between kidney dysfunction and levels of N-terminal pro-brain natriuretic peptides (NT-proBNP), with regard to prognosis, is complicated and has rarely been analyzed in elderly patients with CHF. Method We conducted a retrospective cohort study involving patients with a CHF history aged ≥ 65 years, who experienced an episode of AKI. Kaplan-Meier curves and Cox or logistic proportional hazards regression models were used to evaluate the association between serum NT-proBNP concentrations and mortality or renal recovery by day 90. Results A total of 1,160 eligible patients with AKI were available for the study. Of this sample, 41.5% of patients died within 90 days of the onset of AKI. Patients with a decreased change in NT-proBNP accompanying the episode of AKI had a lower risk (adjusted OR = 0.56, 95% CI = 0.34-0.91) of more severe AKI (stage 2 and 3 vs. stage 1). The more severe AKI were associated with higher mortality and non-recovery of renal function in elderly patients with CHF, independent of NT-proBNP levels. Elevated levels of baseline lnNT-proBNP (adjusted HR = 1.27, 95% CI = 1.17-1.38) predicted mortality in elderly patients with CHF within 90 days of AKI onset. Patients with a decrease in NT-proBNP accompanying AKI had a lower risk of mortality (adjusted HR = 0.62, 95% CI = 0.48-0.79). However, a decrease in NT-proBNP is a risk factor (adjusted OR = 1.59, 95% CI = 1.02-2.48) for the non-recovery of renal function following AKI-especially in elderly survivors with low baseline NT-proBNP levels. Conclusion A decreased change in NT-proBNP maybe protective for elderly patients with CHF by improving survival outcomes and preventing severe AKI. However, an excessive decrease in NT-proBNP is a risk factor for the non-recovery of renal function following AKI. Avoiding excessive changes in NT-proBNP may be protective for survival and renal injury prognosis.
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Affiliation(s)
- Jiebin Hou
- Department of Nephrology, The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese People’s Liberation Army (PLA) General Hospital, Beijing, China
| | - Xin Zhang
- Institute of Geriatrics, The Second Medical Center, Chinese People’s Liberation Army (PLA) General Hospital, Beijing, China
| | - Zhen Wu
- Department of Nephrology, The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese People’s Liberation Army (PLA) General Hospital, Beijing, China
| | - Yang Liu
- Department of Nephrology, The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese People’s Liberation Army (PLA) General Hospital, Beijing, China
| | - Yabin Zhang
- Department of Nephrology, The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese People’s Liberation Army (PLA) General Hospital, Beijing, China
| | - Jiahui Zhao
- Department of Nephrology, The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese People’s Liberation Army (PLA) General Hospital, Beijing, China
| | - Xiaohua Wang
- Department of Nephrology, The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese People’s Liberation Army (PLA) General Hospital, Beijing, China
| | - Hongyu Chen
- Department of Nephrology, The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese People’s Liberation Army (PLA) General Hospital, Beijing, China
| | - Guang Yang
- Department of Nephrology, The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese People’s Liberation Army (PLA) General Hospital, Beijing, China
| | - Qiang Ma
- Department of Nephrology, The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese People’s Liberation Army (PLA) General Hospital, Beijing, China
| | - Qingli Cheng
- Department of Nephrology, The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese People’s Liberation Army (PLA) General Hospital, Beijing, China,Qingli Cheng,
| | - Qiangguo Ao
- Department of Nephrology, The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese People’s Liberation Army (PLA) General Hospital, Beijing, China,*Correspondence: Qiangguo Ao,
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15
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Wettersten N, Duff S, Horiuchi Y, van Veldhuisen DJ, Mueller C, Filippatos G, Nowak R, Hogan C, Kontos MC, Cannon CM, Müeller GA, Birkhahn R, Taub P, Vilke GM, McDonald K, Mahon N, Nuñez J, Briguori C, Passino C, Maisel A, Murray PT, Ix JH. Implications of worsening renal function before hospitalization for acute heart failure. ESC Heart Fail 2023; 10:532-541. [PMID: 36325747 PMCID: PMC9871662 DOI: 10.1002/ehf2.14221] [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: 07/14/2022] [Revised: 09/13/2022] [Accepted: 10/09/2022] [Indexed: 11/06/2022] Open
Abstract
AIMS Kidney function changes dynamically during AHF treatment, but risk factors for and consequences of worsening renal function (WRF) at hospital admission are uncertain. We aimed to determine the significance of WRF at admission for acute heart failure (AHF). METHODS AND RESULTS We evaluated a subgroup of 406 patients from The Acute Kidney Injury Neutrophil gelatinase-associated lipocalin Evaluation of Symptomatic heart failure Study (AKINESIS) who had serum creatinine measurements available within 3 months before and at the time of admission. Admission WRF was primarily defined as a 0.3 mg/dL or 50% creatinine increase from preadmission. Alternative definitions evaluated were a ≥0.5 mg/dL creatinine increase, ≥25% glomerular filtration rate decrease, and an overall change in creatinine. Predictors of admission WRF were evaluated. Outcomes evaluated were length of hospitalization, a composite of adverse in-hospital events, and the composite of death or HF readmission at 30, 90, and 365 days. Biomarkers' prognostic ability for these outcomes were evaluated in patients with admission WRF. One-hundred six patients (26%) had admission WRF. These patients had features of more severe AHF with lower blood pressure, higher BUN, and lower serum sodium concentrations at admission. Higher BNP (odds ratio [OR] per doubling 1.16-1.28, 95% confidence interval [CI] 1.00-1.55) and lower diastolic blood pressure (OR 0.97-0.98, 95% CI 0.96-0.99) were associated with a higher odds for the three definitions of admission WRF. The primary WRF definition was not associated with a longer hospitalization, but alternative WRF definitions were (1.3 to 1.6 days longer, 95% CI 1.0-2.2). WRF across definitions was not associated with a higher odds of adverse in-hospital events or a higher risk of death or HF readmission. In the subset of patients with WRF, biomarkers were not prognostic for any outcome. CONCLUSIONS Admission WRF is common in AHF patients and is associated with an increased length of hospitalization, but not adverse in-hospital events, death, or HF readmission. Among those with admission WRF, biomarkers did not risk stratify for adverse events.
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Affiliation(s)
- Nicholas Wettersten
- Division of Cardiovascular MedicineSan Diego Veterans Affairs Medical CenterSan DiegoCaliforniaUSA
- Division of Cardiovascular MedicineUniversity of California, San DiegoLa JollaCaliforniaUSA
| | - Stephen Duff
- School of MedicineUniversity College DublinDublinIreland
| | - Yu Horiuchi
- Division of CardiologyMitsui Memorial HospitalTokyoJapan
| | - Dirk J. van Veldhuisen
- Department of Cardiology, University Medical Center GroningenUniversity of GroningenGroningenThe Netherlands
| | - Christian Mueller
- Department of Cardiology, University Hospital BaselUniversity of BaselBaselSwitzerland
| | - Gerasimos Filippatos
- Department of Cardiology, Athens University Hospital AttikonUniversity of AthensAthensGreece
| | - Richard Nowak
- Department of Emergency MedicineHenry Ford Hospital SystemDetroitMichiganUSA
| | - Christopher Hogan
- Division of Emergency Medicine and Acute Care Surgical Services, VCU Medical CenterVirginia Commonwealth UniversityRichmondVirginiaUSA
| | - Michael C. Kontos
- Division of Cardiology, VCU Medical CenterVirginia Commonwealth UniversityRichmondVirginiaUSA
| | - Chad M. Cannon
- Department of Emergency MedicineUniversity of Kansas Medical CenterKansas CityKansasUSA
| | - Gerhard A. Müeller
- Department of Nephrology and Rheumatology, University Medical Center GöttingenUniversity of GöttingenGöttingenGermany
| | - Robert Birkhahn
- Department of Emergency MedicineNew York MethodistBrooklynNew YorkUSA
| | - Pam Taub
- Division of Cardiovascular MedicineUniversity of California, San DiegoLa JollaCaliforniaUSA
| | - Gary M. Vilke
- Department of Emergency MedicineUniversity of California, San DiegoLa JollaCaliforniaUSA
| | - Kenneth McDonald
- Department of Cardiology, Mater Misericordiae University HospitalUniversity College DublinDublinIreland
- Department of CardiologySt. Vincent's University HospitalDublinIreland
| | - Niall Mahon
- Department of CardiologySt. Vincent's University HospitalDublinIreland
| | - Julio Nuñez
- Department of Cardiology, Hospital Clínico Universitario Valencia, INCLIVAUniversity of ValenciaValenciaSpain
- CIBER in Cardiovascular DiseasesMadridSpain
| | - Carlo Briguori
- Department of Cardiology, Interventional CardiologyMediterranea CardiocentroNaplesItaly
| | - Claudio Passino
- Department of Cardiology and Cardiovascular MedicineFondazione Gabriele MonasterioPisaItaly
| | - Alan Maisel
- Division of Cardiovascular MedicineUniversity of California, San DiegoLa JollaCaliforniaUSA
| | | | - Joachim H. Ix
- Division of Nephrology‐Hypertension, Department of MedicineUniversity of California San DiegoLa JollaCaliforniaUSA
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16
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Chávez-Íñiguez JS, Ivey-Miranda JB, De la Vega-Mendez FM, Borges-Vela JA. How to interpret serum creatinine increases during decongestion. Front Cardiovasc Med 2023; 9:1098553. [PMID: 36684603 PMCID: PMC9846337 DOI: 10.3389/fcvm.2022.1098553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 12/12/2022] [Indexed: 01/06/2023] Open
Abstract
During decongestion in acute decompensated heart failure (ADHF), it is common to observe elevations in serum creatinine (sCr) values due to vascular congestion, a mechanism that involves increased central venous pressure that has a negative impact on the nephron, promoting greater absorption of water and sodium, increased interstitial pressure in an encapsulated organ developing "renal tamponade" which is one of main physiopathological mechanism associated with impaired kidney function. For the treatment of this syndrome, it is recommended to use diuretics that generate a high urinary output and natriuresis to decongest the venous system, during this process the sCr values can rise, a phenomenon that may bother some cardiologist and nephrologist, since raise the suspicion of kidney damage that could worsen the prognosis of these patients. It is recommended that increases of up to 0.5 mg/dL from baseline are acceptable, but some patients have higher increases, and we believe that an arbitrary number would be impractical for everyone. These increases in sCr may be related to changes in glomerular hemodynamics and true hypovolemia associated with decongestion, but it is unlikely that they are due to structural injury or truly hypoperfusion and may even have a positive connotation if accompanied by an effective decongestion and be associated with a better prognosis in the medium to long term with fewer major cardiovascular and renal events. In this review, we give a comprehensive point of view on the interpretation of creatinine elevation during decongestion in patients with ADHF.
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Affiliation(s)
- Jonathan S. Chávez-Íñiguez
- Nephrology Service, Hospital Civil de Guadalajara Fray Antonio Alcalde, Guadalajara, Mexico
- University of Guadalajara Health Sciences Center, Guadalajara, Mexico
| | - Juan B. Ivey-Miranda
- Heart Failure and Heart Transplant Clinic, Hospital de Cardiología, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Frida M. De la Vega-Mendez
- Nephrology Service, Hospital Civil de Guadalajara Fray Antonio Alcalde, Guadalajara, Mexico
- University of Guadalajara Health Sciences Center, Guadalajara, Mexico
| | - Julian A. Borges-Vela
- Heart Failure and Heart Transplant Clinic, Hospital de Cardiología, Instituto Mexicano del Seguro Social, Mexico City, Mexico
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Horiuchi Y, Villacorta H, Maisel AS. Natriuretic Peptide-guided Therapy for Heart Failure. Heart Int 2022; 16:112-116. [PMID: 36741100 PMCID: PMC9872778 DOI: 10.17925/hi.2022.16.2.112] [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: 09/21/2022] [Accepted: 10/26/2022] [Indexed: 12/25/2022] Open
Abstract
Heart failure (HF) is a complex syndrome with high mortality and hospitalization rates. Conventional care in patients with HF is usually based on clinical history and physical examination. Natriuretic peptides (NPs), B-type NP (BNP) and N-terminal proBNP, are the gold-standard biomarkers in HF. They are recommended for diagnosing HF, when the physician is uncertain of the diagnosis, and for estimating the prognosis. NPs also guide therapy in HF, as serial NP measurements inform medication adjustments to achieve targets independently of symptoms. In this regard, the data are conflicting. In patients with HF and reduced left ventricular ejection fraction (HFrEF) there is a suggestion that NP-guided therapy is helpful. The studies STARS-BNP and PROTECT demonstrated a reduction in cardiac events with NP-guided therapy. Additionally, mortality in patients aged <75 years reduced in the BATTLESCARRED and TIME-CHF studies, and in a meta-analysis. On the contrary, no differences were observed in the studies PRIMA and GUIDE-IT. In HF with preserved ejection fraction (HFpEF) and in the acute setting, no differences were detected with NP-guided therapy compared with conventional care. In patients at risk of developing HF, NP can be useful to guide therapy and prevent HF. In summary, NP-guided therapy seems to be useful in patients with HFrEF, especially in those aged <75 years, but has no use in HFpEF or in acute HF.
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Affiliation(s)
- Yu Horiuchi
- Division of Cardiology, Mitsui Memorial Hospital, Tokyo, Chiyoda City, Kanda Izumicho, Japan
| | | | - Alan S Maisel
- Division of Cardiovascular Medicine, University of California, San Diego, La Jolla, CA, USA
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18
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Odajima S, Fujimoto W, Kuroda K, Yamashita S, Imanishi J, Iwasaki M, Todoroki T, Okuda M, Hayashi T, Konishi A, Shinohara M, Toh R, Hirata K, Tanaka H. Association of congestion with worsening renal function in acute decompensated heart failure according to age. ESC Heart Fail 2022; 9:4250-4261. [PMID: 36113882 PMCID: PMC9773715 DOI: 10.1002/ehf2.14157] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 08/05/2022] [Accepted: 09/08/2022] [Indexed: 01/19/2023] Open
Abstract
AIMS Acute decompensated heart failure (ADHF) is a frequent cause of hospitalization for patients with heart disease, and ADHF patients are at high risk of heart failure (HF) re-hospitalization. Residual congestion at discharge is also a strong predictor of poor outcomes and re-hospitalization for ADHF patients. However, the impact of residual congestion at discharge on worsening renal function (WRF) in both high-aged and older patients remains uncertain because previous studies of WRF in ADHF patients were conducted for older patients. We therefore designed and conducted a retrospective, population-based study using the Kobe University Heart Failure Registry in Awaji Medical Center (KUNIUMI) Registry to investigate the association of residual congestion at discharge with WRF in ADHF patients according to age. METHODS AND RESULTS We studied 966 hospitalized ADHF patients with a mean age of 80.2 ± 11.4 years from among 1971 listed in the KUNIUMI Registry. WRF was defined as an increase of ≥0.3 mg/dL in the serum creatinine level during the hospital stay compared with the value on admission. The primary endpoint was defined as cardiovascular death or HF re-hospitalization after discharge over a mean follow-up period of 2.0 ± 0.1 years. The primary endpoint was recorded for 369 patients (38.2%). As expected, patients with both WRF and residual congestion at discharge had significantly less favourable outcomes compared with those without one of them, and patients without either of these two characteristics had the most favourable outcomes, whereas those with residual congestion and with WRF had the least favourable outcomes. Moreover, WRF was significantly associated with worse outcomes for high-aged patients ≥80 years old, but not for those <80 years old if decongested. Multivariable Cox regression analysis showed that both residual congestion at discharge and WRF were the independent predictors of outcomes for high-aged patients, but residual congestion at discharge, not WRF, was the independent predictor of outcomes for older patients. CONCLUSIONS Association of residual congestion at discharge with WRF for hospitalized ADHF patients can differ according to age. Our findings showed the importance of WRF and residual congestion at discharge for high-aged ADHF patients and of aggressive diuresis to alleviate congestion for older ADHF patients for better management of such patients in a rapidly ageing society.
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Affiliation(s)
- Susumu Odajima
- Division of Cardiovascular Medicine, Department of Internal MedicineKobe University Graduate School of MedicineKobeJapan
| | - Wataru Fujimoto
- Division of Cardiovascular Medicine, Department of Internal MedicineKobe University Graduate School of MedicineKobeJapan,Department of CardiologyHyogo Prefectural Awaji Medical CenterSumotoJapan
| | - Koji Kuroda
- Department of CardiologyHyogo Prefectural Awaji Medical CenterSumotoJapan
| | - Soichiro Yamashita
- Department of CardiologyHyogo Prefectural Awaji Medical CenterSumotoJapan
| | - Junichi Imanishi
- Department of CardiologyHyogo Prefectural Awaji Medical CenterSumotoJapan
| | - Masamichi Iwasaki
- Department of CardiologyHyogo Prefectural Awaji Medical CenterSumotoJapan
| | - Takafumi Todoroki
- Department of CardiologyHyogo Prefectural Awaji Medical CenterSumotoJapan
| | - Masanori Okuda
- Department of CardiologyHyogo Prefectural Awaji Medical CenterSumotoJapan
| | - Takatoshi Hayashi
- Department of CardiologyHyogo Prefectural Awaji Medical CenterSumotoJapan
| | - Akihide Konishi
- Clinical & Translational Research CenterKobe University HospitalKobeJapan
| | - Masakazu Shinohara
- Division of EpidemiologyKobe University Graduate School of MedicineKobeJapan
| | - Ryuji Toh
- Division of Evidence‐based Laboratory MedicineKobe University Graduate School of MedicineKobeJapan
| | - Ken‐ichi Hirata
- Division of Cardiovascular Medicine, Department of Internal MedicineKobe University Graduate School of MedicineKobeJapan,Division of Evidence‐based Laboratory MedicineKobe University Graduate School of MedicineKobeJapan
| | - Hidekazu Tanaka
- Division of Cardiovascular Medicine, Department of Internal MedicineKobe University Graduate School of MedicineKobeJapan
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19
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Wettersten N, Duff S, Murray PT. Diuretic Resistance-A Key to Identifying Clinically Significant Worsening Renal Function in Heart Failure? Mayo Clin Proc 2022; 97:1598-1600. [PMID: 36058571 DOI: 10.1016/j.mayocp.2022.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 07/25/2022] [Indexed: 11/25/2022]
Affiliation(s)
- Nicholas Wettersten
- Division of Cardiovascular Medicine, San Diego Veterans Affairs Medical Center, San Diego, CA; Division of Cardiovascular Medicine, University of California, San Diego, La Jolla, CA
| | - Stephen Duff
- School of Medicine, University College Dublin, Dublin, Ireland
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20
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Decongestion, kidney injury and prognosis in patients with acute heart failure. Int J Cardiol 2022; 354:29-37. [PMID: 35202737 DOI: 10.1016/j.ijcard.2022.02.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 02/11/2022] [Accepted: 02/16/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND In patients with acute heart failure (AHF), the development of worsening renal function with appropriate decongestion is thought to be a benign functional change and not associated with poor prognosis. We investigated whether the benefit of decongestion outweighs the risk of concurrent kidney tubular damage and leads to better outcomes. METHODS We retrospectively analyzed data from the AKINESIS study, which enrolled AHF patients requiring intravenous diuretic therapy. Urine neutrophil gelatinase-associated lipocalin (uNGAL) and B-type natriuretic peptide (BNP) were serially measured during the hospitalization. Decongestion was defined as ≥30% BNP decrease at discharge compared to admission. Univariable and multivariable Cox models were assessed for one-year mortality. RESULTS Among 736 patients, 53% had ≥30% BNP decrease at discharge. Levels of uNGAL and BNP at each collection time point had positive but weak correlations (r ≤ 0.133). Patients without decongestion and with higher discharge uNGAL values had worse one-year mortality, while those with decongestion had better outcomes regardless of uNGAL values (p for interaction 0.018). This interaction was also significant when the change in BNP was analyzed as a continuous variable (p < 0.001). Although higher peak and discharge uNGAL were associated with mortality in univariable analysis, only ≥30% BNP decrease was a significant predictor after multivariable adjustment. CONCLUSIONS Among AHF patients treated with diuretic therapy, decongestion was generally not associated with kidney tubular damage assessed by uNGAL. Kidney tubular damage with adequate decongestion does not impact outcomes; however, kidney injury without adequate decongestion is associated with a worse prognosis.
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21
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Meijers WC, Bayes-Genis A, Mebazaa A, Bauersachs J, Cleland JGF, Coats AJS, Januzzi JL, Maisel AS, McDonald K, Mueller T, Richards AM, Seferovic P, Mueller C, de Boer RA. Circulating heart failure biomarkers beyond natriuretic peptides: review from the Biomarker Study Group of the Heart Failure Association (HFA), European Society of Cardiology (ESC). Eur J Heart Fail 2021; 23:1610-1632. [PMID: 34498368 PMCID: PMC9292239 DOI: 10.1002/ejhf.2346] [Citation(s) in RCA: 68] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 08/13/2021] [Accepted: 09/07/2021] [Indexed: 12/18/2022] Open
Abstract
New biomarkers are being evaluated for their ability to advance the management of patients with heart failure. Despite a large pool of interesting candidate biomarkers, besides natriuretic peptides virtually none have succeeded in being applied into the clinical setting. In this review, we examine the most promising emerging candidates for clinical assessment and management of patients with heart failure. We discuss high-sensitivity cardiac troponins (Tn), procalcitonin, novel kidney markers, soluble suppression of tumorigenicity 2 (sST2), galectin-3, growth differentiation factor-15 (GDF-15), cluster of differentiation 146 (CD146), neprilysin, adrenomedullin (ADM), and also discuss proteomics and genetic-based risk scores. We focused on guidance and assistance with daily clinical care decision-making. For each biomarker, analytical considerations are discussed, as well as performance regarding diagnosis and prognosis. Furthermore, we discuss potential implementation in clinical algorithms and in ongoing clinical trials.
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Affiliation(s)
- Wouter C Meijers
- Department of Cardiology, University Medical Center Groningen, Groningen, The Netherlands
| | - Antoni Bayes-Genis
- Heart Institute, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, CIBERCV, Barcelona, Spain
| | - Alexandre Mebazaa
- Inserm U942-MASCOT; Université de Paris; Department of Anesthesia and Critical Care, Hôpitaux Saint Louis & Lariboisière; FHU PROMICE, Paris, France.,Université de Paris, Paris, France.,Department of Anesthesia and Critical Care, Hôpitaux Saint Louis & Lariboisière, Paris, France.,FHU PROMICE, Paris, France
| | - Johann Bauersachs
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - John G F Cleland
- Robertson Centre for Biostatistics and Clinical Trials, University of Glasgow; National Heart & Lung Institute, Imperial College London, London, UK
| | - Andrew J S Coats
- Monash University, Melbourne, Australia.,University of Warwick, Coventry, UK
| | | | | | | | - Thomas Mueller
- Department of Clinical Pathology, Hospital of Bolzano, Bolzano, Italy
| | - A Mark Richards
- Christchurch Heart Institute, Christchurch, New Zealand.,Cardiovascular Research Institute, National University of Singapore, Singapore
| | - Petar Seferovic
- Faculty of Medicine, Belgrade University, Belgrade, Serbia.,Serbian Academy of Sciences and Arts, Belgarde, Serbia
| | | | - Rudolf A de Boer
- Department of Cardiology, University Medical Center Groningen, Groningen, The Netherlands
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22
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Turner JM, Cox ZL, Testani JM. Improving renal function during diuresis: useful information or just noise? Eur J Heart Fail 2021; 23:1131-1133. [PMID: 34117684 DOI: 10.1002/ejhf.2267] [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: 05/29/2021] [Accepted: 06/10/2021] [Indexed: 11/08/2022] Open
Affiliation(s)
- Jeffrey M Turner
- Department of Internal Medicine, Section of Nephrology, Yale School of Medicine, New Haven, CT, USA
| | - Zachary L Cox
- Department of Pharmacy Practice, Lipscomb University College of Pharmacy, Nashville, TN, USA
| | - Jeffrey M Testani
- Department of Internal Medicine, Section of Cardiology, Yale School of Medicine, New Haven, CT, USA
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23
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Horiuchi Y, Wettersten N, van Veldhuisen DJ, Mueller C, Filippatos G, Nowak R, Hogan C, Kontos MC, Cannon CM, Müeller GA, Birkhahn R, Taub P, Vilke GM, Barnett O, McDonald K, Mahon N, Nuñez J, Briguori C, Passino C, Maisel A, Murray PT. Relation of Decongestion and Time to Diuretics to Biomarker Changes and Outcomes in Acute Heart Failure. Am J Cardiol 2021; 147:70-79. [PMID: 33617811 DOI: 10.1016/j.amjcard.2021.01.040] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Revised: 01/20/2021] [Accepted: 01/22/2021] [Indexed: 01/03/2023]
Abstract
Prompt treatment may mitigate the adverse effects of congestion in the early phase of heart failure (HF) hospitalization, which may lead to improved outcomes. We analyzed 814 acute HF patients for the relationships between time to first intravenous loop diuretics, changes in biomarkers of congestion and multiorgan dysfunction, and 1-year composite end point of death or HF hospitalization. B-type natriuretic peptide (BNP), high sensitivity cardiac troponin I (hscTnI), urine and serum neutrophil gelatinase-associated lipocalin, and galectin 3 were measured at hospital admission, hospital day 1, 2, 3 and discharge. Time to diuretics was not correlated with the timing of decongestion defined as BNP decrease ≥ 30% compared with admission. Earlier BNP decreases but not time to diuretics were associated with earlier and greater decreases in hscTnI and urine neutrophil gelatinase-associated lipocalin, and lower incidence of the composite end point. After adjustment for confounders, only no BNP decrease at discharge was significantly associated with mortality but not the composite end point (p = 0.006 and p = 0.062, respectively). In conclusion, earlier time to decongestion but not the time to diuretics was associated with better biomarker trajectories. Residual congestion at discharge rather than the timing of decongestion predicted a worse prognosis.
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Affiliation(s)
- Yu Horiuchi
- Division of Cardiovascular Medicine, University of California San Diego, La Jolla, California; Division of Cardiology, Mitsui Memorial Hospital, Tokyo, Japan
| | - Nicholas Wettersten
- Division of Cardiovascular Medicine, University of California San Diego, La Jolla, California
| | - Dirk J van Veldhuisen
- Department of Cardiology, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
| | - 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, Michigan
| | - Christopher Hogan
- Division of Emergency Medicine and Acute Care Surgical Services, VCU Medical Center, Virginia Commonwealth University, Richmond, Virginia
| | - Michael C Kontos
- Division of Cardiology, VCU Medical Center, Virginia Commonwealth University, Richmond, Virginia
| | - Chad M Cannon
- Department of Emergency Medicine, University of Kansas Medical Center, Kansas City, Kansas
| | - Gerhard A Müeller
- Department of Nephrology and Rheumatology, University Medical Centre Göttingen, University of Göttingen, Göttingen, Germany
| | - Robert Birkhahn
- Department of Emergency Medicine, New York Methodist Hospital, New York, New York
| | - Pam Taub
- Division of Cardiovascular Medicine, University of California San Diego, La Jolla, California
| | - Gary M Vilke
- Department of Emergency Medicine, University of California San Diego, La Jolla, California
| | - Olga Barnett
- Division of Cardiology, Danylo Halytsky Lviv National Medical University, Lviv, Ukraine
| | - Kenneth McDonald
- Department of Cardiology, School of Medicine, University College Dublin, Dublin, Ireland; Department of Cardiology, St Vincent's University Hospital, Dublin, Ireland
| | - Niall Mahon
- Department of Cardiology, School of Medicine, University College Dublin, Dublin, Ireland; Department of Cardiology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Julio Nuñez
- Department of Cardiology, Valencia University Hospital, INCLIVA, Valencia, Spain; Centro de Investigación Biomédica en Red (CIBER) in Cardiovascular Diseases, Madrid, Spain
| | - Carlo Briguori
- Department of 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, California
| | - Patrick T Murray
- Department of Medicine, School of Medicine, University College Dublin, Dublin, Ireland.
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24
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Horiuchi YU, Wettersten N, Veldhuisen DJV, Mueller C, Filippatos G, Nowak R, Hogan C, Kontos MC, Cannon CM, Müeller GA, Birkhahn R, Taub P, Vilke GM, Barnett O, McDONALD K, Mahon N, Nuñez J, Briguori C, Passino C, Maisel A, Murray PT. Potential Utility of Cardiorenal Biomarkers for Prediction and Prognostication of Worsening Renal Function in Acute Heart Failure. J Card Fail 2021; 27:533-541. [PMID: 33296713 DOI: 10.1016/j.cardfail.2020.11.025] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Revised: 11/09/2020] [Accepted: 11/18/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND Multiple different pathophysiologic processes can contribute to worsening renal function (WRF) in acute heart failure. METHODS AND RESULTS We retrospectively analyzed 787 patients with acute heart failure for the relationship between changes in serum creatinine and biomarkers including brain natriuretic peptide, high sensitivity cardiac troponin I, galectin 3, serum neutrophil gelatinase-associated lipocalin, and urine neutrophil gelatinase-associated lipocalin. WRF was defined as an increase of greater than or equal to 0.3 mg/dL or 50% in creatinine within first 5 days of hospitalization. WRF was observed in 25% of patients. Changes in biomarkers and creatinine were poorly correlated (r ≤ 0.21) and no biomarker predicted WRF better than creatinine. In the multivariable Cox analysis, brain natriuretic peptide and high sensitivity cardiac troponin I, but not WRF, were significantly associated with the 1-year composite of death or heart failure hospitalization. WRF with an increasing urine neutrophil gelatinase-associated lipocalin predicted an increased risk of heart failure hospitalization. CONCLUSIONS Biomarkers were not able to predict WRF better than creatinine. The 1-year outcomes were associated with biomarkers of cardiac stress and injury but not with WRF, whereas a kidney injury biomarker may prognosticate WRF for heart failure hospitalization.
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Affiliation(s)
- Y U Horiuchi
- From the Division of Cardiovascular Medicine, University of California San Diego, La Jolla, California; Division of Cardiology, Mitsui Memorial Hospital, Tokyo, Japan
| | - Nicholas Wettersten
- From the Division of Cardiovascular Medicine, University of California San Diego, La Jolla, California
| | - Dirk J van Veldhuisen
- Department of Cardiology, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
| | - 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, Michigan
| | - Christopher Hogan
- Division of Emergency Medicine and Acute Care Surgical Services, VCU Medical Center, Virginia Commonwealth University, Richmond, Virginia
| | - Michael C Kontos
- Division of Cardiology, VCU Medical Center, Virginia Commonwealth University, Richmond, Virginia
| | - Chad M Cannon
- Department of Emergency Medicine, University of Kansas Medical Center, Kansas City, Kansas
| | - Gerhard A Müeller
- Department of Nephrology and Rheumatology, University Medical Centre Göttingen, University of Göttingen, Göttingen, Germany
| | - Robert Birkhahn
- Department of Emergency Medicine, New York Methodist Hospital, Brooklyn, New York
| | - Pam Taub
- From the Division of Cardiovascular Medicine, University of California San Diego, La Jolla, California
| | - Gary M Vilke
- Department of Emergency Medicine, University of California San Diego, La Jolla, California
| | - Olga Barnett
- Division of Cardiology, Danylo Halytsky Lviv National Medical University, Lviv Oblast, Ukraine
| | - Kenneth McDONALD
- Department of Cardiology, School of Medicine, University College Dublin, Belfield, Dublin, Ireland; Department of Cardiology, St Vincent's University Hospital, Dublin, Ireland
| | - Niall Mahon
- Department of Cardiology, School of Medicine, University College Dublin, Belfield, Dublin, Ireland; Department of Cardiology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Julio Nuñez
- Department of Cardiology, Valencia University Hospital, INCLIVA, Valencia, Spain; Centro de Investigación Biomédica en Red (CIBER) in Cardiovascular Diseases, Madrid, Spain
| | - Carlo Briguori
- Department of Cardiology, Mediterranea Cardiocentro, Naples, Italy
| | - Claudio Passino
- Department of Cardiology and Cardiovascular Medicine, Fondazione Gabriele Monasterio, Pisa, Italy; and the
| | - Alan Maisel
- From the Division of Cardiovascular Medicine, University of California San Diego, La Jolla, California
| | - Patrick T Murray
- Department of Medicine, School of Medicine, University College Dublin, Health Sciences Centre, Dublin, Ireland.
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25
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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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26
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Zhang H, Zhang N, Jiang W, Lun X. Clinical significance of the long non-coding RNA NEAT1/miR-129-5p axis in the diagnosis and prognosis for patients with chronic heart failure. Exp Ther Med 2021; 21:512. [PMID: 33791021 PMCID: PMC8005689 DOI: 10.3892/etm.2021.9943] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 02/24/2021] [Indexed: 12/14/2022] Open
Abstract
Chronic heart failure (CHF) is the leading cause of death worldwide. The regulatory interactions of long non-coding RNA (lncRNAs) and microRNAs (miRs) have important roles in multiple diseases. However, the clinical significance of the nuclear-enriched abundant transcript 1 (NEAT1)/miR-129-5p axis in CHF has remained elusive. The present study explored whether the NEAT1/miR-129-5p axis may be a suitable diagnostic and prognostic marker for CHF. The expression of lncRNA NEAT1 and miR-129-5p in the serum of patients with CHF was analyzed by reverse transcription-quantitative PCR. Furthermore, inter-indicator correlations were assessed by Pearson correlation coefficient analysis. Receiver operating characteristic (ROC) curves were generated to evaluate the ability of NEAT1, miR-129-5p and brain natriuretic peptide (BNP) to identify patients with CHF. The prognostic value of the NEAT1/miR-129-5p axis was analyzed by drawing Kaplan-Meier survival curves and by Cox logistic regression analysis. Baseline data were not significantly different between CHF (n=70) and control subjects (n=62). The serum level of NEAT1 was increased and the expression level of miR-129-5p was decreased in patients with CHF (all P<0.001). The ROC curves suggested that serum NEAT1 and miR-129-5p were of diagnostic value in patients with CHF and the combined diagnostic accuracy of NEAT1, miR-129-5p and BNP was significantly improved. Kaplan-Meier and multivariate Cox regression analysis suggested that low NEAT1 and high miR-129-5p were able to predict overall survival of patients with CHF (all P<0.01). In conclusion, the present study indicated that patients with CHF had increased NEAT1 and decreased miR-129-5p expression. The deregulated NEAT1/miR-129-5p axis may provide novel non-invasive biomarkers for the diagnosis and prognosis of CHF.
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Affiliation(s)
- Haohua Zhang
- Department of Anesthesiology, Weifang People's Hospital, Weifang, Shandong 261041, P.R. China
| | - Nianli Zhang
- Department of Anesthesiology, Weifang People's Hospital, Weifang, Shandong 261041, P.R. China
| | - Wenbin Jiang
- Department of Cardiovascular Surgery, Weifang People's Hospital, Weifang, Shandong 261041, P.R. China
| | - Xiaoqin Lun
- Department of Anesthesiology, Weifang People's Hospital, Weifang, Shandong 261041, P.R. China
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Biomarkers in Acute Heart Failure: Diagnosis, Prognosis, and Treatment. INTERNATIONAL JOURNAL OF HEART FAILURE 2021; 3:81-105. [PMID: 36262882 PMCID: PMC9536694 DOI: 10.36628/ijhf.2020.0036] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 12/28/2020] [Accepted: 01/11/2021] [Indexed: 01/16/2023]
Abstract
Heart failure is a global health problem. An episode of acute heart failure (AHF) is a period of substantial morbidity and mortality with few advances in the management of an episode that have improved outcomes. The measurement of multiple biomarkers has become an integral adjunctive tool for the management of AHF. Many biomarkers are now well established in their ability to assist with diagnosis and prognostication of an AHF patient. There are also emerging biomarkers that are showing significant promise in the areas of diagnosis and prognosis. For improving the management of AHF, both established and novel biomarkers may assist in guiding medical therapy and subsequently improving outcomes. Thus, it is important to understand the different abilities and limitations of established and emerging biomarkers in AHF so that they may be correctly interpreted and integrated into clinical practice for AHF. This knowledge may improve the care of AHF patients. This review will summarize the evidence of both established and novel biomarkers for diagnosis, prognosis and management in AHF so that the treating clinician may become more comfortable incorporating these biomarkers into clinical practice in an evidence-based manner.
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Tomasoni D, Adamo M, Anker MS, von Haehling S, Coats AJS, Metra M. Heart failure in the last year: progress and perspective. ESC Heart Fail 2020; 7:3505-3530. [PMID: 33277825 PMCID: PMC7754751 DOI: 10.1002/ehf2.13124] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 11/11/2020] [Indexed: 12/11/2022] Open
Abstract
Research about heart failure (HF) has made major progress in the last years. We give here an update on the most recent findings. Landmark trials have established new treatments for HF with reduced ejection fraction. Sacubitril/valsartan was superior to enalapril in PARADIGM-HF trial, and its initiation during hospitalization for acute HF or early after discharge can now be considered. More recently, new therapeutic pathways have been developed. In the DAPA-HF and EMPEROR-Reduced trials, dapagliflozin and empagliflozin reduced the risk of the primary composite endpoint, compared with placebo [hazard ratio (HR) 0.74; 95% confidence interval (CI) 0.65-0.85; P < 0.001 and HR 0.75; 95% CI 0.65-0.86; P < 0.001, respectively]. Second, vericiguat, an oral soluble guanylate cyclase stimulator, reduced the composite endpoint of cardiovascular death or HF hospitalization vs. placebo (HR 0.90; 95% CI 0.82-0.98; P = 0.02). On the other hand, both the diagnosis and treatment of HF with preserved ejection fraction, as well as management of advanced HF and acute HF, remain challenging. A better phenotyping of patients with HF would be helpful for prognostic stratification and treatment selection. Further aspects, such as the use of devices, treatment of arrhythmias, and percutaneous treatment of valvular heart disease in patients with HF, are also discussed and reviewed in this article.
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Affiliation(s)
- Daniela Tomasoni
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public HealthUniversity of BresciaBresciaItaly
- Cardiology and Cardiac Catheterization Laboratory, Cardio‐thoracic DepartmentCivil HospitalsBresciaItaly
| | - Marianna Adamo
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public HealthUniversity of BresciaBresciaItaly
- Cardiology and Cardiac Catheterization Laboratory, Cardio‐thoracic DepartmentCivil HospitalsBresciaItaly
| | - Markus S. Anker
- Division of Cardiology and Metabolism, Department of Cardiology (CVK)Charité–University Medicine BerlinBerlinGermany
- Berlin Institute of Health Center for Regenerative Therapies (BCRT)BerlinGermany
- German Centre for Cardiovascular Research (DZHK), partner site BerlinBerlinGermany
- Department of Cardiology (CBF)Charité–University Medicine BerlinBerlinGermany
| | - Stephan von Haehling
- Department of Cardiology and PneumologyUniversity of Göttingen Medical CenterGöttingenGermany
- German Centre for Cardiovascular Research (DZHK), partner site GöttingenGöttingenGermany
| | - Andrew J. S. Coats
- Centre for Clinical and Basic Research, Department of Medical SciencesIRCCS San Raffaele PisanaRomeItaly
| | - Marco Metra
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public HealthUniversity of BresciaBresciaItaly
- Cardiology and Cardiac Catheterization Laboratory, Cardio‐thoracic DepartmentCivil HospitalsBresciaItaly
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Yamada T, Ueyama H, Chopra N, Yamaji T, Azushima K, Kobayashi R, Kinguchi S, Urate S, Suzuki T, Abe E, Saigusa Y, Wakui H, Partridge P, Burger A, Bravo CA, Rodriguez MA, Ivey-Miranda J, Tamura K, Testani J, Coca S. Systematic Review of the Association Between Worsening Renal Function and Mortality in Patients With Acute Decompensated Heart Failure. Kidney Int Rep 2020; 5:1486-1494. [PMID: 32954072 PMCID: PMC7486197 DOI: 10.1016/j.ekir.2020.06.031] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 06/05/2020] [Accepted: 06/24/2020] [Indexed: 12/25/2022] Open
Abstract
Introduction Outcomes in acute decompensated heart failure (ADHF) have remained poor. Worsening renal function (WRF) is common among patients with ADHF. However, the impact of WRF on the prognosis is controversial. We hypothesized that in patients with ADHF, the achievement of concomitant decongestion would diminish the signal for harm associated with WRF. Methods We performed a systematic search of PubMed, EMBASE, and the Cochrane Library up to December 2019 for studies that assessed signs of decongestion in patients with WRF during ADHF admission. The primary outcome was all-cause mortality and heart transplantation. Results Thirteen studies were selected with a pooled population of 8138 patients. During the follow-up period of 60–450 days, 19.2% of patients died. Unstratified, patients with WRF versus no WRF had a higher risk for mortality (odds ratio [OR], 1.71 [95% confidence interval {CI}, 1.45–2.01]; P < 0.0001). However, patients who achieved decongestion had a similar prognosis (OR, 1.15 [95% CI, 0.89–1.49]; P = 0.30). Moreover, patients with WRF who achieved decongestion had a better prognosis compared with those without WRF or decongestion (OR, 0.63 [95% CI, 0.46–0.86]; P = 0.004). This tendency persisted for the sensitivity analyses. Conclusions Decongestion is a powerful effect modifier that attenuates harmful associations of WRF with mortality. Future studies should not assess WRF as an endpoint without concomitant assessment of achieved volume status.
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Affiliation(s)
- Takayuki Yamada
- Department of Medicine, Mount Sinai Beth Israel, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Hiroki Ueyama
- Department of Medicine, Mount Sinai Beth Israel, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Nitin Chopra
- Department of Medicine, Mount Sinai Beth Israel, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Takahiro Yamaji
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Kengo Azushima
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan.,Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore Medical School, Singapore
| | - Ryu Kobayashi
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Sho Kinguchi
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Shingo Urate
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Toru Suzuki
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Eriko Abe
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Yusuke Saigusa
- Department of Biostatistics, Yokohama City University School of Medicine, Yokohama, Japan
| | - Hiromichi Wakui
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Paulina Partridge
- College of Arts and Sciences, University of Miami, Coral Gables, Florida, USA
| | - Alfred Burger
- Department of Medicine, Mount Sinai Beth Israel, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Claudio A Bravo
- Department of Medicine, Division of Cardiology, Columbia University Medical Center, New York, New York, USA
| | - Maria A Rodriguez
- Department of Medicine, Division of Cardiology, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Juan Ivey-Miranda
- Cardiology Hospital, XXI Century National Medical Center, Mexican Social Security Institute, Mexico City, Mexico
| | - Kouichi Tamura
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Jeffery Testani
- Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Steven Coca
- Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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30
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Adamo M, Lombardi CM, Metra M. December 2019 at a glance: economic burden, co-morbidities, and prognosis. Eur J Heart Fail 2020; 21:1485-1486. [PMID: 31889423 DOI: 10.1002/ejhf.1276] [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: 09/11/2019] [Accepted: 09/16/2019] [Indexed: 01/29/2023] Open
Affiliation(s)
- Marianna Adamo
- Cardio-Thoracic Department, Civil Hospitals; and Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Carlo Mario Lombardi
- Cardio-Thoracic Department, Civil Hospitals; and Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Marco Metra
- Cardio-Thoracic Department, Civil Hospitals; and Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
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