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Lu Y, Ni W, Qu X, Chen C, Shi S, Guo K, Lin K, Zhou H. Spironolactone for Preventing Contrast-Induced Nephropathy After Percutaneous Coronary Intervention in Patients With Acute Myocardial Infarction and Chronic Kidney Disease. Angiology 2024:33197241251889. [PMID: 38679489 DOI: 10.1177/00033197241251889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2024]
Abstract
Patients with acute myocardial infarction (AMI) and chronic kidney disease (CKD) are at high risk of contrast-induced nephropathy (CIN), which can subsequently worsen the overall prognosis. To evaluate the efficacy of spironolactone for CIN prevention, 410 patients with AMI and CKD receiving percutaneous coronary intervention (PCI) were retrospectively analyzed. Among them, 240 and 170 patients were enrolled in the standard treatment and spironolactone groups (spironolactone was administered 2 days before and 3 days after PCI), respectively. The primary endpoint of CIN was defined as a 0.5 mg/dL or >25% increase from the baseline serum creatinine level within 48-72 h post-PCI. CIN incidence was significantly lower in the spironolactone group than in the standard treatment group (11.2 vs 26.7%, P < .001). Further, cardiac re-hospitalization (hazard ratio [HR]: 0.515; 95% CI: 0.382-0.694; P < .001) and cardiac death (HR: 0.612; 95% CI: 0.429-0.872; P = .007) risks were significantly lower in patients who received long-term spironolactone with a median treatment duration of 42 months after discharge. Spironolactone might lower the risk of CIN, and long-term use of spironolactone reduces the risk of cardiac re-hospitalization and cardiac death in patients with AMI and CKD undergoing PCI.
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Affiliation(s)
- Yucheng Lu
- Department of Cardiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Weicheng Ni
- Department of Cardiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Xiang Qu
- Department of Cardiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Changxi Chen
- Department of Cardiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Sanling Shi
- Department of Cardiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Kun Guo
- Department of Cardiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Ken Lin
- Department of Cardiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Hao Zhou
- Department of Cardiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
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Lin TL, Chen IL, Lai WH, Chen YJ, Chang PH, Wu KH, Wang YC, Li WF, Liu YW, Wang CC, Lee IK. Prognostic factors for critically ill surgical patients with unplanned intensive care unit readmission: Developing a novel predictive scoring model for predicting readmission. Surgery 2024; 175:543-551. [PMID: 38008606 DOI: 10.1016/j.surg.2023.10.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 09/15/2023] [Accepted: 10/24/2023] [Indexed: 11/28/2023]
Abstract
BACKGROUND Unplanned readmission to the surgical intensive care unit has been demonstrated to worsen patient outcomes. Our objective was to identify risk factors and outcomes associated with unplanned surgical intensive care unit readmission and to develop a predictive scoring model to identify patients at high risk of readmission. METHODS We retrospectively analyzed patients admitted to the surgical intensive care unit (2020-2021) and categorized them as either with or without unplanned readmission. RESULTS Of 1,112 patients in the derivation cohort, 76 (6.8%) experienced unplanned surgical intensive care unit readmission, with sepsis being the leading cause of readmission (35.5%). Patients who were readmitted had significantly higher in-hospital mortality rates than those who were not. Multivariate analysis identified congestive heart failure, high Sequential Organ Failure Assessment-Hepatic score, use of carbapenem during surgical intensive care unit stay, as well as factors before surgical intensive care unit discharge such as inadequate glycemic control, positive fluid balance, low partial pressure of oxygen in arterial blood/fraction of inspired oxygen ratio, and receipt of total parenteral nutrition as independent predictors for unplanned readmission. The scoring model developed using these predictors exhibited good discrimination between readmitted and non-readmitted patients, with an area under the curve of 0.74. The observed rates of unplanned readmission for scores of <4 points and ≥4 points were 4% and 20.2% (P < .001), respectively. The model also demonstrated good performance in the validation cohort, with an area under the curve of 0.74 and 19% observed unplanned readmission rate for scores ≥4 points. CONCLUSION Besides congestive heart failure, clinicians should meticulously re-evaluate critical variables such as the Sequential Organ Failure Assessment-Hepatic score, partial pressure of oxygen in arterial blood/fraction of inspired oxygen ratio, glycemic control, and fluid status before releasing the patient from the surgical intensive care unit. It is crucial to determine the reasons for using carbapenems during surgical intensive care unit stay and the causes for the inability to discontinue total parenteral nutrition before discharging the patient from the surgical intensive care unit.
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Affiliation(s)
- Ting-Lung Lin
- Department of Surgery, Kaohsiung Chang Gung Memorial Hospital, Taiwan; Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - I-Ling Chen
- Chang Gung University College of Medicine, Kaohsiung, Taiwan; Department of Pharmacy, Kaohsiung Chang Gung Memorial Hospital, Taiwan; School of Pharmacy, Kaohsiung Medical University, Taiwan
| | - Wei-Hung Lai
- Department of Surgery, Kaohsiung Chang Gung Memorial Hospital, Taiwan; Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Ying-Ju Chen
- Department of Surgery, Kaohsiung Chang Gung Memorial Hospital, Taiwan; Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Po-Hsun Chang
- Chang Gung University College of Medicine, Kaohsiung, Taiwan; Department of Pharmacy, Kaohsiung Chang Gung Memorial Hospital, Taiwan
| | - Kuan-Han Wu
- Chang Gung University College of Medicine, Kaohsiung, Taiwan; Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, Taiwan
| | - Yu-Chen Wang
- Department of Surgery, Kaohsiung Chang Gung Memorial Hospital, Taiwan; Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Wei-Feng Li
- Department of Surgery, Kaohsiung Chang Gung Memorial Hospital, Taiwan; Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yueh-Wei Liu
- Department of Surgery, Kaohsiung Chang Gung Memorial Hospital, Taiwan; Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chih-Chi Wang
- Department of Surgery, Kaohsiung Chang Gung Memorial Hospital, Taiwan; Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Ing-Kit Lee
- Chang Gung University College of Medicine, Kaohsiung, Taiwan; Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Taiwan.
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Wittczak A, Ślot M, Bielecka-Dabrowa A. The Importance of Optimal Hydration in Patients with Heart Failure-Not Always Too Much Fluid. Biomedicines 2023; 11:2684. [PMID: 37893057 PMCID: PMC10604032 DOI: 10.3390/biomedicines11102684] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 09/26/2023] [Accepted: 09/27/2023] [Indexed: 10/29/2023] Open
Abstract
Heart failure (HF) is a leading cause of morbidity and mortality and a major public health problem. Both overhydration and dehydration are non-physiological states of the body that can adversely affect human health. Congestion and residual congestion are common in patients hospitalized for HF and are associated with poor prognosis and high rates of rehospitalization. However, the clinical problem of dehydration is also prevalent in healthcare and community settings and is associated with increased morbidity and mortality. This article provides a comprehensive review of the issue of congestion and dehydration in HF, including HF guidelines, possible causes of dehydration in HF, confirmed and potential new diagnostic methods. In particular, a full database search on the relationship between dehydration and HF was performed and all available evidence in the literature was reviewed. The novel hypothesis of chronic subclinical hypohydration as a modifiable risk factor for HF is also discussed. It is concluded that maintaining euvolemia is the cornerstone of HF management. Physicians have to find a balance between decongestion therapy and the risk of dehydration.
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Affiliation(s)
- Andrzej Wittczak
- Department of Preventive Cardiology and Lipidology, Medical University of Lodz, 90-419 Lodz, Poland
- Department of Cardiology and Congenital Diseases of Adults, Polish Mother’s Memorial Hospital Research Institute, 93-338 Lodz, Poland;
| | - Maciej Ślot
- Department of Cardiology and Congenital Diseases of Adults, Polish Mother’s Memorial Hospital Research Institute, 93-338 Lodz, Poland;
- Faculty of Physics and Applied Informatics, University of Lodz, 90-236 Lodz, Poland
| | - Agata Bielecka-Dabrowa
- Department of Preventive Cardiology and Lipidology, Medical University of Lodz, 90-419 Lodz, Poland
- Department of Cardiology and Congenital Diseases of Adults, Polish Mother’s Memorial Hospital Research Institute, 93-338 Lodz, Poland;
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Thanapholsart J, Khan E, Lee GA. A Current Review of the Uses of Bioelectrical Impedance Analysis and Bioelectrical Impedance Vector Analysis in Acute and Chronic Heart Failure Patients: An Under-valued Resource? Biol Res Nurs 2023; 25:240-249. [PMID: 36342073 PMCID: PMC10021121 DOI: 10.1177/10998004221132838] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND There is a need to detect and prevent fluid overload and malnutrition in heart failure. Bioelectrical impedance analysis and bioelectrical impedance vector analysis are medical instruments that can advance heart failure management by generating values of body composition and body water, assisting clinicians to detect fluid and nutritional status. However, there is a lack of evidence to summarise how they have been used among heart failure patients. METHOD A systematic search was conducted. RESULT Two hundred and four papers were screened. Forty-eight papers were reviewed, and 46 papers were included in this review. The literature shows that bioelectrical impedance analysis and bioelectrical impedance vector analysis were mostly used to assess fluid and nutritional status, together with diagnostic and prognostic values. Contraindication of using BIA and implications for practice are also demonstrated. CONCLUSION The findings suggest that bioelectrical impedance vector analysis is superior to bioelectrical impedance analysis when assessing hydration/nutritional status in heart failure. Assessing a patient using bioelectrical impedance analysis /bioelectrical impedance vector analysis, together with natriuretic peptide -heart failure biomarkers, increases the diagnostic accuracy of heart failure. Further studies are required to examine the cost effectiveness of using these instruments in clinical practice.
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Affiliation(s)
- Jenjiratchaya Thanapholsart
- Division of Applied Technologies for Clinical Care, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, 4616King's College London, London, UK
| | - Ehsan Khan
- Department of Adult Nursing, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, 4616King's College London, London, UK
| | - Geraldine A Lee
- Division of Applied Technologies for Clinical Care, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, 4616King's College London, London, UK
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Mayne KJ, Shemilt R, Keane DF, Lees JS, Mark PB, Herrington WG. Bioimpedance indices of fluid overload and cardiorenal outcomes in heart failure and chronic kidney disease: a systematic review. J Card Fail 2022; 28:1628-1641. [PMID: 36038013 DOI: 10.1016/j.cardfail.2022.08.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 07/23/2022] [Accepted: 08/04/2022] [Indexed: 01/19/2023]
Abstract
BACKGROUND Bioimpedance-based estimates of fluid overload have been widely studied and systematically reviewed in dialysis populations, but data from heart failure or non-dialysis chronic kidney disease (CKD) populations have not. METHODS AND RESULTS We conducted a systematic review of studies using whole-body bioimpedance from heart failure and non-dialysis CKD populations which reported associations with mortality, cardiovascular outcomes and/or CKD progression. We searched MEDLINE, Embase databases and the Cochrane CENTRAL registry from inception to 14th March 2022. Thirty one eligible studies were identified: 20 heart failure and 11 CKD cohorts, with 2 studies including over 1000 participants. A wide range of different bioimpedance methods were used across the studies (heart failure: 8 parameters; CKD: 6). Studies generally reported positive associations, but between-study differences in bioimpedance methods, fluid overload exposure definitions, and modelling approaches precluded meta-analysis. The largest identified study was in non-dialysis CKD (Chronic Renal Insufficiency Cohort, 3751 participants) which reported adjusted hazard ratios (95% confidence intervals) for phase angle <5.59 versus ≥6.4 of 2.02 (1.67-2.43) for all-cause mortality; 1.80 (1.46-2.23) for heart failure events; and 1.78 (1.56-2.04) for CKD progression. CONCLUSIONS Bioimpedance indices of fluid overload are associated with risk of important cardiorenal outcomes in heart failure and CKD. Facilitation of more widespread use of bioimpedance needs consensus on the optimum device, standardized analytical methods, and larger studies including more detailed characterization of cardiac and renal phenotypes.
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Affiliation(s)
- Kaitlin J Mayne
- Medical Research Council Population Health Research Unit, Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, UK; Institute of Cardiovascular & Medical Sciences, BHF Glasgow Cardiovascular Research Centre (GCRC), University of Glasgow, Glasgow, UK.
| | - Richard Shemilt
- Institute of Cardiovascular & Medical Sciences, BHF Glasgow Cardiovascular Research Centre (GCRC), University of Glasgow, Glasgow, UK
| | - David F Keane
- CÚRAM SFI Research Centre for Medical Devices, HRB-Clinical Research Facility Galway, National University of Ireland Galway, Ireland
| | - Jennifer S Lees
- Institute of Cardiovascular & Medical Sciences, BHF Glasgow Cardiovascular Research Centre (GCRC), University of Glasgow, Glasgow, UK
| | - Patrick B Mark
- Institute of Cardiovascular & Medical Sciences, BHF Glasgow Cardiovascular Research Centre (GCRC), University of Glasgow, Glasgow, UK
| | - William G Herrington
- Medical Research Council Population Health Research Unit, Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, UK.
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Goffredo G, Barone R, Di Terlizzi V, Correale M, Brunetti ND, Iacoviello M. Biomarkers in Cardiorenal Syndrome. J Clin Med 2021; 10:jcm10153433. [PMID: 34362216 PMCID: PMC8348334 DOI: 10.3390/jcm10153433] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Accepted: 07/29/2021] [Indexed: 01/16/2023] Open
Abstract
Cardiorenal syndrome is a clinical manifestation of the bidirectional interaction between the heart and kidney diseases. Over the last years, in patients with cardiovascular diseases, several biomarkers have been studied in order to better assess renal function as well as to identify patients prone to experiencing chronic or acute worsening of renal function. The aim of this review is to focus on the possible clinical usefulness of the most recent biomarkers in the setting of cardiorenal syndrome.
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Affiliation(s)
- Giovanni Goffredo
- Department of Medical and Surgical Sciences, University of Foggia, Viale Luigi Pinto 1, 71122 Foggia, Italy; (G.G.); (R.B.); (V.D.T.); (M.C.); (N.D.B.)
- Cardiology Unit, University Policlinic Hospital Riuniti, Viale Luigi Pinto 1, 71122 Foggia, Italy
| | - Roberta Barone
- Department of Medical and Surgical Sciences, University of Foggia, Viale Luigi Pinto 1, 71122 Foggia, Italy; (G.G.); (R.B.); (V.D.T.); (M.C.); (N.D.B.)
- Cardiology Unit, University Policlinic Hospital Riuniti, Viale Luigi Pinto 1, 71122 Foggia, Italy
| | - Vito Di Terlizzi
- Department of Medical and Surgical Sciences, University of Foggia, Viale Luigi Pinto 1, 71122 Foggia, Italy; (G.G.); (R.B.); (V.D.T.); (M.C.); (N.D.B.)
- Cardiology Unit, University Policlinic Hospital Riuniti, Viale Luigi Pinto 1, 71122 Foggia, Italy
| | - Michele Correale
- Department of Medical and Surgical Sciences, University of Foggia, Viale Luigi Pinto 1, 71122 Foggia, Italy; (G.G.); (R.B.); (V.D.T.); (M.C.); (N.D.B.)
- Cardiology Unit, University Policlinic Hospital Riuniti, Viale Luigi Pinto 1, 71122 Foggia, Italy
| | - Natale Daniele Brunetti
- Department of Medical and Surgical Sciences, University of Foggia, Viale Luigi Pinto 1, 71122 Foggia, Italy; (G.G.); (R.B.); (V.D.T.); (M.C.); (N.D.B.)
- Cardiology Unit, University Policlinic Hospital Riuniti, Viale Luigi Pinto 1, 71122 Foggia, Italy
| | - Massimo Iacoviello
- Department of Medical and Surgical Sciences, University of Foggia, Viale Luigi Pinto 1, 71122 Foggia, Italy; (G.G.); (R.B.); (V.D.T.); (M.C.); (N.D.B.)
- Cardiology Unit, University Policlinic Hospital Riuniti, Viale Luigi Pinto 1, 71122 Foggia, Italy
- Correspondence:
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Zisis G, Halabi A, Huynh Q, Neil C, Carrington M, Marwick TH. Use of novel non-invasive techniques and biomarkers to guide outpatient management of fluid overload and reduce hospital readmission: systematic review and meta-analysis. ESC Heart Fail 2021; 8:4228-4242. [PMID: 34296530 PMCID: PMC8497362 DOI: 10.1002/ehf2.13510] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Revised: 06/02/2021] [Accepted: 06/23/2021] [Indexed: 12/03/2022] Open
Abstract
Aims Fluid congestion is a leading cause of hospital admission, readmission, and mortality in heart failure (HF). We performed a systematic review and meta‐analysis to determine the effectiveness of an advanced fluid management programme (AFMP). The AFMP was defined as an intervention providing tailored diuretic therapy guided by intravascular volume assessment, in hospitalized patients or after discharge. The AFMP group was compared with patients who received standard care treatment. The aim of this systematic review and meta‐analysis was to determine the effectiveness of an AFMP in improving patient outcomes. Methods and results A systematic review of randomized controlled trials, case–control studies, and crossover studies using the terms ‘heart failure’, ‘fluid management’, and ‘readmission’ was conducted in PubMed, CINAHL, and Scopus up until November 2020. Studies reporting the association of an AFMP on readmission and/or mortality were included in our meta‐analyses. Risk of bias was assessed in non‐randomized studies using the Newcastle–Ottawa Scale. From 232 retrieved studies, 12 were included in the data synthesis. The 6040 patients in the included studies had a mean age of 72 ± 4 years and mean left ventricular ejection fraction of 39 ± 8%, there were slightly more men (n = 3022) than women, and the follow‐up period was a mean of 4.8 ± 3.1 months. Readmission data were available in 5362 patients; of these, 1629 were readmitted. Mortality data were available in 5787 patients; of these, 584 died. HF patients who had an AFMP in hospital and/or after discharge had lower odds of all‐cause readmission (odds ratio—OR 0.64 [95% confidence interval—CI 0.44, 0.92], P = 0.02) with moderate heterogeneity (I2 = 46.5) and lower odds of all‐cause mortality (OR 0.82 [95% CI 0.69, 0.98], P = 0.03) with low heterogeneity (I2 = 0). The use of an AFMP was equally effective in reducing readmission and mortality regardless of age and follow‐up duration. Effective pre‐discharge diuresis was associated with significantly lower readmission odds (OR 0.43 [95% CI 0.26, 0.71], P = 0.001) compared with a fluid management plan as part of post‐discharge follow‐up. Conclusions An effective AFMP is associated with improving readmission and mortality in HF. Our results encourage attainment of optimal volume status at discharge and prescription of optimal diuretic dose. Ongoing support to maintain euvolaemia and effective collaboration between healthcare teams, along with effective patient education and engagement, may help to reduce adverse outcomes in HF patients.
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Affiliation(s)
- Georgios Zisis
- Baker Heart and Diabetes Institute, 75 Commercial Road, Melbourne, Victoria, 3004, Australia.,Baker Department of Cardiometabolic Health, University of Melbourne, Melbourne, Victoria, Australia.,Faculty of Medicine, Nursing and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia.,Western Health, Melbourne, Victoria, Australia
| | - Amera Halabi
- Baker Heart and Diabetes Institute, 75 Commercial Road, Melbourne, Victoria, 3004, Australia.,School of Public Health and Preventative Medicine, Monash University, Melbourne, Victoria, Australia
| | - Quan Huynh
- Baker Heart and Diabetes Institute, 75 Commercial Road, Melbourne, Victoria, 3004, Australia.,Baker Department of Cardiometabolic Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Christopher Neil
- Baker Heart and Diabetes Institute, 75 Commercial Road, Melbourne, Victoria, 3004, Australia.,Faculty of Medicine, Nursing and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia.,Western Health, Melbourne, Victoria, Australia
| | - Melinda Carrington
- Baker Heart and Diabetes Institute, 75 Commercial Road, Melbourne, Victoria, 3004, Australia.,Baker Department of Cardiometabolic Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Thomas H Marwick
- Baker Heart and Diabetes Institute, 75 Commercial Road, Melbourne, Victoria, 3004, Australia.,Baker Department of Cardiometabolic Health, University of Melbourne, Melbourne, Victoria, Australia.,Faculty of Medicine, Nursing and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia.,Western Health, Melbourne, Victoria, Australia.,School of Public Health and Preventative Medicine, Monash University, Melbourne, Victoria, Australia
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Bioelectrical impedance analysis-guided fluid management promotes primary fascial closure after open abdomen: a randomized controlled trial. Mil Med Res 2021; 8:36. [PMID: 34099065 PMCID: PMC8180439 DOI: 10.1186/s40779-021-00329-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Accepted: 05/27/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Fluid overload (FO) after resuscitation is frequent and contributes to adverse outcomes among postinjury open abdomen (OA) patients. Bioelectrical impedance analysis (BIA) is a promising tool for monitoring fluid status and FO. Therefore, we sought to investigate the efficacy of BIA-directed fluid resuscitation among OA patients. METHODS A pragmatic, prospective, randomized, observer-blind, single-center trial was performed for all trauma patients requiring OA between January 2013 and December 2017 to a national referral center. A total of 140 postinjury OA patients were randomly assigned in a 1:1 ratio to receive either a BIA-directed fluid resuscitation (BIA) protocol that included fluid administration with monitoring of hemodynamic parameters and different degrees of interventions to achieve a negative fluid balance targeting the hydration level (HL) measured by BIA or a traditional fluid resuscitation (TRD) in which clinicians determined the fluid resuscitation regimen according to traditional parameters during 30 days of ICU management. The primary outcome was the 30-day primary fascial closure (PFC) rate. The secondary outcomes included the time to PFC, postoperative 7-day cumulative fluid balance (CFB) and adverse events within 30 days after OA. The Kaplan-Meier method and the log-rank test were utilized for PFC after OA. A generalized linear regression model for the time to PFC and CFB was built. RESULTS A total of 134 patients completed the trial (BIA, n = 66; TRD, n = 68). The BIA patients were significantly more likely to achieve PFC than the TRD patients (83.33% vs. 55.88%, P < 0.001). In the BIA group, the time to PFC occurred earlier than that of the TRD group by an average of 3.66 days (P < 0.001). Additionally, the BIA group showed a lower postoperative 7-day CFB by an average of 6632.80 ml (P < 0.001) and fewer complications. CONCLUSION Among postinjury OA patients in the ICU, the use of BIA-guided fluid resuscitation resulted in a higher PFC rate and fewer severe complications than the traditional fluid resuscitation strategy.
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Samoni S, Villa G, De Rosa S, Husain-Syed F, Guglielmetti G, Tofani L, De Cal M, Nalesso F, Meola M, Ronco C. Ultrasonographic Intraparenchymal Renal Resistive Index Variation for Assessing Renal Functional Reserve in Patients Scheduled for Cardiac Surgery: A Pilot Study. Blood Purif 2021; 51:147-154. [PMID: 34044391 DOI: 10.1159/000516438] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 04/09/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Cardiac surgery-associated acute kidney injury (CSA-AKI) is a common complication in patients undergoing cardiac surgery. Preoperative renal functional reserve (RFR) has been demonstrated to be highly predictive of CSA-AKI. We have previously demonstrated that intraparenchymal renal resistive index variation (IRRIV) measured by ultrasound (US) can identify the presence of RFR in healthy individuals. This study aimed (1) to examine the correlation between the US IRRIV test and RFR measured through the protein loading test in patients undergoing elective cardiac surgery and (2) to determine the value of the 2 methods for predicting occurrence of AKI or subclinical AKI after cardiac surgery. METHODS Consecutive patients scheduled for cardiac surgery were enrolled for this pilot study. The protein loading test and the IRRIV test were performed in all patients 2 days before cardiac surgery. Correlation between IRRIV and RFR was tested using Pearson correlation analysis. Association between presence of RFR and positive IRRIV test, presence of RFR and AKI and subclinical AKI, and positive IRRIV test and AKI and subclinical AKI was evaluated using logistic regression analysis. Receiver operating characteristic (ROC) curve analysis was performed to evaluate the values of IRRIV for predicting RFR, RFR for predicting AKI and subclinical AKI, and IRRIV for predicting AKI and subclinical AKI. RESULTS Among the 31 patients enrolled, significant association was found between IRRIV and RFR (r = 0.81; 95% CI: 0.63-0.90; p < 0.01). The association between RFR and IRRIV was described in 27/31 (87.1%) patients. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the IRRIV test were 100, 84, 60, and 100%, respectively. In ROC curve analysis, the area under the curve (AUC) was 0.80 (95% CI: 0.64-0.96). After cardiac surgery, 1/31 (3.2%) patient had AKI and 12/31 (38.7%) had subclinical AKI. RFR predicted subclinical AKI (odds ratio [OR] = 0.93; 95% CI: 0.87-0.98; p = 0.02). The sensitivity, specificity, PPV, and NPV of the RFR were 61, 88.8, 80, and 76%, respectively; the AUC was 0.75 (95% CI: 0.59-0.91). IRRIV predicts subclinical AKI (OR = 0.79; 95% CI: 0.67-0.93; p = 0.005). The sensitivity, specificity, PPV, and NPV of the IRRIV test were 46.1, 100, 100, and 72%, respectively; the AUC was 0.73 (95% CI: 0.58-0.87). CONCLUSION This pilot study suggests that a positive IRRIV test can significantly predict the presence of RFR in patients scheduled for cardiac surgery. RFR measured by the protein loading test or by the US IRRIV test can predict the occurrence of subclinical postoperative AKI. The findings of this study need to be confirmed in large patient cohorts.
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Affiliation(s)
- Sara Samoni
- Department of Nephrology and Dialysis, ASST Lariana, S. Anna Hospital, Como, Italy
| | - Gianluca Villa
- Department of Anesthesia and Intensive Care, Section of Oncological Anesthesia and Intensive Care, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Silvia De Rosa
- Department of Anesthesia and Intensive Care, San Bortolo Hospital, Vicenza, Italy
| | - Faeq Husain-Syed
- Department of Internal Medicine II, Division of Nephrology, Pulmonology and Critical Care Medicine, University Hospital Giessen and Marburg, Giessen, Germany
| | - Gabriele Guglielmetti
- Department of Translational Medicine, Nephrology and Kidney Transplantation Unit, University of Piemonte Orientale, "Maggiore della Carità" University Hospital, Novara, Italy
| | - Lorenzo Tofani
- Department of Neurosciences, Psychology, Drug Research and Child Health, University of Florence, Florence, Italy
| | - Massimo De Cal
- Department of Nephrology, Dialysis and Transplantation and International Renal Research Institute Vicenza (IRRIV), San Bortolo Hospital, Vicenza, Italy
| | - Federico Nalesso
- Department of Medicine, Nephrology, Dialysis and Transplantation Unit, University of Padua, Padua, Italy
| | - Mario Meola
- Institute of Life Sciences, Sant'Anna School of Advanced Studies, Pisa, Italy
| | - Claudio Ronco
- Department of Nephrology, Dialysis and Transplantation and International Renal Research Institute Vicenza (IRRIV), San Bortolo Hospital, Vicenza, Italy.,Department of Medicine (DIMED), University of Padua, Padua, Italy
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Argaiz ER. VExUS Nexus: Bedside Assessment of Venous Congestion. Adv Chronic Kidney Dis 2021; 28:252-261. [PMID: 34906310 DOI: 10.1053/j.ackd.2021.03.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 03/02/2021] [Accepted: 03/09/2021] [Indexed: 12/19/2022]
Abstract
Organ dysfunction in the setting of heart failure is mainly determined by backward transmission of increased right atrial pressure. Although traditional point-of-care ultrasound applications such as inferior vena cava and lung ultrasound have been increasingly incorporated in the clinical care of congestive heart failure, they do not directly evaluate the hemodynamic consequences of high right atrial pressure on organ blood flow. Congestion induces alterations in the venous flow patterns of abdominal organs that can be readily assessed using Doppler imaging. These alterations have been consistently associated with congestive organ dysfunction and adverse clinical outcomes. In this article, we provide a comprehensive overview of the bedside assessment of venous congestion using Doppler imaging. The review focuses mainly on the normal and abnormal Doppler patterns of the hepatic, portal, and intrarenal veins along with clinical examples of how to incorporate this tool in the management of patients with venous congestion.
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11
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Argaiz ER, Rola P, Gamba G. Dynamic Changes in Portal Vein Flow during Decongestion in Patients with Heart Failure and Cardio-Renal Syndrome: A POCUS Case Series. Cardiorenal Med 2021; 11:59-66. [PMID: 33477157 DOI: 10.1159/000511714] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 09/15/2020] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Optimal method for noninvasive assessment of venous congestion remains an unresolved issue. Portal vein (PV) and intrarenal venous flow alterations are markers of abdominal venous congestion and have been associated with acute kidney injury (AKI) in cardiac surgery patients. It is currently unknown if portal vein flow (PVF) alterations in heart failure can be reversed with diuretic treatment and track decongestion. OBJECTIVE The aim of this study is to evaluate PVF alterations in patients with ADHF at arrival and after decongestive treatment. METHODS Assessment of venous congestion using point-of-care ultrasound was performed in 12 patients with ADHF (6 patients with left-sided heart failure and 6 patients with right-sided heart failure). Evaluation included inferior vena cava (IVC) size and collapsibility in addition to PV Doppler to determine pulsatility fraction (PF). RESULTS Increased PV PF (81.75 ± 13%) was found on admission. After effective decongestive treatment, it improved to (17.43 ± 2.2%). Improvement in IVC size and collapsibility was seen in most patients with left-sided heart failure and none of the patients with right-sided heart failure. Improvement in PV PF coincided with return to baseline of Serum Cr in patients that presented with AKI. CONCLUSIONS Evaluation of abdominal venous congestion by point-of-care ultrasound could aid in diagnosis and follow-up of patients with congestive kidney injury.
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Affiliation(s)
- Eduardo R Argaiz
- Department of Internal Medicine, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Tlalpan, Mexico City, Mexico,
| | - Philippe Rola
- Division of Intensive Care, Santa Cabrini Hospital, Montreal, Québec, Canada
| | - Gerardo Gamba
- Department of Internal Medicine, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Tlalpan, Mexico City, Mexico.,Molecular Physiology Unit, Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México, Mexico City, Mexico
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12
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Indrawijaya YYA, Suharjono S, Aminuddin M, Retnowati E, Rahman GM. Changes on Serum Troponin T Level before and after Taking Standard Therapy Medication in Heart Failure Patients. FOLIA MEDICA INDONESIANA 2021. [DOI: 10.20473/fmi.v56i1.24548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Patients with advanced heart failure (NYHA FC III and IV heart failure) had positive cardiac troponin levels in previous cohort studies. In heart failure, cardiac troponin T (cTnT) is a biomarker that is sensitive to myocardial damage, especially myocardial necrosis. However, there is still little information regarding changes in cTnT levels during standard therapy. This prospective observational study is aimed at evaluating changes in cTnT levels before and after theadministration of standard therapy and evaluating symptom improvement before and after the administration of standard therapy in patients with severe heart failure. Measurement of cTnT levels and symptom improvement parameters before treatment was carried out on the first day of the inpatient and measurement after therapy was carried out on the last day of the inpatient. Sampling was done by consecutive sampling and found 30 patients in the inpatient room of the SMF Cardiovascular Disease, Dr. Soetomo Hospital, Surabaya during the months of May-July 2017. The results of the study obtained the average cTnT levels before therapy 33.48 + 31.88 pg/ml and the average cTnT levels after therapy 46.32 + 52.68 pg/ml. Based on the statistical difference test with the Wilcoxon sign-ranked test, there was no significant change in cTnT levels (p = 0.318). On the parameter of clinical symptom improvement, there was a significant decrease in pulse, respiratory rate, blood pressure, and mean arterial pressure before and after administration of therapy (p <0.05). There was no change in troponin T levels before and after the administration of therapy meant there was no worsening of myocardial necrosis.
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La Porta E, Lanino L, Calatroni M, Caramella E, Avella A, Quinn C, Faragli A, Estienne L, Alogna A, Esposito P. Volume Balance in Chronic Kidney Disease: Evaluation Methodologies and Innovation Opportunities. Kidney Blood Press Res 2021; 46:396-410. [PMID: 34233334 DOI: 10.1159/000515172] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 02/10/2021] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Patients affected by chronic kidney disease are at a risk of cardiovascular morbidity and mortality. Body fluids unbalance is one of the main characteristics of this condition, as fluid overload is highly prevalent in patients affected by the cardiorenal syndrome. SUMMARY We describe the state of the art and new insights into body volume evaluation. The mechanisms behind fluid balance are often complex, mainly because of the interplay of multiple regulatory systems. Consequently, its management may be challenging in clinical practice and even more so out-of-hospital. Availability of novel technologies offer new opportunities to improve the quality of care and patients' outcome. Development and validation of new technologies could provide new tools to reduce costs for the healthcare system, promote personalized medicine, and boost home care. Due to the current COVID-19 pandemic, a proper monitoring of chronic patients suffering from fluid unbalances is extremely relevant. Key Message: We discuss the main mechanisms responsible for fluid overload in different clinical contexts, including hemodialysis, peritoneal dialysis, and heart failure, emphasizing the potential impact provided by the implementation of the new technologies.
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Affiliation(s)
- Edoardo La Porta
- Department of Cardionephrology, Istituto Clinico Di Alta Specialità (ICLAS), Rapallo, Italy
- Department of Internal Medicine (DIMI), University of Genoa, Genoa, Italy
| | - Luca Lanino
- Department of Internal Medicine (DIMI), University of Genoa, Genoa, Italy
| | - Marta Calatroni
- Division of Nephrology, Humanitas Clinical and Research Center, Milan, Italy
| | - Elena Caramella
- Division of Nephrology and Dialysis, Ospedale Sant'Anna, San Fermo della Battaglia, Como, Italy
| | - Alessandro Avella
- Division of Nephrology and Dialysis, Ospedale di Circolo e Fondazione Macchi, Varese, Italy
| | - Caroline Quinn
- Department of Biological Sciences, Rensselaer Polytechnic Institute, Troy, New York, USA
| | - Alessandro Faragli
- Department of Internal Medicine and Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany
- Department of Internal Medicine and Cardiology, Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Berlin Institute of Health (BIH), Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Luca Estienne
- Department of Nephrology and Dialysis, SS. Antonio e Biagio e Cesare Arrigo Hospital, Alessandria, Italy
| | - Alessio Alogna
- Department of Internal Medicine and Cardiology, Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Berlin Institute of Health (BIH), Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Pasquale Esposito
- Division of Nephrology, Department of Internal Medicine, Dialysis and Transplantation, University of Genoa and IRCCS Policlinico San Martino, Genoa, Italy
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Caccialanza R, Cereda E, Klersy C, Milani P, Cappello S, Martinelli V, Turri A, Basset M, Borioli V, Nuvolone M, Caraccia M, Lavatelli F, Masi S, Lobascio F, Foli A, Merlini G, Palladini G. Bioelectrical impedance vector analysis-derived phase angle predicts survival in patients with systemic immunoglobulin light-chain amyloidosis. Amyloid 2020; 27:168-173. [PMID: 32212933 DOI: 10.1080/13506129.2020.1737004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Background: The aim of the present prospective study (ClinicalTrials.gov Identifier: NCT02111538) was to assess the prognostic value of phase angle (PhA), derived from bioimpedance vectorial analysis (BIVA), in patients affected by systemic amyloid light-chain (AL) amyloidosis.Methods: One hundred-twenty seven consecutive newly diagnosed, treatment-naïve patients with histologically confirmed AL amyloidosis were enrolled. Nutritional assessment including BIVA-derived PhA was performed before treatment initiation.Results: PhA was associated with unintentional weight loss, caloric intake and the physical component of quality of life (QoL). After a median follow-up of 16.3 months (25th-75th percentile: 8.4-28.9 months), 49 (38.6%) subjects had died. At multivariable Cox proportional hazard analysis, PhA ≤4.3 independently predicted survival (HR = 2.26 [95%CI, 1.04-4.89]; p = .038]) after controlling for hydration status, haematologic response to treatment and modified Mayo Clinic cardiac stage. There was no effect modification of PhA on mortality by cardiac stage (P for interaction = 0.61).Conclusions: In AL amyloidosis, BIVA-derived PhA is associated with the common parameters implied in malnutrition assessment and QoL, and adjusted for hydration independently predicts survival. Due to its feasibility, BIVA should be systematically considered for the nutritional and clinical assessment of AL patients, in whom nutritional intervention trials are warranted.
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Affiliation(s)
- Riccardo Caccialanza
- Clinical Nutrition and Dietetics Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Emanuele Cereda
- Clinical Nutrition and Dietetics Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Catherine Klersy
- Biometry and Clinical Epidemiology Service, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Paolo Milani
- Amyloidosis Research and Treatment Center, Fondazione IRCCS Policlinico San Matteo and, University Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | - Silvia Cappello
- Clinical Nutrition and Dietetics Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | | | - Annalisa Turri
- Clinical Nutrition and Dietetics Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Marco Basset
- Amyloidosis Research and Treatment Center, Fondazione IRCCS Policlinico San Matteo and, University Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | - Valeria Borioli
- Clinical Nutrition and Dietetics Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Mario Nuvolone
- Amyloidosis Research and Treatment Center, Fondazione IRCCS Policlinico San Matteo and, University Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | - Marilisa Caraccia
- Clinical Nutrition and Dietetics Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Francesca Lavatelli
- Amyloidosis Research and Treatment Center, Fondazione IRCCS Policlinico San Matteo and, University Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | - Sara Masi
- Clinical Nutrition and Dietetics Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Federica Lobascio
- Clinical Nutrition and Dietetics Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Andrea Foli
- Amyloidosis Research and Treatment Center, Fondazione IRCCS Policlinico San Matteo and, University Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | - Giampaolo Merlini
- Amyloidosis Research and Treatment Center, Fondazione IRCCS Policlinico San Matteo and, University Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | - Giovanni Palladini
- Amyloidosis Research and Treatment Center, Fondazione IRCCS Policlinico San Matteo and, University Department of Molecular Medicine, University of Pavia, Pavia, Italy
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Hankinson SJ, Williams CH, Ton VK, Gottlieb SS, Hong CC. Should we overcome the resistance to bioelectrical impedance in heart failure? Expert Rev Med Devices 2020; 17:785-794. [PMID: 32658589 DOI: 10.1080/17434440.2020.1791701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Heart failure is associated with increased neurohormonal activation that results in changes in body composition including volume overload and the loss of skeletal muscle, body fat, and bone density. Bioelectrical impedance measures body composition based on the conduction of electrical current through body fluids. AREAS COVERED The PubMed and Scopus databases were reviewed up to the third week of June 2020. Cross-sectional studies, retrospective observational studies, prospective observational studies, and randomized controlled trials have examined numerous bioelectrical impedance monitoring strategies to guide the diagnosis, prognosis, and treatment of heart failure. These monitoring strategies include intrathoracic impedance, lung impedance, bioelectrical impedance vector analysis, leg bioelectrical impedance, and thoracic bioreactance. EXPERT COMMENTARY Based on the current evidence, more studies are needed to validate bioelectrical impedance in heart failure. Lung impedance appears to be useful for guiding heart failure treatment in patients with ST-elevation myocardial infarction and improving outcomes in outpatients with heart failure. Furthermore, bioelectrical impedance has potential as a noninvasive, quantitative heart failure variable for population-based research.
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Affiliation(s)
- Stephen J Hankinson
- Department of Medicine, Division of Cardiovascular Medicine, University of Maryland School of Medicine , Baltimore, MD, USA
| | - Charles H Williams
- Department of Medicine, Division of Cardiovascular Medicine, University of Maryland School of Medicine , Baltimore, MD, USA
| | - Van-Khue Ton
- Department of Medicine, Division of Cardiovascular Medicine, University of Maryland School of Medicine , Baltimore, MD, USA.,Harvard Medical School, Division of Cardiology, Massachusetts General Hospital , Boston, MA, USA
| | - Stephen S Gottlieb
- Department of Medicine, Division of Cardiovascular Medicine, University of Maryland School of Medicine , Baltimore, MD, USA
| | - Charles C Hong
- Department of Medicine, Division of Cardiovascular Medicine, University of Maryland School of Medicine , Baltimore, MD, USA
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16
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Denneman N, Hessels L, Broens B, Gjaltema J, Stapel SN, Stohlmann J, Nijsten MW, Oudemans-van Straaten HM. Fluid balance and phase angle as assessed by bioelectrical impedance analysis in critically ill patients: a multicenter prospective cohort study. Eur J Clin Nutr 2020; 74:1410-1419. [DOI: 10.1038/s41430-020-0622-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Revised: 03/20/2020] [Accepted: 03/23/2020] [Indexed: 02/08/2023]
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17
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Rangaswami J, Bhalla V, Blair JEA, Chang TI, Costa S, Lentine KL, Lerma EV, Mezue K, Molitch M, Mullens W, Ronco C, Tang WHW, McCullough PA. Cardiorenal Syndrome: Classification, Pathophysiology, Diagnosis, and Treatment Strategies: A Scientific Statement From the American Heart Association. Circulation 2020; 139:e840-e878. [PMID: 30852913 DOI: 10.1161/cir.0000000000000664] [Citation(s) in RCA: 566] [Impact Index Per Article: 141.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Cardiorenal syndrome encompasses a spectrum of disorders involving both the heart and kidneys in which acute or chronic dysfunction in 1 organ may induce acute or chronic dysfunction in the other organ. It represents the confluence of heart-kidney interactions across several interfaces. These include the hemodynamic cross-talk between the failing heart and the response of the kidneys and vice versa, as well as alterations in neurohormonal markers and inflammatory molecular signatures characteristic of its clinical phenotypes. The mission of this scientific statement is to describe the epidemiology and pathogenesis of cardiorenal syndrome in the context of the continuously evolving nature of its clinicopathological description over the past decade. It also describes diagnostic and therapeutic strategies applicable to cardiorenal syndrome, summarizes cardiac-kidney interactions in special populations such as patients with diabetes mellitus and kidney transplant recipients, and emphasizes the role of palliative care in patients with cardiorenal syndrome. Finally, it outlines the need for a cardiorenal education track that will guide future cardiorenal trials and integrate the clinical and research needs of this important field in the future.
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18
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Packer M. Lessons learned from the DAPA-HF trial concerning the mechanisms of benefit of SGLT2 inhibitors on heart failure events in the context of other large-scale trials nearing completion. Cardiovasc Diabetol 2019; 18:129. [PMID: 31585532 PMCID: PMC6778368 DOI: 10.1186/s12933-019-0938-6] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2019] [Accepted: 09/27/2019] [Indexed: 02/08/2023] Open
Abstract
Four large-scale trials in type 2 diabetes have shown that sodium-glucose cotransporter 2 (SGLT2) inhibitors prevent the occurrence of serious heart failure events. Additionally, the DAPA-HF trial demonstrated a benefit of dapagliflozin to reduce major adverse outcomes in patients with established heart failure with a reduced ejection fraction. The trial sheds light on potential mechanisms. In DAPA-HF, the benefits of dapagliflozin on heart failure were seen to a similar extent in both patients with or without diabetes, thus undermining the hypothesis that these drugs mitigate glycemia-related cardiotoxicity. The action of SGLT2 inhibitors to promote ketogenesis is also primarily a feature of the action of these drugs in patients with diabetes, raising doubts that enhanced ketogenesis contributes to the benefit on heart failure. Also, dapagliflozin does not have a meaningful effect to decrease circulating natriuretic peptides, and it did not potentiate the actions of diuretics in DAPA-HF; moreover, intensification of diuretics therapy does not reduce cardiovascular death, questioning a benefit of SGLT2 inhibitors that is mediated by an action on renal sodium excretion. Finally, although hematocrit increases with SGLT2 inhibitors might favorably affect patients with coronary artery disease, in DAPA-HF, the benefit of dapagliflozin was similar in patients with or without an ischemic cardiomyopathy; furthermore, increases in hematocrit do not favorably affect the clinical course of patients with heart failure. Therefore, the results of DAPA-HF do not support many currently-held hypotheses about the mechanism of action of SGLT2 inhibitors in heart failure. Ongoing trials are likely to provide further insights.
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Affiliation(s)
- Milton Packer
- Baylor Heart and Vascular Institute, Baylor University Medical Center, 621N. Hall Street, Dallas, TX, 75226, USA. .,Imperial College, London, UK.
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Massari F, Scicchitano P, Iacoviello M, Valle R, Sanasi M, Piscopo A, Guida P, Mastropasqua F, Caldarola P, Ciccone MM. Serum biochemical determinants of peripheral congestion assessed by bioimpedance vector analysis in acute heart failure. Heart Lung 2019; 48:395-399. [PMID: 31113676 DOI: 10.1016/j.hrtlng.2019.04.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 04/21/2019] [Accepted: 04/23/2019] [Indexed: 01/09/2023]
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Maioli M, Toso A, Leoncini M, Musilli N, Grippo G, Ronco C, McCullough PA, Bellandi F. Bioimpedance-Guided Hydration for the Prevention of Contrast-Induced Kidney Injury: The HYDRA Study. J Am Coll Cardiol 2019; 71:2880-2889. [PMID: 29929610 DOI: 10.1016/j.jacc.2018.04.022] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Revised: 03/30/2018] [Accepted: 04/03/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Intravascular volume expansion plays a major role in the prevention of contrast-induced acute kidney injury (CI-AKI). Recommended standard amounts of fluid infusion before procedures do not produce homogeneous responses in subjects with different initial hydration status. OBJECTIVES The goal of this study was to compare the effect of standard and double intravenous (IV) infusion volumes in patients with low body fluid level, assessed by using bioimpedance vector analysis (BIVA), on the incidence of CI-AKI after elective coronary angiographic procedures. METHODS A total of 303 patients with low BIVA level on admission were randomized to receive standard volume saline (1 ml/kg/h for 12 h before and after the procedure) or double volume saline (2 ml/kg/h). Patients (n = 715) with an optimal BIVA level received standard volume saline and were included in a prospective registry. The saline infusion was halved in all patients with an ejection fraction <40%. BIVA was repeated immediately before the angiographic procedure in all patients. CI-AKI was defined as an increase in levels of cystatin C ≥10% above baseline at 24 h after contrast administration. RESULTS The incidence of CI-AKI was significantly lower (11.5% vs. 22.3%; p = 0.015) in patients receiving double volume saline than in those receiving standard volume saline, respectively. Before the angiographic procedure, 50% of the double volume patients achieved the optimal BIVA level compared with only 27.7% in the standard group (p = 0.0001). The findings were consistent in all the pre-specified subgroups excluding patients with a left ventricular ejection fraction <40% (p for interaction = 0.01). CONCLUSIONS Evaluation of BIVA levels on admission in patients with stable coronary artery disease allows adjustment of intravascular volume expansion, resulting in lower CI-AKI occurrence after angiographic procedures. (Personalized Versus Standard Hydration for Prevention of CI-AKI: A Randomized Trial With Bioimpedance Analysis; NCT02225431).
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Affiliation(s)
- Mauro Maioli
- Division of Cardiology, Santo Stefano Hospital, Prato, Italy
| | - Anna Toso
- Division of Cardiology, Santo Stefano Hospital, Prato, Italy.
| | - Mario Leoncini
- Division of Cardiology, Santo Stefano Hospital, Prato, Italy
| | - Nicola Musilli
- Division of Cardiology, Santo Stefano Hospital, Prato, Italy
| | - Gabriele Grippo
- Division of Cardiology, Santo Stefano Hospital, Prato, Italy
| | - Claudio Ronco
- Department of Nephrology, International Renal Research Institute (IRRIV), S. Bortolo Hospital, Vicenza, Italy
| | - Peter A McCullough
- Department of Internal Medicine, Division of Cardiology, Baylor University Medical Center, Dallas, Texas; Baylor Heart and Vascular Institute, Dallas, Texas; Baylor Jack and Jane Hamilton Heart and Vascular Hospital, Dallas, Texas; The Heart Hospital Baylor Plano, Plano, Texas. https://twitter.com/McCulloughBHVH
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Lukaski HC, Vega Diaz N, Talluri A, Nescolarde L. Classification of Hydration in Clinical Conditions: Indirect and Direct Approaches Using Bioimpedance. Nutrients 2019; 11:nu11040809. [PMID: 30974817 PMCID: PMC6521329 DOI: 10.3390/nu11040809] [Citation(s) in RCA: 84] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 04/06/2019] [Accepted: 04/08/2019] [Indexed: 12/16/2022] Open
Abstract
Although the need to assess hydration is well recognized, laboratory tests and clinical impressions are impractical and lack sensitivity, respectively, to be clinically meaningful. Different approaches use bioelectrical impedance measurements to overcome some of these limitations and aid in the classification of hydration status. One indirect approach utilizes single or multiple frequency bioimpedance in regression equations and theoretical models, respectively, with anthropometric measurements to predict fluid volumes (bioelectrical impedance spectroscopy-BIS) and estimate fluid overload based on the deviation of calculated to reference extracellular fluid volume. Alternatively, bioimpedance vector analysis (BIVA) uses direct phase-sensitive measurements of resistance and reactance, measured at 50 kHz, normalized for standing height, then plotted on a bivariate graph, resulting in a vector with length related to fluid content, and direction with phase angle that indexes hydration status. Comparison with healthy population norms enables BIVA to classify (normal, under-, and over-) and rank (change relative to pre-treatment) hydration independent of body weight. Each approach has wide-ranging uses in evaluation and management of clinical groups with over-hydration with an evolving emphasis on prognosis. This review discusses the advantages and limitations of BIS and BIVA for hydration assessment with comments on future applications.
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Affiliation(s)
- Henry C Lukaski
- Department of Kinesiology and Public Health Education, University of North Dakota, Grand Forks, ND 58202-7166, USA.
| | - Nicanor Vega Diaz
- Nephrology Service, University Hospital of Grand Canary and Faculty of Science, University Los Palmas, 35019 Los Palmas, Grand Canary, Spain.
| | - Antonio Talluri
- Antonio Talluri, Fatbyte, Inc., 50012 Bagno a Ripoli, Florence, Italy.
| | - Lexa Nescolarde
- Department of Electronic Engineering, Universitat Politècnica de Catalunya, 08034 Barcelona, Spain.
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22
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Curbelo J, Rodriguez-Cortes P, Aguilera M, Gil-Martinez P, Martín D, Suarez Fernandez C. Comparison between inferior vena cava ultrasound, lung ultrasound, bioelectric impedance analysis, and natriuretic peptides in chronic heart failure. Curr Med Res Opin 2019; 35:705-713. [PMID: 30185067 DOI: 10.1080/03007995.2018.1519502] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND Heart failure (HF) is an important healthcare problem. Knowing volume status in outpatients with chronic HF to adjust treatment and to avoid decompensations is a challenge. The aim of this study is comparing the usefulness of inferior vena cava (IVC) ultrasound, lung ultrasound, bioelectrical impedance analysis (BIA), and natriuretic peptides in the follow-up of outpatients with chronic HF. METHODS This was a prospective cohort study. Ninety-nine patients with chronic HF were included consecutively as they attended scheduled medical visits. The different techniques were performed on the day of the clinic visit, and the result was hidden from the patients and the responsible medical team. Follow-up time was 1 year. Outcome events checked were a combination of death or hospitalization, due to HF. RESULTS Thirty-six patients (36.4%) died or were hospitalized for HF. They had a significantly lower IVC collapse, and a greater number of lung B-lines and higher NTproBNP levels compared to patients who remained stable. There were no differences in the BIA parameters. After multivariable analysis, cut-off points of IVC collapse <30%, number of pulmonary B lines greater than 5, and NTproBNP levels greater than 2000 pg/ml were associated with increased risk of HF death or admission. NTproBNP had the best area under the curve. CONCLUSION Evaluation of congestion in outpatients with chronic HF may be based on NTproBNP, IVC ultrasound, or lung ultrasound; they are useful in identifying patients at high risk of hospitalization or death due to HF.
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Affiliation(s)
- Jose Curbelo
- a Internal Medicine Department, Hospital Universitario La Princesa , Madrid , Spain
- b Medicine Department, Universidad Autónoma de Madrid , Madrid , Spain
| | - Pablo Rodriguez-Cortes
- a Internal Medicine Department, Hospital Universitario La Princesa , Madrid , Spain
- b Medicine Department, Universidad Autónoma de Madrid , Madrid , Spain
| | - Maria Aguilera
- a Internal Medicine Department, Hospital Universitario La Princesa , Madrid , Spain
- b Medicine Department, Universidad Autónoma de Madrid , Madrid , Spain
| | - Paloma Gil-Martinez
- a Internal Medicine Department, Hospital Universitario La Princesa , Madrid , Spain
- b Medicine Department, Universidad Autónoma de Madrid , Madrid , Spain
| | - Daniel Martín
- a Internal Medicine Department, Hospital Universitario La Princesa , Madrid , Spain
- b Medicine Department, Universidad Autónoma de Madrid , Madrid , Spain
| | - Carmen Suarez Fernandez
- a Internal Medicine Department, Hospital Universitario La Princesa , Madrid , Spain
- b Medicine Department, Universidad Autónoma de Madrid , Madrid , Spain
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Aguirre MA, Lynch I, Hardman B. Perioperative Management of Pulmonary Hypertension and Right Ventricular Failure During Noncardiac Surgery. Adv Anesth 2018; 36:201-230. [PMID: 30414638 DOI: 10.1016/j.aan.2018.07.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- Marco A Aguirre
- Department of Anesthesiology and Pain Management, The University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390-7208, USA.
| | - Isaac Lynch
- Department of Anesthesiology and Pain Management, The University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390-7208, USA
| | - Bailor Hardman
- Department of Anesthesiology and Pain Management, The University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390-7208, USA
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Massari F, Scicchitano P, Ciccone MM, Caldarola P, Aspromonte N, Iacoviello M, Barro S, Pantano I, Valle R. Bioimpedance vector analysis predicts hospital length of stay in acute heart failure. Nutrition 2018; 61:56-60. [PMID: 30703569 DOI: 10.1016/j.nut.2018.10.028] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 10/19/2018] [Accepted: 10/23/2018] [Indexed: 01/06/2023]
Abstract
OBJECTIVE Congestion in acute heart failure (AHF) affects survival curves and hospital length of stay (LOS). The evaluation of congestion, however, is not totally objective. The aim of this study was to verify the accuracy of bioelectrical impedance vector analysis (BIVA) in predicting the LOS in AHF patients. METHODS This is a retrospective study. A total of 706 patients (367 male; mean age: 78 ± 10 y) who had been admitted to hospital with an AHF event were enrolled. All underwent anthropometric and clinical evaluation, baseline transthoracic echocardiography, and biochemical and BIVA evaluations. RESULTS The comparison among the clinical characteristics of congestion, LOS, and hyperhydration status revealed that the higher the hydration status, the longer the LOS (from 7.36 d [interquartile range: 7.34-7.39 d] in normohydrated patients to 9.04 d [interquartile range: 8.85- 9.19 d] in severe hyperhydrated patients; P < 0.05). At univariate analysis, brain natriuretic peptide, blood urea nitrogen, New York Heart Association class, hemoglobin, hydration index, and peripheral edema all had a statistically significant influence on LOS. At multivariate analysis, only brain natriuretic peptide (P < 0.0001), blood urea nitrogen (P = 0.011), and hydration index (P < 0.0001) were significantly associated to LOS. CONCLUSIONS Congestion evaluated by BIVA is an independent predictor of length of total hospital stay in HF patients with acute decompensation. The quick and reliable detection of congestion permits the administration of target therapy for AHF, thus reducing LOS and treatment costs.
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Affiliation(s)
| | - Pietro Scicchitano
- Cardiology Section, F. Perinei Hospital, Altamura, Bari, Italy; Section of Cardiovascular Diseases, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy.
| | - Marco Matteo Ciccone
- Section of Cardiovascular Diseases, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | | | - Nadia Aspromonte
- Department of Cardiovascular and Thoracic Sciences, Catholic University of the Sacred Heart Agostino Gemelli Foundation, Rome, Italy
| | - Massimo Iacoviello
- Section of Cardiovascular Diseases, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | - Sabrina Barro
- Cardiology Department, Hospital of San Donà di Piave (Venezia), Italy
| | - Ivan Pantano
- Cardiology Department, Hospital of Chioggia, Chioggia (Venezia), Italy
| | - Roberto Valle
- Cardiology Department, Hospital of Chioggia, Chioggia (Venezia), Italy
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Kobayashi M, Rossignol P, Ferreira JP, Aragão I, Paku Y, Iwasaki Y, Watanabe M, Fudim M, Duarte K, Zannad F, Girerd N. Prognostic value of estimated plasma volume in acute heart failure in three cohort studies. Clin Res Cardiol 2018; 108:549-561. [DOI: 10.1007/s00392-018-1385-1] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Accepted: 10/15/2018] [Indexed: 12/19/2022]
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Mullie L, Obrand A, Bendayan M, Trnkus A, Ouimet M, Moss E, Chen‐Tournoux A, Rudski LG, Afilalo J. Phase Angle as a Biomarker for Frailty and Postoperative Mortality: The BICS Study. J Am Heart Assoc 2018; 7:e008721. [PMID: 30371163 PMCID: PMC6201414 DOI: 10.1161/jaha.118.008721] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Accepted: 07/02/2018] [Indexed: 01/19/2023]
Abstract
Background Phase angle (PA) is a bioimpedance measurement that is determined lean body mass and hydration status. Patients with low PA values are more likely to be frail, sarcopenic, or malnourished. Previous work has shown that low PA predicts adverse outcomes after cardiac surgery, but the effect of PA on survival has not previously been assessed in this setting. Methods and Results The BICS (Bioimpedance in Cardiac Surgery) study recruited 277 patients undergoing major cardiac surgery at 2 university-affiliated hospitals in Montreal, QC, Canada. Bioimpedance measurements as well as frailty and nutritional assessments were performed preoperatively. The primary outcome was all-cause mortality. Secondary outcomes were 30-day mortality, postoperative morbidity, and hospital length of stay. There were 10 deaths at 1 month of follow-up and 16 deaths at 12 months of follow-up. PA was associated with age, sex, body mass index, comorbidities, and frailty, as measured by the Short Physical Performance Battery and Fried scales. After adjusting for Society of Thoracic Surgeons-predicted mortality, lower PA was associated with higher mortality at 1 month (adjusted odds ratio, 3.57 per 1° decrease in PA ; 95% confidence interval, 1.35-9.47) and at 12 months (adjusted odds ratio, 3.03 per 1° decrease in PA ; 95% confidence interval, 1.30-7.09), a higher risk of overall morbidity (adjusted hazard ratio, 2.51 per 1° decrease in PA ; 95% confidence interval, 1.32-4.75), and a longer hospital length of stay (adjusted β, 4.8 days per 1° decrease in PA ; 95% confidence interval, 1.3-8.2 days). Conclusions Low PA is associated with frailty and is predictive of mortality, morbidity, and length of stay after major cardiac surgery. Further work is needed to determine the responsiveness of PA to interventions aimed at reversing frailty.
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Affiliation(s)
- Louis Mullie
- Centre for Clinical EpidemiologyLady Davis InstituteMcGill UniversityMontrealQuebecCanada
- Division of Internal MedicineMcGill UniversityMontrealQuebecCanada
| | - Alexandrine Obrand
- Centre for Clinical EpidemiologyLady Davis InstituteMcGill UniversityMontrealQuebecCanada
- School of EngineeringMassachusetts Institute of TechnologyCambridgeMA
| | - Melissa Bendayan
- Centre for Clinical EpidemiologyLady Davis InstituteMcGill UniversityMontrealQuebecCanada
- Division of Experimental MedicineFaculty of MedicineMcGill UniversityMontrealQuebecCanada
| | - Amanda Trnkus
- Centre for Clinical EpidemiologyLady Davis InstituteMcGill UniversityMontrealQuebecCanada
| | - Marie‐Claude Ouimet
- Centre for Innovative MedicineMcGill University Health CentreMcGill UniversityMontrealQuebecCanada
| | - Emmanuel Moss
- Division of Cardiac SurgeryJewish General HospitalMcGill UniversityMontrealQuebecCanada
| | | | - Lawrence G. Rudski
- Centre for Clinical EpidemiologyLady Davis InstituteMcGill UniversityMontrealQuebecCanada
- Division of CardiologyJewish General HospitalMcGill UniversityMontrealQuebecCanada
| | - Jonathan Afilalo
- Centre for Clinical EpidemiologyLady Davis InstituteMcGill UniversityMontrealQuebecCanada
- Division of Experimental MedicineFaculty of MedicineMcGill UniversityMontrealQuebecCanada
- Division of CardiologyJewish General HospitalMcGill UniversityMontrealQuebecCanada
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27
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Fu S, Ping P, Zhu Q, Ye P, Luo L. Brain Natriuretic Peptide and Its Biochemical, Analytical, and Clinical Issues in Heart Failure: A Narrative Review. Front Physiol 2018; 9:692. [PMID: 29922182 PMCID: PMC5996066 DOI: 10.3389/fphys.2018.00692] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Accepted: 05/17/2018] [Indexed: 12/11/2022] Open
Abstract
Heart failure (HF) is a primary cause of morbidity and mortality worldwide. As the most widely studied and commonly applied natriuretic peptide (NP), B-type natriuretic peptide (BNP) has the effects of diuresis, natriuresis, vasodilation, anti-hypertrophy, and anti-fibrosis and it inhibits the renin-angiotensin-aldosterone and sympathetic nervous systems to maintain cardiorenal homeostasis and counteract the effects of HF. Both BNP and N-terminal pro B-type natriuretic peptide (NT-proBNP) are applied as diagnostic, managing, and prognostic tools for HF. However, due to the complexity of BNP system, the diversity of BNP forms and the heterogeneity of HF status, there are biochemical, analytical, and clinical issues on BNP not fully understood. Current immunoassays cross-react to varying degrees with pro B-type natriuretic peptide (proBNP), NT-proBNP and various BNP forms and cannot effectively differentiate between these forms. Moreover, current immunoassays have different results and may not accurately reflect cardiac function. It is essential to design assays that can recognize specific forms of BNP, NT-proBNP, and proBNP to obtain more clinical information. Not only the processing of proBNP (corin/furin) and BNP (neprilysin), but also the effects of glycosylation on proBNP processing and BNP assays, should be targeted in future studies to enhance their diagnostic, therapeutic, and prognostic values.
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Affiliation(s)
- Shihui Fu
- Department of Geriatric Cardiology, Chinese People's Liberation Army General Hospital, Beijing, China.,Department of Cardiology and Hainan Branch, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Ping Ping
- Department of Pharmaceutical Care, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Qiwei Zhu
- Department of Geriatric Cardiology, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Ping Ye
- Department of Geriatric Cardiology, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Leiming Luo
- Department of Geriatric Cardiology, Chinese People's Liberation Army General Hospital, Beijing, China
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Mortality among patients due to adverse drug reactions that lead to hospitalization: a meta-analysis. Eur J Clin Pharmacol 2018; 74:819-832. [PMID: 29556685 DOI: 10.1007/s00228-018-2441-5] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2018] [Accepted: 03/07/2018] [Indexed: 10/17/2022]
Abstract
PURPOSE The aim of this study was to estimate the prevalence of mortality among patients due to adverse drug reactions that lead to hospitalisation (fatal ADRAd), to explore the heterogeneity in its estimation through subgroup analysis of study characteristics, and to identify system-organ classes involved and causative drugs for fatal ADRAd. METHODS We identified prospective ADRAd-related studies via screening of the PubMed and Google Scholar databases with appropriate key terms. We estimated the prevalence of fatal ADRAd using a double arcsine method and explored heterogeneity using the following study characteristics: age groups, wards, study region, ADR definitions, ADR identification methods, study duration and sample size. We examined patterns of fatal ADRAd and causative drugs. RESULTS Among 312 full-text articles assessed, 49 studies satisfied the selection criteria and were included in the analysis. The mean prevalence of fatal ADRAd was 0.20% (95% CI: 0.13-0.27%; I2 = 93%). The age groups and study wards were the important heterogeneity modifiers. The mean fatal ADRAd prevalence varied from 0.01% in paediatric patients to 0.44% in the elderly. Subgroup analysis showed a higher prevalence of fatal ADRAd in intensive care units, emergency departments, multispecialty wards and whole hospitals. Computer-based monitoring systems in combination with other methods detected higher mortality. Intracranial haemorrhage, renal failure and gastrointestinal bleeding accounted for more than 50% of fatal ADRAdcases. Warfarin, aspirin, renin-angiotensin system (RAS) inhibitors and digoxin accounted for 60% of fatal ADRAd. CONCLUSIONS ADRAd is an important cause of mortality. Strategies targeting the safer use of warfarin, aspirin, RAS inhibitors and digoxin could reduce the large number of fatal ADRAdcases.
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Roumelioti ME, Glew RH, Khitan ZJ, Rondon-Berrios H, Argyropoulos CP, Malhotra D, Raj DS, Agaba EI, Rohrscheib M, Murata GH, Shapiro JI, Tzamaloukas AH. Fluid balance concepts in medicine: Principles and practice. World J Nephrol 2018; 7:1-28. [PMID: 29359117 PMCID: PMC5760509 DOI: 10.5527/wjn.v7.i1.1] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Revised: 11/16/2017] [Accepted: 11/27/2017] [Indexed: 02/06/2023] Open
Abstract
The regulation of body fluid balance is a key concern in health and disease and comprises three concepts. The first concept pertains to the relationship between total body water (TBW) and total effective solute and is expressed in terms of the tonicity of the body fluids. Disturbances in tonicity are the main factor responsible for changes in cell volume, which can critically affect brain cell function and survival. Solutes distributed almost exclusively in the extracellular compartment (mainly sodium salts) and in the intracellular compartment (mainly potassium salts) contribute to tonicity, while solutes distributed in TBW have no effect on tonicity. The second body fluid balance concept relates to the regulation and measurement of abnormalities of sodium salt balance and extracellular volume. Estimation of extracellular volume is more complex and error prone than measurement of TBW. A key function of extracellular volume, which is defined as the effective arterial blood volume (EABV), is to ensure adequate perfusion of cells and organs. Other factors, including cardiac output, total and regional capacity of both arteries and veins, Starling forces in the capillaries, and gravity also affect the EABV. Collectively, these factors interact closely with extracellular volume and some of them undergo substantial changes in certain acute and chronic severe illnesses. Their changes result not only in extracellular volume expansion, but in the need for a larger extracellular volume compared with that of healthy individuals. Assessing extracellular volume in severe illness is challenging because the estimates of this volume by commonly used methods are prone to large errors in many illnesses. In addition, the optimal extracellular volume may vary from illness to illness, is only partially based on volume measurements by traditional methods, and has not been determined for each illness. Further research is needed to determine optimal extracellular volume levels in several illnesses. For these reasons, extracellular volume in severe illness merits a separate third concept of body fluid balance.
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Affiliation(s)
- Maria-Eleni Roumelioti
- Division of Nephrology, Department of Medicine, University of New Mexico School of Medicine, Albuquerque, NM 87131, United States
| | - Robert H Glew
- Department of Surgery, University of New Mexico School of Medicine, Albuquerque, NM 87131, United States
| | - Zeid J Khitan
- Division of Nephrology, Department of Medicine, Joan Edwards School of Medicine, Marshall University, Huntington, WV 25701, United States
| | - Helbert Rondon-Berrios
- Division of Renal and Electrolyte, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA 15260, United States
| | - Christos P Argyropoulos
- Division of Nephrology, Department of Medicine, University of New Mexico School of Medicine, Albuquerque, NM 87131, United States
| | - Deepak Malhotra
- Division of Nephrology, Department of Medicine, University of Toledo School of Medicine, Toledo, OH 43614-5809, United States
| | - Dominic S Raj
- Division of Renal Disease and Hypertension, Department of Medicine, George Washington University, Washington, DC 20037, United States
| | - Emmanuel I Agaba
- Division of Nephology, Department of Medicine, Jos University Medical Center, Jos, Plateau State 930001, Nigeria
| | - Mark Rohrscheib
- Division of Nephrology, Department of Medicine, University of New Mexico School of Medicine, Albuquerque, NM 87131, United States
| | - Glen H Murata
- Research Service, Raymond G Murphy VA Medical Center and University of New Mexico School of Medicine, Albuquerque, NM 87108, United States
| | | | - Antonios H Tzamaloukas
- Research Service, Raymond G Murphy VA Medical Center and University of New Mexico School of Medicine, Albuquerque, NM 87108, United States
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Santarelli S, Russo V, Lalle I, De Berardinis B, Navarin S, Magrini L, Piccoli A, Codognotto M, Castello LM, Avanzi GC, Villacorta H, Precht BLC, de Araújo Porto PB, Villacorta AS, Di Somma S. Usefulness of combining admission brain natriuretic peptide (BNP) plus hospital discharge bioelectrical impedance vector analysis (BIVA) in predicting 90 days cardiovascular mortality in patients with acute heart failure. Intern Emerg Med 2017; 12:445-451. [PMID: 27987064 DOI: 10.1007/s11739-016-1581-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Accepted: 11/24/2016] [Indexed: 01/19/2023]
Abstract
Heart failure is a disease characterized by high prevalence and mortality, and frequent rehospitalizations. The aim of this study is to investigate the prognostic power of combining brain natriuretic peptide (BNP) and congestion status detected by bioelectrical impedance vector analysis (BIVA) in acute heart failure patients. This is an observational, prospective, and a multicentre study. BNP assessment was measured upon hospital arrival, while BIVA analysis was obtained at the time of discharge. Cardiovascular deaths were evaluated at 90 days by a follow up phone call. 292 patients were enrolled. Compared to survivors, BNP was higher in the non-survivors group (mean value 838 vs 515 pg/ml, p < 0.001). At discharge, BIVA shows a statistically significant difference in hydration status between survivors and non-survivors [respectively, hydration index (HI) 85 vs 74, p < 0.001; reactance (Xc) 26.7 vs 37, p < 0.001; resistance (R) 445 vs 503, p < 0.01)]. Discharge BIVA shows a prognostic value in predicting cardiovascular death [HI: area under the curve (AUC) 0.715, 95% confidence interval (95% CI) 0.65-0.76; p < 0.004; Xc: AUC 0.712, 95% CI 0.655-0.76, p < 0.007; R: AUC 0.65, 95% CI 0.29-0.706, p < 0.0247]. The combination of BIVA with BNP gives a greater prognostic power for cardiovascular mortality [combined receiving operating characteristic (ROC): AUC 0.74; 95% CI 0.68-0.79; p < 0.001]. In acute heart failure patients, higher BNP levels upon hospital admission, and congestion detected by BIVA at discharge have a significant predictive value for 90 days cardiovascular mortality. The combined use of admission BNP and BIVA discharge seems to be a useful tool for increasing prognostic power in these patients.
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Affiliation(s)
- Simona Santarelli
- Department of Medical-Surgery Sciences and Translational Medicine, Emergency Medicine, Postgraduate School of Emergency Medicine, University La Sapienza, Via di Grottarossa 1035/1039, 00189, Rome, Italy
| | - Veronica Russo
- Department of Medical-Surgery Sciences and Translational Medicine, Emergency Medicine, Postgraduate School of Emergency Medicine, University La Sapienza, Via di Grottarossa 1035/1039, 00189, Rome, Italy
| | - Irene Lalle
- Department of Medical-Surgery Sciences and Translational Medicine, Emergency Medicine, Postgraduate School of Emergency Medicine, University La Sapienza, Via di Grottarossa 1035/1039, 00189, Rome, Italy
| | - Benedetta De Berardinis
- Department of Medical-Surgery Sciences and Translational Medicine, Emergency Medicine, Postgraduate School of Emergency Medicine, University La Sapienza, Via di Grottarossa 1035/1039, 00189, Rome, Italy
| | - Silvia Navarin
- Department of Medical-Surgery Sciences and Translational Medicine, Emergency Medicine, Postgraduate School of Emergency Medicine, University La Sapienza, Via di Grottarossa 1035/1039, 00189, Rome, Italy
| | - Laura Magrini
- Department of Medical-Surgery Sciences and Translational Medicine, Emergency Medicine, Postgraduate School of Emergency Medicine, University La Sapienza, Via di Grottarossa 1035/1039, 00189, Rome, Italy
| | | | | | - Luigi Maria Castello
- Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy
| | - Gian Carlo Avanzi
- Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy
| | - Humberto Villacorta
- Department of Cardiology, Fluminense Federal University, Niteroi, RJ, Brazil
- Hospital Unimed Rio, Rio de Janeiro, RJ, Brazil
| | | | | | | | - Salvatore Di Somma
- Department of Medical-Surgery Sciences and Translational Medicine, Emergency Medicine, Postgraduate School of Emergency Medicine, University La Sapienza, Via di Grottarossa 1035/1039, 00189, Rome, Italy.
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Aspromonte N, Gulizia MM, Clerico A, Di Tano G, Emdin M, Feola M, Iacoviello M, Latini R, Mortara A, Valle R, Misuraca G, Passino C, Masson S, Aimo A, Ciaccio M, Migliardi M. ANMCO/ELAS/SIBioC Consensus Document: biomarkers in heart failure. Eur Heart J Suppl 2017; 19:D102-D112. [PMID: 28751838 PMCID: PMC5520761 DOI: 10.1093/eurheartj/sux027] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Biomarkers have dramatically impacted the way heart failure (HF) patients are evaluated and managed. A biomarker is a characteristic that is objectively measured and evaluated as an indicator of normal biological or pathogenic processes, or pharmacological responses to a therapeutic intervention. Natriuretic peptides [B-type natriuretic peptide (BNP) and N-terminal proBNP] are the gold standard biomarkers in determining the diagnosis and prognosis of HF, and a natriuretic peptide-guided HF management looks promising. In the last few years, an array of additional biomarkers has emerged, each reflecting different pathophysiological processes in the development and progression of HF: myocardial insult, inflammation, fibrosis, and remodelling, but their role in the clinical care of the patient is still partially defined and more studies are needed before to be well validated. Moreover, several new biomarkers have the potential to identify patients with early renal dysfunction and appear to have promise to help the management cardio-renal syndrome. With different biomarkers reflecting HF presence, the various pathways involved in its progression, as well as identifying unique treatment options for HF management, a closer cardiologist-laboratory link, with a multi-biomarker approach to the HF patient, is not far ahead, allowing the unique opportunity for specifically tailoring care to the individual pathological phenotype.
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Affiliation(s)
- Nadia Aspromonte
- CCU-Cardiology Department, Presidio Ospedaliero San Filippo Neri, Via Martinotti, 20, 00135 Rome, Italy
| | - Michele Massimo Gulizia
- Cardiology Department, Ospedale Garibaldi-Nesima, Azienda di Rilievo Nazionale e Alta Specializzazione “Garibaldi”, Catania, Italy
| | - Aldo Clerico
- Laboratory of Endocrinology and Cardiovascular Cell Biology, Fondazione Toscana G. Monasterio-CNR, Scuola Superiore Sant’Anna, Pisa, Italy
| | - Giuseppe Di Tano
- Istituti Ospitalieri, Cardiology Unit, Cremona, and Scuola Superiore Sant’Anna, Pisa, Italy
| | - Michele Emdin
- Cardiology and Cardiovascular Medicine Department, Fondazione Toscana G. Monasterio, Italy
| | - Mauro Feola
- Cardiac Rehabilitation - Congestive Cardiac Unit, Ospedale Maggiore SS. Trinità, Fossano (CN), Italy
| | | | - Roberto Latini
- Cardiovascular Research Department, Istituto Mario Negri, Milano, Italy
| | - Andrea Mortara
- Clinical Cardiology and Heart Failure Unit, Policlinico di Monza, Monza (MB), Italy
| | - Roberto Valle
- Cardiology Department, Ospedale Civile, Chioggia (Venezia), Italy
| | | | - Claudio Passino
- Cardiology and Cardiovascular Medicine Department, Fondazione Toscana G. Monasterio, Italy
| | - Serge Masson
- Cardiovascular Research Department, Istituto Mario Negri, Milano, Italy
| | - Alberto Aimo
- Cardiology and Cardiovascular Medicine Department, Fondazione Toscana G. Monasterio, Italy
| | - Marcello Ciaccio
- Clinical Biochemistry and Molecular Medicine Section, Dipartimento di Pathobiology and Medical Biotechnology Department, Università degli Studi, Palermo, Italy
| | - Marco Migliardi
- Laboratory of Analysis, A.O. Ordine Mauriziano, Torino, Italy
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Nwosu C, Mezue K, Bhagatwala K, Ezema N. A Practical Comprehensive Approach to Management of Acute Decompensated Heart Failure. Curr Cardiol Rev 2016; 12:311-317. [PMID: 26926295 PMCID: PMC5304255 DOI: 10.2174/1573403x12666160301120030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Revised: 02/12/2016] [Accepted: 02/15/2016] [Indexed: 12/11/2022] Open
Abstract
Heart failure (HF) has a high incidence and prevalence in the USA and worldwide. It is a very common cause of significant morbidity and mortality with serious cost implications on the US health sector. The primary focus of this review is to synthesize an effective comprehensive care plan for patients in acute decompensated heart failure (ADHF) based on the most current evidence available. It begins with a brief overview of the pathophysiology, clinical presentation and evaluation of patients in ADHF. It then reviews management goals and treatment guidelines, with emphasis on challenges presented by diuretic resistance and worsening renal function (WRF). It provides information on recognition of advanced HF even during acute presentation, estimation of prognosis and proactive identification of patients that will benefit from mechanical cardiac devices, transplantation and palliative care/hospice. In addition, it presents strategies to address the problem of readmissions, which is an ominous prognostic factor with enormous economic burden.
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Affiliation(s)
- Chukwunweike Nwosu
- Abington Memorial Hospital, 1200 Old York Road, Abington PA. 19001. USA.
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Núñez J, Mascarell B, Stubbe H, Ventura S, Bonanad C, Bodí V, Núñez E, Miñana G, Fácila L, Bayés-Genis A, Chorro FJ, Sanchis J. Bioelectrical impedance vector analysis and clinical outcomes in patients with acute heart failure. J Cardiovasc Med (Hagerstown) 2016; 17:283-90. [PMID: 25333379 DOI: 10.2459/jcm.0000000000000208] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
AIMS Fluid overload is a hallmark in acute heart failure (AHF). Bioelectrical impedance vector analysis (BIVA) has emerged as a noninvasive method for quantifying patients' hydration. We aimed to evaluate the effect of BIVA hydration status (BHS) measured before discharge on mortality and rehospitalization for AHF. METHODS We included 369 consecutive patients discharged from the cardiology department from a third-level hospital with a diagnosis of AHF. On the basis of BHS, patients were grouped into three categories: hyper-hydration (>74.3%), normo-hydration (72.7-74.3%) and dehydration (<72.7%). Appropriate survival techniques were used to evaluate the association between BHS and the risk of death and readmission for AHF. RESULTS At a median follow-up of 12 months (interquartile range, IQR: 5-19), 80 (21.7%) deaths and 93 (25.2%) readmissions for AHF were registered. The mortality and readmission rates for the BHS categories were hyper-hydration (3.28 and 3.83 per 10 persons-years); normo-hydration (1.43 and 2.68 per 10 persons-years); and dehydration (2.24 and 2.53 per 10 persons-years) (P < 0.05 for all comparisons). In an adjusted analysis, BHS displayed a significant association with mortality (P = 0.004), with a higher mortality risk in those with hyperhydration. Likewise, BHS showed to linearly predict AHF-readmission risk [hazard ratio 1.06 (1.03-1.10); P = 0.001 per increase in 1%]. CONCLUSION In patients admitted with AHF, BHS assessed before discharge was independently associated with the risk of death and AHF-readmission.
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Affiliation(s)
- Julio Núñez
- aServicio de Cardiología, Hospital Clínico Universitario bServicio de Cardiología, Hospital de Manises cServicio de Cardiología, Hospital General Universitario de Valencia dServicio de Cardiología, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
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Chioncel O, Collins SP, Greene SJ, Ambrosy AP, Vaduganathan M, Macarie C, Butler J, Gheorghiade M. Natriuretic peptide-guided management in heart failure. J Cardiovasc Med (Hagerstown) 2016; 17:556-68. [DOI: 10.2459/jcm.0000000000000329] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Gil Martínez P, Mesado Martínez D, Curbelo García J, Cadiñanos Loidi J. Amino-terminal pro-B-type natriuretic peptide, inferior vena cava ultrasound, and biolectrical impedance analysis for the diagnosis of acute decompensated CHF. Am J Emerg Med 2016; 34:1817-22. [PMID: 27396536 DOI: 10.1016/j.ajem.2016.06.043] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Revised: 06/07/2016] [Accepted: 06/09/2016] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Both Framingham criteria and natriuretic peptides (NPs) may worsen their diagnostic validity for acute decompensated heart failure (ADHF) in elderly patients with comorbidities, mainly renal failure. Ultrasound of inferior vena cava (IVCu) and bioelectrical impedance analysis (BIA) are useful tools for detecting ADHF, although their utility compared with NP is not fully established. METHODS AND RESULTS We conducted a prospective study with 96 patients who presented at the emergency department with dyspnea and were classified as ADHF and non-ADHF groups. Inferior vena cava ultrasonography measured maximum and minimum inferior vena cava diameters and collapsibility index (CIx), whereas BIA calculated resistance (Rz) and reactance (Xc). The primary goal was to compare amino-terminal pro-B-type NP (NT-proBNP), IVCu, and BIA for identifying ADHF. The ADHF group showed significantly (P<.001) higher NT-proBNP values (5801 vs 599 pg/mL), higher maximum IVC diameter (2.26 vs 1.58 cm), higher minimum IVC diameter (1.67 vs 0,7 cm), and lower CIx (27% vs 59%), as well as lower Rz (458.8 vs 627.1 Ohm) and lower Xc (23.5 vs 38.4 Ohm) compared with the non-ADHF group. The estimated area under the curve for ADHF diagnosis was 0.84 for NT-proBNP, 0.90 for maximum IVC diameter, 0.93 for minimum IVC diameter, and 0.90 for CIx, as well as 0.83 and 0.80 for Rz and Xc respectively, without finding significant difference. Cutoff values for diagnosis of ADHF with IVCu and BIA are proposed. Amino-terminal pro-B-type NP values significantly varied in patients with renal impairment, independently of ADHF status, whereas neither IVCu nor BIA did. CONCLUSIONS Inferior vena cava ultrasonography and BIA analysis are as useful as NT-proBNP to ADHF diagnosis, validated in an elderly population with kidney disease.
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Affiliation(s)
- Paloma Gil Martínez
- Emergency and Internal Medicine Department, Universitary Hospital La Princesa, Universidad Autónoma de Madrid, Madrid, Spain; Heart Failure Division, Internal Medicine Department, Hospital Universitario de la Princesa, Universidad Autónoma de Madrid, Madrid, Spain.
| | - Daniel Mesado Martínez
- Emergency and Internal Medicine Department, Universitary Hospital La Princesa, Universidad Autónoma de Madrid, Madrid, Spain; Internal Medicine Department, Hospital General de Villalba, Madrid, Spain.
| | - Jose Curbelo García
- Emergency and Internal Medicine Department, Universitary Hospital La Princesa, Universidad Autónoma de Madrid, Madrid, Spain; Heart Failure Division, Internal Medicine Department, Hospital Universitario de la Princesa, Universidad Autónoma de Madrid, Madrid, Spain.
| | - Julen Cadiñanos Loidi
- Emergency and Internal Medicine Department, Universitary Hospital La Princesa, Universidad Autónoma de Madrid, Madrid, Spain; Internal Medicine Department, Hospital General de Villalba, Madrid, Spain.
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Li JJ, Xiang XL, Tian XY, Shi YF. Clinical Research on Brain Natriuretic Peptide Guiding the Application of β1 Receptor Blocker in Patients with Moderate to Severe Heart Failure. ACTA CARDIOLOGICA SINICA 2016; 31:52-8. [PMID: 27122846 DOI: 10.6515/acs20140728a] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND This study aimed to explore the feasibility of guiding the application of metoprolol succinate in patients with moderate to severe heart failure (HF) through monitoring plasma brain natriuretic peptide (BNP) levels. METHODS A total of 195 patients with moderate to severe HF (NYHA Functional Class III to IV) were selected and randomized into two groups: an observation group and a BNP group. The groups were established to observe the clinical conditions and establish plasma BNP levels to guide the application of metoprolol succinate. The average start-up of metoprolol succinate and average dose of metoprolol succinate after one month, as well as the recurrence rate and mortality of HF during hospital stay were compared between the two groups. RESULTS Start-up of metoprolol succinate was shorter in the BNP group than in the observation group [(5.89 ± 1.76) d vs. (7.03 ± 2.08) d, p < 0.01], but no significant differences in recurrence rate (26.60% vs. 23.91%, p > 0.05) and mortality (6.38% vs. 5.43%, p > 0.05) of HF were observed between the two groups. The average dose of metoprolol succinate after one month was higher in the BNP group compared with that of the observation group [(47.65 ± 13.09) mg/d vs. (35.08 ± 11.08) mg/d, p < 0.01]. CONCLUSIONS Although monitoring plasma BNP might have limited the clinical impact on the change of left ventricular ejection fraction, recurrence of HF or mortality within 1 month, it could safely facilitate early use and up-titration of the metoprolol succinate in patients with moderate to severe HF. KEY WORDS BNP; Heart failure; β receptor blocker.
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Affiliation(s)
- Jiang-Jin Li
- Department of Cardiology, Huai'an First People's Hospital, Nanjing Medical University, Huai'an 223300, Jiangsu Province, P. R. China
| | - Xiao-Li Xiang
- Department of Cardiology, Huai'an First People's Hospital, Nanjing Medical University, Huai'an 223300, Jiangsu Province, P. R. China
| | - Xiao-Yi Tian
- Department of Cardiology, Huai'an First People's Hospital, Nanjing Medical University, Huai'an 223300, Jiangsu Province, P. R. China
| | - Ya-Fei Shi
- Department of Cardiology, Huai'an First People's Hospital, Nanjing Medical University, Huai'an 223300, Jiangsu Province, P. R. China
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Santarelli S, Russo V, Lalle I, De Berardinis B, Vetrone F, Magrini L, Di Stasio E, Piccoli A, Codognotto M, Mion MM, Castello LM, Avanzi GC, Di Somma S. Prognostic value of decreased peripheral congestion detected by Bioelectrical Impedance Vector Analysis (BIVA) in patients hospitalized for acute heart failure: BIVA prognostic value in acute heart failure. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2016; 6:339-347. [DOI: 10.1177/2048872616641281] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Affiliation(s)
- Simona Santarelli
- Department of Medical-Surgery Sciences and Translational Medicine, Emergency Department Sant’Andrea Hospital, Postgraduate School of Emergency Medicine, University La Sapienza, Rome, Italy
| | - Veronica Russo
- Department of Medical-Surgery Sciences and Translational Medicine, Emergency Department Sant’Andrea Hospital, Postgraduate School of Emergency Medicine, University La Sapienza, Rome, Italy
| | - Irene Lalle
- Department of Medical-Surgery Sciences and Translational Medicine, Emergency Department Sant’Andrea Hospital, Postgraduate School of Emergency Medicine, University La Sapienza, Rome, Italy
| | - Benedetta De Berardinis
- Department of Medical-Surgery Sciences and Translational Medicine, Emergency Department Sant’Andrea Hospital, Postgraduate School of Emergency Medicine, University La Sapienza, Rome, Italy
| | - Francesco Vetrone
- Department of Medical-Surgery Sciences and Translational Medicine, Emergency Department Sant’Andrea Hospital, Postgraduate School of Emergency Medicine, University La Sapienza, Rome, Italy
| | - Laura Magrini
- Department of Medical-Surgery Sciences and Translational Medicine, Emergency Department Sant’Andrea Hospital, Postgraduate School of Emergency Medicine, University La Sapienza, Rome, Italy
| | - Enrico Di Stasio
- Institute of Biochemistry and Clinical Biochemistry, Catholic University of Sacred Heart, Rome, Italy
| | | | | | | | - Luigi M Castello
- Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy
| | - Gian Carlo Avanzi
- Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy
| | - Salvatore Di Somma
- Department of Medical-Surgery Sciences and Translational Medicine, Emergency Department Sant’Andrea Hospital, Postgraduate School of Emergency Medicine, University La Sapienza, Rome, Italy
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Samoni S, Vigo V, Reséndiz LIB, Villa G, De Rosa S, Nalesso F, Ferrari F, Meola M, Brendolan A, Malacarne P, Forfori F, Bonato R, Donadio C, Ronco C. Impact of hyperhydration on the mortality risk in critically ill patients admitted in intensive care units: comparison between bioelectrical impedance vector analysis and cumulative fluid balance recording. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2016; 20:95. [PMID: 27060079 PMCID: PMC4826521 DOI: 10.1186/s13054-016-1269-6] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Accepted: 03/22/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND Studies have demonstrated a positive correlation between fluid overload (FO) and adverse outcomes in critically ill patients. The present study aims at defining the impact of hyperhydration on the Intensive Care Unit (ICU) mortality risk, comparing Bioelectrical Impedance Vector Analysis (BIVA) assessment with cumulative fluid balance (CFB) recording. METHODS We performed a prospective, dual-centre, clinician-blinded, observational study of consecutive patients admitted to ICU with an expected length of ICU stay of at least 72 hours. During observational period (72-120 hours), CFB was recorded and cumulative FO was calculated. At the admission and daily during the observational period, BIVA was performed. We considered FO between 5% and 9.99% as moderate and a FO ≥ 10% as severe. According to BIVA hydration scale of lean body mass, patients were classified as normohydrated (>72.7%-74.3%), mild (>71%-72.7%), moderate (>69%-71%) and severe (≤ 69%) dehydrated and mild (>74.3%-81%), moderate (>81%-87%) and severe (>87%) hyperhydrated. Two multivariate logistic regression models were performed: the ICU mortality was the response variable, while the predictor variables were hyperhydration, measured by BIVA (BIVA model), and FO (FO model). A p-value <0.05 was considered to indicate statistical significance. RESULTS One hundred and twenty-five patients were enrolled (mean age 64.8 ± 16.0 years, 65.6% male). Five hundred and fifteen BIVA measurements were performed. The mean CFB recorded at the end of the observational period was 2.7 ± 4.1 L, while the maximum hydration of lean body mass estimated by BIVA was 83.67 ± 6.39%. Severe hyperhydration measured by BIVA was the only variable found to be significantly associated with ICU mortality (OR 22.91; 95% CI 2.38-220.07; p < 0.01). CONCLUSIONS The hydration status measured by BIVA seems to predict mortality risk in ICU patients better than the conventional method of fluid balance recording. Moreover, it appears to be safe, easy to use and adequate for bedside evaluation. Randomized clinical trials with an adequate sample size are needed to validate the diagnostic properties of BIVA in the goal-directed fluid management of critically ill patients in ICU.
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Affiliation(s)
- Sara Samoni
- Institute of Life Sciences, Sant'Anna School of Advanced Studies, Pisa, Italy. .,Department of Nephrology, Dialysis and Transplantation, San Bortolo Hospital, International Renal Research Institute Vicenza (IRRIV), Viale Rodolfi, 37, 36100, Vicenza, Italy.
| | - Valentina Vigo
- Department of Clinical & Experimental Medicine, University of Pisa, Pisa, Italy
| | - Luis Ignacio Bonilla Reséndiz
- Department of Nephrology, Dialysis and Transplantation, San Bortolo Hospital, International Renal Research Institute Vicenza (IRRIV), Viale Rodolfi, 37, 36100, Vicenza, Italy
| | - Gianluca Villa
- Department of Nephrology, Dialysis and Transplantation, San Bortolo Hospital, International Renal Research Institute Vicenza (IRRIV), Viale Rodolfi, 37, 36100, Vicenza, Italy
| | - Silvia De Rosa
- Department of Nephrology, Dialysis and Transplantation, San Bortolo Hospital, International Renal Research Institute Vicenza (IRRIV), Viale Rodolfi, 37, 36100, Vicenza, Italy
| | - Federico Nalesso
- Department of Nephrology, Dialysis and Transplantation, San Bortolo Hospital, International Renal Research Institute Vicenza (IRRIV), Viale Rodolfi, 37, 36100, Vicenza, Italy
| | - Fiorenza Ferrari
- Department of Nephrology, Dialysis and Transplantation, San Bortolo Hospital, International Renal Research Institute Vicenza (IRRIV), Viale Rodolfi, 37, 36100, Vicenza, Italy.,Department of Anaesthesiology and Intensive Care, San Bortolo Hospital, Vicenza, Italy
| | - Mario Meola
- Institute of Life Sciences, Sant'Anna School of Advanced Studies, Pisa, Italy.,Department of Clinical & Experimental Medicine, University of Pisa, Pisa, Italy
| | - Alessandra Brendolan
- Department of Nephrology, Dialysis and Transplantation, San Bortolo Hospital, International Renal Research Institute Vicenza (IRRIV), Viale Rodolfi, 37, 36100, Vicenza, Italy
| | - Paolo Malacarne
- Department of Anaesthesia and Intensive Care Unit 6, Cisanello Hospital, Pisa, Italy
| | - Francesco Forfori
- Department of Anaesthesia and Intensive Care Unit 4, Cisanello Hospital, Pisa, Italy
| | - Raffaele Bonato
- Department of Anaesthesiology and Intensive Care, San Bortolo Hospital, Vicenza, Italy
| | - Carlo Donadio
- Department of Clinical & Experimental Medicine, University of Pisa, Pisa, Italy
| | - Claudio Ronco
- Department of Nephrology, Dialysis and Transplantation, San Bortolo Hospital, International Renal Research Institute Vicenza (IRRIV), Viale Rodolfi, 37, 36100, Vicenza, Italy
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Abdominal admittance helps to predict the amount of fluid accumulation in patients with acute heart failure syndromes. J Cardiol 2016; 67:352-7. [DOI: 10.1016/j.jjcc.2015.04.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Revised: 04/05/2015] [Accepted: 04/30/2015] [Indexed: 12/27/2022]
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A new tool to measure hydration status in acute heart failure – Is bioelectrical impedance vector analysis (BIVA) making its way to the wards? Rev Clin Esp 2016; 216:126-7. [DOI: 10.1016/j.rce.2016.01.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Accepted: 01/23/2016] [Indexed: 11/15/2022]
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Trejo-Velasco B, Fabregat-Andrés Ó, Montagud V, Morell S, Núñez J, Fácila L. Valor pronóstico del análisis del vector de bioimpedancia en pacientes ingresados por descompensación aguda de insuficiencia cardiaca: cohorte de validación. Rev Clin Esp 2016; 216:121-5. [DOI: 10.1016/j.rce.2015.12.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Revised: 11/10/2015] [Accepted: 12/13/2015] [Indexed: 10/22/2022]
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Prognostic value of analysing the bioimpedance vector for patients hospitalized for acute decompensated heart failure: A validation cohort. Rev Clin Esp 2016. [DOI: 10.1016/j.rceng.2015.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Iwaz JA, Maisel AS. Recent advances in point-of-care testing for natriuretic peptides: potential impact on heart failure diagnosis and management. Expert Rev Mol Diagn 2016; 16:641-50. [PMID: 26919295 DOI: 10.1586/14737159.2016.1158105] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Heart failure is a leading cause of morbidity and mortality worldwide. The presenting symptoms of heart failure are often nonspecific. The diagnosis of heart failure has traditionally relied heavily upon clinical exam findings, which are often subjective and have low sensitivity. Efficient and rapid diagnosis of heart failure in the emergency room setting can reduce health care costs, hospital admission and ER visits, and improve patient care. Natriuretic peptides are objective biomarkers that can help with diagnosis, prognosis and management of heart failure. The most extensively studied and clinically utilized natriuretic peptides include brain natriuretic peptide (BNP) and N-terminal proBNP (NT-proBNP). Point-of-care testing in the emergency room setting can result in faster triage times. Point-of-care testing can also be utilized in the outpatient setting for real-time management of patients with heart failure.
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Affiliation(s)
- James A Iwaz
- a San Diego Medical Center , University of California , San Diego , CA , USA.,b Department of Medicine, Section of Cardiology , Veterans Affairs Medical Center , San Diego , CA , USA
| | - Alan S Maisel
- a San Diego Medical Center , University of California , San Diego , CA , USA.,b Department of Medicine, Section of Cardiology , Veterans Affairs Medical Center , San Diego , CA , USA
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Early Ventricular Dysfunction After Anthracycline Chemotherapy in Children. Pediatr Cardiol 2016; 37:537-44. [PMID: 26667956 DOI: 10.1007/s00246-015-1311-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Accepted: 11/21/2015] [Indexed: 12/25/2022]
Abstract
The aim of this study was to determine the effect of induction dose of anthracycline chemotherapy on the biventricular function among children with acute hematological malignancies (AHM) using tissue Doppler imaging (TDI) and 2D speckle tracking echocardiography (2D-STE). Thirty pediatric patients with AHM and a mean age of 9.24 ± 4.14 years performed conventional echocardiography, TDI and 2D-STE. After induction chemotherapy, the RV showed mainly a diastolic alteration in its function manifested in significant reduction in the tricuspid TDI-derived E' and E'/A' ratio compared with the baseline (20.40 ± 3.81 vs. 17.47 ± 3.87 cm/s, p = 0.001, 1.29 ± 0.27 vs. 1.03 ± 0.37, p < 0.01, respectively), while the TDI-derived RV MPI and isovolumetric relaxation time of RV were significantly increased (0.32 ± 0.06 vs. 0.36 ± 0.08, p < 0.01, 24.73 ± 8.62 vs. 28.47 ± 11.51 ms, p < 0.05, respectively). The LV showed post-chemotherapy mainly an alteration in its longitudinal systolic function in the form of a reduction in MAPSE (13.61 ± 2.00 vs. 11.95 ± 1.75 mm; p < 0.001), TDI-derived systolic velocity of lateral mitral annulus (10.98 ± 2.34 vs. 10.03 ± 1.83 cm/s, p < 0.05), 2D-STE-derived global longitudinal strain (-21.58 ± 2.54 vs. -19.18 ± 3.59 %, p = 0.001) and 2D-STE-derived global longitudinal strain rate (-1.76 ± 0.22 vs. 1.55 ± 0.29 1/s, p < 0.05), with preservation of LV diastolic function when compared to baseline. TDI and 2D-STE could be used for early detection of anthracycline-induced cardiotoxicity in the pediatric age group. Early after induction chemotherapy, the RV develops mainly diastolic dysfunction, while the LV showed a relative longitudinal systolic impairment.
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Kim YJ, Jeon HJ, Kim YH, Jeon J, Ham YR, Chung S, Choi DE, Na KR, Lee KW. Overhydration measured by bioimpedance analysis and the survival of patients on maintenance hemodialysis: a single-center study. Kidney Res Clin Pract 2015; 34:212-8. [PMID: 26779424 PMCID: PMC4688576 DOI: 10.1016/j.krcp.2015.10.006] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Revised: 09/15/2015] [Accepted: 10/06/2015] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Bioimpedance analysis (BIA) helps measuring the constituents of the body noninvasively. Prior studies suggest that BIA-guided fluid assessment helps to predict survival in dialysis patients. We aimed to evaluate the clinical usefulness of BIA for predicting the survival rate of hemodialysis patients in Korea. METHODS We conducted a single-center retrospective study. All patients were diagnosed with end-stage renal disorder and started maintenance hemodialysis between June 2009 and April 2014. BIA was performed within the 1(st) week from the start of hemodialysis. The patients were classified into 2 groups based on volume status measured by the body composition monitor (BCM; Fresenius): an overhydrated group [OG; overhydration/extracellular water (OH/ECW) >15%] and a nonoverhydrated group (NOG; OH/ECW ≤15%). RESULTS A total of 344 patients met the inclusion criteria. Of these, 252 patients (73.3%) were categorized into the OG and 92 patients (26.7%) into the NOG. Age- and sex-matching patients were selected with a rate of 2:1. Finally, 160 overhydrated patients and 80 nonoverhydrated patients were analyzed. Initial levels of hemoglobin and serum albumin were significantly lower in the OG. During follow-up, 43 patients from the OG and 7 patients from the NOG died (median follow-up duration, 24.0 months). The multivariate-adjusted all-cause mortality was significantly increased in the OG (odds ratio, 2.569; P = 0.033) and older patients (odds ratio, 1.072/y; P < 0.001). No significant difference of all-cause or disease-specific admission rate was observed between the 2 groups. CONCLUSION The ratio of OH/ECW volume measured with body composition monitor is related to the overall survival of end-stage renal disorder patients who started maintenance hemodialysis.
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Affiliation(s)
- Ye Jin Kim
- Department of Internal Medicine, Chungnam National University Hospital, Daejeon, Korea
| | - Hong Jae Jeon
- Department of Internal Medicine, Chungnam National University Hospital, Daejeon, Korea
| | - Yoo Hyung Kim
- Department of Internal Medicine, Chungnam National University Hospital, Daejeon, Korea
| | - Jaewoong Jeon
- Department of Internal Medicine, Chungnam National University Hospital, Daejeon, Korea
| | - Young Rok Ham
- Department of Internal Medicine, Chungnam National University Hospital, Daejeon, Korea
| | - Sarah Chung
- Department of Internal Medicine, Chungnam National University Hospital, Daejeon, Korea
| | - Dae Eun Choi
- Department of Internal Medicine, Chungnam National University Hospital, Daejeon, Korea
| | - Ki Ryang Na
- Department of Internal Medicine, Chungnam National University Hospital, Daejeon, Korea
| | - Kang Wook Lee
- Department of Internal Medicine, Chungnam National University Hospital, Daejeon, Korea
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Berezin AE, Kremzer AA, Samura TA, Martovitskaya YV, Malinovskiy YV, Oleshko SV, Berezina TA. Predictive value of apoptotic microparticles to mononuclear progenitor cells ratio in advanced chronic heart failure patients. J Cardiol 2015; 65:403-11. [PMID: 25123603 DOI: 10.1016/j.jjcc.2014.06.014] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Revised: 06/19/2014] [Accepted: 06/25/2014] [Indexed: 10/24/2022]
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Stotts NA, Arai SR, Cooper BA, Nelson JE, Puntillo KA. Predictors of thirst in intensive care unit patients. J Pain Symptom Manage 2015; 49:530-8. [PMID: 25116914 PMCID: PMC4324384 DOI: 10.1016/j.jpainsymman.2014.07.001] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2014] [Revised: 07/20/2014] [Accepted: 07/23/2014] [Indexed: 12/30/2022]
Abstract
CONTEXT Thirst is a pervasive, intense, and distressing symptom in intensive care unit (ICU) patients. Although thirst may be avoided and/or treated, scant data are available to help providers identify patients most in need. OBJECTIVES This study was designed to identify predictors of the presence, intensity, and distress of thirst in ICU patients. METHODS This descriptive cross-sectional study enrolled 353 patients from three ICUs (medical-surgical, cardiac, and neurological). To measure outcomes, patients were asked to report the presence of thirst (yes/no) and, if present, to rate its intensity and distress on zero to 10 numeric rating scales (10=worst). Predictor variables were demographic (e.g., age), treatment-related (e.g., opioids), and biological (e.g., total body water). Data were analyzed with logistic regression and truncated regression with alpha preset at 0.05. RESULTS Thirst presence was predicted by high opioid doses (≥ 50 mg), high furosemide doses (>60 mg), selective serotonin reuptake inhibitors, and low ionized calcium. Thirst intensity was predicted by patients not receiving oral fluid and having a gastrointestinal (GI) diagnosis. Thirst distress was predicted by mechanical ventilation, negative fluid balance, antihypertensive medications, and a GI or "other" diagnosis. CONCLUSION Thirst presence was predicted by selected medications (e.g., opioids). Thirst intensity and/or thirst distress were predicted by other treatments (e.g., mechanical ventilation) and medical diagnoses (e.g., GI). This is one of the first studies describing predictors of the multidimensional characteristics of thirst. Clinicians can use these data to target ICU patients whose thirst might warrant treatment.
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Affiliation(s)
- Nancy A Stotts
- University of California San Francisco, San Francisco, California, USA.
| | - Shoshana R Arai
- University of California San Francisco, San Francisco, California, USA
| | - Bruce A Cooper
- University of California San Francisco, San Francisco, California, USA
| | - Judith E Nelson
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Cohen-Solal A, Laribi S, Ishihara S, Vergaro G, Baudet M, Logeart D, Mebazaa A, Gayat E, Vodovar N, Pascual-Figal DA, Seronde MF. Prognostic markers of acute decompensated heart failure: the emerging roles of cardiac biomarkers and prognostic scores. Arch Cardiovasc Dis 2014; 108:64-74. [PMID: 25534886 DOI: 10.1016/j.acvd.2014.10.002] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2014] [Revised: 09/25/2014] [Accepted: 10/02/2014] [Indexed: 12/12/2022]
Abstract
Rapidly assessing outcome in patients with acute decompensated heart failure is important but prognostic factors may differ from those used routinely for stable chronic heart failure. Multiple plasma biomarkers, besides the classic natriuretic peptides, have recently emerged as potential prognosticators. Furthermore, prognostic scores that combine clinical and biochemical data may also be useful. However, compared with the scores used in chronic heart failure, scores for acute decompensated heart failure have not been validated. This article reviews potential biomarkers, with a special focus on biochemical biomarkers, and possible prognostic scores that could be used by the clinician when assessing outcome in patients with acute heart failure.
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Affiliation(s)
- Alain Cohen-Solal
- UMR-S 942 "Biomarqueurs et Insuffisances Cardiaques", Paris, France; Université Paris Diderot, Sorbonne Paris Cité, Paris, France; Cardiology department, hôpital Lariboisière, Assistance publique-Hôpitaux de Paris, 2, rue Ambroise-Paré, 75010 Paris, France; DHU FIRE, Sorbonne Paris Cité, Paris, France.
| | - Said Laribi
- UMR-S 942 "Biomarqueurs et Insuffisances Cardiaques", Paris, France; Emergency department, hôpital Lariboisière, Assistance publique-Hôpitaux de Paris, Paris, France
| | - Shiro Ishihara
- UMR-S 942 "Biomarqueurs et Insuffisances Cardiaques", Paris, France; Cardiology department, Steel Memorial Yawata Hospital, Kitakyushu, Japan
| | - Giuseppe Vergaro
- UMR-S 942 "Biomarqueurs et Insuffisances Cardiaques", Paris, France; Cardiology and cardiovascular medicine division, Fondazione Toscana Gabriele Monasterio per la Ricerca Medica e di Sanità Pubblica, CNR-Regione Toscana, Pisa, Italy
| | - Mathilde Baudet
- Cardiology department, hôpital Lariboisière, Assistance publique-Hôpitaux de Paris, 2, rue Ambroise-Paré, 75010 Paris, France
| | - Damien Logeart
- UMR-S 942 "Biomarqueurs et Insuffisances Cardiaques", Paris, France; Université Paris Diderot, Sorbonne Paris Cité, Paris, France; Cardiology department, hôpital Lariboisière, Assistance publique-Hôpitaux de Paris, 2, rue Ambroise-Paré, 75010 Paris, France; DHU FIRE, Sorbonne Paris Cité, Paris, France
| | - Alexandre Mebazaa
- UMR-S 942 "Biomarqueurs et Insuffisances Cardiaques", Paris, France; Université Paris Diderot, Sorbonne Paris Cité, Paris, France; DHU FIRE, Sorbonne Paris Cité, Paris, France; Anaesthesia-ICU department, hôpital Lariboisière, Assistance publique-Hôpitaux de Paris, Paris, France
| | - Etienne Gayat
- UMR-S 942 "Biomarqueurs et Insuffisances Cardiaques", Paris, France; Université Paris Diderot, Sorbonne Paris Cité, Paris, France; DHU FIRE, Sorbonne Paris Cité, Paris, France; Anaesthesia-ICU department, hôpital Lariboisière, Assistance publique-Hôpitaux de Paris, Paris, France
| | - Nicolas Vodovar
- UMR-S 942 "Biomarqueurs et Insuffisances Cardiaques", Paris, France
| | - Domingo A Pascual-Figal
- Cardiology department, hospital Virgen de la Arrixaca, school of medicine, university of Murcia, Murcia, Spain
| | - Marie-France Seronde
- UMR-S 942 "Biomarqueurs et Insuffisances Cardiaques", Paris, France; Cardiology department, CHU de Besançon, Besançon, France
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Kinugasa Y, Kato M, Sugihara S, Yanagihara K, Yamada K, Hirai M, Yamamoto K. Multidisciplinary intensive education in the hospital improves outcomes for hospitalized heart failure patients in a Japanese rural setting. BMC Health Serv Res 2014; 14:351. [PMID: 25134951 PMCID: PMC4141092 DOI: 10.1186/1472-6963-14-351] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2014] [Accepted: 08/14/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Heart failure (HF) patients living in rural areas have a lack of HF knowledge and poor self-care because of limited medical care access. Multidisciplinary education to improve self-care behavior is indispensable for such patients. The present study evaluated whether intensive inpatient education improved outcomes of hospitalized HF patients in a Japanese rural setting. METHODS An inpatient HF management program based on multidisciplinary team intervention was applied to hospitalized HF patients in a Japanese rural area. We defined patients treated within the program from May 2009 to April 2011 as the intervention group (n = 144), and those treated with the usual care from May 2006 to April 2009 as the usual care group (n = 133). The composite endpoints of HF hospitalization and all-cause mortality were compared between the two groups. RESULTS Compared with patients in the usual care group, those in the intervention group more often received the optimal interventions such as discharge use of β-blockers, cardiac rehabilitation, pre-discharge diagnostic tests, and multidisciplinary intensive education including nurse-led patient education, pharmacist's medication teaching, and dietitian's nutritional guidance (all P < 0.05). The incidence of the composite endpoints significantly decreased after introducing the program (P < 0.001). Among a number of interventions, multidisciplinary intensive education was the most effective intervention to improve the primary outcome (P < 0.001). CONCLUSIONS Multidisciplinary intensive education is a key strategy for helping improve the outcome for Japanese HF patients in a rural setting. Our data may give a positive impact on the improvement of healthcare system in Japan.
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Affiliation(s)
- Yoshiharu Kinugasa
- Division of Cardiovascular Medicine, Department of Molecular Medicine and Therapeutics, Faculty of Medicine, Tottori University, 36-1 Nishicho, 683-8504 Yonago, Japan
| | - Masahiko Kato
- Division of Cardiovascular Medicine, Department of Molecular Medicine and Therapeutics, Faculty of Medicine, Tottori University, 36-1 Nishicho, 683-8504 Yonago, Japan
| | - Shinobu Sugihara
- Division of Cardiovascular Medicine, Department of Molecular Medicine and Therapeutics, Faculty of Medicine, Tottori University, 36-1 Nishicho, 683-8504 Yonago, Japan
| | - Kiyotaka Yanagihara
- Division of Cardiovascular Medicine, Department of Molecular Medicine and Therapeutics, Faculty of Medicine, Tottori University, 36-1 Nishicho, 683-8504 Yonago, Japan
| | - Kensaku Yamada
- Division of Cardiovascular Medicine, Department of Molecular Medicine and Therapeutics, Faculty of Medicine, Tottori University, 36-1 Nishicho, 683-8504 Yonago, Japan
| | - Masayuki Hirai
- Division of Cardiovascular Medicine, Department of Molecular Medicine and Therapeutics, Faculty of Medicine, Tottori University, 36-1 Nishicho, 683-8504 Yonago, Japan
| | - Kazuhiro Yamamoto
- Division of Cardiovascular Medicine, Department of Molecular Medicine and Therapeutics, Faculty of Medicine, Tottori University, 36-1 Nishicho, 683-8504 Yonago, Japan
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50
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Usefulness of combining galectin-3 and BIVA assessments in predicting short- and long-term events in patients admitted for acute heart failure. BIOMED RESEARCH INTERNATIONAL 2014; 2014:983098. [PMID: 25101304 PMCID: PMC4101236 DOI: 10.1155/2014/983098] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/27/2014] [Revised: 05/15/2014] [Accepted: 05/16/2014] [Indexed: 12/02/2022]
Abstract
Introduction. Acute heart failure (AHF) is associated with a higher risk for the occurrence of rehospitalization and death. Galectin-3 (GAL3) is elevated in AHF patients and is an indicator in predicting short-term mortality. The total body water using bioimpedance vector analysis (BIVA) is able to identify mortality within AHF patients. The aim of this study was to evaluate the short- and long-term predictive value of GAL3, BIVA, and the combination of both in AHF patients in Emergency Department (ED). Methods. 205 ED patients with AHF were evaluated by testing for B type natriuretic peptide (BNP) and GAL3. The primary endpoint was death and rehospitalization at 30, 60, 90, and 180 days and 12 and 18 months. AHF patients were evaluated at the moment of ED arrival with clinical judgment and GAL3 and BIVA measurement. Results. GAL3 level was significantly higher in patients >71 years old, and with eGFR < 30 cc/min. The area under the curve (AUC) of GAL3 + BIVA, GAL3 and BIVA for death and rehospitalization both when considered in total and when considered serially for the follow-up period showed that the combination has a better prognostic value. Kaplan-Meier survival curve for GAL3 values >17.8 ng/mL shows significant survival difference. At multivariate Cox regression analysis GAL3 is an independent variable to predict death + rehospitalization with a value of 32.24 ng/mL at 30 days (P < 0.005). Conclusion. In patients admitted for AHF an early assessment of GAL3 and BIVA seems to be useful in identifying patients at high risk for death and rehospitalization at short and long term. Combining the biomarker and the device could be of great utility since they monitor the severity of two pathophysiological different mechanisms: heart fibrosis and fluid overload.
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