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Nawrocka-Millward S, Biegus J, Fudim M, Guzik M, Iwanek G, Ponikowski P, Zymliński R. The role of urine chloride in acute heart failure. Sci Rep 2024; 14:14100. [PMID: 38890417 PMCID: PMC11189561 DOI: 10.1038/s41598-024-64747-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 06/12/2024] [Indexed: 06/20/2024] Open
Abstract
In our retrospective study, we aimed to investigate the relationship between urinary chloride (uCl-) and selected clinical and laboratory biomarkers, renal function, and patient outcomes in the acute heart failure (AHF) population. We divided 248 adult patients (≥ 18 years) with AHF into two groups: low uCl- (< 115 mmol/L) and high uCl-. The mean age of the patient group was 70.2 ± 12.6, and 182 patients were male (73.4%). Clinical endpoints included in-hospital mortality, one-year mortality, and a composite endpoint of one-year mortality and rehospitalization for heart failure. Patients were followed up for at least one year. Relevant clinical and baseline biomarker data were collected, including markers concerning inflammation, liver and kidney function, perfusion and congestion, iron status, cardiac remodeling, gasometry, renin and aldosterone. Low uCl- was associated with worse in-hospital outcomes, including higher in-hospital mortality (7.7% vs. 1.4%, p = 0.014), the need for inotropic support (20.19% vs. 2.08%, p ≤ 0.001), worsening of HF during therapy (17.31% vs. 4.86%, p ≤ 0.001), and the need for treatment in an intensive cardiac care unit (33.65% vs. 15.28%, p ≤ 0.001). Low uCl- was a significant predictor of one-year mortality (40.4% vs. 16.7%, p < 0.05) and the composite outcome (HR 2.42, 95% CI 1.43-4.08, p < 0.001). In the multivariable analysis, uCl- was independently associated with the risk of one-year mortality (HR 0.92, 95% CI 0.87-0.98, p < 0.05) and the composite outcome (HR 0.95, 95% CI 0.92-0.99, p < 0.05). Our findings suggest that low uCl- is a marker of more advanced heart failure, activation of the renin-angiotensin-aldosterone system and is related to worse one-year outcomes.
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Affiliation(s)
| | - Jan Biegus
- University Clinical Hospital, Wroclaw, Poland
- Institute of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland
| | - Marat Fudim
- Institute of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland
- Division of Cardiology, Duke University Medical Center, Durham, NC, USA
- Duke Clinical Research Institute, Durham, NC, USA
| | - Mateusz Guzik
- University Clinical Hospital, Wroclaw, Poland
- Institute of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland
| | - Gracjan Iwanek
- University Clinical Hospital, Wroclaw, Poland
- Institute of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland
| | - Piotr Ponikowski
- University Clinical Hospital, Wroclaw, Poland
- Institute of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland
| | - Robert Zymliński
- University Clinical Hospital, Wroclaw, Poland
- Institute of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland
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2
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Machine Learning Approach to Understand Worsening Renal Function in Acute Heart Failure. Biomolecules 2022; 12:biom12111616. [DOI: 10.3390/biom12111616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 10/26/2022] [Accepted: 10/31/2022] [Indexed: 11/06/2022] Open
Abstract
Acute heart failure (AHF) is a common and severe condition with a poor prognosis. Its course is often complicated by worsening renal function (WRF), exacerbating the outcome. The population of AHF patients experiencing WRF is heterogenous, and some novel possibilities for its analysis have recently emerged. Clustering is a machine learning (ML) technique that divides the population into distinct subgroups based on the similarity of cases (patients). Given that, we decided to use clustering to find subgroups inside the AHF population that differ in terms of WRF occurrence. We evaluated data from the three hundred and twelve AHF patients hospitalized in our institution who had creatinine assessed four times during hospitalization. Eighty-six variables evaluated at admission were included in the analysis. The k-medoids algorithm was used for clustering, and the quality of the procedure was judged by the Davies–Bouldin index. Three clinically and prognostically different clusters were distinguished. The groups had significantly (p = 0.004) different incidences of WRF. Inside the AHF population, we successfully discovered that three groups varied in renal prognosis. Our results provide novel insight into the AHF and WRF interplay and can be valuable for future trial construction and more tailored treatment.
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3
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Urban S, Błaziak M, Jura M, Iwanek G, Zdanowicz A, Guzik M, Borkowski A, Gajewski P, Biegus J, Siennicka A, Pondel M, Berka P, Ponikowski P, Zymliński R. Novel Phenotyping for Acute Heart Failure—Unsupervised Machine Learning-Based Approach. Biomedicines 2022; 10:biomedicines10071514. [PMID: 35884819 PMCID: PMC9313459 DOI: 10.3390/biomedicines10071514] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 06/23/2022] [Accepted: 06/24/2022] [Indexed: 01/14/2023] Open
Abstract
Acute heart failure (AHF) is a life-threatening, heterogeneous disease requiring urgent diagnosis and treatment. The clinical severity and medical procedures differ according to a complex interplay between the deterioration cause, underlying cardiac substrate, and comorbidities. This study aimed to analyze the natural phenotypic heterogeneity of the AHF population and evaluate the possibilities offered by clustering (unsupervised machine-learning technique) in a medical data assessment. We evaluated data from 381 AHF patients. Sixty-three clinical and biochemical features were assessed at the admission of the patients and were included in the analysis after the preprocessing. The K-medoids algorithm was implemented to create the clusters, and optimization, based on the Davies-Bouldin index, was used. The clustering was performed while blinded to the outcome. The outcome associations were evaluated using the Kaplan-Meier curves and Cox proportional-hazards regressions. The algorithm distinguished six clusters that differed significantly in 58 variables concerning i.e., etiology, clinical status, comorbidities, laboratory parameters and lifestyle factors. The clusters differed in terms of the one-year mortality (p = 0.002). Using the clustering techniques, we extracted six phenotypes from AHF patients with distinct clinical characteristics and outcomes. Our results can be valuable for future trial constructions and customized treatment.
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Affiliation(s)
- Szymon Urban
- Institute of Heart Diseases, Wroclaw Medical University, 50-556 Wroclaw, Poland; (M.B.); (M.J.); (G.I.); (A.Z.); (M.G.); (A.B.); (P.G.); (J.B.); (P.P.); (R.Z.)
- Correspondence:
| | - Mikołaj Błaziak
- Institute of Heart Diseases, Wroclaw Medical University, 50-556 Wroclaw, Poland; (M.B.); (M.J.); (G.I.); (A.Z.); (M.G.); (A.B.); (P.G.); (J.B.); (P.P.); (R.Z.)
| | - Maksym Jura
- Institute of Heart Diseases, Wroclaw Medical University, 50-556 Wroclaw, Poland; (M.B.); (M.J.); (G.I.); (A.Z.); (M.G.); (A.B.); (P.G.); (J.B.); (P.P.); (R.Z.)
| | - Gracjan Iwanek
- Institute of Heart Diseases, Wroclaw Medical University, 50-556 Wroclaw, Poland; (M.B.); (M.J.); (G.I.); (A.Z.); (M.G.); (A.B.); (P.G.); (J.B.); (P.P.); (R.Z.)
| | - Agata Zdanowicz
- Institute of Heart Diseases, Wroclaw Medical University, 50-556 Wroclaw, Poland; (M.B.); (M.J.); (G.I.); (A.Z.); (M.G.); (A.B.); (P.G.); (J.B.); (P.P.); (R.Z.)
| | - Mateusz Guzik
- Institute of Heart Diseases, Wroclaw Medical University, 50-556 Wroclaw, Poland; (M.B.); (M.J.); (G.I.); (A.Z.); (M.G.); (A.B.); (P.G.); (J.B.); (P.P.); (R.Z.)
| | - Artur Borkowski
- Institute of Heart Diseases, Wroclaw Medical University, 50-556 Wroclaw, Poland; (M.B.); (M.J.); (G.I.); (A.Z.); (M.G.); (A.B.); (P.G.); (J.B.); (P.P.); (R.Z.)
| | - Piotr Gajewski
- Institute of Heart Diseases, Wroclaw Medical University, 50-556 Wroclaw, Poland; (M.B.); (M.J.); (G.I.); (A.Z.); (M.G.); (A.B.); (P.G.); (J.B.); (P.P.); (R.Z.)
| | - Jan Biegus
- Institute of Heart Diseases, Wroclaw Medical University, 50-556 Wroclaw, Poland; (M.B.); (M.J.); (G.I.); (A.Z.); (M.G.); (A.B.); (P.G.); (J.B.); (P.P.); (R.Z.)
| | - Agnieszka Siennicka
- Department of Physiology and Patophysiology, Wroclaw Medical University, 50-368 Wroclaw, Poland;
| | - Maciej Pondel
- Institute of Information Systems in Economics, Wroclaw University of Economics and Business, 53-345 Wroclaw, Poland;
| | - Petr Berka
- Department of Information and Knowledge Engineering, Prague University of Economics and Business, W. Churchill Sq. 1938/4, 130 67 Prague, Czech Republic;
| | - Piotr Ponikowski
- Institute of Heart Diseases, Wroclaw Medical University, 50-556 Wroclaw, Poland; (M.B.); (M.J.); (G.I.); (A.Z.); (M.G.); (A.B.); (P.G.); (J.B.); (P.P.); (R.Z.)
| | - Robert Zymliński
- Institute of Heart Diseases, Wroclaw Medical University, 50-556 Wroclaw, Poland; (M.B.); (M.J.); (G.I.); (A.Z.); (M.G.); (A.B.); (P.G.); (J.B.); (P.P.); (R.Z.)
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4
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Biomarkers of Myocardial Injury and Remodeling in Heart Failure. J Pers Med 2022; 12:jpm12050799. [PMID: 35629221 PMCID: PMC9144334 DOI: 10.3390/jpm12050799] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 05/08/2022] [Accepted: 05/13/2022] [Indexed: 02/04/2023] Open
Abstract
With its complicated pathophysiology, high incidence and prevalence, heart failure remains a major public concern. In hopes of improving diagnosis, treatment and prognosis, the utility of many different biomarkers is researched vigorously around the world. In this review, biomarkers of myocardial remodeling and fibrosis (galectin-3, soluble isoform of suppression of tumorigenicity 2, matrix metalloproteinases, osteopontin, interleukin-6, syndecan-4, myostatin, procollagen type I C-terminal propeptide, procollagen type III N-terminal propeptide, vascular endothelial growth factor, nitric oxidase synthetase and asymmetric dimethylarginine), myocyte injury (heart-type fatty acid-binding protein, glutathione S-transferase P1 and heat shock protein 60), as well as iron metabolism (ferritin, transferrin saturation, soluble transferrin receptor and hepcidin), are considered in terms of possible clinical applicability and significance. Our short review consists of a summary of the aforementioned cardiovascular biomarkers’ clinical relevance and perspectives.
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High sensitivity Troponins In Patients with elevated prohormone of beta natriuretic peptide and acute heart failure (HIGH TRIP Trial). Sci Rep 2022; 12:1838. [PMID: 35115590 PMCID: PMC8813956 DOI: 10.1038/s41598-022-05759-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 01/18/2022] [Indexed: 12/11/2022] Open
Abstract
In patients presented to emergency rooms, Pro hormone of Natriuretic Peptide (Pro BNP) essay is overly sensitive test to rule out heart failure but less specific in predicting outcomes in follow-ups, in this study we ought to find the added value of High Sensitivity cardiac Troponin I (Hs-cTn I), in patients presented acutely with heart failure and its impact on mortality when Pro BNP is highly elevated. Prospective cohort study, inclusion criteria were age above 18 and clearly positive NT Pro BNP > 1000 pg/ml, with 12 months follow up period, primary end point was mortality from heart failure, secondary endpoint was need for rehospitalization. 95 patients were enrolled, divided into overt and non-overt pulmonary edema groups. Mean (Pro BNP) was 6184 and 5927 pg/ml and mean (Hs-cTn I) were 19.27 and 0.17 ng/ml respectively, Mean Ejection fraction was 48 ± 7 and 47 ± 7 for each group sequentially. Mortality rate was 4 (13%) in the higher Hs-c Tn I group, and 1 (1.6%) in the low troponin level group p = .03, odd ratio was 8.5, 95% CI (0.9-80). Need for re-hospitalization was present in 12 (38%) Vs 7 (8%) patients, p = .0081, odd ratio 4.8, 95% CI (1.7-14.2). In COX proportional hazard analysis, only Hs-cTn I was a significant predictor of poor outcome in this high-risk cohort with p = 0.0001. Adding (Hs-cTrop I) assay to the panel of laboratory testing, in patients presented to ER with acute heart failure and with high Pro-BNP > 1000, may further predicts mortality and rehospitalization rate.
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Biegus J, Zymliński R, Fudim M, Testani J, Sokolski M, Marciniak D, Ponikowska B, Guzik M, Garus M, Urban S, Ponikowski P. Spot urine sodium in acute heart failure: differences in prognostic value on admission and discharge. ESC Heart Fail 2021; 8:2597-2602. [PMID: 33932273 PMCID: PMC8318409 DOI: 10.1002/ehf2.13372] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 03/28/2021] [Accepted: 04/08/2021] [Indexed: 12/16/2022] Open
Abstract
AIMS Most studies examined spot urine sodium's (sUNa+ ) prognostic utility during the early phase of acute heart failure (AHF) hospitalization. In AHF, sodium excretion is related to clinical status; therefore, we investigated the differences in the prognostic information of spot UNa+ throughout the course of hospitalization for AHF (admission vs. discharge). METHODS AND RESULTS The study population were AHF patients (n = 172), who survived the index hospitalization. We compared the relationship between early (on admission, at 24 and 48 h) and discharge sUNa+ measurements with post-discharge study endpoints: composite of 1 year all-cause mortality and AHF rehospitalization (with time to first event analysis) as well as with each event in separation. There were 49 (28.5%) deaths, 40 (23.3%) AHF rehospitalizations, while the composite endpoint occurred in 69 (40.1%) during 1 year follow-up. The sUNa+ had prognostic significance for the composite endpoint when assessed on admission, at 24 and at 48 h: hazard ratios (HRs) with 95% confidence intervals (CIs) (per 10 mmol/L) were 0.88 (0.82-0.94); 0.87 (0.81-0.91); 0.90 (0.84-0.96), all P < 0.005. In contrast to early, active decongestion phase, discharge sUNa+ had no prognostic significance HR (95% CI) (per 10 mmol/L): 0.99 (0.93-1.06) P = 0.79 for the composite endpoint, which was independent from the dose of oral furosemide prescribed at that timepoint (average causal mediation effects: -0.38; P = 0.71). Similarly, discharge sUNa+ was neither associated with 1 year mortality HR (95% CI) (per 10 mmol/L): 0.97 (0.89-1.05) P = 0.48 nor with AHF rehospitalizations HR (95% CI) (per 10 mmol/l): 1.03 (0.94-1.12), P = 0.56. The comparison of longitudinal profiles of sUNa+ during hospitalization showed significantly higher values within the early, active decongestive phase in those who did not experience composite endpoint when compared with those who did: admission: 94 ± 34 vs. 76 ± 35; Day 1: 85 ± 36 vs. 65 ± 37; Day 2: 84 ± 37 vs. 67 ± 35, all P < 0.005 (mmol/L), respectively. There was no difference between those groups in discharge sUNa+ : 73 ± 35 vs. 70 ± 35 P = 0.82 (mmol/L). CONCLUSIONS Spot UNa+ assessed at early phase of hospitalization and at discharge have different prognostic significance, which confirms that it should be always interpreted along with clinical context.
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Affiliation(s)
- Jan Biegus
- Department of Heart Diseases, Wroclaw Medical University, Borowska 213, Wroclaw, 50-556, Poland.,Centre for Heart Diseases, Wroclaw University Hospital, Wroclaw, Poland
| | - Robert Zymliński
- Department of Heart Diseases, Wroclaw Medical University, Borowska 213, Wroclaw, 50-556, Poland.,Centre for Heart Diseases, Wroclaw University Hospital, Wroclaw, Poland
| | - Marat Fudim
- Division of Cardiology, Duke University Medical Center, Durham, NC, USA.,Duke Clinical Research Institute, Durham, NC, USA
| | | | - Mateusz Sokolski
- Department of Heart Diseases, Wroclaw Medical University, Borowska 213, Wroclaw, 50-556, Poland.,Centre for Heart Diseases, Wroclaw University Hospital, Wroclaw, Poland
| | - Dominik Marciniak
- Department of Drugs Form Technology, Faculty of Pharmacy, Wroclaw Medical University, Wroclaw, Poland
| | - Barbara Ponikowska
- Student scientific organization, Department of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland
| | - Mateusz Guzik
- Centre for Heart Diseases, Wroclaw University Hospital, Wroclaw, Poland
| | - Mateusz Garus
- Centre for Heart Diseases, Wroclaw University Hospital, Wroclaw, Poland
| | - Szymon Urban
- Student scientific organization, Department of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland
| | - Piotr Ponikowski
- Department of Heart Diseases, Wroclaw Medical University, Borowska 213, Wroclaw, 50-556, Poland.,Centre for Heart Diseases, Wroclaw University Hospital, Wroclaw, Poland
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7
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Sokolska JM, Sokolski M, Zymliński R, Biegus J, Siwołowski P, Nawrocka-Millward S, Swoboda K, Gajewski P, Jankowska EA, Banasiak W, Ponikowski P. Distinct clinical phenotypes of congestion in acute heart failure: characteristics, treatment response, and outcomes. ESC Heart Fail 2020; 7:3830-3840. [PMID: 32909684 PMCID: PMC7754722 DOI: 10.1002/ehf2.12973] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 08/10/2020] [Accepted: 08/11/2020] [Indexed: 12/29/2022] Open
Abstract
Aims Patients with acute heart failure (AHF) are included into clinical trials regardless of differences in baseline clinical characteristics. The aim of this study was to assess patients with AHF according to the presence of central and/or peripheral congestion at hospital admission and evaluate treatment response and outcomes in studied phenotypes. Methods and results We investigated retrospectively 352 patients (mean age: 68 ± 13 years, 77% men) hospitalized due to AHF with the signs of congestion on admission. Patients were divided according to the type of signs of congestion into three groups: A, isolated pulmonary congestion (n = 52, 15%); B, isolated peripheral congestion (n = 31, 9%); and C, signs of mixed (peripheral and central) congestion (n = 269, 76%). Patients from Group A had lower concentration of urea, bilirubin, and gamma‐glutamyl transferase whereas higher level of haematocrit, albumin, and leukocytes on admission. The highest baseline N‐terminal pro‐B‐type natriuretic peptide level (median: 4113 vs. 3634 vs. 6093 pg/mL) and percentage of patients with chronic heart failure (56 vs. 58 vs. 74%; A vs. B. vs. C, respectively, all P < 0.01) were observed in Group C. There were no differences in terms of demographics, co‐morbidities, left ventricular ejection fraction, and applied treatment between studied groups. Patients from Group A had the highest systolic blood pressure on admission (145 ± 37 vs. 122 ± 20 vs. 130 ± 29 mmHg) and the biggest decrease in systolic blood pressure [−22 (−45 to −4) vs. −2 (−13 to 2) vs. −10 (−25 to 0) mmHg] and heart rate [−16 (−35 to −1.5) vs. −1 (−10 to 5) vs. −7 (−20 to 0) b.p.m.] with the lowest weight change [−1.0 (−1.0 to 0) vs. −2.9 (−3.8 to −0.9) vs. −2.0 (−3.0 to −1.0) kg; all P < 0.01] after 48 h of hospitalization. There were differences in short‐term and long‐term outcomes with favourable results in Group A. Group A experienced less frequent in‐hospital heart failure worsening during the first 48 h (4 vs. 23 vs. 7%), had shorter length of hospital stay [6 (5–8) vs. 7 (5–11) vs. 7 (6–11) days], and had lower 1 year all‐cause mortality (12 vs. 28 vs. 29%; all P < 0.05). Presence of peripheral congestion on admission was independent predictor for all‐cause mortality within 1 year [hazard ratio (95% confidence interval): 2.68 (1.06–6.79); P = 0.04]. Conclusions Patterns of congestion in AHF are associated with differences in clinical characteristics, treatment response, and outcomes. It needs to be considered once planning clinical trials in AHF.
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Affiliation(s)
- Justyna Maria Sokolska
- Department of Heart Diseases, Wroclaw Medical University, ul. Borowska 213, Wrocław, 50-556, Poland.,Department of Cardiology, University Heart Center, University Hospital Zurich, Zürich, Switzerland
| | - Mateusz Sokolski
- Department of Heart Diseases, Wroclaw Medical University, ul. Borowska 213, Wrocław, 50-556, Poland.,Centre for Heart Diseases, University Hospital, Wrocław, Poland
| | - Robert Zymliński
- Department of Heart Diseases, Wroclaw Medical University, ul. Borowska 213, Wrocław, 50-556, Poland.,Centre for Heart Diseases, University Hospital, Wrocław, Poland
| | - Jan Biegus
- Department of Heart Diseases, Wroclaw Medical University, ul. Borowska 213, Wrocław, 50-556, Poland.,Centre for Heart Diseases, University Hospital, Wrocław, Poland
| | - Paweł Siwołowski
- Department of Heart Diseases, Wroclaw Medical University, ul. Borowska 213, Wrocław, 50-556, Poland.,Centre for Heart Diseases, Clinical Military Hospital, Wrocław, Poland
| | | | - Katarzyna Swoboda
- Centre for Heart Diseases, Clinical Military Hospital, Wrocław, Poland
| | - Piotr Gajewski
- Department of Heart Diseases, Wroclaw Medical University, ul. Borowska 213, Wrocław, 50-556, Poland.,Centre for Heart Diseases, University Hospital, Wrocław, Poland
| | - Ewa Anita Jankowska
- Department of Heart Diseases, Wroclaw Medical University, ul. Borowska 213, Wrocław, 50-556, Poland.,Centre for Heart Diseases, University Hospital, Wrocław, Poland
| | - Waldemar Banasiak
- Centre for Heart Diseases, Clinical Military Hospital, Wrocław, Poland
| | - Piotr Ponikowski
- Department of Heart Diseases, Wroclaw Medical University, ul. Borowska 213, Wrocław, 50-556, Poland.,Centre for Heart Diseases, University Hospital, Wrocław, Poland
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Zhou F, Niu L, Zhao M, Ni WX, Liu J. Real-time three-dimensional echocardiography predicts cardiotoxicity induced by postoperative chemotherapy in breast cancer patients. World J Clin Cases 2020; 8:2542-2553. [PMID: 32607331 PMCID: PMC7322441 DOI: 10.12998/wjcc.v8.i12.2542] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 04/01/2020] [Accepted: 06/02/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The anthracycline chemotherapeutic drugs are cardiotoxic. Studies have found some indicators related to cardiotoxicity. However, there is currently no accurate indicator that can predict cardiac toxicity early.
AIM To explore the diagnostic value of real-time three-dimensional echocardiography (RT3DE) in predicting cardiac toxicity in breast cancer patients undergoing chemotherapy.
METHODS Female breast cancer patients who underwent radical mastectomy and postoperative chemotherapy at the Affiliated Hanzhou First People’s Hospital, Zhejiang University School of Medicine were recruited. All patients were routinely administered with chemotherapy for four cycles (T1-T4) after surgery. Two-dimensional (2D) echocardiography, RT3DE, and serological examinations were performed after each cycle of chemotherapy. Patients were divided into a toxic group and a non-toxic group based on whether patients had Δ left ventricular ejection fraction > 10% after one year of chemotherapy. Repeated measurement analysis of variance was used to compare the changes in 2D echocardiographic indicators, serological indicators, and RT3DE indicators before and after chemotherapy. Multivariate logistic regression was used to identify independent predictive indicators for cardiac toxicity in postoperative chemotherapy patients. Receiver operating characteristics (ROC) curve analysis was performed to analyze the diagnostic value of potential indicators in the diagnosis of cardiotoxicity.
RESULTS A total of 107 female breast cancer patients were included in the study. T4 maximum peak velocity in early diastole (E peak)/mitral annulus lateral tissue Doppler (e' peak) (E/e'), serological indicators [T4 cardiac troponin I (cTnI) and T4 pro-brain natriuretic peptide (Pro-BNP)], T3 minimum left atrial volume (LAV), T4 LAVmin, T3 LAV before the start of the P wave (LAVprep), and T4 LAVprep in the toxicity group were significantly higher than those in the non-toxic group. Multivariate logistic regression found that T4 cTnI, T4 Pro-BNP, T3 LAVmin, T4 LAVmin, T3 LAVprep, and T4 LAVprep had potential predictive value for cardiac toxicity (P < 0.05). ROC results showed that T4 LAVmin had the highest accuracy for diagnosing cardiac toxicity [area under the curve (AUC) = 0.947; sensitivity = 78.57%; specificity = 94.62%], followed by T4 LAVprep (AUC = 0.899; sensitivity = 100%; specificity = 66.67%). The accuracies of LAVprep and LAVprep in predicting cardiac toxicity were higher than those of T3 LAVmin and T3 LAVprep.
CONCLUSION RT3DE of left atrial volume can be used to predict the cardiotoxicity caused by chemotherapy, and it is expected to guide the clinical adjustment of dose and schedule in time.
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Affiliation(s)
- Fang Zhou
- Department of Breast Surgery, Key Laboratory of Clinical Cancer Pharmacology and Toxicology Research of Zhejiang Province, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou 310006, Zhejiang Province, China
| | - Lin Niu
- Department of Ultrasound, Key Laboratory of Clinical Cancer Pharmacology and Toxicology Research of Zhejiang Province, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou 310006, Zhejiang Province, China
| | - Min Zhao
- Department of Ultrasound, Key Laboratory of Clinical Cancer Pharmacology and Toxicology Research of Zhejiang Province, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou 310006, Zhejiang Province, China
| | - Wei-Xing Ni
- Department of Ultrasound, Key Laboratory of Clinical Cancer Pharmacology and Toxicology Research of Zhejiang Province, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou 310006, Zhejiang Province, China
| | - Jian Liu
- Department of Breast Surgery, Key Laboratory of Clinical Cancer Pharmacology and Toxicology Research of Zhejiang Province, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou 310006, Zhejiang Province, China
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9
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Roset A, Jacob J, Herrero-Puente P, Alquézar A, Martín-Sanchez FJ, Llorens P, Gil V, Cabello I, Richard F, Garrido JM, Gil C, Llauger L, Wussler D, Mueller C, Miró Ò. High-sensitivity cardiac troponin T 30 days all-come mortality in patients with acute heart failure. A Propensity Score-Matching Analysis Based on the EAHFE Registry. TROPICA4 Study. Eur J Clin Invest 2020; 50:e13248. [PMID: 32306389 DOI: 10.1111/eci.13248] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 04/05/2020] [Accepted: 04/12/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND Acute heart failure (AHF) patients with high troponin levels have a worse prognosis. High-sensitive troponin T (hs-TnT) has been used as a tool to stratify prognosis in many scales but always as a qualitative and not as a quantitative variable. OBJECTIVES The main objective of this study was to determine the best hs-TnT cut-off for prediction of 30-day all-cause mortality. METHODS The EAHFE registry, a prospective follow-up cohort of patients with AHF, was analysed. We performed a propensity score analysis of the optimal hs-TnT cut-off point previously determined by receiver operating characteristic (ROC) curve analysis. RESULTS Of the 13 791 patients in the EAHFE cohort, we analysed 3190 patients in whom hs-TnT determination was available. The area under the ROC curve for 30-day all-cause mortality was 0.70 (CI95% 0.68 to 0.71; P < .001), establishing an optimal cut-off of hs-TnT of 35 ng/L. The sensitivity and specificity of this cut-off were 76.2 and 55.5%, respectively, with a negative predictive value (NPV) of 95.3%. A propensity score was made with 34 variables showing differences based on the cut-off of 35 ng/L for hs-TnT. In the analysis of the population obtained with the propensity score, patients with hs-TnT > 35 ng/L showed a greater 30-day all-cause mortality, with a HR of 2.95 (CI95% 1.83-4.75; P < .001). External validation reported similar results. CONCLUSIONS An hs-TnT value of 35 ng/L is an adequate cut-off to evaluate the prediction of 30-day all-cause mortality with a NPV of 95.3%.
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Affiliation(s)
- Alex Roset
- Emergency Department, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - Javier Jacob
- Emergency Department, Hospital Universitari de Bellvitge, Barcelona, Spain
| | | | - Aitor Alquézar
- Emergency Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Francisco Javier Martín-Sanchez
- Emergency Department, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria Hospital Clínico San Carlos (IdISSC), Universidad Complutense de Madrid, Madrid, Spain
| | - Pere Llorens
- Department of Emergency Medicine, Short-Stay Unit and Hospital at-home, Hospital General Universitario de Alicante, Alicante, Spain
| | - Victor Gil
- Emergency Department, Hospital Clín, Research Group Emergencies: Processes and Diseases, IDIBAPS, Barcelona, Spain
| | - Irene Cabello
- Emergency Department, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - Fernando Richard
- Emergency Department, Hospital Universitario de Burgos, Burgos, Spain
| | | | - Cristina Gil
- Emergency Department, Hospital Universitario de Salamanca, Salamanca, Spain
| | - Lluis Llauger
- Department of Emergency Medicine, Hospital Universitari de Vic, Barcelona, Spain
| | - Desiree Wussler
- Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Christian Mueller
- Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Òscar Miró
- Emergency Department, Hospital Clín, Research Group Emergencies: Processes and Diseases, IDIBAPS, Barcelona, Spain
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10
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Biegus J, Demissei B, Postmus D, Cotter G, Davison BA, Felker GM, Filippatos G, Gimpelewicz C, Greenberg B, Metra M, Severin T, Teerlink JR, Voors AA, Ponikowski P. Hepatorenal dysfunction identifies high-risk patients with acute heart failure: insights from the RELAX-AHF trial. ESC Heart Fail 2019; 6:1188-1198. [PMID: 31568696 PMCID: PMC6989278 DOI: 10.1002/ehf2.12477] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Revised: 05/09/2019] [Accepted: 05/21/2019] [Indexed: 12/26/2022] Open
Abstract
AIMS Episodes of acute heart failure (AHF) may lead to end-organ dysfunction. In this post hoc analysis of the Relaxin in Acute Heart Failure trial, we used the MELD-XI (Model of End-Stage Liver Dysfunction) score to examine hepatorenal dysfunction in patients with AHF. METHODS AND RESULTS On admission, the MELD-XI score was elevated (abnormal) in 918 (82%) patients, with 638 (57%) having isolated renal dysfunction (creatinine > 1 mg/dL), 73 (6.5%) isolated liver dysfunction (bilirubin > 1 mg/dL), and 207 (18.5%) coexisting dysfunction of the kidneys and the liver (both creatinine and bilirubin > 1 mg/dL). The percentage of patients with elevated MELD-XI score remained constant through a 60 day follow-up, as we observed a gradual decrease of liver dysfunction prevalence, counterbalanced by an increase in renal dysfunction. Serelaxin treatment was associated with a lower MELD-XI score on Day 2 and Day 5 (both P < 0.05), but this difference vs. placebo disappeared during longer follow-up. In the multivariable model, an elevated MELD-XI score on admission was associated with higher 180 day mortality: hazard ratios (95% confidence interval) for cardiovascular death were 3.10 (1.22-7.87), and for all-cause death 2.47 (1.19-5.15); both P < 0.05. The addition of the MELD-XI score to a prespecified prognostic model increased the discrimination of the model for all-cause death, but the increment in the C-index was only modest: 0.013 (P = 0.02). CONCLUSIONS In patients with AHF, hepatorenal dysfunction is prevalent and related to poor outcome. The MELD-XI score is a useful prognosticator in AHF.
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Affiliation(s)
- Jan Biegus
- Department of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland.,Department of Cardiology, Centre for Heart Diseases, Clinical Military Hospital, Wroclaw, Poland
| | - Biniyam Demissei
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Douwe Postmus
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Gad Cotter
- Momentum Research, Inc., Durham, NC, USA
| | | | | | - Gerasimos Filippatos
- School of Medicine, University of Cyprus, Nicosia, Cyprus.,School of Medicine, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | | | | | - Marco Metra
- Institute of Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Thomas Severin
- Novartis Pharmaceuticals Corporation, New Hanover, NJ, USA
| | - John R Teerlink
- Section of Cardiology, San Francisco Veterans Affairs Medical Center and School of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Adriaan A Voors
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Piotr Ponikowski
- Department of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland.,Department of Cardiology, Centre for Heart Diseases, Clinical Military Hospital, Wroclaw, Poland
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11
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Zymliński R, Sokolski M, Biegus J, Siwołowski P, Nawrocka-Millward S, Sokolska JM, Dudkowiak M, Marciniak D, Todd J, Jankowska EA, Banasiak W, Ponikowski P. Multi-organ dysfunction/injury on admission identifies acute heart failure patients at high risk of poor outcome. Eur J Heart Fail 2018; 21:744-750. [PMID: 30561066 DOI: 10.1002/ejhf.1378] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 10/23/2018] [Accepted: 11/06/2018] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Clinical consequences of an interplay between dysfunction/injury of different end-organs in acute heart failure (AHF) remain unknown. METHODS AND RESULTS In 284 consecutive AHF patients, end-organ dysfunction/injury was defined as cardiac [troponin I level above the upper reference limit (URL, > 0.056 ng/mL)], kidney (estimated glomerular filtration rate < 60 mL/min/1.73 m2 ), and liver [at least one of the following: aspartate transaminase (AST)/alanine transaminase (ALT) > 3 times the URL (> 114 IU/L and > 105 IU/L for AST and ALT, respectively), bilirubin above the URL (> 1.3 mg/mL), albumin below the lower reference limit (< 3.5 mg/dL)]. The primary endpoints were early (within first 48 h) in-hospital worsening of heart failure and 1-year all-cause mortality. On admission, cardiac, kidney, liver dysfunction/injury were present in 38%, 50%, and 54% of patients, respectively. Patients were classified as having 0, 1, 2, or 3 organ injury/dysfunction (17%, 36%, 35%, and 12% of patients, respectively). Baseline clinical characteristics and co-morbidity profile were similar across groups. Patients with three organ dysfunction/injury had the worst 1-year survival rate [46%; hazard ratio (HR) with 95% confidence interval (CI) vs. patients without organ dysfunction: 6.75 (2.52-18.13), those with two (67%; HR 3.54, 95% CI 1.38-9.08), one (84%; HR 1.58, 95% CI 0.58-4.30), or no organ dysfunction/injury (90%); P < 0.01]. Worsening of heart failure was more frequent in patients with three and two vs. those with one or no organ dysfunction/injury (37% vs. 38% vs. 23% vs. 21%, P < 0.05). CONCLUSIONS In patients with AHF, dysfunction/injury of > 1 end-organ dysfunction/injury identifies patients at the highest risk of poor outcomes.
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Affiliation(s)
- Robert Zymliński
- Department of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland.,Cardiology Department, Centre for Heart Diseases, Military Hospital, Wroclaw, Poland
| | - Mateusz Sokolski
- Department of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland.,Cardiology Department, Centre for Heart Diseases, Military Hospital, Wroclaw, Poland
| | - Jan Biegus
- Department of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland.,Cardiology Department, Centre for Heart Diseases, Military Hospital, Wroclaw, Poland
| | - Paweł Siwołowski
- Department of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland.,Cardiology Department, Centre for Heart Diseases, Military Hospital, Wroclaw, Poland
| | | | - Justyna M Sokolska
- Department of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland.,Cardiology Department, Centre for Heart Diseases, Military Hospital, Wroclaw, Poland
| | - Marta Dudkowiak
- Department of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland.,Cardiology Department, Centre for Heart Diseases, Military Hospital, Wroclaw, Poland
| | - Dominik Marciniak
- Department of Drugs Form Technology, Wroclaw Medical University, Wroclaw, Poland
| | | | - Ewa A Jankowska
- Department of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland.,Cardiology Department, Centre for Heart Diseases, Military Hospital, Wroclaw, Poland
| | - Waldemar Banasiak
- Cardiology Department, Centre for Heart Diseases, Military Hospital, Wroclaw, Poland
| | - Piotr Ponikowski
- Department of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland.,Cardiology Department, Centre for Heart Diseases, Military Hospital, Wroclaw, Poland
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12
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Sokolska JM, Sokolski M, Zymliński R, Biegus J, Siwołowski P, Nawrocka‐Millward S, Jankowska EA, Todd J, Banasiak W, Ponikowski P. Patterns of dyspnoea onset in patients with acute heart failure: clinical and prognostic implications. ESC Heart Fail 2018; 6:16-26. [PMID: 30426729 PMCID: PMC6351893 DOI: 10.1002/ehf2.12371] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 09/06/2018] [Accepted: 09/08/2018] [Indexed: 12/21/2022] Open
Abstract
Aims Despite attempts to improve the management of patients with acute heart failure (HF), virtually all therapeutic agents investigated in large clinical trials failed to show any consistent reduction in mortality and morbidity. Complexity of the clinical syndrome of acute HF seems to be likely an underlying explanation. Traditionally, clinical trials studied mixed patient populations with acute HF, and only recently, better clinical characterization of patients has been proposed. Dyspnoea is the most common presenting symptom related to hospital admission for acute HF. Whether in patients with acute HF, the pattern of symptoms onset preceding hospital admission is associated with clinical characteristics, and the outcomes have not yet been established. Methods and results We investigated 137 patients (mean age: 65 ± 13 years; 80% men) hospitalized due to acute HF with dyspnoea as major reported symptom, who were divided according to the time of its onset into those with acute (n = 98) vs. subacute (n = 39) onset (i.e. within 7 days vs. >7 days preceding hospital admission, respectively). On admission, the former group presented higher blood pressure (138 ± 33 vs. 121 ± 32 mmHg), more often moderate–severe pulmonary congestion (33 vs. 8%), and lower bilirubin level [1.07 (0.72–1.60) vs. 1.27 (0.87–2.06); P < 0.05 in all comparisons]. There were no other differences in baseline clinical characteristics and laboratory indices. Higher percentage of patients with an acute dyspnoea onset reported marked/moderate dyspnoea relief after 6 (18% vs. 7%), 24 (59% vs. 24%), and 48 h (80% vs. 46% assessed as an improvement of at least 5 points in self‐reported 10‐point Likert scale; P < 0.05 in all time points). In patients with an acute onset of dyspnoea after 48 h, a decrease of N‐terminal pro BNP was more frequently observed (83% vs. 65%), and the levels of endothelin‐1 were more reduced [−1.1 (−2.9–0.03) vs 0.4 (−2.2–1.4); all P < 0.05]. Patients with acute onset experienced less in‐hospital HF worsening (13% vs. 40%, P = 0.001), and 1 year cardiovascular mortality was significantly lower (20% vs. 41%, P = 0.01). On the multivariable analysis, subacute pattern of dyspnoea was independent predictor of 12 month cardiovascular mortality in patients with acute HF after adjusting for other prognostic factors: systolic blood pressure, urea, and HF de novo [hazard ratio (95% confidence interval): 2.32 (1.13–4.75), P = 0.02]. Conclusions In patients with acute HF, the pattern of symptoms onset is associated with baseline differences in clinical characteristics, biomarker profile, response to standard treatment, and the long‐term outcomes. This is relevant information for planning future clinical trials.
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Affiliation(s)
- Justyna Maria Sokolska
- Department of Heart DiseasesWroclaw Medical UniversityWroclawPoland
- Department of Cardiology, Military HospitalCentre for Heart DiseasesWroclawPoland
| | - Mateusz Sokolski
- Department of Heart DiseasesWroclaw Medical UniversityWroclawPoland
- Department of Cardiology, Military HospitalCentre for Heart DiseasesWroclawPoland
| | - Robert Zymliński
- Department of Heart DiseasesWroclaw Medical UniversityWroclawPoland
- Department of Cardiology, Military HospitalCentre for Heart DiseasesWroclawPoland
| | - Jan Biegus
- Department of Heart DiseasesWroclaw Medical UniversityWroclawPoland
- Department of Cardiology, Military HospitalCentre for Heart DiseasesWroclawPoland
| | - Paweł Siwołowski
- Department of Cardiology, Military HospitalCentre for Heart DiseasesWroclawPoland
| | | | - Ewa Anita Jankowska
- Department of Cardiology, Military HospitalCentre for Heart DiseasesWroclawPoland
- Laboratory for Applied Research on Cardiovascular System, Department of Heart DiseasesWroclaw Medical UniversityWroclawPoland
| | - John Todd
- Singulex, California Inc.AlamedaCAUSA
| | - Waldemar Banasiak
- Department of Cardiology, Military HospitalCentre for Heart DiseasesWroclawPoland
| | - Piotr Ponikowski
- Department of Heart DiseasesWroclaw Medical UniversityWroclawPoland
- Department of Cardiology, Military HospitalCentre for Heart DiseasesWroclawPoland
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13
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Zymliński R, Biegus J, Sokolski M, Siwołowski P, Nawrocka-Millward S, Todd J, Jankowska EA, Banasiak W, Cotter G, Cleland JG, Ponikowski P. Increased blood lactate is prevalent and identifies poor prognosis in patients with acute heart failure without overt peripheral hypoperfusion. Eur J Heart Fail 2018; 20:1011-1018. [PMID: 29431284 DOI: 10.1002/ejhf.1156] [Citation(s) in RCA: 84] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Revised: 01/12/2018] [Accepted: 01/15/2018] [Indexed: 12/28/2022] Open
Abstract
AIMS Lactate is produced by anaerobic metabolism and may reflect inadequate tissue perfusion in conditions such as acute heart failure (AHF). We evaluated the prevalence and clinical significance of elevated blood lactate on admission in patients with AHF. METHODS AND RESULTS We enrolled 237 patients with AHF (mean age 67 ± 12 years; 70% men) presenting without overt clinical evidence of peripheral hypoperfusion ('warm haemodynamic profile'). Median (upper and lower quartiles) blood lactate on admission was 1.8 (1.5; 2.4) mmol/L; 103 (43%) patients had an elevated blood lactate (≥2 mmol/L). Patients with an elevated lactate had higher blood high-sensitivity troponin I [15.4 (8.5; 26.1) vs. 9.9 (4.3; 19.6) pg/mL], aspartate aminotransferase [28 (20; 44) vs 24 (19; 36) IU/L] and endothelin-1 (12.1 ± 6.2 vs. 9.3 ± 3.9 pg/mL) (all P < 0.05). In this group plasma concentration of neutrophil gelatinase-associated lipocalin increased during the first 48 h, whereas values fell for those with normal baseline lactate [1.9 (-3.2; 9.7) vs. -1.3 (-13.9; 5.6) μg/dL; P < 0.05). One-year mortality was higher amongst patients with an elevated blood lactate (36% vs. 21%; P < 0.05). After adjustment for other well-established prognostic variables, blood lactate on admission predicted poor outcome (hazard ratio 1.24, 95% confidence interval 1.08-1.41; P < 0.05). CONCLUSIONS An elevated blood lactate on admission is common in AHF patients without overt clinical evidence of peripheral hypoperfusion and is associated with markers of organ dysfunction/damage and a worse prognosis.
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Affiliation(s)
- Robert Zymliński
- Cardiology Department, Centre for Heart Diseases, Military Hospital, Wroclaw, Poland.,Department of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland
| | - Jan Biegus
- Cardiology Department, Centre for Heart Diseases, Military Hospital, Wroclaw, Poland.,Department of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland
| | - Mateusz Sokolski
- Cardiology Department, Centre for Heart Diseases, Military Hospital, Wroclaw, Poland.,Department of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland
| | - Paweł Siwołowski
- Cardiology Department, Centre for Heart Diseases, Military Hospital, Wroclaw, Poland
| | | | | | - Ewa A Jankowska
- Cardiology Department, Centre for Heart Diseases, Military Hospital, Wroclaw, Poland.,Department of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland
| | - Waldemar Banasiak
- Cardiology Department, Centre for Heart Diseases, Military Hospital, Wroclaw, Poland
| | | | - John G Cleland
- National Heart and Lung Institute, Imperial College London (Royal Brompton & Harefield Hospitals), London, UK, and Robertson Centre for Biostatistics & Clinical Trials, Institute of Health & Wellbeing, University of Glasgow, Glasgow, UK
| | - Piotr Ponikowski
- Cardiology Department, Centre for Heart Diseases, Military Hospital, Wroclaw, Poland.,Department of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland
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14
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Ghasemi-Roudsari S, Al-Shimary A, Varcoe B, Byrom R, Kearney L, Kearney M. A portable prototype magnetometer to differentiate ischemic and non-ischemic heart disease in patients with chest pain. PLoS One 2018; 13:e0191241. [PMID: 29351337 PMCID: PMC5774725 DOI: 10.1371/journal.pone.0191241] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Accepted: 12/11/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Magnetocardiography (MCG) is a non-invasive technique used to measure and map cardiac magnetic fields. We describe the predictive performance of a portable prototype magnetometer designed for use in acute and routine clinical settings. We assessed the predictive ability of the measurements derived from the magnetometer for the ruling-out of healthy subjects and patients whose chest pain has a non-ischemic origin from those with ischemic heart disease (IHD). METHODS MCG data were analyzed from a technical performance study, a pilot clinical study, and a young healthy reference group. Participants were grouped to enable differentiation of those with IHD versus non-IHD versus controls: Group A (70 IHD patients); Group B (69 controls); Group C (37 young healthy volunteers). Scans were recorded in an unshielded room. Between-group differences were explored using analysis of variance. The ability of 10 candidate MCG predictors to predict normal/abnormal cases was analyzed using logistic regression. Predictive performance was internally validated using repeated five-fold cross-validation. RESULTS Three MCG predictors showed a significant difference between patients and age-matched controls (P<0.001); eight predictors showed a significant difference between patients and young healthy volunteers (P<0.001). Logistic regression comparing patients with controls yielded a specificity of 35.0%, sensitivity of 95.4%, and negative predictive value for the ruling-out of IHD of 97.8% (area under the curve 0.78). CONCLUSION This analysis represents a preliminary indication that the portable magnetometer can help rule-out healthy subjects and patients whose chest pain has a non-ischemic origin from those with IHD.
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Affiliation(s)
| | - Abbas Al-Shimary
- Department of Physics and Astronomy, University of Leeds, Leeds, United Kingdom
- * E-mail:
| | - Benjamin Varcoe
- Department of Physics and Astronomy, University of Leeds, Leeds, United Kingdom
| | - Rowena Byrom
- Division of Cardiovascular and Diabetes Research, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, United Kingdom
| | - Lorraine Kearney
- Division of Cardiovascular and Diabetes Research, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, United Kingdom
| | - Mark Kearney
- Division of Cardiovascular and Diabetes Research, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, United Kingdom
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