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Lv B, Wang Z, Suo Y, Shao S, Yuan M, Zhang Y, Wang L, Li G, Bao Q. IL-2Rα is a potential biomarker for heart failure diagnosis of patients with end-stage renal disease and haemodialysis. ESC Heart Fail 2024. [PMID: 39263807 DOI: 10.1002/ehf2.15051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 08/05/2024] [Accepted: 08/21/2024] [Indexed: 09/13/2024] Open
Abstract
AIMS Heart failure (HF) is a leading cause of mortality in patients with end-stage renal disease (ESRD) undergoing haemodialysis. Identifying novel predictors of HF is essential for improving diagnostic precision and enhancing patient outcomes. METHODS This study included 68 participants from the Haemodialysis Centre at the Second Hospital of Tianjin Medical University. Clinical characteristics and echocardiographic data were collected and analysed. We measured the plasma of 44 cytokines to investigate their correlation with cardiac function and their potential as HF biomarkers. RESULTS In the HF with reduced ejection fraction (HFrEF) group, the levels of several cytokines, including stem cell growth factor-β (SCGF-β), C-X-C motif chemokine 10 (CXCL10), interleukin-1α (IL-1α), interleukin-6 (IL-6), interleukin-8 (IL-8), interleukin-16 (IL-16), interleukin-1 receptor antagonist protein (IL-1Ra), interferon-γ (IFN-γ), tumour necrosis factor-α (TNF-α), leukaemia inhibitory factor (LIF), C-C motif chemokine 3 (CCL3), interleukin-10 (IL-10), interleukin-2 receptor subunit alpha (IL-2Rα), tumour necrosis factor ligand superfamily member 10 (TNFSF10), macrophage colony-stimulating factor (M-CSF), granulocyte colony-stimulating factor (G-CSF) and stem cell factor (SCF), were significantly increased, while C-C motif chemokine 11 (CCL11)/eotaxin levels were decreased compared with those in the control group (P < 0.05). Receiver operating characteristic (ROC) curve analysis highlighted TNF-α [area under the ROC curve (AUC) = 0.85, odds ratio (OR) = 1.080, 95% confidence interval (CI): 1.033-1.128, P = 0.001], IFN-γ (AUC = 0.84, OR = 1.836, 95% CI: 1.289-2.615, P = 0.003) and IL-2Rα (AUC = 0.82, OR = 1.022, 95% CI: 1.009-1.035, P = 0.001) as excellent predictors for HFrEF in haemodialysis patients with ESRD, and they outperformed soluble suppression of tumourigenicity-2 (sST2) but slightly underperformed N-terminal pro-brain natriuretic peptide (NT-proBNP). IL-2Rα (AUC = 0.77, OR = 1.018, 95% CI: 1.007-1.030, P = 0.001) demonstrated superior diagnostic capabilities when distinguishing patients with HF with left ventricular ejection fraction (LVEF) <50% from controls. IL-2Rα emerged as a robust biomarker for left ventricular HF, while TNF-α (AUC = 0.89, OR = 1.140, 95% CI: 1.039-1.250, P = 0.005) showed promise in assessing HF severity in patients with ESRD. IL-2Rα (AUC = 0.80, OR = 1.017, 95% CI: 1.007-1.027, P = 0.001) also significantly predicted right ventricular systolic dysfunction. During a median follow-up of 14 months, 10 patients (14.7%) experienced all-cause mortality. Multivariate Cox regression analysis confirmed that plasma IL-2Rα was an independent predictor of all-cause death [hazard ratio (HR): 1.010, 95% CI: 1.001-1.020, P = 0.039] after adjusting for other variables. CONCLUSIONS This study underscores the potential of IL-2Rα as a valuable biomarker for HF diagnosis and management in haemodialysis patients with ESRD and contributes to our understanding of this high-risk population.
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Affiliation(s)
- Bingya Lv
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China
| | - Zhe Wang
- Department of Kidney Disease and Blood Purification Centre, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China
| | - Ya Suo
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China
| | - Shuai Shao
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China
| | - Meng Yuan
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China
| | - Yue Zhang
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China
| | - Lihua Wang
- Department of Kidney Disease and Blood Purification Centre, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China
| | - Guangping Li
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China
| | - Qiankun Bao
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China
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Anastasiou V, Peteinidou E, Tountas C, Daios S, Moysidis DV, Fardoulis E, Gogos C, Theodorakopoulou M, Iatridi F, Sarafidis P, Giannakoulas G, Karamitsos T, Delgado V, Ziakas A, Kamperidis V. Right Ventricular and Right Atrial Strain Are Associated with Kidney Dysfunction in Acute Heart Failure. Diagnostics (Basel) 2024; 14:1576. [PMID: 39061713 PMCID: PMC11275611 DOI: 10.3390/diagnostics14141576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2024] [Revised: 07/14/2024] [Accepted: 07/16/2024] [Indexed: 07/28/2024] Open
Abstract
BACKGROUND In acute heart failure (HF), low cardiac output and venous congestion are pathophysiological mechanisms that contribute to renal function impairment. This study investigated the association between advanced echocardiographic measures of right ventricular and atrial function and renal impairment in patients with acute HF. METHODS AND RESULTS A total of 377 patients hospitalized for acute HF were prospectively evaluated. Estimated glomerular filtration rate (eGFR) on admission was measured using the 2021 Chronic Kidney Disease Epidemiology Collaboration creatinine equation. Advanced echocardiographic assessment was performed on admission. Patients with eGFR < 45 mL/min/1.73 m2 were more likely to have chronic heart failure, chronic atrial fibrillation, and type 2 diabetes mellitus compared to patients with eGFR ≥ 45 mL/min/1.73 m2. Patients with lower eGFR had lower cardiac output, higher mean E/e' ratio, larger right ventricular (RV) size, worse RV free wall longitudinal strain, more impaired right atrial (RA) reservoir strain, and more frequent severe tricuspid regurgitation. RV free wall longitudinal strain and RA reservoir strain were the only independent echocardiographic associates of low eGFR, whereas cardiac output was not. CONCLUSIONS Impaired RV and RA longitudinal strain were independently associated with eGFR < 45 mL/min/1.73 m2 in acute HF, while reduced cardiac output was not. This suggests that RV and RA dysfunction underlying venous congestion and increased renal afterload are more important pathophysiological determinants of renal impairment in acute HF than reduced cardiac output.
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Affiliation(s)
- Vasileios Anastasiou
- 1st Department of Cardiology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, AHEPA Hospital, St. Kiriakidi 1, 546 36 Thessaloniki, Greece; (V.A.); (E.P.); (S.D.); (E.F.); (C.G.); (G.G.); (T.K.); (A.Z.)
| | - Emmanouela Peteinidou
- 1st Department of Cardiology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, AHEPA Hospital, St. Kiriakidi 1, 546 36 Thessaloniki, Greece; (V.A.); (E.P.); (S.D.); (E.F.); (C.G.); (G.G.); (T.K.); (A.Z.)
| | - Christos Tountas
- Cardiology Department, Sismanoglio Hospital, 151 26 Athens, Greece;
| | - Stylianos Daios
- 1st Department of Cardiology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, AHEPA Hospital, St. Kiriakidi 1, 546 36 Thessaloniki, Greece; (V.A.); (E.P.); (S.D.); (E.F.); (C.G.); (G.G.); (T.K.); (A.Z.)
| | | | - Emmanouil Fardoulis
- 1st Department of Cardiology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, AHEPA Hospital, St. Kiriakidi 1, 546 36 Thessaloniki, Greece; (V.A.); (E.P.); (S.D.); (E.F.); (C.G.); (G.G.); (T.K.); (A.Z.)
| | - Christos Gogos
- 1st Department of Cardiology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, AHEPA Hospital, St. Kiriakidi 1, 546 36 Thessaloniki, Greece; (V.A.); (E.P.); (S.D.); (E.F.); (C.G.); (G.G.); (T.K.); (A.Z.)
| | - Marieta Theodorakopoulou
- Department of Nephrology, School of Medicine, Aristotle University of Thessaloniki, Hippokration Hospital, 546 42 Thessaloniki, Greece; (M.T.); (F.I.); (P.S.)
| | - Fotini Iatridi
- Department of Nephrology, School of Medicine, Aristotle University of Thessaloniki, Hippokration Hospital, 546 42 Thessaloniki, Greece; (M.T.); (F.I.); (P.S.)
| | - Pantelis Sarafidis
- Department of Nephrology, School of Medicine, Aristotle University of Thessaloniki, Hippokration Hospital, 546 42 Thessaloniki, Greece; (M.T.); (F.I.); (P.S.)
| | - George Giannakoulas
- 1st Department of Cardiology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, AHEPA Hospital, St. Kiriakidi 1, 546 36 Thessaloniki, Greece; (V.A.); (E.P.); (S.D.); (E.F.); (C.G.); (G.G.); (T.K.); (A.Z.)
| | - Theodoros Karamitsos
- 1st Department of Cardiology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, AHEPA Hospital, St. Kiriakidi 1, 546 36 Thessaloniki, Greece; (V.A.); (E.P.); (S.D.); (E.F.); (C.G.); (G.G.); (T.K.); (A.Z.)
| | - Victoria Delgado
- Department of Cardiology, Hospital University Germans Triasi Pujol, 08916 Barcelona, Spain;
| | - Antonios Ziakas
- 1st Department of Cardiology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, AHEPA Hospital, St. Kiriakidi 1, 546 36 Thessaloniki, Greece; (V.A.); (E.P.); (S.D.); (E.F.); (C.G.); (G.G.); (T.K.); (A.Z.)
| | - Vasileios Kamperidis
- 1st Department of Cardiology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, AHEPA Hospital, St. Kiriakidi 1, 546 36 Thessaloniki, Greece; (V.A.); (E.P.); (S.D.); (E.F.); (C.G.); (G.G.); (T.K.); (A.Z.)
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Olsen J, Tunuguntla H, Alali A, Choudhry S, Hope KD, Puri K, Spinner JA, Akcan-Arikan A, Price JF. Central Venous Pressure and Impaired Renal Function in Children and Young Adults With Cardiovascular Disease. JACC. ADVANCES 2024; 3:100995. [PMID: 39129999 PMCID: PMC11312305 DOI: 10.1016/j.jacadv.2024.100995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 03/08/2024] [Accepted: 03/13/2024] [Indexed: 08/13/2024]
Abstract
Background Traditionally, low cardiac output has been considered the primary hemodynamic driver of renal function and injury. Adult data suggest that central venous pressure (CVP) is a more important factor. Objectives The authors hypothesized that in children with cardiovascular disease, higher CVP predicts lower estimated glomerular filtration rate (eGFR) and worsening renal function (WRF). Methods We performed a single-center cohort study of patients aged 3 months to 21 years with biventricular circulation undergoing cardiac catheterization. Pearson's correlation and linear and Cox regression analyses were performed to determine associations with eGFR at the time of catheterization and WFR within 180 days after catheterization. Results 312 patients had median age 7.9 years (IQR: 2.3 to 14.5 years), median eGFR 97 mL/min/1.73 m2 (IQR: 81-118 mL/min/1.73 m2), median CVP 7 mm Hg (IQR: 5-9 mm Hg), and median cardiac index 3.7 mL/min/m2 (IQR: 2.9-4.6 mL/min/m2). Nearly half (48%) were transplant recipients. In multivariable analysis, CVP was independently associated with eGFR (β = -2.65; 95% CI: -4.02, -1.28; P < 0.001), as was being a transplant recipient (β = -10.20; 95% CI: -17.74, -2.65; P = 0.008), while cardiac index was not. Fifty-one patients (16%) developed WRF. In a proportional hazards model adjusting for cardiac index, only higher CVP (HR: 1.10; 95% CI: 1.04-1.17; P = 0.002) and greater contrast volume by weight (HR: 1.05; 95% CI: 1.01-1.10; P = 0.021) predicted WRF. CVP ≥7 mm Hg likewise predicted WRF (HR: 2.57; 95% CI: 1.29-5.12; P = 0.007). Conclusions Among children with a spectrum of cardiovascular disease, higher CVP is associated with lower eGFR and development of WRF, independent of cardiac index.
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Affiliation(s)
- Jillian Olsen
- Department of Pediatrics, Division of Cardiology, Baylor College of Medicine/Texas Children's Hospital, Houston, Texas, USA
| | - Hari Tunuguntla
- Department of Pediatrics, Division of Cardiology, Baylor College of Medicine/Texas Children's Hospital, Houston, Texas, USA
| | - Alexander Alali
- Department of Pediatrics, Division of Cardiology, Baylor College of Medicine/Texas Children's Hospital, Houston, Texas, USA
| | - Swati Choudhry
- Department of Pediatrics, Division of Cardiology, Baylor College of Medicine/Texas Children's Hospital, Houston, Texas, USA
| | - Kyle D. Hope
- Department of Pediatrics, Division of Cardiology, Baylor College of Medicine/Texas Children's Hospital, Houston, Texas, USA
| | - Kriti Puri
- Department of Pediatrics, Division of Critical Care Medicine, Baylor College of Medicine/Texas Children's Hospital, Houston, Texas, USA
| | - Joseph A. Spinner
- Department of Pediatrics, Division of Cardiology, Baylor College of Medicine/Texas Children's Hospital, Houston, Texas, USA
| | - Ayse Akcan-Arikan
- Department of Pediatrics, Division of Critical Care Medicine, Baylor College of Medicine/Texas Children's Hospital, Houston, Texas, USA
- Division of Critical Care Medicine
| | - Jack F. Price
- Department of Pediatrics, Division of Cardiology, Baylor College of Medicine/Texas Children's Hospital, Houston, Texas, USA
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Martinez Manzano JM, Prendergast A, John T, Leguizamon R, McLaren I, Khan R, Geller A, Wattanachayakul P, Malin J, Jarrett SA, Lo KB, Benzaquen S, Witzke C. Association of mildly elevated pulmonary vascular resistance with major cardiovascular events in pulmonary hypertension and chronic kidney disease: A retrospective cohort analysis. Pulm Circ 2024; 14:e12401. [PMID: 38887741 PMCID: PMC11181768 DOI: 10.1002/pul2.12401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Revised: 05/27/2024] [Accepted: 06/05/2024] [Indexed: 06/20/2024] Open
Abstract
Pulmonary hypertension (PH) is associated with adverse outcomes in chronic kidney disease (CKD) patients. Our study suggests mildly elevated pulmonary vascular resistance ( > 2 to ≤ 3) is independently associated with major adverse cardiovascular events at 1-year follow-up. Early diagnosis of precapillary PH in CKD patients can potentially improve clinical outcomes.
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Affiliation(s)
| | | | - Tara John
- Department of MedicineJefferson Einstein HospitalPhiladelphiaPennsylvaniaUSA
| | - Raul Leguizamon
- Department of MedicineJefferson Einstein HospitalPhiladelphiaPennsylvaniaUSA
| | - Ian McLaren
- Department of MedicineJefferson Einstein HospitalPhiladelphiaPennsylvaniaUSA
| | - Rasha Khan
- Department of MedicineJefferson Einstein HospitalPhiladelphiaPennsylvaniaUSA
| | - Andrew Geller
- Department of MedicineJefferson Einstein HospitalPhiladelphiaPennsylvaniaUSA
| | | | - John Malin
- Department of MedicineJefferson Einstein HospitalPhiladelphiaPennsylvaniaUSA
| | - Simone A. Jarrett
- Department of MedicineJefferson Einstein HospitalPhiladelphiaPennsylvaniaUSA
| | - Kevin Bryan Lo
- Department of MedicineJefferson Einstein HospitalPhiladelphiaPennsylvaniaUSA
| | - Sadia Benzaquen
- Department of Pulmonary and Critical CareJefferson Einstein HospitalPhiladelphiaPennsylvaniaUSA
| | - Christian Witzke
- Department of CardiologyJefferson Einstein HospitalPhiladelphiaPennsylvaniaUSA
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Walther CP, Civitello AB, Lamba HK, Mondal NK, Navaneethan SD. Kidney Function Trajectories and Right Heart Failure Following LVAD Implantation. J Am Heart Assoc 2024; 13:e031305. [PMID: 38420763 PMCID: PMC10944080 DOI: 10.1161/jaha.123.031305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 12/01/2023] [Indexed: 03/02/2024]
Abstract
BACKGROUND Preoperative kidney dysfunction is a risk factor for right heart failure (RHF) after implantation of a left ventricular assist device (LVAD). However, characteristic kidney function trajectories before and after post-LVAD RHF are uncertain, so we investigated this. METHODS AND RESULTS We identified individuals who received primary continuous-flow LVAD implantation from July 1, 2014 to December 31, 2017 in the Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) data set. Incident RHF was ascertained using the INTERMACS definition at 1 and 3 months and classified as transient or persistent. Kidney function trajectories before and after RHF onset, and relationships of baseline kidney function with RHF risk at the different time points, were assessed. We identified 8076 LVAD recipients who met inclusion criteria. Incident RHF was present at 1 month in 26.4%. There were 4850 individuals with follow-up at 3 months, with incident RHF in 4.2%. Kidney function trajectories differed from pre-LVAD implantation to 1-month follow-up by RHF category, with those developing persistent RHF having no improvement in baseline kidney function. For trajectories before the 3-month RHF ascertainment time, the shape was similar for those with and without RHF, with lower estimated glomerular filtration rate levels among those who developed RHF. Baseline estimated glomerular filtration rate levels below the normal range were associated with higher risk of RHF at 1 and 3 months. CONCLUSIONS In LVAD recipients, preimplantation kidney function and subsequent kidney function trajectories differed substantially by RHF at 1 and 3 months postimplantation, even after adjustment for several confounders. This may demonstrate bidirectional associations between kidney function and right ventricular function in LVAD recipients.
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Affiliation(s)
- Carl P. Walther
- Selzman Institute for Kidney Health, Section of Nephrology, Department of MedicineBaylor College of MedicineHoustonTX
| | - Andrew B. Civitello
- Section of Cardiology, Department of MedicineBaylor College of MedicineHoustonTX
- Advanced Heart Failure Center of ExcellenceBaylor College of MedicineHoustonTX
| | - Harveen K. Lamba
- Division of Cardiothoracic Transplantation and Circulatory Support, Department of SurgeryBaylor College of MedicineHoustonTX
| | - Nandan K. Mondal
- Division of Cardiothoracic Transplantation and Circulatory Support, Department of SurgeryBaylor College of MedicineHoustonTX
| | - Sankar D. Navaneethan
- Selzman Institute for Kidney Health, Section of Nephrology, Department of MedicineBaylor College of MedicineHoustonTX
- Section of NephrologyMichael E. DeBakey Veterans Affairs Medical CenterHoustonTX
- Institute of Clinical and Translational Research, Baylor College of MedicineHoustonTX
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Vernooij RWM, van Ommen ALN, Valstar GB, Cramer MJ, Teske AJ, Menken R, Hofstra L, Rutten FH, Bots ML, den Ruijter HM, Verhaar MC. Association of mild kidney dysfunction with diastolic dysfunction and heart failure with preserved ejection fraction. ESC Heart Fail 2024; 11:315-326. [PMID: 38011017 PMCID: PMC10804207 DOI: 10.1002/ehf2.14511] [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: 12/08/2022] [Revised: 07/13/2023] [Accepted: 08/10/2023] [Indexed: 11/29/2023] Open
Abstract
AIMS We aim to investigate the association between kidney dysfunction and left ventricular diastolic dysfunction parameters and heart failure with preserved ejection fraction (HFpEF) and whether this is sex-specific. METHODS AND RESULTS We included participants from the HELPFul observational study. Outpatient clinical care data, including echocardiography, and an expert panel judgement on HFpEF was collected. Estimated glomerular filtration rate (eGFR) was calculated by creatinine and cystatin C without race. The association between eGFR with E/e', left ventricular mass index, relative wall thickness, and stage C/D heart failure was tested by multivariable adjusted regression models, stratified by sex, reporting odds ratios and 95% confidence intervals (95% confidence interval). We analysed 880 participants, mean age 62.9 (standard deviation: 9.3) years, 69% female. Four hundred six participants had mild (37.6%) kidney dysfunction (eGFR: 60-89 mL/min/1.73 m2 ) or moderate (8.5%) kidney dysfunction (eGFR: 30-59 mL/min/1.73 m2 ). HFpEF was significantly more prevalent in participants with mild and moderate kidney dysfunction (10.3% and 16.0%, respectively) than participants with normal kidney function (3.4%). A lower kidney function was associated with higher E/e' and higher relative wall thickness values. Participants with moderate kidney dysfunction had a higher likelihood of American College of Cardiology/American Heart Association stage C/D HF (odds ratio: 2.07, 95% confidence interval: 1.23, 3.49) than participants with normal kidney functions. CONCLUSIONS Both mild and moderate kidney dysfunction are independently associated with left ventricular diastolic dysfunction parameters and HFpEF. This association is independent of sex and strongest for moderate kidney dysfunction. Considering mild-to-moderate kidney dysfunction as risk factor for HFpEF may help identify high-risk groups benefiting most from early intervention.
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Affiliation(s)
- Robin W. M. Vernooij
- Department of Nephrology and Hypertension, University Medical Center UtrechtUtrecht UniversityUtrechtThe Netherlands
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center UtrechtUtrecht UniversityUtrechtThe Netherlands
| | - Anne‐Mar L. N. van Ommen
- Laboratory of Experimental Cardiology, University Medical Center UtrechtUtrecht UniversityUtrechtThe Netherlands
| | - Gideon B. Valstar
- Laboratory of Experimental Cardiology, University Medical Center UtrechtUtrecht UniversityUtrechtThe Netherlands
| | - Maarten Jan Cramer
- Department of CardiologyUniversity Medical Center UtrechtUtrechtThe Netherlands
| | - Arco J. Teske
- Department of CardiologyUniversity Medical Center UtrechtUtrechtThe Netherlands
| | - Roxana Menken
- Cardiology Centers of the NetherlandsUtrechtThe Netherlands
| | - Leo Hofstra
- Cardiology Centers of the NetherlandsUtrechtThe Netherlands
| | - Frans H. Rutten
- Department of General Practice, Julius Center for Health Sciences and Primary Care, University Medical Center UtrechtUtrecht UniversityUtrechtThe Netherlands
| | - Michiel L. Bots
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center UtrechtUtrecht UniversityUtrechtThe Netherlands
| | - Hester M. den Ruijter
- Laboratory of Experimental Cardiology, University Medical Center UtrechtUtrecht UniversityUtrechtThe Netherlands
| | - Marianne C. Verhaar
- Department of Nephrology and Hypertension, University Medical Center UtrechtUtrecht UniversityUtrechtThe Netherlands
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Farooq MU, Latib A, Jorde UP. Tricuspid Regurgitation in Congestive "End-Organ" Failure: Outline of an Opportunity. Cardiol Rev 2024; 32:18-23. [PMID: 35452428 DOI: 10.1097/crd.0000000000000455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Tricuspid regurgitation (TR) is a progressive disease that can be addressed only partially by medical therapy. Progression of TR is associated with worsening end-organ function and worse survival, yet tricuspid valve interventions are usually only performed in advanced stages. Recent evidence suggests a pivotal role for TR and pulsatile venous congestion in the pathophysiology of renal and hepatic dysfunction. This critical knowledge has provided the opportunity to optimally define the appropriate timing of transcatheter tricuspid valve interventions, integrating concurrent or impending functional consequences with severity of TR.
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Affiliation(s)
- Muhammed U Farooq
- From the Division of Cardiology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY
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8
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Zhang J, Hu Z, Tan Y, Ye J. Causal relationship from heart failure to kidney function and CKD: A bidirectional two-sample mendelian randomization study. PLoS One 2023; 18:e0295532. [PMID: 38079381 PMCID: PMC10712866 DOI: 10.1371/journal.pone.0295532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 11/20/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Heart Failure (HF) is a widespread condition that affects millions of people, and it is caused by issues with the heart and blood vessels. Even though we know hypertension, coronary artery disease, obesity, diabetes, and genetics can increase the risk of HF and Chronic Kidney Disease (CKD), the exact cause of these conditions remains a mystery. To bridge this gap, we adopted Mendelian Randomization (MR), which relies on genetic variants as proxies. METHODS We used data from European populations for our Bidirectional Two-Sample MR Study, which included 930,014 controls and 47,309 cases of HF from the HERMES consortium, as well as 736,396 controls and 51,256 cases of CKD. We also employed several MR variations, including MR-Egger, Inverse Variance Weighted (IVW), and Weighted Median Estimator (WME), to guarantee the results were accurate and comprehensive.). RESULTS In this study, the MR analysis found that individuals with a genetic predisposition for HF have an elevated risk of CKD. Our study revealed a significant association between the genetic prediction of HF and the risk of CKD, as evidenced by the IVW method [with an odds ratio (OR) of 1.12 (95% CI, 1.03-1.21), p = 0.009] and the WME [with an OR of 1.14 (95% CI, 1.03-1.26), p = 0.008]. This causal relationship remained robust even after conducting MR analysis while adjusting for the effects of diabetes and hypertension, yielding ORs of 1.13 (IVW:95% CI, 1.03-1.23), 1.12 (MR-Egger: 95% CI, 0.85-1.48), and 1.15 (WME:95% CI, 1.04-1.27) (p = 0.008). However, in the reverse analysis aiming to explore CKD and renal function as exposures and HF as the outcome, we did not observe a statistically significant causal link between CKD and HF. CONCLUSION Our study demonstrates the significance of HF in CKD progression, thus having meaningful implications for treatment and the potential for discovering new therapies. To better understand the relationship between HF and CKD, we need to conduct research in a variety of populations.
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Affiliation(s)
- Junyu Zhang
- Institute of Traditional Chinese Medicine Diagnostics, Hunan University of Chinese Medicine, Changsha, Hunan, China
| | - Zhixi Hu
- Institute of Traditional Chinese Medicine Diagnostics, Hunan University of Chinese Medicine, Changsha, Hunan, China
- Hunan Provincial Key Laboratory of Diagnostic Research in Chinese Medicine, Hunan University of Chinese Medicine, Changsha, Hunan, China
| | - Yuquan Tan
- Institute of Traditional Chinese Medicine Diagnostics, Hunan University of Chinese Medicine, Changsha, Hunan, China
- Hunan Provincial Key Laboratory of Diagnostic Research in Chinese Medicine, Hunan University of Chinese Medicine, Changsha, Hunan, China
| | - Jiahao Ye
- Institute of Traditional Chinese Medicine Diagnostics, Hunan University of Chinese Medicine, Changsha, Hunan, China
- Hunan Provincial Key Laboratory of Diagnostic Research in Chinese Medicine, Hunan University of Chinese Medicine, Changsha, Hunan, China
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Sala A, Hahn RT, Kodali SK, Mack MJ, Maisano F. Tricuspid Valve Regurgitation: Current Understanding and Novel Treatment Options. JOURNAL OF THE SOCIETY FOR CARDIOVASCULAR ANGIOGRAPHY & INTERVENTIONS 2023; 2:101041. [PMID: 39132395 PMCID: PMC11307688 DOI: 10.1016/j.jscai.2023.101041] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 04/08/2023] [Accepted: 05/03/2023] [Indexed: 08/13/2024]
Abstract
Managing patients with severe symptomatic tricuspid regurgitation (TR) remains extremely challenging, with a lack of consensus on when and how to treat it. Tricuspid valve pathology has been disregarded for a very long time because of the established belief that treating left-sided heart diseases would lead to the resolution or significant improvement of TR. Initially considered benign, severe TR has been found to be a strong predictor of prognosis. Despite the increasing prevalence and the disabling nature of this disease, the great majority of patients with clinically significant TR have seldom been considered for structural interventions. Numerous surgical and transcatheter treatment options are now available; however, optimal timing and procedural selection remain crucial aspects influencing outcomes. According to recent evidence in the literature, early referral is associated with good short and long-term outcomes, and various predictors of favorable outcomes following either surgical or transcatheter treatment have been identified. Evaluation by a multidisciplinary heart team with expertise in tricuspid valve disease is of paramount importance to identify adequate treatment for every patient.
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Affiliation(s)
- Alessandra Sala
- Department of Cardiac Surgery, Vita-Salute San Raffaele University, IRCCS San Raffaele Hospital, Milan, Italy
| | - Rebecca T. Hahn
- Department of Cardiology, Columbia University Medical Center/NewYork-Presbyterian Hospital, New York, New York
| | - Susheel K. Kodali
- Department of Cardiology, Columbia University Medical Center/NewYork-Presbyterian Hospital, New York, New York
| | - Michael J. Mack
- Department of Cardiac Surgery, Baylor Scott & White Health, Plano, Texas
| | - Francesco Maisano
- Department of Cardiac Surgery, Vita-Salute San Raffaele University, IRCCS San Raffaele Hospital, Milan, Italy
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10
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Lopez-López A, Franco-Gutiérrez R, Pérez-Pérez AJ, Regueiro-Abel M, Elices-Teja J, Abou-Jokh-Casas C, González-Juanatey C. Impact of Hyperkalemia in Heart Failure and Reduced Ejection Fraction: A Retrospective Study. J Clin Med 2023; 12:3595. [PMID: 37240702 PMCID: PMC10219257 DOI: 10.3390/jcm12103595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Revised: 05/17/2023] [Accepted: 05/19/2023] [Indexed: 05/28/2023] Open
Abstract
(1) Background: Hyperkalemia is a common finding in patients with heart failure and reduced ejection fraction (HFrEF), though its prognostic significance is controversial. There is no consensus on optimal potassium levels in these patients. The primary endpoint of this study was to determine the 5-year incidence of hyperkalemia in a cohort of patients with HFrEF. Secondary endpoints were to determine predictors of hyperkalemia and its impact on overall 5-year mortality; (2) Methods: retrospective, longitudinal, single-center observational study of patients with HFrEF followed-up in a specialized unit between 2011 and 2019. Hyperkalemia was considered as potassium concentration > 5.5 mEq/L; (3) Results: Hyperkalemia was observed in 170 (16.8%) of the 1013 patients. The 5-year hyperkalemia-free survival rate was 82.1%. Hyperkalemia was more frequent at the beginning of follow-up. Factors associated with hyperkalemia in the multivariate analysis were baseline potassium (HR 3.13, 95%CI 2.15-4.60; p < 0.001), creatinine clearance (HR 0.99, 95%CI 0.98-0.99; p = 0.013), right ventricular function (HR 0.95, 95%CI 0.91-0.99; p = 0.016) and diabetes mellitus (HR 1.40, 95%CI 1.01-1.96; p = 0.047). The overall survival rate at 5 years was 76.4%. Normal-high potassium levels (5-5.5 mEq/L) were inversely associated with mortality (HR 0.60, 95%CI 0.38-0.94; p = 0.025); (4) Conclusions: Hyperkalemia is a common finding in patients with HFrEF with an impact on the optimization of neurohormonal treatment. In our retrospective study, potassium levels in the normal-high range seem to be safe and are not associated with increased mortality.
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Affiliation(s)
- Andrea Lopez-López
- Cardiology Department, Hospital Universitario Lucus Augusti, 27003 Lugo, Spain; (A.L.-L.); (R.F.-G.); (A.J.P.-P.); (M.R.-A.); (J.E.-T.); (C.A.-J.-C.)
- Biodiscovery HULA-USC Group, Instituto de Investigación Sanitaria de Santiago de Compostela IDIS, 27003 Lugo, Spain
| | - Raúl Franco-Gutiérrez
- Cardiology Department, Hospital Universitario Lucus Augusti, 27003 Lugo, Spain; (A.L.-L.); (R.F.-G.); (A.J.P.-P.); (M.R.-A.); (J.E.-T.); (C.A.-J.-C.)
- Biodiscovery HULA-USC Group, Instituto de Investigación Sanitaria de Santiago de Compostela IDIS, 27003 Lugo, Spain
| | - Alberto José Pérez-Pérez
- Cardiology Department, Hospital Universitario Lucus Augusti, 27003 Lugo, Spain; (A.L.-L.); (R.F.-G.); (A.J.P.-P.); (M.R.-A.); (J.E.-T.); (C.A.-J.-C.)
- Biodiscovery HULA-USC Group, Instituto de Investigación Sanitaria de Santiago de Compostela IDIS, 27003 Lugo, Spain
| | - Margarita Regueiro-Abel
- Cardiology Department, Hospital Universitario Lucus Augusti, 27003 Lugo, Spain; (A.L.-L.); (R.F.-G.); (A.J.P.-P.); (M.R.-A.); (J.E.-T.); (C.A.-J.-C.)
- Biodiscovery HULA-USC Group, Instituto de Investigación Sanitaria de Santiago de Compostela IDIS, 27003 Lugo, Spain
| | - Juliana Elices-Teja
- Cardiology Department, Hospital Universitario Lucus Augusti, 27003 Lugo, Spain; (A.L.-L.); (R.F.-G.); (A.J.P.-P.); (M.R.-A.); (J.E.-T.); (C.A.-J.-C.)
- Biodiscovery HULA-USC Group, Instituto de Investigación Sanitaria de Santiago de Compostela IDIS, 27003 Lugo, Spain
| | - Charigan Abou-Jokh-Casas
- Cardiology Department, Hospital Universitario Lucus Augusti, 27003 Lugo, Spain; (A.L.-L.); (R.F.-G.); (A.J.P.-P.); (M.R.-A.); (J.E.-T.); (C.A.-J.-C.)
- Biodiscovery HULA-USC Group, Instituto de Investigación Sanitaria de Santiago de Compostela IDIS, 27003 Lugo, Spain
| | - Carlos González-Juanatey
- Cardiology Department, Hospital Universitario Lucus Augusti, 27003 Lugo, Spain; (A.L.-L.); (R.F.-G.); (A.J.P.-P.); (M.R.-A.); (J.E.-T.); (C.A.-J.-C.)
- Biodiscovery HULA-USC Group, Instituto de Investigación Sanitaria de Santiago de Compostela IDIS, 27003 Lugo, Spain
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Meyer MJ, Jameson SA, Gillig EJ, Aggarwal A, Ratcliffe SJ, Baldwin M, Singh KE, Clouse WD, Blank RS. Clinical implications of preoperative echocardiographic findings on cardiovascular outcomes following vascular surgery: An observational trial. PLoS One 2023; 18:e0280531. [PMID: 36656845 PMCID: PMC9851553 DOI: 10.1371/journal.pone.0280531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Accepted: 12/29/2022] [Indexed: 01/20/2023] Open
Abstract
INTRODUCTION Peripheral artery disease and cardiac disease are often comorbid conditions. Echocardiography is a diagnostic tool that can be performed preoperatively to risk stratify patients by a functional cardiac test. We hypothesized that ventricular dysfunction and valvular lesions were associated with an increased incidence of expanded major adverse cardiac events (Expanded MACE). METHODS AND MATERIALS Retrospective cohort study from 2011 to 2020 including all patients from a major academic center who had vascular surgery and an echocardiographic study within two years of the index procedure. RESULTS 813 patients were included in the study; a majority had a history of smoking (86%), an ASA score of 3 (65%), and were male (68%). Carotid endarterectomy was the most common surgery (24%) and the least common surgery was open abdominal aortic aneurysm repair (5%). We found no significant association between the echocardiographic findings of left ventricular dysfunction, right ventricular dysfunction, or valvular lesions and the postoperative development of Expanded MACE. CONCLUSIONS The preoperative echocardiographic findings of left ventricular dysfunction, right ventricular dysfunction and moderate to severe valvular lesions were not predictive of an increased incidence of postoperative Expanded MACE. We identified a significant association between RV dysfunction and post-operative dialysis that should be interpreted carefully due to the small number of outcomes. The transition from open to endovascular surgery and advances in perioperative management may have led to improved cardiovascular outcomes. TRIAL REGISTRATION Trial Registration: NCT04836702 (clinicaltrials.gov). https://www.google.com/search?client=firefox-b-d&q=NCT04836702.
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Affiliation(s)
- Matthew J. Meyer
- Department of Anesthesiology, University of Virginia School of Medicine, Charlottesville, VA, United States of America
- * E-mail:
| | - Slater A. Jameson
- Department of Anesthesiology, University of Virginia School of Medicine, Charlottesville, VA, United States of America
| | - Edward J. Gillig
- Department of Anesthesiology, Newton Wellesley Hospital, Newton, MA, United States of America
| | - Ankur Aggarwal
- Department of Surgery, Franciscan Physicians Network Vascular Surgeons, Indianapolis, IN, United States of America
| | - Sarah J. Ratcliffe
- Department of Public Health Sciences, University of Virginia School of Medicine, Charlottesville, VA, United States of America
| | - Mary Baldwin
- Department of Surgery, University of Virginia School of Medicine, Charlottesville, VA, United States of America
| | - Karen E. Singh
- Department of Anesthesiology, University of Virginia School of Medicine, Charlottesville, VA, United States of America
| | - W. Darrin Clouse
- Department of Surgery, University of Virginia School of Medicine, Charlottesville, VA, United States of America
| | - Randal S. Blank
- Department of Anesthesiology, University of Virginia School of Medicine, Charlottesville, VA, United States of America
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Kramer T, Brinkkoetter P, Rosenkranz S. Right Heart Function in Cardiorenal Syndrome. Curr Heart Fail Rep 2022; 19:386-399. [PMID: 36166185 PMCID: PMC9653308 DOI: 10.1007/s11897-022-00574-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/12/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE OF REVIEW Since CRS is critically dependent on right heart function and involved in interorgan crosstalk, assessment and monitoring of both right heart and kidney function are of utmost importance for clinical outcomes. This systematic review aims to comprehensively report on novel diagnostic and therapeutic paradigms that are gaining importance for the clinical management of the growing heart failure population suffering from CRS. RECENT FINDINGS Cardiorenal syndrome (CRS) in patients with heart failure is associated with poor outcome. Although systemic venous congestion and elevated central venous pressure have been recognized as main contributors to CRS, they are often neglected in clinical practice. The delicate hemodynamic balance in CRS is particularly determined by the respective status of the right heart. The consideration of hemodynamic and CRS profiles is advantageous in tailoring treatment for better preservation of renal function. Assessment and monitoring of right heart and renal function by known and emerging tools like renal Doppler ultrasonography or new biomarkers may have direct clinical implications.
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Affiliation(s)
- Tilmann Kramer
- Klinik III Für Innere Medizin, Herzzentrum Der Universität Zu Köln, Köln, Germany.
- Cologne Cardiovascular Research Center (CCRC), Klinikum Der Universität Zu Köln, Köln, Germany.
| | - Paul Brinkkoetter
- Cologne Cardiovascular Research Center (CCRC), Klinikum Der Universität Zu Köln, Köln, Germany
- Klinik II Für Innere Medizin, Nephrologie, Universität Zu Köln, Köln, Germany
- Center for Molecular Medicine Cologne (CMMC), Universität Zu Köln, Köln, Germany
| | - Stephan Rosenkranz
- Klinik III Für Innere Medizin, Herzzentrum Der Universität Zu Köln, Köln, Germany
- Cologne Cardiovascular Research Center (CCRC), Klinikum Der Universität Zu Köln, Köln, Germany
- Center for Molecular Medicine Cologne (CMMC), Universität Zu Köln, Köln, Germany
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13
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Ghio S, Acquaro M, Agostoni P, Ambrosio G, Carluccio E, Castiglione V, Colombo D, D’Alto M, Delle Grottaglie S, Dini FL, Emdin M, Fortunato M, Guaricci AI, Jacoangeli F, Marra AM, Paolillo S, Papa S, Scajola LV, Correale M, Palazzuoli A. Right heart failure in left heart disease: imaging, functional, and biochemical aspects of right ventricular dysfunction. Heart Fail Rev 2022:10.1007/s10741-022-10276-0. [DOI: 10.1007/s10741-022-10276-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/25/2022] [Indexed: 11/17/2022]
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14
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Harrison NE, Favot MJ, Gowland L, Lenning J, Henry S, Gupta S, Abidov A, Levy P, Ehrman R. Point-of-care echocardiography of the right heart improves acute heart failure risk stratification for low-risk patients: The REED-AHF prospective study. Acad Emerg Med 2022; 29:1306-1319. [PMID: 36047646 PMCID: PMC9671834 DOI: 10.1111/acem.14589] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 08/23/2022] [Accepted: 08/26/2022] [Indexed: 01/25/2023]
Abstract
OBJECTIVES Validated acute heart failure (AHF) clinical decision instruments (CDI) insufficiently identify low-risk patients meriting consideration of outpatient treatment. While pilot data show that tricuspid annulus plane systolic excursion (TAPSE) is associated with adverse events, no AHF CDI currently incorporates point-of-care echocardiography (POCecho). We evaluated whether TAPSE adds incremental risk stratification value to an existing CDI. METHODS Prospectively enrolled patients at two urban-academic EDs had POCechos obtained before or <1 h after first intravenous diuresis, positive pressure ventilation, and/or nitroglycerin. STEMI and cardiogenic shock were excluded. AHF diagnosis was adjudicated by double-blind expert review. TAPSE, with an a priori cutoff of ≥17 mm, was our primary measure. Secondary measures included eight additional right heart and six left heart POCecho parameters. STRATIFY is a validated CDI predicting 30-day death/cardiopulmonary resuscitation, mechanical cardiac support, intubation, new/emergent dialysis, and acute myocardial infarction or coronary revascularization in ED AHF patients. Full (STRATIFY + POCecho variable) and reduced (STRATIFY alone) logistic regression models were fit to calculate adjusted odds ratios (aOR), category-free net reclassification index (NRIcont ), ΔSensitivity (NRIevents ), and ΔSpecificity (NRInonevents ). Random forest assessed variable importance. To benchmark risk prediction to standard of care, ΔSensitivity and ΔSpecificity were evaluated at risk thresholds more conservative/lower than the actual outcome rate in discharged patients. RESULTS A total of 84/120 enrolled patients met inclusion and diagnostic adjudication criteria. Nineteen percent experiencing the primary outcome had higher STRATIFY scores compared to those event free (233 vs. 212, p = 0.009). Five right heart (TAPSE, TAPSE/PASP, TAPSE/RVDD, RV-FAC, fwRVLS) and no left heart measures improved prediction (p < 0.05) adjusted for STRATIFY. Right heart measures also had higher variable importance. TAPSE ≥ 17 mm plus STRATIFY improved prediction versus STRATIFY alone (aOR 0.24, 95% confidence interval [CI] 0.06-0.91; NRIcont 0.71, 95% CI 0.22-1.19), and specificity improved by 6%-32% (p < 0.05) at risk thresholds more conservative than the standard-of-care benchmark without missing any additional events. CONCLUSIONS TAPSE increased detection of low-risk AHF patients, after use of a validated CDI, at risk thresholds more conservative than standard of care.
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Affiliation(s)
- Nicholas E. Harrison
- Indiana University School of MedicineIndianapolisIndianaUSA,Wayne State UniversityDetroitMichiganUSA
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15
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Right ventricular failure in left heart disease: from pathophysiology to clinical manifestations and prognosis. Heart Fail Rev 2022:10.1007/s10741-022-10282-2. [PMID: 36284079 PMCID: PMC9596338 DOI: 10.1007/s10741-022-10282-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/12/2022] [Indexed: 11/04/2022]
Abstract
Right heart failure (RHF) is a clinical syndrome in which symptoms and signs are caused by dysfunction and/or overload of the right heart structures, predominantly the right ventricle (RV), resulting in systemic venous hypertension, peripheral oedema and finally, the impaired ability of the right heart to provide tissue perfusion. Pathogenesis of RHF includes the incompetence of the right heart to maintain systemic venous pressure sufficiently low to guarantee an optimal venous return and to preserve renal function. Virtually, all myocardial diseases involving the left heart may be responsible for RHF. This may result from coronary artery disease, hypertension, valvular heart disease, cardiomyopathies and myocarditis. The most prominent clinical signs of RHF comprise swelling of the neck veins with an elevation of jugular venous pressure and ankle oedema. As the situation worsens, fluid accumulation becomes generalised with extensive oedema of the legs, congestive hepatomegaly and eventually ascites. Diagnosis of RHF requires the presence of signs of elevated right atrial and venous pressures, including dilation of neck veins, with at least one of the following criteria: (1) compromised RV function; (2) pulmonary hypertension; (3) peripheral oedema and congestive hepatomegaly. Early recognition of RHF and identifying the underlying aetiology as well as triggering factors are crucial to treating patients and possibly reversing the clinical manifestations effectively and improving prognosis.
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Park S, Yum Y, Cha JJ, Joo HJ, Park JH, Hong SJ, Yu CW, Lim DS. Prevalence and Clinical Impact of Electrocardiographic Abnormalities in Patients with Chronic Kidney Disease. J Clin Med 2022; 11:jcm11185414. [PMID: 36143060 PMCID: PMC9506179 DOI: 10.3390/jcm11185414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 09/09/2022] [Accepted: 09/10/2022] [Indexed: 11/16/2022] Open
Abstract
Chronic kidney disease (CKD) is a strong risk factor for cardiovascular disease. An electrocardiogram (ECG) is a basic test for screening cardiovascular disease. However, the impact of ECG abnormalities on cardiovascular prognosis in patients with CKD is largely unknown. A total of 2442 patients with CKD (stages 3−5) who underwent ECG between 2013 and 2015 were selected from the electronic health record database of the Korea University Anam Hospital. ECG abnormalities were defined using the Minnesota classification. The five-year major adverse cerebrocardiovascular event (MACCE), the composite of death, myocardial infarction (MI), and stroke were analyzed. The five-year incidences for MACCE were 27.7%, 20.8%, and 17.2% in patients with no, minor, and major ECG abnormality (p < 0.01). Kaplan−Meier curves also showed the highest incidence of MI, death, and MACCE in patients with major ECG abnormality. Multivariable Cox regression analysis revealed age, sex, diabetes, CKD stage, hsCRP, antipsychotic use, and major ECG abnormality as independent risk predictors for MACCE (adjusted HR of major ECG abnormality: 1.39, 95% CI: 1.09−1.76, p < 01). Among the detailed ECG diagnoses, sinus tachycardia, myocardial ischemia, atrial premature complex, and right axis deviation were proposed as important ECG diagnoses. The accuracy of cardiovascular risk stratification was improved when the ECG results were added to the conventional SCORE model (net reclassification index 0.07). ECG helps to predict future cerebrocardiovascular events in CKD patients. ECG diagnosis can be useful for cardiovascular risk evaluation in CKD patients when applied in addition to the conventional risk stratification model.
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Affiliation(s)
- Sejun Park
- Department of Internal Medicine, Korea University Anam Hospital, Seoul 02841, Korea
| | - Yunjin Yum
- Department of Biostatistics, Korea University College of Medicine, Seoul 02841, Korea
| | - Jung-Joon Cha
- Department of Internal Medicine, Division of Cardiology, Korea University Anam Hospital, Seoul 02841, Korea
| | - Hyung Joon Joo
- Department of Internal Medicine, Division of Cardiology, Korea University Anam Hospital, Seoul 02841, Korea
- Department of Medical Informatics, Korea University College of Medicine, Seoul 02841, Korea
- Research Institute for Medical Bigdata Science, College of Medicine, Korea University, Seoul 02708, Korea
- Correspondence: ; Tel.: +82-2-920-6411
| | - Jae Hyoung Park
- Department of Internal Medicine, Division of Cardiology, Korea University Anam Hospital, Seoul 02841, Korea
| | - Soon Jun Hong
- Department of Internal Medicine, Division of Cardiology, Korea University Anam Hospital, Seoul 02841, Korea
| | - Cheol Woong Yu
- Department of Internal Medicine, Division of Cardiology, Korea University Anam Hospital, Seoul 02841, Korea
| | - Do-Sun Lim
- Department of Internal Medicine, Division of Cardiology, Korea University Anam Hospital, Seoul 02841, Korea
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Xu H, Wang H, Chen S, Chen Q, Xu T, Xu Z, Sun Y. Prognostic Value of Modified Model for End-Stage Liver Disease Score in Patients Undergoing Isolated Tricuspid Valve Replacement. Front Cardiovasc Med 2022; 9:932142. [PMID: 35845070 PMCID: PMC9283717 DOI: 10.3389/fcvm.2022.932142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 06/09/2022] [Indexed: 11/13/2022] Open
Abstract
Objective Though the prognostic value of the model for end-stage liver disease (MELD) score in tricuspid surgery was confirmed, the unstable international normalized ratio (INR) may affect the evaluation effectiveness of the MELD score for isolated tricuspid valve replacement (ITVR). The aim of the study was to assess the prognostic value of modified MELD for ITVR. Methods and Results A total of 152 patients who underwent ITVR were evaluated. The adverse outcome was defined as in-hospital mortality after surgery. The receiver operating characteristic (ROC) curve analysis demonstrated that a modified MELD score with albumin replacing INR (MELD-albumin) score presented well prognostic value [area under the curve (AUC) = 0.731, p = 0.006] for in-hospital mortality. Through Cox regression and further interval validation, the MELD-albumin score was identified as an independent predictor for in-hospital mortality. The optimal cutoff value of MELD-albumin was identified as 8.58 through maximally selected log-rank statistics. In addition, restricted cubic spline analysis demonstrated the linear inverse relationship between MELD-albumin and hazard ratio (HR) for in-hospital mortality. Kaplan–Meier analysis illustrated that in-hospital mortality was increased significantly in the high MELD-albumin (MELD-albumin ≥8.58) group than in the low MELD-albumin group (MELD-albumin <8.58; p < 0.001). Furthermore, high MELD-albumin was associated with lower body mass index (BMI), the incidence of lower extremities edema and moderate drinking history, and the MELD-albumin score was correlated with the value of aspartate transaminase (AST), alanine transaminase (ALT), and albumin. Furthermore, the incidence of renal failure (p = 0.003) and pulmonary infection (p = 0.042) was increased significantly in the high MELD-albumin group. Conclusion The MELD-albumin score could provide prognostic value for ITVR. In addition, the MELD-albumin score was useful in risk stratification and patient selection for patients with tricuspid regurgitation (TR) prior to ITVR.
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Affiliation(s)
- Hongjie Xu
- Department of Cardiovascular Surgery, Changhai Hospital, Naval Medical University, Shanghai, China
| | - He Wang
- Department of Cardiovascular Surgery, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Shisong Chen
- Department of Cardiovascular Surgery, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Qian Chen
- Department of Cardiovascular Surgery, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Tianyu Xu
- Department of Cardiovascular Surgery, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Zhiyun Xu
- Department of Cardiovascular Surgery, Changhai Hospital, Naval Medical University, Shanghai, China
- *Correspondence: Zhiyun Xu,
| | - Yangyong Sun
- Department of Cardiovascular Surgery, Changhai Hospital, Naval Medical University, Shanghai, China
- Department of Cardiothoracic Surgery, Affiliated People’s Hospital of Jiangsu University, Zhenjiang, China
- Yangyong Sun,
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Bivona DJ, Tallavajhala S, Abdi M, Oomen PJ, Gao X, Malhotra R, Darby AE, Monfredi OJ, Mangrum JM, Mason PK, Mazimba S, Salerno M, Kramer CM, Epstein FH, Holmes JW, Bilchick KC. Machine learning for multidimensional response and survival after cardiac resynchronization therapy using features from cardiac magnetic resonance. Heart Rhythm O2 2022; 3:542-552. [PMID: 36340495 PMCID: PMC9626744 DOI: 10.1016/j.hroo.2022.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background Cardiac resynchronization therapy (CRT) response is complex, and better approaches are required to predict survival and need for advanced therapies. Objective The objective was to use machine learning to characterize multidimensional CRT response and its relationship with long-term survival. Methods Associations of 39 baseline features (including cardiac magnetic resonance [CMR] findings and clinical parameters such as glomerular filtration rate [GFR]) with a multidimensional CRT response vector (consisting of post-CRT left ventricular end-systolic volume index [LVESVI] fractional change, post-CRT B-type natriuretic peptide, and change in peak VO2) were evaluated. Machine learning generated response clusters, and cross-validation assessed associations of clusters with 4-year survival. Results Among 200 patients (median age 67.4 years, 27.0% women) with CRT and CMR, associations with more than 1 response parameter were noted for the CMR CURE-SVD dyssynchrony parameter (associated with post-CRT brain natriuretic peptide [BNP] and LVESVI fractional change) and GFR (associated with peak VO2 and post-CRT BNP). Machine learning defined 3 response clusters: cluster 1 (n = 123, 90.2% survival [best]), cluster 2 (n = 45, 60.0% survival [intermediate]), and cluster 3 (n = 32, 34.4% survival [worst]). Adding the 6-month response cluster to baseline features improved the area under the receiver operating characteristic curve for 4-year survival from 0.78 to 0.86 (P = .02). A web-based application was developed for cluster determination in future patients. Conclusion Machine learning characterizes distinct CRT response clusters influenced by CMR features, kidney function, and other factors. These clusters have a strong and additive influence on long-term survival relative to baseline features.
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Seghatol FF, Martin KD, Haj-Asaad A, Xie M, Prabhu SD. Relation of Cardiorenal Syndrome to Mitral and Tricuspid Regurgitation in Acute Decompensated Heart Failure. Am J Cardiol 2022; 168:99-104. [PMID: 35045927 DOI: 10.1016/j.amjcard.2021.12.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 12/03/2021] [Accepted: 12/08/2021] [Indexed: 11/27/2022]
Abstract
This study aimed to investigate the role of secondary mitral regurgitation (MR) and tricuspid regurgitation (TR) in the pathogenesis of cardiorenal syndrome (CRS). Worsening renal function in patients with acute decompensated heart failure receiving diuretic therapy is defined as CRS and is related to central venous congestion. The role of secondary MR and TR is not well studied. We retrospectively reviewed the electronic medical records of 80 consecutive patients hospitalized with acute decompensated heart failure. Patients were divided into 2 groups: group 1 (CRS) if creatinine increased >0.3 mg/dl from baseline and group 2 (no CRS) if creatinine remained stable or improved with diuretic therapy. Admission creatinine was higher in group 1 compared with group 2 (1.5 vs 1.2 mg/dl, p = 0.033). The magnitude of MR and TR were higher by both visual assessment (moderate to severe [3+] or severe [4+] MR in 68% of patients in group 1 vs 3% in group 2, p <0.0001; 3+ or 4+ TR in 48% of patients in group 1 vs 10% in group 2, p = 0.0004) and by vena contracta (MR 0.6 ± 0.2 cm in group 1 vs 0.4 ± 0.1 cm in group 2, p <0.0001; TR 0.5 ± 0.2 cm in group 1 vs 0.4 ± 0.2 cm in group 2, p = 0.0013). By using receiver operating characteristic curves, MR and TR were the most sensitive parameters in predicting CRS. In conclusion, renal function on admission and moderate to severe or severe MR and TR are highly predictive of the risk of developing CRS.
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Affiliation(s)
| | - Kimberly D Martin
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama
| | | | - Min Xie
- Division of Cardiology, Department of Medicine
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Jabagi H, Nantsios A, Ruel M, Mielniczuk LM, Denault AY, Sun LY. A standardized definition for right ventricular failure in cardiac surgery patients. ESC Heart Fail 2022; 9:1542-1552. [PMID: 35266332 PMCID: PMC9065859 DOI: 10.1002/ehf2.13870] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 01/28/2022] [Accepted: 02/17/2022] [Indexed: 11/07/2022] Open
Abstract
Right ventricular failure (RVF) is a significant cause of mortality and morbidity after cardiac surgery. Despite its prognostic importance, RVF remains under investigated and without a universally accepted definition in the perioperative setting. We foresee that the provision of a standardized perioperative definition for RVF based on practical and objective criteria will help to improve quality of care through early detection and facilitate the generalization of RVF research to advance this field. This article provides an overview of RVF aetiology, pathophysiology, current diagnostic modalities, as well as a summary of existing RVF definitions. This is followed by our proposal for a standardized definition of perioperative RVF, one that captures RV structural and functional abnormalities through a multimodal approach based on anatomical, echocardiographic, and haemodynamic criteria that are readily available in the perioperative setting (Central Image).
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Affiliation(s)
- Habib Jabagi
- Division of Cardiac Surgery, Valley Health System, Ridgewood, NJ, USA
| | - Alex Nantsios
- Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Marc Ruel
- Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Lisa M Mielniczuk
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - André Y Denault
- Department of Anesthesiology and Critical Care Division, Montreal Heart Institute and Université de Montréal, Montreal, QC, Canada
| | - Louise Y Sun
- Division of Cardiac Anesthesiology, University of Ottawa Heart Institute, Room H-2206, 40 Ruskin Street, Ottawa, ON, K1Y 4W7, Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada.,Cardiovascular Research Program, Institute for Clinical Evaluative Sciences, Ottawa, ON, Canada
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21
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Sala A, Lorusso R, Alfieri O. Isolated tricuspid regurgitation: A plea for early correction. Int J Cardiol 2022; 353:80-85. [DOI: 10.1016/j.ijcard.2022.01.069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 01/31/2022] [Indexed: 11/29/2022]
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22
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Renal and hepatic function of patients with severe tricuspid regurgitation undergoing inferior caval valve implantation. Sci Rep 2021; 11:21800. [PMID: 34750484 PMCID: PMC8576027 DOI: 10.1038/s41598-021-01322-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 10/25/2021] [Indexed: 11/21/2022] Open
Abstract
Due to progressive abdominal-venous congestion severe tricuspid regurgitation (TR) is a common cause of cardiorenal and cardiohepatic syndrome. We initiated the TRICAVAL study to compare interventional valve implantation into the inferior vena cava (CAVI) versus optimal medical therapy (OMT) in severe TR. In the present subanalysis, we aimed to evaluate the effects of CAVI on clinical signs of congestion, renal and hepatic function. TRICAVAL was an investigator-initiated, randomized trial. Twenty-eight patients with severe TR were randomized to OMT or CAVI using an Edwards Sapien XT valve. Probands who completed the 3-month follow-up (CAVI [n = 8], OMT [n = 10]) were evaluated by medical history, clinical examination, and laboratory testing at baseline, 3 and 12 months. After 3 months, the CAVI group exhibited a significant reduction of body weight (from 80.7 [69.0–87.7] kg to 75.5 [63.8–84.6] kg, p < 0.05) and abdominal circumference (from 101.5 ± 13.8 cm to 96.3 ± 15.4 cm, p ≤ 0.01) and a trend to lower doses of diuretics compared to OMT. Renal and hepatic function parameters did not change significantly. Within a short-term follow-up, CAVI led to an improvement of clinical signs of venous congestion and a non-significant reduction of diuretic doses compared to OMT.
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23
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Ishiwata J, Daimon M, Nakanishi K, Sugimoto T, Kawata T, Shinozaki T, Nakao T, Hirokawa M, Sawada N, Yoshida Y, Amiya E, Hatano M, Morita H, Yatomi Y, Komuro I. Combined evaluation of right ventricular function using echocardiography in non-ischaemic dilated cardiomyopathy. ESC Heart Fail 2021; 8:3947-3956. [PMID: 34346188 PMCID: PMC8497345 DOI: 10.1002/ehf2.13519] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 06/15/2021] [Accepted: 07/05/2021] [Indexed: 12/25/2022] Open
Abstract
AIMS Although comprehensive assessment of right ventricular (RV) function using multiple echocardiographic parameters is recommended for management of patients with non-ischaemic dilated cardiomyopathy (DCM), it is unclear which RV parameters to combine. Additionally, normalization of RV parameters by estimated pulmonary artery systolic pressure (PASP), in consideration of RV-pulmonary artery coupling, may be clinically significant. The aim of our study was to elucidate the best combination of echocardiographic RV functional parameters, with or without indexing for PASP, to predict outcome in patients with heart failure with reduced ejection fraction secondary to DCM. METHODS AND RESULTS We retrospectively analysed 109 DCM patients with left ventricular ejection fraction <40%. RV size was assessed by RV end-diastolic area (RVEDA) and RV end-systolic area (RVESA) from RV-focused apical four-chamber view. RV function was assessed by fractional area change (FAC) and tricuspid annular plane systolic excursion (TAPSE) and by RV longitudinal strain (RVLS) using two-dimensional speckle-tracking echocardiography. All functional parameters were also indexed for estimated PASP. Cox analyses were used to evaluate the association of RV morphology and functional parameters with 1 year outcome (composite of left ventricular assist device implantation and all-cause death). Area under the curve was used to compare prognostic values. Mean age was 44 ± 14 years, and 76 (69.7%) were men. Mean left ventricular ejection fraction was 21.9%, median RVEDA was 22.1 cm2 , FAC was 27.0%, TAPSE was 15.0 mm, and RVLS was -12.5%. Forty-one (37.6%) patients experienced the primary outcome. Multivariate Cox analysis revealed that RVEDA, RVESA, FAC, TAPSE, RVLS, FAC/PASP, and RVLS/PASP were independent predictors for primary outcome (all P < 0.05). However, normalization with PASP did not improve area under the curve for any RV functional parameters. When we evaluate hazard ratios according to the combination of two echocardiographic parameters of RV function, patients with impairment of both FAC (<27%) and RVLS (>-8.6%) had significantly higher hazard ratio than those with either impairment alone (11.3 vs. 3.4, P < 0.001); the other combinations did not improve prognostic value. CONCLUSIONS Normalizing echocardiographic RV parameters for PASP did not improve the prognostic values for our population. Meanwhile, combined evaluation of FAC and RVLS improved risk stratification in patients with heart failure with reduced ejection fraction secondary to DCM.
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Affiliation(s)
- Jumpei Ishiwata
- Department of Cardiovascular MedicineThe University of Tokyo HospitalTokyoJapan
| | - Masao Daimon
- Department of Cardiovascular MedicineThe University of Tokyo HospitalTokyoJapan
- Department of Clinical LaboratoryThe University of Tokyo HospitalTokyoJapan
| | - Koki Nakanishi
- Department of Cardiovascular MedicineThe University of Tokyo HospitalTokyoJapan
| | | | - Takayuki Kawata
- Department of Cardiovascular MedicineSassa General HospitalTokyoJapan
| | - Tomohiro Shinozaki
- Department of Information and Computer Technology, Faculty of EngineeringTokyo University of ScienceTokyoJapan
| | - Tomoko Nakao
- Department of Clinical LaboratoryThe University of Tokyo HospitalTokyoJapan
| | - Megumi Hirokawa
- Department of Cardiovascular MedicineThe University of Tokyo HospitalTokyoJapan
| | - Naoko Sawada
- Department of Cardiovascular MedicineThe University of Tokyo HospitalTokyoJapan
| | - Yuriko Yoshida
- Department of Cardiovascular MedicineThe University of Tokyo HospitalTokyoJapan
| | - Eisuke Amiya
- Department of Cardiovascular MedicineThe University of Tokyo HospitalTokyoJapan
- Department of Therapeutic Strategy for Heart FailureThe University of Tokyo HospitalTokyoJapan
| | - Masaru Hatano
- Department of Cardiovascular MedicineThe University of Tokyo HospitalTokyoJapan
- Department of Therapeutic Strategy for Heart FailureThe University of Tokyo HospitalTokyoJapan
| | - Hiroyuki Morita
- Department of Cardiovascular MedicineThe University of Tokyo HospitalTokyoJapan
| | - Yutaka Yatomi
- Department of Clinical LaboratoryThe University of Tokyo HospitalTokyoJapan
| | - Issei Komuro
- Department of Cardiovascular MedicineThe University of Tokyo HospitalTokyoJapan
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24
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Marra AM, Sherman AE, Salzano A, Guazzi M, Saggar R, Squire IB, Cittadini A, Channick RN, Bossone E. Right Heart Pulmonary Circulation Unit Involvement in Left-Sided Heart Failure: Diagnostic, Prognostic, and Therapeutic Implications. Chest 2021; 161:535-551. [PMID: 34592320 DOI: 10.1016/j.chest.2021.09.023] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 09/15/2021] [Accepted: 09/17/2021] [Indexed: 02/06/2023] Open
Abstract
Although long neglected, the right heart (RH) is now widely accepted as a pivotal player in heart failure (HF) either with reduced or preserved ejection fraction. The chronic overload of the pulmonary microcirculation results in an initial phase characterized by right ventricular (RV) hypertrophy, right atrial dilation, and diastolic dysfunction. This progresses to overt RH failure when RV dilation and systolic dysfunction lead to RV-pulmonary arterial (RV-PA) uncoupling with low RV output. In the context of its established relevance to progression of HF, clinicians should consider assessment of the RH with information from clinical assessment, biomarkers, and imaging. Notably, no single parameter can predict prognosis alone in HF. Assessments simultaneously should encompass RV systolic function, pulmonary pressures, an estimation of RV-PA coupling, and RH morphologic features. Despite a large volume of evidence indicating the relevance of RH function to the clinical syndrome of HF, evidence-based management strategies are lacking. Targeting RH dysfunction in HF should be an objective of future investigations, being an unmet need in the current management of HF.
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Affiliation(s)
- Alberto M Marra
- Department of Translational Medical Sciences, "Federico II" University Hospital and School of Medicine, Naples, Italy; Italian Clinical Outcome Research and Reporting Program, Naples, Italy; Centre for Pulmonary Hypertension, Thoraxklinik at Heidelberg University Hospital, Heidelberg, Germany.
| | - Alexander E Sherman
- Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Andrea Salzano
- IRCCS SDN, Diagnostic and Nuclear Research Institute, Naples, Italy
| | - Marco Guazzi
- Cardiology Division, San Paolo Hospital, University of Milano School of Medicine, Milano, Italy; IRCCS, Policlinico San Donato, Milano, Italy
| | - Rajan Saggar
- Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Iain B Squire
- Department of Cardiovascular Sciences, University of Leicester, National Institute for Health Research (NIHR) Leicester Biomedical Research Centre, Leicester, England
| | - Antonio Cittadini
- Department of Translational Medical Sciences, "Federico II" University Hospital and School of Medicine, Naples, Italy; Italian Clinical Outcome Research and Reporting Program, Naples, Italy
| | - Richard N Channick
- Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Eduardo Bossone
- Italian Clinical Outcome Research and Reporting Program, Naples, Italy; Division of Cardiology, A Cardarelli Hospital, Naples, Italy
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25
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Pretransplant Right Ventricular Dysfunction Is Associated With Increased Mortality After Heart Transplantation: A Hard Inheritance to Overcome. J Card Fail 2021; 28:259-269. [PMID: 34509597 DOI: 10.1016/j.cardfail.2021.08.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Revised: 08/20/2021] [Accepted: 08/22/2021] [Indexed: 01/29/2023]
Abstract
BACKGROUND Right ventricular dysfunction (RVD) is a major issue in patients with advanced heart failure because it precludes the implantation of left ventricular assist device, usually leaving heart transplantation (HTx) as the only available treatment option. The pulmonary artery pulsatility index (PAPi) is a hemodynamic parameter integrating information of right ventricular function and of pulmonary circulation. Our aim is to evaluate the association of preoperative RVD, hemodynamically defined as a low PAPi, with post-HTx survival. METHODS AND RESULTS Consecutive adult HTx recipient at 2 Italian transplant centers between 2000 and 2018 with available data on pre-HTx right heart catheterization were included retrospectively. RVD was defined as a value of PAPi lower than the 25th percentile of the study population. The association of RVD with the 1-year post-HTx mortality and other secondary end points were evaluated. Multivariate logistic regression was used to adjust for clinical and hemodynamic variables. Analyses stratified by pulmonary vascular resistance (PVR) status (≥3 Woods units vs <3 Woods units) were also performed. Among 657 HTx recipients (female 31.1%, age 53 ± 11 years), patients with pre-HTx RVD (PAPi of <1.68) had significantly lower 1-year survival rates (77.8% vs 87.1%, P = .005), also after adjusting for estimated glomerular filtration rate, total bilirubin, PVR, serum sodium, inotropes, and mechanical circulatory support at HTx (hazard ratio 2.0, 95% confidence interval, 1.3-3.1). RVD was also associated with post-HTx renal replacement therapy (hazard ratio 2.0, 95% confidence interval 1.05-3.30) and primary graft dysfunction (hazard ratio 1.7, , 95% confidence interval 1.02-3.30). When stratifying patients by estimated PVR status, RVD was associated with worse 1-year survival among patients with normal PVR (76.9% vs 88.3%, P = .003), but not in those with increased PVR (78.6% vs 83.2%, P = .49). CONCLUSIONS Preoperative RVD, evaluated through PAPi, is associated with mortality and morbidity after HTx, providing incremental prognostic value over traditional clinical and hemodynamic parameters.
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26
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Butcher SC, Fortuni F, Dietz MF, Prihadi EA, van der Bijl P, Ajmone Marsan N, Bax JJ, Delgado V. Renal function in patients with significant tricuspid regurgitation: pathophysiological mechanisms and prognostic implications. J Intern Med 2021; 290:715-727. [PMID: 34114700 PMCID: PMC8453518 DOI: 10.1111/joim.13312] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 04/17/2021] [Accepted: 05/05/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND The pathophysiological mechanisms linking tricuspid regurgitation (TR) and chronic kidney disease (CKD) remain unknown. This study aimed to determine which pathophysiological mechanisms related to TR are independently associated with renal dysfunction and to evaluate the impact of renal impairment on long-term prognosis in patients with significant (≥ moderate) secondary TR. METHODS A total of 1234 individuals (72 [IQR 63-78] years, 50% male) with significant secondary TR were followed up for the occurrence of all-cause mortality and the presence of significant renal impairment (eGFR of <60 mL min-1 1.73 m-2 ) at the time of baseline echocardiography. RESULTS Multivariable analysis demonstrated that severe right ventricular (RV) dysfunction (TAPSE < 14 mm) was independently associated with the presence of significant renal impairment (OR 1.49, 95% CI 1.11 to 1.99, P = 0.008). Worse renal function was associated with a significant reduction in survival at 1 and 5 years (85% vs. 87% vs. 68% vs. 58% at 1 year, and 72% vs. 64% vs. 39% vs. 19% at 5 years, for stage 1, 2, 3 and 4-5 CKD groups, respectively, P < 0.001). The presence of severe RV dysfunction was associated with reduced overall survival in stage 1-3 CKD groups, but not in stage 4-5 CKD groups. CONCLUSIONS Of the pathophysiological mechanisms identified by echocardiography that are associated with significant secondary TR, only severe RV dysfunction was independently associated with the presence of significant renal impairment. In addition, worse renal function according to CKD group was associated with a significant reduction in survival.
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Affiliation(s)
- S. C. Butcher
- From theDepartment of CardiologyLeiden University Medical CenterLeidenThe Netherlands
- Department of CardiologyRoyal Perth HospitalPerthWAAustralia
| | - F. Fortuni
- From theDepartment of CardiologyLeiden University Medical CenterLeidenThe Netherlands
- Department of Molecular MedicineUniversity of PaviaPaviaItaly
| | - M. F. Dietz
- From theDepartment of CardiologyLeiden University Medical CenterLeidenThe Netherlands
| | - E. A. Prihadi
- From theDepartment of CardiologyLeiden University Medical CenterLeidenThe Netherlands
- Antwerp Cardiovascular CenterZNA MiddelheimAntwerpBelgium
| | - P. van der Bijl
- From theDepartment of CardiologyLeiden University Medical CenterLeidenThe Netherlands
| | - N. Ajmone Marsan
- From theDepartment of CardiologyLeiden University Medical CenterLeidenThe Netherlands
| | - J. J. Bax
- From theDepartment of CardiologyLeiden University Medical CenterLeidenThe Netherlands
| | - V. Delgado
- From theDepartment of CardiologyLeiden University Medical CenterLeidenThe Netherlands
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Vijiiac A, Onciul S, Guzu C, Scarlatescu A, Petre I, Zamfir D, Onut R, Deaconu S, Dorobantu M. Forgotten No More-The Role of Right Ventricular Dysfunction in Heart Failure with Reduced Ejection Fraction: An Echocardiographic Perspective. Diagnostics (Basel) 2021; 11:diagnostics11030548. [PMID: 33808566 PMCID: PMC8003573 DOI: 10.3390/diagnostics11030548] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 03/09/2021] [Accepted: 03/15/2021] [Indexed: 12/28/2022] Open
Abstract
During the last decade, studies have raised awareness of the crucial role that the right ventricle plays in various clinical settings, including diseases primarily linked to the left ventricle. The assessment of right ventricular performance with conventional echocardiography is challenging. Novel echocardiographic techniques improve the functional assessment of the right ventricle and they show good correlation with the gold standard represented by cardiac magnetic resonance. This review summarizes the traditional and innovative echocardiographic techniques used in the functional assessment of the right ventricle, focusing on the role of right ventricular dysfunction in heart failure with reduced ejection fraction and providing a perspective on recent evidence from literature.
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Affiliation(s)
- Aura Vijiiac
- Department of Cardiology, Carol Davila University of Medicine and Pharmacy, 050513 Bucharest, Romania; (S.O.); (I.P.); (S.D.); (M.D.)
- Department of Cardiology, Emergency Clinical Hospital, 014461 Bucharest, Romania; (C.G.); (A.S.); (D.Z.); (R.O.)
- Correspondence: ; Tel.: +40-(75)-2298-189
| | - Sebastian Onciul
- Department of Cardiology, Carol Davila University of Medicine and Pharmacy, 050513 Bucharest, Romania; (S.O.); (I.P.); (S.D.); (M.D.)
- Department of Cardiology, Emergency Clinical Hospital, 014461 Bucharest, Romania; (C.G.); (A.S.); (D.Z.); (R.O.)
| | - Claudia Guzu
- Department of Cardiology, Emergency Clinical Hospital, 014461 Bucharest, Romania; (C.G.); (A.S.); (D.Z.); (R.O.)
| | - Alina Scarlatescu
- Department of Cardiology, Emergency Clinical Hospital, 014461 Bucharest, Romania; (C.G.); (A.S.); (D.Z.); (R.O.)
| | - Ioana Petre
- Department of Cardiology, Carol Davila University of Medicine and Pharmacy, 050513 Bucharest, Romania; (S.O.); (I.P.); (S.D.); (M.D.)
- Department of Cardiology, Emergency Clinical Hospital, 014461 Bucharest, Romania; (C.G.); (A.S.); (D.Z.); (R.O.)
| | - Diana Zamfir
- Department of Cardiology, Emergency Clinical Hospital, 014461 Bucharest, Romania; (C.G.); (A.S.); (D.Z.); (R.O.)
| | - Roxana Onut
- Department of Cardiology, Emergency Clinical Hospital, 014461 Bucharest, Romania; (C.G.); (A.S.); (D.Z.); (R.O.)
| | - Silvia Deaconu
- Department of Cardiology, Carol Davila University of Medicine and Pharmacy, 050513 Bucharest, Romania; (S.O.); (I.P.); (S.D.); (M.D.)
- Department of Cardiology, Emergency Clinical Hospital, 014461 Bucharest, Romania; (C.G.); (A.S.); (D.Z.); (R.O.)
| | - Maria Dorobantu
- Department of Cardiology, Carol Davila University of Medicine and Pharmacy, 050513 Bucharest, Romania; (S.O.); (I.P.); (S.D.); (M.D.)
- Department of Cardiology, Emergency Clinical Hospital, 014461 Bucharest, Romania; (C.G.); (A.S.); (D.Z.); (R.O.)
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Cardiac MRI assessment of the right ventricle pre-and post-kidney transplant. Int J Cardiovasc Imaging 2021; 37:1757-1766. [PMID: 33475872 DOI: 10.1007/s10554-020-02153-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 12/29/2020] [Indexed: 10/22/2022]
Abstract
Worsening renal function in chronic kidney disease correlates with worsening right ventricular (RV) systolic function. We evaluated the association between kidney transplantation (KT) and RV structure and systolic function, and the relationships between RV and left ventricular (LV) changes, blood pressure, and specific cardiac biomarkers, in patients with end-stage kidney disease using cardiac magnetic resonance imaging (CMR). In this prospective, multi-centre, cohort study, 39 adult patients on dialysis receiving KT and 42 patients eligible for, but not yet receiving KT, were recruited. CMR was performed at baseline, and repeated at 12 months. Among 81 patients (mean age 51 years, 30% female), RV end-diastolic volume index (RVEDVi), end-systolic volume index (RVESVi), mass index (RVMi), and ejection fraction (RVEF) did not change significantly within either the dialysis or KT group over 12 months (all p ≥ 0.10). There were no significant differences in the 12-month changes of these parameters between the dialysis and KT groups (all p ≥ 0.10). RVMI demonstrated positive correlations with NT-proBNP and systolic blood pressure, but not GDF-15, at baseline and at 12 months. Changes in RVEDVi, RVESVi, and RVEF were positively correlated with changes in LVEDVi, LVESVi, and LVEF, respectively over 12 months (Spearman r = 0.72, 0.52, and 0.41; all p < 0.001), but not mass index (Spearman r = 0.20, p = 0.078). In conclusion, there were no significant changes in RV mass, volumes, or systolic function 12 months after KT, as compared with continuation of dialysis. The associations between RV and LV remodeling may suggest similar underlying pathophysiologic mechanisms.
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29
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Miyajima Y, Toyama T, Mori M, Nakade Y, Sato K, Yamamura Y, Ogura H, Yoneda-Nakagawa S, Oshima M, Miyagawa T, Usui S, Oe H, Kitajima S, Hara A, Iwata Y, Sakai N, Shimizu M, Sakai Y, Furuichi K, Wada T. Relationships between kidney dysfunction and left ventricular diastolic dysfunction: a hospital-based retrospective study. J Nephrol 2021; 34:773-780. [PMID: 33400138 DOI: 10.1007/s40620-020-00940-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 11/30/2020] [Indexed: 01/19/2023]
Abstract
BACKGROUND Preclinical left ventricular diastolic dysfunction (LVDD) is a high-risk state for heart failure. Kidney dysfunction is a known risk factor for heart failure, but its association with asymptomatic LVDD is not well-known. METHODS A hospital-based retrospective cohort study was conducted on patients who underwent echocardiogram between 2006 and 2016 to assess the association between baseline kidney function and LVDD on echocardiogram. E/e' ratio was defined as the ratio of peak velocity of early diastolic left ventricular inflow (E) to mitral annular velocity (e'). The primary outcome was time to development of LVDD, which was defined as E/e' ratio > 14. The changes in the E/e' ratio and other echocardiographic parameters were assessed using a mixed effects model. RESULTS Among 1167 patients, the mean age was 61 years, and the mean baseline E/e' ratio and ejection fraction were 9.6 and 69%, respectively. During a median follow-up of 3.2 years, 231 (19.8%) people developed LVDD. According to eGFR (mL/min/1.73 m2), the risk for LVDD based on hazard ratio [95% confidence interval (95% CI)] was 1.20 (0.82, 1.75) for 60 to < 90, 1.42 (0.87, 2.31) for 45 to < 60, and 2.57 (1.61, 4.09) for < 45 (P trend < 0.001). The adjusted risks (95% CI) for annual change in E/e' ratio was 0.09 (0.03, 0.14) overall and 0.28 (0.11, 0.45) in the lowest eGFR group; the trend in changes in annual E/e' ratio by baseline eGFR was significant (P trend = 0.01). CONCLUSIONS Relatively low kidney function was related with the risks for LVDD. Long-term cohort studies are warranted to confirm the association between LVDD and symptomatic heart failure in patients with kidney dysfunction.
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Affiliation(s)
- Yoshiyasu Miyajima
- Department of Nephrology and Laboratory Medicine, Kanazawa University, Kanazawa, Japan.,Department of Clinical Laboratory, Kanazawa University Hospital, Kanazawa, Japan
| | - Tadashi Toyama
- Department of Nephrology and Laboratory Medicine, Kanazawa University, Kanazawa, Japan. .,Innovative Clinical Research Center, Kanazawa University, Kanazawa, Japan.
| | - Mika Mori
- Department of Clinical Laboratory, Kanazawa University Hospital, Kanazawa, Japan.,Department of Cardiovascular Medicine, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan
| | - Yusuke Nakade
- Department of Nephrology and Laboratory Medicine, Kanazawa University, Kanazawa, Japan.,Department of Clinical Laboratory, Kanazawa University Hospital, Kanazawa, Japan
| | - Koichi Sato
- Department of Nephrology and Laboratory Medicine, Kanazawa University, Kanazawa, Japan
| | - Yuta Yamamura
- Department of Nephrology and Laboratory Medicine, Kanazawa University, Kanazawa, Japan
| | - Hisayuki Ogura
- Department of Nephrology and Laboratory Medicine, Kanazawa University, Kanazawa, Japan.,Innovative Clinical Research Center, Kanazawa University, Kanazawa, Japan
| | | | - Megumi Oshima
- Department of Nephrology and Laboratory Medicine, Kanazawa University, Kanazawa, Japan
| | - Taro Miyagawa
- Department of Nephrology and Laboratory Medicine, Kanazawa University, Kanazawa, Japan
| | - Soichiro Usui
- Department of Clinical Laboratory, Kanazawa University Hospital, Kanazawa, Japan.,Department of Cardiovascular Medicine, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan
| | - Hiroyasu Oe
- Department of Clinical Laboratory, Kanazawa University Hospital, Kanazawa, Japan
| | - Shinji Kitajima
- Department of Nephrology and Laboratory Medicine, Kanazawa University, Kanazawa, Japan
| | - Akinori Hara
- Department of Nephrology and Laboratory Medicine, Kanazawa University, Kanazawa, Japan
| | - Yasunori Iwata
- Department of Nephrology and Laboratory Medicine, Kanazawa University, Kanazawa, Japan
| | - Norihiko Sakai
- Department of Nephrology and Laboratory Medicine, Kanazawa University, Kanazawa, Japan
| | - Miho Shimizu
- Department of Nephrology and Laboratory Medicine, Kanazawa University, Kanazawa, Japan
| | - Yoshio Sakai
- Department of Nephrology and Laboratory Medicine, Kanazawa University, Kanazawa, Japan.,Department of Clinical Laboratory, Kanazawa University Hospital, Kanazawa, Japan
| | - Kengo Furuichi
- Department of Nephrology, Kanazawa Medical University School of Medicine, Uchinada, Japan
| | - Takashi Wada
- Department of Nephrology and Laboratory Medicine, Kanazawa University, Kanazawa, Japan. .,Department of Clinical Laboratory, Kanazawa University Hospital, Kanazawa, Japan.
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30
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Ascione G, Del Forno B, Carino D, Lapenna E, Schiavi D, Denti P, Bisogno A, Verzini A, Iaci G, Alfieri O, Castiglioni A, De Bonis M. Treatment of isolated tricuspid regurgitation in 2020: an update. Fac Rev 2020; 9:26. [PMID: 33659958 PMCID: PMC7886069 DOI: 10.12703/r/9-26] [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] [Indexed: 11/15/2022] Open
Abstract
Tricuspid valve regurgitation is an insidious pathology that is associated with increased mortality if left untreated. Conversely, surgical correction of tricuspid regurgitation is burdened by poor outcomes, especially when right ventricular dysfunction, kidney disease, or liver disease occur. There is, therefore, increasing interest in transcatheter approaches as an alternative to surgery in patients at high or prohibitive surgical risk. The development of percutaneous devices to treat tricuspid regurgitation has several technical challenges, mainly because of the complexity of valve anatomy, thus requiring accurate patient selection. Here we review the currently available transcatheter approaches to treat severe tricuspid regurgitation.
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Affiliation(s)
- Guido Ascione
- Department of Cardiac Surgery, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Benedetto Del Forno
- Department of Cardiac Surgery, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Davide Carino
- Department of Cardiac Surgery, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Elisabetta Lapenna
- Department of Cardiac Surgery, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | - Paolo Denti
- Department of Cardiac Surgery, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Arturo Bisogno
- Department of Cardiac Surgery, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Alessandro Verzini
- Department of Cardiac Surgery, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giuseppe Iaci
- Department of Cardiac Surgery, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Ottavio Alfieri
- Department of Cardiac Surgery, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Alessandro Castiglioni
- Department of Cardiac Surgery, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Michele De Bonis
- Department of Cardiac Surgery, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Milan, Italy
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31
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Nakagawa A, Yasumura Y, Yoshida C, Okumura T, Tateishi J, Yoshida J, Abe H, Tamaki S, Yano M, Hayashi T, Nakagawa Y, Yamada T, Nakatani D, Hikoso S, Sakata Y. Prognostic Importance of Right Ventricular-Vascular Uncoupling in Acute Decompensated Heart Failure With Preserved Ejection Fraction. Circ Cardiovasc Imaging 2020; 13:e011430. [DOI: 10.1161/circimaging.120.011430] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Background:
Recent accumulating evidence reveals that the right ventricular (RV)-pulmonary artery (PA) uncoupling is associated with poor outcome in patients with heart failure (HF), RV dysfunction, and pulmonary hypertension. However, the prognostic utility of RV-PA uncoupling in HF with preserved ejection fraction (HFpEF) remains elusive. In this study, we aim to investigate the associations of RV-PA uncoupling with outcomes of HFpEF inpatients.
Methods:
We prospectively studied 655 patients, registered in PURSUIT-HFpEF (The Prospective Multicenter Obervational Study of Patients with Heart Failure with Preserved Ejection Fraction), a multicenter observational study of Japanese HFpEF inpatients. We assigned registered patients based on the determined value of tricuspid annular plane systolic excursion/pulmonary artery systolic pressure ratio that can predict primary outcome as an indicator of RV-PA uncoupling.
Results:
Univariable Cox regression testing revealed that RV-PA uncoupling was associated with the primary endpoint of all-cause death, HF rehospitalization, and cerebrovascular events (hazard ratio [HR] 1.77 [95% CI, 1.34–2.32],
P
<0.0001) and the secondary endpoints of all-cause death and HF rehospitalization (HR 2.75 [95% CI, 1.77–4.33],
P
<0.0001, HR 1.63 [95% CI, 1.18–2.26],
P
=0.0036, respectively). Multivariable analysis also showed that RV-PA uncoupling was significantly associated with primary endpoint and all-cause death independent of age, sex, atrial fibrillation, renal dysfunction, elevated E/e’, and elevated NT-proBNP (N-terminal pro-B-type natriuretic peptide) (HR 1.38 [95% CI, 1.01–1.88],
P
=0.0413, HR 1.85 [95% CI, 1.14–3.01],
P
=0.0129, respectively).
Conclusions:
Prospective study of a hospitalized cohort revealed that RV-PA uncoupling was independently associated with adverse outcomes in acute decompensated patients with HFpEF.
Registration:
URL:
https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000024414
. Unique identifier: UMIN000021831.
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Affiliation(s)
- Akito Nakagawa
- Division of Cardiovascular Medicine, Amagasaki-Chuo Hospital, Hyogo, Japan (A.N., Y.Y., C.Y., T.O., J.T., J.Y.)
- Department of Medical Informatics (A.N.), Osaka University Graduate School of Medicine, Suita, Japan
| | - Yoshio Yasumura
- Division of Cardiovascular Medicine, Amagasaki-Chuo Hospital, Hyogo, Japan (A.N., Y.Y., C.Y., T.O., J.T., J.Y.)
| | - Chikako Yoshida
- Division of Cardiovascular Medicine, Amagasaki-Chuo Hospital, Hyogo, Japan (A.N., Y.Y., C.Y., T.O., J.T., J.Y.)
| | - Takahiro Okumura
- Division of Cardiovascular Medicine, Amagasaki-Chuo Hospital, Hyogo, Japan (A.N., Y.Y., C.Y., T.O., J.T., J.Y.)
| | - Jun Tateishi
- Division of Cardiovascular Medicine, Amagasaki-Chuo Hospital, Hyogo, Japan (A.N., Y.Y., C.Y., T.O., J.T., J.Y.)
| | - Junichi Yoshida
- Division of Cardiovascular Medicine, Amagasaki-Chuo Hospital, Hyogo, Japan (A.N., Y.Y., C.Y., T.O., J.T., J.Y.)
| | - Haruhiko Abe
- Cardiovascular Division, National Hospital Organization Osaka National Hospital, Japan (H.A.)
| | - Shunsuke Tamaki
- Division of Cardiology, Osaka General Medical Center, Japan (S.T., T.Y.)
| | - Masamichi Yano
- Division of Cardiology, Osaka Rosai Hospital, Sakai, Japan (M.Y.)
| | | | - Yusuke Nakagawa
- Division of Cardiology, Kawanishi City Hospital, Hyogo, Japan (Y.N.)
| | - Takahisa Yamada
- Division of Cardiology, Osaka General Medical Center, Japan (S.T., T.Y.)
| | - Daisaku Nakatani
- Department of Cardiovascular Medicine (D.N., S.H., Y.S.), Osaka University Graduate School of Medicine, Suita, Japan
| | - Shungo Hikoso
- Department of Cardiovascular Medicine (D.N., S.H., Y.S.), Osaka University Graduate School of Medicine, Suita, Japan
| | - Yasushi Sakata
- Department of Cardiovascular Medicine (D.N., S.H., Y.S.), Osaka University Graduate School of Medicine, Suita, Japan
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32
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Bayne J, Francke M, Ma E, Rubin GA, Avula UMR, Baksh H, Givens R, Wan EY. Increased Incidence of Chronic Kidney Injury in African Americans Following Cardiac Transplantation. J Racial Ethn Health Disparities 2020; 8:1435-1446. [PMID: 33113077 DOI: 10.1007/s40615-020-00906-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Revised: 10/20/2020] [Accepted: 10/20/2020] [Indexed: 01/10/2023]
Abstract
OBJECTIVES This study examined whether African American race was associated with an elevated risk of chronic kidney disease (CKD) post-cardiac transplantation. BACKGROUND CKD often occurs after cardiac transplantation and may require renal replacement therapy (RRT) or renal transplant. African American patients have a higher risk for kidney disease as well as worse post-cardiac transplant morbidity and mortality. It is unclear, however, if there is a propensity for African Americans to develop CKD after cardiac transplant. METHODS The Institutional Review Board of Columbia University Medical Center approved the retrospective study of 151 adults (57 African American and 94 non-African American) who underwent single-organ heart transplant from 2013 to 2016. The primary outcome was a decrease in estimated glomerular filtration rate (eGFR), development of CKD, and end-stage renal disease (ESRD) requiring RRT after 2 years. RESULTS African American patients had a significant decline in eGFR post-cardiac transplant compared to non-African American patients (- 34 ± 6 vs. - 20 ± 4 mL/min/1.73 m2, p < 0.0006). African American patients were more likely to develop CKD stage 2 or worse (eGFR < 90 mL/min/1.73 m2) than non-African American patients (81% vs. 59%, p < 0.0005). CONCLUSIONS This is the first study to report that African American patients are at a significantly higher risk for eGFR decline and CKD at 2 years post-cardiac transplant. Future investigation into risk reduction is necessary for this patient population.
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Affiliation(s)
- Joseph Bayne
- Division of Cardiology, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Michael Francke
- Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Elaine Ma
- Division of Cardiology, Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, 622 W168 Street, PH 3-Center, New York, NY, 10032, USA
| | - Geoffrey A Rubin
- Division of Cardiology, Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, 622 W168 Street, PH 3-Center, New York, NY, 10032, USA
| | - Uma Mahesh R Avula
- Division of Cardiology, Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, 622 W168 Street, PH 3-Center, New York, NY, 10032, USA
| | - Haajra Baksh
- Division of Cardiology, Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, 622 W168 Street, PH 3-Center, New York, NY, 10032, USA
| | - Raymond Givens
- Division of Cardiology, Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, 622 W168 Street, PH 3-Center, New York, NY, 10032, USA
| | - Elaine Y Wan
- Division of Cardiology, Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, 622 W168 Street, PH 3-Center, New York, NY, 10032, USA.
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33
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Tonchev I, Heberman D, Peretz A, Medvedovsky AT, Gotsman I, Rashi Y, Poles L, Goland S, Perlman GY, Danenberg HD, Beeri R, Shuvy M. Acute kidney injury after MitraClip implantation in patients with severe mitral regurgitation. Catheter Cardiovasc Interv 2020; 97:E868-E874. [DOI: 10.1002/ccd.29250] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 08/17/2020] [Indexed: 12/20/2022]
Affiliation(s)
- Ivaylo Tonchev
- Heart Institute Hadassah‐Hebrew University Medical Center Jerusalem Israel
| | - Dan Heberman
- Heart Center, Kaplan Medical Center Rehovot Israel
| | - Alona Peretz
- Heart Institute Hadassah‐Hebrew University Medical Center Jerusalem Israel
| | | | - Israel Gotsman
- Heart Institute Hadassah‐Hebrew University Medical Center Jerusalem Israel
| | - Yonatan Rashi
- Heart Institute Hadassah‐Hebrew University Medical Center Jerusalem Israel
| | - Lion Poles
- Heart Center, Kaplan Medical Center Rehovot Israel
| | - Sorel Goland
- Heart Center, Kaplan Medical Center Rehovot Israel
| | - Gidon Y. Perlman
- Heart Institute Hadassah‐Hebrew University Medical Center Jerusalem Israel
| | - Haim D. Danenberg
- Heart Institute Hadassah‐Hebrew University Medical Center Jerusalem Israel
| | - Ronen Beeri
- Heart Institute Hadassah‐Hebrew University Medical Center Jerusalem Israel
| | - Mony Shuvy
- Heart Institute Hadassah‐Hebrew University Medical Center Jerusalem Israel
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34
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Ishigami J, Trevisan M, Lund LH, Jernberg T, Coresh J, Matsushita K, Carrero J. Acceleration of kidney function decline after incident hospitalization with cardiovascular disease: the Stockholm
CREAtinine
Measurements (
SCREAM
) project. Eur J Heart Fail 2020; 22:1790-1799. [DOI: 10.1002/ejhf.1968] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 06/24/2020] [Accepted: 07/15/2020] [Indexed: 01/01/2023] Open
Affiliation(s)
- Junichi Ishigami
- Department of Epidemiology Johns Hopkins Bloomberg School of Public Health Baltimore MD USA
| | - Marco Trevisan
- Department of Medical Epidemiology and Biostatistics Karolinska Institutet Stockholm Sweden
| | - Lars H. Lund
- Department of Medicine Unit of Cardiology, Heart and Vascular Theme, Karolinska Institutet, Karolinska University Hospital Stockholm Sweden
| | - Tomas Jernberg
- Department of Clinical Sciences Danderyd Hospital, Karolinska Institutet Stockholm Sweden
| | - Josef Coresh
- Department of Epidemiology Johns Hopkins Bloomberg School of Public Health Baltimore MD USA
| | - Kunihiro Matsushita
- Department of Epidemiology Johns Hopkins Bloomberg School of Public Health Baltimore MD USA
| | - Juan‐Jesus Carrero
- Department of Medical Epidemiology and Biostatistics Karolinska Institutet Stockholm Sweden
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35
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Rozenbaum Z, Atlan L, Taieb P, Shalmon T, Berliner S, Arbel Y, Aviram G. Early cardio-renal interactions among apparently healthy individuals undergoing coronary CT. Int J Cardiol 2020; 312:117-122. [DOI: 10.1016/j.ijcard.2020.02.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Revised: 02/01/2020] [Accepted: 02/14/2020] [Indexed: 10/25/2022]
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36
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Benefits of peritoneal ultrafiltration in HFpEF and HFrEF patients. BMC Nephrol 2020; 21:179. [PMID: 32410664 PMCID: PMC7222460 DOI: 10.1186/s12882-020-01777-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Accepted: 03/20/2020] [Indexed: 01/18/2023] Open
Abstract
Background Peritoneal ultrafiltration (pUF) in refractory heart failure (HF) reduces the incidence of decompensation episodes, which is of particular significance as each episode incrementally adds to mortality. Nevertheless, there are insufficient data about which patient cohort benefits the most. The objective of this study was to compare pUF in HFrEF and HFpEF, focusing on functional status, hospitalizations, surrogate endpoints and mortality. Methods This study involves 143 patients, who could be classified as either HFpEF (n = 37, 25.9%) or HFrEF (n = 106, 74.1%) and who received pUF due to refractory HF. Results Baseline eGFR was similar in HFrEF (23.1 ± 10.6 mg/dl) and HFpEF (27.8 ± 13.2 mg/dl). Significant improvements in NYHA class were found in HFpEF (3.19 ± 0.61 to 2.72 ± 0.58, P < 0.001) and HFrEF (3.45 ± 0.52 to 2.71 ± 0.72, P < 0.001). CRP decreased in HFrEF (19.4 ± 17.6 mg/l to 13.7 ± 21.4 mg/l, P = 0.018) and HFpEF (33.7 ± 52.6 mg/l to 17.1 ± 26.3 mg/l, P = 0.004). Body weight was significantly reduced in HFrEF (81.1 ± 14.6 kg to 77.2 ± 15.6 kg, P = 0.003) and HFpEF (86.9 ± 15.8 kg to 83.1 ± 15.9 kg, P = 0.005). LVEF improved only in HFrEF (25.9 ± 6.82% to 30.4 ± 12.2%, P = 0.046). BCR decreased significantly in HFrEF and HFpEF (55.7 ± 21.9 to 34.3 ± 17.9 P > 0.001 and 50.5 ± 68.9 to 37.6 ± 21.9, P = 0.006). Number of hospitalization episodes as well as number of hospitalization days decreased significantly only in HFpEF (total number 2.88 ± 1.62 to 1.25 ± 1.45, P < 0.001, days 40.4 ± 31.7 to 18.3 ± 22.5 days, P = 0.005). Conclusions pUF offers various benefits in HFpEF and HFrEF, but there are also substantial differences. In particular, hospitalization rates were found to be significantly reduced in HFpEF patients, indicating a greater medical and economical advantage. However, LVEF was only found to be improved in HFrEF patients. While pUF can now be regarded as an option to supplement classical HF therapy, further studies are desirable to obtain specifications about pUF in HFpEF, HFmEF and HFrEF patients.
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37
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Abstract
Cardiorenal syndrome is a complex interplay of dysregulated heart and kidney interaction that leads to multiorgan system dysfunction, which is not an uncommon occurrence in the setting of right heart failure. The traditional concept of impaired perfusion and forward flow recently has been modified to include the recognition of systemic venous congestion as a contributor, with direct and indirect mechanisms, including elevated renal venous pressure, reduced renal perfusion pressure, increased renal interstitial pressure, tubular dysfunction, splanchnic congestion, and neurohormonal and inflammatory activation. Treatment options beyond diuretics and vasoactive drugs remain limited and lack supportive evidence.
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Affiliation(s)
- Thida Tabucanon
- Kaufman Center for Heart Failure Treatment and Recovery, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, 9500 Euclid Avenue, Desk J3-4, Cleveland, OH 44195, USA
| | - Wai Hong Wilson Tang
- Kaufman Center for Heart Failure Treatment and Recovery, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, 9500 Euclid Avenue, Desk J3-4, Cleveland, OH 44195, USA; Department of Cardiovascular Medicine, Cleveland Clinic, 9500 Euclid Avenue, Desk J3-4, Cleveland, OH 44195, USA.
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38
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Correale M, Mallardi A, Mazzeo P, Tricarico L, Diella C, Romano V, Ferraretti A, Leopizzi A, Merolla G, Di Biase M, Brunetti ND. Sacubitril/valsartan improves right ventricular function in a real-life population of patients with chronic heart failure: The Daunia Heart Failure Registry. IJC HEART & VASCULATURE 2020; 27:100486. [PMID: 32140553 PMCID: PMC7044512 DOI: 10.1016/j.ijcha.2020.100486] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Accepted: 02/17/2020] [Indexed: 02/06/2023]
Abstract
Background Previous studies and case-series showed improvement in left ventricular (LV) function and reverse remodeling after sacubitril/valsartan therapy in real-world studies. We therefore aimed to evaluate whether also right ventricular (RV) function may improve after sacubitril/valsartan therapy. Methods Sixty consecutive patients with chronic heart failure and NYHA class II-III were followed up for 12 months after therapy with sacubitril/valsartan. Left and (RV) function was assessed at baseline and after 12 months of therapy. Results At 12-month control, therapy with sacubitril/valsartan was associated with a significant improvement in a series of echo parameters: LVEF (p < 0.05), LV end-systolic volume (p < 0.01), left atrium area (p < 0.05).Right ventricular echo parameters were also improved after sacubitril/valsartan therapy: PAsP (31.0 ± 12.8 vs 34.7 ± 12.5 mmHg, p < 0.05), TAPSE (17.8 ± 3.9 vs 16.5 ± 4.0 mm, p < 0.001); mean PAsP reduction was 3.7 ± 11.4 mmHg (-6.3 ± 37.7%), mean TAPSE increase 1.3 ± 2.5 mm (+9.5 ± 15.7%).Indexed (%) improvement in PAsP (r 0.33, p < 0.01) and TAPSE (r -0.42, p < 0.01) values were proportional to baseline levels. Improvement in PAsP and TAPSE were independent of left ventricular improvements except for PAsP and end-systolic volumes (r 0.44, p < 0.01). Conclusions In a real world scenario, sacubitril/valsartan was associated with an improved RV function.
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Affiliation(s)
| | - Adriana Mallardi
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Pietro Mazzeo
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Lucia Tricarico
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Claudia Diella
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Valentina Romano
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | | | - Alessandra Leopizzi
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | | | - Matteo Di Biase
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
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39
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Ishigami J, Cowan LT, Demmer RT, Grams ME, Lutsey PL, Carrero JJ, Coresh J, Matsushita K. Incident Hospitalization with Major Cardiovascular Diseases and Subsequent Risk of ESKD: Implications for Cardiorenal Syndrome. J Am Soc Nephrol 2020; 31:405-414. [PMID: 31919105 DOI: 10.1681/asn.2019060574] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Accepted: 11/16/2019] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Cardiorenal syndrome is a well known concept, bolstered by extensive investigations of CKD as a risk factor of cardiovascular disease. However, data on whether cardiovascular disease increases long-term risk of ESKD are sparse. METHODS We assessed the association of incident hospitalization with major cardiovascular diseases (heart failure, atrial fibrillation, coronary heart disease, and stroke) with subsequent risk of ESKD among individuals enrolled in the Atherosclerosis Risk in Communities study; the analysis included 9047 individuals without prevalent cardiovascular disease at their fourth study visit. Each relevant incident cardiovascular disease event was entered into multivariable Cox proportional hazard models as a time-varying exposure to estimate hazard ratios. RESULTS During a median follow-up of 17.5 years, there were 2598 cases of hospitalization with cardiovascular disease (heart failure, n=1269; atrial fibrillation, n=1337; coronary heart disease, n=696; and stroke, n=559) and 210 cases of incident ESKD. The incidence of major cardiovascular disease was associated with increased risk of ESKD, with the highest risk for heart failure (hazard ratio, 11.40; 95% confidence interval, 8.38 to 15.50), followed by coronary heart disease, atrial fibrillation, and stroke. When we analyzed heart failure with preserved ejection fraction and heart failure with reduced ejection fraction separately, the risk was nominally higher for heart failure with preserved ejection fraction. CONCLUSIONS Major incident cardiovascular disease events were associated with ESKD, independent of kidney risk factors. In particular, heart failure showed a very strong association with ESKD. Our findings highlight the importance of monitoring and managing kidney disease in patients with cardiovascular disease. The potentially distinct contribution to ESKD of heart failure with preserved versus reduced ejection fraction deserves future investigation.
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Affiliation(s)
- Junichi Ishigami
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland;
| | - Logan T Cowan
- Department of Biostatistics, Epidemiology, and Environmental Health Science, Georgia Southern University, Statesboro, Georgia
| | - Ryan T Demmer
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota
| | - Morgan E Grams
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.,Department of Medicine, Johns Hopkins University, Baltimore, Maryland; and
| | - Pamela L Lutsey
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota
| | - Juan-Jesus Carrero
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Josef Coresh
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Kunihiro Matsushita
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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40
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Cho JS, Shim JK, Lee S, Song JW, Choi N, Lee S, Kwak YL. Chronic progression of cardiac surgery associated acute kidney injury: Intermediary role of acute kidney disease. J Thorac Cardiovasc Surg 2019; 161:681-688.e3. [PMID: 31959433 DOI: 10.1016/j.jtcvs.2019.10.101] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 10/24/2019] [Accepted: 10/25/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE The association between acute kidney injury (AKI) and chronic kidney disease (CKD) remains elusive in cardiac surgery. We investigated the association between postoperative AKI and CKD development, emphasizing the intermediary role of acute kidney disease (AKD), in patients undergoing valvular heart surgery. METHODS We assessed the occurrence of postoperative AKI (7 days postsurgery), AKD (3 months postsurgery), and CKD (12 months postsurgery) in 1386 patients. The primary outcome was the development of AKD and CKD according to AKI occurrence. Relevant risk factors of AKI, AKD, and CKD were identified through multivariable regression analysis. RESULTS AKI occurred in 23.9% of patients with normal preoperative renal function. Even with early recovery of renal function within 3 days, AKI increased the risk of AKD (odds ratio [OR], 3.21; 95% confidence interval [CI], 1.98-5.20, P < .001) and CKD (OR, 2.86; 95% CI, 1.68-4.86, P < .001), whereas persistent AKI further increased the risk of AKD (OR, 12.07; 95% CI, 5.56-26.21, P < .001) and CKD (OR, 10.54; 95% CI, 4.01-27.76, P < .001). We also found these relationships in patients with pre-existing renal dysfunction. Multivariable analysis identified 3-month postoperative heart failure and high right ventricular systolic pressure as independent risk factors for CKD. CONCLUSIONS Even after early recovery, postvalvular heart surgery AKI was associated with increased risk of CKD via AKD in a graded manner related to AKI severity and persistence. Postoperative cardiac dysfunction assessed 3 months postsurgery also significantly influenced CKD development, indicating a need for close follow-up of cardiac and renal function to improve patient outcomes.
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Affiliation(s)
- Jin Sun Cho
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jae-Kwang Shim
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea; Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sak Lee
- Department of Thoracic and Cardiovascular Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jong-Wook Song
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea; Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Nakcheol Choi
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sugeun Lee
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Young-Lan Kwak
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea; Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea.
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Taramasso M, Gavazzoni M, Pozzoli A, Dreyfus GD, Bolling SF, George I, Kapos I, Tanner FC, Zuber M, Maisano F, Hahn RT. Tricuspid Regurgitation. JACC Cardiovasc Imaging 2019; 12:605-621. [DOI: 10.1016/j.jcmg.2018.11.034] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Revised: 11/05/2018] [Accepted: 11/13/2018] [Indexed: 12/21/2022]
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42
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Grossekettler L, Schmack B, Meyer K, Brockmann C, Wanninger R, Kreusser MM, Frankenstein L, Kihm LP, Zeier M, Katus HA, Remppis A, Schwenger V. Peritoneal dialysis as therapeutic option in heart failure patients. ESC Heart Fail 2019; 6:271-279. [PMID: 30815994 PMCID: PMC6437425 DOI: 10.1002/ehf2.12411] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 01/06/2019] [Indexed: 12/30/2022] Open
Abstract
Aims Each episode of acute decompensated heart failure (HF) incrementally adds to mortality. Peritoneal dialysis (PD) offers an alternative therapeutic option in refractory HF and reduces the incidence of decompensation episodes. The objective of this study was to determine the efficacy of PD, in terms of functional status, surrogate endpoints, rate of hospitalizations, and mortality. Methods and results This study is based on the registry of the German Society of Nephrology, involving 159 patients receiving PD treatment due to refractory HF between January 2010 and December 2014. Body weight was reduced by PD (82.2 ± 14.9 to 78.4 ± 14.8 kg, P < 0.001), and significant improvements in New York Heart Association functional class (3.38 ± 0.55 to 2.85 ± 0.49, P < 0.001) were found already after 3 months. Left ventricular ejection fraction did not change (31.5 ± 13.8 to 34.0 ± 15.7%, P = 0.175). C‐reactive protein improved with PD treatment (33.7 ± 52.6 to 17.1 ± 26.3 mg/L, P = 0.004). Blood urea nitrogen/creatinine ratio decreased significantly (148.7 ± 68.3 to 106.7 ± 44.8 mg/dL, P < 0.001). Hospitalization rates decreased significantly (total number 2.86 ± 1.88 to 1.90 ± 1.78, P = 0.001, and 39.2 ± 30.7 to 27.1 ± 25.2 days, P = 0.004). One year mortality was 39.6% in end‐stage HF patients treated with PD. Conclusions Peritoneal dialysis offers an additional therapeutic option in end‐stage HF and is associated with improved New York Heart Association classification and reduced hospitalization. Although PD treatment was associated with various benefits, further studies are necessary to identify which patients benefit the most from PD.
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Affiliation(s)
- Leonie Grossekettler
- Department of Internal Medicine III, Cardiology, Angiology and Pulmonology, University Hospital of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Bastian Schmack
- Clinic for Cardiac Surgery, University Hospital of Heidelberg, Heidelberg, Germany
| | - Katrin Meyer
- Clinic for Cardiology, Heart and Vascular Center, Bad Bevensen, Germany
| | | | | | - Michael M Kreusser
- Department of Internal Medicine III, Cardiology, Angiology and Pulmonology, University Hospital of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Lutz Frankenstein
- Department of Internal Medicine III, Cardiology, Angiology and Pulmonology, University Hospital of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Lars P Kihm
- Department of Internal Medicine I, Endocrinology and Nephrology, University Hospital of Heidelberg, Heidelberg, Germany
| | - Martin Zeier
- Department of Internal Medicine I, Endocrinology and Nephrology, University Hospital of Heidelberg, Heidelberg, Germany
| | - Hugo A Katus
- Department of Internal Medicine III, Cardiology, Angiology and Pulmonology, University Hospital of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Andrew Remppis
- Clinic for Cardiology, Heart and Vascular Center, Bad Bevensen, Germany
| | - Vedat Schwenger
- Department of Internal Medicine I, Endocrinology and Nephrology, University Hospital of Heidelberg, Heidelberg, Germany.,Department of Kidney, Blood Pressure and Autoimmune Diseases, Katharinenhospital, Klinikum Stuttgart, Stuttgart, Germany
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Reuillard A, Garrouste C, Pereira B, Azarnoush K, Souteyrand G, Aniort J, Innorta A, Clerfond G, Heng AE, Eschalier R, Motreff P, Combaret N. Evolution of chronic kidney disease after surgical aortic valve replacement or transcatheter aortic valve implantation. Arch Cardiovasc Dis 2019; 112:162-170. [PMID: 30655226 DOI: 10.1016/j.acvd.2018.10.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 07/22/2018] [Accepted: 10/04/2018] [Indexed: 12/22/2022]
Abstract
BACKGROUND Immediate improvement in kidney function has been reported after surgical aortic valve replacement or transcatheter aortic valve implantation. Long-term data, however, are not available. AIM To assess the evolution of kidney function in chronic kidney disease stage 3b-5, 1 year after surgical aortic valve replacement or transcatheter aortic valve implantation. METHODS All patients with chronic kidney disease stage 3b-5 undergoing surgical aortic valve replacement or transcatheter aortic valve implantation for aortic stenosis in a single centre were included. Kidney function was assessed 1 year postprocedure. Improvement or deterioration in estimated glomerular filtration rate was defined by an increase or decrease of 5mL/min/1.73 m2, respectively. RESULTS Overall, 127 procedures were analysed (54 surgical aortic valve replacements and 73 transcatheter aortic valve implantations). Kidney function improved in 51% of patients at 1 year (45% of the surgical aortic valve replacement group versus 57% of the transcatheter aortic valve implantation group; P=0.21), and deteriorated in only 14% of patients at 1 year (18% of the surgical aortic valve replacement group versus 10% of the transcatheter aortic valve implantation group; P=0.22). Almost a quarter of patients (23%) had an improvement in estimated glomerular filtration rate of>15mL/min/1.73 m2, and this was consistent at later follow-up. Few patients went onto chronic dialysis at 1 year (three after surgical aortic valve replacement and one after transcatheter aortic valve implantation). Acute kidney injury was an independent prognostic factor for long-term deterioration in kidney function (odds ratio 2.1, 95% confidence interval 1.4-3.6; P=0.006). CONCLUSION Aortic valve replacement, whether by surgical aortic valve replacement or transcatheter aortic valve implantation, improved estimated glomerular filtration rate at 1 year in more than half of patients with chronic kidney disease stage 3b-5.
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Affiliation(s)
- Adrien Reuillard
- Service de cardiologie, CHU de Clermont-Ferrand, 58, rue Montalembert, 63000 Clermont-Ferrand, France.
| | - Cyril Garrouste
- Service de néphrologie, CHU de Clermont-Ferrand, 63000 Clermont-Ferrand, France
| | - Bruno Pereira
- Unité de biostatistiques (délégation à la recherche clinique et à l'innovation), CHU de Clermont-Ferrand, 63000 Clermont-Ferrand, France
| | - Kasra Azarnoush
- Service de chirurgie cardiaque, CHU de Clermont-Ferrand, 63000 Clermont-Ferrand, France
| | - Géraud Souteyrand
- Service de cardiologie, institut Pascal, université Clermont-Auvergne, CHU de Clermont-Ferrand, 63000 Clermont-Ferrand, France
| | - Julien Aniort
- Service de néphrologie, CHU de Clermont-Ferrand, 63000 Clermont-Ferrand, France
| | - Andrea Innorta
- Service de chirurgie cardiaque, CHU de Clermont-Ferrand, 63000 Clermont-Ferrand, France
| | - Guillaume Clerfond
- Service de cardiologie, institut Pascal, université Clermont-Auvergne, CHU de Clermont-Ferrand, 63000 Clermont-Ferrand, France
| | - Anne Elisabeth Heng
- Service de néphrologie, CHU de Clermont-Ferrand, 63000 Clermont-Ferrand, France
| | - Romain Eschalier
- Service de cardiologie, institut Pascal, université Clermont-Auvergne, CHU de Clermont-Ferrand, 63000 Clermont-Ferrand, France
| | - Pascal Motreff
- Service de cardiologie, institut Pascal, université Clermont-Auvergne, CHU de Clermont-Ferrand, 63000 Clermont-Ferrand, France
| | - Nicolas Combaret
- Service de cardiologie, institut Pascal, université Clermont-Auvergne, CHU de Clermont-Ferrand, 63000 Clermont-Ferrand, France
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Lo K, Mezue K, Ram P, Goyal A, Shah M, Krishnamoorthy P, Gupta S, Pressman G, Rangaswami J. Echocardiographic and Hemodynamic Parameters Associated with Diminishing Renal Filtration among Patients with Heart Failure with Preserved Ejection Fraction. Cardiorenal Med 2018; 9:83-91. [DOI: 10.1159/000494089] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Accepted: 09/27/2018] [Indexed: 11/19/2022] Open
Abstract
Background: Renal dysfunction is an important predictor of poor outcomes in patients with heart failure with preserved ejection fraction (HFpEF). Right ventricular (RV) dysfunction is implicated as one of the explanations for worsening renal function in cardiorenal syndrome. Novel right heart catheterization (RHC) parameters such as pulmonary artery pulsatility index (PAPi) and right atrial to pulmonary capillary wedge pressure ratio (RA:PCWP) have been found as predictors of RV dysfunction. However, most studies investigating these parameters have been done in the setting of myocardial infarction or left ventricular assist device implantation, with limited data on these metrics in patients with HFpEF. Objective: The purpose of this study was to determine whether novel RHC parameters such as RA:PCWP and PAPi correlate with long-term renal outcomes among patients with HFpEF. Methods: A retrospective single-center study of adult patients with a documented diagnosis of heart failure who had RHC was performed between January 2006 and December 2010 at Einstein Med ical Center Philadelphia. Selected patients also had a serum B-type natriuretic peptide level ≥100 pg/mL and a PCWP ≥15 mm Hg. Patients with an ejection fraction < 50%, including those with recovered ejection fraction, and end-stage renal disease were excluded. Results: A total of 81 patients with a clinical diagnosis of HFpEF were identified who met the inclusion criteria. On multivariate analysis, after adjusting for age, sex, race, diabetes, hypertension, and cardiac index, PAPi was associated with long-term estimated glomerular filtration rate (eGFR) (β = 3.43, 95% CI = 0.635–6.23, p = 0.017), and RA:PCWP showed a trend towards significance (β = 14.81, 95% CI = –0.096–29.73, p = 0.051). The results were unchanged after further adjustment for eGFR at the time of RHC. Conclusion: Novel hemodynamic indices obtained by RHC may have predictive value for long-term renal dysfunction in patients with HFpEF.
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Pavo N, Yarragudi R, Puttinger H, Arfsten H, Strunk G, Bojic A, Hülsmann M, Vychytil A. Parameters associated with therapeutic response using peritoneal dialysis for therapy refractory heart failure and congestive right ventricular dysfunction. PLoS One 2018; 13:e0206830. [PMID: 30452453 PMCID: PMC6242305 DOI: 10.1371/journal.pone.0206830] [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: 02/11/2018] [Accepted: 10/19/2018] [Indexed: 02/01/2023] Open
Abstract
Background In patients with refractory heart failure (HF) peritoneal dialysis (PD) is associated with improved functional status and decrease in hospitalization. However, previous studies did not focus on right ventricular dysfunction as an important pathophysiologic component of cardiorenal syndrome. Methods In a prospective cohort study PD was started in 40 patients with refractory right HF (with/without left HF). Refractoriness to conservative therapy was defined as persistent right heart congestion/ascites with intensified diuretic treatment and/or ≥2 hospitalizations within 6 months because of cardiac decompensation despite optimal medical treatment, and/or acute renal failure during intensified conservative treatment of cardiac decompensations. Results Patient survival was 55.0% at 1 year, 35.0% at 2 years and 27.5% at 3 years. The number of hospitalization days declined after initiation of PD for both cardiac [13 (IQR 1–53) days before vs. 1 (IQR 0–12) days after start of PD, p<0.001] and unplanned reasons [12 (IQR 3–44) days before vs. 1 (IQR 0–33) days after start of PD, p = 0.007]. Using a combined endpoint including survival time of ≥1 year and either improvement in quality of life or decline in hospitalizations we found that patients with extended ascites, higher systolic pulmonary artery pressure, more marked impairment of right ventricular function and tricuspid valve insufficiency, higher residual renal function as well as those who could perform PD without assistance have benefited most from this therapy. Conclusions Patients with more pronounced backward failure, less marked residual renal functional impairment and those not depending on assistance for therapy are likely to profit most from PD.
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Affiliation(s)
- Noemi Pavo
- Department of Internal Medicine II, Clinical Division of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Rajashri Yarragudi
- Department of Internal Medicine III, Clinical Division of Nephrology and Dialysis, Medical University of Vienna, Vienna, Austria
| | - Heidi Puttinger
- Department of Internal Medicine III, Clinical Division of Nephrology and Dialysis, Medical University of Vienna, Vienna, Austria
| | - Henrike Arfsten
- Department of Internal Medicine II, Clinical Division of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Guido Strunk
- Complexity Research, Vienna, Austria
- FH Campus Vienna, Vienna, Austria
- Technical University Dortmund, Dortmund, Germany
| | - Andja Bojic
- Department of Internal Medicine II, Clinical Division of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Martin Hülsmann
- Department of Internal Medicine II, Clinical Division of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Andreas Vychytil
- Department of Internal Medicine III, Clinical Division of Nephrology and Dialysis, Medical University of Vienna, Vienna, Austria
- * E-mail:
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Left Atrial Volume as a Biomarker of Target Organ Damage in Cardionephrology. Chest 2018; 154:893-903. [DOI: 10.1016/j.chest.2018.05.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Revised: 04/21/2018] [Accepted: 05/01/2018] [Indexed: 02/06/2023] Open
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Chitturi C, Novak JE. Diuretics in the Management of Cardiorenal Syndrome. Adv Chronic Kidney Dis 2018; 25:425-433. [PMID: 30309460 DOI: 10.1053/j.ackd.2018.08.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 08/13/2018] [Accepted: 08/14/2018] [Indexed: 12/21/2022]
Abstract
The leading cause of death worldwide is cardiovascular disease. The heart and the kidneys are functionally interdependent, such that dysfunction in one organ may cause dysfunction in the other. By one estimate, more than 60% of patients with congestive heart failure develop chronic kidney disease. Volume overload and congestion are hallmarks of heart failure, and these findings are associated with severe symptoms and poor outcomes. Given the importance of congestion, diuretics remain a cornerstone of heart failure management. However, diuretic treatment remains largely empirical, with little evidence currently available to guide decisions. In this review, we discuss the pathophysiology of cardiorenal syndrome, the pharmacology of loop diuretics, mechanisms of diuretic resistance, and evidence-based treatment paradigms.
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Assessment of right ventricular dysfunction in end-stage renal disease patients on maintenance haemodialysis by cardiac magnetic resonance imaging. Eur J Radiol 2018; 102:89-94. [DOI: 10.1016/j.ejrad.2018.02.036] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Revised: 02/23/2018] [Accepted: 02/28/2018] [Indexed: 11/19/2022]
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Kanjanahattakij N, Sirinvaravong N, Aguilar F, Agrawal A, Krishnamoorthy P, Gupta S. High Right Ventricular Stroke Work Index Is Associated with Worse Kidney Function in Patients with Heart Failure with Preserved Ejection Fraction. Cardiorenal Med 2018; 8:123-129. [PMID: 29617005 DOI: 10.1159/000486629] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2017] [Accepted: 01/02/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND In patients with heart failure with preserved ejection fraction (HFpEF), worse kidney function is associated with worse overall cardiac mechanics. Right ventricular stroke work index (RVSWI) is a parameter of right ventricular function. The aim of our study was to determine the relationship between RVSWI and glomerular filtration rate (GFR) in patients with HFpEF. METHOD This was a single-center cross-sectional study. HFpEF is defined as patients with documented heart failure with ejection fraction > 50% and pulmonary wedge pressure > 15 mm Hg from right heart catheterization. RVSWI (normal value 8-12 g/m/beat/m2) was calculated using the formula: RVSWI = 0.0136 × stroke volume index × (mean pulmonary artery pressure - mean right atrial pressure). Univariate and multivariate linear regression analysis was performed to study the correlation between RVSWI and GFR. RESULT Ninety-one patients were included in the study. The patients were predominantly female (n = 64, 70%) and African American (n = 61, 67%). Mean age was 66 ± 12 years. Mean GFR was 59 ± 35 mL/min/1.73 m2. Mean RVSWI was 11 ± 6 g/m/beat/m2. Linear regression analysis showed that there was a significant independent inverse relationship between RVSWI and GFR (unstandardized coefficient = -1.3, p = 0.029). In the subgroup with combined post and precapillary pulmonary hypertension (Cpc-PH) the association remained significant (unstandardized coefficient = -1.74, 95% CI -3.37 to -0.11, p = 0.04). CONCLUSION High right ventricular workload indicated by high RVSWI is associated with worse renal function in patients with Cpc-PH. Further prospective studies are needed to better understand this association.
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Affiliation(s)
| | - Natee Sirinvaravong
- Department of Medicine, Einstein Medical Center, Philadelphia, Pennsylvania, USA
| | - Francisco Aguilar
- Department of Medicine, Einstein Medical Center, Philadelphia, Pennsylvania, USA
| | - Akanksha Agrawal
- Department of Medicine, Einstein Medical Center, Philadelphia, Pennsylvania, USA
| | - Parasuram Krishnamoorthy
- Cardiology Division, Department of Internal Medicine, Einstein Medical Center, Philadelphia, Pennsylvania, USA
| | - Shuchita Gupta
- Cardiology Division, Department of Internal Medicine, Einstein Medical Center, Philadelphia, Pennsylvania, USA
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Saha SK, Luo XX, Gopal AS, Govind SC, Fang F, Liu M, Zhang Q, Ma C, Dong M, Kiotsekoglou A, Yu CM. Incremental prognostic value of multichamber deformation imaging and renal function status to predict adverse outcome in heart failure with reduced ejection fraction. Echocardiography 2018; 35:450-458. [PMID: 29399878 DOI: 10.1111/echo.13821] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
AIMS Deformation imaging, particularly of left-sided heart, is fast becoming an essential tool in clinical cardiology. However, data are scant regarding the value of biventricular and bi-atrial deformation in association with comorbidities in heart failure with reduced left ventricular ejection fraction (HFREF). METHODS AND RESULTS Forty-nine subjects (72 ± 13 years; 28 male) with HFREF and 14 age-matched controls underwent deformation imaging including LV global longitudinal strain (LVGLS%), right ventricular strain (RVS%), and left atrial reservoir strain (LARS%). Standard echo parameters included LVEF%, E/E' ratio, and pulmonary artery systolic pressure (PASP). Mean ± SD of LVEF, LVGLS%, and RVS% were 31% ± 8%, 7% ± 3%, and 17% ± 7%, respectively, and were significantly lower compared with controls (all P < .0001). Over a follow-up period of 4.2 years, 24% of patients died and 48% had a composite outcome of death and heart failure hospitalization. In the logistic regression model, taking the composite of death and heart failure hospitalization as a dichotomous variable, RVS%, E/E' ratio, and PASP were the only significant univariate predictors of adverse outcome (R2 = .68, all P < .05). In the multivariate model, however, only PASP predicted adverse outcome. PASP also had the largest AUC (0.8) in the ROC analysis. A creatinine level of >88 μmol/L (SCREAT) and a cutoff value of LA reservoir strain (LARS %) at <16.7% provided the best sensitivity (86%) and specificity (40%) with an odds ratio of 3.8. In the Kaplan-Meier survival estimate, LARS%-SCREAT predicted all-cause mortality and HF hospitalization. CONCLUSION Multichamber deformation imaging along with renal function and PASP could best predict adverse outcome in HFREF.
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Affiliation(s)
| | - Xia-Xia Luo
- Department of Ultrasonography, Shenzhen Hospital, Southern Medical University, Shenzhen, China.,Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | | | | | - Fang Fang
- Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing Anzhen Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Ming Liu
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Qing Zhang
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Chunyan Ma
- Department of Cardiovascular Ultrasound, The First Hospital of China Medical University, Liaoning, China
| | - Ming Dong
- Department of Pathophysiology, School of Medicine, Shenzhen University, Shenzhen, China
| | - Anatoli Kiotsekoglou
- Department of Clinical Physiology, University Hospital of Örebro, Örebro, Sweden
| | - Cheuk-Man Yu
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China.,Chiu Hin Kwong Heart Center, Hong Kong Baptist Hospital, Hong Kong, Hong Kong
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