1
|
Chemouni F, Nishikawa TC, Groyer H, Diaby O, Chollet J, Ittah D. Hospital Resource Utilization and Costs in Patients with Heart Failure in France. PHARMACOECONOMICS - OPEN 2023; 7:927-940. [PMID: 37713172 PMCID: PMC10721763 DOI: 10.1007/s41669-023-00431-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/16/2023] [Indexed: 09/16/2023]
Abstract
BACKGROUND AND OBJECTIVES Heart failure (HF) is one of the leading causes of morbidity and mortality, and economic burden on the healthcare system. The aim of this study was to estimate the current hospital resource utilization and costs for HF patients in France. METHODS This retrospective cohort study included adult HF patients hospitalized in France between January 1, 2019 and December 31, 2019. Data related to sociodemographic characteristics, number and duration of hospital stays, use of medical procedures or expensive and innovative drugs/medical devices included in the "liste-en-sus", and comorbidities were retrieved from the French national hospital discharge database. Data were further stratified based on the presence or absence of cardiac decompensation, comorbidities, ejection fraction (EF) status, and incident/prevalent patients. RESULTS In 2019, a total of 430,544 patients were hospitalized in France with HF as a primary or associated diagnosis, with 51.9% male and 48.1% female and a mean age of 79.0 years. More than 75% of the study population was composed of prevalent HF patients. About 3.1% of patients were diagnosed with at least one event of cardiac decompensation during follow-up. Also, 20.2% and 9.9% of patients were identified with preserved and reduced EFs, respectively. The average number and length of hospital stays were 1.7 per patient and 10.4 days per patient, respectively. The annual cost of hospitalization for HF was €8341.3 per patient. Presence of cardiac decompensation at index date or during follow-up, reduced EF, and comorbidities were associated with numerically higher frequency and length of hospitalization, and hospitalization cost. For hospitalization and 'liste-en-sus' medical devices, higher cost was observed in incident than prevalent HF patients, while for 'liste-en-sus' drugs, higher cost was reported in prevalent than incident HF patients. CONCLUSION This study highlighted the high economic hospital burden of HF in France. More studies investigating different HF patient profiles must be conducted to help determine the main factors of hospital cost for HF.
Collapse
Affiliation(s)
- Frank Chemouni
- Grand Hôpital de l'Est Francilien, site de Marne-la-Vallée, 2-4 Cours de la Gondoire, 77600, Jossigny, France
| | | | - Harinala Groyer
- Boehringer Ingelheim France, 100-104 avenue de France, 75013, Paris, France
| | - Oumou Diaby
- IQVIA, Real World Solutions France, 17 bis Place des Reflets, 92026, Courbevoie, France
| | - Julien Chollet
- Boehringer Ingelheim France, 100-104 avenue de France, 75013, Paris, France
| | - Deborah Ittah
- Boehringer Ingelheim France, 100-104 avenue de France, 75013, Paris, France
| |
Collapse
|
2
|
Kantharia BK, Singh A, Narasimhan B, Wu L, Karnik R, Chutani S, Shah AN. Cardiac resynchronization therapy in patients with heart failure and narrow QRS complexes (≤ 130 ms): role of speckle tracking echocardiography and different interventricular (VV) pacing intervals. J Interv Card Electrophysiol 2021; 63:369-377. [PMID: 34138397 DOI: 10.1007/s10840-021-01021-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Accepted: 06/09/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE Response to cardiac resynchronization therapy (CRT) in patients with heart failure with reduced ejection fraction (HFrEF) depends on the degree of correction of interventricular (VV) electromechanical dyssynchrony between the left and right ventricles (LV, RV). Wide (> 130 ms [ms]) QRS interval is used as a qualifying ECG parameter for CRT device implantation. In this study, we aimed to evaluate myocardial strain (S) and myocardial strain patterns (SP) and strain rate (SR) by speckle tracking echocardiography (STE) and mechanical characteristics at different VV intervals in acute settings and long-term outcome from "sequential LV-RV" pacing programming in patients with narrow (< 130 ms) and wide (> 130 ms) QRS complexes as a basis for extending CRT in select patients with narrow QRS. METHODS From a previously established cohort of patients who had undergone CRT device implantation, we identified patients with narrow (< 130 ms) and wide (> 130 ms) QRS complexes, groups A and B respectively. In all patients, we assessed myocardial SP and SR by STE, and mechanical characteristics at VV intervals: "LV Off," "VV0," "VV60," and "RV Off" to provide "RV-only," "simultaneous BiV," "sequential LV-RV," and "LV-only" pacing in the acute settings, and subsequently long-term clinical outcomes with CRT devices programmed to VV60. We compared acute STE characteristics and long-term clinical outcomes between the groups. RESULTS The study cohort comprised 271 patients (age 69.2 ± 10.3 years [mean ± SD], male-60%). Group A (n = 69) and group B (n = 202) were well matched for the clinical variables, including distribution of patients with ischemic versus non-ischemic cardiomyopathies. QRS width and left ventricular ejection fraction (LVEF) in groups A and B were 120.1 ± 12.3 ms and 152.1 ± 12.9 ms (p < 0.05), and 22.3 ± 9.4%, and 23.3 ± 10.2% (p = not significant [NS]). With VV0, VV60, and LV-only timings, corresponding LVEF rates in the acute settings were 31.45 ± 10.9%, 40.08 ± 8.3%, and 44.32 ± 7.98% (p < 0.01) in group A, and 38.94 ± 8.5%, 46.91 ± 7.33%, and 49.9 ± 8.94% (p < 0.01) in group B, and accounted for similar incremental percentage increase in LVEF compared to baseline in group A (43.2 ± 51.7%, 80.9 ± 61.4%, and 93.4 ± 65.6% respectively) and group B (67.3 ± 82.0%, 100.6 ± 94.3%, and 112.9 ± 95.7% respectively) (p = NS). Abnormal SP and SR were consistently observed with RV pacing that improved with VV60 and LV-only pacing in both groups. Strain scores at different VV timings were similar between the groups (p = NS). At 1-year follow-up, LVEF improved from 22.4 ± 8.0% to 39.8 ± 11.5% (p ≤ 0.001) for the total cohort with similar increments observed in both groups (p = NS). There were fewer NYHA III-IV class patients at 1 year in both groups. CONCLUSIONS Comparable myocardial SP and SR characteristics and LVEF improvement with VV60 and LV-only pacing in the acute setting and long-term outcome of CRT by "sequential LV-RV" pacing seen in patients with both narrow and wide QRS duration suggest that CRT device implantation may be justified in select patients with HFrEF and narrow QRS duration (< 130 ms) who have demonstrable dyssynchrony and abnormal myocardial SP and SR characteristics.
Collapse
Affiliation(s)
- Bharat K Kantharia
- Cardiovascular and Heart Rhythm, 30 West 60th Street, Suite 1U, New York, NY, 10023, USA. .,Icahn School of Medicine At Mount Sinai, New York, NY, USA.
| | - Amarnauth Singh
- Phoenix Heart Cardiovascular, Banner Thunderbird Medical Center, Glendale, AZ, USA
| | | | - Lingling Wu
- Icahn School of Medicine At Mount Sinai, New York, NY, USA
| | - Rahool Karnik
- Phoenix Heart Cardiovascular, Banner Thunderbird Medical Center, Glendale, AZ, USA
| | - Surendra Chutani
- Cardiovascular and Heart Rhythm, 30 West 60th Street, Suite 1U, New York, NY, 10023, USA
| | - Arti N Shah
- Cardiovascular and Heart Rhythm, 30 West 60th Street, Suite 1U, New York, NY, 10023, USA.,Icahn School of Medicine At Mount Sinai, New York, NY, USA
| |
Collapse
|
3
|
Improve self-care in heart failure. Int J Nurs Sci 2021; 8:243-244. [PMID: 33997141 PMCID: PMC8105536 DOI: 10.1016/j.ijnss.2021.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Accepted: 01/07/2021] [Indexed: 11/21/2022] Open
|
4
|
Oike F, Yamamoto E, Sueta D, Tokitsu T, Usuku H, Nishihara T, Takae M, Fujisue K, Arima Y, Kanazawa H, Ito M, Hanatani S, Araki S, Takashio S, Sakamoto K, Suzuki S, Kawano H, Soejima H, Kaikita K, Tsujita K. Clinical significance of diastolic late mitral annular velocity in heart failure with preserved ejection fraction. Int J Cardiol 2020; 316:145-151. [DOI: 10.1016/j.ijcard.2020.03.077] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 03/20/2020] [Accepted: 03/30/2020] [Indexed: 10/24/2022]
|
5
|
Kakino T, Saku K, Nishikawa T, Sunagawa K. The Partial Support of the Left Ventricular Assist Device Shifts the Systemic Cardiac Output Curve Upward in Proportion to the Effective Left Ventricular Ejection Fraction in Pressure-Volume Loop. Front Cardiovasc Med 2020; 7:163. [PMID: 33102535 PMCID: PMC7522370 DOI: 10.3389/fcvm.2020.00163] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 08/10/2020] [Indexed: 11/26/2022] Open
Abstract
Left ventricular assist device (LVAD) has been saving many lives in patients with severe left ventricular (LV) failure. Recently, a minimally invasive transvascular LVAD such as Impella enables us to support unstable hemodynamics in severely ill patients. Although LVAD support increases total LV cardiac output (COTLV) at the expense of decreases in the native LV cardiac output (CONLV), the underlying mechanism determining COTLV remains unestablished. This study aims to clarify the mechanism and develop a framework to predict COTLV under known LVAD flow (COLVAD). We previously developed a generalized framework of circulatory equilibrium that consists of the integrated CO curve and the VR surface as common functions of right atrial pressure (PRA) and left atrial pressure (PLA). The intersection between the integrated CO curve and the VR surface defines circulatory equilibrium. Incorporating LVAD into this framework indicated that LVAD increases afterload, which in turn decreases CONLV. The total LV cardiac output (COTLV) under LVAD support becomes COTLV = CONLV+EFe · COLVAD, where EFe is effective ejection fraction, i.e., Ees/(Ees+Ea). Ees and Ea represent LV end-systolic elastance (Ees) and effective arterial elastance (Ea), respectively. In other words, LVAD shifts the total LV cardiac output curve upward by EFe · COLVAD. In contrast, LVAD does not change the VR surface or the right ventricular CO curve. In six anesthetized dogs, we created LV failure by the coronary ligation of the left anterior descending artery and inserted LVAD by withdrawing blood from LV and pumping out to the femoral artery. We determined the parameters of the CO curve with a volume-change technique. We then changed the COLVAD stepwise from 0 to 70–100 ml/kg/min and predicted hemodynamics by using the proposed circulatory equilibrium. Predicted COTLV, PRA, and PLA for each step correlated well with those measured (SEE; 2.8 ml/kg/min 0.17 mmHg, and 0.65 mmHg, respectively, r2; 0.993, 0.993, and 0.965, respectively). The proposed framework quantitatively predicted the upward-shift of the total CO curve resulting from the synergistic effect of LV systolic function and LVAD support. The proposed framework can contribute to the safe management of patients with LVAD.
Collapse
Affiliation(s)
| | - Keita Saku
- Department of Cardiovascular Dynamics, National Cerebral and Cardiovascular Center Research Institute, Osaka, Japan.,Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Takuya Nishikawa
- Department of Cardiovascular Dynamics, National Cerebral and Cardiovascular Center Research Institute, Osaka, Japan
| | | |
Collapse
|
6
|
Wang XY, Zhang F, Zhang C, Zheng LR, Yang J. The Biomarkers for Acute Myocardial Infarction and Heart Failure. BIOMED RESEARCH INTERNATIONAL 2020; 2020:2018035. [PMID: 32016113 PMCID: PMC6988690 DOI: 10.1155/2020/2018035] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Revised: 11/05/2019] [Accepted: 12/04/2019] [Indexed: 01/06/2023]
Abstract
The use of a large number of cardiovascular biomarkers, meant to complement the use of the electrocardiogram, echocardiography cardiac imaging, and clinical symptom assessment, has become a routine in clinical diagnosis, differential diagnosis, risk stratification, and prognosis and guides the management of patients with suspected cardiovascular diseases. There is a broad consensus that cardiac troponin and natriuretic peptides are the preferred biomarkers in clinical practice for the diagnosis of the acute coronary syndrome and heart failure, respectively, while the roles and possible clinical applications of several other potential biomarkers are still under study. This review mainly focuses on the recent studies of the roles and clinical applications of troponin and natriuretic peptides, which seem to be the best-validated markers in distinguishing and predicting the future cardiac events of patients with suspected cardiovascular diseases. Additionally, the review briefly discusses some of the large number of potential markers that may play a more prominent role in the future.
Collapse
Affiliation(s)
- Xi-Ying Wang
- Department of Cardiology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Fen Zhang
- Department of Cardiology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Chi Zhang
- Department of Cardiology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Liang-Rong Zheng
- Department of Cardiology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Jian Yang
- Department of Cardiology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| |
Collapse
|
7
|
The Perspectives of Health Care Professionals on Providing End of Life Care and Palliative Care for Patients With Chronic Heart Failure: An Integrative Review. Heart Lung Circ 2019; 28:539-552. [DOI: 10.1016/j.hlc.2018.10.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 08/06/2018] [Accepted: 10/08/2018] [Indexed: 11/23/2022]
|
8
|
Blohm ME, Arndt F, Fröschle GM, Langenbach N, Sandig J, Vettorazzi E, Mir TS, Hecher K, Weil J, Kozlik-Feldmann R, Blankenberg S, Zeller T, Singer D. Cardiovascular Biomarkers in Amniotic Fluid, Umbilical Arterial Blood, Umbilical Venous Blood, and Maternal Blood at Delivery, and Their Reference Values for Full-Term, Singleton, Cesarean Deliveries. Front Pediatr 2019; 7:271. [PMID: 31312624 PMCID: PMC6614192 DOI: 10.3389/fped.2019.00271] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Accepted: 06/17/2019] [Indexed: 12/19/2022] Open
Abstract
Background: Several cardiovascular biomarkers have regulatory functions in perinatal physiology. Aim: This study aimed to analyze the feto-maternal distribution pattern of biomarkers in samples of amniotic fluid, umbilical arterial blood, umbilical venous blood, and maternal blood samples, and to establish reference values. Each linked sample set consisted of the combined samples obtained in an individual pregnancy. Study design: We performed a prospective, observational, cross-sectional, single-center study. Subjects: The sample cohort included 189 neonates who were born to 170 mothers. A total of 162/189 neonates were full term and 129/189 were delivered by elective cesarean section. Outcome measures: Midregional pro-adrenomedullin (MRproADM [nmol/L]), midregional pro-atrial natriuretic peptide (MRproANP [pmol/L]), brain natriuretic peptide (BNP [pg/mL]), N-terminal pro-brain natriuretic peptide (NTproBNP [pg/mL]), copeptin [pmol/L], and high-sensitive troponin I (hsTnI [pg/mL]) levels were measured. Results: In singleton, full-term, primary cesarean deliveries (n = 91), biomarker levels (median, [IQR]) at delivery were as follows. MRproADM levels in umbilical arterial blood/umbilical venous blood/amniotic fluid/maternal blood were 0.88 (0.20)/0.95 (0.18)/2.80 (1.18)/1.10 (0.54), respectively. MRproANP levels were 214.23 (91.38)/216.03 (86.15)/0.00 (3.82)/50.67 (26.81), respectively. BNP levels were 14.60 (25.18)/22.08 (18.91)/7.15 (6.01)/6.20 (18.23), respectively. NTproBNP levels were 765.48 (555.24)/816.45 (675.71)/72.03 (55.58)/44.40 (43.94), respectively. Copeptin levels were 46.17 (290.42)/5.54 (9.08)/9.97 (7.44)/4.61 (4.59), respectively. Levels of hsTnI were 6.20 (4.25)/5.60 (5.01)/0.45 (1.73)/2.50 (2.40), respectively. Conclusion: We determined reference values for biomarkers in term neonates delivered by primary cesarean section in amniotic fluid, umbilical arterial and venous blood, and maternal blood. Biomarkers in the fetal circulation appear to be of primary fetal origin, except for MRproADM.
Collapse
Affiliation(s)
- Martin E Blohm
- Division of Neonatology and Pediatric Intensive Care, Department of Pediatrics, University Children's Hospital, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Florian Arndt
- Department of Pediatric Cardiology, University Heart & Vascular Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Glenn M Fröschle
- Division of Neonatology and Pediatric Intensive Care, Department of Pediatrics, University Children's Hospital, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Nora Langenbach
- Division of Neonatology and Pediatric Intensive Care, Department of Pediatrics, University Children's Hospital, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jan Sandig
- Division of Neonatology and Pediatric Intensive Care, Department of Pediatrics, University Children's Hospital, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Eik Vettorazzi
- Center for Experimental Medicine, Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Thomas S Mir
- Department of Pediatric Cardiology, University Heart & Vascular Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Kurt Hecher
- Department of Obstetrics and Fetal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jochen Weil
- Department of Pediatric Cardiology, University Heart & Vascular Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Rainer Kozlik-Feldmann
- Department of Pediatric Cardiology, University Heart & Vascular Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Stefan Blankenberg
- Department of General and Interventional Cardiology, University Heart & Vascular Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,German Center for Cardiovascular Research, Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Tanja Zeller
- Department of General and Interventional Cardiology, University Heart & Vascular Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,German Center for Cardiovascular Research, Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Dominique Singer
- Division of Neonatology and Pediatric Intensive Care, Department of Pediatrics, University Children's Hospital, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| |
Collapse
|
9
|
Kobusiak-Prokopowicz M, Krzysztofik J, Kaaz K, Jolda-Mydlowska B, Mysiak A. MMP-2 and TIMP-2 in Patients with Heart Failure and Chronic Kidney Disease. Open Med (Wars) 2018; 13:237-246. [PMID: 29915813 PMCID: PMC6004519 DOI: 10.1515/med-2018-0037] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2017] [Accepted: 04/20/2018] [Indexed: 01/25/2023] Open
Abstract
The aim of the study was to assess MMP-2 (matrix metalloproteinase-2) and TIMP-2 (tissue inhibitor of metalloproteinase-2) serum levels in patients with diverse types of heart failure (HF) and chronic kidney disease (CKD). 101 patients with chronic HF were enrolled. Each patient has assessed the serum levels of MMP-2, TIMP-2, and NT-proBNP. Patients were initially classified into 2 groups based on their LVEF. 43 patients were classified into the HFREF group (HF with Reduced Ejection Fraction) and 58 characterized as HFPEF (HF with Preserved Ejection Fraction). Next, all patients were subdivided into 4 groups according to the degree of diastolic dysfunction. 38 patients with CKD were classified into HF/CKD(+) group. The HF/CKD(-) (HF without CKD) group comprised 61 patients. This study provides original data on positive correlation between ejection fraction and MMP-2 levels in all patients with heart failure. Elevated levels of MMP-2 and TIMP-2 were found in serum from patients with chronic kidney disease; in addition, serum levels of MMP-2 were correlated with the degree of kidney failure. In all groups of patients there was positive correlation between MMP-2 and TIMP-2. Among patients with heart failure etiology was not related to MMP-2 and TIMP-2 serum levels.
Collapse
Affiliation(s)
| | | | - Konrad Kaaz
- Wroclaw Medical University, Cardiology Department, Wroclaw, Poland
| | | | - Andrzej Mysiak
- Wroclaw Medical University, Cardiology Department, Wroclaw, Poland
| |
Collapse
|
10
|
Laszlo R, Konz H, Kunz K, Dallmeier D, Klenk J, Denkinger M, Koenig W, Rothenbacher D, Steinacker For The ActiFE Study Group JM. Evaluation of left and right ventricular systolic and diastolic electromechanical synchrony in older people: a population-based observational study. Physiol Res 2017; 66:933-948. [PMID: 28937256 DOI: 10.33549/physiolres.933453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
It is unknown whether physiological ageing also goes along with electromechanical asynchrony of contraction. Aim of the study was to evaluate synchrony of contraction in older people with ("non-healthy") or without ("healthy") evidence for structural cardiac disease. In 547 persons (age 76.7+/-5.5 years, 306 male, 241 female) recruited from a population-based cohort of the ActiFE-Ulm study including a random sample of people >/=65 years old living in the region of Ulm, Germany, various PW- and TDI-Doppler based markers for asynchrony were obtained by echocardiography. Within a subgroup of 84 healthy subjects, at most minimal systolic and diastolic asynchrony was found. Concerning systolic asynchrony, similar observations were made within the non-healthy subgroup. However, extent of diastolic left ventricular intraventricular asynchrony and also - by tendency - diastolic interventricular asynchrony was increased in comparison to the healthy subgroup. To conclude, no evidence that physiological ageing might go along with relevant left or right ventricular systolic or diastolic electromechanical asynchrony was found in our study. Furthermore, our population-based data support the results from other clinical studies with rather selected cohorts that structural heart diseases might go along with increased diastolic asynchrony.
Collapse
Affiliation(s)
- R Laszlo
- Division of Sports and Rehabilitation Medicine, Ulm University, Ulm, Germany.
| | | | | | | | | | | | | | | | | |
Collapse
|
11
|
Abstract
Cardiac resynchronization therapy (CRT) is included in international consensus guidelines as a treatment with proven efficacy in well-selected patients on top of optimal medical therapy. Although all the guidelines strongly recommend CRT for LBBB with QRS duration greater than 150 milliseconds, lower strength of recommendation is reported for QRS duration of 120 to 150 milliseconds, especially if not associated with LBBB. CRT is not recommended for a QRS of less than 120 milliseconds. No indication emerges for guiding the implant based on echocardiographic evaluation of dyssynchrony. Many data indicate that CRT is underused and there is heterogeneity in its implementation.
Collapse
|
12
|
Attitude towards knowledge of the disease and psychological characteristics of patients with systolic heart failure. HEALTH PSYCHOLOGY REPORT 2016. [DOI: 10.5114/hpr.2017.62748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
<b>Background</b><br />
We aimed to investigate the relationships between selected psychological features of patients with chronic systolic heart failure (HF) and their attitude towards knowledge of the disease.<br />
<br />
<b>Participants and procedure</b><br />
This prospective study among 75 patients with stable systolic HF consisted of 2 parts: a quantitative approach, conducted during the hospitalization (based on 4 psychological questionnaires: the Multidimensional Health Locus of Control Scale; the Coping Inventory for Stressful Situations; the Acceptance of Illness Scale; and the Patient’s Request Form) and a qualitative approach (phone interviews performed later).<br />
<br />
<b>Results</b><br />
Fifty-nine percent of patients declared the need for possessing knowledge about their disease. Psychological questionnaires did not allow us to characterize groups of patients with extremely different attitudes towards knowledge about the disease. Patients who did not want to look for any information, although they admitted that their knowledge was poor, were characterized by the conviction that nobody has an influence on their health status. Patients who were likely to read drug labels were characterized by the active style of coping.<br />
<br />
<b>Conclusions</b><br />
The attitude towards knowledge about the disease is diverse among patients with systolic HF, and it is not easy to explain these differences using their psychological features assessed in the present study. Further studies focused on assessing the patient’s willingness to acquire knowledge about HF, using more accurate measures, are needed, especially for healthcare professionals, who still look for an improvement in understanding the needs of their patients.
Collapse
|
13
|
Amr A, Kayvanpour E, Sedaghat-Hamedani F, Passerini T, Mihalef V, Lai A, Neumann D, Georgescu B, Buss S, Mereles D, Zitron E, Posch AE, Würstle M, Mansi T, Katus HA, Meder B. Personalized Computer Simulation of Diastolic Function in Heart Failure. GENOMICS PROTEOMICS & BIOINFORMATICS 2016; 14:244-52. [PMID: 27477449 PMCID: PMC4996856 DOI: 10.1016/j.gpb.2016.04.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Revised: 04/21/2016] [Accepted: 04/26/2016] [Indexed: 01/14/2023]
Abstract
The search for a parameter representing left ventricular relaxation from non-invasive and invasive diagnostic tools has been extensive, since heart failure (HF) with preserved ejection fraction (HF-pEF) is a global health problem. We explore here the feasibility using patient-specific cardiac computer modeling to capture diastolic parameters in patients suffering from different degrees of systolic HF. Fifty eight patients with idiopathic dilated cardiomyopathy have undergone thorough clinical evaluation, including cardiac magnetic resonance imaging (MRI), heart catheterization, echocardiography, and cardiac biomarker assessment. A previously-introduced framework for creating multi-scale patient-specific cardiac models has been applied on all these patients. Novel parameters, such as global stiffness factor and maximum left ventricular active stress, representing cardiac active and passive tissue properties have been computed for all patients. Invasive pressure measurements from heart catheterization were then used to evaluate ventricular relaxation using the time constant of isovolumic relaxation Tau (τ). Parameters from heart catheterization and the multi-scale model have been evaluated and compared to patient clinical presentation. The model parameter global stiffness factor, representing diastolic passive tissue properties, is correlated significantly across the patient population with τ. This study shows that multi-modal cardiac models can successfully capture diastolic (dys) function, a prerequisite for future clinical trials on HF-pEF.
Collapse
Affiliation(s)
- Ali Amr
- Institute for Cardiomyopathies, Department of Medicine III, University of Heidelberg, 69120 Heidelberg, Germany; German Centre for Cardiovascular Research (DZHK), Heidelberg/Mannheim, Germany
| | - Elham Kayvanpour
- Institute for Cardiomyopathies, Department of Medicine III, University of Heidelberg, 69120 Heidelberg, Germany; German Centre for Cardiovascular Research (DZHK), Heidelberg/Mannheim, Germany
| | - Farbod Sedaghat-Hamedani
- Institute for Cardiomyopathies, Department of Medicine III, University of Heidelberg, 69120 Heidelberg, Germany; German Centre for Cardiovascular Research (DZHK), Heidelberg/Mannheim, Germany
| | - Tiziano Passerini
- Siemens Healthcare, Medical Imaging Technologies, Princeton, NJ 08540, USA
| | - Viorel Mihalef
- Siemens Healthcare, Medical Imaging Technologies, Princeton, NJ 08540, USA
| | - Alan Lai
- Institute for Cardiomyopathies, Department of Medicine III, University of Heidelberg, 69120 Heidelberg, Germany
| | - Dominik Neumann
- Siemens Healthcare, Medical Imaging Technologies, Princeton, NJ 08540, USA
| | - Bogdan Georgescu
- Siemens Healthcare, Medical Imaging Technologies, Princeton, NJ 08540, USA
| | - Sebastian Buss
- Institute for Cardiomyopathies, Department of Medicine III, University of Heidelberg, 69120 Heidelberg, Germany
| | - Derliz Mereles
- Institute for Cardiomyopathies, Department of Medicine III, University of Heidelberg, 69120 Heidelberg, Germany
| | - Edgar Zitron
- Institute for Cardiomyopathies, Department of Medicine III, University of Heidelberg, 69120 Heidelberg, Germany
| | - Andreas E Posch
- Siemens Healthcare, Strategy and Innovation, 91052 Erlangen, Germany
| | | | - Tommaso Mansi
- Siemens Healthcare, Medical Imaging Technologies, Princeton, NJ 08540, USA
| | - Hugo A Katus
- Institute for Cardiomyopathies, Department of Medicine III, University of Heidelberg, 69120 Heidelberg, Germany; German Centre for Cardiovascular Research (DZHK), Heidelberg/Mannheim, Germany
| | - Benjamin Meder
- Institute for Cardiomyopathies, Department of Medicine III, University of Heidelberg, 69120 Heidelberg, Germany; German Centre for Cardiovascular Research (DZHK), Heidelberg/Mannheim, Germany.
| |
Collapse
|
14
|
Cenik F, Schoberwalter D, Keilani M, Maehr B, Wolzt M, Marhold M, Crevenna R. Neuromuscular electrical stimulation of the thighs in cardiac patients with implantable cardioverter defibrillators. Wien Klin Wochenschr 2016; 128:802-808. [PMID: 27457876 PMCID: PMC5104798 DOI: 10.1007/s00508-016-1045-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Revised: 06/21/2016] [Accepted: 06/27/2016] [Indexed: 12/04/2022]
Abstract
Background The aim of this systematic review was to update scientific knowledge concerning the safety of neuromuscular electrical stimulation (NMES) to increase exercise capacity and prevent cardiac cachexia in patients with implantable cardioverter defibrillators (ICDs). Methods A systematic review including the electronic databases PubMed, MEDLINE, and SCOPUS was conducted for the time period from 1966 to March 31, 2016. Results Only four articles fulfilled the inclusion criteria (three original articles/safety studies and one case report). The three (safety) studies used NMES to increase muscle strength and/or endurance capacity of the thighs. NMES did not show electromagnetic interference (EMI) with ICD function. EMI was described in a case report of 2 patients with subpectoral ICDs and application of NMES on abdominal muscles. Conclusion This review indicates that NMES may be applied in cardiac ICD patients if 1) individual risks (e. g., pacing dependency, acute heart failure, unstable angina, ventricular arrhythmic episode in the last 3 months) are excluded by performing a safety check before starting NMES treatment and 2) “passive” exercise using NMES is performed only for thighs and gluteal muscles in 3) compliant ICD patients (especially for home-based NMES) and 4) the treatment is regularly supervised by a physician and the device is examined after the first use of NMES to exclude EMI. Nevertheless, further studies including larger sample sizes are necessary to exclude any risk when NMES is used in this patient group.
Collapse
Affiliation(s)
- Fadime Cenik
- Department of Physical Medicine and Rehabilitation, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Dieter Schoberwalter
- Department of Physical Medicine and Rehabilitation, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.,Department of Cardiology, Hanusch-Krankenhaus, Vienna, Austria
| | - Mohammad Keilani
- Department of Physical Medicine and Rehabilitation, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Bruno Maehr
- Department of Physical Medicine and Rehabilitation, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.,Therapiezentrum Rosalienhof, Versicherungsanstalt öffentlich Bediensteter, Bad Tatzmannsdorf, Austria
| | - Michael Wolzt
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Maximilian Marhold
- Department of Internal Medicine I/Oncology, Medical University of Vienna, Vienna, Austria
| | - Richard Crevenna
- Department of Physical Medicine and Rehabilitation, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
| |
Collapse
|
15
|
MAIONE D, CICERO AFG, BACCHELLI S, COSENTINO ER, DEGLI ESPOSTI D, MANNERS DN, RINALDI ER, ROSTICCI M, SENALDI R, AMBROSIONI E, BORGHI C. The VO2-on Kinetics in Constant Load Exercise Sub-Anaerobic Threshold Reflects Endothelial Function and Dysfunction in Muscle Microcirculation. Physiol Res 2015; 64:807-19. [DOI: 10.33549/physiolres.932833] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
To propose a test to evaluate endothelial function, based on VO2 on-transition kinetics in sub-anaerobic threshold (AT) constant load exercise, we tested healthy subjects and patients with ischemic-hypertensive cardiopathy by two cardiopulmonary tests on a cycle ergometer endowed with an electric motor to overcome initial inertia: a pre-test and, after at least 24 h, one 6 min constant load exercise at 90 % AT. We measured net phase 3 VO2-on kinetics and, by phase 2 time constant (τ), valued endothelial dysfunction. We found shorter τ in repeated tests, shorter time between first and second test, by persisting endothelium-dependent arteriolar vasodilatation and/or several other mechanisms. Reducing load to 80 % and 90 % AT did not produce significant changes in τ of healthy volunteers, while in heart patients an AT load of 70 %, compared to 80 % AT, shortened τ (=4.38±1.65 s, p=0.013). In heart patients, no correlation was found between NYHA class, ejection fraction (EF), and the two variables derived from incremental cycle cardio-pulmonary exercise, as well as between EF and τ; while NYHA class groups were well correlated with τ duration (r=0.92, p=0.0001). Doxazosin and tadalafil also significantly reduced τ. In conclusion, the O2 consumption kinetics during the on-transition of constant load exercise below the anaerobic threshold are highly sensitive to endothelial function in muscular microcirculation, and constitute a marker for the evaluation of endothelial dysfunction.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - C. BORGHI
- Department of Medicine and Surgery Sciences, University of Bologna, Italy
| |
Collapse
|
16
|
Boriani G, Nesti M, Ziacchi M, Padeletti L. Cardiac Resynchronization Therapy: An Overview on Guidelines. Card Electrophysiol Clin 2015; 7:673-693. [PMID: 26596811 DOI: 10.1016/j.ccep.2015.08.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Cardiac resynchronization therapy (CRT) is included in international consensus guidelines as a treatment with proven efficacy in well-selected patients on top of optimal medical therapy. Although all the guidelines strongly recommend CRT for LBBB with QRS duration greater than 150 milliseconds, lower strength of recommendation is reported for QRS duration of 120 to 150 milliseconds, especially if not associated with LBBB. CRT is not recommended for a QRS of less than 120 milliseconds. No indication emerges for guiding the implant based on echocardiographic evaluation of dyssynchrony. Many data indicate that CRT is underused and there is heterogeneity in its implementation.
Collapse
Affiliation(s)
- Giuseppe Boriani
- Institute of Cardiology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, S. Orsola-Malpighi University Hospital, Via Giuseppe Massarenti 9, Bologna 40138, Italy.
| | - Martina Nesti
- Electrophysiology and Pacing Centre, Heart and Vessels Department, University of Firenze, Largo Brambilla 3, Firenze 50134, Italy
| | - Matteo Ziacchi
- Institute of Cardiology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, S. Orsola-Malpighi University Hospital, Via Giuseppe Massarenti 9, Bologna 40138, Italy
| | - Luigi Padeletti
- Specialty School in Cardiovascular Diseases, University of Firenze, Largo Brambilla 3, Firenze 50134, Italy
| |
Collapse
|
17
|
Abstract
Patients on long-term left ventricular assist device (LVAD) support present unique challenges in the intensive care unit. It is crucial to know the status of end-organ perfusion, which may require invasive hemodynamic monitoring with a systemic arterial and pulmonary artery catheter. Depending on the indication for LVAD support (bridge to decision or cardiac transplantation vs destination therapy), it is important to readdress goals of care with the patient (if possible) and their family after major events have occurred that challenge the survival of the patient.
Collapse
Affiliation(s)
- Edo Y Birati
- Division of Cardiovascular Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - J Eduardo Rame
- Division of Cardiovascular Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA.
| |
Collapse
|
18
|
Floras JS, Ponikowski P. The sympathetic/parasympathetic imbalance in heart failure with reduced ejection fraction. Eur Heart J 2015; 36:1974-82b. [PMID: 25975657 DOI: 10.1093/eurheartj/ehv087] [Citation(s) in RCA: 168] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Accepted: 03/06/2015] [Indexed: 12/20/2022] Open
Abstract
Cardiovascular autonomic imbalance, a cardinal phenotype of human heart failure, has adverse implications for symptoms during wakefulness and sleep; for cardiac, renal, and immune function; for exercise capacity; and for lifespan and mode of death. The objectives of this Clinical Review are to summarize current knowledge concerning mechanisms for disturbed parasympathetic and sympathetic circulatory control in heart failure with reduced ejection fraction and its clinical and prognostic implications; to demonstrate the patient-specific nature of abnormalities underlying this common phenotype; and to illustrate how such variation provides opportunities to improve or restore normal sympathetic/parasympathetic balance through personalized drug or device therapy.
Collapse
Affiliation(s)
- John S Floras
- University Health Network and Mount Sinai Hospital Division of Cardiology, University of Toronto, Suite 1614, 600 University Avenue, Toronto, Ontario, Canada M5G 1X5
| | - Piotr Ponikowski
- Department for Heart Disease, Medical University, Clinical Military Hospital, Wroclaw, Poland
| |
Collapse
|
19
|
Gigli L, Barabino D, Sartori P, Rossi P, Reggiardo G, Chiarella F, Rosa GM, Bertero G. The implantable cardioverter defibrillator in primary prevention: a revision of monocentric study group. J Cardiovasc Med (Hagerstown) 2015; 15:653-8. [PMID: 24983347 DOI: 10.2459/jcm.0000000000000112] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
AIMS To evaluate the outcome of a population implanted with an implantable cardioverter defibrillator (ICD) for primary prevention in terms of mortality, morbidity and appropriate and inappropriate interventions. Secondly, to compare the performances of single-chamber vs. dual-chamber devices. METHODS We examined all patients with CAD or CMD who received an ICD in primary prevention with at least 6 months of follow-up. For each patient were evaluated, primarily, survival, complications related to the implantation and performance of the device (antitachycardia pacing/shock). RESULTS Of 193 patients, 163 were men (84.5). Mean age was 64.4 ± 10 years. One hundred and twenty patients (62%) were affected by CAD and 73 (38%) by CMD. The ejection fraction was 26 ± 6%. Fifty-three patients (27.5%) received a dual-chamber ICD, whereas 140 (72.5%) received a single-chamber ICD. There were periprocedural complications in 5.2% of the patients. At a mean follow-up of 49.9 months, 55 patients (28.5%) died. Appropriate interventions were documented in 40 patients (20.7%). In 36 patients (18%), inappropriate interventions occurred. Patients implanted with dual-chamber ICD had an overall mortality of 17% compared to 32.4% for those implanted with single-chamber ICD (P = 0.029). Mortality was higher in patients with CAD (33.9%) (P = 0.032). Among the fatalities, 69% occurred in patients who had an ejection fraction 25% or less at the time of implantation and 31% in patients with an ejection fraction greater than 25% (P = 0.013). CONCLUSIONS The 4-year survival was 72%. The overall mortality was higher in patients with CAD. More than two-thirds of the deceased had an ejection fraction less than 25%. The dual-chamber ICD patients had a significantly lower mortality rate.
Collapse
Affiliation(s)
- L Gigli
- aElectrophysiology, Department of General Internal Medicine, IRCCS San Martino University Hospital - IST National Institute for Cancer Research bMedi Service Management Unit World Trade Center cPrimary Hospital, Department of General Internal Medicine, IRCCS San Martino University Hospital - IST National Institute for Cancer Research, Genoa, Italy *D. Barabino deceased
| | | | | | | | | | | | | | | |
Collapse
|
20
|
Cowie MR. The global relevance of disease management programmes for heart failure. Eur J Heart Fail 2014; 16:927-8. [PMID: 25065498 DOI: 10.1002/ejhf.141] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Accepted: 07/02/2014] [Indexed: 11/06/2022] Open
Affiliation(s)
- Martin R Cowie
- Clinical Cardiology, National Heart and Lung Institute, Imperial College London (Royal Brompton Hospital), London, UK
| |
Collapse
|