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Pagnesi M, Vilamajó OAG, Meiriño A, Dumont CA, Mebazaa A, Davison B, Adamo M, Arrigo M, Barros M, Biegus J, Celutkiene J, Čerlinskaitė-Bajorė K, Chioncel O, Cohen-Solal A, Damasceno A, Diaz R, Edwards C, Filippatos G, Gayat E, Kimmoun A, Lam CSP, Novosadova M, Pang PS, Ponikowski P, Saidu H, Sliwa K, Takagi K, Ter Maaten JM, Tomasoni D, Voors AA, Cotter G, Metra M. Blood pressure and intensive treatment up-titration after acute heart failure hospitalization: Insights from the STRONG-HF trial. Eur J Heart Fail 2024; 26:638-651. [PMID: 38444216 DOI: 10.1002/ejhf.3174] [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: 09/17/2023] [Revised: 02/04/2024] [Accepted: 02/12/2024] [Indexed: 03/07/2024] Open
Abstract
AIMS A high-intensity care (HIC) strategy with rapid guideline-directed medical therapy (GDMT) up-titration and close follow-up visits improved outcomes, compared to usual care (UC), in patients recently hospitalized for acute heart failure (AHF). Hypotension is a major limitation to GDMT implementation. We aimed to assess the impact of baseline systolic blood pressure (SBP) on the effects of HIC versus UC and the role of early SBP changes in STRONG-HF. METHODS AND RESULTS A total of 1075 patients hospitalized for AHF with SBP ≥100 mmHg were included in STRONG-HF. For the purpose of this post-hoc analysis, patients were stratified by tertiles of baseline SBP (<118, 118-128, and ≥129 mmHg) and, in the HIC arm, by tertiles of changes in SBP from the values measured before discharge to those measured at 1 week after discharge (≥2 mmHg increase, ≤7 mmHg decrease to <2 mmHg increase, and ≥8 mmHg decrease). The primary endpoint was 180-day heart failure rehospitalization or death. The effect of HIC versus UC on the primary endpoint was independent of baseline SBP evaluated as tertiles (pinteraction = 0.77) or as a continuous variable (pinteraction = 0.91). In the HIC arm, patients with increased, stable and decreased SBP at 1 week reached 83.5%, 76.2% and 75.3% of target doses of GDMT at day 90. The risk of the primary endpoint was not significantly different between patients with different SBP changes at 1 week (adjusted p = 0.46). CONCLUSIONS In STRONG-HF, the benefits of HIC versus UC were independent of baseline SBP. Rapid GDMT up-titration was performed also in patients with an early SBP drop, resulting in similar 180-day outcome as compared to patients with stable or increased SBP.
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Affiliation(s)
- Matteo Pagnesi
- Cardiology, ASST Spedali Civili and Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | | | | | | | - Alexandre Mebazaa
- Université Paris Cité, INSERM UMR-S 942(MASCOT), Paris, France
- Department of Anesthesiology and Critical Care and Burn Unit, Saint-Louis and Lariboisière Hospitals, FHU PROMICE, DMU Parabol, APHP.Nord, Paris, France
| | - Beth Davison
- Université Paris Cité, INSERM UMR-S 942(MASCOT), Paris, France
- Momentum Research Inc, Durham, NC, USA
- Heart Initiative, Durham, NC, USA
| | - Marianna Adamo
- Cardiology, ASST Spedali Civili and Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Mattia Arrigo
- Department of Internal Medicine, Stadtspital Zurich, Zurich, Switzerland
| | | | - Jan Biegus
- Institute of Heart Diseases, Wroclaw Medical University, Wrocław, Poland
| | - Jelena Celutkiene
- Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Kamilė Čerlinskaitė-Bajorė
- Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Ovidiu Chioncel
- Emergency Institute for Cardiovascular Diseases 'Prof. C.C. Iliescu', University of Medicine 'Carol Davila', Bucharest, Romania
| | - Alain Cohen-Solal
- Université Paris Cité, INSERM UMR-S 942(MASCOT), Paris, France
- Department of Cardiology, Lariboisière University Hospital, APHP Nord, Paris, France
| | | | - Rafael Diaz
- Estudios Clínicos Latinoamérica, Instituto Cardiovascular de Rosario, Rosario, Argentina
| | | | - Gerasimos Filippatos
- National and Kapodistrian University of Athens, School of Medicine, Attikon University Hospital, Athens, Greece
| | - Etienne Gayat
- Université Paris Cité, INSERM UMR-S 942(MASCOT), Paris, France
- Department of Anesthesiology and Critical Care and Burn Unit, Saint-Louis and Lariboisière Hospitals, FHU PROMICE, DMU Parabol, APHP.Nord, Paris, France
| | - Antoine Kimmoun
- Université de Lorraine, Nancy, France
- INSERM, Défaillance Circulatoire Aigue et Chronique, Nancy, France
- Service de Médecine Intensive et Réanimation Brabois, CHRU de Nancy, Vandœuvre-lès-Nancy, France
| | - Carolyn S P Lam
- National Heart Centre Singapore and Duke-National University of Singapore, Singapore
- Department of Cardiology, University of Groningen, University Medical Centre Groningen, Groningen, Netherlands
| | | | - Peter S Pang
- Department of Emergency Medicine, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Piotr Ponikowski
- Institute of Heart Diseases, Wroclaw Medical University, Wrocław, Poland
| | - Hadiza Saidu
- Murtala Muhammed Specialist Hospital/Bayero University Kano, Kano, Nigeria
| | - Karen Sliwa
- Cape Heart Institute, Department of Medicine and Cardiology, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | | | - Jozine M Ter Maaten
- Service de Médecine Intensive et Réanimation Brabois, CHRU de Nancy, Vandœuvre-lès-Nancy, France
| | - Daniela Tomasoni
- Cardiology, ASST Spedali Civili and Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Adriaan A Voors
- Service de Médecine Intensive et Réanimation Brabois, CHRU de Nancy, Vandœuvre-lès-Nancy, France
| | - Gad Cotter
- Université Paris Cité, INSERM UMR-S 942(MASCOT), Paris, France
- Momentum Research Inc, Durham, NC, USA
- Heart Initiative, Durham, NC, USA
| | - Marco Metra
- Cardiology, ASST Spedali Civili and Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
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Xu M, Li Y, Zhao W, Song X, Gan G, Li B, Zhou X. Association between admission prothrombin time activity and hospital readmission in heart failure: A retrospective study. Clin Chim Acta 2023; 548:117463. [PMID: 37392864 DOI: 10.1016/j.cca.2023.117463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 06/24/2023] [Accepted: 06/28/2023] [Indexed: 07/03/2023]
Abstract
BACKGROUND Coagulopathy is a common complication of heart failure (HF), but the prognostic significance of coagulation abnormalities for HF is still poorly understood. This investigation sought to elucidate the association between admission prothrombin time activity (PTA) and short-term readmission in HF. METHODS In this retrospective study, we extracted data from a publicly accessible database for hospitalized HF patients in China. The admission laboratory findings were screened by the least absolute shrinkage and selection operator (LASSO) regression. Afterward, the study population was stratified according to the admission PTA level. In univariate and multivariate analysis, we employed logistics regression model to evaluate the association of admission PTA level with short-term readmission. Subgroup analysis was preformed to examine the interaction effect between admission PTA level and covariates, including age, sex, and systolic blood pressure (SBP). RESULTS A total of 1505 HF patients were included, of whom 58.7% were female and 35.6% were between 70 and 79 y. In LASSO procedure, admission PTA level was included in optimized models for short-term readmission, and readmitted patients tended to have a lower admission PTA level. Multivariate analysis suggested that the low admission PTA level (admission PTA ≤ 62.3%) was associated with increased risk of 90-day readmission (odds ratio 1.63 [95% CI, 1.09 to 2.46]; P = 0.02) and 180-day readmission (odds ratio 1.65 [95% CI, 1.18 to 2.33]; P = 0.01) compared with patients with the highest admission PTA level (admission PTA ≥ 76.8%) after full adjustment. Moreover, no significant interaction effect was observed in the subgroup analysis, except for admission SBP. CONCLUSION Low admission PTA level is associated with an increased risk of 90-day and 180-day hospital readmission in patients with HF.
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Affiliation(s)
- MengDa Xu
- Department of Anesthesiology, General Hospital of Central Theater Command of PLA, Wuhan, China
| | - Yue Li
- The First School of Clinical Medicine, Southern Medical University, GuangZhou, China
| | - WeiLiang Zhao
- China-Japan Union Hospital of Jilin University, ChangChun, China
| | - XiaoYang Song
- Department of Anesthesiology, General Hospital of Central Theater Command of PLA, Wuhan, China
| | - GuoSheng Gan
- Department of Anesthesiology, General Hospital of Central Theater Command of PLA, Wuhan, China
| | - BiXi Li
- Department of Anesthesiology, General Hospital of Central Theater Command of PLA, Wuhan, China
| | - Xiang Zhou
- Department of Anesthesiology, General Hospital of Central Theater Command of PLA, Wuhan, China; The First School of Clinical Medicine, Southern Medical University, GuangZhou, China.
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Gao R, Qu Q, Guo Q, Sun J, Liao S, Zhu Q, Zhu X, Cheang I, Yao W, Zhang H, Li X, Zhou Y. Construction of a web-based dynamic nomogram for predicting the prognosis in acute heart failure. ESC Heart Fail 2023. [PMID: 37076115 PMCID: PMC10375097 DOI: 10.1002/ehf2.14371] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 03/17/2023] [Accepted: 03/23/2023] [Indexed: 04/21/2023] Open
Abstract
AIMS The early identification and appropriate management may provide clinically meaningful and substained benefits in patients with acute heart failure (AHF). This study aimed to develop an integrative nomogram with myocardial perfusion imaging (MPI) for predicting the risk of all-cause mortality in AHF patients. METHODS AND RESULTS Prospective study of 147 patients with AHF who received gated MPI (59.0 [47.5, 68.0] years; 78.2% males) were enrolled and followed for the primary endpoint of all-cause mortality. We analysed the demographic information, laboratory tests, electrocardiogram, and transthoracic echocardiogram by the least absolute shrinkage and selection operator (LASSO) regression for selection of key features. A multivariate stepwise Cox analysis was performed to identify independent risk factors and construct a nomogram. The predictive values of the constructed model were compared by Kaplan-Meier curve, area under the curves (AUCs), calibration plots, continuous net reclassification improvement, integrated discrimination improvement, and decision curve analysis. The 1, 3, and 5 year cumulative rates of death were 10%, 22%, and 29%, respectively. Diastolic blood pressure [hazard ratio (HR) 0.96, 95% confidence interval (CI) 0.93-0.99; P = 0.017], valvular heart disease (HR 3.05, 95% CI 1.36-6.83; P = 0.007), cardiac resynchronization therapy (HR 0.37, 95% CI 0.17-0.82; P = 0.014), N-terminal pro-B-type natriuretic peptide (per 100 pg/mL; HR 1.02, 95% CI 1.01-1.03; P < 0.001), and rest scar burden (HR 1.03, 95% CI 1.01-1.06; P = 0.008) were independent risk factors for patients with AHF. The cross-validated AUCs (95% CI) of nomogram constructed by diastolic blood pressure, valvular heart disease, cardiac resynchronization therapy, N-terminal pro-B-type natriuretic peptide, and rest scar burden were 0.88 (0.73-1.00), 0.83 (0.70-0.97), and 0.79 (0.62-0.95) at 1, 3, and 5 years, respectively. Continuous net reclassification improvement and integrated discrimination improvement were also observed, and the decision curve analysis identified the greater net benefit of the nomogram across a wide range of threshold probabilities (0-100% at 1 and 3 years; 0-61% and 62-100% at 5 years) compared with dismissing the included factors or using either factor alone. CONCLUSIONS A predictive nomogram for the risk of all-cause mortality in patients with AHF was developed and validated in this study. The nomogram incorporated the rest scar burden by MPI is highly predictive, and may help to better stratify clinical risk and guide treatment decisions in patients with AHF.
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Affiliation(s)
- Rongrong Gao
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China
| | - Qiang Qu
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China
| | - Qixin Guo
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China
| | - Jinyu Sun
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China
| | - Shengen Liao
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China
| | - Qingqing Zhu
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China
| | - Xu Zhu
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China
| | - Iokfai Cheang
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China
| | - Wenming Yao
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China
| | - Haifeng Zhang
- Department of Cardiology, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Gusu School, Nanjing Medical University, 26 Daoqian Street, Suzhou, 215002, China
- Department of Cardiology, Jiangsu Province Hospital, 300 Guangzhou Road, Nanjing, 210029, China
| | - Xinli Li
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China
| | - Yanli Zhou
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China
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Effect of different blood pressure levels on short-term outcomes in hospitalized heart failure patients. INTERNATIONAL JOURNAL OF CARDIOLOGY. CARDIOVASCULAR RISK AND PREVENTION 2023; 16:200169. [PMID: 36874045 PMCID: PMC9975204 DOI: 10.1016/j.ijcrp.2023.200169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Revised: 12/30/2022] [Accepted: 01/12/2023] [Indexed: 01/15/2023]
Abstract
Background To investigate the influence of blood pressure (BP) level on short-term prognosis of heart failure (HF), the effect of the BP level on clinical end point events 3 months after discharge was observed. Methods A retrospective cohort study was performed on 1492 hospitalized HF patients. All patients were divided according to systolic blood pressure (SBP) per 20 mmHg and diastolic blood pressure (DBP) per 10 mmHg. Logistic regression analysis was used to analyze the relationship between BP level and heart failure rehospitalization, cardiac death, all-cause death and a composite end point of heart failure rehospitalization/all-cause death at 3 month follow-up after discharge. Results After multivariable adjustment, the relationship between SBP and DBP levels and outcomes followed an inverted J curve relationship. Compared with the reference group (110 < SBP≤130 mmHg), the risk of all end point events significantly increased in the SBP≤90 mmHg group included heart failure rehospitalization (OR 8.16, 95%CI 2.88-23.11, P < 0.001), cardiac death (OR 5.43, 95%CI 1.97-14.96, P = 0.001), all-cause death (OR 4.85, 95%CI 1.76-13.36, P = 0.002), and composite end point (OR 2.76, 95%CI 1.03-7.41, P = 0.044). SBP>150 mmHg significantly increased the risk of heart failure rehospitalization (OR 2.67, 95%CI 1.15-6.18, P = 0.022). Compared with.the reference group (65 < DBP≤75 mmHg), cardiac death (OR 2.64, 95%CI 1.15-6.05, P = 0.022) and all-cause death (OR 2.67, 95%CI 1.20-5.93, P = 0.016) was significantly increased in DBP≤55 mmHg group. There was no significant difference among subgroups according to left ventricular ejection fraction (P > 0.05). Conclusions There is a significant difference in the short-term prognosis 3 months after discharge in HF patients with different BP levels at discharge. There was an inverted J curve relationship between BP levels and prognosis.
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Chen AY, Kannan S, Chu ES, Sumarsono A. Association of 48-h net fluid status with change in renal function and dyspnea among patients with decompensated heart failure: A pooled cohort analysis of three acute heart failure trials. J Hosp Med 2023; 18:382-390. [PMID: 36811486 DOI: 10.1002/jhm.13070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 01/17/2023] [Accepted: 02/04/2023] [Indexed: 02/24/2023]
Abstract
BACKGROUND Acute heart failure (AHF) exacerbations are a leading cause of hospitalization in the United States. Despite the frequency of AHF hospitalizations, there are inadequate data or practice guidelines on how quickly diuresis should be achieved. OBJECTIVE To study the association of 48-h net fluid change and (A) 72-h change in creatinine and (B) 72-h change in dyspnea among patients with acute heart failure. DESIGNS, SETTINGS, AND PARTICIPANTS This is a retrospective, pooled cohort analysis of patients from the DOSE, ROSE, and ATHENA-HF trials. INTERVENTIONS The primary exposure was 48-h net fluid status. MAIN OUTCOMES AND MEASURES The co-primary outcomes were 72-h change in creatinine and 72-h change in dyspnea. The secondary outcome was risk of 60-day mortality or rehospitalization. RESULTS Eight hundred and seven patients were included. The mean 48-h net fluid status was -2.9 L. A nonlinear association was observed with net fluid status and creatinine change, such that creatinine improved with each liter net negative up to 3.5 L (-0.03 mg/dL per liter negative [95% confidence interval [CI]: -0.06 to -0.01) and remained stable beyond 3.5 L (-0.01 [95% CI: -0.02 to 0.001], p = .17). Net fluid loss was associated with a monotonic improvement of dyspnea (1.4-point improvement per liter negative [95% CI: 0.7-2.2], p = .0002). Each liter net negative by 48 h was also associated with 12% decreased odds of 60-day rehospitalization or death (odds ratio: 0.88; 95% CI: 0.82-0.95; p = .002). CONCLUSION Aggressive net fluid targets within the first 48 h are associated with effective relief of patient self-reported dyspnea and improved long-term outcomes without adversely affecting renal function.
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Affiliation(s)
- Alyssa Y Chen
- University of Texas Southwestern Medical School, Dallas, Texas, USA
| | - Subhasri Kannan
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Division of Hospital Medicine, University of Texas Southwestern at Parkland Health, Dallas, Texas, USA
| | - Eugene S Chu
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Division of Hospital Medicine, University of Texas Southwestern at Parkland Health, Dallas, Texas, USA
| | - Andrew Sumarsono
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Division of Hospital Medicine, University of Texas Southwestern at Parkland Health, Dallas, Texas, USA
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Zhao X, Gu B, Li Q, Li J, Zeng W, Li Y, Guan Y, Huang M, Lei L, Zhong G. Machine learning approach identified clusters for patients with low cardiac output syndrome and outcomes after cardiac surgery. Front Cardiovasc Med 2022; 9:962992. [PMID: 36061544 PMCID: PMC9434347 DOI: 10.3389/fcvm.2022.962992] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 07/25/2022] [Indexed: 11/18/2022] Open
Abstract
Background Low cardiac output syndrome (LCOS) is the most serious physiological abnormality with high mortality for patients after cardiac surgery. This study aimed to explore the multidimensional data of clinical features and outcomes to provide individualized care for patients with LCOS. Methods The electronic medical information of the intensive care units (ICUs) was extracted from a tertiary hospital in South China. We included patients who were diagnosed with LCOS in the ICU database. We used the consensus clustering approach based on patient characteristics, laboratory data, and vital signs to identify LCOS subgroups. The consensus clustering method involves subsampling from a set of items, such as microarrays, and determines to cluster of specified cluster counts (k). The primary clinical outcome was in-hospital mortality and was compared between the clusters. Results A total of 1,205 patients were included and divided into three clusters. Cluster 1 (n = 443) was defined as the low-risk group [in-hospital mortality =10.1%, odds ratio (OR) = 1]. Cluster 2 (n = 396) was defined as the medium-risk group [in-hospital mortality =25.0%, OR = 2.96 (95% CI = 1.97–4.46)]. Cluster 3 (n = 366) was defined as the high-risk group [in-hospital mortality =39.2%, OR = 5.75 (95% CI = 3.9–8.5)]. Conclusion Patients with LCOS after cardiac surgery could be divided into three clusters and had different outcomes.
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Affiliation(s)
- Xu Zhao
- Department of Pharmaceutical Sciences, Institute of Clinical Pharmacology, Sun Yat-sen University, Guangzhou, China
| | - Bowen Gu
- Laboratory of South China Structural Heart Disease, Department of Intensive Care Unit of Cardiovascular Suregery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangzhou, China
| | - Qiuying Li
- Laboratory of South China Structural Heart Disease, Department of Intensive Care Unit of Cardiovascular Suregery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangzhou, China
| | - Jiaxin Li
- Laboratory of South China Structural Heart Disease, Department of Intensive Care Unit of Cardiovascular Suregery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangzhou, China
| | - Weiwei Zeng
- Department of Pharmacy, The Second People's Hospital of Longgang District, Shenzhen, China
| | - Yagang Li
- Department of Pharmaceutical Sciences, Institute of Clinical Pharmacology, Sun Yat-sen University, Guangzhou, China
| | - Yanping Guan
- Department of Pharmaceutical Sciences, Institute of Clinical Pharmacology, Sun Yat-sen University, Guangzhou, China
| | - Min Huang
- Department of Pharmaceutical Sciences, Institute of Clinical Pharmacology, Sun Yat-sen University, Guangzhou, China
| | - Liming Lei
- Laboratory of South China Structural Heart Disease, Department of Intensive Care Unit of Cardiovascular Suregery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangzhou, China
- *Correspondence: Liming Lei
| | - Guoping Zhong
- Department of Pharmaceutical Sciences, Institute of Clinical Pharmacology, Sun Yat-sen University, Guangzhou, China
- Guoping Zhong
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Grand J, Nielsen OW, Møller JE, Hassager C, Jakobsen JC. Vasodilators for acute heart failure – a protocol for a systematic review of randomized clinical trials with meta‐analysis and Trial Sequential Analysis. Acta Anaesthesiol Scand 2022; 66:1156-1164. [PMID: 36054782 PMCID: PMC9542024 DOI: 10.1111/aas.14130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 07/30/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Johannes Grand
- Department of Cardiology Copenhagen University Hospital Hvidovre and Amager‐Hospital, Kettegård Alle 30 Copenhagen Denmark
| | - Olav W. Nielsen
- Department of Cardiology Bispebjerg Hospital Copenhagen University Hospital, Rigshospitalet Bispebjerg Bakke 23 Copenhagen
- University of Copenhagen, Department of Clinical Medicine Copenhagen Denmark
| | - Jacob Eifer Møller
- The Heart Center, Copenhagen University Hospital Rigshospitalet, Department of Cardiology Copenhagen Denmark
- Odense University Hospital, Department of Cardiology, University of Southern Denmark, Department of Clinical Medicine Odense Denmark
| | - Christian Hassager
- The Heart Center, Copenhagen University Hospital Rigshospitalet, Department of Cardiology Copenhagen Denmark
- University of Copenhagen, Department of Clinical Medicine Copenhagen Denmark
| | - Janus Christian Jakobsen
- Copenhagen Trial Unit, Centre for Clinical Intervention Research Copenhagen University Hospital – Rigshospitalet Copenhagen Denmark
- Department of Regional Health Research, Faculty of Health Sciences University of Southern Denmark Odense Denmark
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Grand J, Miger K, Sajadieh A, Køber L, Torp-Pedersen C, Ertl G, López-Sendón J, Pietro Maggioni A, Teerlink JR, Sato N, Gimpelewicz C, Metra M, Holbro T, Nielsen OW. Blood Pressure Drops During Hospitalization for Acute Heart Failure Treated With Serelaxin: A Patient-Level Analysis of 4 Randomized Controlled Trials. Circ Heart Fail 2022; 15:e009199. [PMID: 35184572 DOI: 10.1161/circheartfailure.121.009199] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Hypotensive events and drops in systolic blood pressure (SBP-drop) are frequent in patients hospitalized with acute heart failure. We investigated whether SBP-drops are associated with outcomes in patients treated with serelaxin. METHODS Patient-level retrospective analyses of 4 prospective trials investigating serelaxin in acute heart failure. Main inclusion criteria were SBP 125 to 180 mm Hg, pulmonary congestion, and elevated NT-proBNP (N-terminal pro-B-type natriuretic peptide). SBP-drops were prospectively defined as SBP<100 mm Hg, or, if SBP remained >100 mm Hg, a drop from baseline of 40 mm Hg from baseline. Outcomes were a short-term composite outcome (worsening heart failure, hospital readmission for heart failure or all-cause mortality through 14 days) and 180-day mortality. RESULTS Overall, 2559/11 226 (23%) patients had an SBP-drop. SBP-drop, versus no SBP-drop, was associated with a worse outcome: cumulative incidence of 180-day mortality (11% versus 9%, hazard ratio [HR]. 1.21 [95% CI, 1.05-1.39]; P=0.009) and the short-term outcome (11% versus 9%, HR, 1.29 [95% CI, 1.13-1.49]; P<0.001). Of the 2 SBP-drop components, an SBP<100 mm Hg was associated with the worst outcome compared with a 40 mm Hg drop: short-term outcome (11% versus 10%) and HRs of 1.32 (95% CI, 1.13-1.55; P=0.0005) and 1.22 (95% CI, 0.97-1.56; P=0.09), for each component respectively, with a P value for interaction of 0.05. SBP-drops were associated with a worse short-term outcome in the placebo group (HR, 1.46 [95% CI, 1.19-1.79]; P=0.0003), but not in the serelaxin-group (HR, 1.18 [95% CI, 0.97-1.42]; P=0.10); P interaction=0.003. CONCLUSIONS SBP-drops in patients with acute heart failure and normal to high SBP at admission is associated with worse short- and long-term outcomes especially for SBP <100 mm Hg. However, in patients treated with the intravenous vasodilator serelaxin, SBP-drops seemed less harmful. REGISTRATION URL: https://www.clinicaltrials.gov; Unique identifiers: NCT02064868, NCT02007720, NCT01870778, NCT00520806.
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Affiliation(s)
- Johannes Grand
- Department of Cardiology Bispebjerg Hospital, University of Copenhagen, Denmark. (J.G., K.M., A.S., O.W.N.)
| | - Kristina Miger
- Department of Cardiology Bispebjerg Hospital, University of Copenhagen, Denmark. (J.G., K.M., A.S., O.W.N.)
| | - Ahmad Sajadieh
- Department of Cardiology Bispebjerg Hospital, University of Copenhagen, Denmark. (J.G., K.M., A.S., O.W.N.)
| | - Lars Køber
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark. (L.K.)
| | | | - Georg Ertl
- German Comprehensive Heart Failure Center, Department of Internal Medicine I, University Hospital Würzburg (G.E.)
| | - José López-Sendón
- IdiPaz Research Institute, Hospital La Paz, Autonomous University of Madrid, Spain (J.L.-S.)
| | - Aldo Pietro Maggioni
- Associazione Nazionale Medicin Cardiologi Ospedalieri Research Center, Florence, Italy (A.P.M.).,Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy (A.P.M.)
| | - John R Teerlink
- Section of Cardiology, San Francisco Veterans Affairs Medical Center and School of Medicine, University of California San Francisco (J.R.T.)
| | - Naoki Sato
- Department of Cardiovascular Medicine, Kawaguchi Cardiovascular and Respiratory Hospital, Saitama, Japan (N.S.)
| | | | - Marco Metra
- ASST Spedali Civili and Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Italy (M.M.)
| | | | - Olav W Nielsen
- Department of Cardiology Bispebjerg Hospital, University of Copenhagen, Denmark. (J.G., K.M., A.S., O.W.N.).,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark. (O.W.N.)
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