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Imamura Y, Suzuki A, Kamishima K, Suzuki K, Yamaguchi J. Prognostic factors in patients with heart failure and sarcopenia: an observational retrospective study. Egypt Heart J 2024; 76:52. [PMID: 38683441 PMCID: PMC11058133 DOI: 10.1186/s43044-024-00484-4] [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: 05/12/2023] [Accepted: 04/19/2024] [Indexed: 05/01/2024] Open
Abstract
BACKGROUND Heart failure (HF) prevalence increases with age, and sarcopenia is a poor prognostic factor in patients with HF. We aimed to evaluate the characteristics and prognostic factors in patients with HF and sarcopenia. RESULTS We retrospectively reviewed 256 consecutive patients admitted to our hospital for HF between May 2018 and May 2021, underwent dual-energy X-ray absorptiometry, and were diagnosed with sarcopenia. The primary endpoint was all-cause mortality. The prognoses and characteristics were evaluated and compared between patients with left ventricular ejection fraction (LVEF) < 50% (reduced LVEF, HF with reduced ejection fraction [HFrEF]) and those with LVEF ≥ 50% (preserved LVEF, HF with preserved ejection fraction [HFpEF]). 83 (32%) and 173 (68%) patients had HFrEF and HFpEF, respectively. The HFrEF group had fewer women, lower hypertension rates, higher ischemic heart disease rates, and brain natriuretic peptide (BNP) levels than did the HFpEF group. Kaplan-Meier analysis for all-cause death showed that the HFrEF group had a significantly worse prognosis than the HFpEF group [log-rank p = 0.002]. CONCLUSIONS In patients with HF and sarcopenia, older age, higher New York Heart Association (NYHA) class, BNP levels, and reduced LVEF were independent predictors of death after evaluation. During the treatment of patients with HF and sarcopenia, it is necessary to manage treatment with close attention to BNP and LVEF.
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Affiliation(s)
- Yasutaka Imamura
- Department of Cardiology, Rissho Koseikai Kosei Hospital, Tokyo, Japan
| | - Atsushi Suzuki
- Department of Cardiology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan.
| | - Kazuho Kamishima
- Department of Cardiology, Rissho Koseikai Kosei Hospital, Tokyo, Japan
| | - Kazuhito Suzuki
- Department of Cardiology, Rissho Koseikai Kosei Hospital, Tokyo, Japan
| | - Junichi Yamaguchi
- Department of Cardiology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
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Jin Y, Wen CY, Yue F, Wang H, Yin L, Zhao Y, Mao K, Xin F. Automatic quantitative measurement of left atrial pressure using mitral regurgitation spectrum: clinical study on comparison with floating catheter. Eur J Med Res 2022; 27:217. [DOI: 10.1186/s40001-022-00849-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 10/10/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Introduction
To explore how to measure LAPEq accurately and quantitatively, that is, the left atrial pressure (LAP) measured and calculated by equation method using mitral regurgitation spectrum.
Methods
The mitral regurgitation spectrum, pulmonary arteriolar wedge pressure (PAWP) and invasive arterial systolic pressure of radial artery of 28 patients were collected simultaneously, including 3 patients with rheumatic heart disease, 15 patients with mitral valve prolapse and 10 patients with coronary artery bypass grafting, patients with moderate or above aortic stenosis were excluded. LAPBp (Doppler sphygmomanometer method), LAPEq (Equation method) and LAPC (Catheter method) were measured synchronously, and the measurement results of the three methods were compared and analyzed. A special intelligent Doppler spectrum analysis software was self-designed to accurately measure LAPEq. This study had been approved by the ethics committee of the Northern Theater General Hospital (K-2019-17), and applied for clinical trial (No. Chictr 190023812).
Results
It was found that there was no significant statistical difference between the measurement results of LAPC and LAPEq (t = 0.954, P = 0.348), and significant correlation between the two methods [r = 0.908(0.844, 0.964), P < 0.001]. Although the measurement results of LAPC and LAPBP are consistent in the condition of non-severe eccentric mitral regurgitation, there are significant differences in the overall case and weak correlation between the two methods [r = 0.210, (−0.101, 0.510), P = 0.090]. In MVP patients with P1 or P3 prolapse, the peak pressure difference of MR was underestimated due to the serious eccentricity of MR, which affected the accuracy of LAPBP measurement.
Conclusions
It was shown that there is a good correlation between LAPEq and LAPC, which verifies that the non-invasive and direct quantitative measurement of left atrial pressure based on mitral regurgitation spectrum is feasible and has a good application prospect.
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Oxidative Stress and Inflammatory Modulation of Ca 2+ Handling in Metabolic HFpEF-Related Left Atrial Cardiomyopathy. Antioxidants (Basel) 2020; 9:antiox9090860. [PMID: 32937823 PMCID: PMC7555173 DOI: 10.3390/antiox9090860] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 09/09/2020] [Accepted: 09/10/2020] [Indexed: 12/17/2022] Open
Abstract
Metabolic syndrome-mediated heart failure with preserved ejection fraction (HFpEF) is commonly accompanied by left atrial (LA) cardiomyopathy, significantly affecting morbidity and mortality. We evaluate the role of reactive oxygen species (ROS) and intrinsic inflammation (TNF-α, IL-10) related to dysfunctional Ca2+ homeostasis of LA cardiomyocytes in a rat model of metabolic HFpEF. ZFS-1 obese rats showed features of HFpEF and atrial cardiomyopathy in vivo: increased left ventricular (LV) mass, E/e’ and LA size and preserved LV ejection fraction. In vitro, LA cardiomyocytes exhibited more mitochondrial-fission (MitoTracker) and ROS-production (H2DCF). In wildtype (WT), pro-inflammatory TNF-α impaired cellular Ca2+ homeostasis, while anti-inflammatory IL-10 had no notable effect (confocal microscopy; Fluo-4). In HFpEF, TNF-α had no effect on Ca2+ homeostasis associated with decreased TNF-α receptor expression (western blot). In addition, IL-10 substantially improved Ca2+ release and reuptake, while IL-10 receptor-1 expression was unaltered. Oxidative stress in metabolic syndrome mediated LA cardiomyopathy was increased and anti-inflammatory treatment positively affected dysfunctional Ca2+ homeostasis. Our data indicates, that patients with HFpEF-related LA dysfunction might profit from IL-10 targeted therapy, which should be further explored in preclinical trials.
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Kapłon-Cieślicka A, Laroche C, Crespo-Leiro MG, Coats AJS, Anker SD, Filippatos G, Maggioni AP, Hage C, Lara-Padrón A, Fucili A, Drożdż J, Seferovic P, Rosano GMC, Mebazaa A, McDonagh T, Lainscak M, Ruschitzka F, Lund LH. Is heart failure misdiagnosed in hospitalized patients with preserved ejection fraction? From the European Society of Cardiology - Heart Failure Association EURObservational Research Programme Heart Failure Long-Term Registry. ESC Heart Fail 2020; 7:2098-2112. [PMID: 32618139 PMCID: PMC7524216 DOI: 10.1002/ehf2.12817] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 05/12/2020] [Accepted: 05/20/2020] [Indexed: 01/14/2023] Open
Abstract
Aims In hospitalized patients with a clinical diagnosis of acute heart failure (HF) with preserved ejection fraction (HFpEF), the aims of this study were (i) to assess the proportion meeting the 2016 European Society of Cardiology (ESC) HFpEF criteria and (ii) to compare patients with restrictive/pseudonormal mitral inflow pattern (MIP) vs. patients with MIP other than restrictive/pseudonormal. Methods and results We included hospitalized participants of the ESC‐Heart Failure Association (HFA) EURObservational Research Programme (EORP) HF Long‐Term Registry who had echocardiogram with ejection fraction (EF) ≥ 50% during index hospitalization. As no data on e', E/e' and left ventricular (LV) mass index were gathered in the registry, the 2016 ESC HFpEF definition was modified as follows: elevated B‐type natriuretic peptide (BNP) (≥100 pg/mL for acute HF) and/or N‐terminal pro‐BNP (≥300 pg/mL) and at least one of the echocardiographic criteria: (i) presence of LV hypertrophy (yes/no), (ii) left atrial volume index (LAVI) of >34 mL/m2), or (iii) restrictive/pseudonormal MIP. Next, all patients were divided into four groups: (i) patients with restrictive/pseudonormal MIP on echocardiography [i.e. with presumably elevated left atrial (LA) pressure], (ii) patients with MIP other than restrictive/pseudonormal (i.e. with presumably normal LA pressure), (iii) atrial fibrillation (AF) group, and (iv) ‘grey area’ (no consistent description of MIP despite no report of AF). Of 6365 hospitalized patients, 1848 (29%) had EF ≥ 50%. Natriuretic peptides were assessed in 28%, LV hypertrophy in 92%, LAVI in 13%, and MIP in 67%. The 2016 ESC HFpEF criteria could be assessed in 27% of the 1848 patients and, if assessed, were met in 52%. Of the 1848 patients, 19% had restrictive/pseudonormal MIP, 43% had MIP other than restrictive/pseudonormal, 18% had AF and 20% were grey area. There were no differences in long‐term all‐cause or cardiovascular mortality, or all‐cause hospitalizations or HF rehospitalizations between the four groups. Despite fewer non‐cardiac comorbidities reported at baseline, patients with MIP other than restrictive/pseudonormal (i.e. with presumably normal LA pressure) had more non‐cardiovascular (14.0 vs. 6.7 per 100 patient‐years, P < 0.001) and cardiovascular non‐HF (13.2 vs. 8.0 per 100 patient‐years, P = 0.016) hospitalizations in long‐term follow‐up than patients with restrictive/pseudonormal MIP. Conclusions Acute HFpEF diagnosis could be assessed (based on the 2016 ESC criteria) in only a quarter of patients and confirmed in half of these. When assessed, only one in three patients had restrictive/pseudonormal MIP suggestive of elevated LA pressure. Patients with MIP other than restrictive/pseudonormal (suggestive of normal LA pressure) could have been misdiagnosed with acute HFpEF or had echocardiography performed after normalization of LA pressure. They were more often hospitalized for non‐HF reasons during follow‐up. Symptoms suggestive of acute HFpEF may in some patients represent non‐HF comorbidities.
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Affiliation(s)
| | - Cécile Laroche
- EURObservational Research Programme (EORP), European Society of Cardiology, Sophia-Antipolis, France
| | - Maria G Crespo-Leiro
- Unidad de Insuficiencia Cardiaca y Trasplante Cardiaco, Complexo Hospitalario Universitario A Coruna (CHUAC), INIBIC, UDC, CIBERCV, A Coruña, Spain
| | | | - Stefan D Anker
- Division of Cardiology and Metabolism; Department of Cardiology (CVK); and Berlin-Brandenburg Center for Regenerative Therapies (BCRT); German Centre for Cardiovascular Research (DZHK) partner site Berlin; Charité Universitätsmedizin Berlin, Germany & Department of Cardiology and Pneumology, University Medicine Göttingen (UMG), Göttingen, Germany
| | - Gerasimos Filippatos
- School of Medicine, University of Cyprus & Heart Failure Unit, Department of Cardiology, University Hospital Attikon, National and Kapodistrian University of Athens, Athens, Greece
| | - Aldo P Maggioni
- EURObservational Research Programme (EORP), European Society of Cardiology, Sophia-Antipolis, France.,ANMCO Research Centre, Florence, Italy
| | - Camilla Hage
- Unit of Cardiology, Department of Medicine, Karolinska Institutet, and Heart and Vascular Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Antonio Lara-Padrón
- Unidad de Insuficiencia Cardiaca, Servicio de Cardiología, Complejo Hospital Universitario de Canarias, San Cristóbal de La Laguna, Santa Cruz de Tenerife, Spain
| | - Alessandro Fucili
- Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Jarosław Drożdż
- Department of Cardiology, Medical University of Lodz, Lodz, Poland
| | - Petar Seferovic
- Faculty of Medicine, University of Belgrade; Serbian Academy of Sciences and Arts, Belgrade, Serbia
| | | | - Alexandre Mebazaa
- Department of Anaesthesia and Critical Care, University Hospitals Saint Louis-Lariboisière, APHP; University Paris Diderot; UMR 942 Inserm - MASCOT, Paris, France
| | | | - Mitja Lainscak
- Department of Internal Medicine, General Hospital Murska Sobota, Slovenia, and Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | | | - Lars H Lund
- Unit of Cardiology, Department of Medicine, Karolinska Institutet, and Heart and Vascular Theme, Karolinska University Hospital, Stockholm, Sweden
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Cui X, Zhou J, Pivodic A, Dahlström U, Ge J, Fu M. Temporal trends in cause-specific readmissions and their risk factors in heart failure patients in Sweden. Int J Cardiol 2020; 306:116-122. [PMID: 32145935 DOI: 10.1016/j.ijcard.2020.02.048] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Revised: 02/12/2020] [Accepted: 02/18/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND It remains unclear whether readmissions of patients with heart failure (HF) have decreased over time in an era of improved therapy and management of HF. This study aimed to determine the temporal short- and long-term trends of cause-specific rehospitalization and their risk factors in a Swedish context. METHODS HF patients in the Swedish Heart Failure Registry (SwedeHF) were investigated. Maximum follow-up time was 1 year. Outcomes included the first occurrence of all-cause, cardiovascular (CV) and HF rehospitalizations. Cox proportional hazards models were performed to determine the impact of increasing years on risk for rehospitalization and its known risk factors. RESULTS Totally, 25,644 index-hospitalized HF patients in SwedeHF from 2004 to 2011 were enrolled in the study. For 8 years, the incidence risk of 1-year all-cause rehospitalization remained unchanged, whereas the incidence risk of CV (P = 0.038) or HF (P = 0.0038) rehospitalization decreased. After adjustment for age and sex, a 3% decrease per every second year was observed for 1-year CV and HF rehospitalizations (P < 0.05). However, time to the first occurring all-cause, CV and HF rehospitalization did not change significantly from 2004 to 2011 (P-values 0.13-0.87). When two study periods (2004-2005 vs. 2010-2011) were compared, the risk factor profile for rehospitalization was found to change. CONCLUSIONS Throughout the 8-year study period, CV- and HF-related rehospitalizations decreased, whereas all-cause rehospitalization remained unchanged, indicating a parallel increase in non-CV rehospitalization in the HF patients.
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Affiliation(s)
- Xiaotong Cui
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, China; Shanghai Institute of Cardiovascular Diseases, Shanghai, China; Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
| | - Jingmin Zhou
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, China; Shanghai Institute of Cardiovascular Diseases, Shanghai, China
| | - Aldina Pivodic
- Statistiska Konsultgruppen, Gothenburg, Sweden; Department of Ophthalmology, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Ulf Dahlström
- Department of Cardiology, Linköping University, Linköping, Sweden; Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Junbo Ge
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, China; Shanghai Institute of Cardiovascular Diseases, Shanghai, China
| | - Michael Fu
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Eriksson B, Wändell P, Dahlström U, Näsman P, Lund LH, Edner M. Limited value of NT-proBNP as a prognostic marker of all-cause mortality in patients with heart failure with preserved and mid-range ejection fraction in primary care: A report from the swedish heart failure register. Scand J Prim Health Care 2019; 37:434-443. [PMID: 31724475 PMCID: PMC6883415 DOI: 10.1080/02813432.2019.1684029] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Aim: The prognostic value of natriuretic peptides in the management of heart failure (HF) patients with ejection fraction (EF) <40% is well established, but is less known for those with EF ≥40% managed in primary care (PC). Therefore, the aim of this study is to describe the prognostic significance of plasma NT-proBNP in such patients managed in PC.Subjects: We included 924 HF patients (48% women) with EF ≥40% and NT-proBNP registered in the Swedish Heart Failure Registry. Follow-up was 1100 ± 687 days.Results: One-, three- and five-year mortality rates were 8.1%, 23.9% and 44.7% in patients with EF 40-50% (HFmrEF) and 7.3%, 23.6% and 37.2% in patients with EF ≥50% (HFpEF) (p = 0.26). Patients with the highest mean values of NT-proBNP had the highest all-cause mortality but wide standard deviations (SDs). In univariate regression analysis, there was an association only between NT-proBNP quartiles and all-cause mortality. In HFmrEF patients, hazard ratio (HR) was 1.96 (95% CI 1.60-2.39) p < 0.0001) and in HFpEF patients, HR was 1.72 (95% CI 1.49-1.98) p < 0.0001). In a multivariate Cox proportional hazard regression analysis, adjusted for age, NYHA class, atrial fibrillation and GFR class, this association remained regarding NT-proBNP quartiles [HR 1.83 (95% CI 1.38-2.44), p < 0.0001] and [HR 1.48 (95% CI 1.16-1.90), p = 0.0001], HFmrEF and HFpEF, respectively.Conclusion: NT-proBNP has a prognostic value in patients with HF and EF ≥40% managed in PC. However, its clinical utility is limited due to high SDs and the fact that it is not independent in this population which is characterized by high age and much comorbidity.Key pointsIt is uncertain whether NT-proBNP predicts risk in heart failure with preserved ejection fraction (EF > 40%, HFpEF) managed in primary care.We show that high NT-proBNP predicts increased all-cause mortality in HFpEF-patients managed in primary care.The clinical use is however limited due to large standard deviations, many co-morbidities and high age.Many of these co-morbidities contribute to all-cause mortality and management of these patients should also focus on these co-morbidities.
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Affiliation(s)
- Björn Eriksson
- Department of Neurobiology, Care Sciences and Society (NVS), Division of Family Medicine and Primary Care, Karolinska Institutet, Huddinge, Sweden;
- CONTACT Björn ErikssonGustavsbergs VC, Odelbergs väg 19, Gustavsberg 13440, Sweden
| | - Per Wändell
- Department of Neurobiology, Care Sciences and Society (NVS), Division of Family Medicine and Primary Care, Karolinska Institutet, Huddinge, Sweden;
| | - Ulf Dahlström
- Department of Cardiology, Linköping University, Linköping, Sweden;
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden;
| | - Per Näsman
- Center for Safety Research, KTH Royal Institute of Technology, Stockholm, Sweden;
| | - Lars H. Lund
- Department of Cardiology, Division of Medicine, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Magnus Edner
- Department of Neurobiology, Care Sciences and Society (NVS), Division of Family Medicine and Primary Care, Karolinska Institutet, Huddinge, Sweden;
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Gologorsky RC, Roy S. Ultrafiltration for management of fluid overload in patients with heart failure. Artif Organs 2019; 44:129-139. [DOI: 10.1111/aor.13549] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 06/13/2019] [Accepted: 07/23/2019] [Indexed: 12/19/2022]
Affiliation(s)
- Rebecca C. Gologorsky
- Department of Surgery University of California, San Francisco‐East Bay Oakland California
- Department of Bioengineering and Therapeutic Sciences University of California San Francisco California
| | - Shuvo Roy
- Department of Bioengineering and Therapeutic Sciences University of California San Francisco California
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Michels da Silva D, Langer H, Graf T. Inflammatory and Molecular Pathways in Heart Failure-Ischemia, HFpEF and Transthyretin Cardiac Amyloidosis. Int J Mol Sci 2019; 20:ijms20092322. [PMID: 31083399 PMCID: PMC6540104 DOI: 10.3390/ijms20092322] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Revised: 05/01/2019] [Accepted: 05/07/2019] [Indexed: 02/06/2023] Open
Abstract
Elevated pro-inflammatory biomarkers and cytokines are associated with morbidity and mortality in heart failure (HF). Preclinical and clinical studies have shown multiple inflammatory mechanisms causing cardiac remodeling, dysfunction and chronic failure. Therapeutics in trials targeting the immune response in heart failure and its effects did not result in evident benefits regarding clinical endpoints and mortality. This review elaborates pathways of immune cytokines in pathogenesis and worsening of heart failure in clinical and cellular settings. Besides the well-known mechanisms of immune activation and inflammation in atherosclerosis causing ischemic cardiomyopathy or myocarditis, attention is focused on other mechanisms leading to heart failure such as transthyretin (TTR) amyloidosis or heart failure with preserved ejection fraction. The knowledge of the pathogenesis in heart failure and amyloidosis on a molecular and cellular level might help to highlight new disease defining biomarkers and to lead the way to new therapeutic targets.
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Affiliation(s)
- Diana Michels da Silva
- Department of Cardiology, Angiology and Intensive Care, Medicine Medical Clinic II, University Heart Center Lübeck, 23562 Lübeck, Germany.
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, 23562 Lübeck, Germany.
| | - Harald Langer
- Department of Cardiology, Angiology and Intensive Care, Medicine Medical Clinic II, University Heart Center Lübeck, 23562 Lübeck, Germany.
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, 23562 Lübeck, Germany.
| | - Tobias Graf
- Department of Cardiology, Angiology and Intensive Care, Medicine Medical Clinic II, University Heart Center Lübeck, 23562 Lübeck, Germany.
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, 23562 Lübeck, Germany.
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9
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Rosa GM, Scagliola R, Ghione P, Valbusa A, Brunelli C, Carbone F, Montecucco F, Monacelli F. Predictors of cardiovascular outcome and rehospitalization in elderly patients with heart failure. Eur J Clin Invest 2019; 49:e13044. [PMID: 30368802 DOI: 10.1111/eci.13044] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Revised: 10/22/2018] [Accepted: 10/23/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND Heart failure (HF) is a major public health problem and represents the only cardiac disease continuing to increase in prevalence, in particular among elderly patients. The frequent rehospitalizations have a negative impact on quality of life of patients with HF, constituting a substantial cost for patients and the health system. The aim of this review was to look into biochemical, echocardiographic and socioeconomical parameters as predictors of clinical outcomes and rehospitalizations. METHODS This narrative review is based on the material searched for and obtained via PubMed from January 2000 up to March 2018. The search terms we used were as follows: "elderly, heart failure, cardiovascular" in combination with "biomarker, echocardiography and hospitalization." RESULTS This review analyses the potential predictive role of biochemical and echocardiographic and socioeconomical parameters on clinical outcomes (particularly cardiovascular) and hospital readmissions in patients with chronic HF. We focused on risk stratification of elderly patients with HF, who constitute a category of frail subjects at higher risk for readmission to hospital. CONCLUSIONS In elderly subjects with chronic HF, the risk stratification could benefit of a multiparametric approach combining biochemical, echocardiographic, demographic and socioeconomical parameters, thus ensuring a better quality of life and at the same time a better allocation of financial resources.
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Affiliation(s)
- Gian M Rosa
- Clinic of Cardiovascular Diseases, University of Genoa, Genoa, Italy.,IRCCS Ospedale Policlinico San Martino Genoa - Italian Cardiovascular Network, Genoa, Italy
| | | | - Paola Ghione
- Clinic of Cardiovascular Diseases, University of Genoa, Genoa, Italy
| | - Alberto Valbusa
- IRCCS Ospedale Policlinico San Martino Genoa - Italian Cardiovascular Network, Genoa, Italy
| | - Claudio Brunelli
- Clinic of Cardiovascular Diseases, University of Genoa, Genoa, Italy.,IRCCS Ospedale Policlinico San Martino Genoa - Italian Cardiovascular Network, Genoa, Italy
| | - Federico Carbone
- Department of Internal Medicine, First Clinic of Internal Medicine, University of Genoa, Genoa, Italy
| | - Fabrizio Montecucco
- IRCCS Ospedale Policlinico San Martino Genoa - Italian Cardiovascular Network, Genoa, Italy.,Department of Internal Medicine, and Centre of Excellence for Biomedical Research (CEBR), First Clinic of Internal Medicine, University of Genoa, Genoa, Italy
| | - Fiammetta Monacelli
- IRCCS Ospedale Policlinico San Martino Genoa, Genoa, Italy.,Department of Internal Medicine, Geriatric Unit, University of Genoa, Genoa, Italy
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Mohananey D, Heidari-Bateni G, Villablanca PA, Iturrizaga Murrieta JC, Vlismas P, Agrawal S, Bhatia N, Mookadam F, Ramakrishna H. Heart Failure With Preserved Ejection Fraction—A Systematic Review and Analysis of Perioperative Outcomes. J Cardiothorac Vasc Anesth 2018; 32:2423-2434. [DOI: 10.1053/j.jvca.2017.11.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Indexed: 12/18/2022]
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11
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Eriksson B, Wändell P, Dahlström U, Näsman P, Lund LH, Edner M. Comorbidities, risk factors and outcomes in patients with heart failure and an ejection fraction of more than or equal to 40% in primary care- and hospital care-based outpatient clinics. Scand J Prim Health Care 2018; 36:207-215. [PMID: 29633886 PMCID: PMC6066291 DOI: 10.1080/02813432.2018.1459654] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE The aim of this study is to describe patients with heart failure and an ejection fraction (EF) of more than or equal to 40%, managed in both Primary- and Hospital based outpatient clinics separately with their prognosis, comorbidities and risk factors. Further to compare the heart failure medication in the two groups. DESIGN We used the prospective Swedish Heart Failure Registry to include 9654 out-patients who had HF and EF ≥40%, 1802 patients were registered in primary care and 7852 in hospital care. Descriptive statistical tests were used to analyze base line characteristics in the two groups and multivariate logistic regression analysis to assess mortality rate in the groups separately. SETTING The prospective Swedish Heart Failure Registry. SUBJECTS Patients with heart failure and an ejection fraction (EF) of more than or equal to 40%. MAIN OUTCOME MEASURES Comorbidities, risk factors and mortality. RESULTS Mean-age was 77.5 (primary care) and 70.3 years (hospital care) p < 0.0001, 46.7 vs. 36.3% women respectively (p < 0.0001) and EF ≥50% 26.1 vs. 13.4% (p < 0.0001). Co-morbidities were common in both groups (97.2% vs. 92.3%), the primary care group having more atrial fibrillation, hypertension, ischemic heart disease and COPD. According to the multivariate logistic regression analysis smoking, COPD and diabetes were the most important independent risk factors in the primary care group and valvular disease in the hospital care group. All-cause mortality during mean follow-up of almost 4 years was 31.5% in primary care and 27.8% in hospital care. One year-mortality rates were 7.8%, and 7.0% respectively. CONCLUSION Any co-morbidity was noted in 97% of the HF-patients with an EF of more than or equal to 40% managed at primary care based out-patient clinics and these patients had partly other independent risk factors than those patients managed in hospital care based outpatients clinics. Our results indicate that more attention should be payed to manage COPD in the primary care group. KEY POINTS 97% of heart failure patients with an ejection fraction of more than or equal to 40% managed at primary care based out-patient clinics had any comorbidity. Patients in primary care had partly other independent risk factors than those in hospital care. All-cause mortality during mean follow-up of almost 4 years was higher in primary care compared to hospital care. In matched HF-patients RAS-antagonists, beta-blockers as well as the combination of the two drugs were more seldom prescribed when managed in primary care compared with hospital care.
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Affiliation(s)
- B. Eriksson
- Division of Family Medicine, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet, Huddinge, Sweden;
- CONTACT Björn Eriksson Gustavsbergs VCOdelbergs väg 19 13440 Gustavsberg, Stockholm, Sweden
| | - P. Wändell
- Division of Family Medicine, NVS, Karolinska Institutet, Sweden;
| | - U. Dahlström
- Department of Cardiology and Department of Medical and Health Sciences, Linköping University, SwedenLinköping;
| | - P. Näsman
- Centre for Safety Research, KTH Royal Institute of Technology, Stockholm, Sweden;
| | - L. H. Lund
- Karolinska Institutet, Department of Medicine, Unit of Cardiology, Karolinska University Hospital, Stockholm, Sweden;
| | - M. Edner
- Cardiology Unit, N3: 06, Department of Medicine, Karolinska Institute and University Hospital, Stockholm, Sweden
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12
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Kitagawa M, Yamanaka Y, Adachi T, Ito J, Fukase K, Ohta I, Katagiri T. Hyponatremia with Loss of High Signal Intensity in the Posterior Pituitary Lobe on T1-weighted Magnetic Resonance Imaging. Intern Med 2017; 56:3205-3209. [PMID: 29021435 PMCID: PMC5742394 DOI: 10.2169/internalmedicine.8616-16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Herein, we report on an 82-year-old woman who presented with anorexia. The patient had hyponatremia with preserved urinary osmotic pressure. T1-weighted magnetic resonance imaging (MRI) showed a lack of high signal intensity (SI) in the posterior pituitary lobe. Based on the patient's high levels of N-terminal prohormone of brain natriuretic peptide (NT-proBNP), heart failure was suspected. The heart failure may have caused arginine vasopressin (AVP) secretion. The depletion of AVP secretory granules may therefore cause the posterior pituitary gland to disappear on T1-weighted MRI.
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Affiliation(s)
- Masayuki Kitagawa
- Department of Internal Medicine, Yamagata Prefectural Kahoku Hospital, Japan
| | - Yoshihiro Yamanaka
- Department of Internal Medicine, Yamagata Prefectural Kahoku Hospital, Japan
| | - Toru Adachi
- Department of Internal Medicine, Yamagata Prefectural Kahoku Hospital, Japan
| | - Junitsu Ito
- Department of Internal Medicine, Yamagata Prefectural Kahoku Hospital, Japan
| | - Kazutoshi Fukase
- Department of Internal Medicine, Yamagata Prefectural Kahoku Hospital, Japan
| | - Ikuro Ohta
- Department of Internal Medicine, Yamagata Prefectural Kahoku Hospital, Japan
| | - Tadashi Katagiri
- Department of Neurology, Yamagata Prefectural Kahoku Hospital, Japan
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13
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Lourenço AP, Leite-Moreira AF, Balligand JL, Bauersachs J, Dawson D, de Boer RA, de Windt LJ, Falcão-Pires I, Fontes-Carvalho R, Franz S, Giacca M, Hilfiker-Kleiner D, Hirsch E, Maack C, Mayr M, Pieske B, Thum T, Tocchetti CG, Brutsaert DL, Heymans S. An integrative translational approach to study heart failure with preserved ejection fraction: a position paper from the Working Group on Myocardial Function of the European Society of Cardiology. Eur J Heart Fail 2017; 20:216-227. [DOI: 10.1002/ejhf.1059] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2016] [Revised: 09/08/2017] [Accepted: 10/01/2017] [Indexed: 12/28/2022] Open
Affiliation(s)
- Andre P. Lourenço
- Department of Surgery and Physiology & Cardiovascular Research Centre, Faculty of Medicine; University of Porto; Portugal
| | - Adelino F. Leite-Moreira
- Department of Surgery and Physiology & Cardiovascular Research Centre, Faculty of Medicine; University of Porto; Portugal
| | - Jean-Luc Balligand
- Pole of Pharmacology and Therapeutics, Institut de Recherche Experimentale et Clinique (IREC), and Clinique Universitaire Saint-Luc; Université catholique de Louvain; Brussels Belgium
| | - Johann Bauersachs
- Klinik fuer Kardiologie und Angiologie Medizinische Hochschule; Hannover Germany
| | - Dana Dawson
- Reader in Cardiovascular Medicine and Honorary Consultant Cardiologist, University of Aberdeen; UK
| | | | - Leon J. de Windt
- Department of Cardiology, CARIM School for Cardiovascular Diseases Faculty of Health, Medicine and Life Sciences; Maastricht University; The Netherlands
| | - Inês Falcão-Pires
- Department of Surgery and Physiology & Cardiovascular Research Centre, Faculty of Medicine; University of Porto; Portugal
| | - Ricardo Fontes-Carvalho
- Department of Surgery and Physiology & Cardiovascular Research Centre, Faculty of Medicine; University of Porto; Portugal
| | - Stefan Franz
- University Hospital Halle; Department of Internal Medicine III; Halle, Saale Germany
| | - Mauro Giacca
- Molecular Medicine Laboratory, International Centre for Genetic Engineering and Biotechnology (ICGEB) & Department of Medical, Surgical and Health Sciences; University of Trieste; Trieste Italy
| | | | - Emilio Hirsch
- Department of Molecular Biotechnology and Health Sciences; University of Turin; Torino Italy
| | - Christoph Maack
- Klinik für Innere Medizin III; Universitätsklinikum des Saarlandes; Homburg Germany
| | - Manuel Mayr
- The James Black Centre and King's British Heart Foundation Centre, King's College; University of London; London UK
| | - Burkert Pieske
- Department of Cardiology, Charité, Campus Virchow & German Centre for Cardiovascular Research (DZHK), Charite & Berlin Institute of Health, Berlin; Germany & Department of Cardiology, University of Graz; Graz Austria
| | - Thomas Thum
- Institute of Molecular and Translational Therapeutic Strategies (IMTTS), IFB-Tx, & REBIRTH Excellence Cluster, Hannover Medical School, Hannover, Germany, and National Heart and Lung Institute; Imperial College London; UK
| | - Carlo G. Tocchetti
- Department of Translational Medical Sciences, Division of Internal Medicine; Federico II University; Naples Italy
| | | | - Stephane Heymans
- Department of Cardiology, Maastricht University Medical Center & CARIM; Maastricht University; Maastricht The Netherlands
- Cardiovascular Sciences; University of Leuven; Belgium
- Netherlands Heart Institute; Utrecht The Netherlands
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14
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Obi EN, Swindle JP, Turner SJ, Russo PA, Altan A. Health Care Costs for Patients with Heart Failure Escalate Nearly 3-Fold in Final Months of Life. J Manag Care Spec Pharm 2017; 22:1446-1456. [PMID: 27882835 PMCID: PMC10398255 DOI: 10.18553/jmcp.2016.22.12.1446] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Heart failure (HF) is a severe chronic disease with growing prevalence and health care burden as well as high mortality. End-of-life cost data for patients with HF may inform disease and medication therapy management. OBJECTIVES To (a) characterize a real-world sample of patients with HF who died; (b) estimate health care costs for 6 months and semiannually for 24 months, before death; and (c) examine associations between patient characteristics and predeath health care costs. METHODS This was a retrospective study of commercial and Medicare Advantage with Part D (MAPD) enrollees (aged ≥ 18 years), using data from a large national health plan. Included patients had evidence of HF during January 1, 2009-December 31, 2013, based on ≥ 1 inpatient hospitalization or ≥ 2 noninpatient encounters with diagnosis code for HF and evidence of mortality during July 1, 2009-December 31, 2013. Demographic data, comorbidities, guideline-directed HF-related outpatient pharmacotherapy (HFRx), and predeath health care costs (all-cause and HF-related) were described. A generalized linear model examined associations between all-cause health care costs (months 6 and 1 previous to death) and specific patient characteristics. RESULTS Of 48,026 identified patients, mean age was 77.9 years; 52.8% were female; 93.0% were MAPD enrolled; 92.5% had Quan-Charlson comor-bidity score ≥ 3; and about one quarter (26.0%) had no evidence of HFRx. Over the last 6 months of life, monthly all-cause total cost increased 3.2-fold for MAPD enrollees and 2.8-fold for commercial enrollees, although pharmacy cost decreased slightly (0.8-fold for both plan types). Cumulative 6-month all-cause medical cost was $37,186 for MAPD enrollees and $143,363 for commercial enrollees (68.8% and 73.2% due to hospitalization, respectively), and cumulative HF-related medical cost was $20,794 for MAPD enrollees and $78,440 for commercial enrollees (88.8% and 95.3% due to hospitaliza-tion, respectively). Over the last 24 months, semiannual all-cause total cost increased 3.2-fold for MAPD enrollees and 4.5-fold for commercial enroll-ees, although pharmacy cost increased only slightly (1.1-fold and 1.3-fold, respectively). Based on multivariable analysis, factors associated with higher risk of incurring a cost increase between month 6 and month 1 before death included older age (75-84 years: cost ratio [CR] = 1.33, P < 0.001; 226585 years: CR = 1.43, P < 0.001), comorbid coronary heart disease (CR = 1.12, P = 0.003), and no evidence of HFRx (CR = 1.48, P < 0.001). CONCLUSIONS Patients with HF experienced ≥ 2.8-fold increase in monthly all-cause total cost over the last 6 months of life, which was driven by hospitalization. Although MAPD enrollees incurred greater cost increases, cumulative costs were higher for commercial enrollees. After multivariable adjustment, older age, comorbid coronary heart disease, and no evidence of HFRx were among factors associated with higher risk of cost increase over the last 6 months of life. Study findings provide predeath cost information that should be useful in value assessments of innovative HF interventions and highlight impact of HFRx on predeath health care costs.
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Affiliation(s)
- Engels N Obi
- 1 Institute for Health Outcomes Policy & Economics, Rutgers University, Piscataway, New Jersey, and Health Economics & Outcomes Research, Novartis Pharmaceuticals, East Hanover, New Jersey
| | | | - Stuart J Turner
- 3 Health Economics & Outcomes Research, Novartis Pharmaceuticals, East Hanover, New Jersey
| | - Patricia A Russo
- 3 Health Economics & Outcomes Research, Novartis Pharmaceuticals, East Hanover, New Jersey
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15
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Hoshida S, Shinoda Y, Ikeoka K, Minamisaka T, Fukuoka H, Inui H, Watanabe T. Fluctuation of Dynamic Diastolic Function Relative to Static Cardiac Structure - New Insights Into the Underlying Mechanism of Heart Failure With Preserved Ejection Fraction in Elderly Patients. Circ J 2017; 81:755-758. [PMID: 28132965 DOI: 10.1253/circj.cj-16-1126] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The mechanisms of heart failure with preserved ejection fraction (HFpEF) need to be clarified immediately.Methods and Results:We examined diastolic function relative to arterial elasticity among hypertensive patients with preserved EF. Diastolic elastance (EdI)/effective arterial elastance (EaI), EdI/EaI=E/e'/(0.9×systolic blood pressure [SBP]) was significantly more impaired in women than in men among patients ≥75 years. The higher EdI/EaI value in elderly women implies they are intermittently exposed to higher left ventricular filling pressure relative to SBP during daily life. CONCLUSIONS Highly fluctuating impairment of diastolic function relative to arterial elasticity may predispose elderly women to pulmonary edema.
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Affiliation(s)
- Shiro Hoshida
- Department of Cardiovascular Medicine, Yao Municipal Hospital
| | | | - Kuniyasu Ikeoka
- Department of Cardiovascular Medicine, Yao Municipal Hospital
| | | | | | - Hirooki Inui
- Department of Cardiovascular Medicine, Yao Municipal Hospital
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16
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Santas E, Valero E, Mollar A, García-Blas S, Palau P, Miñana G, Núñez E, Sanchis J, Chorro FJ, Núñez J. Carga de hospitalizaciones recurrentes tras una hospitalización por insuficiencia cardiaca aguda: insuficiencia cardiaca con función sistólica conservada frente a reducida. Rev Esp Cardiol 2017. [DOI: 10.1016/j.recesp.2016.06.027] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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17
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Kai M, Kai H. More Attention Should Be Paid to Abnormalities of Circadian Blood Pressure Rhythm in Heart Failure Patients. Circ J 2017; 81:153-154. [PMID: 28049924 DOI: 10.1253/circj.cj-16-1269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Mamiko Kai
- Department of Pharmaceutical and Health Care Management, Faculty of Pharmaceutical Sciences, Fukuoka University
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18
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Santas E, Valero E, Mollar A, García-Blas S, Palau P, Miñana G, Núñez E, Sanchis J, Chorro FJ, Núñez J. Burden of Recurrent Hospitalizations Following an Admission for Acute Heart Failure: Preserved Versus Reduced Ejection Fraction. ACTA ACUST UNITED AC 2016; 70:239-246. [PMID: 27816423 DOI: 10.1016/j.rec.2016.06.021] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Accepted: 06/09/2016] [Indexed: 11/29/2022]
Abstract
INTRODUCTION AND OBJECTIVES Heart failure with preserved ejection fraction and reduced ejection fraction share a high mortality risk. However, differences in the rehospitalization burden over time between these 2 entities remains unclear. METHODS We prospectively included 2013 consecutive patients discharged for acute heart failure. Of these, 1082 (53.7%) had heart failure with preserved ejection fraction and 931 (46.2%) had heart failure with reduced ejection fraction. Cox and negative binomial regression methods were used to evaluate the risks of death and repeat hospitalizations, respectively. RESULTS At a median follow-up of 2.36 years (interquartile range: 0.96-4.65), 1018 patients (50.6%) died, and 3804 readmissions were registered in 1406 patients (69.8%). Overall, there were no differences in mortality between heart failure with preserved ejection fraction and heart failure with reduced ejection fraction (16.7 vs 16.1 per 100 person-years, respectively; P=0794), or all-cause repeat hospitalization rates (62.1 vs 62.2 per 100 person-years, respectively; P=.944). After multivariable adjustment, and compared with patients with heart failure with reduced ejection fraction, patients with heart failure with preserved ejection fraction exhibited a similar risk of all-cause readmissions (incidence rate ratio=1.04; 95%CI, 0.93-1.17; P=.461). Regarding specific causes, heart failure with preserved ejection fraction showed similar risks of cardiovascular and heart failure-related rehospitalizations (incidence rate ratio=0.93; 95%CI, 0.82-1.06; P=.304; incidence rate ratio=0.96; 95% confidence interval, 0.83-1.13; P=.677, respectively), but had a higher risk of noncardiovascular readmissions (incidence rate ratio=1.24; 95%CI, 1.04-1.47; P=.012). CONCLUSIONS Following an admission for acute heart failure, patients with heart failure with preserved ejection fraction have a similar rehospitalization burden to those with heart failure with reduced ejection fraction. However, patients with heart failure with preserved ejection fraction are more likely to be readmitted for noncardiovascular causes.
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Affiliation(s)
- Enrique Santas
- Servicio de Cardiología, Hospital Clínico Universitario de Valencia, INCLIVA, Universitat de Valencia, Valencia, Spain
| | - Ernesto Valero
- Servicio de Cardiología, Hospital Clínico Universitario de Valencia, INCLIVA, Universitat de Valencia, Valencia, Spain
| | - Anna Mollar
- Servicio de Cardiología, Hospital Clínico Universitario de Valencia, INCLIVA, Universitat de Valencia, Valencia, Spain
| | - Sergio García-Blas
- Servicio de Cardiología, Hospital Clínico Universitario de Valencia, INCLIVA, Universitat de Valencia, Valencia, Spain
| | - Patricia Palau
- Servicio de Cardiología, Hospital La Plana, Universitat Jaume I, Castellón, Spain
| | - Gema Miñana
- Servicio de Cardiología, Hospital Clínico Universitario de Valencia, INCLIVA, Universitat de Valencia, Valencia, Spain
| | - Eduardo Núñez
- Servicio de Cardiología, Hospital Clínico Universitario de Valencia, INCLIVA, Universitat de Valencia, Valencia, Spain
| | - Juan Sanchis
- Servicio de Cardiología, Hospital Clínico Universitario de Valencia, INCLIVA, Universitat de Valencia, Valencia, Spain
| | - Francisco Javier Chorro
- Servicio de Cardiología, Hospital Clínico Universitario de Valencia, INCLIVA, Universitat de Valencia, Valencia, Spain
| | - Julio Núñez
- Servicio de Cardiología, Hospital Clínico Universitario de Valencia, INCLIVA, Universitat de Valencia, Valencia, Spain.
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Suzuki H, Matsumoto Y, Ota H, Sugimura K, Takahashi J, Ito K, Miyata S, Furukawa K, Arai H, Fukumoto Y, Taki Y, Shimokawa H. Hippocampal Blood Flow Abnormality Associated With Depressive Symptoms and Cognitive Impairment in Patients With Chronic Heart Failure. Circ J 2016; 80:1773-80. [PMID: 27295999 DOI: 10.1253/circj.cj-16-0367] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Depressive symptoms and memory impairment are prevalent in patients with chronic heart failure (CHF). Although the mechanisms remain to be elucidated, the hippocampus (an important brain area for emotion and memory) may be a possible neural substrate for these symptoms. METHODS AND RESULTS We prospectively enrolled 40 Stage C patients, who had past or current CHF symptoms, and as controls 40 Stage B patients, who had structural heart disease but had never had CHF symptoms, in Brain Assessment and Investigation in Heart Failure Trial (B-HeFT) (UMIN000008584). As the primary index, we measured cerebral blood flow (CBF) in the 4 anterior-posterior segments of the hippocampus, using brain MRI analysis. Depressive symptoms, immediate memory (IM) and delayed memory (DM) were assessed using Geriatric Depression Scale (GDS), and Wechsler Memory Scale-revised (WMS-R), respectively. Hippocampus CBF in the most posterior segment was significantly lower in Stage C than in Stage B group (P=0.029 adjusted for Holm's method). Multiple regression analysis identified significant association between hippocampus CBF and GDS or DM score in Stage C group (all P<0.05). GDS score was significantly higher, and IM and DM scores were lower in Stage C patients with hippocampus CBF below the median than those with hippocampus CBF above the median (all P<0.05). CONCLUSIONS Hippocampus abnormalities are associated with depressive symptoms and cognitive impairment in CHF patients. (Circ J 2016; 80: 1773-1780).
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Affiliation(s)
- Hideaki Suzuki
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine
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20
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Ideguchi T, Tsuruda T, Sato Y, Kitamura K. Coexisting Hyponatremia and Decline in Diastolic Blood Pressure Predispose to Atrial Standstill in Hyperkalemic Patients. Circ J 2016; 80:1781-6. [PMID: 27301330 DOI: 10.1253/circj.cj-16-0283] [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] [Indexed: 11/09/2022]
Abstract
BACKGROUND Atrial standstill is one of the important clinical consequences on the heart in severe hyperkalemia, but it occurs even at modest potassium ion elevation. The extent to which other factors might potentiate the electrocardiographic changes induced by hyperkalemia remains unclear. METHODS AND RESULTS This was a retrospective review of the data on 12,639 hospital admissions over a 15-year period. A total of 778 patients with hyperkalemia were identified, 28 of whom had atrial standstill, and had several parameters measured prior to any treatment of hyperkalemia. Patients with atrial standstill were older (P=0.036), had lower diastolic blood pressure (DBP; P<0.0001) and serum sodium concentration (P<0.0001), higher serum potassium (P<0.0001), and high prevalence of angiotensin converting-enzyme inhibitor (ACEI; P=0.009) or mineral corticoid receptor (MR)-blocker (P=0.006), compared with those without atrial standstill. On multivariate logistic regression, DBP <67 mmHg (P=0.006), serum sodium ion <135 mmol/L (P=0.006) and serum potassium ion >6.1 mmol/L (P=0.018) were identified as independent indicators of atrial standstill, after adjusting for sex, age, chronic maintenance hemodialysis, diuretics use or ACEI/angiotensin receptor blocker and MR blocker. CONCLUSIONS Hyponatremia and decline in DBP are associated with atrial standstill in patients with hyperkalemia. (Circ J 2016; 80: 1781-1786).
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Affiliation(s)
- Takeshi Ideguchi
- Department of Internal Medicine, Circulatory and Body Fluid Regulation, Faculty of Medicine, University of Miyazaki
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21
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Factors related to outcome in heart failure with a preserved (or normal) left ventricular ejection fraction. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2016; 2:153-163. [DOI: 10.1093/ehjqcco/qcw026] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Indexed: 12/15/2022]
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22
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Formiga F, Pérez-Calvo JI. [Heart failure with preserved ejection fraction. Is there light at the end of the tunnel?]. Rev Esp Geriatr Gerontol 2016; 51:63-65. [PMID: 26775173 DOI: 10.1016/j.regg.2015.11.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2015] [Accepted: 11/18/2015] [Indexed: 06/05/2023]
Affiliation(s)
- Francesc Formiga
- Programa de Geriatría, Servicio de Medicina Interna, Hospital Universitari de Bellvitge, IDIBELL, L'Hospitalet de LLobregat, Barcelona, España.
| | - Juan Ignacio Pérez-Calvo
- Servicio de Medicina Interna, Hospital Clínico Universitario Lozano Blesa, Facultad de Medicina, Instituto de Investigación Sanitaria de Aragón (IIS-Aragón), Zaragoza, España
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23
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Abstract
Beta-blockers are the cornerstone treatment for congestive heart failure (HF). Current HF guidelines commonly recommend β-blockers for the treatment of HF with reduced left ventricular ejection fraction (LVEF). The effect of β-blockers, however, is less clear for HF patients with preserved LVEF, unstable severe acute HF, or right ventricular failure. This review summarizes the effect of β-blockers in various clinical situations and suggests a strategy for optimal use. (Circ J 2016; 80: 565-571).
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Affiliation(s)
- Hae-Young Lee
- Internal Medicine, Seoul National University Hospital
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24
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Kusaka H, Sugiyama S, Yamamoto E, Akiyama E, Matsuzawa Y, Hirata Y, Fujisue K, Kurokawa H, Matsubara J, Sugamura K, Maeda H, Jinnouchi H, Matsui K, Ogawa H. Low-Normal Serum Sodium and Heart Failure-Related Events in Patients With Heart Failure With Preserved Left Ventricular Ejection Fraction. Circ J 2016; 80:411-7. [DOI: 10.1253/circj.cj-15-0878] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Hiroaki Kusaka
- Department of Cardiovascular Medicine, Faculty of Life Sciences, Graduate School of Medical Science, Kumamoto University
| | - Seigo Sugiyama
- Department of Cardiovascular Medicine, Faculty of Life Sciences, Graduate School of Medical Science, Kumamoto University
- Cardiovascular Division Diabetes Care Center, Jinnouchi Hospital
| | - Eiichiro Yamamoto
- Department of Cardiovascular Medicine, Faculty of Life Sciences, Graduate School of Medical Science, Kumamoto University
| | - Eiichi Akiyama
- Division of Cardiology, Yokohama City University Medical Center
| | | | - Yoshihiro Hirata
- Department of Cardiovascular Medicine, Faculty of Life Sciences, Graduate School of Medical Science, Kumamoto University
| | - Koichiro Fujisue
- Department of Cardiovascular Medicine, Faculty of Life Sciences, Graduate School of Medical Science, Kumamoto University
| | - Hirofumi Kurokawa
- Department of Cardiovascular Medicine, Faculty of Life Sciences, Graduate School of Medical Science, Kumamoto University
| | - Junichi Matsubara
- Department of Cardiovascular Medicine, Faculty of Life Sciences, Graduate School of Medical Science, Kumamoto University
| | - Koichi Sugamura
- Department of Cardiovascular Medicine, Faculty of Life Sciences, Graduate School of Medical Science, Kumamoto University
| | - Hirofumi Maeda
- Department of Cardiovascular Medicine, Faculty of Life Sciences, Graduate School of Medical Science, Kumamoto University
| | - Hideaki Jinnouchi
- Diabetes Care Center, Jinnouchi Hospital
- Division of Preventive Cardiology, Department of Cardiovascular Medicine, Kumamoto University Hospital
| | - Kunihiko Matsui
- Department of Community Medicine, Kumamoto University Hospital
| | - Hisao Ogawa
- Department of Cardiovascular Medicine, Faculty of Life Sciences, Graduate School of Medical Science, Kumamoto University
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