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Zhang H, Zhou Y, Cheng F, Zhu Y, Li N, Peng X, Wu M, Huang H, Zhang L, Liao M, Xiao S, Chen Y, Chen S, Liu Z, Yi L, Fan J, Zeng J. Prognostic impact of lung ultrasound detected B-lines on hospitalised ischaemic heart failure with mildly reduced ejection fraction patients. Open Heart 2023; 10:e002480. [PMID: 38065587 PMCID: PMC10711819 DOI: 10.1136/openhrt-2023-002480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 11/15/2023] [Indexed: 12/18/2023] Open
Abstract
OBJECTIVES Prognostic impact of lung ultrasound-derived B-lines (LUS-BL) in heart failure with mildly reduced left ventricular ejection fraction (HFmrEF) patients remains elusive. We evaluated the correlation between LUS-BL and prognosis in HFmrEF patients. METHODS This is a subgroup analysis based on our previously published retrospective study with 1691 HFmrEF patients. This subgroup analysis involved 574 patients with LUS-BL results at admission. After discharge, patients underwent clinical follow-up for a minimum of 1 year through telephone, clinical visits or community visits. The primary endpoint was defined as cardiovascular (CV) event, including CV-related mortality or HF hospitalisation at 90 days and 1 year after discharge. RESULTS CV event at 90 days was significantly increased with higher LUS-BL number (0, 1-2, 3-9 and ≥10: 20%, 14%, 18% and 33%, p=0.008), while CV event rate at 1 year was similar among groups (45% vs 45% vs 42% vs 50%, p=0.573). Older age, hypertension (HR=2.06, 95% CI 1.31 to 3.25), higher right ventricular diameter (>23 mm, HR=2.008, 95% CI 1.37 to 2.94), increased ratio of early transmitral flow velocity to early mitral annular velocity (>24, HR=1.79, 95% CI 1.11 to 2.26) and higher LUS-BL number (>11, HR=1.510, 95% CI 1.01 to 2.26) were identified as independent determinants associated with increased risk of CV event at 90 days after discharge. The Harrell's C-Statistic analysis, based on the Cox regression models, demonstrated a significant improvement in the predictive ability of the model that incorporated both clinical and echocardiographic risk factors along with LUS-BL (areas under the curve (AUC)=0.72) compared with the model comprising only clinical risk factors and LUS-BL (AUC=0.69, p=0.036), or to the model with echocardiographic risk factors and LUS-BL (AUC=0.68, p=0.025). CONCLUSION In HFmrEF patients with ischaemic heart disease, admission LUS-BL>11 is independently associated with an increased risk of CV event at 90 days following discharge.
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Affiliation(s)
- Hui Zhang
- Department of Cardiology, Xiangtan Central Hospital, Xiangtan, Hunan, China
- University of South China, Hengyang, Hunan, China
| | - Yuying Zhou
- Department of Cardiology, Xiangtan Central Hospital, Xiangtan, Hunan, China
- University of South China, Hengyang, Hunan, China
| | | | - Yunlong Zhu
- Department of Cardiology, Xiangtan Central Hospital, Xiangtan, Hunan, China
- Department of Cardiology, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Na Li
- Department of Cardiology, Xiangtan Central Hospital, Xiangtan, Hunan, China
- University of South China, Hengyang, Hunan, China
| | - Xin Peng
- Department of Cardiology, Xiangtan Central Hospital, Xiangtan, Hunan, China
- University of South China, Hengyang, Hunan, China
| | - Mingxin Wu
- Department of Cardiology, Xiangtan Central Hospital, Xiangtan, Hunan, China
| | - Haobo Huang
- Department of Cardiology, Xiangtan Central Hospital, Xiangtan, Hunan, China
| | - Lingling Zhang
- Department of Cardiology, Xiangtan Central Hospital, Xiangtan, Hunan, China
| | - Min Liao
- Department of Cardiology, Xiangtan Central Hospital, Xiangtan, Hunan, China
| | - Sha Xiao
- Department of Cardiology, Xiangtan Central Hospital, Xiangtan, Hunan, China
| | - Yongliang Chen
- Department of Cardiology, Xiangtan Central Hospital, Xiangtan, Hunan, China
- University of South China, Hengyang, Hunan, China
| | - Sihao Chen
- Department of Cardiology, Xiangtan Central Hospital, Xiangtan, Hunan, China
- University of South China, Hengyang, Hunan, China
| | - Zhican Liu
- Department of Cardiology, Xiangtan Central Hospital, Xiangtan, Hunan, China
| | - Liqing Yi
- Department of Cardiology, Xiangtan Central Hospital, Xiangtan, Hunan, China
| | - Jie Fan
- Department of Cardiology, Xiangtan Central Hospital, Xiangtan, Hunan, China
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Pulmonary Artery Systolic Pressure and Cava Vein Status in Acute Heart Failure with Preserved Ejection Fraction: Clinical and Prognostic Implications. Diagnostics (Basel) 2023; 13:diagnostics13040692. [PMID: 36832179 PMCID: PMC9955829 DOI: 10.3390/diagnostics13040692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Revised: 01/30/2023] [Accepted: 02/02/2023] [Indexed: 02/15/2023] Open
Abstract
BACKGROUND Peak tricuspid regurgitation (TR) velocity and inferior cava vein (ICV) distention are two recognized features of increased pulmonary artery pressure (PASP) and right atrial pressure, respectively. Both parameters are related to pulmonary and systemic congestion and adverse outcomes. However, few data exist about the assessment of PASP and ICV in acute patients affected by heart failure with preserved ejection fraction (HFpEF). Thus, we investigated the relationship existing among clinical and echocardiographic features of congestion, and we analyzed the prognostic impact of PASP and ICV in acute HFpEF patients. METHODS AND RESULTS We analyzed clinical congestion PASP and ICV value in consecutive patients admitted in our ward by echocardiographic examination using peak Doppler velocity tricuspid regurgitation and ICV diameter and collapse for the assessment of PASP and ICV dimension, respectively. A total of 173 HFpEF patients were included in the analysis. The median age was 81 and median left ventricular ejection fraction (LVEF) was 55% [50-57]. Mean values of PASP was 45 mmHg [35-55] and mean ICV was 22 [20-24] mm. Patients with adverse events during follow-up showed significantly higher values of PASP (50 [35-55] vs. 40 [35-48] mmHg, (p = 0.005) and increased values of ICV (24 [22-25] vs. 22 [20-23] mm, p < 0.001). Multivariable analysis showed prognostic power of ICV dilatation (HR 3.22 [1.58-6.55], p = 0.001) and clinical congestion score ≥ 2 (HR 2.35 [1.12-4.93], p = 0.023), but PASP increase did not reach statistical significance (p = 0.874). The combination of PASP > 40 mmHg and ICV > 21 mm was capable of identifying patients with increased events (45% vs. 20%). CONCLUSIONS ICV dilatation provides additional prognostic information with respect to PASP in patients with acute HFpEF. A combined model adding PASP and ICV assessment to clinical evaluation is a useful tool for predicting HF related events.
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Kerexeta J, Larburu N, Escolar V, Lozano-Bahamonde A, Macía I, Beristain Iraola A, Graña M. Prediction and Analysis of Heart Failure Decompensation Events Based on Telemonitored Data and Artificial Intelligence Methods. J Cardiovasc Dev Dis 2023; 10:jcdd10020048. [PMID: 36826544 PMCID: PMC9958752 DOI: 10.3390/jcdd10020048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 01/24/2023] [Accepted: 01/26/2023] [Indexed: 01/31/2023] Open
Abstract
Cardiovascular diseases are the leading cause of death globally, taking an estimated 17.9 million lives each year. Heart failure (HF) occurs when the heart is not able to pump enough blood to satisfy metabolic needs. People diagnosed with chronic HF may suffer from cardiac decompensation events (CDEs), which cause patients' worsening. Being able to intervene before decompensation occurs is the major challenge addressed in this study. The aim of this study is to exploit available patient data to develop an artificial intelligence (AI) model capable of predicting the risk of CDEs timely and accurately. Materials and Methods: The vital variables of patients (n = 488) diagnosed with chronic heart failure were monitored between 2014 and 2022. Several supervised classification models were trained with these monitoring data to predict CDEs, using clinicians' annotations as the gold standard. Feature extraction methods were applied to identify significant variables. Results: The XGBoost classifier achieved an AUC of 0.72 in the cross-validation process and 0.69 in the testing set. The most predictive physiological variables for CAE decompensations are weight gain, oxygen saturation in the final days, and heart rate. Additionally, the answers to questionnaires on wellbeing, orthopnoea, and ankles are strongly significant predictors.
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Affiliation(s)
- Jon Kerexeta
- Vicomtech Foundation, Basque Research and Technology Alliance (BRTA), 20009 Donostia, Spain
- e-Health Department, Biodonostia Health Research Institute, Paseo Dr Begiristain s/n, 20014 San Sebastián, Spain
- Computational Intelligence Group, Computer Science Faculty, University of the Basque Country, UPV/EHU, 20018 San Sebastián, Spain
- Correspondence:
| | - Nekane Larburu
- Vicomtech Foundation, Basque Research and Technology Alliance (BRTA), 20009 Donostia, Spain
- e-Health Department, Biodonostia Health Research Institute, Paseo Dr Begiristain s/n, 20014 San Sebastián, Spain
| | - Vanessa Escolar
- Cardiology Department, School of Medicine, Basurto University Hospital, 48013 Bilbao, Spain
| | | | - Iván Macía
- Vicomtech Foundation, Basque Research and Technology Alliance (BRTA), 20009 Donostia, Spain
- e-Health Department, Biodonostia Health Research Institute, Paseo Dr Begiristain s/n, 20014 San Sebastián, Spain
- Computational Intelligence Group, Computer Science Faculty, University of the Basque Country, UPV/EHU, 20018 San Sebastián, Spain
| | - Andoni Beristain Iraola
- Vicomtech Foundation, Basque Research and Technology Alliance (BRTA), 20009 Donostia, Spain
- e-Health Department, Biodonostia Health Research Institute, Paseo Dr Begiristain s/n, 20014 San Sebastián, Spain
- Computational Intelligence Group, Computer Science Faculty, University of the Basque Country, UPV/EHU, 20018 San Sebastián, Spain
| | - Manuel Graña
- Computational Intelligence Group, Computer Science Faculty, University of the Basque Country, UPV/EHU, 20018 San Sebastián, Spain
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Advances and Challenges in Diagnosis and Management of Heart Failure. Diagnostics (Basel) 2022; 12:diagnostics12051103. [PMID: 35626259 PMCID: PMC9139998 DOI: 10.3390/diagnostics12051103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 04/24/2022] [Indexed: 11/16/2022] Open
Abstract
The prevalence of heart failure (HF) with reduced (r) and preserved (p) ejection fraction (EF) continues to rise globally despite current advances in diagnostics and improvements to medical management [...]
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Hernandez M, Sullivan RD, McCune ME, Reed GL, Gladysheva IP. Sodium-Glucose Cotransporter-2 Inhibitors Improve Heart Failure with Reduced Ejection Fraction Outcomes by Reducing Edema and Congestion. Diagnostics (Basel) 2022; 12:diagnostics12040989. [PMID: 35454037 PMCID: PMC9024630 DOI: 10.3390/diagnostics12040989] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 03/30/2022] [Accepted: 04/12/2022] [Indexed: 02/07/2023] Open
Abstract
Pathological sodium-water retention or edema/congestion is a primary cause of heart failure (HF) decompensation, clinical symptoms, hospitalization, reduced quality of life, and premature mortality. Sodium-glucose cotransporter-2 inhibitors (SGLT-2i) based therapies reduce hospitalization due to HF, improve functional status, quality, and duration of life in patients with HF with reduced ejection fraction (HFrEF) independently of their glycemic status. The pathophysiologic mechanisms and molecular pathways responsible for the benefits of SGLT-2i in HFrEF remain inconclusive, but SGLT-2i may help HFrEF by normalizing salt-water homeostasis to prevent clinical edema/congestion. In HFrEF, edema and congestion are related to compromised cardiac function. Edema and congestion are further aggravated by renal and pulmonary abnormalities. Treatment of HFrEF patients with SGLT-2i enhances natriuresis/diuresis, improves cardiac function, and reduces natriuretic peptide plasma levels. In this review, we summarize current clinical research studies related to outcomes of SGLT-2i treatment in HFrEF with a specific focus on their contribution to relieving or preventing edema and congestion, slowing HF progression, and decreasing the rate of rehospitalization and cardiovascular mortality.
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Affiliation(s)
- Michelle Hernandez
- Department of Medicine, College of Medicine-Phoenix, University of Arizona, Phoenix, AZ 85004, USA; (M.H.); (R.D.S.); (M.E.M.); (G.L.R.)
- School of Medicine, Universidad Autónoma de Guadalajara, Zapopan 45129, Mexico
| | - Ryan D. Sullivan
- Department of Medicine, College of Medicine-Phoenix, University of Arizona, Phoenix, AZ 85004, USA; (M.H.); (R.D.S.); (M.E.M.); (G.L.R.)
| | - Mariana E. McCune
- Department of Medicine, College of Medicine-Phoenix, University of Arizona, Phoenix, AZ 85004, USA; (M.H.); (R.D.S.); (M.E.M.); (G.L.R.)
| | - Guy L. Reed
- Department of Medicine, College of Medicine-Phoenix, University of Arizona, Phoenix, AZ 85004, USA; (M.H.); (R.D.S.); (M.E.M.); (G.L.R.)
| | - Inna P. Gladysheva
- Department of Medicine, College of Medicine-Phoenix, University of Arizona, Phoenix, AZ 85004, USA; (M.H.); (R.D.S.); (M.E.M.); (G.L.R.)
- Correspondence: ; Tel.: +1-(602)-827-2919
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Ilieșiu AM, Hodorogea AS, Balahura AM, Bădilă E. Non-Invasive Assessment of Congestion by Cardiovascular and Pulmonary Ultrasound and Biomarkers in Heart Failure. Diagnostics (Basel) 2022; 12:diagnostics12040962. [PMID: 35454010 PMCID: PMC9024731 DOI: 10.3390/diagnostics12040962] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 04/05/2022] [Accepted: 04/06/2022] [Indexed: 02/04/2023] Open
Abstract
Worsening chronic heart failure (HF) is responsible for recurrent hospitalization and increased mortality risk after discharge, irrespective to the ejection fraction. Symptoms and signs of pulmonary and systemic congestion are the most common cause for hospitalization of acute decompensated HF, as a consequence of increased cardiac filling pressures. The elevated cardiac filling pressures, also called hemodynamic congestion, may precede the occurrence of clinical congestion by days or weeks. Since HF patients often have comorbidities, dyspnoea, the main symptom of HF, may be also caused by respiratory or other illnesses. Recent studies underline the importance of the diagnosis and treatment of hemodynamic congestion before HF symptoms worsen, reducing hospitalization and improving prognosis. In this paper we review the role of integrated evaluation of biomarkers and imaging technics, i.e., echocardiography and pulmonary ultrasound, for the diagnosis, prognosis and treatment of congestion in HF patients.
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Affiliation(s)
- Adriana Mihaela Ilieșiu
- Cardiology and Internal Medicine Department, Theodor Burghele Clinical Hospital, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania;
| | - Andreea Simona Hodorogea
- Cardiology and Internal Medicine Department, Theodor Burghele Clinical Hospital, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania;
- Correspondence: ; Tel.: +40-72-631-5872
| | - Ana-Maria Balahura
- Internal Medicine Department, Bucharest Clinical Emergency Hospital, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania; (A.-M.B.); (E.B.)
| | - Elisabeta Bădilă
- Internal Medicine Department, Bucharest Clinical Emergency Hospital, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania; (A.-M.B.); (E.B.)
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Association between Lung Fluid Levels Estimated by Remote Dielectric Sensing Values and Invasive Hemodynamic Measurements. J Clin Med 2022; 11:jcm11051208. [PMID: 35268298 PMCID: PMC8910973 DOI: 10.3390/jcm11051208] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 02/22/2022] [Accepted: 02/22/2022] [Indexed: 02/01/2023] Open
Abstract
Background: Remote dielectric sensing (ReDS™) is an electromagnetic-based technology used to noninvasively measure lung fluid levels. The association between ReDS values and invasively measured hemodynamics, particularly among those with small physics, remains unknown. Methods: Consecutive patients with chronic heart failure who were admitted to our institute and underwent invasive right heart catheterization as well as simultaneous ReDS measurement at clinically stable conditions between September and November 2021 were prospectively included. The colinearity between ReDS values and pulmonary capillary wedge pressure was studied. Results: In total, 30 patients (median 79 (73, 84) years old, 13 men) were included. Median ReDS value was 26% (22%, 28%). ReDS values had a moderate collinearity with pulmonary capillary wedge pressure (r = 0.698, p < 0.001), even among those with a body height < 155 cm. ReDS values with a cutoff of 28% predicted a pulmonary capillary wedge pressure > 15 mmHg with sensitivity 0.70 and specificity 0.75. Conclusions: An electromagnetic-based engineering ReDS might be a potential tool to estimate cardiac pressure in patients with heart failure, including those with small physics.
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Imamura T, Hori M, Koi T, Fukui T, Oshima A, Fujioka H, Ueno Y, Onoda H, Tanaka S, Fukuda N, Ueno H, Kinugawa K. Relationship Between Body Posture and Lung Fluid Volume Assessed Using a Novel Noninvasive Remote Dielectric Sensing System. Circ Rep 2022; 4:25-28. [PMID: 35083385 PMCID: PMC8710642 DOI: 10.1253/circrep.cr-21-0130] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 11/09/2021] [Accepted: 11/12/2021] [Indexed: 11/23/2022] Open
Abstract
Background:
The relationship between body posture and lung fluid level has not been quantified thus far. Remote dielectric sensing (ReDSTM) is a recently introduced non-invasive electromagnetic-based technology to quantify lung fluid percentage. Methods and Results:
ReDS values were measured at different body postures (i.e., sitting, supine, and supine with legs elevated) in a healthy volunteer cohort (n=16; median age 39 years, 69% men, median [interquartile range {IQR}] body mass index 23.3 kg/m2
[21.0–26.2 kg/m2]). In the sitting position, the median ReDS value was 27% (IQR 25–29%). The ReDS value increased significantly in the supine position (median 28%; IQR 27–30%; P=0.009), and increased further upon leg elevation (median 29%; IQR 28–32%; P=0.001). Conclusions:
In this proof-of-concept study, the relationship between body posture and lung fluid level was quantitatively validated in a healthy cohort.
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Affiliation(s)
| | - Masakazu Hori
- Second Department of Internal Medicine, Toyama University
| | - Takatoshi Koi
- Second Department of Internal Medicine, Toyama University
| | - Takuya Fukui
- Second Department of Internal Medicine, Toyama University
| | - Akira Oshima
- Second Department of Internal Medicine, Toyama University
| | - Hayato Fujioka
- Second Department of Internal Medicine, Toyama University
| | - Yohei Ueno
- Second Department of Internal Medicine, Toyama University
| | - Hiroshi Onoda
- Second Department of Internal Medicine, Toyama University
| | - Shuhei Tanaka
- Second Department of Internal Medicine, Toyama University
| | | | - Hiroshi Ueno
- Second Department of Internal Medicine, Toyama University
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