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Václavík J, Špinar J, Vindiš D, Vítovec J, Widimský P, Číhalík Č, Linhart A, Málek F, Táborský M, Dušek L, Jarkovský J, Fedorco M, Felšöci M, Miklík R, Pařenica J. ECG in patients with acute heart failure can predict in-hospital and long-term mortality. Intern Emerg Med 2014; 9:283-91. [PMID: 23054408 DOI: 10.1007/s11739-012-0862-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2012] [Accepted: 09/15/2012] [Indexed: 11/24/2022]
Abstract
Initial risk stratification in patients with acute heart failure (AHF) is poorly validated. Previous studies tended to evaluate the prognostic significance of only one or two selected ECG parameters. The aim of this study was to evaluate the impact of multiple ECG parameters on mortality in AHF. The Acute Heart Failure Database (AHEAD) registry collected data from 4,153 patients admitted for AHF to seven hospitals with Catheter Laboratory facilities. Clinical variables, heart rate, duration of QRS, QT and QTC intervals, type of rhythm and ST-T segment changes on admission were collected in a web-based database. 12.7 % patients died during hospitalisation, the remainder were discharged and followed for a median of 16.2 months. The most important parameters were a prolonged QRS and a junctional rhythm, which independently predict both in-hospital mortality [QRS > 100 ms, odds ratio (OR) 1.329, 95 % CI 1.052-1.680; junctional rhythm, OR 3.715, 95 % CI 1.748-7.896] and long-term mortality (QRS > 120 ms, OR 1.428, 95 % CI 1.160-1.757; junctional rhythm, OR 2.629, 95 % CI 1.538-4.496). Increased hospitalisation mortality is predicted by ST segment elevation (OR 1.771, 95 % CI 1.383-2.269) and prolonged QTC interval >475 ms (OR 1.483, 95 % CI 1.016-2.164). Presence of atrial fibrillation and bundle branch block is associated with increased unadjusted long-term mortality, but mostly reflects more advanced heart disease, and their predictive significance is attenuated in the multivariate analysis. ECG in patients admitted for acute heart failure carries significant short- and long-term prognostic information, and should be carefully evaluated.
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Affiliation(s)
- Jan Václavík
- Department of Internal Medicine I-Cardiology, University Hospital Olomouc, Palacký University School of Medicine, I. P. Pavlova 6, 775 20, Olomouc, Czech Republic,
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Felšöci M, Paőenica J, Spinar J, Vítovec J, Widimský P, Linhart A, Václavík J, Málek F, Bambuch M, Miklík R, Špinarová L, Bělohlávek J, Číhalík Č, Jarkovský J. Impact of antecedent hypertension on outcomes in patients hospitalized with severe forms of acute heart failure. Acta Cardiol 2012; 67:515-23. [PMID: 23252001 DOI: 10.1080/ac.67.5.2174125] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Even though several studies described a positive influence of elevated initial blood pressure on the outcome in acute heart failure (AHF), data specifically addressed to a population with severe AHF associated with antecedent hypertension, regardless of admission blood pressure values, are missing. METHODS AND RESULTS From the 4153 consecutive patients enrolled in the Czech AHF registry we selected 1343 patients who suffered from pulmonary oedema or cardiogenic shock and compared them according to the presence of antecedent hypertension. Demographic, clinical, laboratory, treatment profiles and mortality rates were assessed and predictors of short- and long-term outcome were identified. Patients with antecedent hypertension (n = 1053, 78%) were older (P < 0.001), more often women (P = 0.001), having more co-morbidities and a worse laboratory profile. A trend for worse survival of hypertensive patients was observed when compared to a non-hypertensive cohort (1-, 2-, 3-year survival 70.0, 61.5, 55.5% vs. 72.6, 68.2, 64.0%, P = 0.062). Age and creatinine levels were independently associated with mortality during the whole follow-up period (P < 0.001). Low left ventricular ejection fraction, need of mechanical ventilation, inotropic and vasopressor support, were adversely related to in-hospital mortality (P < 0.001). On the other hand, presence of initial tachycardia improved short-term outcome (P = 0.007). Long-term survival was worsened by initial atrial fibrillation (P = 0.036) and anaemia (P < 0.001) while the presence of de-novo AHF improved it (P = 0.009). CONCLUSIONS Long-term antecedent hypertension is not significantly correlated with mortality after an episode of severe AHF, but probably still participates in vascular and end-organ damage. Survival of these patients is determined by other associated co-morbidities.
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Affiliation(s)
- Marián Felšöci
- First Department of Internal Medicine – Cardiology, University Hospital Brno and Faculty of Medicine of Masaryk University, Brno, Czech Republic
| | - Jiří Paőenica
- First Department of Internal Medicine – Cardiology, University Hospital Brno and Faculty of Medicine of Masaryk University, Brno, Czech Republic
- International Clinical Research Center – Department of Cardiovascular Disease, St. Anne’s University Hospital, Brno, Czech Republic
| | - Jindřich Spinar
- First Department of Internal Medicine – Cardiology, University Hospital Brno and Faculty of Medicine of Masaryk University, Brno, Czech Republic
- International Clinical Research Center – Department of Cardiovascular Disease, St. Anne’s University Hospital, Brno, Czech Republic
| | - Jiří Vítovec
- First Department of Internal Medicine – Cardioangiology, St. Anne’s University Hospital and Faculty of Medicine Masaryk University, Brno, Czech Republic
| | - Petr Widimský
- Cardiocenter, University Hospital Vinohrady and Th ird Faculty of Medicine of Charles University, Prague, Czech Republic
| | - Aleš Linhart
- Second Department of Internal Medicine, General University Hospital and First Medical Faculty of Charles University, Prague, Czech Republic
| | - Jan Václavík
- First Department of Internal Cardiovascular Medicine – Cardiology, University Hospital Olomouc and Faculty of Medicine of Palacky University, Olomouc, Czech Republic
| | - Filip Málek
- Department of Cardiology, Cardiocenter, Na Homolce Hospital, Prague, Czech Republic
| | - Miroslav Bambuch
- Department of Internal Medicine – Cardiovascular centre, T. Bata Regional Hospital, Zlin, Czech Republic
| | - Roman Miklík
- First Department of Internal Medicine – Cardiology, University Hospital Brno and Faculty of Medicine of Masaryk University, Brno, Czech Republic
- International Clinical Research Center – Department of Cardiovascular Disease, St. Anne’s University Hospital, Brno, Czech Republic
| | - Lenka Špinarová
- First Department of Internal Medicine – Cardioangiology, St. Anne’s University Hospital and Faculty of Medicine Masaryk University, Brno, Czech Republic
| | - Jan Bělohlávek
- Second Department of Internal Medicine, General University Hospital and First Medical Faculty of Charles University, Prague, Czech Republic
| | - Čestmír Číhalík
- Department of Internal Medicine – Cardiovascular centre, T. Bata Regional Hospital, Zlin, Czech Republic
| | - Jiří Jarkovský
- Institute of Biostatistics and Analyses, Masaryk University, Brno, Czech Republic
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