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Williams S, Kalakoutas A, Olusanya S, Schrage B, Tavazzi G, Carnicelli AP, Montero S, Vandenbriele C, Luk A, Lim HS, Bhagra S, Ott SC, Farrero M, Samsky MD, Kennedy JLW, Sen S, Agrawal R, Rampersad P, Coniglio A, Pappalardo F, Barnett C, Proudfoot AG. The management of heart failure cardiogenic shock: an international RAND appropriateness panel. Crit Care 2024; 28:105. [PMID: 38566212 PMCID: PMC10988801 DOI: 10.1186/s13054-024-04884-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Accepted: 03/20/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND Observational data suggest that the subset of patients with heart failure related CS (HF-CS) now predominate critical care admissions for CS. There are no dedicated HF-CS randomised control trials completed to date which reliably inform clinical practice or clinical guidelines. We sought to identify aspects of HF-CS care where both consensus and uncertainty may exist to guide clinical practice and future clinical trial design, with a specific focus on HF-CS due to acute decompensated chronic HF. METHODS A 16-person multi-disciplinary panel comprising of international experts was assembled. A modified RAND/University of California, Los Angeles, appropriateness methodology was used. A survey comprising of 34 statements was completed. Participants anonymously rated the appropriateness of each statement on a scale of 1 to 9 (1-3 as inappropriate, 4-6 as uncertain and as 7-9 appropriate). RESULTS Of the 34 statements, 20 were rated as appropriate and 14 were rated as inappropriate. Uncertainty existed across all three domains: the initial assessment and management of HF-CS; escalation to temporary Mechanical Circulatory Support (tMCS); and weaning from tMCS in HF-CS. Significant disagreement between experts (deemed present when the disagreement index exceeded 1) was only identified when deliberating the utility of thoracic ultrasound in the immediate management of HF-CS. CONCLUSION This study has highlighted several areas of practice where large-scale prospective registries and clinical trials in the HF-CS population are urgently needed to reliably inform clinical practice and the synthesis of future societal HF-CS guidelines.
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Affiliation(s)
- Stefan Williams
- Perioperative Medicine Department, Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London, EC1A 7BE, UK
| | - Antonis Kalakoutas
- Perioperative Medicine Department, Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London, EC1A 7BE, UK
| | - Segun Olusanya
- Perioperative Medicine Department, Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London, EC1A 7BE, UK
| | - Benedict Schrage
- Department of Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - Guido Tavazzi
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
- Intensive Care, Fondazione Policlinico San Matteo Hospital IRCCS, Pavia, Italy
| | - Anthony P Carnicelli
- Division of Cardiology, Medical University of South Carolina, Charleston, SC, USA
| | - Santiago Montero
- Acute Cardiovascular Care Unit, Cardiology, Hospital Germans Trias i Pujol, Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | - Adriana Luk
- Division of Cardiology, Department of Medicine, Peter Munk Cardiac Centre, University Health Network, Toronto, ON, Canada
| | - Hoong Sern Lim
- Department of Cardiology, University Hospital Birmingham NHS Foundation Trust, Birmingham, UK
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
| | - Sai Bhagra
- Advanced Heart Failure and Transplantation, Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - Sascha C Ott
- Department of Cardiac Anesthesiology and Intensive Care Medicine, German Heart Center Berlin, Berlin, Germany
| | | | - Marc D Samsky
- Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Jamie L W Kennedy
- Heart Failure / Transplant Program, Inova Heart and Vascular Institute, Falls Church, VA, USA
| | - Sounok Sen
- Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Richa Agrawal
- Division of Cardiology, Duke University Medical Center, Durham, NC, USA
| | | | - Amanda Coniglio
- Division of Cardiology, Duke University Medical Center, Durham, NC, USA
| | - Federico Pappalardo
- Department of Cardiothoracic and Vascular Anaesthesia and Intensive Care, AO SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Christopher Barnett
- Division of Cardiology, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Alastair G Proudfoot
- Perioperative Medicine Department, Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London, EC1A 7BE, UK.
- William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK.
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Chodakowski P, Sokal A, Manka A, Szwarc B, Bogus P, Cornelussen R, Eggen M, Kornet L. Electrical Diuretics: Dorsal Root Ganglion Stimulation to Increase Diuresis. Neuromodulation 2024:S1094-7159(24)00029-1. [PMID: 38363246 DOI: 10.1016/j.neurom.2023.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 11/20/2023] [Accepted: 12/07/2023] [Indexed: 02/17/2024]
Abstract
BACKGROUND Stimulation of diuresis is an essential component of heart failure treatment to reduce fluid overload. Over time, increasing doses of loop diuretics are required to achieve adequate urine output, and approximately 30% to 45% of patients develop diuretic resistance. We investigated the feasibility of affecting renal afferent sensory nerves by dorsal root ganglion neurostimulation as an alternative to medication to increase diuresis. MATERIALS AND METHODS Acute volume overload with an elevated and stable pulmonary capillary wedge pressure (PCWP) was induced by infusion of isotonic fluid in swine (N = 7). In each experiment, diuresis and blood electrolyte levels were measured during cycles of up to two hours (baseline, stimulation, poststimulation) through bladder catheterization. Efficacy was tested using bilateral dorsal root ganglion (bDRG) stimulation at the T11 and/or T12 vertebral levels. RESULTS An elevated, stable PCWP (15 ± 4 mm Hg, N = 7) was obtained after uploading. Under these conditions, average diuresis increased 20% to 205% compared with no stimulation. Side effects such as motor stimulation were mitigated by decreasing current or terminated spontaneously without intervention. There was no negative effect on acute kidney function because blood electrolyte concentrations remained stable. When stimulation was deactivated, urine output decreased significantly but did not return to baseline levels, suggesting a carry-over effect of up to two hours. CONCLUSIONS Electrical stimulation (bDRG) at T11 and/or T12 increased diuresis in an acute volume overload model. Side effects caused by unintended (motor) stimulation could be eliminated by reducing the electrical current while sustaining increased diuresis.
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Affiliation(s)
- Pawel Chodakowski
- Department of Neurosurgery, Jan Paul II Hospital, Jastrzebie Zdroj, Poland
| | - Adam Sokal
- Department of Cardiology and Angiology Silesian Centre for Heart Diseases, Zabrze, Poland; Medical University of Silesia, WNOZ Bytom, Poland
| | | | - Bartlomiej Szwarc
- Research and Technology, Medtronic, Bakken Research Center, Maastricht, the Netherlands
| | - Piotr Bogus
- Silesian Park of Medical Technology, Kardio-Med Silesia, Zabrze, Poland
| | - Richard Cornelussen
- Research and Technology, Medtronic, Bakken Research Center, Maastricht, the Netherlands
| | - Michael Eggen
- Research and Technology, Medtronic, Bakken Research Center, Maastricht, the Netherlands
| | - Lilian Kornet
- Research and Technology, Medtronic, Bakken Research Center, Maastricht, the Netherlands.
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Guzelce MC, Colak N, Ucar G, Orhan E. Prognostic value of the NEWS + Lactate score in patients with decompensated heart failure in the emergency department. ESC Heart Fail 2023; 10:3604-3611. [PMID: 37771311 PMCID: PMC10682865 DOI: 10.1002/ehf2.14537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 08/04/2023] [Accepted: 09/08/2023] [Indexed: 09/30/2023] Open
Abstract
AIMS The National Early Warning Score (NEWS) is a scoring system that predicts increased mortality and morbidity in critical diseases. The National Early Warning Score + Lactate (NEWS + L) score was created by adding lactate values to this scoring system. In our study, we aimed to determine the value of the NEWS + L score in predicting clinical deterioration in patients presenting with acute decompensated heart failure (chronic heart failure). METHODS AND RESULTS In this observational, cross-sectional study, patients with decompensated heart failure who were admitted to the emergency department between 1 October 2020 and 31 December 2020 were included. Patients were divided into two groups: those with and without poor prognostic outcomes. The main outcomes were in-hospital mortality, discharge after treatment in the emergency department, admission to the ward, and admission to the intensive care unit. We analysed a total of 141 applications from 130 patients. The mean age was 72.6 ± 11.8 years, and 50.8% were female. Poor prognostic outcomes were observed in 92 (65%) patients. There was no difference between the patients with and without poor prognostic outcomes in terms of mean age, gender, and comorbidities, except for atrial fibrillation. There was a statistically significant difference between the patients without and with poor prognosis outcomes in terms of NEWS {3 [interquartile range (IQR): 0-5] and 6 [IQR: 3-8]} and NEWS + L scores [4.7 (IQR: 2.3-7.2) and 8.0 (IQR: 5.2-10.4)] (P < 0.001). The area under the curve values for predicting poor prognosis were calculated as 0.719 for NEWS, 0.734 for NEWS + L, and 0.601 for lactate values. The rate of poor prognostic outcomes was higher (79%) in patients with moderate and high NEWS scores. Patients with Q1 NEWS + L scores had a lower rate of poor prognostic outcomes, while patients with Q2, Q3, and Q4 scores of NEWS + L had a higher rate of poor prognostic outcomes. CONCLUSIONS The NEWS score and the addition of the lactate value to this score, the NEWS + L score, were higher in patients with poor prognostic outcomes who presented with decompensated heart failure in our emergency department. NEWS + L slightly outperformed the NEWS score in predicting prognosis. The NEWS + L score shows promise as a prognostic indicator for patients with decompensated heart failure presenting to the emergency department.
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Affiliation(s)
- Mustafa Can Guzelce
- Department of Emergency Medicine, Faculty of MedicineDokuz Eylul UniversityBalcova35340IzmirTurkey
| | - Nese Colak
- Department of Emergency Medicine, Faculty of MedicineDokuz Eylul UniversityBalcova35340IzmirTurkey
| | - Gucluhan Ucar
- Department of Emergency Medicine, Faculty of MedicineDokuz Eylul UniversityBalcova35340IzmirTurkey
| | - Ertug Orhan
- Department of Emergency Medicine, Faculty of MedicineDokuz Eylul UniversityBalcova35340IzmirTurkey
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Satti DI, Hussain T, Ahmed S, Saqib BUH, Malik J, Umair F. Outcomes of ambulance arrival vs. self-presentation in acute heart failure: an insight from the heart failure registry in Pakistan. Expert Rev Cardiovasc Ther 2022; 20:409-413. [PMID: 35522982 DOI: 10.1080/14779072.2022.2075344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVES We aimed to demonstrate the outcomes of various presentations of acute heart failure (AHF), as well as test the generalizability of previous results in routine clinical practice. METHODS This retrospective cohort study compares two patient groups of AHF: those who self-presented compared to those who used an ambulance. The primary endpoint was the measure of 30-, 180-, and 365-day cardiovascular (CV) mortality after the index hospitalization event. Secondary endpoints included HF rehospitalization within 30 days of enrollment, index hospital stay, and death from any cause during the index hospitalization. The relationship between the two modes of presentation was calculated by multivariate analysis. RESULTS A total of 14,454 patients with AHF presented to the emergency department. Patients who presented by ambulance had a higher 30-, 180-, and 365-day mortality than those who self-presented (30-day: 5.57% vs. 3.53%, OR [95% CI]: 0.65 [0.24-0.93], p-value <0.001; 180-day: 11.25% vs. 8.41%, OR [95% CI]: 0.52 [0.34-0.97], p-value = 0.021; and 365-day: 19.25% vs. 15.48%, OR [95% CI]: 0.67 [0.33-0.95], p-value <0.001). CONCLUSION AHF patients who presented via ambulance had a higher 30-, 180-, and 365-day mortality as compared to self-presentation.
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Affiliation(s)
- Danish Iltaf Satti
- Department of Medicine, Shifa Tameer e Millat University, Islamabad, Pakistan
| | - Talib Hussain
- Department of Cardiology, Armed Forces Institute of Cardiology, Rawalpindi, Pakistan
| | - Sohail Ahmed
- Department of Cardiology, DHQ Hospital Chakwal, Chakwal, Pakistan
| | | | - Jahanzeb Malik
- Department of Cardiology, Rawalpindi Institute of Cardiology, Rawalpindi, Pakistan
| | - Farhan Umair
- Department of Cardiology, Punjab Institute of Cardiology, Lahore, Pakistan
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Inamori T, Kodama K, Tamura Y, Okamatsu H, Sashida Y, Horibata Y, Taguchi E, Nakao K, Sakamoto T. Inappropriate sinus tachycardia-induced cardiomyopathy with severe functional mitral regurgitation and successful treatment with ivabradine. J Cardiol Cases 2022; 25:6-9. [PMID: 35024059 DOI: 10.1016/j.jccase.2021.05.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Revised: 05/12/2021] [Accepted: 05/19/2021] [Indexed: 11/22/2022] Open
Abstract
Ivabradine increases stroke volume, but does not have a negative impact on blood pressure (BP). Thus, a patient with low BP can benefit from treatment with ivabradine. A 72-year-old Japanese woman with asthma and chronic bronchitis presented with dyspnea. Her heart rate (HR) was 126 beats per minute and an electrocardiogram showed sinus tachycardia. The chest X-ray showed cardiomegaly and pulmonary congestion. A transthoracic echocardiogram (TTE) showed reduced left ventricular ejection function (LVEF) and severe functional mitral regurgitation (MR). We diagnosed her with inappropriate sinus tachycardia (IST) and heart failure (HF) due to tachycardia-induced cardiomyopathy. After resolving the pulmonary congestion with diuretics, we administered a minimum dose of bisoprolol, which resulted in re-exacerbation of the HF. Because IST was persistent, we initiated treatment with ivabradine. As soon as ivabradine was started, the HR decreased, the BP gradually increased, and HF compensation was achieved. Bisoprolol was continued and losartan was started. In summary, we used ivabradine for a patient with tachycardia, low BP, a low LVEF, and severe MR. By optimizing the medical therapy, exercise tolerance improved and she was discharged. The serum brain natriuretic peptide was significantly reduced and TTE showed an improved LVEF and reduced MR. <Learning objective: We managed a patient who had low blood pressure (BP) due to tachycardia, reduced left ventricular ejection function (LVEF), and severe mitral regulation (MR). In this case, ivabradine had a novel effect; specifically, heart rate was reduced and BP increased. As a result of the drug effects, we could prescribe a renin-angiotensin-system inhibitor. With optimal medical therapy, LVEF was restored and functional MR was reduced. In similar cases, ivabradine can be a key drug for medical therapy of heart failure.>.
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Hatamnejad MR, Bazrafshan H, Hosseinpour M, Izadpanah P, Kasravi MR, Bazrafshan M. Ventricular repolarization indicators in risk stratification of decompensated heart failure patients with ventricular systolic dysfunction. Caspian J Intern Med 2022; 13:533-545. [PMID: 35974927 PMCID: PMC9348206 DOI: 10.22088/cjim.13.3.533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 09/04/2021] [Accepted: 02/26/2022] [Indexed: 11/10/2022]
Abstract
Background Ventricular repolarization measurement by QTc interval and QT dispersion can recognize high-risk patients. Previous research tended to evaluate the act of repolarization indicators alone but this study aimed to elucidate their prognostic utility before and after modifying confounding parameters in risk stratification of different aspects of prognosis in decompensated heart failure patients with systolic dysfunction. Methods Data of 98 variables were evaluated to determine their predictive value concerning arrhythmic events, in-hospital, and long-term mortality. Results From 858 cases that presented with acute heart failure, 19.2% (n=165) were enrolled in the study. During hospitalization, arrhythmic events and cardiac-related mortality occurred in 56(33.9%) and 11(7%) patients, respectively. QTc and QT dispersion were independent predictors of arrhythmia and in-hospital mortality after adjustment of the variables (arrhythmic events: QTc interval OR 1.085, P=0.007, QT dispersion OR 1.077, P=0.007, in-hospital mortality: QTc interval OR 1.116, P=0.009, QT dispersion OR 1.067, P=0.011). After being discharged, they were tracked for 181±56 days. Within the 16 deaths in follow-up time, 6 sudden cardiac deaths were documented. Cox regression, defined QTc as the predictor of all-cause and sudden death mortality (all-cause: HR 1.041, 95% CI 1.015-1.067, P=0.002; sudden death: HR 1.063, 95% CI 1.023-1.105, P=0.002); nevertheless, efforts to demonstrate QT dispersion as the predictor failed. Conclusion The predictive nature of QT parameters was significant after modification of the variables; therefore, they should be measured for risk stratification of ventricular repolarization arrhythmia and death in decompensated heart failure patients.
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Affiliation(s)
- Mohammad Reza Hatamnejad
- Faculty of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran,Al-Zahra Charity Hospital, Department of Cardiology Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hamed Bazrafshan
- Department of Cardiology, Shiraz University of Medical Sciences, Shiraz, Iran,Al-Zahra Charity Hospital, Department of Cardiology Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Morteza Hosseinpour
- Faculty of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran,Al-Zahra Charity Hospital, Department of Cardiology Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Peyman Izadpanah
- Department of Cardiology, Shiraz University of Medical Sciences, Shiraz, Iran,Al-Zahra Charity Hospital, Department of Cardiology Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Mehdi Bazrafshan
- Faculty of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
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Issa VS, Ayub-Ferreira SM, Schroyens M, Chizzola PR, Soares PR, Lage SHG, Bocchi EA. The course of patients with Chagas heart disease during episodes of decompensated heart failure. ESC Heart Fail 2021; 8:1460-1471. [PMID: 33595916 PMCID: PMC8006612 DOI: 10.1002/ehf2.13232] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 07/04/2020] [Accepted: 01/19/2021] [Indexed: 11/11/2022] Open
Abstract
AIMS This study aimed to analyse the clinical presentation and prognosis of patients with Chagas cardiomyopathy and decompensated heart failure (HF), as compared with other aetiologies. METHODS AND RESULTS A prospective cohort of patients admitted with decompensated HF. We included 767 patients (63.9% male), with median age of 58 years [interquartile range 48.2-66.7 years]. Main aetiologies were non-Chagas/non-ischaemic cardiomyopathies in 389 (50.7%) patients, ischaemic disease in 209 (27.2%), and Chagas disease in 169 (22%). Median left ventricular ejection fraction was 26% (interquartile range 22-35%). Patients with Chagas differed from both patients with non-Chagas/non-ischaemic and ischaemic cardiomyopathies for a higher proportion of cardiogenic shock at admission (17.8%, 11.6%, and 11%, respectively, P < 0.001) and had lower blood pressure at admission (systolic blood pressure 90 [80-102.5], 100 [85-110], and 100 [88.2-120] mmHg, P < 0.001) and lower heart rate (heart rate 71 [60-80], 87 [70-102], and 79 [64-96.5] b.p.m., P < 0.001). Further, patients with Chagas had higher serum BNP level (1544 [734-3148], 1061 [465-239], and 927 [369-1455] pg/mL, P < 0.001), higher serum bilirubin (1.4 [0.922.44], 1.2 [0.77-2.19], and 0.84 [0.49-1.45] mg/dL, P < 0.001), larger left ventricular diameter (68 [63-73], 67 [58-74], and 62 [56.8-68.3] mm, respectively, P < 0.001), lower left ventricular ejection fraction (25 [21-30]%, 26 [22-35]%, and 30 [25-38]%, P < 0.001), and a higher proportion of patients with right ventricular function (48.8%, 40.7%, and 25.9%, P < 0.001). Patients with Chagas disease were more likely to receive inotropes than patients with non-Chagas/non-ischaemic and ischaemic cardiomyopathies (77.5%, 67.5%, and 62.5%, respectively, P = 0.007) and also to receive intra-aortic balloon pumping (30.8%, 16.2%, and 10.5%, P < 0.001). Overall, the rates of death or urgent transplant were higher among patients with Chagas than in other aetiologies, a difference that was driven mostly due to increased rate of heart transplant during hospital admission (20.2%, 10.3%, and 8.1%). The prognosis of patients at 180 days after hospital admission was worse for patients with Chagas disease as compared with other aetiologies. In patients with Chagas, age [odds ratio (OR) = 0.934, confidence interval (CI)95% 0.901-0.982, P = 0.005], right ventricular dysfunction by echocardiography (OR = 2.68, CI95% 1.055-6.81, P = 0.016), and urea (OR = 1.009, CI95% 1.001-1.018, P = 0.038) were significantly associated with prognosis. CONCLUSIONS Patients with Chagas cardiomyopathy and decompensated HF have a distinct clinical presentation and worse prognosis compared with other aetiologies.
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Affiliation(s)
- Victor Sarli Issa
- Department of Cardiology, Antwerp University Hospital, Wilrijkstraat 10, Edegem, 2650, Belgium
| | - Silvia Moreira Ayub-Ferreira
- Heart Institute (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Matthew Schroyens
- Department of Cardiology, Antwerp University Hospital, Wilrijkstraat 10, Edegem, 2650, Belgium
| | - Paulo Roberto Chizzola
- Heart Institute (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Paulo Rogerio Soares
- Heart Institute (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Silvia Helena Gelas Lage
- Heart Institute (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Edimar Alcides Bocchi
- Heart Institute (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
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Bocchi EA, Lima IGCV, Biselli B, Salemi VMC, Ferreira SMA, Chizzola PR, Munhoz RT, Pessoa RS, Cardoso FAM, Bello MVDO, Hajjar LA, Gomes BR. Worsening of heart failure by coronavirus disease 2019 is associated with high mortality. ESC Heart Fail 2021; 8:943-952. [PMID: 33498096 PMCID: PMC8006661 DOI: 10.1002/ehf2.13199] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 11/25/2020] [Accepted: 12/28/2020] [Indexed: 01/08/2023] Open
Abstract
AIMS Patients with advanced heart failure (HF) with reduced left ventricular ejection fraction (HFrEF) and concurrent coronavirus disease 2019 (COVID-19) might have a higher risk of severe events. METHODS AND RESULTS We retrospectively studied 16 patients with advanced HFrEF who developed COVID-19 between 1 March and 29 May 2020. Follow-up lasted until 30 September. Ten patients previously hospitalized with decompensated HFrEF were infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) during hospitalization. Six patients undergoing ambulatory care at initiation of COVID-19 symptoms were hospitalized because of advanced HFrEF. All patients who experienced worsening of HFrEF due to COVID-19 required higher doses or introduction of additional inotropic drugs or intra-aortic balloon pump in the intensive care unit. The mean intravenous dobutamine dose before SARS-CoV-2 infection in previously hospitalized patients (n = 10) and the median (inter-quartile range) peak intravenous dobutamine dose during SARS-CoV-2 infection in all patients (n = 16) were 2 (0-7) μg/kg/min and 20 (14-20) (P < 0.001), respectively. During follow-up, 56% underwent heart transplantation (n = 2) or died (n = 7). Four patients died during hospitalization from mixed shock consequent to severe acute respiratory syndrome with inflammatory storm syndrome associated with septic and cardiogenic shock during COVID-19. After COVID-19 recovery, two patients died from mixed septic and cardiogenic shock and one from sustained ventricular tachycardia and cardiogenic shock. Five patients were discharged from hospital to ambulatory care. Four were awaiting heart transplantation. CONCLUSION Worsening of advanced HF by COVID-19 is associated with high mortality. This report highlights the importance of preventing COVID-19 in patients with advanced HF.
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Affiliation(s)
- Edimar Alcides Bocchi
- Heart Failure Clinics of the Heart Institute (InCor) of São Paulo University Medical School, São Paulo, Brazil
| | | | - Bruno Biselli
- Heart Failure Clinics of the Heart Institute (InCor) of São Paulo University Medical School, São Paulo, Brazil
| | - Vera Maria Cury Salemi
- Heart Failure Clinics of the Heart Institute (InCor) of São Paulo University Medical School, São Paulo, Brazil
| | | | - Paulo Roberto Chizzola
- Heart Failure Clinics of the Heart Institute (InCor) of São Paulo University Medical School, São Paulo, Brazil
| | - Robinson Tadeu Munhoz
- Heart Failure Clinics of the Heart Institute (InCor) of São Paulo University Medical School, São Paulo, Brazil
| | - Ranna Santos Pessoa
- Heart Institute (Incor) of São Paulo University Medical School, São Paulo, Brazil
| | | | | | | | - Brenno Rizerio Gomes
- Heart Failure Clinics of the Heart Institute (InCor) of São Paulo University Medical School, São Paulo, Brazil
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Berkovitch A, Mazin I, Younis A, Shlomo N, Nof E, Goldenberg I, Beinart R. CHA2DS2-VASc score performance to predict stroke after acute decompensated heart failure with and without reduced ejection fraction. Europace 2020; 21:1639-1645. [PMID: 31390461 DOI: 10.1093/europace/euz192] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Accepted: 06/19/2019] [Indexed: 11/13/2022] Open
Abstract
AIMS To validate the utility of CHA2DS2-VASc score to predict the annual risk of stroke in patients admitted with acute heart failure, comparing those with preserved ejection fraction (HF-presEF) and reduced ejection fraction (HF-redEF). METHODS AND RESULTS We investigated 2922 patients with known atrial fibrillation who were admitted to the Sheba Medical Center for acute decompensated heart failure (HF). Anticoagulation therapy was prescribed based on CHA2DS2-VASc score or physician's discretion. Subjects were divided into four pre-specified groups based on HF type and median CHA2DS2-VASc score: HF-presEF with CHA2DS2-VASc <5(N = 731), HF-presEF with CHA2DS2-VASc ≥5 (N = 1102), HF-redEF with CHA2DS2-VASc <5 (N = 563), and HF-redEF with CHADS2-VASc ≥5 (N = 526). The primary endpoint was an ischaemic stroke at 1 year. Mean age of the study population was 79 ± 11 years, of whom more than half were women. The median CHA2DS2-VASc score for the entire study population was 5.0 (interquartile range 25-75%: 4-6). Stroke rate for the entire study population was 6.6%. Multivariate Cox regression proportional hazards regression analysis revealed that in both HF-redEF and HF-presEF patients, each one-point increment in CHA2DS2-VASc was associated with a corresponding 28% increase in stroke risk (P < 0.001). The Kaplan-Meier's survival analysis revealed that in the same CHADS2-VASc category (high vs. low), no difference was found between HF-redEF and HF-presEF with regards to the risk of stroke. CONCLUSION Our key finding is that the CHA2DS2-VASc score is a valid and powerful predictor of subsequent stroke among patients admitted with acute heart failure decompensation regardless of heart failure type.
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Affiliation(s)
- Anat Berkovitch
- Leviev Heart Center, Chaim Sheba Medical Center Affiliated to Sackler Medical School, Tel-Aviv University, Tel Hashomer, Israel
| | - Israel Mazin
- Leviev Heart Center, Chaim Sheba Medical Center Affiliated to Sackler Medical School, Tel-Aviv University, Tel Hashomer, Israel
| | - Arwa Younis
- Leviev Heart Center, Chaim Sheba Medical Center Affiliated to Sackler Medical School, Tel-Aviv University, Tel Hashomer, Israel
| | - Nir Shlomo
- Leviev Heart Center, Chaim Sheba Medical Center Affiliated to Sackler Medical School, Tel-Aviv University, Tel Hashomer, Israel
| | - Eyal Nof
- Leviev Heart Center, Chaim Sheba Medical Center Affiliated to Sackler Medical School, Tel-Aviv University, Tel Hashomer, Israel.,Pinchas Borenstein Talpiot Medical Leadership Program, Chaim Sheba Medical Center Affiliated to Sackler Medical School, Tel-Aviv University, Tel Hashomer, Israel
| | - Ilan Goldenberg
- The University of Rochester Medical Center, Rochester, NY, USA
| | - Roy Beinart
- Leviev Heart Center, Chaim Sheba Medical Center Affiliated to Sackler Medical School, Tel-Aviv University, Tel Hashomer, Israel.,Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Limburg, The Netherlands
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10
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Vazquez-Montes MDLA, Debray TPA, Taylor KS, Speich B, Jones N, Collins GS, Hobbs FDRR, Magriplis E, Maruri-Aguilar H, Moons KGM, Parissis J, Perera R, Roberts N, Taylor CJ, Kadoglou NPE, Trivella M. UMBRELLA protocol: systematic reviews of multivariable biomarker prognostic models developed to predict clinical outcomes in patients with heart failure. Diagn Progn Res 2020; 4:13. [PMID: 32864468 PMCID: PMC7448313 DOI: 10.1186/s41512-020-00081-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 07/23/2020] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Heart failure (HF) is a chronic and common condition with a rising prevalence, especially in the elderly. Morbidity and mortality rates in people with HF are similar to those with common forms of cancer. Clinical guidelines highlight the need for more detailed prognostic information to optimise treatment and care planning for people with HF. Besides proven prognostic biomarkers and numerous newly developed prognostic models for HF clinical outcomes, no risk stratification models have been adequately established. Through a number of linked systematic reviews, we aim to assess the quality of the existing models with biomarkers in HF and summarise the evidence they present. METHODS We will search MEDLINE, EMBASE, Web of Science Core Collection, and the prognostic studies database maintained by the Cochrane Prognosis Methods Group combining sensitive published search filters, with no language restriction, from 1990 onwards. Independent pairs of reviewers will screen and extract data. Eligible studies will be those developing, validating, or updating any prognostic model with biomarkers for clinical outcomes in adults with any type of HF. Data will be extracted using a piloted form that combines published good practice guidelines for critical appraisal, data extraction, and risk of bias assessment of prediction modelling studies. Missing information on predictive performance measures will be sought by contacting authors or estimated from available information when possible. If sufficient high quality and homogeneous data are available, we will meta-analyse the predictive performance of identified models. Sources of between-study heterogeneity will be explored through meta-regression using pre-defined study-level covariates. Results will be reported narratively if study quality is deemed to be low or if the between-study heterogeneity is high. Sensitivity analyses for risk of bias impact will be performed. DISCUSSION This project aims to appraise and summarise the methodological conduct and predictive performance of existing clinically homogeneous HF prognostic models in separate systematic reviews.Registration: PROSPERO registration number CRD42019086990.
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Affiliation(s)
- Maria D. L. A. Vazquez-Montes
- Nuffield Department of Primary Care Health Sciences, Radcliffe Observatory Quarter, University of Oxford, Woodstock Road, Oxford, OX2 6GG UK
| | - Thomas P. A. Debray
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Windmill Road, Oxford, OX3 7LD UK
- Julius Center for Health Sciences and Primary Care, University Medical Center (UMC), Utrecht University, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Kathryn S. Taylor
- Nuffield Department of Primary Care Health Sciences, Radcliffe Observatory Quarter, University of Oxford, Woodstock Road, Oxford, OX2 6GG UK
| | - Benjamin Speich
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Windmill Road, Oxford, OX3 7LD UK
- Basel Institute for Clinical Epidemiology and Biostatistics, Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Nicholas Jones
- Nuffield Department of Primary Care Health Sciences, Radcliffe Observatory Quarter, University of Oxford, Woodstock Road, Oxford, OX2 6GG UK
| | - Gary S. Collins
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Windmill Road, Oxford, OX3 7LD UK
- National Institute for Health Research Oxford Biomedical Research Centre, John Radcliffe Hospital, Oxford, UK
| | - F. D. R. Richard Hobbs
- Nuffield Department of Primary Care Health Sciences, Radcliffe Observatory Quarter, University of Oxford, Woodstock Road, Oxford, OX2 6GG UK
| | - Emmanuella Magriplis
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Windmill Road, Oxford, OX3 7LD UK
- Department of Food Science and Nutrition, Agricultural University of Athens, Iera Odos, 75 Athens, Greece
| | - Hugo Maruri-Aguilar
- School of Mathematical Sciences, Queen Mary University of London, E1 4NS, London, UK
| | - Karel G. M. Moons
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Windmill Road, Oxford, OX3 7LD UK
- Julius Center for Health Sciences and Primary Care, University Medical Center (UMC), Utrecht University, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - John Parissis
- Second Department of Cardiology, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Rafael Perera
- Nuffield Department of Primary Care Health Sciences, Radcliffe Observatory Quarter, University of Oxford, Woodstock Road, Oxford, OX2 6GG UK
| | - Nia Roberts
- Bodleian Health Care Libraries, University of Oxford, Oxford, UK
| | - Clare J. Taylor
- Nuffield Department of Primary Care Health Sciences, Radcliffe Observatory Quarter, University of Oxford, Woodstock Road, Oxford, OX2 6GG UK
| | - Nikolaos P. E. Kadoglou
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Windmill Road, Oxford, OX3 7LD UK
| | - Marialena Trivella
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Windmill Road, Oxford, OX3 7LD UK
| | - on behalf of the proBHF group
- Nuffield Department of Primary Care Health Sciences, Radcliffe Observatory Quarter, University of Oxford, Woodstock Road, Oxford, OX2 6GG UK
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Windmill Road, Oxford, OX3 7LD UK
- Julius Center for Health Sciences and Primary Care, University Medical Center (UMC), Utrecht University, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
- Basel Institute for Clinical Epidemiology and Biostatistics, Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
- National Institute for Health Research Oxford Biomedical Research Centre, John Radcliffe Hospital, Oxford, UK
- Department of Food Science and Nutrition, Agricultural University of Athens, Iera Odos, 75 Athens, Greece
- School of Mathematical Sciences, Queen Mary University of London, E1 4NS, London, UK
- Second Department of Cardiology, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
- Bodleian Health Care Libraries, University of Oxford, Oxford, UK
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11
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Matsuda Y, Masuda M, Asai M, Iida O, Kanda T, Mano T. Bailout cryoballoon ablation for hemodynamically unstable atrial fibrillation in patients with decompensated heart failure. HeartRhythm Case Rep 2020; 6:685-689. [PMID: 33101932 PMCID: PMC7573379 DOI: 10.1016/j.hrcr.2020.06.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
| | - Masaharu Masuda
- Kansai Rosai Hospital Cardiovascular Center, Amagasaki, Japan
| | - Mitsutoshi Asai
- Kansai Rosai Hospital Cardiovascular Center, Amagasaki, Japan
| | - Osamu Iida
- Kansai Rosai Hospital Cardiovascular Center, Amagasaki, Japan
| | - Takashi Kanda
- Kansai Rosai Hospital Cardiovascular Center, Amagasaki, Japan
| | - Toshiaki Mano
- Kansai Rosai Hospital Cardiovascular Center, Amagasaki, Japan
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12
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Shi X, Bao J, Zhang H, Wang H, Li L, Zhang Y. Patients with high-dose diuretics should get ultrafiltration in the management of decompensated heart failure: a meta-analysis. Heart Fail Rev 2020; 24:927-940. [PMID: 31209772 PMCID: PMC6834743 DOI: 10.1007/s10741-019-09812-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
The identification of specific patients with decompensated heart failure (DHF) who may benefit from ultrafiltration (UF) is important in clinical practice. We undertook a meta-analysis to compare the effects of ultrafiltration and diuretics on major clinical outcomes. The outcomes included weight change, length of hospital stay, rehospitalization for HF, mortality, change in serum creatinine, dialysis dependence, and adverse outcomes. We identified 14 trials including 975 patients with HF, met the eligibility criteria. There was a reduction in heart failure-related rehospitalization in ultrafiltration group when compared with the diuretic group. Subgroup analyses revealed a trend toward the decreased HF readmissions in ultrafiltration plus diuretic therapy group but did not reach statistical significance compared with ultrafiltration alone therapy. Overall, UF treatment did not produce apparent beneficial effects for weight loss, lengths of hospitalization, total mortality, the change of serum creatinine, and dialysis rate. Subgroup analyses showed increase in the serum creatinine were significantly higher for a higher dose regimen (> 200 mg/day) when compared with lower dose diuretic therapy (< 200 mg/day). As for adverse events, UF patients were associated with an increased risk of hypotension and lower risk of neurologic symptoms. The current results revealed ultrafiltration was associated with significant reduction in the rate of rehospitalization. Increase in the serum creatinine was observed in patients with high-dose diuretic regimen. Patients with high-dose diuretics should get ultrafiltration therapy.
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Affiliation(s)
- Xiaofeng Shi
- Emergency department, Tianjin First Center Hospital, Tianjin, China
| | - Jiating Bao
- Intensive Care Unit, Tianjin First Center Hospital, Tianjin, China
| | - Haili Zhang
- General Surgery Department, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Hao Wang
- Emergency department, Tianjin First Center Hospital, Tianjin, China
| | - Lei Li
- Department of Vascular Surgery, The Second Hospital of Dalian Medical University, Dalin, China.
| | - Yue Zhang
- Institute of Urology, The second Hospital of Tianjin Medical University, Tianjin, China.
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13
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Abstract
Purpose of Review To provide an overview of the potential iatrogenic causes of acute decompensated heart failure (AHF) and an evidence-based management strategy to address this. Recent Findings As the heart failure (HF) population continues to age and become burdened with greater comorbidities and polypharmacy, patients become more susceptible to the iatrogenic precipitants of HF. The following clinical scenarios are familiar to clinicians, but the sequelae to AHF are often unanticipated: HF medications withdrawn during an intercurrent illness and not restarted, cardiotoxic therapy prescribed for cancer without timely and regular monitoring of left ventricular function, excessive intravenous fluids administered for sepsis or postoperatively, a blood transfusion volume not adjusted for body weight, iatrogenic anaemia that goes unnoticed or an inappropriate type of pacemaker implanted in a patient with underlying left ventricular systolic dysfunction. Summary Iatrogenic decompensated HF is a phenomenon that is infrequently documented in the literature but increasingly confronted by clinicians of all specialties. It is associated with a high mortality and morbidity rate. By having greater awareness of these triggers, iatrogenic AHF should be one that is prevented rather than managed when it occurs.
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14
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Goy CB, Yanicelli LM, Vargas N, Marquez LLL, Tazar J, Madrid RE, Herrera MC. Vascular Parameters for Ambulatory Monitoring of Congestive Heart Failure Patients: Proof of Concept. Cardiovasc Eng Technol 2019; 10:618-627. [PMID: 31598894 DOI: 10.1007/s13239-019-00432-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Accepted: 10/01/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE Prompt detection of congestion is an essential target in order to prevent heart failure (HF) related hospitalization, being ambulatory monitoring a promising strategy to do so. A successful non-invasive ambulatory monitoring system requires automatic devices for physiological data recording; these data must give information about HF deterioration early enough to predict HF-related adverse events. This work aims to evaluate seven vascular parameters for the ambulatory monitoring of congestive heart failure patients. METHODS Seven vascular parameters are proposed as indicators of HF deterioration. These parameters are obtained using venous occlusion plethysmography; a technique that uses hardware able of being miniaturized and easily integrated into wearables for ambulatory monitoring. The ability of the proposed vascular parameters to detect congestion is evaluated in eight healthy volunteers and ten congestive heart failure patients with different congestion levels-mild, moderate and severe. RESULTS Most parameters distinguish between healthy volunteers and heart failure patients, and some of them present significant differences between volunteers and low levels of congestion-mild or moderate. CONCLUSION Home monitoring of some of the proposed parameters could detect HF deterioration on its onset and alert to health personnel.
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Affiliation(s)
- C B Goy
- Laboratorio de Medios e Interfases (LAMEIN)-Departamento de Bioingeniería, Facultad de Ciencias Exactas y Tecnología, Universidad Nacional de Tucumán, Av. Independencia 1900, Tucumán, Argentina. .,Instituto Superior de Investigaciones Biológicas, Consejo Nacional de Investigaciones Científicas y Técnicas, Chacabuco 461, Tucumán, Argentina. .,Laboratorio de Investigaciones Cardiovasculares Multidisciplinarias-Departamento de Bioingeniería, Facultad de Ciencias Exactas y Tecnología, Universidad Nacional de Tucumán, Av. Independencia 1900, Tucumán, Argentina. .,Departamento de Ing. Eléctrica, Electrónica y Computación, Facultad de Ciencias Exactas y Tecnología, Universidad Nacional de Tucumán, Av. Independencia 1900, Tucumán, Argentina.
| | - L M Yanicelli
- Instituto Superior de Investigaciones Biológicas, Consejo Nacional de Investigaciones Científicas y Técnicas, Chacabuco 461, Tucumán, Argentina.,Laboratorio de Investigaciones Cardiovasculares Multidisciplinarias-Departamento de Bioingeniería, Facultad de Ciencias Exactas y Tecnología, Universidad Nacional de Tucumán, Av. Independencia 1900, Tucumán, Argentina
| | - N Vargas
- Instituto Superior de Investigaciones Biológicas, Consejo Nacional de Investigaciones Científicas y Técnicas, Chacabuco 461, Tucumán, Argentina.,Laboratorio de Investigaciones Cardiovasculares Multidisciplinarias-Departamento de Bioingeniería, Facultad de Ciencias Exactas y Tecnología, Universidad Nacional de Tucumán, Av. Independencia 1900, Tucumán, Argentina
| | | | - J Tazar
- Instituto de Cardiología, Av. Mitre 760, Tucumán, Argentina
| | - R E Madrid
- Laboratorio de Medios e Interfases (LAMEIN)-Departamento de Bioingeniería, Facultad de Ciencias Exactas y Tecnología, Universidad Nacional de Tucumán, Av. Independencia 1900, Tucumán, Argentina.,Instituto Superior de Investigaciones Biológicas, Consejo Nacional de Investigaciones Científicas y Técnicas, Chacabuco 461, Tucumán, Argentina
| | - M C Herrera
- Instituto Superior de Investigaciones Biológicas, Consejo Nacional de Investigaciones Científicas y Técnicas, Chacabuco 461, Tucumán, Argentina.,Laboratorio de Investigaciones Cardiovasculares Multidisciplinarias-Departamento de Bioingeniería, Facultad de Ciencias Exactas y Tecnología, Universidad Nacional de Tucumán, Av. Independencia 1900, Tucumán, Argentina
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15
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García-Gutiérrez S, Quintana López JM, Antón-Ladislao A, Gallardo Rebollal MS, Rilo Miranda I, Morillas Bueno M, Murga Eizagaetxebarria N, Palenzuela Arocena R, Pulido E, Barrio Beraza I, Aguirre Larracoechea U, Arostegui I. External validity of a prognostic score for acute heart failure based on the Epidemiology of Acute Heart Failure in Emergency Departments registry: the EAHFE-3D scale. Emergencias 2019; 30:84-90. [PMID: 29547230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
OBJECTIVES To validate the EAHFE-3D scale, based on the Acute Heart Failure in Emergency Departments registry, in a cohort of patients attended for acute heart failure. MATERIAL AND METHODS Study of a multipurpose cohort of patients with acute heart failure in 3 hospitals in the Basque Country between 2011 and 2013. We extracted age, baseline New York Heart Association functional class, systolic blood pressure, baseline arterial oxygen saturation, sodium level in blood, and emergency department treatments (noninvasive mechanical ventilation, use of inotropic agents and vasopressors) in order to calculate each patient's EAHFE-3D score. The main outcome variable was mortality within 3 days of arrival at the emergency department. RESULTS The patient sample for score validation consisted of 717 patients with complete information. The model's intercept was 0.5 (95% CI, -2.7 to 3.7) and the slope was 1.3 (95% CI, 0.4 to 2.2). The area under the receiver operating characteristic curve was 0.76 (95% CI, 0.58 to 0.94). CONCLUSION The EAHFE-3D scale's ability to discriminate was good in this patient sample and similar to that reported by the authors who developed the scale; however, calibration was poor. The scale should be studied further before it is applied in clinical practice.
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Affiliation(s)
- Susana García-Gutiérrez
- Unidad de Investigación, Hospital Galdakao-Usansolo [Osakidetza], Red de Investigación en Servicios de Salud en Enfermedades Crónicas [REDISSEC], Galdakao, Bizkaia, España
| | - José M Quintana López
- Unidad de Investigación, Hospital Galdakao-Usansolo [Osakidetza], Red de Investigación en Servicios de Salud en Enfermedades Crónicas [REDISSEC], Galdakao, Bizkaia, España
| | - Ane Antón-Ladislao
- Unidad de Investigación, Hospital Galdakao-Usansolo [Osakidetza], Red de Investigación en Servicios de Salud en Enfermedades Crónicas [REDISSEC], Galdakao, Bizkaia, España
| | | | | | | | | | | | - Esther Pulido
- Servicio de Urgencias, Hospital Galdakao-Usansolo, Galdakao, Bizkaia, España
| | - Irantzu Barrio Beraza
- Departamento de Matemática Aplicada, Estadística e Investigación Operativa, Universidad del País Vasco UPV/EHU, Leioa, España. Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Galdakao, España
| | - Urko Aguirre Larracoechea
- Unidad de Investigación, Hospital Galdakao-Usansolo [Osakidetza], Red de Investigación en Servicios de Salud en Enfermedades Crónicas [REDISSEC], Galdakao, Bizkaia, España
| | - Inmaculada Arostegui
- Departamento de Matemática Aplicada, Estadística e Investigación Operativa, Universidad del País Vasco UPV/EHU, Leioa, España. Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Galdakao, España
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16
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Abstract
PURPOSE OF REVIEW Heart failure is associated with an enormous burden on both patients and health care systems in the USA. Several national policy initiatives have focused on improving the quality of heart failure care, including reducing readmissions following hospitalization, which are common, costly, and, at least in part, preventable. The transition from inpatient to ambulatory care setting and the immediate post-hospitalization period present an opportunity to further optimize guideline concordant medical therapy, identify reversible issues related to worsening heart failure, and evaluate prognosis. It can also provide opportunities for medication reconciliation and optimization, consideration of device-based therapies, appropriate management of comorbidities, identification of individual barriers to care, and a discussion of goals of care based on prognosis. RECENT FINDINGS Recent studies suggest that attention to detail regarding patient comorbidities, barriers to care, optimization of both diuretic and neurohormonal therapies, and assessment of prognosis improve patient outcomes. Despite the fact that the transition period appears to be an optimal time to address these issues in a comprehensive manner, most patients are not referred to programs specializing in this approach post hospital discharge. The objective of this review is to provide an outline for early post discharge care that allows clinicians and other health care providers to care for these heart failure patients in a manner that is both firmly rooted in the guidelines and patient-centered. Data regarding which intervention is most likely to confer benefit to which subset of patients with this disease is lacking and warrants further study.
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Affiliation(s)
- Richard J Soucier
- Sections of Cardiovascular Medicine, Yale University School of Medicine, 135 College Street, Suite 230, New Haven, CT, 06520, USA
| | - P Elliott Miller
- Sections of Cardiovascular Medicine, Yale University School of Medicine, 135 College Street, Suite 230, New Haven, CT, 06520, USA
| | - Joseph J Ingrassia
- Division of Cardiology, University of Connecticut Health Center, 263 Farmington Ave, Farmington, CT, 06032, USA
| | - Ralph Riello
- Division of Pharmacy, Yale University School of Medicine, New Haven, CT, USA
| | - Nihar R Desai
- Sections of Cardiovascular Medicine, Yale University School of Medicine, 135 College Street, Suite 230, New Haven, CT, 06520, USA.,Center for Outcomes Research and Evaluation, Yale New Haven Health System, Yale New Haven Hospital, New Haven, CT, USA
| | - Tariq Ahmad
- Sections of Cardiovascular Medicine, Yale University School of Medicine, 135 College Street, Suite 230, New Haven, CT, 06520, USA.
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17
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Soloveva A, Kobalava Z, Fudim M, Ambrosy AP, Villevalde S, Bayarsaikhan M, Garmash I, Naumenko M. Relationship of Liver Stiffness With Congestion in Patients Presenting With Acute Decompensated Heart Failure. J Card Fail. 2019;25:176-187. [PMID: 30721735 DOI: 10.1016/j.cardfail.2019.01.020] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 12/22/2018] [Accepted: 01/27/2019] [Indexed: 12/16/2022]
Abstract
OBJECTIVE The significance of liver stiffness (LS) in the setting of cardiovascular congestion during the course of acute decompensated heart failure (ADHF) is under investigation. The aim of this study was to assess LS with the use of transient elastography (TE) and its associations with volume overload as determined by means of bioimpedance vector analysis (BIVA) in ADHF. METHODS AND RESULTS TE (Fibroscan 502; Echosens) and BIVA (ABC-01, Medass) were performed in the first 48 hours of admission and on the day of discharge in 149 ADHF patients without known primary chronic liver disease or acute hepatitis. During hospitalization the median value of LS decreased from 12.2 kPa (interquartile range 6.3-23.6) to 8.7 (5.9-14.4) kPa (P < .001). Changes in LS correlated (P < .001) with changes in weight and BIVA parameters. LS was compared with histologic features of livers of ADHF patients who died (n = 7). Liver fibrosis 2B-4 was observed but was not associated with LS. LS at discharge was associated with increased risk of 12-month all-cause death, HF readmission, and the combined end point. CONCLUSIONS There was a moderate association between LS with clinical congestion and volume overload according to BIVA and no correlation with degree of histologic liver fibrosis. LS may be a marker of negative HF outcomes.
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18
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Abstract
Cardiogenic shock (CS) refractory to conventional therapies continues to be a challenging medical syndrome, with poor prognosis and high complication and mortality rates. The application and use of temporary mechanical circulatory support (MCS) is a component in the treatment of CS patients and should be applied early in the presentation. Crucial to the success of their application, temporary MCS devices should be chosen based on degree of patient acuity and etiology of CS. Not all temporary MCS devices deliver the same degree of hemodynamic support and range from minimal support to systemic support via veno-arterial extracorporeal membrane oxygenation.
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Affiliation(s)
- Kimber Eleuteri
- Mechanical Circulatory Support, Medtronic, 500 Old Connecticut Path, Framingham, MA 01701, USA.
| | - Michael Mathias Koerner
- Cardiovascular Intensive Care, Integris Baptist Medical Center, 3300 Northwest Expressway, Oklahoma City, OK 73112, USA
| | - Douglas Horstmanshof
- Department of Heart Failure Cardiology, Integris Baptist Medical Center, 3300 Northwest Expressway, Oklahoma City, OK 73112, USA
| | - Aly El Banayosy
- Department of Heart Failure Cardiology, Integris Baptist Medical Center, 3300 Northwest Expressway, Oklahoma City, OK 73112, USA
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19
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Moreira da Silva Guimarães S, de Souza Cruz WM, de Souza Weigert G, Scalco FB, Colafranceschi AS, Ribeiro MG, Boaventura GT. Decompensated Chronic Heart Failure Reduces Plasma L-carnitine. Arch Med Res 2018; 49:278-281. [PMID: 30268703 DOI: 10.1016/j.arcmed.2018.09.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 09/14/2018] [Indexed: 01/16/2023]
Abstract
The heart has an intense aerobic metabolism and is among the most metabolically active organs in the body. Its tissue stores fatty acid, the main energetic substrate, and requires high concentrations of plasma L-carnitine. This nutrient is essential in the transport of fatty acids to the mitochondria to generate energy and maintain the proper concentration of coenzyme A free. In decompensated chronic heart failure metabolic changes, associated with inflammation, alter the metabolism of L-carnitine and compromise cardiac energy metabolism. The aim of this study was to evaluate plasma L-carnitine in chronic heart failure patients during cardiac decompensation. A cross-sectional study was conducted with 109 volunteers with chronic heart failure. Participants were stratified in the compensated (HF compensated) and decompensated (decompensated HF) groups. Plasma L-carnitine was evaluated by the spectrophotometric enzymatic method. Low plasma L-carnitine was found in the decompensated HF group (p = 0.0001). In this group it was also observed that 29.1% of the participants presented plasma L-carnitine below the reference range (<20 mmol). Reduced plasma L-carnitine in patients with decompensated chronic systolic heart failure was founded. These findings suggest that plasma L-carnitine assessment may be helpful in clinical practice for the treatment of patients with cardiac decompensation.
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Affiliation(s)
- Sheila Moreira da Silva Guimarães
- Fluminense Federal University, Postgraduate Program in Pathology, Experimental Nutrition Laboratory, Niterói, Rio de Janeiro, Brazil.
| | - Wanise Maria de Souza Cruz
- Federal University of Rio de Janeiro, School of Medicine, Postgraduate in Clinical Medicine, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Guilherme de Souza Weigert
- Deparment of Surgical Procedures, National Institute of Cardiology, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Fernanda Bertão Scalco
- Federal University of Rio de Janeiro (UFRJ), Institute of Chemistry Inborn Errors of Metabolism Laboratory (LABEIM), Rio de Janeiro, Rio de Janeiro, Brazil
| | - Alexandre Siciliano Colafranceschi
- Federal University of Rio de Janeiro (UFRJ), Institute of Chemistry Inborn Errors of Metabolism Laboratory (LABEIM), Rio de Janeiro, Rio de Janeiro, Brazil
| | - Marcia Gonçalves Ribeiro
- Federal University of Rio de Janeiro, School of Medicine, Postgraduate in Clinical Medicine, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Gilson Teles Boaventura
- Fluminense Federal University, Postgraduate Program in Pathology, Experimental Nutrition Laboratory, Niterói, Rio de Janeiro, Brazil
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Scrutinio D, Guida P, Passantino A, Ammirati E, Oliva F, Lagioia R, Frigerio M. Application of competing risks analysis improved prognostic assessment of patients with decompensated chronic heart failure and reduced left ventricular ejection fraction. J Clin Epidemiol 2018; 103:31-9. [PMID: 30009940 DOI: 10.1016/j.jclinepi.2018.07.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2018] [Revised: 05/15/2018] [Accepted: 07/05/2018] [Indexed: 11/20/2022]
Abstract
OBJECTIVE The Kaplan-Meier method may overestimate absolute mortality risk (AMR) in the presence of competing risks. Urgent heart transplantation (UHT) and ventricular assist device implantation (VADi) are important competing events in heart failure. We sought to quantify the extent of bias of the Kaplan-Meier method in estimating AMR in the presence of competing events and to analyze the effect of covariates on the hazard for death and competing events in the clinical model of decompensated chronic heart failure with reduced ejection fraction (DCHFrEF). STUDY DESIGN AND SETTING We studied 683 patients. We used the cumulative incidence function (CIF) to estimate the AMR at 1 year. CIF estimate was compared with the Kaplan-Meier estimate. The Fine-Gray subdistribution hazard analysis was used to assess the effect of covariates on the hazard for death and UHT/VADi. RESULTS The Kaplan-Meier estimate of the AMR was 0.272, whereas the CIF estimate was 0.246. The difference was more pronounced in the patient subgroup with advanced DCHF (0.424 vs. 0.338). The Fine-Gray subdistribution hazard analysis revealed that established risk markers have qualitatively different effects on the incidence of death or UHT/VADi. CONCLUSION Competing risks analysis allows more accurately estimating AMR and better understanding the association between covariates and major outcomes in DCHFrEF.
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Baeza-Trinidad R, Mosquera-Lozano JD, Gómez-Del Mazo M, Ariño-Pérez de Zabalza I. Evolution of bendopnea during admission in patients with decompensated heart failure. Eur J Intern Med 2018; 51:e23-e24. [PMID: 29496314 DOI: 10.1016/j.ejim.2018.02.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Accepted: 02/23/2018] [Indexed: 10/17/2022]
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Abstract
Purpose of Review Acute decompensated heart failure is a serious and common condition where close monitoring of symptoms, vital signs, haemodynamic and other markers are needed after the patient is admitted to hospital as the in-hospital outcome is poor. This review focuses on advances in the assessment and monitoring of these patients. Recent Findings The adoption of the CHAMP acronym to identify precipitating factors and of the classification using wet-warm, wet-cold, dry-warm and dry-cold categories is an improvement regarding assessment. Summary Although the outcome of acute decompensated heart failure has remained poor with no new treatments found for a number of years, a structured approach to assessment and monitoring is now available.
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Affiliation(s)
- Danish Ali
- Department of Cardiology, University Hospital Coventry and Warwickshire, Clifford Bridge Road, Coventry, CV2 2DX, UK
| | - Prithwish Banerjee
- Department of Cardiology, University Hospital Coventry and Warwickshire, Clifford Bridge Road, Coventry, CV2 2DX, UK.
- Faculty of Health & Life Sciences, Coventry University, Coventry, UK.
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Abstract
Purpose of Review The purpose of this review is to describe the extent and scope of acute heart failure (AHF), place it within its clinical context and highlight some of the difficulties in defining it as a pathophysiological entity. Recent Findings A diagnosis of AHF is made when patients present acutely with signs and symptoms of heart failure, often with decompensation of pre-existing cardiomyopathy. The most current guidelines classify based on clinical features at initial presentation and are used to both risk stratify and guide the management of haemodynamic compromise. Despite this, AHF remains a diagnosis with a poor prognosis and there is no therapy proven to have long-term mortality benefits. Summary We provide an introduction to AHF and discuss its definition, causes and precipitants. We also present epidemiological and demographic data to suggest that there is significant patient heterogeneity and that AHF is not a single pathology, but rather a range of pathophysiological entities. This poses a challenge when designing clinical trials and may, at least in part, explain why the results in this area have been largely disappointing.
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Affiliation(s)
- Sameer Kurmani
- Department of Cardiovascular Sciences, University of Leicester Glenfield Hospital, Leicester, LE3 9QP, UK.
| | - Iain Squire
- NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, LE3 9QP, UK
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Minami S, Hamano T, Iwatani H, Mizui M, Kimura Y, Isaka Y. Tolvaptan promotes urinary excretion of sodium and urea: a retrospective cohort study. Clin Exp Nephrol 2017; 22:550-561. [PMID: 29052786 DOI: 10.1007/s10157-017-1475-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Accepted: 08/31/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Tolvaptan (TLV) promotes aquaresis; however, little is known about its effect on solute excretion in chronic kidney disease (CKD). METHODS We retrospectively studied CKD patients with decompensated heart failure (HF) or those with autosomal dominant polycystic kidney disease (ADPKD) receiving TLV. Patients with an increased urine volume of more than twice of daily variance were defined as "responders" in HF. We compared the ability of the urinary osmolality (U-OSM) change and urinary creatinine concentration ([U-Cr]) change to discriminate "responders". The fractional excretion of sodium (FeNa) and urea nitrogen (FeUN), and blood urea nitrogen (BUN) were monitored. RESULTS In 30 responders among 53 HF patients, TLV increased FeUN significantly from 36.1 to 44.2% after starting TLV, but not FeNa. Since U-OSM is determined partially by urinary UN concentration, the decrease of [U-Cr] after treatment outperformed the U-OSM decrement to discriminate responders, as shown in receiver operating characteristic curve analysis and significantly higher net reclassification index. In 13 ADPKD patients, TLV increased FeUN (34.8, 47.3%, p = 0.02), and significant decrease of BUN by 2.3 (95% confidence interval 0.4-4.2) mg/dL was observed even 3 months after the intervention. Systolic blood pressure decreased significantly by 14.2 (95% confidence interval 4.0-24.4) mmHg along with the increase in FeNa, leading to reduced dosage of antihypertensives in 6 patients. CONCLUSION TLV promotes the excretion of sodium and urea. The change in [U-Cr] is useful for early discrimination of responders. Hypotension should be carefully monitored during high-dose TLV therapy.
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Affiliation(s)
- Satoshi Minami
- Department of Nephrology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Takayuki Hamano
- Department of Comprehensive Kidney Disease Research, Osaka University Graduate School of Medicine, D11, 2-2 Yamadaoka, Suita, Osaka, Japan, 565-0871.
| | - Hirotsugu Iwatani
- Department of Nephrology, National Hospital Organization Osaka National Hospital, Chuo-ku, Osaka, Osaka, Japan
| | - Masayuki Mizui
- Department of Nephrology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Yoshiki Kimura
- Department of Nephrology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Yoshitaka Isaka
- Department of Nephrology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
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Abstract
An array of interventional therapeutics is available in the modern era, with uses depending on acute or chronic situations. This article focuses on support in acute decompensated heart failure and cardiogenic shock, including intra-aortic balloon pumps, continuous aortic flow augmentation, and extra-corporeal membrane oxygenation.
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Affiliation(s)
- Nishtha Sodhi
- Cardiovascular Division, Washington University, 660 South Euclid Avenue, St Louis, MO 63110, USA
| | - John M Lasala
- Cardiovascular Division, Washington University, 660 South Euclid Avenue, St Louis, MO 63110, USA.
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Abstract
Advanced heart failure is a heterogeneous condition unified by a very high mortality unless right treatment is instituted at the right time. The first step is understanding the mechanism leading to instability: hemodynamic or ischemic. Right kind of therapy; drugs (ionotropic) or IABP or other cardiac assist devices should be chosen according to mechanism of insult as well as degree of insult. Drugs such as ionotropes are effective only in very early course but if the decompensation has progressed beyond a certain point device such as IABP may be effective but again only early in the course when CPO? 0.6. Beyond a certain point, even IABP may not be effective: here only Impella (2.5, CP or 5) or Tandem Heart may be effective. However, beyond a certain point CPO < 0.53, even these devices may not be effective. Thus crux of the matter is choice of a right device/drug and timing of its institution.
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Testani JM, Brisco MA, Kociol RD, Jacoby D, Bellumkonda L, Parikh CR, Coca SG, Tang WHW. Substantial Discrepancy Between Fluid and Weight Loss During Acute Decompensated Heart Failure Treatment. Am J Med 2015; 128:776-83.e4. [PMID: 25595470 PMCID: PMC4475432 DOI: 10.1016/j.amjmed.2014.12.020] [Citation(s) in RCA: 79] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Revised: 12/15/2014] [Accepted: 12/15/2014] [Indexed: 12/31/2022]
Abstract
BACKGROUND Net fluid and weight loss are used ubiquitously to monitor diuretic response in acute decompensated heart failure research and patient care. However, the performance of these metrics has never been evaluated critically. The weight and volume of aqueous fluids such as urine should be correlated nearly perfectly and with very good agreement. As a result, significant discrepancy between fluid and weight loss during the treatment of acute decompensated heart failure would indicate measurement error in 1 or both of the parameters. METHODS The correlation and agreement (Bland-Altman method) between diuretic-induced fluid and weight loss were examined in 3 acute decompensated heart failure trials and cohorts: (1) Diuretic Optimization Strategies Evaluation (DOSE) (n = 254); (2) Evaluation Study of Congestive Heart Failure and Pulmonary Artery Catheterization Effectiveness (ESCAPE) (n = 348); and (3) Penn (n = 486). RESULTS The correlation between fluid and weight loss was modest (DOSE r = 0.55; ESCAPE r = 0.48; Penn r = 0.51; P < .001 for all), and the 95% limits of agreement were wide (DOSE -7.9 to 6.4 kg-L; ESCAPE -11.6 to 7.5 kg-L; Penn -14.5 to 11.3 kg-L). The median relative disagreement ranged from ±47.0% to 63.5%. A bias toward greater fluid than weight loss was found across populations (-0.74 to -2.1 kg-L, P ≤ .002). A consistent pattern of baseline characteristics or in-hospital treatment parameters that could identify patients at risk of discordant fluid and weight loss was not found. CONCLUSIONS Considerable discrepancy between fluid balance and weight loss is common in patients treated for acute decompensated heart failure. Awareness of the limitations inherent to these commonly used metrics and efforts to develop more reliable measures of diuresis are critical for both patient care and research in acute decompensated heart failure.
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Affiliation(s)
- Jeffrey M Testani
- Department of Internal Medicine, Yale University School of Medicine, New Haven, Conn; Program of Applied Translational Research, Yale University School of Medicine, New Haven, Conn.
| | - Meredith A Brisco
- Department of Medicine, Cardiovascular Division, Medical University of South Carolina, Charleston
| | - Robb D Kociol
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass
| | - Daniel Jacoby
- Department of Internal Medicine, Yale University School of Medicine, New Haven, Conn
| | - Lavanya Bellumkonda
- Department of Internal Medicine, Yale University School of Medicine, New Haven, Conn
| | - Chirag R Parikh
- Department of Internal Medicine, Yale University School of Medicine, New Haven, Conn; Program of Applied Translational Research, Yale University School of Medicine, New Haven, Conn
| | - Steven G Coca
- Department of Internal Medicine, Yale University School of Medicine, New Haven, Conn; Program of Applied Translational Research, Yale University School of Medicine, New Haven, Conn
| | - W H Wilson Tang
- Section of Heart Failure and Cardiac Transplantation, The Cleveland Clinic, Cleveland, Ohio
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Luers C, Sutcliffe A, Binder L, Irle S, Pieske B. NT-proANP and NT-proBNP as prognostic markers in patients with acute decompensated heart failure of different etiologies. Clin Biochem 2013; 46:1013-9. [PMID: 23542086 DOI: 10.1016/j.clinbiochem.2013.03.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2012] [Revised: 02/16/2013] [Accepted: 03/17/2013] [Indexed: 01/17/2023]
Abstract
BACKGROUND AND PURPOSE Peak NT-proANP and NT-proBNP plasma levels after hospital admission may be of additional prognostic value in patients with acute decompensation of heart failure. The time-course of natriuretic plasma levels after hospital admission, and a possible influence of the underlying etiology on the time-course have not been sufficiently investigated. METHODS AND RESULTS Natriuretic peptide plasma levels of 85 patients with decompensated heart failure from ischemic and non-ischemic origins were measured at baseline and at 12h after hospital admission. NT-proBNP plasma levels on admission were lower compared to 12-hour-plasma levels, whereas NT-proANP plasma levels on admission were higher compared to 12-hour-plasma levels. Twenty-six patients (31%) died within the first 30 days. In patients who died within the first 30 days after admission NT-proANP and NT-proBNP plasma levels on admission and 12h later were significantly higher compared to survivors. Irrespective of different etiologies NT-proANP on admission and NT-proBNP 12h after admission were highest and demonstrated superior impact with respect to the prediction of 30-day-mortality. CONCLUSIONS NT-proANP and NT-proBNP are powerful markers of 30-day-mortality in patients with acute heart failure of ischemic and non-ischemic origins. With respect to the prediction of 30-day-mortality, NT-proBNP plasma levels at 12h after admission are comparable with NT-proANP plasma levels on admission. These data underline the fact that with regard to etiology-dependent hemodynamic changes and plasma half-time, the determination of peak plasma levels is of highest importance for the estimation of the impact of natriuretic peptides on the prognosis of patients with decompensated heart failure.
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Koniari K, Parissis J, Paraskevaidis I, Anastasiou-Nana M. Treating volume overload in acutely decompensated heart failure: established and novel therapeutic approaches. Eur Heart J Acute Cardiovasc Care 2012; 1:256-68. [PMID: 24062916 PMCID: PMC3760543 DOI: 10.1177/2048872612457044] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2012] [Accepted: 07/16/2012] [Indexed: 01/10/2023]
Abstract
BACKGROUND Most patients hospitalized for acutely decompensated heart failure (ADHF) present with symptoms and signs of volume overload, which is also associated with substantially high rates of death and rehospitalization in ADHF. OBJECTIVE To review the recent experimental and clinical evidence on existing therapeutic algorithms and investigational drugs used for the treatment of volume overload in ADHF patients. METHODS A systematic search of peer-reviewed publications was performed on Medline and EMBASE from January 1990 to March 2012. The results of unpublished trials were obtained from presentations at national and international meetings. RESULTS Apart from intrinsic renal insufficiency and neurohormonal activation, volume overload through venous congestion may be the primary haemodynamic factor triggering the worsening of renal function in ADHF patients. It is well known that heart and kidneys are closely interrelated and an acute or chronic disorder in one organ may induce acute or chronic dysfunction in the other organ. Established therapeutic strategies, (e.g. loop diuretics, vasodilators, and inotropes), are sometimes associated with limited clinical success due to tolerance and the need for frequent up titration of the doses in order to achieve the desired effect. That leads to an increasing interest in novel options, such as the use of adenosine A1 receptor antagonists, vasopressin antagonists, and renal-protective dopamine. Initial clinical trials have shown quite encouraging results in some heart failure subpopulations but have failed to demonstrate a clear beneficial role of these agents. On the other hand, ultrafiltration appears to be a more promising therapeutic procedure that will improve volume regulation, while preserving renal and cardiac function. CONCLUSION Further clinical studies are required in order to determine their net effect on renal function and potential cardiovascular outcomes. Until then, management of volume overload in ADHF patients remains a challenge for the clinicians.
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Iqbal N, Wentworth B, Choudhary R, Landa ADLP, Kipper B, Fard A, Maisel AS. Cardiac biomarkers: new tools for heart failure management. Cardiovasc Diagn Ther 2012; 2:147-64. [PMID: 24282708 PMCID: PMC3839143 DOI: 10.3978/j.issn.2223-3652.2012.06.03] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2012] [Accepted: 06/08/2012] [Indexed: 12/14/2022]
Abstract
The last decade has seen exciting advances in the field of biomarkers used in managing patients with heart failure (HF). Biomarker research has broadened our knowledge base, shedding more light on the underlying pathophysiological mechanisms occurring in patients with both acute and chronic HF. The criterion required by an ideal cardiovascular biomarker has been progressively changing to an era of sensitive assays that can be used to guide treatment. Recent technological advances have made it possible to rapidly measure even minute amounts of these proteins by means of higher sensitivity assays. With a high prevalence of comorbidities associated with HF, an integrated approach utilizing multiple biomarkers have shown promise in predicting mortality, better risk stratification and reducing re-hospitalizations, thus lowering health-care costs. This review provides a brief insight into recent advances in the field of biomarkers currently used in the diagnosis and prognosis of patients with acute and chronic HF.
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Affiliation(s)
- Navaid Iqbal
- Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
| | - Bailey Wentworth
- Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
| | - Rajiv Choudhary
- Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
| | | | - Benjamin Kipper
- Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
| | - Arrash Fard
- Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
| | - Alan S. Maisel
- Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
- Department of Medicine, University of California at San Diego, La Jolla, CA, USA
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