Presence of Atrial Fibrillation does not Affect Long-term Prognosis in Patients who are Hospitalized with Acute Decompensated Heart Failure

Background: Comorbidities are associated with poor clinical outcome in heart failure patients. AHEAD (A: atrial fibrillation; H: hemoglobin; E: elderly; A: abnormal renal parameters; D: diabetes mellitus) score has been related to clinical outcomes in patients with acute decompensated heart failure (ADHF). On the other hand, systemic inflammation plays a critical role in the outcomes of heart failure. Malnutrition is also associated with poor outcome in heart failure patients. It has been recently reported that advanced lung cancer inflammation index (ALI), which is calculated as body mass index х serum albumin / neutrophil to lymphocyte ratio, is an independent prognostic marker in several types of cancer. We sought to investigate the prognostic value of the combination of AHEAD score and ALI in ADHF patients. Methods and Results: We studied 263 patients admitted for ADHF and discharged with survival. At the discharge, we obtained ALI and AHEAD score (range 0-5, atrial fibrillation, hemoglobin <13 mg/dL for men and 12 mg/dL for women, age >70 years, creatinine >130 μmol/L, and diabetes mellitus). During a follow-up period of 5.0±4.2 yrs, 67 patients had cardiovascular death (CVD). At multivariate Cox analysis, AHEAD score and ALI were significantly independently associated with CVD, independently of prior heart failure hospitalization, systolic blood pressure and serum sodium level. The patients with both greater AHEAD score (≥median value=3) and lower ALI (≤median value=42.3) had a significantly increased risk of CVD than those with either and none of them (45% vs 24% vs 13%, p<0.0001, respectively). Conclusion: ALI would provide the additional long-term prognostic information to AHEAD score in patients with ADHF.

Download Full-text

Long-term serial changes of cardiac sympathetic nerve dysfunction in acute decompensated heart failure patients with reduced, mid-range and preserved left ventricular ejection fraction

European Heart Journal ◽

10.1093/ehjci/ehaa946.1211 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

M Seo ◽

T Yamada ◽

T Watanabe ◽

T Morita ◽

Y Furukawa ◽

...

Keyword(s):

Heart Failure ◽

Sympathetic Nerve ◽

Acute Decompensated Heart Failure ◽

Decompensated Heart Failure ◽

Left Ventricular Ejection ◽

Mibg Imaging ◽

Cardiac Sympathetic Nerve ◽

Heart Failure Hospitalization ◽

Nerve Dysfunction

Abstract Background Cardiac sympathetic nerve dysfunction, which is assessed by I-123 metaiodobenzylguanidine (MIBG) imaging, is associated with the poor outcomes in patients with chronic heart failure (CHF). Serial evaluation of cardiac MIBG imaging was shown to be useful for predicting adverse outcome in CHF. However, there was no information available on long-term serial changes of cardiac sympathetic nerve dysfunction after discharge of acute decompensated heart failure (ADHF) hospitalization. Purpose We aimed to clarify the serial change of cardiac MIBG imaging parameter in long-term after discharge of heart failure hospitalization, especially relating to HFrEF (LVEF<40%), HFmrEF (40%≤LVEF<50%) and HFpEF (LVEF≥50%). Methods We studied 112 patients (HFrEF; n=44, HFmrEF; n=23 and HFpEF; n=45) who were admitted for ADHF, discharged with survival and without heart failure hospitalization during follow-up period. All patients underwent cardiac MIBG imaging at the timing of discharge, in 6–12 months and in 18–24 months after discharge. The cardiac MIBG heart to mediastinum ratio (H/M) was calculated on the early image and the delayed image (late H/M). The cardiac MIBG washout rate (WR) was calculated from the early and delayed planar images after taking radioactive decay of I-123 into consideration. Results In HFrEF patients, late H/M was significantly improved from discharge to 6–12 months data (1.60±0.24 vs 1.75±0.31, p<0.0001). Late H/M of HFmrEF patients was also significantly improved from discharge to 18–24 months data (1.71±0.27 vs 1.84±0.29 p=0.043). On the other hand, late H/M of HFpEF patients was not significantly changed. As for WR, WR in HFrEF and HFmrEF patients was significantly improved from discharge to 18–24 months data, although WR of HFpEF was not significantly changed. Conclusion The improvement in cardiac sympathetic nerve dysfunction was observed in patients with HFrEF and HFmrEF, not in HFpEF, after the discharge of acute heart failure hospitalization. Funding Acknowledgement Type of funding source: None

Download Full-text

Serial echocardiographical assessment for urgent control of rapid atrial fibrillation in acute heart failure

European Heart Journal ◽

10.1093/ehjci/ehaa946.1213 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

N Iwahashi ◽

J Kirigaya ◽

M Horii ◽

Y Hanajima ◽

T Abe ◽

...

Keyword(s):

Heart Failure ◽

Atrial Fibrillation ◽

Confidence Interval ◽

Odds Ratio ◽

Acute Decompensated Heart Failure ◽

Decompensated Heart Failure ◽

Right Heart Catheterization ◽

Heart Catheterization ◽

Reduced Ejection Fraction ◽

Initial Hospitalization

Abstract Objectives Doppler echocardiography is a well-recognized technique for noninvasive evaluation; however, little is known about its efficacy in patients with rapid atrial fibrillation (AF) accompanied by acute decompensated heart failure (ADHF). The aim of this study was to explore the usefulness of serial echocardiographical assessment for rapid AF patients with ADHF. Patients A total of 110 ADHF patients with reduced ejection fraction (HFrEF) and rapid AF who were admitted to the CCU unit and received landiolol treatmentto decrease the heart rate (HR) to <110 bpm and change HR (ΔHR) of >20% within 24 hours were enrolled. Interventions Immediately after admission, the patients (n=110) received landiolol, and its dose was increased to the maximum; then, we repeatedly performed echocardiography. Among them, 39 patients were monitored using invasive right heart catheterization (RHC) simultaneously with echocardiography. Measurements and main results There were significant relationships between Doppler and RHC parameters through the landiolol treatment (Figure, baseline–max HR treatment). We observed for the major adverse events (MAE) during initial hospitalization, which included cardiac death, HF prolongation (required intravenous treatment at 30 days), and worsening renal function (WRF). MAE occurred in 44 patients, and logistic regression analyses showed that the mean left atrial pressure (mLAP)-Doppler (odds ratio = 1.132, 95% confidence interval [CI]: 1.05–1.23, p=0.0004) and stroke volume (SV)-Doppler (odds ratio = 0.93, 95% confidence interval [CI]: 0.89–0.97, p=0.001) at 24 hours were the significant predictors for MAE, and multivariate analysis showed that mLAP-Doppler was the strongest predictor (odds ratio = 1.16, 95% CI: 0.107–1.27, p=0.0005) (Table). Conclusions During the control of the rapid AF in HFrEF patients withADHF, echocardiography was useful to assess their hemodynamic condition, even at bedside. Doppler for rapid AF of ADHF Funding Acknowledgement Type of funding source: None

Download Full-text

Anemia is a Major Determinant of Long-Term Mortality and Hospitalization in Patients Hospitalized With Acute Decompensated Heart Failure: A Report from the Korean Heart Failure Registry (KorHFR)

Journal of Cardiac Failure ◽

10.1016/j.cardfail.2010.06.348 ◽

2010 ◽

Vol 16 (8) ◽

pp. S99

Author(s):

Sung-Ji Park ◽

Dong-Ju Choi ◽

Jin-Ho Choi ◽

Enu-Seok Cheon ◽

Gyu-Hyung Lee ◽

...

Keyword(s):

Heart Failure ◽

Acute Decompensated Heart Failure ◽

Decompensated Heart Failure ◽

Major Determinant ◽

Long Term Mortality

Download Full-text

Role of comorbidities in heart failure prognosis Part I: Anaemia, iron deficiency, diabetes, atrial fibrillation

European Journal of Preventive Cardiology ◽

10.1177/2047487320960288 ◽

2020 ◽

Vol 27 (2_suppl) ◽

pp. 27-34

Author(s):

Stefania Paolillo ◽

Angela B Scardovi ◽

Jeness Campodonico

Keyword(s):

Diabetes Mellitus ◽

Heart Failure ◽

Atrial Fibrillation ◽

Chronic Heart Failure ◽

Iron Deficiency ◽

Prognostic Impact ◽

Heart Failure Patients ◽

Cardiovascular Comorbidities ◽

Long Term Prognosis

Cardiovascular and non-cardiovascular comorbidities are frequently observed in heart failure patients, complicating the therapeutic management and leading to poor prognosis. The prompt recognition of associated comorbid conditions is of great importance to optimize the clinical management, the follow-up, and the treatment of patients affected by chronic heart failure. Anaemia and iron deficiency are commonly reported in all heart failure forms, have a multifactorial aetiology and are responsible for reduced exercise tolerance, impaired quality of life, and poor long-term prognosis. Diabetes mellitus is highly prevalent in heart failure and a poor glycaemic control is associated with worst outcome. Two specific heart failure forms are usually observed in diabetic patients: an ischaemic cardiomyopathy or a typical diabetic cardiomyopathy. The implementation of use of sodium-glucose cotransporter-2 inhibitors will much improve in the near future the long-term prognosis of patients affected by heart failure and diabetes. Among cardiovascular comorbidities, atrial fibrillation is the most common arrhythmic disease of heart failure patients and it is still not clear whether its presence should be considered as a prognostic indicator or as a marker of advanced disease. The aim of the present review was to explore the clinical and prognostic impact of anaemia and iron deficiency, diabetes mellitus, and atrial fibrillation in patients affected by chronic heart failure.

Download Full-text