THE IMPACT OF HEMODYNAMICALLY SIGNIFICANT MITRAL REGURGITATION ON LEFT ATRIAL DYNAMICS IN PATIENTS HOSPITALIZED FOR ACUTE DECOMPENSATED HEART FAILURE

2019 ◽  
Vol 73 (9) ◽  
pp. 1522
Author(s):  
Maurizio Losito ◽  
Andrea Giammaresi ◽  
Valentina Labate ◽  
Maria Michela Caracciolo ◽  
Francesco Bandera ◽  
...  
Keyword(s):  
Heart Failure ◽  
Mitral Regurgitation ◽  
Left Atrial ◽  
Acute Decompensated Heart Failure ◽  
Decompensated Heart Failure ◽  
The Impact

scholarly journals Mitral Regurgitation Severity Dynamic During Acute Decompensated Heart Failure Treatment.

2021 ◽  
Author(s):  
Kamil Bugała ◽  
Paweł Rubiś ◽  
Mateusz K Hołda ◽  
Małgorzata Konieczyńska ◽  
Piotr Bijak ◽  
...  
Keyword(s):  
Heart Failure ◽  
Mitral Regurgitation ◽  
Left Atrial ◽  
Acute Decompensated Heart Failure ◽  
Decompensated Heart Failure ◽  
Laboratory Evaluation ◽  
Heart Failure Treatment ◽  
Severity Class ◽  
Echocardiographic Assessment ◽  
Atrial Area

Abstract Purpose: Acute decompensated heart failure (ADHF) treatment leads to significant hemodynamic changes. The aim of our study was to quantitatively analyze the dynamics of mitral regurgitation (MR) severity (evaluated by transthoracic echocardiography) which occur during the treatment of ADHF and to correlate these changes with the clinical condition of patients as well as heart failure biochemical markers. Methods: The study included 27 consecutive adult patients (40.7% females, mean age 71.19±11.2 years) who required hospitalization due to signs of acute HF. Echocardiographic assessment was performed upon admission and discharge together with clinical and laboratory evaluation. Results: Significant reduction in dyspnea intensity [0-100 scale] (81.48±9.07 vs. 45.00±11.04 pts, p<0.001), body weight (84.98±18.52 vs. 79.77±17.49 kg, p<0,001), and NT-proBNP level (7520.56±5288.62 vs. 4949.88±3687.86 pg/ml, p=0.001) was found. The severity of MR parameters decreased significantly (MR volume 44.92±22.83 vs. 30.88±18.77 ml, p<0.001; EROA 0.37±0.17 vs. 0.25±0.16 cm2, p<0.001; VC 6.21±1.48 vs. 5.26±1.61 mm, p<0.001). Left atrial area (35.86±9.11 vs. 32.47±9.37, p<0.001) and mitral annular diameter (42.33±6.63 vs. 39.72±5.05. p<0.001) also underwent statistically significant reductions. An increase in LVEF was observed (34.73±13.88 vs. 40.24±13.19 %, p<0.001). In 40.7% of patients, a change in MR severity class (transition from a higher class to a lower one) was observed: 6/8 (75%) patients transitioned from severe to moderate and 6/18 (33.3%) patients transitioned from moderate to mild class.Conclusions: Treatment of ADHF leads to a significant reduction in MR severity, together with significant reductions in left atrial and mitral annular dimensions. Quantitative measurement of MR dynamics offer valuable assistance for ADHF management.

scholarly journals Mitral regurgitation severity dynamic during acute decompensated heart failure treatment

2021 ◽  
Author(s):  
Kamil Bugała ◽  
Paweł Rubiś ◽  
Mateusz K. Hołda ◽  
Małgorzata Konieczyńska ◽  
Piotr Bijak ◽  
...  
Keyword(s):  
Heart Failure ◽  
Mitral Regurgitation ◽  
Left Atrial ◽  
Acute Decompensated Heart Failure ◽  
Decompensated Heart Failure ◽  
Laboratory Evaluation ◽  
Heart Failure Treatment ◽  
Severity Class ◽  
Echocardiographic Assessment ◽  
Atrial Area

AbstractAcute decompensated heart failure (ADHF) treatment leads to significant hemodynamic changes. The aim of our study was to quantitatively analyze the dynamics of mitral regurgitation (MR) severity (evaluated by transthoracic echocardiography) which occur during the treatment of ADHF and to correlate these changes with the clinical condition of patients as well as heart failure biochemical markers. The study included 27 consecutive adult patients (40.7% females, mean age 71.19 ± 11.2 years) who required hospitalization due to signs of acute HF. Echocardiographic assessment was performed upon admission and discharge together with clinical and laboratory evaluation. Significant reduction in dyspnea intensity [0–100 scale] (81.48 ± 9.07 vs. 45.00 ± 11.04 pts, p < 0.001), body weight (84.98 ± 18.52 vs. 79.77 ± 17.49 kg, p < 0.001), and NT-proBNP level (7520.56 ± 5288.62 vs. 4949.88 ± 3687.86 pg/ml, p = 0.001) was found. The severity of MR parameters decreased significantly (MR volume 44.92 ± 22.83 vs. 30.88 ± 18.77 ml, p < 0.001; EROA 0.37 ± 0.17 vs. 0.25 ± 0.16 cm2, p < 0.001; VC 6.21 ± 1.48 vs. 5.26 ± 1.61 mm, p < 0.001). Left atrial area (35.86 ± 9.11 vs. 32.47 ± 9.37, p < 0.001) and mitral annular diameter (42.33 ± 6.63 vs. 39.72 ± 5.05. p < 0.001) also underwent statistically significant reductions. An increase in LVEF was observed (34.73 ± 13.88 vs. 40.24 ± 13.19%, p < 0.001). In 40.7% of patients, a change in MR severity class (transition from a higher class to a lower one) was observed: 6/8 (75%) patients transitioned from severe to moderate and 6/18 (33.3%) patients transitioned from moderate to mild class. Treatment of ADHF leads to a significant reduction in MR severity, together with significant reductions in left atrial and mitral annular dimensions. Quantitative measurement of MR dynamics offer valuable assistance for ADHF management.

scholarly journals The Impact of Early Tolvaptan Administration in the Patients Admitted by Acute Decompensated Heart Failure

2016 ◽  
Vol 22 (9) ◽  
pp. S187
Author(s):  
Kei Tsukamoto ◽  
Kenjiro Oyabu ◽  
Kazuyuki Hamada ◽  
Syun Hasegawa ◽  
Masahiro Watanabe ◽  
...  
Keyword(s):  
Heart Failure ◽  
Acute Decompensated Heart Failure ◽  
Decompensated Heart Failure ◽  
The Impact

scholarly journals ALTERATION IN RENAL FUNCTION FOLLOWING LOOP DIURETICS IN PATIENTS WITH ACUTE DECOMPENSATED HEART FAILURE

2019 ◽  
pp. 61-63
Author(s):  
PRUDENCE A RODRIGUES ◽  
SOUMYA GK ◽  
NADIA GRACE BUNSHAW ◽  
SARANYA N ◽  
SUJITH K ◽  
...  
Keyword(s):  
Heart Failure ◽  
Renal Function ◽  
Renal Injury ◽  
Loop Diuretic ◽  
Acute Decompensated Heart Failure ◽  
Diuretic Therapy ◽  
Decompensated Heart Failure ◽  
Loop Diuretics ◽  
Contributing Factors ◽  
The Impact

Objective: The objective of the study was to monitor the impact of loop diuretic therapy in patients with acute decompensated heart failure (ADHF) and to assess other predictors of renal dysfunction in patients with ADHF. Methods: An observational study over a period of 6 months from January 2018 to June 2018 in the Department of Cardiology, in a Tertiary Care Teaching Hospital, Coimbatore, Tamil Nadu. Patients on diuretic therapy (loop diuretic) were enrolled. Patients with prior chronic kidney disease were excluded from the study. The patients were evaluated based on change in serum creatinine (SCr) and other contributing factors were assessed by acute kidney injury network and worsening of renal function criteria. Results: A total of 135 patients were enrolled, of which 73% were males and 27% were females. The mean age of the subjects was 61.55±13 years. The baseline means SCr was 1.62±0.92 mg/dl. On evaluation, 41% were really affected and 59% remain unaffected. Factors such as hypertension (p=0.047) and angiotensin-converting enzyme inhibitors (ACE-I) (p=0.023) were found to be significant predictors of renal injury. Conclusion: Variation in renal function in ADHF patients was multifactorial. The direct influence of loop diuretics on renal function was present but was not well established. Hypertension and ACE-I have found to show influence in the development of renal injury as contributing factors. There exists both positive and negative consequence of loop diuretics on renal function.

scholarly journals Renal Function during Hospitalization and Outcome in Chinese Patients with Acute Decompensated Heart Failure

2021 ◽  
Author(s):  
Hao-Wei Lee ◽  
Chin-Chou Huang ◽  
Chih-Yu Yang ◽  
Hsin-Bang Leu ◽  
Po-Hsun Huang ◽  
...  
Keyword(s):  
Heart Failure ◽  
Renal Function ◽  
Clinical Outcomes ◽  
Acute Decompensated Heart Failure ◽  
Significant Risk ◽  
Decompensated Heart Failure ◽  
Chinese Patients ◽  
Cox Regression Analysis ◽  
The Impact

Abstract It is well known that the heart and kidney have a bi-directional correlation, in which organ dysfunction results in maladaptive changes in the other. We aimed to investigate the impact of renal function and its decline during hospitalization on clinical outcomes in patients with acute decompensated heart failure (ADHF). A total of 119 consecutive Chinese patients admitted for ADHF were prospectively enrolled. The course of renal function was presented with estimated glomerular filtration rate (eGFR), calculated by the four-variable equation proposed by the Modification of Diet in Renal Disease (MDRD) Study. Worsening renal function (WRF), defined as eGFR decline between admission (eGFRadmission) and pre-discharge (eGFRpredischarge), occurred in 41 patients. Clinical outcomes during the follow-up period were defined as 4P-major adverse cardiovascular events (4P-MACE), including the composition of cardiovascular death, nonfatal myocardial infarction, nonfatal stroke, and nonfatal HF hospitalization. During an average follow-up period of 2.6±3.2 years, 66 patients experienced 4P-MACE. Cox regression analysis revealed that impaired eGFRpredischarge, but not eGFRadmission or WRF, was significantly correlated with the development of 4P-MACE (HR, 2.003; 95% CI, 1.072–3.744; P=0.029). In conclusion, impaired renal function before discharge, but not WRF, is a significant risk factor for poor outcomes in patients with ADHF.

Adverse cardiovascular outcome predicted by left atrial strain in acute decompensated heart failure

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
M Barki ◽  
M Losito ◽  
M Carrozzo ◽  
M.M Caracciolo ◽  
M Rovida ◽  
...  
Keyword(s):  
Heart Failure ◽  
Left Atrial ◽  
Acute Decompensated Heart Failure ◽  
Significant Proportion ◽  
Decompensated Heart Failure ◽  
Primary Role ◽  
Cox Regression Analysis ◽  
Coronary Syndrome ◽  
Non Invasive ◽  
B Lines

Abstract Background A significant proportion of patients hospitalized for acute decompensated heart failure (ADHF) are readmitted to the hospital within 30 days, resulting in a major social and economic burden. Thus, risk stratification and identification of targets of therapy is of basic importance. Non-invasive imaging modality such as transthoracic echocardiography (TTE) represents a cornerstone tool to approach this clinical scenario for early recognition of high-risk patients. Purpose To define whether left atrial (LA) dynamics, evaluated by means of speckle tracking echocardiography (STE), may represent a predictor of cardiac events and early re-hospitalization in patients admitted to the emergency department (ED) for ADHF, in comparison with other non-invasive established prognostic index in heart failure (HF) such as NT-proBNP, B-lines at lung ultrasonography (LUS) and right ventricular (RV) to Pulmonary Circulation (PC) uncoupling evaluated through Tricuspid Annular Plane Systolic Excursion (TAPSE)/Pulmonary Arterial Systolic Pressure (PASP) ratio. Methods Seventy patients (mean age 75.6±11 years, 57% males) presenting with ADHF were prospectively enrolled within 24–48 hours from admission. In the acute phase and at pre-discharge the following variables have been collected: NT-proBNP, B-lines, TAPSE/PASP ratio, Left Atrial Volume indexed (LAVi) and global-peak atrial longitudinal strain (G-PALS). Results During a median follow-up of nine months we observed 18 events consisting of 7 deaths, 8 re-hospitalizations for ADHF, 1 re-hospitalization for acute coronary syndrome, 1 stroke and 1 mitral valve replacement. Multivariate Cox-regression analysis identified LAVi and GPALS at discharge, along with NT-proBNP, B-lines and TAPSE/PASP ratio, as independent predictors of major adverse CV events (LAVi: p=0.04; GPALS: p=0.05; NT-proBNP: p&lt;0.001; B-lines: p=0.03; TAPSE/PASP: p&lt;0.001) (Table 1). Conclusions Short-term re-hospitalization in ADHF is crucial and the identification of a higher risk through sensitive and potentially new hemodynamic phenotypes is of relevance. Our findings, although preliminary, may suggest a primary role of LA dynamics in this context. Funding Acknowledgement Type of funding source: None

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