Utility of BNP as a biomarker for assessing functional class during therapy in a heart failure specialty clinic

Abstract Background Patients with congestive heart failure (CHF) are vulnerable to contrast-induced acute kidney injury (CI-AKI), but few prediction models are currently available. Objectives We aimed to establish a simple nomogram for CI-AKI risk assessment for patients with CHF undergoing coronary angiography. Methods A total of 1876 consecutive patients with CHF (defined as New York Heart Association functional class II-IV or Killip class II-IV) were enrolled and randomly (2:1) assigned to a development cohort and a validation cohort. The endpoint was CI-AKI defined as serum creatinine elevation of ≥0.3 mg/dL or 50% from baseline within the first 48–72 hours following the procedure. Predictors for the nomogram were selected by multivariable logistic regression with a stepwise approach. The discriminative power was assessed using the area under the receiver operating characteristic (ROC) curve and was compared with the classic Mehran score in the validation cohort. Calibration was assessed using the Hosmer–Lemeshow test and 1000 bootstrap samples. Results The incidence of CI-AKI was 9.06% (n=170) in the total sample, 8.64% (n=109) in the development cohort and 9.92% (n=61) in the validation cohort (p=0.367). The simple nomogram including four predictors (age, intra-aortic balloon pump, acute myocardial infarction and chronic kidney disease) demonstrated a similar predictive power as the Mehran score (area under the curve: 0.80 vs 0.75, p=0.061), as well as a well-fitted calibration curve. Conclusions The present simple nomogram including four predictors is a simple and reliable tool to identify CHF patients at risk of CI-AKI, whereas further external validations are needed. Figure 1 Funding Acknowledgement Type of funding source: None

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Revisiting heart failure assessment based on objective measures in NYHA functional classes I and II

Heart ◽

10.1136/heartjnl-2020-317984 ◽

2020 ◽

pp. heartjnl-2020-317984

Author(s):

Mariana Blacher ◽

André Zimerman ◽

Pedro H B Engster ◽

Eduardo Grespan ◽

Carisi A Polanczyk ◽

...

Keyword(s):

Heart Failure ◽

Nyha Class ◽

Heart Association ◽

Functional Class ◽

Class I ◽

Objective Measures ◽

Functional Evaluation ◽

Self Perception ◽

Reduced Ejection Fraction ◽

Nyha Classification

ObjectiveNew York Heart Association (NYHA) functional class plays a central role in heart failure (HF) assessment but might be unreliable in mild presentations. We compared objective measures of HF functional evaluation between patients classified as NYHA I and II in the Rede Brasileira de Estudos em Insuficiência Cardíaca (ReBIC)-1 Trial.MethodsThe ReBIC-1 Trial included outpatients with stable HF with reduced ejection fraction. All patients had simultaneous protocol-defined assessment of NYHA class, 6 min walk test (6MWT), N-terminal pro-brain natriuretic peptide (NT-proBNP) levels and patient’s self-perception of dyspnoea using a Visual Analogue Scale (VAS, range 0–100).ResultsOf 188 included patients with HF, 122 (65%) were classified as NYHA I and 66 (35%) as NYHA II at baseline. Although NYHA class I patients had lower dyspnoea VAS Scores (median 16 (IQR, 4–30) for class I vs 27.5 (11–49) for class II, p=0.001), overlap between classes was substantial (density overlap=60%). A similar profile was observed for NT-proBNP levels (620 pg/mL (248–1333) vs 778 (421–1737), p=0.015; overlap=78%) and for 6MWT distance (400 m (330–466) vs 351 m (286–408), p=0.028; overlap=64%). Among NYHA class I patients, 19%–34% had one marker of HF severity (VAS Score >30 points, 6MWT <300 m or NT-proBNP levels >1000 pg/mL) and 6%–10% had two of them. Temporal change in functional class was not accompanied by variation on dyspnoea VAS (p=0.14).ConclusionsMost patients classified as NYHA classes I and II had similar self-perception of their limitation, objective physical capabilities and levels of natriuretic peptides. These results suggest the NYHA classification poorly discriminates patients with mild HF.

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Remote monitoring of chronic heart failure patients: invasive versus non-invasive tools for optimising patient management

Netherlands Heart Journal ◽

10.1007/s12471-019-01342-8 ◽

2019 ◽

Vol 28 (1) ◽

pp. 3-13 ◽

Cited By ~ 5

Author(s):

J. F. Veenis ◽

J. J. Brugts

Keyword(s):

Heart Failure ◽

New York ◽

Chronic Heart Failure ◽

Remote Monitoring ◽

Heart Association ◽

The United States ◽

Pharmacological Therapy ◽

Functional Class ◽

Class Iii ◽

Additional Tool

AbstractExacerbations of chronic heart failure (HF) with the necessity for hospitalisation impact hospital resources significantly. Despite all of the achievements in medical management and non-pharmacological therapy that improve the outcome in HF, new strategies are needed to prevent HF-related hospitalisations by keeping stable HF patients out of the hospital and focusing resources on unstable HF patients. Remote monitoring of these patients could provide the physicians with an additional tool to intervene adequately and promptly. Results of telemonitoring to date are inconsistent, especially those of telemonitoring with traditional non-haemodynamic parameters. Recently, the CardioMEMS device (Abbott Inc., Atlanta, GA, USA), an implantable haemodynamic remote monitoring sensor, has shown promising results in preventing HF-related hospitalisations in chronic HF patients hospitalised in the previous year and in New York Heart Association functional class III in the United States. This review provides an overview of the available evidence on remote monitoring in chronic HF patients and future perspectives for the efficacy and cost-effectiveness of these strategies.

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Study of digoxin use in a public health unit

Anais da Academia Brasileira de Ciências ◽

10.1590/0001-3765201520140133 ◽

2015 ◽

Vol 87 (2) ◽

pp. 1033-1040 ◽

Cited By ~ 1

Author(s):

Felipe C. Souza ◽

Emiliana B. Marques ◽

Rogério B.M. Scaramello ◽

B.V. Christianne

Keyword(s):

Public Health ◽

Heart Failure ◽

Therapeutic Range ◽

Systolic Dysfunction ◽

Functional Class ◽

Ventricular Rate ◽

Health Unit ◽

Class Iii ◽

Plasma Digoxin ◽

Public Health Unit

Digoxin is used for heart failure associated to systolic dysfunction and high ventricular rate. It has a narrow therapeutic range and intoxication may occur due to drug interactions or comorbidities. The aim of this work was to study digoxin use in a public health unit delineating the profile of patients susceptible to digitalis intoxication. Medical records belonging to patients admitted to the cardiomyopathy ward of the health unit (2009-2010) and in use of digoxin were analyzed. Among 647 patients admitted, 185 individuals using digoxin and possessed records available. The registration of plasma digoxin concentration was found in 80 records and it was out of the therapeutic range in 42 patients (52.5%). This group of individuals was constituted mainly by males patients (79%), functional class III of heart failure (65%), exhibiting renal failure (33%). The evaluated sample reflects the epidemiology of heart failure in Brazil and, although pharmacotherapy had been according to Brazilian Guidelines, apparently the monitoring was not performed as recommended. This work highlighs the necessity of plasma digoxin constant monitoring during pharmacotherapy and the development of protocols that enable a safer use, especially in male patients, functional class III and with renal dysfunction.

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Providers’ assignment of NYHA functional class in patients with heart failure: A vignette study

Heart & Lung ◽

10.1016/j.hrtlng.2021.07.009 ◽

2021 ◽

Author(s):

Kelly D. Stamp ◽

Marilyn A. Prasun ◽

Thomas P. McCoy ◽

Lisa Rathman

Keyword(s):

Heart Failure ◽

Functional Class ◽

Vignette Study ◽

Nyha Functional Class ◽

Patients With Heart Failure

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Abstract 14203: Secondary Sarcopenia Assessed by Computed Tomography Can Predict Hospitalization for Heart Failure in Adults With Fontan Circulation

Circulation ◽

10.1161/circ.142.suppl_3.14203 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Yumi Shiina ◽

Michinobu Nagao ◽

Kei Inai

Keyword(s):

Heart Failure ◽

Computed Tomography ◽

Skeletal Muscle ◽

Negative Impact ◽

Heart Association ◽

Functional Class ◽

Fontan Circulation ◽

Protein Losing Enteropathy ◽

Psoas Major Muscle ◽

Fontan Patients

Introduction: Sarcopenia is one of the important predictors of heart failure (HF) in patients with cardiac problems. Hypothesis: Skeletal muscle pump is very important to maintain Fontan circulation. We aimed to quantify the volume of the psoas major muscle (PMM) and investigate whether it is relevant to HF hospitalization in adults with Fontan circulation. Methods: A total of 154 adults with Fontan circulation, and 30 age-matched adults were studied retrospectively. We identified secondary sarcopenia by measuring the PMM volume, using non-contrast abdominal computed tomography (CT). Results: PMM indexed volume in Fontan patients was lower than controls (206.4+/-18.0 cc/m2 vs 288.0+/-61.1 cc/m2, P<0.0001). In Fontan men, PMM indexed volume correlated with New York Heart Association functional class (NYHA FC). PMM indexed volume in Fontan women correlated with age, NYHA FC, and serum creatinine. Using a multivariate Cox hazards analysis, NYHA FC ≧3 was an important prediction of hospitalization due to HF in Fontan men. In Fontan women, NYHA FC ≧3, brain natriuretic peptide (BNP), PMM indexed volume, and protein losing enteropathy (PLE) were important predictions of hospitalization due to HF. Among all Fontan patients, those with low PMM volumes had a poorer prognosis in HF (Log rank P=0.012 [men] and 0.0009 [women]). Conclusions: PMM volume reduction has an adjunctive prediction of HF hospitalization in adults with Fontan circulation, particularly in Fontan females. Secondary sarcopenia may have a negative impact on the prognosis of HF in this population. The assessment of skeletal muscle mass also may be a comprehensive screening tool for multi-organ dysfunction in Fontan circulation.

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Development of a diagnostic model focusing on nutritional indicators for frailty classification in people with chronic heart failure

European Journal of Cardiovascular Nursing ◽

10.1093/eurjcn/zvab080 ◽

2021 ◽

Author(s):

Yiqin Gu ◽

Chaofeng Li ◽

Jing Yan ◽

Guoping Yin ◽

Guilan Lu ◽

...

Keyword(s):

Heart Failure ◽

Folic Acid ◽

Chronic Heart Failure ◽

Nutritional Status ◽

Functional Class ◽

Brier Score ◽

Diagnostic Model ◽

Serum Samples ◽

Frailty Status ◽

C Statistic

Abstract Aims Frailty has a great impact on the quality of life of patients with chronic heart failure (CHF), which needs to be judged in time. To develop a diagnostic model based on nutritional indicators to judge the frailty status of patients with chronic heart failure (Frailty-CHF). Methods and results In the data collection part of this study, questionnaire method and biomedical measurement method were adopted. The trace elements in serum samples were detected by high performance liquid chromatography, chemiluminescence, and inductively coupled plasma mass spectrometry. We used Excel for data consolidation, and then imported the data into R software for modelling. Lasso method was used for variable screening, and Logistics regression fitting model was used after variables were determined. The internal validation of the model was completed by Bootstrap re-sampling. A total of 123 patients were included in this study. After variables’ screening, age, nutritional status-heart failure, New York Heart Association Functional Class (NYHA), micronutrients B12, Ca, folic acid, and Se were included in the model, the c statistic and Brier score of the original model were 0.9697 and 0.0685, respectively. After Bootstrap re-sampling adjustment, the c statistic and Brier score were 0.8503 and 0.1690. Conclusion In this study, a diagnostic model of age, nutritional status-heart failure, NYHA, the micronutrients B12, Ca, folic acid, and Se was established. It could help healthcare professionals better identify the frailty status in patients with CHF.

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