Beta-blockade therapy for NYHA class iv heart failure — effects in 5 patients with dilated cardiomyopathy-

Objectives: The goal of this study was to evaluate whether serum fibroblast growth factor 21 (FGF21) levels can be used to predict the prognosis of dilated cardiomyopathy (DCM). Methods: 241 patients with DCM and 80 control subjects were recruited and followed up for an average of 16.12 months. A 2-dimensional (2-D) echocardiography technique was performed to calculate the left ventricular end-diastolic diameter (LVEDD) and left ventricular ejection fraction (LVEF) percentages. The levels of N-terminal pro-B-type natriuretic peptide (NT-proBNP) and creatinine were measured in routine clinical laboratory tests. Serum FGF21 levels were measured by enzyme-linked immunosorbent assay (ELISA). Results: The levels of serum FGF21 were significantly higher in the DCM groups than in the control groups (225.85 ± 32.57 vs. 145.36 ± 30.57, p < 0.001). Serum FGF21 levels were positively correlated with the NYHA functional classification of heart failure (HF) (r = 0.610, p < 0.001) and NT-proBNP levels (r = 0.741, p < 0.001). Moreover, a negative correlation was observed between the serum FGF21 levels and the LVEF (r = –0.402, p < 0.001). FGF21, NT-proBNP, the LVEF and a history of atrial fibrillation (AF) correlated significantly with NYHA class IV (p < 0.05). The AUC of NT-proBNP for predicting NYHA class IV in DCM patients was greater than that of FGF21 (0.830 vs. 0.772, p < 0.001). Overall, 133 patients with DCM were recorded at the end point. Kaplan-Meier analysis results showed that the survival probability of those individuals with high levels of FGF21 and NT-proBNP was significantly lower than of those with low levels of these factors (p < 0.001). In the multivariate Cox analysis, FGF21 (HR 2.561; 95% CI 1.705–3.849) and NT-proBNP (HR 4.458; 95% CI 2.645–7.513) were independent predictors of a poor prognosis in DCM patients. Conclusions: Serum FGF21 levels were associated with the risk factors, severity, and prognosis of DCM. Therefore, FGF21 may serve as a novel biomarker for the prognosis of DCM.

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Outcome of Albumin Infusion in Heart Failure Patients

University Heart Journal ◽

10.3329/uhj.v15i2.42646 ◽

2019 ◽

Vol 15 (2) ◽

pp. 47-53

Author(s):

Ashaduzzaman Talukder ◽

Mohamed Mausool Siraj ◽

Md Noornabi Khondokar ◽

SM Ahsan Habib ◽

Md Abu Salim ◽

...

Keyword(s):

Heart Failure ◽

Serum Albumin ◽

Nyha Class ◽

Class Ii ◽

Class I ◽

Class Iii ◽

Albumin Infusion ◽

Group A ◽

Group B ◽

Class Iv

Background: Heart Failure (HF) is a major public health burden worldwide. Approximately 5 million Americans, 0.4–2% of the general European population and over 23 million people worldwide are living with heart failure. Like few other chronic disease, low serum albumin is common in patients with heart failure (HF). However, very few studies evaluated the outcome of albumin infusion in different stages of HF. Therefore, the objective of this study is to assess the outcome of albumin infusion in heart failure patients. Methods: It was a cross-sectional study. A total of 50 cases of chronic heart failure with reduced ejection fraction and NYHA class III or IV with serum albumin level <2.5g/dl who were admitted in CCUwere selected by purposive sampling, from September 2017 to August 2018. 100ml of 20% albumin was infused and serum albumin was measured after 3 days. Then the patients were divided into two groups, Patients who failed to attain serum albumin of 3g/dl(Group A) or Patients who attained serum albumin of ≥3g/dl (Group B). Analysis and comparison for symptomatic improvement of heart failure by NHYA classification and LVEF was done at 10th day after infusion between group A and B. Result: Among the 50 patients, mean age of patients was 53.64 ± 13.44 years (age range: 26-84 years) with a male-female ratio of 3:2 (60%-male vs 40%- female). Majority patients were previously re-admitted at least two times (40%), 28% were re-admitted once, 16% were re-admitted three times and 4% were re-admitted for four times. Of all, 56% patients presented NYHA class IV and AHA stage D heart failure (56%) and 44% patients presented with NYHA class III and AHA stage C. At day 10 follow up following albumin infusion, overall frequency of following ten days of albumin therapy, in group B, 8 patients (72.7%) among Class III improved to Class I and 3 patients (27.3%) improved to class II. Also, 7 patients (50%), 5 patients (35.7%) and 2 patients (14.3%) among class IV improved to respectively class I, class II and class III. In group A, 3 patients (27.3%) among class III improve to class II and 8 patients (72.7%) remain in class III. Also, 2 patients (14.3%), 5 Patients (35.7%) and 7 patients (50%) among class IV improve to respectively class I, class II and class III. Moreover, statistically significant improvement was noted in ejection fraction of patents irrespective of initial class of heart failure (p<0.001) in group B patients compare to group A (p<0.09). Conclusion: In this study, the improvement of heart failure was more in patients who attained albumin level of ≥3g/dl.Therefore, in can be concluded that albumin infusion improves both subjective and objective improvement of patients with heart failure. University Heart Journal Vol. 15, No. 2, Jul 2019; 47-53

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P440One-year outcomes of cardiac resynchronization therapy in non-ambulatory NYHA class IV heart failure patients

EP Europace ◽

10.1093/ehjci/eux141.163 ◽

2017 ◽

Vol 19 (suppl_3) ◽

pp. iii96-iii96

Author(s):

G. Loughlin ◽

E. Gonzalez-Torrecilla ◽

R. Peinado ◽

C. Alvarez ◽

P. Avila ◽

...

Keyword(s):

Heart Failure ◽

Cardiac Resynchronization Therapy ◽

Nyha Class ◽

Cardiac Resynchronization ◽

Resynchronization Therapy ◽

Heart Failure Patients ◽

Class Iv

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Sunshine Heart C-Pulse: device for NYHA Class III and ambulatory Class IV heart failure

Future Cardiology ◽

10.2217/fca-2016-0030 ◽

2016 ◽

Vol 12 (5) ◽

pp. 521-531 ◽

Cited By ~ 2

Author(s):

Matthew C Black ◽

Erin M Schumer ◽

Michael Rogers ◽

Jaimin Trivedi ◽

Mark S Slaughter

Keyword(s):

Heart Failure ◽

Nyha Class ◽

Class Iii ◽

Class Iv

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765 Is acute response to calcium sensitizers drugs predictive of response to cardiac contractility modulation in NYHA IV patients?

European Heart Journal Supplements ◽

10.1093/eurheartj/suab139.057 ◽

2021 ◽

Vol 23 (Supplement_G) ◽

Author(s):

Francesca Esposito ◽

Paolo Vitillo ◽

Francesco Urraro ◽

Felice Nappi ◽

Francesco Rotondi ◽

...

Keyword(s):

Heart Failure ◽

Electronic Device ◽

Enzyme Inhibitor ◽

Nyha Class ◽

Interventricular Septum ◽

Left Ventricular ◽

Calcium Handling ◽

High Dose ◽

Short Term Treatment ◽

Class Iv

Abstract A 53-years old man presented to our institution with a diagnosis of decompensated heart failure NYHA Class IV. He had a history of ischaemic heart disease with severe biventricular dysfunction, diabetes, hypertension, dyslipidaemia, advanced chronic kidney disease, previous explanation of dual-chamber implantable electronic device (ICD) due to endocarditis and subsequent implantation of subcutaneous ICD in primary prevention. Home therapy included uptitrated angiotensin-converting enzyme inhibitor, β-blocker, loop-diuretic, spironolactone, acetylsalicylic acid, and oral hypoglycemics. Clinical examination showed signs and symptoms of systemic and pulmonary congestion with pleural effusion and ascites. Echocardiography revealed diffuse left ventricular (LV) hypokinesis with an ejection fraction (EF) of 25%, severe right ventricular dysfunction and increased filling pressures. He was treated with high dose of i.v. diuretics with mild improvement of dyspnoea. However, haemodynamic stability was labile with worsening of symptoms as soon as mild down-titration of iv diuretics was attempted. Levosimendan, a calcium-sensitizer inodilator, indicated for short-term treatment of acutely decompensated severe chronic heart failure (HF), was administered with good clinical response. Thus, we thought that the patient could have benefited from contractility modulation therapy (CCM) which acts on intramyocardial calcium handling. CCM is a novel therapeutic option for patients with classes III–IV HF with EF ≥ 25% to ≤ 45% and narrow QRS complex that acts on intramyocardial calcium-handling. CCM proved effective in alleviating symptoms, improving exercise tolerance and quality of life, and reducing hospitalization rates in HF. It improves myocardial contractility, reverses the foetal myocyte gene program associated with HF and facilitates cardiac reverse remodelling. Therefore, an Optimizer Smart System (Impulse Dynamics) was implanted. Two pacing electrodes were placed on the interventricular septum in apical and mid-septal position, respectively. The leads were connected to a pulse-generator in a right pectoral pocket. In the following days, we observed a progressive improvement in clinical status, with gradual resolution of peripheral oedema, dyspnoea and fatigue and significant weight loss. Six-month echocardiography showed a stable value of EF and significant improvement in stroke volume (35.2 ml from 24.8 ml at baseline). The patient did not undergo further hospitalization for decompensated HF and was in stable ambulatory NYHA Class IV. We believe CCM is an option in patients with advanced HF in which avoiding recurrent hospitalizations, with their overt increase mortality, is often a challenging therapeutic goal. 765 Figure

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Severe heart failure (NYHA Class IV) is associated with increased left ventricular mass index and short mitral deceleration time in severe aortic valve stenosis

Echocardiography ◽

10.1111/echo.13895 ◽

2018 ◽

Vol 35 (8) ◽

pp. 1108-1115

Author(s):

Sayuki Kobayashi ◽

Hiroto Utsunomiya ◽

Takahiro Shiota

Keyword(s):

Heart Failure ◽

Aortic Valve ◽

Left Ventricular Mass ◽

Aortic Valve Stenosis ◽

Left Ventricular Mass Index ◽

Nyha Class ◽

Severe Heart Failure ◽

Left Ventricular ◽

Class Iv ◽

Deceleration Time

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Abstract 273: Incidence and Predictors of Heart Failure Hospitalization in Veterans Undergoing Cardioverter-Defibrillator Implantation in the Outcomes among Veterans with Implantable Defibrillators (OVID) Registry

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/circoutcomes.6.suppl_1.a273 ◽

2013 ◽

Vol 6 (suppl_1) ◽

Author(s):

Preston M Schneider ◽

David F Katz ◽

Cara N Pelligrini ◽

Paul A Heidenreich ◽

Ryan G Aleong ◽

...

Keyword(s):

Heart Failure ◽

Hospital Readmission ◽

Nyha Class ◽

Left Ventricular Ejection ◽

Implantable Defibrillators ◽

Heart Failure Hospitalization ◽

Readmission Rates ◽

Hospitalization Rates ◽

One Year ◽

Class Iv

Introduction: Recent quality improvement initiatives and CMS policies have placed an additional focus on rates of hospital readmission. The rate of hospital readmission after defibrillator implantation is unknown. Our study examines 30 day, 90 day, and 1 year rates as well as risk factor associations with readmission following defibrillator implantation in the Veterans Affairs population. Methods: Among veterans enrolled in the Outcomes among Veterans with Implantable Defibrillators (OVID) registry between 2003 and 2009, 3,913 were identified as within 3 months of initial ICD implantation. Baseline clinical characteristics and hospitalizations were abstracted from the electronic medical record. Rates of thirty day, ninety day, and one year hospital readmission were calculated and predictors of subsequent heart failure hospitalization were determined using Cox proportional hazards models. Results: Among 3,913 patients we identified 65 hospital readmissions by 30 days, 93 by 90 days, and 308 by 1 year. This results in a thirty day, ninety day, and one year readmission rate of 1.7%, 4.0%, and 12.3%, respectively. Of the examined predictors, age, left ventricular ejection fraction < 25%, New York Heart Association (NYHA) class IV symptoms, prior heart failure hospitalization, heart failure diagnosis for longer than 9 months, chronic kidney disease, diabetes, and COPD were significant predictors of heart failure hospitalization. The strongest predictor was heart failure hospitalization within the 6 months prior to implantation (HR 2.42, 95% CI 1.94 - 3.00). Patients with NYHA Class IV symptoms had the highest hospitalization rates at 6.3%, 12.6%, and 27.8% at 30 days, 90 days, and 1 year after implantation respectively. Hospitalization rates for selected variables are shown in the Table. Conclusions: Hospital readmission rates after defibrillator implantation in this cohort are lower than previously published rates of heart failure readmission among patients with heart failure. Of the candidate predictors examined, heart failure hospitalization within 6 months prior to implantation was the strongest predictor of future hospitalization and patients with NYHA Class IV symptoms had the highest readmission rates.

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Oxidative Stress Markers and C-Reactive Protein Are Related to Severity of Heart Failure in Patients with Dilated Cardiomyopathy

Mediators of Inflammation ◽

10.1155/2014/147040 ◽

2014 ◽

Vol 2014 ◽

pp. 1-10 ◽

Cited By ~ 19

Author(s):

Celina Wojciechowska ◽

Ewa Romuk ◽

Andrzej Tomasik ◽

Bronisława Skrzep-Poloczek ◽

Ewa Nowalany-Kozielska ◽

...

Keyword(s):

Oxidative Stress ◽

Heart Failure ◽

Dilated Cardiomyopathy ◽

Nyha Class ◽

Right Heart Catheterization ◽

Heart Catheterization ◽

Hemodynamic Parameters ◽

C Reactive Protein ◽

Reactive Protein ◽

Hs Crp

Background.The aim of study was to determine relationships between functional capacity (NYHA class), left ventricle ejection fraction (LVEF), hemodynamic parameters, and biomarkers of redox state and inflammation in patients with dilated cardiomyopathy (DCM).Methods. DCM patients (n=109, aged45.97±10.82years), NYHA class IIV, and LVEF2.94±7.1% were studied. Controls comprised age-matched healthy volunteers (n=28). Echocardiography and right heart catheterization were performed. Serum activities of superoxide dismutase isoenzymes (MnSOD and CuZnSOD), concentrations of uric acid (UA), malondialdehyde (MDA), and C-reactive protein (hs-CRP) were measured.Results. MnSOD, UA, hs-CRP, and MDA were significantly higher in DCM patients compared to controls. Except MDA concentration, above parameters were higher in patients in III-IV NYHA class or with lower LVEF. hsCRP correlated with of MnSOD (P<0.05) and CuZnSOD activity (P<0.01). Both isoenzymes positively correlated with mPAP and pulmonary capillary wedge pressure (MnSOD, resp.,P<0.01andP<0.05and CuZnSODP<0.05;P<0.05). UA positively correlated with MnSOD (P<0.05), mPAP (P<0.05), and PVRI (P<0.05). The negative correlation between LVEF and UA (P<0.01) was detected.Conclusion. There are relationships among the severity of symptoms of heart failure, echocardiographic hemodynamic parameters, oxidative stress, and inflammatory activation. Increased MnSOD activity indicates the mitochondrial source of ROS in patients with advanced heart failure.

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Wearable Defibrillators Within a NYHA Class IV Heart Failure Population

Journal of Cardiac Failure ◽

10.1016/j.cardfail.2010.06.196 ◽

2010 ◽

Vol 16 (8) ◽

pp. S57

Author(s):

Nicole R. Bianco ◽

Brian L. Wilmer ◽

Steven J. Szymkiewicz

Keyword(s):

Heart Failure ◽

Nyha Class ◽

Class Iv

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