265 Fluid restriction does not alter time to clinical stability following emergency admission for NYHA class IV heart failure

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

Journal of Cardiac Failure ◽

10.1016/s1071-9164(99)91249-6 ◽

1999 ◽

Vol 5 (3) ◽

pp. 72

Author(s):

Shinya Hiramitsu ◽

Shin-ichiro Morimoto ◽

Akihisa Uemura ◽

Masatsugu Ohtsuki ◽

Yasuchika Kato ◽

...

Keyword(s):

Heart Failure ◽

Dilated Cardiomyopathy ◽

Nyha Class ◽

Beta Blockade ◽

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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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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Biventricular Pacing for Congestive Heart Failure: Early Experience in Surgical Epicardial versus Coronary Sinus Lead Placement

The Heart Surgery Forum ◽

10.1532/hsf.1008 ◽

2005 ◽

Vol 6 (1) ◽

pp. 1 ◽

Cited By ~ 26

Author(s):

Hironori Izutani ◽

Kara J. Quan ◽

Lee A. Biblo ◽

Inderjit S. Gill

Keyword(s):

Heart Failure ◽

Congestive Heart Failure ◽

Coronary Sinus ◽

Biventricular Pacing ◽

Nyha Class ◽

Left Ventricular ◽

Epicardial Lead ◽

Lead Placement ◽

Coronary Sinus Lead ◽

Class Iv

Objective: Biventricular pacing (BVP) has recently been introduced for the treatment of refractory congestive heart failure. Coronary sinus lead placement for left ventricular pacing is technically difficult, has a risk of lead dislodgement, and has long procedure times. Surgical epicardial lead placement has the potential advantage of the visual selection of an optimal pacing site, does not need exposure to ionic radiation, and allows lead multiplicity, but it does require a thoracotomy and general anesthesia. We report our early experience of BVP with both modalities. Methods: BVP was performed in 12 patients with New York Heart Association (NYHA) class IV congestive heart failure (10 men, 2 women). Mean patient age was 68.7 years (range, 41-83 years). Surgical epicardial leads were placed through a 2- to 3-inch incision via a left fourth or fifth intercostal thoracotomy in 4 patients with single lung ventilation under general anesthesia. The other 8 patients underwent transvenous coronary sinus lead placement under conscious sedation. Results: Postoperative NYHA class status improved from class IV to class II in 8 patients and to class III in 3 patients. In 5 of the 8 patients who had undergone follow-up echocardiography with mitral regurgitation, the severity of the mitral regurgitation improved. The mean left ventricular ejection fractions before and after BVP were 18.3% � 8.3% and 20.5% � 8.0%, respectively (P = .16). Mean fluoroscopy and total procedure times for transvenous lead placement were 77 � 19 minutes and 266 � 117 minutes, respectively. The mean surgery time for epicardial lead placement was 122 � 13 minutes. There were no differences between the 2 methods in pacing threshold or in lead dislodgement. There were no complications related to the surgery or the laboratory procedure. Conclusion: In patients with NYHA class IV congestive heart failure, epicardial lead placement through a minithoracotomy for BVP was performed safely with benefits equivalent to those of coronary sinus lead placement and with a shorter procedure time.

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