scholarly journals P840 A surprising outcome

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
R Rocha ◽  
R Fernandes ◽  
J Carvalho ◽  
J Pais ◽  
D Bras ◽  
...  
Keyword(s):  
Heart Failure ◽  
Transoesophageal Echocardiography ◽  
High Morbidity ◽  
Ischemic Lesion ◽  
Vena Contracta ◽  
Small Nodule ◽  
Medical Response ◽  
Amoxicillin Clavulanate ◽  
Characteristic Features ◽  
Coronary Cusp

Abstract Introduction infective endocarditis(IE) is a high morbidity and mortality disease, and heart failure,central nervous system embolization and annular abscess account for common complications.Nevertheless,intracardiac fistula is rare and predicts higher mortality and urgency for surgery. Case 84years old male patient,with an aortic bioprosthesis valve Perimount n23 since 2015,was admitted to internal medicine ward 3months before,due to Enterococcus faecalis bacteremia.at that time,transoesophageal echocardiography(TEE) revealed moderate to severe mitral valve(MV) regurgitation(vena contracta 0.7cm) and trivial tricuspid regurgitation,but did not showed any suggestive images of endocarditis.the patient was treated with 14days of amoxicillin-clavulanate. On the current presentation,due to fadigue to mild physical activity and fever for 2weeks,he was admitted to cardiology ward for further investigation.blood cultures were positive for the previous agent,so antibiotherapy with ampicillin 12g/day and gentamicin 240mg id was started.TEE revealed thickening of aortic bioprosthesis’ leaflets with preserved systolic opening.aortic valve annulus thickening,mainly near the non-coronary cusp,was evident, without characteristic features of peri-annular abscess.on ventricular side of the prosthesis,there was a vegetation(10.7x10.8mm). a small nodule lesion,coherent with a second vegetation,was present on the MV’s posterior leaflet,without regurgitation’s worsening. a third one was observed on the septal leaflet of the tricuspid valve(7.3x6.5mm),which also caused an increasement in severity of the regurgitation,quantified as moderate. On the sixth day,the patient presented with right arm paresis,so a brain CT was performed,showing an ischemic lesion on the left middle cerebral artery.Reevaluation,5days later,owing to new neurological changes,showed multiple acute vertebrobasilar embolic strokes. As a result of poor medical response and embolic strokes,the patient was referred to surgical treatment. however, due to prohibitive surgical risk (euroscore 59%), the patient was refused. After 6weeks of blood culture driven antibiotherapy,a reevaluation TEE revealed a periprosthetic pseudoaneurysm with small aorta-to-right atrium fistula.no vegetations were found. Conclusion rate complication of cardiac fistulae is high,60%of the patients develop heart failure and mortality rate is higher than 40%.although conservative treatment was addressed,after 8months discharge,the patient remains with few heart failure symptoms(NYHA classII).

Heart failure in an elderly population

2001 ◽  
Vol 11 (4) ◽  
pp. 311-321
Author(s):  
DN Carmichael ◽  
Michael Lye
Keyword(s):  
Heart Failure ◽  
Treatment Options ◽  
Clinical Syndrome ◽  
Point Of View ◽  
Diagnostic Challenge ◽  
The Common ◽  
Characteristic Features ◽  
The Many ◽  
Neuroendocrine Activation ◽  
Symptoms And Signs

Heart failure has been defined in many ways and definitions change over time. The multiplicity of definitions reflect the paucity of our understanding of the primary underlying physiology of heart failure and the many diseases for which heart failure is the common end-point. Fundamentally, heart failure represents a failure of the heart to meet the body’s requirement for blood supply for whatever reason. It is thus a clinical syndrome with characteristic features – not a single disease in its own right. The syndrome includes symptoms and signs of organ underperfusion, fluid retention and neuroendocrine activation. The syndrome arises from a range of possible causes of which ischaemic heart disease is the commonest. From the point of view of a clinician, the underlying pathology will determine treatment options and prognosis. The extensive range of possible aetiologies present a diagnostic challenge both to correctly identify the syndrome amongst all other causes of dyspnoea and to identify the aetiology, allowing optimization of treatment.

scholarly journals Creatinine Levels at Admission as Predictors of In-Hospital Major Adverse Cardiovascular Events in Acute Heart Failure Patient

2020 ◽  
Vol 6 (1) ◽  
pp. 16-22
Author(s):  
Farida Hanum Margolang ◽  
Refli Hasan ◽  
Abdul Halim Raynaldo ◽  
Harris Hasan ◽  
Ali Nafiah ◽  
...  
Keyword(s):  
Heart Failure ◽  
Acute Heart Failure ◽  
Roc Curve ◽  
Cardiovascular Events ◽  
Major Adverse Cardiovascular Events ◽  
High Morbidity ◽  
Roc Curve Analysis ◽  
Heart Failure Patients ◽  
Long Term Prognosis

Background: Acute heart failure is a global health problem with high morbidity and mortality. Short term and long term prognosis of these patients is poor. Therefore, early identification of patients at high risk for major adverse cardiovascular events (MACEs) during hospitalization was needed to improve outcome. Creatinine levels at admission could be used as predictors of major adverse cardiovascular events in acute heart failure patients because creatinine is a simple and routine biomarker of renal function examined in patients with acute heart failure. This study aimed to determine whether creatinine can be used as a predictor of major adverse adverse cardiovascular events in patients with acute heart failure.Methods: This study is a prospective cohort study of 108 acute heart failure patients treated at H. Adam Malik Hospital from July 2018 to January 2019. Creatinine cut-off points were determined using the ROC curve, then bivariate and multivariate analyzes were performed to determine predictors of major adverse cardiovascular events during hospitalization.Results: From 108 study subjects, 24 (22.2%) subjects experienced major adverse cardiovascular events during hospitalization. The subjects who died were 20 people (83.4%), subjects with arrhythmia were 2 people (8.3%), and those who had stroke were 2 people (8.3 %). Through the ROC curve analysis, we found creatinine cut-off values of ≥1.7 mg / dl (AUC 0.899, 95% CI 0.840- 0.957, p <0.05). Creatinine ≥1.7 mg/dl could predict major adverse cardiovascular events with a sensitivity of 87.5% and specificity of 79.5%. Multivariate analysis showed that creatinine ≥1.7 mg / dl was an independent factor to predict MACEs during hospitalization in this study (OR 18,310, p 0.001) as well as creatinine clearance and heart rate.Conclusion: Creatinine levels at admission is an independent predictor for major adverse cardiovascular events during hospitalization in acute heart failure patients.

Abstract 15170: In-hospital Utilization and Outcomes of Palliative Care Consultation in Patients With Advanced Heart Failure Complicated by Cardiogenic Shock Requiring Mechanical Circulatory Support

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Jelani Grant ◽  
Louis Vincent ◽  
Bertrand Ebner ◽  
Jennifer Maning ◽  
Igor Vaz ◽  
...  
Keyword(s):  
Heart Failure ◽  
Palliative Care ◽  
Cardiogenic Shock ◽  
Mechanical Circulatory Support ◽  
Life Experiences ◽  
Advanced Heart Failure ◽  
Circulatory Support ◽  
High Morbidity ◽  
Palliative Care Consultation ◽  
Care Consultation

Introduction: Hospitalizations associated with advanced heart failure (HF) requiring mechanical circulatory support (MCS) are usually associated with a high morbidity, mortality and a protracted hospital course. Prior studies have shown that the early inclusion of palliative care specialist is associated with better end-of-life experiences. Methods: The National Inpatient Sample Database was queried from 2012 to 2017 for relevant International Classification of Diseases (ICD)-9 and ICD-10 procedural and diagnostic codes to identify patients above 18 years with advanced HF admitted with cardiogenic shock requiring MCS. Baseline characteristics and in-hospital outcomes were compared among patients evaluated by palliative care and those who were not. A p-value of <0.001 was considered statistically significant. Results: There were 748,360 patients hospitalized for advanced HF complicated by cardiogenic shock requiring MCS, of these a palliative care consult was placed in 118,015 (15.8%) patients. Patients evaluated by palliative care were older (70.6±14.9 vs. 64.9±16.3 years old, p<0.001) and had a higher prevalence of atrial fibrillation (39.3 vs. 35.1%,p<0.001) and chronic kidney disease (40.4 vs. 33.3, p<0.001), however had lower hypertension (57.4 vs. 59.7%, p<0.001), diabetes (35.4 vs. 36.5%, p<0.001), coronary artery disease (51.2 vs. 58.4%, p<0.001) and acute coronary syndromes (39.2 vs. 45.0%, p<0.001). Consulting palliative care was associated with a shorter length of stay (8.8±12.0 vs. 11.9±15.5 days, p<0.001), lower total hospital cost ($161,972±265,156 vs. $219,114±318,387, p<0.001) and higher Do Not Resuscitate (DNR) orders (30.8 vs. 5.8%, p<0.001). Mortality rates were higher in the palliative care cohort (73.4 vs. 29.4%, p<0.001). Conclusions: Despite the high morbidity and mortality associated with advanced HF patients with cardiogenic shock requiring MCS, the overall prevalence of palliative care consultation is exceedingly low. DNR orders were more prevalent in patients seen by the palliative care service. This study highlights the underutilization of palliative care services in this patient population, precluding any perceived benefit in end of life experiences.

Surgical repair of the mitral valve

2018 ◽  
Author(s):  
David Sidebotham ◽  
Alan Merry ◽  
Malcolm Legget ◽  
Gavin Wright
Keyword(s):  
Mitral Regurgitation ◽  
Surgical Repair ◽  
Surgical Techniques ◽  
Transoesophageal Echocardiography ◽  
Degenerative Disease ◽  
Systolic Anterior Motion ◽  
Mitral Repair ◽  
Assessment And Treatment ◽  
Secondary Mitral Regurgitation ◽  
Characteristic Features

Chapter 9 is a new chapter from earlier editions of Practical Perioperative Transoesophageal Echocardiography. In the first part of the chapter, the indications for MV repair are reviewed, and areas of controversy are highlighted. Next, the surgical techniques used for valve repair for different mitral pathologies are summarized, in particular the use of leaflet resection or neochordae for repair of degenerative disease. Considerations for minimally invasive mitral repair are briefly reviewed. The bulk of the chapter is given over to TOE assessment prior to, and following, surgical repair. Characteristic features of, and associated complications encountered with, different mitral pathologies are presented. In particular, the risk factors for post-operative systolic anterior motion (SAM) in patients with degenerative disease and failure of a reduction annuloplasty in patients with secondary mitral regurgitation are described. The final section of the chapter details the post-repair assessment, with an emphasis on the features of an optimal repair, quantifying residual mitral regurgitation, mechanisms of repair failure, and assessment and treatment of post-operative SAM.

Hope in Patients Hospitalized With Heart Failure

2005 ◽  
Vol 14 (5) ◽  
pp. 417-425 ◽  
Author(s):  
Tone Rustøen ◽  
Jill Howie ◽  
Ingrid Eidsmo ◽  
Torbjørn Moum
Keyword(s):  
Heart Failure ◽  
New York ◽  
Satisfaction With Life ◽  
Heart Association ◽  
Response Shift ◽  
High Morbidity ◽  
Class Iii ◽  
Control Subjects ◽  
Patients With Heart Failure ◽  
Comorbid Diseases

• Background Hope is seldom described in patients with heart failure, despite high morbidity and mortality for this population. • Objectives To describe hope in hospitalized patients with heart failure and to evaluate influences of demographic and health-related variables on hope. • Methods Ninety-three patients with heart failure and 441 healthy control subjects completed questionnaires about sociodemographics, health indices, disease severity, and the Herth Hope Index. • Results The patients with heart failure had a mean age of 75 years; 65% were men, and 47% lived alone. Lung diseases and diabetes were the most common comorbid diseases, with 58% classified as New York Heart Association class III. The mean global hope score among patients with heart failure was 37.69 (SD 5.3). Patients with skin (P = .01) and psychiatric (P = .02) disorders reported lower hope scores. Number of comorbid diseases was the only predictor of hope related to disease-specific variables (P = .01). Mean age of the control subjects was 60 years, and 66 (15%) lived alone. Once demographic variables were controlled for, patients with heart failure had significantly higher global hope scores than did control subjects. • Conclusions Adaptation to a life-threatening illness may induce a “response shift” that causes such patients to have more hope than the general population. Patients with heart failure may be more concerned with the past than the future. How patients judge their health and satisfaction with life influences their hope. Interventions supporting hope in patients with heart failure may influence treatment goals.

scholarly journals P249 Iatrogenic aortic cusp laceration causing severe acute traumatic aortic regurgitation secondary to complex percutaneous coronary intervention using rotablator;3DTEE-anatomic correlates

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
V Vadgaonkar ◽  
H Tarief ◽  
S Shivappa ◽  
L Sulaibikh ◽  
S Saif ◽  
...  
Keyword(s):  
Heart Failure ◽  
Aortic Valve ◽  
Aortic Regurgitation ◽  
High Speed ◽  
Past History ◽  
Case Reports ◽  
Free Margin ◽  
Severe Aortic Regurgitation ◽  
Percutaneous Coronary ◽  
Coronary Cusp

Abstract Clinical case 59 years old male known case of long standing diabetes and dyslipidemia presented to our institute with Non-STEMI.His past history was significant for multiple admissions with acute coronary syndromes and percutaneous coronary interventions(PCI). Echocardiogram in this presentation showed preserved biventricular systolic function with no valvulopathies. He was taken up for coronary angiogram which showed significant calcified angulated lesion in LAD/LCX(Left anterior descending and circumflex) with diffuse disease in Ramus/RCA. Mode of revascularisation was discussed in detail with the patient for Rotablation-guided PCI to LAD/LCX vs CABG.He preferred and underwent complex PCI to LAD. During the procedure he developed acute heart failure which was managed conservatively. Immediate TTE showed new severe aortic regurgitation(AR) with probable left coronary cusp(LCC) perforation and preserved LVEF.After stabilization, he was scheduled for TEE which showed tear in the LCC with complex fragmented jet of holodiastolic AR filling the entire LVOT.There was new late diastolic to early systolic MR.3DTEE Enface view of the aortic valve was evident of ovoid shaped laceration in LCC extending till the free margin (Fig 1C). There were additional tears in Non-coronary cusp(NCC) extending till the free margin of right coronary cusp(RCC).3DTEE colour was notable for regurgitant jet origin from LCC/NCC (Fig 2B). Based on above findings,He was offered aortic valve intervention but was reluctant initially.He presented 2 months later with exertional dyspnoea, mild LV dilatation and drop in LVEF to 50%.He consented for surgery and underwent bioprosthetic Aortic valve replacement because of extensive cusp tear and deformation of the valve along with complete revascularisation of the remaining diseased coronaries.Post-operative course was complicated by vasoplegic arrest and acute renal failure which was successfully managed conservatively. Discussion We report this case for the rarity of this post-PCI iatrogenic complication and the incremental role of 3DTEE in identifying the exact pathology.It was proposed that during PCI multiple stalling of rotatbur in calcified LAD caused traction and eventually disengagement of guide causing rotabur to freely hang in ascending aorta close to the cusps.Possibly this rotablator with very high speed(180000rpm) would have momentarily come in contact with the aortic cusps causing cuspal perforation and heart failure in Cath lab.3DTEE correlated very well with the anatomo-pathology and matched with intraoperative finding as shown in figures 2A & 2C.These findings prior to aortic cross clamp could significantly reduce time of surgery as he had an additional CABG procedure to be performed.There are few isolated case reports of post PCI aortic valve perforation but probably ours is the first one secondary to the use of rotablator with near involvement of all the cusps and reasonably accurate 3DTEE-anatomic characterisation. Abstract P249 Figure.

P1087Prevalence and significance of mitral regurgitation in atrial fibrillation coexisting with HFpEF and HFmEF

EP Europace ◽  
2020 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
I Lupasteanu ◽  
A Vijan ◽  
C Delcea ◽  
C Stanescu ◽  
S Bari ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Ejection Fraction ◽  
Prognostic Significance ◽  
Surrogate Marker ◽  
Distinct Type ◽  
Mitral Annulus ◽  
Mitral Valve Regurgitation ◽  
Vena Contracta ◽  
Significant Difference

Abstract Background Recent data has acknowledged atrial induced functional mitral valve regurgitation (MR) in the setting of atrial fibrillation (AF) and/or heart failure with preserved ejection fraction (HFpEF)  as a distinct type of secondary MR, holding prognostic significance. However, evidence on its prevalence is still scarce, especially in the phenotype of mid-range ejection fraction heart failure (HFmEF). Purpose The aim of this study is to evaluate the occurrence of left atrial (LA) enlargement and MR in AF patients with or without heart failure with preserved or mid-range ejection fraction. Methods This retrospective study included 750 consecutive patients with AF admitted to a tertiary hospital from January 2018 to June 2019. We excluded patients with primary valvular disease and HF with reduced EF. MR presence and severity were assessed by evaluating the valve morphology, colour flow imaging and, when feasible, vena contracta and PISA methods. We measured LA anteroposterior diameter and used LA dilatation as a surrogate marker for mitral annulus dilatation. Results We evaluated 584 AF patients: mean age 72.22 ± 10.10 years; 58,73% females; 79.75% had HF: 73.13% of them had HFpEF and 26.87% had HFmEF. Compared to those without HF, patients with HF had a relative risk (RR) of associating LA enlargement of 5.37 (95%CI = 3.05-9.48, p &lt; 0.001) and a RR of associating MR of 1.47 (95%CI 1.08-2.00, p = 0.01). Mean LA diameter was higher in the HF group, compared to non-HF (47.06 ± 7.26 mm vs 40.91 ± 7.10 mm, p &lt; 0.001). MR severity was more likely associated with HF (RR = 1.68, 95%CI = 1.46-1.94, p &lt; 0.001). When comparing results between the two HF subgroups, patients with HFmEF had a higher mean LA diameter than those with HFpEF (48.52 ± 5.68 mm vs 46.36 ± 7.57 mm, p = 0.011), without associating a significant difference in the MR prevalence (72.97% vs 73.98%, p = 0.94). The presence of a dilated LA was directly correlated with MR in the HF group (RR = 1.94, 95%CI = 1.18-3.20, p = 0.023), but not in those without HF (RR = 1.04, 95%CI = 0.57-1.90, p = 0.89). In HF patients, permanent AF associated the highest prevalence of LA dilatation (96.67%) and MR (81.73%) in contrast to paroxysmal AF (81.10%, p &lt; 0.01, respectively 63.43%, p = 0.0002). Conclusions LA dilatation, the presence and severity of MR correlated with AF and HF, especially in permanent AF patients. In patients without HF, LA dilatation did not correlate with the presence of MR. MR prevalence was similar in patients with HFmEF and HFpEF, irrespective of a higher degree of LA dilatation in HFmEF. Our results suggest that the pathophysiological mechanisms involved in LA enlargement and MR are different for different phenotypes of AF in patients with or without HF.

scholarly journals The Diagnostic and Therapeutic Value of Multimarker Analysis in Heart Failure. An Approach to Biomarker-Targeted Therapy

2020 ◽  
Vol 7 ◽  
Author(s):  
Albert Topf ◽  
Moritz Mirna ◽  
Bernhard Ohnewein ◽  
Peter Jirak ◽  
Kristen Kopp ◽  
...  
Keyword(s):  
Heart Failure ◽  
Morbidity And Mortality ◽  
Therapeutic Interventions ◽  
Stress Axis ◽  
High Morbidity ◽  
Matrix Remodeling ◽  
Therapeutic Approaches ◽  
Therapeutic Setting ◽  
Therapeutic Value

Background: Heart failure is a pathophysiological state, which is still associated with high morbidity and mortality despite established therapies. Diverse well-known biomarkers fail to assess the variety of individual pathophysiology in the context of heart failure.Methods: An analysis of prospective, multimarker-specific therapeutic approaches to heart failure based on studies in current literature was performed. A total of 159 screened publications in the field of biomarkers in heart failure were hand-selected and found to be eligible for this study by a team of experts.Results: Established biomarkers of the inflammatory axis, matrix remodeling, fibrosis and oxidative stress axis, as well as potential therapeutic interventions were investigated. Interaction with end organs, such as cardio-hepatic, cardio-renal and cardio-gastrointestinal interactions show the complexity of the syndrome and could be of further therapeutic value. MicroRNAs are involved in a wide variety of physiologic and pathophysiologic processes in heart failure and could be useful in diagnostic as well as therapeutic setting.Conclusion: Based on our analysis by a biomarker-driven approach in heart failure therapy, patients could be treated more specifically in long term with a consideration of different aspects of heart failure. New studies evaluating a multimarker – based therapeutic approach could lead in a decrease in the morbidity and mortality of heart failure patients.

scholarly journals Acquired aortopulmonary fistula: a case report

2020 ◽  
Vol 4 (4) ◽  
pp. 1-5
Author(s):  
Osama Mahmoud ◽  
Hadi Elias ◽  
Arsalan Rafiq ◽  
Amro Alsaid
Keyword(s):  
Heart Failure ◽  
Cardiac Imaging ◽  
Multimodality Imaging ◽  
Main Pulmonary Artery ◽  
Bypass Graft ◽  
Stable Condition ◽  
Transoesophageal Echocardiography ◽  
Ascending Aorta ◽  
Aortic Pseudoaneurysm ◽  
Aortopulmonary Fistula

Abstract Background Aortopulmonary fistula is a rare complication of ascending aorta pathology. Presentation is most commonly dramatic with acute onset chest pain or heart failure secondary to left to right shunting. We describe a patient with acquired aortopulmonary fistula who had an insidious onset of heart failure as his presenting complaint. We also highlight the utility of multimodality cardiac imaging in establishing the diagnosis. Case summary A 79-year-old male patient with a history of coronary artery bypass graft surgery and mechanical aortic valve replacement, 23 years prior, presented with exertional dyspnoea of 7 months duration. An initial workup that included transthoracic and transoesophageal echocardiography as well as coronary and bypass graft angiography failed to diagnose an acquired aortopulmonary fistula complicating an ascending aortic pseudoaneurysm. Upon referral to our institution, the correct diagnosis was suspected on off-axis transthoracic echocardiography. The fistula was subsequently confirmed, and the extent of ascending aorta pathology defined via a multimodality imaging approach that consisted of transoesophageal echocardiography and cardiac computed tomography. The patient underwent successful surgical repair and was discharged in a stable condition. Discussion Acquired aortopulmonary fistula is a rare clinical entity. We describe a patient who had an insidious presentation of heart failure and found to have a large ascending aortic aneurysm that eroded into the main pulmonary artery creating a fistulous communication. The diagnosis was delayed and required a high index of suspicion and multimodality cardiac imaging.

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