It is easy to see, but it is better to foresee: a case report on the favourable alliance between CardioMEMS and levosimendan

Abstract Background In the past years, different devices have been investigated to help in identifying early decompensation events in patients with heart failure (HF) and reduced ejection fraction (EF), reducing hospital admissions. In this report, we present the first patient experience with levosimendan infusion led by CardioMEMS. Case summary A 68-year-old man with HF and reduced EF with more than 20 hospitalizations for exacerbation of HF was enrolled in our HF Clinic from October 2017. Echocardiogram showed a dilated left ventricle with severely reduced EF (29%) and increased pulmonary artery systolic pressure (40 mmHg). From October 2017 to May 2019, the patient went through numerous hospitalizations, despite optimal medical therapy; subsequently, was adopted a strategy of levosimendan infusions guided by CardioMEMS. Levosimendan infusions improved haemodynamic and pressure profiles. The patient was monitored daily by CardioMEMS, and from June to December 2019, he had only two hospitalizations scheduled for levosimendan infusion and none for HF exacerbation. Discussion Our case supports the combination of CardioMEMS and levosimendan for the optimal management of patients with advanced HF. These results further strengthen the development of a randomized clinical trial to demonstrate the clinical usefulness of this device in combination with the levosimendan infusion programme in advanced HF patients.

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Poor Right Ventricular Systolic Function (Lower TAPSE) and Higher Pulmonary Artery Systolic Pressure (PASP) Predicts Early Readmissions and All Cause Mortality in Elderly Patients with Heart Failure

Journal of Cardiac Failure ◽

10.1016/j.cardfail.2014.06.304 ◽

2014 ◽

Vol 20 (8) ◽

pp. S108 ◽

Cited By ~ 1

Author(s):

Gunjan Choudhary ◽

Umashankar Lakshmanadoss ◽

Hari Prasad ◽

Ashok Shah ◽

Zaruhi Babayan ◽

...

Keyword(s):

Heart Failure ◽

Pulmonary Artery ◽

Elderly Patients ◽

Systolic Function ◽

Systolic Pressure ◽

Pulmonary Artery Systolic Pressure ◽

Ventricular Systolic Function ◽

Patients With Heart Failure ◽

Right Ventricular Systolic Function ◽

All Cause Mortality

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Peritoneal Ultrafiltration in Refractory Heart Failure: A Cohort Study

Peritoneal Dialysis International ◽

10.3747/pdi.2012.00290 ◽

2014 ◽

Vol 34 (1) ◽

pp. 64-70 ◽

Cited By ~ 29

Author(s):

Silvio V. Bertoli ◽

Claudio Musetti ◽

Daniele Ciurlino ◽

Carlo Basile ◽

Emilio Galli ◽

...

Keyword(s):

Heart Failure ◽

New York ◽

Hospital Admissions ◽

Systolic Pressure ◽

Heart Association ◽

Decompensated Heart Failure ◽

Pulmonary Artery Systolic Pressure ◽

Refractory Heart Failure ◽

Stage Renal Disease ◽

End Stage

IntroductionAcutely decompensated heart failure (HF) in patients with diuretic resistance is often treated with extracorporeal ultrafiltration. Peritoneal ultrafiltration (PUF) has been proposed for the long-term management of severe HF after resolution of the acute episode. The aim of the present study was to evaluate the use of PUF in the treatment of chronic refractory HF in patients without end-stage renal disease.MethodsThis multicenter (10 nephrology departments throughout Italy) retrospective observational study included patients with severe HF refractory to maximized drug treatment. The patients were proposed for PUF because they had experienced at least 3 hospital admissions in the preceding year for acutely decompensated HF requiring extracorporeal ultrafiltration.ResultsOf the 48 study patients (39 men, 9 women; mean age 74 ± 9 years), 30 received 1 nocturnal icodextrin exchange, 5 required 2 daily exchanges, and 13 received 2 – 4 sessions per week of automated peritoneal dialysis. During the first year, renal function remained stable (initial: 20.8 ± 10.0 mL/min/1.73 m2; end: 22.0 ± 13.6 mL/min/1.73 m2), while pulmonary artery systolic pressure declined to 40 ± 6.09 mmHg from 45.5 ± 9.18 mmHg ( p = 0.03), with a significant concomitant improvement in New York Heart Association functional status. Hospitalizations decreased to 11 ± 17 days/patient–year from 43 ± 33 days/ patient–year before the start of PUF ( p < 0.001). The incidence of peritonitis was 1 episode in 45 patient–months. Patient survival was 85% at 1 year and 56% at 2 years.ConclusionsThis study confirms the satisfactory results of using PUF for chronic HF in elderly patients.

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Medical Treatment of Heart Failure with Reduced Ejection Fraction – Prognostic Indication

International Cardiovascular Forum Journal ◽

10.17987/icfj.v10i0.422 ◽

2017 ◽

Vol 10 ◽

Author(s):

Giuseppe Rosano

Keyword(s):

Heart Failure ◽

Beta Blockers ◽

Great Success ◽

Therapeutic Approaches ◽

First Line ◽

Reduced Ejection Fraction ◽

Medical Interventions ◽

The Past ◽

Patients With Heart Failure ◽

First Line Treatment

An up-to-date review on guideline directed medical therapies that aim to improve prognosis in HFrEF patients. Research on medical interventions that may improve prognosis in patients with chronic heart failure has had great success in the past decades. Therefore, there are well- established classes of drugs – ACEi, beta- blockers, MRAs – that should be used as first line treatment in all patients with heart failure. In the past few years newer therapeutic approaches have been shown to improve prognosis in patients with heart failure but, since the evidence generated by these newer classes of drugs is less than that of the first three classes of drugs these therapies should be implemented only after an initial treatment with the first line drugs has been implemented. This article reviews the advances that have achieved in the treatment of heart failure in terms of a prognostic benefit.

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Acute Diuretic-Sparing Effects of Sacubitril-Valsartan: Staying in the Loop

Journal of Pharmacy Practice ◽

10.1177/08971900211010680 ◽

2021 ◽

pp. 089719002110106

Author(s):

Nicholas J. Orvin ◽

Janna C. Beavers ◽

Stuart D. Russell

Keyword(s):

Heart Failure ◽

Loop Diuretic ◽

Hospital Admissions ◽

Total Daily Dose ◽

Reduced Ejection Fraction ◽

Patients With Heart Failure ◽

Ed Visits ◽

Sparing Effect ◽

Median Change

Background: Previous literature has suggested a potential diuretic sparing effect as early as 6 months following sacubitril-valsartan initiation in patients with heart failure with reduced ejection fraction (HFrEF); however, whether this effect manifests earlier after initiation is unclear. Objective: To evaluate the acute diuretic-sparing effects of sacubitril-valsartan. Methods: This was a single-center, retrospective analysis of outpatients with HFrEF initiated on sacubitril-valsartan with follow up within 90 ± 30 days and a concomitant loop diuretic prescription. The primary outcome was the percent of patients with an increase, decrease or no change in loop diuretic total daily dose (TDD). Key secondary outcomes included change in loop diuretic TDD (mg furosemide equivalents) and hospital admissions or emergency department (ED) visits. Results: A total of 145 patients were included (overall cohort) with 120 continuing sacubitril-valsartan at follow up (on-treatment cohort). In the on-treatment cohort, 20% (n = 24) had a reduction in loop diuretic TDD and 10% had an increase (n = 12). Median change in loop diuretic TDD was unchanged from baseline to follow up (p 0.13). In patients on >80 mg TDD of furosemide at baseline (n = 9), mean change was-53 ± 44 mg (p 0.006). Hospitalizations (6.2%) and ED visits (0.7%) for heart failure were infrequent. Conclusion: Patients may require a loop diuretic dose reduction within 2-3 months following sacubitril-valsartan initiation. This diuretic-sparing effect appears larger in those on higher baseline loop diuretic doses, and closer follow up may be warranted for these patients.

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P3553Right ventricular echocardiographic composite parameters in predicting major adverse cardiac events in patients with heart failure with reduced ejection fraction

European Heart Journal ◽

10.1093/eurheartj/ehz745.0416 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

M S Stefanovic ◽

I S Srdanovic ◽

A M Milovancev ◽

S B Bjelic ◽

A V Vulin ◽

...

Keyword(s):

Heart Failure ◽

Ejection Fraction ◽

Right Ventricle ◽

Predictive Value ◽

Independent Predictor ◽

Systolic Pressure ◽

Reduced Ejection Fraction ◽

Patients With Heart Failure ◽

Relationship Of

Abstract Background Echocardiography assessment of right ventricle still play an indispensable role in diagnosis, decision-making for further therapy and risk assessment of patients with heart failure with reduced ejection fraction (HFrEF). Aims Our objective was to compare the predictive value of five composite echo parameters of right ventricle (RV) in decompensated patients with HFrEF. Methods and results A total of 191 NYHA III-IV patients admitted for decompensation of advanced HFrEF (EF=25.53±6,87%) were prospectively enrolled. During the follow-up period mean period of 340±84 days, 111 (58.1%) patients met the primary composite endpoint (MACE) of cardiac death, rehospitalization due to repeated decompensation, malignant rhythm disorders, heart attack or stroke. The average time of MACE occurrence was 110.5±98.7 days. Among group of patients with MACE, during the follow-up, there were 34 (30.6%) cardiac related deaths. Re-hospitalization due to cardiovascular causes had 77 patients (69.4%). The study was performed at our hospital between June 2016 and January 2018. Patients were assessed for the following combined echo parameters: (i) relationship of right and left ventricle basal diameter (RVb/LVb x0,1); (ii) relationship of tricuspid annular plane systolic excursion and right ventricle systolic pressure (TAPSE/RVSP mm/mmHg); (iii) relationship of tricuspid annular systolic velocity and right ventricle systolic pressure (TAs'x100/ RVSP cm/s/mmHg); (iv) product of tricuspid annular systolic velocity and pulmonic valve acceleration time (TAs'x PVAcT (cm/s2 x 1000)); (v) product of systolic and diastolic velocity of tricuspid annulus (TAs xTAe). The last three parameters were result of this study and were not mentioned in earlier researches. In this study, univariat analysis of combined RV echo parameters, TAPSE/RVSP, TAs'x100 /RVSP as well as TAs'xPVAcT have been shown to be highly significant predictors of MACE, p=0.001. The TAs'xTAe' product has been also distinguished as a significant predictor of MACE, p=0.04, as well as the ratio RVb/LVb x 0.1, p=0.007. Multivariate analysis of these five combined RV echo parameters shows that significant independent predictor of MACE turned out to be TAs'x100/RVSP (p<0.001, HR = 0.668 (0.531–0.840)). Obtained by reconstruction of the ROC curve (Area = 0.70 (95% CI 0.59–0.75); p<0.001, we have got cut off value of TAs'x100/RVSP = 1.92 (cm/s/mmHg). Kaplan-Meier curves were constructed by comparing the time to the occurrence of MACE. Patients with TAs'x100/RVSP ≤1.92 (cm/s/mmHg) have a significantly worse prognosis (Log Rank p<0.001). Conclusion New variable TAs'x100/RVSP, derived from this research, proved to be the most powerful combined RV echo parameter, independent predictor of one year MACE, with a better predictive value compared to the already described combined parameters in the literature.

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