scholarly journals Cardiac amyloid presenting as cardiogenic shock: case series

2021 ◽  
Vol 5 (7) ◽  
Author(s):  
Monique Oye ◽  
Pooja Dhruva ◽  
Fadi Kandah ◽  
Melissa Oye ◽  
Emil Missov
Keyword(s):  
Heart Failure ◽  
African American ◽  
Ejection Fraction ◽  
Cardiogenic Shock ◽  
Cardiac Amyloidosis ◽  
Clinical Status ◽  
Case Series ◽  
Reduced Ejection Fraction ◽  
Cardiac Amyloid ◽  
First Case

Abstract Background Amyloidosis is a systemic infiltrative disease that can affect nearly every organ in the human body. It is characterized by the deposition of misfolded protein within various tissues and organs. Once there is cardiac involvement this portends a worse prognosis. Case summary We describe a case series of two patients with cardiac amyloidosis presenting as a cardiogenic shock. There were several missed opportunities in diagnosing cardiac amyloid prior to their fatal presentations. In the first case, a 65-year-old African-American male patient presented with worsening shortness of breath and signs of heart failure. Echocardiography revealed preserved ejection fraction. He was diagnosed with light chain subtype of cardiac amyloidosis, and rapidly deteriorated during his admission. Patient in the second case is a 75-year-old African-American female who presented with worsening heart failure and hypotension. Echocardiography revealed reduced ejection fraction. She was diagnosed with transthyretin cardiac amyloid. Her clinical status worsened during admission and she went into cardiogenic shock requiring multiple vasopressors. Discussion This case series discusses two incidences of cardiac amyloidosis presenting as cardiogenic shock in African-American patients. This article postulates that cardiac amyloidosis may be misdiagnosed for more common causes of heart failure especially among this demographic group. Once patients with cardiac amyloid present with cardiogenic shock their clinical course is typically rapidly fatal despite aggressive measures. Earlier detection is imperative to prevent poor outcomes.

P3542Natriuretic peptides added to clinical parameters predict two-year prognosis of patients with chronic heart with mid-range and reduced ejection fraction

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
J Spinar ◽  
L Spinarova ◽  
M Spinarova ◽  
K Labr ◽  
J Jarkovsky ◽  
...  
Keyword(s):  
Heart Failure ◽  
Chronic Heart Failure ◽  
Ejection Fraction ◽  
Heart Transplantation ◽  
Natriuretic Peptides ◽  
Prognostic Score ◽  
Clinical Status ◽  
Reduced Ejection Fraction ◽  
Nyha Classification ◽  
Patients With Heart Failure

Abstract Background The guidelines recommend to determine natriuretic peptides, clinical status (NYHA classification) and comorbidities in order to predict the prognosis in patients with heart failure. The aim ofthis registry was to develop a prognostic score in chronic heart failure patients, using clinical status, comorbidities and natriuretic peptides. Methods Consecutive 1088 patients with stable chronic heart failure with reduced ejection fraction (HFrEF) (LVEF<40%) and mid-range EF (HFmrEF) (LVEF 40–49%) were enrolled. Two-year all-cause mortality, heart transplantation and/or LVAD implantation were defined as the primary endpoint (MACE). Results The occurrence of MACE was 14.9% and increased with higher NYHA, 4.9% (NYHA I), 11.4% (NYHA II) and 27.8% (NYHA III-IV) (p<0.001). The occurrence of MACE was 3%, 10% and 15–37% in patients with NT-proBNP levels ≤125pg/ml, 126–1000pg/ml and >1000pg/ml respectively. Discrimination abilities of NYHA and NT-proBNP were (AUC 0.670; p<0.001 and AUC 0.722; p<0.001). The predictive value of the developed clinical model, which took account of older age, advanced heart failure (NYHA III+IV), anaemia, hyponatraemia, hyperuricaemia and taking a higher dose of loop diuretics (>40 mg furosemide daily) (AUC 0.773; p<0.001) was increased by adding the NT-proBNP level (AUC 0.790). Conclusion Natriuretic peptides, clinical status and comorbiditis predict two year prognosis and they can help to a better identification of a high-risk groups of patients with heart failure with reduced and mid range ejection fraction in which more intense treatment should be considered, mainly LVAD implantation or listing to heart transplantation waiting list. Acknowledgement/Funding None

scholarly journals P1818 Baseline clinical, echocardiographic and laboratory characteristics of HFrEF patients who were started with sacubitryl+ walsartan in different clinical status: long-term stabile vs after acute heart f

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
S Wisniowska-Smialek ◽  
A Karabinowska ◽  
K Holcman ◽  
E Dziewiecka ◽  
A Lesniak-Sobelga ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Systolic Function ◽  
Nyha Class ◽  
Clinical Status ◽  
Left Ventricular ◽  
P Value ◽  
Reduced Ejection Fraction ◽  
Heart Failure Exacerbation ◽  
Short Time

Abstract Background According to the latest approach new class ARNI with sacubitryl-valsartan may be ordered in clinically stable heart failure patients with reduced ejection fraction ( HFrEF) or short time after acute heart failure exacerbation. Methods: Since July 2016 till February 2019 we started ARNI in 50 HFrEF patients; 33 (66%) were clinically stabile during at least 3 months and 17 (34%) were short time after HF exacerbation. Results: There were no differences in age (63 vs 58) and BMI between groups. Clinically stabile patients presented significantly lower NYHA class (2 ± 0,5 vs 3 ± 0,7) and lower NT-proBNP level (1948 pg/ml vs 5570 pg/ml) in comparison to those after HF decompensation. There were no differences in left ventricular end-diastolic diameter (LVEDD), volume (LVEDV) and ejection fraction (EF) between both groups. Patients after HF decompensation had greater left and right atrium area(LAA, RAA respectively), higher estimated pulmonary artery pressure (PASP) and reduced right ventricular systolic function expressed with TAPSE (tricuspid annular plane systolic excursion) in comparison to stabile patients. Patients from both groups presented similar physical activity tolerance estimated with 6-minute walking test ( 6- MWT): 369 m vs 402 m (tbl). Conclusions: Clinical, echocardiographic and laboratory differences were observed between groups of HFrEF patients with different clinical status when ARNI was administrated. Parameter Stabile n = 33 After HF decompensation n= 17 p- value BMI [kg/m2] 25(23-36) 25(21-26) 0,72 Age [years] 63 (39-68) 58 (42-67) 0,81 NYHA 2 ± 0,5 3 ± 0,7 0,001 NT-proBNP [pg/ml] 1948(601-2933) 5570(4147-8021) P&lt; 0,001 6 MWT dystans [m] 369(327-432) 402(240-480) 0,32 FW [%] 23 (18-28) 19(15-26) 0,17 LVEDD [mm] 69(59-76) 64(63-71) 0,32 LVEDvol [ml] 242(153-324) 225(178-235) 0,29 TAPSE [mm] 19(14-21) 14(13-16) 0,02 LAA [cm2] 28(24-34) 36(27-39) 0,032 RAA [cm2] 19(16-30) 26(23-32) 0,046 PASP [mmHg] 31(23-43) 43(38-55) 0,046

scholarly journals Diabetes in Patients With Heart Failure With Reduced Ejection Fraction During Hospitalization: A Retrospective Observational Study

2021 ◽  
Vol 12 ◽  
Author(s):  
Yiling Zhou ◽  
Miye Wang ◽  
Si Wang ◽  
Nan Li ◽  
Shengzhao Zhang ◽  
...  
Keyword(s):  
Heart Failure ◽  
Propensity Score ◽  
Ejection Fraction ◽  
Cardiogenic Shock ◽  
Hospital Stay ◽  
Reduced Ejection Fraction ◽  
Icu Admission ◽  
Patients With Heart Failure ◽  
Patients With Diabetes ◽  
Subgroup Effects

BackgroundDiabetes is prevalent worldwide including hospitalized patients with heart failure with reduced ejection fraction (HFrEF). This retrospective study investigated the association of diabetes with in-hospital adverse events in patients with HFrEF.MethodsWe analyzed data from electronic medical records of patients hospitalized with HFrEF in West China Hospital of Sichuan University from January 1, 2011, to September 30, 2018. Propensity score matching balances the baseline characteristics between patients with and without diabetes. Logistic and Poisson regressions investigated the association of diabetes with risks of intubation, cardiogenic shock, acute kidney injury (AKI), intensive care unit (ICU) admission and death during hospitalization, and length of ICU and hospital stay in the matched cases.ResultsAmong 6,022 eligible patients (including 1,998 with diabetes), 1,930 patient pairs with and without diabetes were included by propensity score matching. Patients with diabetes had a significantly increased risk of intubation (odds ratio [OR], 2.69; 95% confidence interval [CI], 2.25–3.22; P&lt;0.001), cardiogenic shock (OR, 2.01; 95% CI, 1.72–2.35; P&lt;0.001), AKI at any stage (OR, 1.67; 95% CI, 1.44–1.94; P&lt;0.001), ICU admission (OR, 1.89; 95% CI, 1.65–2.15; P&lt;0.001), and death (OR, 4.25; 95% CI, 3.06–6.02; P&lt;0.001) during hospitalization. Patients with diabetes had longer ICU (median difference, 1.47 days; 95% CI, 0.96–2.08; P&lt;0.001) and hospital stay (2.20 days; 95% CI, 1.43–2.86; P&lt;0.001) than those without diabetes. There were potential subgroup effects by age and by hypertension, and CKD status on the association of diabetes with risk of AKI at any stage; and subgroup effects by sex and CKD status on the association of diabetes with risk of intubation. The increase in length of hospital stay was larger in patients without hypertension than those with hypertension.ConclusionsAmong patients with HFrEF, those with diabetes have a worse prognosis, including a higher risk of in-hospital intubation, cardiogenic shock, AKI, ICU admission and death during hospitalization, and longer ICU and hospital stay.

scholarly journals Types of hemodynamic response to orthostasis according to continuous blood pressure monitoring: a case series of heart failure with reduced ejection fraction

2021 ◽  
Vol 26 (3S) ◽  
pp. 4574
Author(s):  
D. N. Fedorova ◽  
A. E. Solovieva ◽  
V. L. Galenko ◽  
A. V. Kozlenok ◽  
A. V. Berezina ◽  
...  
Keyword(s):  
Heart Failure ◽  
Blood Pressure ◽  
Ejection Fraction ◽  
Blood Pressure Monitoring ◽  
Case Series ◽  
Hemodynamic Response ◽  
Pressure Monitoring ◽  
Reduced Ejection Fraction ◽  
Additional Tool ◽  
Continuous Blood Pressure

Heart failure (HF) is associated with unfavorable outcomes and high health care costs. Determination of the hemodynamic response to orthostasis can be an additional tool in assessing the stability and compensation of HF patients. Active orthostatic test (AOT) with blood pressure monitoring serves as a simple and available screening method. However, a complete characteristic of the hemodynamic response, especially during the first minute of orthostasis, can be obtained only with continuous blood pressure monitoring. The presented case series demonstrate the types of hemodynamic response in patients with heart failure with reduced ejection fraction in AOT with continuous blood pressure monitoring, available data on the mechanisms of its development, clinical and prognostic role, and also presents the advantages and limitations of AOT.

scholarly journals Medical Treatment of Heart Failure with Reduced Ejection Fraction – Improving Clinical Status and Functional Capacity

2017 ◽  
Vol 10 ◽  
Author(s):  
Cristiana Vitale ◽  
Giuseppe Rosano
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Functional Capacity ◽  
Clinical Status ◽  
Signs And Symptoms ◽  
Ferric Carboxymaltose ◽  
Reduced Ejection Fraction ◽  
Patients With Heart Failure ◽  
Effective Treatments

A contemporary review of treatments that have been shown to improve functional capacity in patients with Heart Failure and reduced Ejection Fraction (HFrEF).  The improvement of functional capacity is one of the main goals of treatment in patients with HFrEF. In the past, despite significant effects on exercise capacity some drugs (e.g. ibopamine, flosequinan) have shown detrimental effects on long- term outcomes in patients with HFrEF. It is perhaps notable that both of these drugs had shown signals of increased safety concerns during the earlier clinical phases of their development. The challenge is to encourage a timely identification of effective treatments that can enhance functional performance in HF without the more difficult and more expensive path to prove all drugs also reduce mortality. It is valuable to have approved and effective treatments that can do the first without the need for the second in all cases, provided adequate safety can be assured. Ivabradine, trimetazidine, ferric carboxymaltose and diuretics have consistently shown to improve functional capacity and symptoms in patients with HFrEF because of their effect on long term prognosis these drugs should always be considered in patients with heart failure. Diuretics improve functional capacity and should be prescribed in patients with signs and symptoms of congestions. Cardiac resynchronisation therapy improves functional capacity in patients with HFrEF in whom it is appropriately applied (QRS &gt;130/150 msec according to morphology).

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