scholarly journals Association between cardiac pathology and outcomes of patients with COVID-19 using a hand-held ultrasound

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
Z Dadon ◽  
N Levi ◽  
A Orlev ◽  
D Belman ◽  
E A Alpert ◽  
...  
Keyword(s):  
Acute Decompensated Heart Failure ◽  
Point Of Care ◽  
Ventilatory Support ◽  
Multivariate Logistic Regression Analysis ◽  
Right Ventricular Dysfunction ◽  
Composite Endpoint ◽  
Decompensated Heart Failure ◽  
Valvular Regurgitation ◽  
Presenting Symptoms ◽  
Funding Sources

Abstract Background The association between COVID-19 infection and the cardiovascular system has been well described. Strict precautions limit the use of formal echocardiography in this setting. Information on the importance of the utilization of a hand-held point-of-care cardiac ultrasound (POCCUS) for cardiac evaluation in these patients is scarce. Objective To investigate the utilization of hand-held echocardiography in COVID-19 hospitalized patients and the association between cardiac pathologies and outcomes. Methods Consecutive patients diagnosed with COVID-19 underwent POCCUS evaluation using a hand-held ultrasound within 24 hours of admission at our institute, throughout March-May 2020. According to the POCCUS results, the patients were divided into two groups: 'Normal' and 'Abnormal' (including left or right ventricular dysfunction or enlargement, or moderate/severe valvular regurgitation/stenosis). Results Among 102 patients, 26 (25.5%) had an abnormal POCCUS study. They were older, with more co-morbidities, cardiovascular disease history, chronic medical therapy, and more severe presenting symptoms, as compared to the group with a normal echocardiography exam. Individual and composite endpoints (advanced ventilatory support, acute decompensated heart failure, shock, or death) are presented in Table 1. Multivariate logistic regression analysis adjusting for pertinent variables revealed that abnormal echocardiography at presentation was independently associated with the composite endpoint OR=4.63 (95% CI 1.51–14.15, p=0.007). Conclusions Abnormal echocardiography results in COVID-19 infection settings are associated with a higher burden of medical comorbidities and independently predict major adverse endpoints. Hand-held POCCUS at presentation can be utilized as an important tool for risk stratification for hospitalized COVID-19 patients. FUNDunding Acknowledgement Type of funding sources: Private hospital(s). Main funding source(s): SZMC Scientific

The clinical impact of delirium in the patients with acute decompensated heart failure

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
Y.A Aikawa ◽  
T.N Noguchi ◽  
I.M Morii
Keyword(s):  
Heart Failure ◽  
Acute Decompensated Heart Failure ◽  
Multivariable Analysis ◽  
Composite Endpoint ◽  
Decompensated Heart Failure ◽  
Cardiovascular Death ◽  
Clinical Impact ◽  
Hospital Death ◽  
Early Screening ◽  
H2 Blocker

Abstract Background Delirium is frequent in-hospital complication in patients with illness. However, the clinical impact of delirium on cardiovascular mortality has not been fully addressed in patients with acute decompensated heart failure (ADHF). Methods Between April 2016 and May 2019, 474 consecutive patients with ADHF admitted to our institution were enrolled and followed for 6 months after discharge. Delirium was defined according to the Intensive Care Delirium Checklist. To compare the clinical outcome, we divided study patients into 3 groups according to the presence or absence of delirium: non-delirium (ND) (n=349), improved-delirium during hospitalization (ID) (n=68), and prolonged delirium (PD) (n=57). Results One hundred twenty-five (26.4%) patients developed delirium. During hospitalization, PD had higher incidence of all-cause death, cardiovascular death, and worsening heart failure compared with ND and ID (20.0% vs. 3.7% and 2.9%, 10.9% vs. 2.5% and 1.4%, 21.8% vs. 2.5% and 4.3%, p<0.001, respectively). Multivariable analysis identified the presence of frailty (OR: 8.56, 95% CI: 3.46–23.7) and dementia (OR: 7.34, 95% CI: 3.52–15.9), use of H2-blocker (OR: 3.41, 95% CI: 1.08–10.9) and plasma level of CRP (OR: 1.30, 95% CI: 1.06–1.61) as significant independent determinants of delirium. Also, in multivariable analysis, the development of frailty (OR: 5.51, 95% CI: 2.80–11.5), delirium (OR: 4.59, 95% CI: 2.23–9.66) and age (OR: 1.06, 95% CI: 1.03–1.11) were the independent determinants of composite endpoint with in-hospital death and discharge to other than home. Early treatment of delirium performed significantly higher in ID than PD (55.7% vs. 29.1%, p=0.003). Conclusion This study suggested that PD contributed to increasing in-hospital events in the patients with ADHF and significance of early screening and treatment for delirium. Figure 1. Outcomes during hospitalization Funding Acknowledgement Type of funding source: None

scholarly journals Hospitalist perspectives of available tests to monitor volume status in patients with heart failure: a qualitative study

2020 ◽  
Author(s):  
Anna M Maw ◽  
Carolina Ortiz-lopez ◽  
Megan A Morris ◽  
Christine Jones ◽  
Elaine Gee ◽  
...  
Keyword(s):  
Heart Failure ◽  
Lung Ultrasound ◽  
Acute Decompensated Heart Failure ◽  
Point Of Care ◽  
Decompensated Heart Failure ◽  
Volume Status ◽  
Structured Interviews ◽  
Patients With Heart Failure ◽  
The Us ◽  
Time Required

AbstractAcute decompensated heart failure is the leading admitting diagnosis in patients 65 and older with more than 1 million hospitalizations per year in the US alone. Traditional tools to evaluate for and monitor volume status in patients with heart failure, including symptoms and physical exam findings, are known to have limited accuracy. In contrast, point of care lung ultrasound is a practical and evidenced-based tool for monitoring of volume status in patients with heart failure. However, few inpatient clinicians currently use this tool to monitor diuresis. We performed semi-structured interviews of 23 hospitalists practicing in 5 geographically diverse academic institutions in the US to better understand how hospitalists currently assess and monitor volume status in patients hospitalized with heart failure. We also explored their perceptions and attitudes toward adoption of lung ultrasound. Hospitalist participants reported poor reliability and confidence in the accuracy of traditional tools to monitor diuresis and expressed interest in learning or were already using lung ultrasound for this purpose. The time required for training and access to equipment that does not impede workflow were considered important barriers to its adoption by interviewees.

scholarly journals RISK STRATIFICATION AND PROGNOSTIC MARKERS IN PATIENTS WITH ACUTE DECOMPENSATED HEART FAILURE

2020 ◽  
pp. 1-4
Author(s):  
Ravinder Bhukar ◽  
Shekhar Kunal ◽  
Pradeep Kumar Meena ◽  
Sourav Bansal ◽  
Himanshu Mahla ◽  
...  
Keyword(s):  
Heart Failure ◽  
Heart Rate ◽  
Risk Stratification ◽  
Hospital Mortality ◽  
Troponin T ◽  
Acute Decompensated Heart Failure ◽  
Nyha Class ◽  
Multivariate Logistic Regression Analysis ◽  
Decompensated Heart Failure ◽  
One Year

Introduction: Heart failure is one of the leading cause of hospitalization and death worldwide having a major impact on the health care systems. Risk stratification of these patients helps to achieve a better clinical outcome with a reduction in morbidity and mortality. Methods: This was a single centre prospective observational study wherein patients with acute decompensated heart failure were enrolled. All enrolled patients underwent detailed clinical history including symptomatology, risk factors for cardiovascular diseases and family history were recorded. All these patients underwent routine haematological and biochemical testing along with documentation of cardiac biomarkers viz. Troponin T and N-terminal pro brain natriuretic peptide (NT pro-BNP). All these patients were then followed for one year. Outcomes in form of in-hospital mortality as well as adverse cardiac events (mortality, rehospitalisation) were documented. Results: A total of 264 patients were included with mean age of 67.6 ± 9.8 years. In-hospital mortality was reported in 28 patients (10.6%) while 27 (10.2%) patients died over a year of follow-up. Patients with an in-hospital mortality were older and higher NYHA class and heart rate, lower ejection fraction, systolic and diastolic blood pressure and higher cardiac troponins and NT-pro BNP levels. Multivariate logistic regression analysis revealed that heart rate, NYHA class, systolic blood pressures, NT pro-BNP and creatinine were independent predictors of mortality. Conclusions: Our study showed that acute heart failure has a substantial in-hospital as well as one year mortality rates. Use of biomarkers leads to a better risk stratification and hence an impact on outcomes.

scholarly journals P1243 Nonbacterial thrombotic endocarditis (NBTE) of the aortic valve: incidental finding in hospitalized patients with advanced heart failure

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
G G Marin ◽  
C Margineanu ◽  
D Penes ◽  
C Maresiu ◽  
S Boiangiu ◽  
...  
Keyword(s):  
Heart Failure ◽  
Clinical Judgment ◽  
Acute Decompensated Heart Failure ◽  
Incidental Finding ◽  
Persistent Atrial Fibrillation ◽  
Decompensated Heart Failure ◽  
Valvular Regurgitation ◽  
Aortic Valves ◽  
Nonbacterial Thrombotic Endocarditis ◽  
Valve Lesion

Abstract Background The presence of small mobile masses on the ventricular side of the aortic valves in the absence of valvular regurgitation and signs of systemic inflammation has been previously described as marantic endocarditis and is now referred to as nonbacterial thrombotic endocarditis (NBTE). It is thought to be associated with endothelial dysfunction and procoagulative status, as is the case of acute decompensated heart failure (HF). Case description We present a series of three male patients, with similar clinical characteristics, who were admitted for acute decompensated HF. All three patients had chronic HF, due to non-ischemic dilated cardiomyopathy with severe biventricular dysfunction, with resynchronization therapy, with elevated natriuretic peptides and previous HF hospitalizations in the past year requiring prolonged intravenous treatments. Other clinical, biological criteria for the definition of advanced HF were also met. All patients were under chronic anticoagulation treatment using a direct oral anticoagulant because of persistent atrial fibrillation. Thorough echocardiographic evaluation (both transthoracic and transoesophageal ultrasound) identified small mobile masses on the ventricular side of the aortic valves, centrally, on the line of cusp coaptation, with only minor central regurgitation. The lack of progression of valve lesion and the absence of gross signs of inflammation (no fever, normal hemoleucogram, normal CRP, repeated negative blood cultures) on serial examinations during several weeks follow-up allowed for the exclusion of infective endocarditis. In one case we also identified a left atrial appendage thrombus and presumably thrombotic masses attached to right side pacing leads. No clinically systemic embolic events were identified. Conclusion We consider this to be an incidental finding in the given subclinical prothrombotic and inflammatory predisposing milieu of advanced chronic HF and the increasing high quality echocardiography imaging. Its clinical significance is still unknown, while differential diagnosis from subacute or chronic endocarditis relies largely on clinical judgment.

scholarly journals Risk assessment of acute kidney injury in patients with acute cardiovascular disease without invasive intervention

Kardiologiia ◽  
2020 ◽  
Vol 59 (12S) ◽  
pp. 46-56
Author(s):  
S. V. Avdoshina ◽  
M. A. Efremovtseva ◽  
S. V. Villevalde ◽  
Zh. D. Kobalava
Keyword(s):  
Blood Pressure ◽  
Cardiovascular Disease ◽  
Acute Kidney Injury ◽  
Acute Decompensated Heart Failure ◽  
Multivariate Logistic Regression Analysis ◽  
Kidney Injury ◽  
Decompensated Heart Failure ◽  
Coronary Syndrome ◽  
Patients At Risk ◽  
Stage 1

Objective. To evaluate the prevalence, predictors, prognostic value of cardiorenal interrelations in patients with acute cardiovascular disease (CVD), and to develop an algorithm for stratification these patients at risk of acute kidney injury (AKI). Materials and methods. 566 patients (pts) were examined: 278 with acute decompensated heart failure (ADHF) and 288 with non-ST-elevation acute coronary syndrome (NSTE-ACS). The levels of electrolytes, glucose, urea, creatinine were evaluated, glomerular filtration rate (GFR) was determined according to the formula CKD-EPI. Chest x-ray, electrocardiography at admission and in dynamics, echocardiography at admission with assessment of systolic and diastolic myocardial functions were performed. Chronic kidney disease (CKD), AKI, ADHF, NSTE-ACS were diagnosed according to Russian and international Guidelines. Mann-Whitney test and multivariate logistic regression analysis were considered significant if p<0.05. Results. Different variants of cardiorenal interrelations were revealed in 366 (64.7%) pts. CKD was diagnosed in 259 (45.8%), with more than half of the cases (61%) diagnosed for the first time at this hospitalization, 62 (11%) pts had signs of kidney damage of unknown duration (which did not allow to diagnose CKD). AKI occurred in 228 (40,3%) pts, more frequently in patients with ADHF vs with NSTE-ACS (43.5 and 37.2%). In all groups stage 1 of AKI was prevalent. In-hospital mortality was significantly higher in pts with AKI vs without AKI (14.9 vs 3.6%, p<0.001). The risk of AKI was determined by kidney function and blood pressure levels at admission, and comorbidities. Conclusion. Prevalence of cardiorenal interactions in patients with acute CVD (ADHF and NSTE-ACS) was 64.7%. Development of AKI was associated with poor prognosis in both groups. Renal function and blood pressure levels on admission are the main predictors of AKI.

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