scholarly journals Left atrial dynamics and congestion status analysis in acute decompensated heart failure based on LVEF categorization

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
M Barki ◽  
M Losito ◽  
M M Caracciolo ◽  
F Bandera ◽  
M Rovida ◽  
...  
Keyword(s):  
Heart Failure ◽  
Left Atrial ◽  
Acute Decompensated Heart Failure ◽  
Strain Analysis ◽  
Decompensated Heart Failure ◽  
Funding Sources ◽  
Significant Difference ◽  
Definition Of ◽  
And Function ◽  
Status Analysis

Abstract Background Left atrial (LA) dynamics play a key role in the hemodynamics assessment of heart failure (HF). LA strain analysis by speckle tracking echocardiography (STE) has recently been introduced in clinical practice. In acute decompensated heart failure (ADHF), LA functional deterioration leads to worsening of pulmonary capillary hypertension and congestion, ultimately impacting prognosis. However, how LA size and function behaves in ADHF according to the different HF phenotypes has never been studied. Purpose To evaluate the diverse morphology and dynamics of the LA, along with a thorough congestion analysis, in ADHF patients with HFpEF, HFmrEF and HFrEF. Methods Eighty-five ADHF patients (mean age 75.6±10.4 years, 59% males) were prospectively enrolled within 24–48 hours from admission to the emergency department. In the acute phase all patients underwent a complete transthoracic echocardiography (TTE) and lung ultrasonography (LUS) associated with blood sample and a thorough clinical examination. LA mechanics was assessed with STE, through the evaluation of global peak atrial longitudinal strain (GPALS). Results Out of 85 patients, 51% were classified as HFrEF, 20% as HFmrEF and 29% as HFpEF. At admission, all patients exhibited a comparable degree of congestion, as testified by increased IVC max. diameter (HFpEF 19±7 mm vs HFrEF 20±6.3 mm vs HFmrEF 17±5.3 mm, p=0.167), incremented PASP (HFpEF 39.2±13.5 mmHg vs HFrEF 42±12 mmHg vs HFmrEF 35.3±10.1 mmHg, p=0.15) and a rising number of B-lines on LUS (HFpEF 20±12.8 vs HFrEF 24±17 vs HFmrEF 21±19, p=0.62). Increased NT-proBNP values in the cohort were also noted, with HFrEF exhibiting the highest levels (HFrEF 11747±1069 ng/l vs HFmrEF 6905±811 ng/l vs HFpEF 3918±374 ng/l; p<0.001). When evaluating LA size and dynamics in the different HF phenotypes (HFrEF, HFmrEF and HFpEF respectively) a significant difference among the three subgroups was noted with HFrEF patients exhibiting a greater LA dilation and a higher impairment in terms of LA reservoir function (lowest GPALS/LAVi ratio) compared to HFpEF patients, who showed relatively less enlarged LA chambers and more preserved dynamics. Interestingly, HFmrEF patients expressed the best coupling between LA function and dimension, with significantly reduced LA dimensions and a more preserved LA function compared to HFrEF and HFpEF (LAVi: HFpEF 50.7±16 ml/m2 vs HFrEF 53.9±15 ml/m2 vs HFmrEF 42.8±10.8 ml/m2, p=0.05*; GPALS HFpEF 17±9.1% vs HFrEF 10±4.85% vs HFmrEF 18.3±6.2%, p<0.001*) (Figure 1 and 2). Conclusions ADHF patients exhibit an heterogeneous response in terms of LA size and function according to LVEF categorization. The definition of subjects expressing the worst coupling between LA size and function appears of relevance in order to facilitate risk stratification and identify patients at higher risk of early re-hospitalization. FUNDunding Acknowledgement Type of funding sources: None.

scholarly journals Effect of adding hydrochlorothiazide to usual treatment of patients with acute decompensated heart failure: a randomized clinical trial

2021 ◽  
Vol 10 (Supplement_1) ◽  
Author(s):  
D Piardi ◽  
M Butzke ◽  
ACM Mazzuca ◽  
BS Gomes ◽  
SG Alves ◽  
...  
Keyword(s):  
Heart Failure ◽  
Clinical Trial ◽  
Randomized Clinical Trial ◽  
Natriuretic Peptides ◽  
Weight Reduction ◽  
Acute Decompensated Heart Failure ◽  
Decompensated Heart Failure ◽  
Vasoactive Drugs ◽  
Funding Sources ◽  
Significant Difference

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Acute decompensated heart failure (ADHF) is the leading cause of hospitalization in patients aged 65 years or older, and most of them present with congestion. The use of hydrochlorothiazide (HCTZ) may increase the response to loop diuretics. Objective: To evaluate the effect of adding HCTZ to furosemide on congestion and symptoms in patients with ADHF. Methods: This randomized clinical trial compared HCTZ 50 mg versus placebo for 3 days in patients with ADHF and signs of congestion. The primary outcome of the study was daily weight reduction. Secondary outcomes were change in creatinine, need for vasoactive drugs, change in natriuretic peptides, congestion score, dyspnea, thirst, and length of stay. Results: Fifty-one patients were randomized — 26 to the HCTZ group and 25 to the placebo group. There was a trend towards additional weight reduction in the HCTZ group (HCTZ: -1.78 ± 1.08 kg/day vs placebo: -1.05 ± 1.51 kg/day; p = 0.062). In post hoc analysis, the HCTZ group demonstrated significant weight reduction for every 40 mg of intravenous furosemide (HCTZ: -0.74 ± 0.47 kg/40 mg vs placebo: -0.33 ± 0.80 kg/40 mg; p = 0.032) - figure. There was a trend to increase in creatinine in the HCTZ group (HCTZ: 0.50 ± 0.37 vs placebo: 0.27 ± 0.40; p = 0.05) but no significant difference in onset of acute renal failure (HCTZ: 58% vs placebo: 41%; p = 0.38). No differences were found in the remaining outcomes - table. Conclusion: There was a trend towards greater daily weight reduction in the HCTZ group. In analysis adjusted to the dose of intravenous furosemide, adding HCTZ 50 mg to furosemide resulted in a synergistic effect on weight loss. Study outcomesOutcomeHCTZPlacebop-valuePrimaryWeight change/day-1.78 ± 1.08-1.05 ± 1.510.062SecondaryLength of stay (days)9 ± 88 ± 90.37Change in creatinine (mg/dL)0.50 ± 0.370.27 ± 0.400.05Need for vasoactive drugs (%)19.212.00.70Congestion score-5.4 ± 4.6-4.8 ± 4.60.68Change in dyspnea scale-4.7 ± 2.7-3.2 ± 3.60.14Thirst scale-1.7 ± 4.50.5 ± 3.80.21Change in natriuretic peptides (%)-11.1 ± 100.3-33.3 ± 50.90.83Plus–minus values are means ± standard deviation.Abstract Figure. Diuretic response

scholarly journals Oral Metolazone Versus Intravenous Chlorothiazide as an Adjunct to Loop Diuretics for Diuresis in Acute Decompensated Heart Failure With Reduced Ejection Fraction

2018 ◽  
Vol 54 (6) ◽  
pp. 351-357 ◽  
Author(s):  
Brian C. Bohn ◽  
Rim M. Hadgu ◽  
Hannah E. Pope ◽  
Jerrica E. Shuster
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Acute Decompensated Heart Failure ◽  
Decompensated Heart Failure ◽  
Oral Formulation ◽  
Loop Diuretics ◽  
Reduced Ejection Fraction ◽  
Significant Difference ◽  
Patients With Heart Failure ◽  
Total Urine

Background: Thiazide diuretics are often utilized to overcome loop diuretic resistance when treating acute decompensated heart failure (ADHF). In addition to a large cost advantage, several pharmacokinetic advantages exist when administering oral metolazone (MTZ) compared with intravenous (IV) chlorothiazide (CTZ), yet many providers are reluctant to utilize an oral formulation to treat ADHF. The purpose of this study was to compare the increase in 24-hour total urine output (UOP) after adding MTZ or CTZ to IV loop diuretics (LD) in patients with heart failure with reduced ejection fraction (HFrEF). Methods and Results: From September 2013 to August 2016, 1002 patients admitted for ADHF received either MTZ or CTZ in addition to LD. Patients were excluded for heart failure with preserved ejection fraction (HFpEF) (n = 469), <24-hour LD or UOP data prior to drug initiation (n = 129), or low dose MTZ/CTZ (n = 91). A total of 168 patients were included with 64% receiving CTZ. No significant difference was observed between the increase in 24-hour total UOP after MTZ or CTZ initiation (1458 [514, 2401] mL vs 1820 [890, 2750] mL, P = .251). Conclusions: Both MTZ and CTZ similarly increased UOP when utilized as an adjunct to IV LD. These results suggest that while thiazide agents can substantially increase UOP in ADHF patients with HFrEF, MTZ and CTZ have comparable effects.

scholarly journals The serum angiotensin-converting enzyme 2 and angiotensin-(1-7) concentrations after optimal therapy for acute decompensated heart failure with reduced ejection fraction

2020 ◽  
Vol 40 (6) ◽  
Author(s):  
Shinji Hisatake ◽  
Shunsuke Kiuchi ◽  
Takayuki Kabuki ◽  
Takashi Oka ◽  
Shintaro Dobashi ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Angiotensin Converting Enzyme ◽  
Acute Decompensated Heart Failure ◽  
Decompensated Heart Failure ◽  
Converting Enzyme ◽  
Healthy Individuals ◽  
Reduced Ejection Fraction ◽  
Optimal Therapy ◽  
Significant Difference

Abstract Objective: Elucidation of the role of angiotensin-converting enzyme (ACE) 2 (ACE2)/angiotensin (Ang)-(1-7)/Mas receptor axis in heart failure is necessary. No previous study has reported serial changes in ACE2 and Ang-(1-7) concentrations after optimal therapy (OT) in acute heart failure (AHF) patients. We aimed to investigate serial changes in serum ACE2 and Ang-(1-7) concentrations after OT in AHF patients with reduced ejection fraction (EF). Methods: ACE2 and Ang-(1-7) concentrations were measured in 68 AHF patients with reduced EF immediately after admission and 1 and 3 months after OT. These parameters were compared with the healthy individuals at three time points. Results: In the acute phase, Ang-(1-7) and ACE2 concentrations was statistically significantly lower and higher in AHF patients than the healthy individuals (2.40 ± 1.11 vs. 3.1 ± 1.1 ng/ml, P&lt;0.005 and 7.45 ± 3.13 vs. 4.84 ± 2.25 ng/ml, P&lt;0.005), respectively. At 1 month after OT, Ang-(1-7) concentration remained lower in AHF patients than the healthy individuals (2.37 ± 1.63 vs. 3.1 ± 1.1 ng/ml, P&lt;0.05); however, there was no statistically significant difference in ACE2 concentration between AHF patients and the healthy individuals. At 3 months after OT, there were no statistically significant differences in Ang-(1-7) and ACE2 concentrations between AHF patients and the healthy individuals. Conclusion: ACE2 concentration was equivalent between AHF patients and the healthy individuals at 1 and 3 months after OT, and Ang-(1-7) concentration was equivalent at 3 months after OT.

Adverse cardiovascular outcome predicted by left atrial strain in acute decompensated heart failure

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
M Barki ◽  
M Losito ◽  
M Carrozzo ◽  
M.M Caracciolo ◽  
M Rovida ◽  
...  
Keyword(s):  
Heart Failure ◽  
Left Atrial ◽  
Acute Decompensated Heart Failure ◽  
Significant Proportion ◽  
Decompensated Heart Failure ◽  
Primary Role ◽  
Cox Regression Analysis ◽  
Coronary Syndrome ◽  
Non Invasive ◽  
B Lines

Abstract Background A significant proportion of patients hospitalized for acute decompensated heart failure (ADHF) are readmitted to the hospital within 30 days, resulting in a major social and economic burden. Thus, risk stratification and identification of targets of therapy is of basic importance. Non-invasive imaging modality such as transthoracic echocardiography (TTE) represents a cornerstone tool to approach this clinical scenario for early recognition of high-risk patients. Purpose To define whether left atrial (LA) dynamics, evaluated by means of speckle tracking echocardiography (STE), may represent a predictor of cardiac events and early re-hospitalization in patients admitted to the emergency department (ED) for ADHF, in comparison with other non-invasive established prognostic index in heart failure (HF) such as NT-proBNP, B-lines at lung ultrasonography (LUS) and right ventricular (RV) to Pulmonary Circulation (PC) uncoupling evaluated through Tricuspid Annular Plane Systolic Excursion (TAPSE)/Pulmonary Arterial Systolic Pressure (PASP) ratio. Methods Seventy patients (mean age 75.6±11 years, 57% males) presenting with ADHF were prospectively enrolled within 24–48 hours from admission. In the acute phase and at pre-discharge the following variables have been collected: NT-proBNP, B-lines, TAPSE/PASP ratio, Left Atrial Volume indexed (LAVi) and global-peak atrial longitudinal strain (G-PALS). Results During a median follow-up of nine months we observed 18 events consisting of 7 deaths, 8 re-hospitalizations for ADHF, 1 re-hospitalization for acute coronary syndrome, 1 stroke and 1 mitral valve replacement. Multivariate Cox-regression analysis identified LAVi and GPALS at discharge, along with NT-proBNP, B-lines and TAPSE/PASP ratio, as independent predictors of major adverse CV events (LAVi: p=0.04; GPALS: p=0.05; NT-proBNP: p&lt;0.001; B-lines: p=0.03; TAPSE/PASP: p&lt;0.001) (Table 1). Conclusions Short-term re-hospitalization in ADHF is crucial and the identification of a higher risk through sensitive and potentially new hemodynamic phenotypes is of relevance. Our findings, although preliminary, may suggest a primary role of LA dynamics in this context. Funding Acknowledgement Type of funding source: None

scholarly journals Gender disparities among hospitalised patients with acute myocardial infarction, acute decompensated heart failure or pneumonia: retrospective cohort study

BMJ Open ◽  
2019 ◽  
Vol 9 (1) ◽  
pp. e022782 ◽  
Author(s):  
Mouaz Alsawas ◽  
Zhen Wang ◽  
M Hassan Murad ◽  
Mohammed Yousufuddin
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Acute Myocardial Infarction ◽  
Cohort Study ◽  
Retrospective Cohort ◽  
Acute Decompensated Heart Failure ◽  
Decompensated Heart Failure ◽  
Men And Women ◽  
Hospitalised Patients ◽  
Significant Difference

ObjectiveTo assess gender disparity in outcomes among hospitalised patients with acute myocardial infarction (AMI), acute decompensated heart failure (ADHF) or pneumonia.DesignA retrospective cohort study.SettingA tertiary referral centre in Midwest, USA.ParticipantsWe evaluated 12 265 adult patients hospitalised with ADHF, 15 777 with AMI and 12 929 with pneumonia, from 1 January 1995 through 31 August 2015. Patients were selected using International Classification of Diseases, Ninth Revision, Clinical Modification codes.Primary and secondary outcome measuresPrevalence of comorbidities, 30-day mortality and 30-day readmission. Comorbidities were chosen from the 20 chronic conditions, specified by the Office of the Assistant Secretary for Health. Logistic regression analysis was conducted adjusting for multiple confounders.ResultsPrevalence of comorbidities was significantly different between men and women in all three conditions. After adjusting for age, length of stay, multicomorbidities and residence, there was no significant difference in 30-day mortality between men and women in AMI or ADHF, but men with pneumonia had slightly higher 30-day mortality with an OR of 1.19 (95% CI 1.06 to 1.34). There was no significant difference in 30-day readmission between men and women with AMI or pneumonia, but women with ADHF were slightly more likely to be readmitted within 30 days with OR 0.90 (95% CI 0.82 to 0.99).ConclusionGender differences in the distribution of comorbidities exist in patients hospitalised with AMI, ADHF and pneumonia. However, there is minimal clinically meaningful impact of these differences on outcomes. Efforts to address gender difference may need to be diverted towards targeting overall population health, reducing race/ethnicity disparity and improving access to care.

scholarly journals Medical management of decompensated heart failure in adult patients: Part 1: Definition and medical management

2020 ◽  
Vol 8 (36) ◽  
pp. 1-9
Author(s):  
Mohamed Elmassry ◽  
Rubayat Rahman ◽  
Pablo Paz ◽  
Barbara Mantilla ◽  
Scott Shurmur ◽  
...  
Keyword(s):  
Heart Failure ◽  
Chronic Heart Failure ◽  
Medical Management ◽  
Acute Decompensated Heart Failure ◽  
Heart Association ◽  
Decompensated Heart Failure ◽  
Fluid Restriction ◽  
Mortality And Morbidity ◽  
Randomized Controlled Clinical Trials ◽  
Definition Of

Acute decompensated heart failure (ADHF) is the leading cause of hospitalization in patients older than 65 years. It continues to increase in prevalence and is associated with significant mortality and morbidity including frequent hospitalizations. The American Heart Association is predicting that more than 8 million Americans will have heart failure by 2030 and that the total direct costs associated with the disease will rise from $21 billion in 2012 to $70 billion in 2030. The definition of ADHF has important limitations, and its management differs significantly from that of chronic heart failure. Although many large, randomized, controlled clinical trials have been conducted in patients with chronic heart failure, it was not until recently that more studies began to address the management of ADHF. The mainstay of ADHF management involves identification of precipitating factors, oxygen supplementation, sodium and fluid restriction, and diuresis. The phenomenon of diuretic resistance is a significant obstacle to relief of congestion and is a field of active investigation. Other important adjuncts to treatment include noninvasive ventilation, inotropes, vasopressors, nitrates, opiates, and vasopressin receptor antagonists. In this review, we will discuss the terminology and classification of ADHF, and review the multiple modalities and strategies available for the management of this disorder. Keywords: heart failure, medical management, complications, devices, palliative care

scholarly journals Impact of polypharmacy on prognosis in patients with acute decompensated heart failure: from the CURE-HF registry

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
M Kanai ◽  
H Motoki ◽  
T Okano ◽  
K Kimura ◽  
M Minamisawa ◽  
...  
Keyword(s):  
Heart Failure ◽  
Poor Prognosis ◽  
Acute Decompensated Heart Failure ◽  
Decompensated Heart Failure ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Study Cohort ◽  
Cardiac Events ◽  
Ventricular Ejection Fraction ◽  
Funding Sources

Abstract Background Polypharmacy would be associated with poor prognosis in patients with heart failure (HF). Methods In 863 patients who discharged after treatment for HF were prospectively enrolled. Number of tablets prescribed at discharge was counted. Death, non-fatal myocardial infarction, non-fatal stroke, and hospitalization for HF were tracked. Results In our study cohort (median age, 78), 447 patients experienced adverse events during median 503 days follow-up. In Kaplan-Meier analysis, a greater number of prescribed tablets was associated with future adverse cardiac events in the crude population. Although patients with the greater number of non-HF medications showed worse outcome, those of HF medications were not associate with the outcome (Figure). Furthermore, the number of tablets was an independent predictor of future cardiovascular events after adjustment for age, gender, B-type natriuretic peptide, hemoglobin, albumin, estimated glomerular filtration rate, and left ventricular ejection fraction (HR 95% CI: 1.295 (1.066–1.573), p=0.009). Conclusions Polypharmacy was associated with poor prognosis. Although the numbers of tablets and non-HF medications were significantly associated with worse out come in HF patients, the number of HF medications was not. FUNDunding Acknowledgement Type of funding sources: None.

Effect of Levosimendan on the short-term clinical efficacy of patients with acute decompensated heart failure

2021 ◽  
Vol 7 (6) ◽  
pp. 6572-6584
Author(s):  
Wang Huping ◽  
Wang Shidong ◽  
Rong A ◽  
Xie Xueliang
Keyword(s):  
Heart Failure ◽  
Heart Disease ◽  
Clinical Efficacy ◽  
Adverse Reactions ◽  
Heart Function ◽  
Acute Decompensated Heart Failure ◽  
Decompensated Heart Failure ◽  
Control Group ◽  
Clinical Effects ◽  
Significant Difference

OBJECTIVE To observe the effect of levosimendan on the clinical efficacy of patients with acute decompensated heart failure (ADHF). METHODS Collected 124 patients with acute decompensated heart failure who were admitted to the cardiology department of our hospital from October 2019 to October 2020. According to the random number table method, they were divided into control group and levosimendan group. The control group was given traditional anti-heart failure treatment, and the levosimendan group was added with levosimendan injection on the basis of the control group. The clinical efficacy indicators, functional indicators, incidence of adverse reactions, mortality during hospitalization, rehospitalization rates and combined endpoint events within 3 months of follow-up were compared before and after treatment. RESULT The results of clinical efficacy comparison showed that the number of significant effective number in the controlgroup was less than that of the levosimendan group, and there was no difference in the number of effective, ineffective and total effective groups; the improvement of dyspnea after treatment in the levosimendan group was better than that of the control group; cardiac color Doppler ultrasound LVEF in control group is higher than Levosimendan group, LVEDV and LVESV are lower than control group; The BNP control group was higher than the levosimendan group. There was no significant difference in renal function between the two groups.The urine output of the control group was less than that of the levosimendan group.There was no statistically significant difference in adverse reactions, rehospitalization rates within 3 months, and mortality between the two groups of patients, and the combined endpoint event (death or rehospitalization) was significantly lower than that of the control group. CONCLUSION Levosimendan in the treatment of patients with acute decompensated heart failure can achieve significant clinical effects, and effectively improve the patient's hemodynamic indicators and increase renal perfusion.With the deepening of the aging of the population in China, the incidence of decompensated heart failure in the elderly population is higher, which seriously affects the normal life. Acute decompensated heart failure (ADHF), a kind of heart disease, is a clinical syndrome characterized by dyspnea with sudden onset and rapid peak based on abnormal heart function (11. It is typical of the late stage of heart disease, usually on the basis of chronic heart failure. The disease is complex and difficult to treat. In addition, the mortality rate of patients is high [2], which endangers the health of patients and threatens their life safety, and is the key disease of current clinical attention. At present, drug therapy is mainly adopted in the clinical treatment to stabilize the hemodynamic level of patients. Clinical practice shows that it is not significantthe to adopt conventional symptomatic treatment effect/which demands a new effective treatment scheme. Levosimendan .a new type of positive inotropic drug, -can increase myocardial contractility and has significant effects in improving heart failure which will reduce mortality, improve the incidence of arrhythmia and bring hope to patients [3]. This study took 124 cases admitted to our hospital as the research object, and analyzed the therapeutic effect of levosimendan. The report are as follows.

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