P2599Echo color doppler evaluation of renal hemodynamic during acute heart failure

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
A Sacchi ◽  
M Galassi ◽  
F Brugioni ◽  
B Ricco' ◽  
F Lami ◽  
...  
Keyword(s):  
Heart Failure ◽  
Acute Heart Failure ◽  
Color Doppler ◽  
Diuretic Therapy ◽  
Systolic Pressure ◽  
Resistive Index ◽  
Kidney Injury ◽  
Pulmonary Artery Systolic Pressure ◽  
Venous Flow ◽  
Renal Hemodynamic

Abstract Background Acute heart failure (AHF) is often accompanied by impairment in renal function. A profound derangement of normal abdominal haemodynamic is always present during this clinical phase. Methods 14 patients (6 F – mean age 80 – mean EF 0.39) admitted for acute heart failure underwent cardiac and renal Echo Doppler examination at day 1-3-5 of Hospital stay. Parameters of arterial and venous flow within cortical right kidney were recorded. Venous Doppler Profile (VDP) was classified as: continuous (C), pulsatile (P), biphasic (B) or monophasic (M) according to the growing degree of derangement. Arterial resistive index (RI) >0.8 was considered elevated. Correlation between renal hemodynamic (and its changes) with biohumoral and echo parameters was sought. Outcome At day 1 VDP was M or B in 8 patients (57%) and in four (50%) of them dropped to C or P at day 5. RI was elevated in 8 patients at day 1 while only in 4 at day 5. VDP and RI were not related to EF or BNP values. One patient died before day 5, no other worsening heart failure episodes occurred. Two patients (14%) developed acute kidney injury but their VDP and RI were normal and did not change. Three patients (21%) did not improve their BNP (decrease >30%) but this was not associated with VDP or RI changes. Elevated derived pulmonary artery systolic pressure (>40 mmHg) was present in 6 out of 8 patients (75%) with M or B VDP and in all 4 patients with both elevated RI and M or B VDP. Venous Pattern Day 1 Day 3 Day 5 Continous 2 8 5 Pulsatile 4 2 4 Biphasic 2 1 2 Monophasic 6 3 2 Arterial RI >0.8 8 6 4 BNP, pg/ml 1060±1180* 372±281* 424±213* Creatinine, mg/dl 1.4±0.6 1.5±0.6 1.3±0.6 Hb, g/dl 12.1±2.3 12.3±3.6 13.2±2.3 *p>0.05. Conclusions This is the first study exploring changes in renal hemodynamic by echo Doppler during AHF. With respect to previous studies among stable patients, our preliminary data shows a higher proportion of deranged renal venous and/or arterial pattern. After diuretic therapy a trend towards improvement in VDP was recorded. No clear association with other clinical and hemodynamic parameters seems evident.

scholarly journals P675 ECHO COLOR DOPPLER EVALUATION OF SPLANCHNIC HEMODYNAMIC DURING ACUTE HEART FAILURE

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
B Ricco" ◽  
A Sacchi ◽  
A Galassi ◽  
R Messora ◽  
M Bertolotti ◽  
...  
Keyword(s):  
Heart Failure ◽  
Acute Heart Failure ◽  
Hepatic Vein ◽  
Color Doppler ◽  
Significant Proportion ◽  
Splenic Vein ◽  
Resistive Index ◽  
Abdominal Ultrasound ◽  
Venous Flow ◽  
Doppler Evaluation

Abstract BACKGROUND Acute heart failure (AHF) seems to provoke profound derangement of abdominal hemodynamic, which causes symptoms and impacts on renal function. METHODS 27 patients (10 F - age 78 - EF 0.39) admitted for AHF underwent cardiac and abdominal ultrasound at day 1 and 5. Arterial and venous flow within liver, spleen and kidney were recorded. Portal and Splenic Vein flow was described as continuous, pulsatile or reversed, whereas hepatic vein systolic and diastolic ratio was measured. Renal Venous Doppler Profile (VDP) was classified as: continuous, pulsatile, biphasic or monophasic. Arterial Resistive Index (RI) ≥0.7 was considered elevated. OUTCOME At day 1 most patients presented with some degree of deranged VDP and high RI in all examined organs. At day 5, a significant proportion of patients improved their VDP in Liver, Kidney and Spleen, while the percentage of patients with collapsing IVC did not significantly change. On the arterial side, the proportion of patients with high Hepatic RI dropped significantly. CONCLUSIONS Our preliminary data show that most deranged VDP in abdominal organs and Hepatic RI improve after decongestion despite a nonsignificant trend in improvement in IVC profile. RESULTS Classification day 1 day 5 p IVC Collapsing 24% 34% ns Portal Vein Continous 22% 50% Pulsatile 72% 50% Reversed 6% 0% <.05* Hepatic Vein S/D≥1 24% 59% S/D <1 60% 28% Reversed S 16% 14% <.05* Hepatic Artery RI ≥0.7 87% 36% <.05 Splenic Vein Flat 28% 57% Pulsatile 56% 33% Reversed 16% 10% <.05* Splenic Artery RI ≥ 0.7 52% 48% ns Renal Vein Continous 11% 39% Pulsatile/Biphasic 52% 52% Monophasic 37% 9% <.05* Renal Artery RI ≥0.7 63% 65% ns * Refers to normal profile versus all other deranged profiles

P5412Prevalence of RV failure assessed by echocardiography in acute dyspnoea cohort

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
K Cerlinskaite ◽  
J Bugaite ◽  
D Gabartaite ◽  
D Verikas ◽  
A Krivickiene ◽  
...  
Keyword(s):  
Heart Failure ◽  
Pulmonary Hypertension ◽  
Right Ventricle ◽  
Acute Heart Failure ◽  
Inferior Vena ◽  
Vena Cava ◽  
Systolic Pressure ◽  
Pulmonary Artery Systolic Pressure ◽  
Heart Failure Patients ◽  
Acute Dyspnoea

Abstract Introduction Recently more attention has been placed on right ventricle (RV) parameters in acute settings. The present study investigates echocardiographic RV parameters in patients with acute heart failure (AHF) or non-AHF acute dyspnoea. Purpose To determine the patterns of RV injury in different profiles of acute dyspnoea. Methods Prospective multicentre observational study included 1455 acutely dyspnoeic patients from 2015 to 2017. RV focused echocardiography was performed during the first 48 hours in 452 (31%) patients. They were compared in three patient profiles based on cause of dyspnoea and history of chronic HF (CHF): 1) AHF; 2) Non-AHF with CHF (Non-AHF+CHF); 3) other non-AHF patients (Non-AHF+other). Results Significant differences in RV morphology and function were observed in the study groups (Table 1). RV global function assessed by tricuspid annular plane systolic excursion (TAPSE) and RV longitudinal shortening was mostly affected in AHF patients. This was accompanied by more enlarged RV and increased right atrial pressure (RAP), assessed by the inferior vena cava diameter and respiratory collapse. Less severely impaired RV function and increased RAP were also observed in non-AHF+CHF patients indicating RV involvement in the chronic disease. Normal RV parameters dominated in Non-AHF+other group, however pulmonary artery systolic pressure >40 mmHg was observed in all profiles, suggesting similar severity of pulmonary hypertension in cardiac or pulmonary causes of acute dyspnoea. Table 1. RV parameters in acute dyspnoea profiles Parameter AHF (n=291) Non-AHF + CHF (n=73) Non-AHF + other (n=88) p value LVEF, % 38 [25–55] 50 [40–55] 55 [50–55] <0.001 RV basal diameter, cm 4.5 [3.9–5.2] 4 [3.5–4.5] 4 [3.5–4.55] <0.001 TAPSE, cm 1.5 [1.2–1.8] 1.8 [1.6–2] 2 [1.5–2.4] <0.001 RV free wall strain, -% −15.3 [−19; −11.24] −19.3 [−24.5; −15.78] −23 [−24.5; −19.69] <0.001 Entire RV strain, -% −12.03 [−15.17; −9.11] −16.4 [−19.31; −10.5] −18 [−18.75; −16.9] <0.001 PASP >40, % 66% 51% 50% 0.039 IVC diameter, cm 2.4 [2–2.8] 2 [1.7–2.4] 1.8 [1.4–2.3] <0.001 IVC collapse, % 34.9 [19.7–50.2] 44.1 [28.7–59.3] 52.6 [35–72.7] <0.001 LVEF, left ventricular ejection fraction; RV, right ventricle; TAPSE, tricuspid annular plane systolic excursion; PASP, pulmonary artery systolic pressure; IVC, inferior vena cava; AHF, acute heart failure; CHF, chronic heart failure. Conclusions Our data confirm more pronounced acute failure of right ventricle in acute heart failure patients than in chronic heart failure patients admitted due to other causes of dyspnoea. Pulmonary hypertension is present in a majority of the acute dyspnoea patients. Acknowledgement/Funding The work was supported by the Research Council of Lithuania, grant Nr. MIP-049/2015 and approved by Lithuanian Bioethics Committee, Nr. L-15-01.

scholarly journals Right ventricular function and its coupling with the pulmonary circulation in acute heart failure

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
M Barki ◽  
M Losito ◽  
M.M Caracciolo ◽  
F Bandera ◽  
M Rovida ◽  
...  
Keyword(s):  
Heart Failure ◽  
Acute Heart Failure ◽  
Acute Phase ◽  
Pulmonary Circulation ◽  
Heart Function ◽  
Systolic Pressure ◽  
Left Ventricular ◽  
Response To Treatment ◽  
The Right ◽  
B Lines

Abstract Background The right ventricle (RV) is extremely sensitive to hemodynamic changes and increased impedance. In acute heart failure (AHF), the development of pulmonary venous congestion and the increase of left ventricular (LV) filling pressures favors pulmonary vascular adverse remodeling and ultimately RV dysfunction, leading to the onset of symptoms and to a further decay of cardiac dynamics. Purpose The aim of the study was to evaluate RV morphology and functional dynamics at admission and discharge in patients hospitalized for AHF, analyzing the role and the response to treatment of the RV and its coupling with pulmonary circulation (PC). Methods Eighty-one AHF patients (mean age 75.75±10.6 years, 59% males) were prospectively enrolled within 24–48 hours from admission to the emergency department (ED). In either the acute phase and at pre-discharge all patients underwent M-Mode, 2-Dimensional and Doppler transthoracic echocardiography (TTE), as well as lung ultrasonography (LUS), to detect an increase of extravascular lung water (EVLW) and development of pleural effusion. Laboratory tests were performed in the acute phase and at pre-discharge including the evaluation of NT-proBNP. Results At baseline we observed a high prevalence of RV dysfunction as documented by a reduced RV systolic longitudinal function [mean tricuspid annular plane systolic excursion (TAPSE) at admission of 16.47±3.86 mm with 50% of the patients exhibiting a TAPSE&lt;16mm], a decreased DTI-derived tricuspid lateral annular systolic velocity (50% of the subjects showed a tricuspid s' wave&lt;10 cm/s) and a reduced RV fractional area change (mean FAC at admission of 36.4±14.6%). Furthermore, an increased pulmonary arterial systolic pressure (PASP) and a severe impairment in terms of RV coupling to PC was detected at initial evaluation (mean PASP at admission: 38.8±10.8 mmHg; average TAPSE/PASP at admission: 0.45±0.17 mm/mmHg). At pre-discharge a significant increment of TAPSE (16.47±3.86 mm vs. 17.45±3.88; p=0.05) and a reduction of PASP (38.8±10.8 mmHg vs. 30.5±9.6mmHg, p&lt;0.001) was observed. Furthermore, in the whole population we assisted to a significant improvement in terms of RV function and its coupling with PC as demonstrated by the significant increase of TAPSE/PASP ratio (TAPSE/PASP: 0.45±0.17 mm/mmHg vs 0.62±0.20 mm/mmHg; p&lt;0.001). Patients significantly reduced from admission to discharge the number of B-lines and NT-proBNP (B-lines: 22.2±17.1 vs. 6.5±5 p&lt;0.001; NT-proBNP: 8738±948 ng/l vs 4227±659 ng/l p&lt;0.001) (Figure 1). Nonetheless, no significant changes of left atrial and left ventricular dimensions and function were noted. Conclusions In AHF, development of congestion and EVLW significantly impact on the right heart function. Decongestion therapy is effective for restoring acute reversal of RV dysfunction, but the question remains on how to impact on the biological properties of the RV. Funding Acknowledgement Type of funding source: None

Tailoring diuretic therapy in acute heart failure: insight into early diuretic response predictors

2013 ◽  
Vol 102 (10) ◽  
pp. 745-753 ◽  
Author(s):  
João Pedro Ferreira ◽  
Mário Santos ◽  
Sofia Almeida ◽  
Irene Marques ◽  
Paulo Bettencourt ◽  
...  
Keyword(s):  
Heart Failure ◽  
Acute Heart Failure ◽  
Diuretic Therapy ◽  
Response Predictors ◽  
Diuretic Response ◽  
Insight Into

scholarly journals Polymorphism of the ITGAM gene (rs7193943) and bioelectric impedance analysis as potential predictors of cachexia in chronic heart failure

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Grzegorz Sobieszek ◽  
Radosław Mlak ◽  
Tomasz Powrózek ◽  
Marcin Mazurek ◽  
Aneta Skwarek-Dziekanowska ◽  
...  
Keyword(s):  
Heart Failure ◽  
Chronic Heart Failure ◽  
Systolic Pressure ◽  
Impedance Analysis ◽  
Severe Malnutrition ◽  
Pulmonary Artery Systolic Pressure ◽  
Integrin Subunit ◽  
Bioelectric Impedance Analysis ◽  
Cardiac Cachexia ◽  
Risk Of Death

AbstractCardiac cachexia (CC) is an unfavorable metabolic syndrome leading to exacerbation of chronic heart failure (CHF) and a higher risk of death. The main factor contributing to the development of cachexia is the ongoing inflammatory process mediated by genes (e.g. Integrin Subunit Alpha M—ITGAM). The study aimed to assess the relationship between a single nucleotide polymorphism (SNP) -323G > A of the ITGAM and the occurrence of nutritional disorders in patients with CHF. 157 CHF patients underwent clinical and nutritional screening. Body composition was evaluated by bioelectrical impedance analysis (BIA). Patients with cachexia were characterized by significantly lower weight, body mass index (BMI), lower fat mass (FM), albumin, and hemoglobin. Lower values of BIA parameters: capacitance of membrane (Cm), phase angle (PA), and impedance ratio (Z200/Z5) were noted in women. Those patients demonstrated significantly higher values of creatinine, c-reactive protein (CRP), N-terminal prohormone of brain natriuretic peptide (NT-proBNP), and pulmonary artery systolic pressure (PASP). A significantly higher risk of cachexia was reported in patients: aged ≥ 74 years (OR 3.55), with renal failure (OR 3.75), New York Heart Association classification (NYHA) III-IV (OR 2.83), with moderate or severe malnutrition according to the score of subjective global assessment (SGA) (OR 19.01) and AA genotype of ITGAM gene (OR 2.03). Determination of the -323G > A SNP in the ITGAM may prove to be a useful marker (after confirmation in further studies and appropriate validation) in the assessment of the risk of nutritional disorders in patients with CHF.

scholarly journals Insuficiencia renal aguda en adultos críticamente enfermos en dos instituciones hospitalarias

2019 ◽  
pp. 47-58
Author(s):  
Lina Lozano Lesmes ◽  
Natalia Andrea Quintero Guzmán ◽  
Jenny Lizeth Cuellar Devia ◽  
Edwin Alberto Torres García ◽  
Samuel Arias Valencia
Keyword(s):  
Heart Failure ◽  
Health Care ◽  
Acute Heart Failure ◽  
Kidney Failure ◽  
Statistical Significance ◽  
Kidney Injury ◽  
Acute Kidney Failure ◽  
Adult Intensive Care Unit ◽  
Health Care Institutions ◽  
Insuficiencia Cardiaca

Objetivo: Cuantificar la incidencia y los factores de exposición relacionados con el desarrollo de la insuficiencia renal aguda en pacientes hospitalizados en unidades de cuidados intensivos adulto durante tres meses. Materiales y métodos: se  realizó un estudio epidemiológico de tipo cuantitativo con dos componentes: descriptivo longitudinal y de cohorte histórica, se emplearon los criterios de AKIN, participaron dos instituciones de salud, una de orden privado y otra de orden público.  Resultados: Se incluyeron 186 pacientes, con una edad promedio de  56,2 +/- 20,14 años.  Se encontró una incidencia del 21,6 % (IC 95 % 17-30) de insuficiencia renal aguda y una tasa de incidencia de 29,2 por cada 100 pacientes año exposición. En promedio la elevación de creatinina fue 0,47 mg/dL y el gasto urinario de 0,37 cc/kg/h, los días en ocurrir el evento 3,1 (IC 95 % 2,48-3,74). Se encontró relación estadísticamente significativa entre insuficiencia cardíaca aguda 6,84 días (IC 95 % 4,21-9,48) (p=0,026),   posoperatorios 9,82 días (IC 95 % 8,42-11,2) (p=0,04) y trauma craneoencefálico 4,5 días (IC 95 % 1,56-7,44) (p=0,043) como causas de ingreso y la aparición de insuficiencia renal aguda Conclusiones:  La proporción de incidencia de insuficiencia renal aguda identificada en el presente estudio, es similar a estudios realizados en Colombia, sin embargo, difiere de otros realizados en el exterior. La sepsis fue el diagnóstico con mayor frecuencia entre los pacientes con insuficiencia renal aguda, seguido de la insuficiencia cardíaca aguda. Se encontró significancia estadística en el desarrollo de la insuficiencia renal aguda y la administración de nitroglicerina. Palabras clave: Enfermedad renal, Estudios Epidemiológicos, Cuidados Críticos, Adulto.    Acute kidney failure in critically ill adults from two health care institutions. Abstract Objective: To quantify the incidence and factors of exposure related to the development of acute kidney failure in hospitalized patients in the adult intensive care unit during three months. Materials and methods: An epidemiological study of quantitative type with two components was performed: descriptive longitudinal study and a retrospective cohort study, AKIN criteria were used, two health care institutions (one private and one public) participated. Results: 186 patients were included with an average age of 56.2 +/- 20,14 years. An incidence of 21.6% was found (IC 95 % 17-30) of acute kidney failure and a rate of incidence of 29.2 for every 100 patients / year of exposure. On average the creatinine elevation was of 0.47 mg/dL and the urine output was of 0.37 cc/kg/h, days of event occurrence 3.1 (IC 95 % 2.48-3.74). A significant statistical relationship was found between acute heart failure 6.84 days (IC 95% 4.21-9.48) (p=0.026), post-operatives 9.82 days (IC 95 % 8.42-11.2) (p=0.04) and traumatic brain injury 4.5 days (IC 95 % 1.56-7.44) (p=0.043), as causes of admission and appearance of acute kidney failure. Conclusions:  The incidence proportion of acute kidney failure identified in the present study, is similar to other studies performed in Colombia, however, it differs from studies performed in other countries. Sepsis was the most frequent diagnosis among patients with acute kidney failure, followed by acute heart failure. Statistical significance was found in the development of acute kidney failure and the intake of nitroglycerin. Keywords: Kidney failure, Epidemiological studies, Critical care, Adult.    Insuficiência renal aguda em adultos criticamente doentes em duas instituições hospitalares   Resumo Objetivo: Quantificar a incidência e os fatores de exposição relacionados com o desenvolvimento da Insuficiência Renal Aguda (IRA) em pacientes adultos hospitalizados em unidades de terapia intensiva durante três meses. Materiais e métodos: realizou-se um estudo epidemiológico de tipo quantitativo com dois componentes: descritivo longitudinal e de coorte histórica, empregaram-se os critérios de AKIN (Acute Kidney Injury Network), participaram duas instituições de saúde, uma de ordem privado e outra de ordem pública.  Resultados: Incluíram-se 186 pacientes, com uma idade média de 56,2 ± 20,14 anos. Encontrou-se uma incidência do 21,6 % (IC 95 % 17-30) de insuficiência renal aguda e uma taxa de incidência de 29,2 por cada 100 pacientes ano exposição. Em média a elevação de creatinina foi de 0,47 mg/dL e o gasto urinário de 0,37 cc/kg/h, os dias em ocorrer o evento 3,1 (IC 95 % 2,48-3,74). Encontrou-se relação estatisticamente significativa entre insuficiência cardíaca aguda (ICA) 6,84 dias (IC 95 % 4,21-9,48) (p=0,026),   pós-operatórios 9,82 dias (IC 95 % 8,42-11,2) (p=0,04) e traumatismo cranioencefálico (TCE) 4,5 dias (IC 95 % 1,56-7,44) (p=0,043) como causas de ingresso e a aparição de insuficiência renal aguda Conclusões:  A proporção de incidência de insuficiência renal aguda identificada no presente estudo, é similar a estudos realizados na Colômbia, no entanto, difere de outros realizados no exterior. A sepse foi o diagnóstico com maior frequência entre os pacientes com insuficiência renal aguda, seguido da insuficiência cardíaca aguda. Obteve-se significância estadística no desenvolvimento da insuficiência renal aguda e a administração de nitroglicerina. Palavras-chave: Adulto, Cuidados Críticos, Doença renal, Estudos Epidemiológicos. 

scholarly journals Prognostic value of biomarkers and co-morbidities in patients with acute heart failure: One-year follow-up study

2017 ◽  
Vol 145 (3-4) ◽  
pp. 118-123
Author(s):  
Dejan Petrovic ◽  
Marina Deljanin-Ilic ◽  
Sanja Stojanovic
Keyword(s):  
Heart Failure ◽  
Renal Failure ◽  
Chronic Renal Failure ◽  
Acute Heart Failure ◽  
Troponin I ◽  
Prognostic Significance ◽  
Systolic Pressure ◽  
High Sensitivity ◽  
Clinical Group ◽  
One Year

Introduction/Objective. Clinical risk stratification of patients hospitalized due to acute heart failure (AHF) applying B-type natriuretic peptide (BNP), troponin I (TnI), and high-sensitivity C-reactive protein (hsCRP) biochemical markers can contribute to early diagnosis of AHF and lower mortality rates. The aim of this study was to investigate the prognostic significance of biomarkers (BNP, TnI, and hsCRP) and co-morbidities concerning one-year mortality in patients with AHF. Methods. Clinical group comprised 124 consecutive unselected patients, age 60?80 years, treated at the Coronary Care Unit of the Niska Banja Institute, Nis. The patients were monitored for one year after the discharge. During the first 24 hours after admission, BNP, TnI, and hsCRP were measured in fasting serum. Results. Total one-year mortality was 29.8%. The levels of serum BNP were significantly higher in the group of non-survivors compared to the group of survivors (1353.8 ?} 507.8 vs. 718.4 ?} 387.6 pg/mL, p < 0.001). We identified several clinical and biochemical prognostic risk factors by univariate and multivariate analysis. Independent predictors of one-year mortality were the following: BNP, TnI, depression, hypotension, chronic renal failure, ejection fraction, and right-ventricle systolic pressure. Conclusion. The presence of BNP and TnI biomarkers and several co-morbidities such as depression or chronic renal failure have significant influence on one-year mortality in patients with AHF.

Abstract 13032: Resolution of Congestion Before Coronary Angiography in Acute Heart Failure is Associated With Reduced Risk of Contrast-induced Acute Kidney Injury

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Jonghanne Park ◽  
Jin Joo Park ◽  
Young-Jin Cho ◽  
Yeon-Yee Yoon ◽  
Il-Young Oh ◽  
...  
Keyword(s):  
Heart Failure ◽  
Acute Kidney Injury ◽  
Body Weight ◽  
Coronary Angiography ◽  
Acute Heart Failure ◽  
Kidney Injury ◽  
Renal Perfusion ◽  
Volume Status ◽  
Absolute Deviation ◽  
Reduced Risk

Objectives: We investigated the risk factors for contrast-induced acute kidney injury (CIAKI) after coronary angiography (CAG) in patients with acute heart failure (AHF), especially with regard to the volume status. Background: Heart failure is a well-known risk factor for CIAKI after CAG. In HF patients, renal perfusion decreases with systemic congestion. Thus, the standard prevention strategy with isotonic solution infusion may be inappropriate while decongestion may be beneficiary in AHF patients undergoing CAG. Deviation from dry body weight suggests imbalanced volume status. Methods: A total of 199 AHF patients who underwent CAG were eligible for the analysis. Absolute deviation of body weight (

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