P2624Association between renal dysfunction and cardiac sympathetic innervation in patients with heart failure

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
F Marsico ◽  
S Paolillo ◽  
P Gargiulo ◽  
I Esposito ◽  
S Dell'aversana ◽  
...  
Keyword(s):  
Heart Failure ◽  
Renal Function ◽  
Renal Dysfunction ◽  
Sympathetic Activity ◽  
Nyha Class ◽  
Sympathetic Innervation ◽  
Venous Blood ◽  
Left Ventricular ◽  
Washout Rate ◽  
Cardiac Sympathetic Innervation

Abstract Introduction In heart failure (HF) a strict interaction exists between heart and kidney. Previous studies reported a significant impact of sympathetic overdrive, that causes beta-adrenoceptor desensitization, in both renal and heart failure progression. It can be hypothesized that renal failure might be associated with impaired sympathetic activity assessed directly at the myocardial level in patients affected by HF. Purpose Aim of the present observational study was to assess the relationship between renal dysfunction and cardiac sympathetic innervation in HF patients with mildly and severely reduced ejection fraction (HFrEF and HFmEF). Methods Two-hundred and sixty-three patients (84% males; 66±10.8 years) with mild-to-severe HF (EF 31±6.8%) underwent iodine-123 meta-iodobenzylguanidine (123I-MIBG) myocardial scintigraphy to assess sympathetic innervation, evaluating early and late heart to mediastinum (H/M) ratios and washout rate. All patients also underwent clinical evaluation and venous blood sample collection for the assessment of serum creatinine and consequently the estimation of glomerular filtration rate (eGFR) by EPI formula. Results A direct correlation was found between EPI-eGFR and late H/M (r=0,215; p<0.001) (figure 1), with an inverse correlation between NYHA class and late H/M (r=0,152; p=0.013), and a direct correlation between left ventricular EF and late H/M (r=0,348; p<0.001). These results were not confirmed for early H/M, nor washout rate. Dividing the population in reduced eGFR and normal eGFR (cut-off ≤60 ml/min/1,73m2), a statistical significant reduction of late H/M value was found in patients with reduced eGFR (late H/M = 1,49±0,21) compared with patients with preserved eGFR (late H/M = 1,56±0,26) (p=0.020). In a multivariate model, adjusting eGFR for NYHA class and left ventricular EF, reduced eGFR and left ventricular EF remained significant predictors of reduced late H/M (p=0.006 and p<0.001, respectively). Figure 1. linear regression curve Conclusions Patients with impaired renal function and HF show impaired cardiac sympathetic activity compared to HF patients with preserved renal function, and reduced eGFR estimated by EPI formula is a significant predictor of reduced late H/M evaluated by 123I-MIBG. Thus, in future studies, the combination of these two parameters might provide addictive prognostic information in HF patients.

Abstract 16875: Cystatin C- versus Creatinine- Based Assessment of Renal Function in Patients Admitted With Heart Failure: Insights From DOSE, ROSE and CARRESS-HF

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Yu Chiang Wang ◽  
Alberto Pinsino ◽  
Lorenzo Braghieri ◽  
Li Pang ◽  
Matteo Fabbri ◽  
...  
Keyword(s):  
Heart Failure ◽  
Renal Function ◽  
Renal Dysfunction ◽  
Muscle Mass ◽  
Cystatin C ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Time Points ◽  
Subsequent Time

Introduction: Serum creatinine (sCr) is routinely used to calculate estimated glomerular filtration rate (eGFR) in heart failure (HF) pts. However, changes in muscle mass may limit the accuracy of sCr as marker of renal function in this population. Cystatin C (CysC) is independent of muscle mass and provides an alternative measure of eGFR. In prior studies, higher sCr/CysC ratio has been associated with higher muscle mass. Herein, we compared CysC- and sCr-based eGFR at serial time points among pts admitted with HF. We hypothesized that muscle mass would decline during HF admission and this would result in a decrease of sCr/CysC ratio. Methods: We pooled pts from 3 trials performed in pts admitted with HF (DOSE, ROSE and CARRESS-HF). eGFR was calculated using CKD-EPI-CysC equation (eGFRCysC) and sCr-based MDRD equation (eGFRsCr). The relative difference between eGFRCysC and eGFRsCr (ΔeGFR) was calculated as follows: (eGFRCysC-eGFRsCr)/ eGFRsCr. To control for confounders, we analyzed changes in sCr/CysC ratio and in ΔeGFR among pts with samples available at both admission and a subsequent time point. Results: A total of 2849 samples were available in 841 pts (age 68 ± 13, 26% female, left ventricular ejection fraction 36 ± 17%). Compared with eGFRsCr, eGFRCysC reclassified 50% of the samples to different GFR categories, mainly to more advanced renal dysfunction (Fig. A). eGFRCysC was significantly lower than eGFRsCr at all time points (Fig. B). From time of admission to all subsequent time points, sCr/CysC ratio declined while ΔeGFR widened (all p-values<0.001). At time of enrollment in CARRESS-HF, each additional day of HF admission was associated with a decline in sCr/CysC ratio of 1.5% (p=0.04). Conclusions: The use of CysC reclassifies a large proportion of pts admitted with HF to more advanced renal dysfunction when compared to sCr-based assessment. The discrepancy between CysC- and sCr-based eGFR appears to widen during HF admission, likely due to muscle mass wasting.

scholarly journals SCINTIGRAPHY WITH 123I-METAIODBENZILGUANIDINE IN EVALUATION OF SYMPATHETIC INNERVATION OF THE LEFT VENTRICULAR IN PATIENTS WITH CORONARY HEART DISEASE AND ATRIAL FIBRILLATION

2014 ◽  
Vol 13 (1) ◽  
pp. 103-109 ◽  
Author(s):  
Yu. B. Lishmanov ◽  
S. M. Minin ◽  
I. Yu. Yefimova ◽  
Yu. V. Saushkina ◽  
I. V. Kisteneva
Keyword(s):  
Atrial Fibrillation ◽  
Sympathetic Activity ◽  
Sympathetic Innervation ◽  
Suspected Coronary Artery Disease ◽  
Left Ventricular ◽  
Washout Rate ◽  
Planar Imaging ◽  
Delayed Imaging ◽  
Group 2 ◽  
Initial Imaging

The aim of this study was assessment of cardiac sympathetic activity in patients with atrial fibrillation by planar scintigraphy with 123I-metaIodbenzilguanidine (123I-MIBG).Material and Methods. The study included 28 (average age (57.4 ± 11.6) years) patients with suspected coronary artery disease. All patients to divide 3 groups: 13 patients (group 1) with paroxysmal AF (PAF),6 patients (group 2) with long-standing persistent AF (LSPAF) and 10 patients with no signs of AF (group 3).Planar imaging was performed to study initial (imaging started 20 minutes after MIBG injection 148 MBq 123I-MIBG) and delayed (imaging started 4 hours after 123I-MIBG injection). For the anterior planar 123I-MIBG images, regions of interest were constructed for the heart and upper mediastinum, and the heart-mediastinal ratio (HMR).Results. The delayed HMR in patients with PAF and LSPAF was significantly lower compared that in patients third group (1.59 ± 0.16, 1.54 ± 0.17 and 1.82 ± 0.11 respectively, p < 0.05). The washout rate of 123I-MIBG in patients with PAF and LSPAF was significantly highest compared that in patients with no signs of AF (33.4 ± 17.5, 29 ± 11.7 and 17.2 ± 9.6 respectively, p < 0.05). In assessment of regional sympathetic activity in patients with LSPAF defect accumulation 123I-MIBG in both the early and delayed scintigrams was significantly higher compared with groups of patients with PAF and without AF.Results of this study indicated, that the patients with atrial fibrillation has of regional LV myocardial changes, according with 123I-MIBG imaging. More sympathetic innervation abnormality was observed in patients with long-standing persistent AF.

Renal Dysfunction - a Possible Marker of Severity of Heart Failure

2018 ◽  
Vol 69 (6) ◽  
pp. 1435-1440
Author(s):  
Mirela Zaharie ◽  
Doina Carstea ◽  
Costin Teodor Streba ◽  
Paul Mitrut ◽  
Adina Dorina Glodeanu ◽  
...  
Keyword(s):  
Heart Failure ◽  
Renal Dysfunction ◽  
Nyha Class ◽  
Clinical Status ◽  
Left Ventricular ◽  
Functional Class ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
The Mean ◽  
Prevalence Of Diabetes Mellitus

Heart failure (HF) and renal dysfunction are frequent associated in the same patient. The purpose of our study was to assess the prevalence of renal dysfunction and the clinical status in admitted patients for decompensated HF. Material and Methods. 397 patients succesively hospitalized for decompensated HF, NYHA III or IV functional class, with left ventricular ejection fraction (LVEF) � 45% were included in the study. Renal dysfunction was defined by glomerular filtration rate (GFR) [ 60 mL/min/1.73 m 2. The mean GFR in patients with HF was 63.89 � 21.5 mL/min/1.73 m2 .The prevalence of renal dysfunction was 49.6%. Patients with GFR [ 60 mL/min/1.73m2, compared with those with preserved renal function were significantly more frequent older (75.37 � 6.84 vs. 71.33 � 8.08 years; p [0.001), females (53,8% vs. 43.5%; p = 0.04), had a significantly higher prevalence of diabetes mellitus (50.2% vs. 28.5%; p [0.001), atrial fibrillation (53.8% vs 46.2%, p = 0.04) and anemia (47.7% vs. 29.5% ; p [0.001). Also, patients with renal dysfunction had more severe HF than those without renal dysfunction (NYHA class IV: 65% vs 45%, p [0.001, clinical congestion: 78.2% vs 68%, p = 0.02, LVEF [35%: 47.21% vs � 35%, p [0.001). Renal dysfunction can be considered an additional marker of severe cardiac dysfunction along with NYHA IV class and low LVEF. The presence of both renal dysfunction and anemia could represent prognostic markers in HF patients with reduced LVEF.

scholarly journals Prevalence of renal dysfunction and its influence on functional capacity in elderly patients with stable chronic heart failure

2012 ◽  
Vol 69 (10) ◽  
pp. 840-845 ◽  
Author(s):  
Dragana Stanojevic ◽  
Svetlana Apostolovic ◽  
Ruzica Jankovic-Tomasevic ◽  
Sonja Salinger-Martinovic ◽  
Milan Pavlovic ◽  
...  
Keyword(s):  
Heart Failure ◽  
Chronic Heart Failure ◽  
Renal Dysfunction ◽  
Functional Capacity ◽  
Exercise Tolerance ◽  
Nyha Class ◽  
The Elderly ◽  
Left Ventricular ◽  
Walking Distance ◽  
Left Ventricular Ejection

Bacground/Aim. Chronic heart failure (CHF) is highly prevalent and constitutes an important public health problem around the world. In spite of a large number of pharmacological agents that successfully decrease mortality in CHF, the effects on exercise tolerance and quality of life are modest. Renal dysfunction is extremely common in patients with CHF and it is strongly related not only to increased mortality and morbidity but to a significant decrease in exercise tolerance, as well. The aim of our study was to investigate the prevalence and influence of the renal dysfunction on functional capacity in the elderly CHF patients. Methods. We included 127 patients aged over 65 years in a stable phase of CHF. The diagnosis of heart failure was based on the latest diagnostic principles of the European Society of Cardiology. The estimated glomerular filtration rate (eGRF) was determined by the abbreviated Modification of Diet in Renal Disease (MDRD2) formula, and patients were categorized using the Kidney Disease Outcomes Quality Initiative (K/DOQI) classification system. Functional capacity was determined by the 6 minute walking test (6MWT). Results. Among 127 patients, 90 were men. The average age was 72.5 ? 4.99 years and left ventricular ejection fraction (LVEF) was 40.22 ? 9.89%. The average duration of CHF was 3.79 ? 4.84 years. Ninty three (73.2%) patients were in New York Heart Association (NYHA) class II and 34 (26.8%) in NYHA class III. Normal renal function (eGFR ? 90 mL/min) had 8.9% of participants, 57.8% had eGFR between 60-89 mL/min (stage 2 or mild reduction in GFR according to K/DOQI classification), 32.2% had eGFR between 30-59 mL/min (stage 3 or moderate reduction in GFR) and 1.1% had eGFR between 15-29 mL/min (stage 4 or severe reduction in GFR). We found statistically significant correlation between eGFR and 6 minute walking distance (6MWD) (r = 0.390, p < 0.001), LVEF (r = 0.268, p < 0.05), NYHA class (? = -0.269, p < 0.05) and age (r = - 0.214, p < 0.05). In multiple regression analysis only patients? age was a predictor of decreased 6MWD < 300 m (OR = 0.8736, CI = 0.7804 - 0.9781, p < 0.05). Conclusion. Renal dysfunction is highly prevalent in the elderly CHF patients. It is associated with decreased functional capacity and therefore with poor prognosis. This study corroborates the use of eGFR not only as a powerful predictor of mortality in CHF, but also as an indicator of the functional capacity of cardiopulmonary system. However, clinicians underestimate a serial measurement of eGFR while it should be the part of a routine evaluation performed in every patient with CHF, particularly in the elderly population.

scholarly journals MO446THE ASSOCIATION BETWEEN RENAL FUNCTION AND LEFT VENTRICULAR DIASTOLIC DYSFUNCTION AND HEART FAILURE WITH PRESERVED EJECTION FRACTION

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Robin Vernooij ◽  
Anne-Mar Van Ommen ◽  
Frans Rutten ◽  
Marianne Verhaar ◽  
Michiel Bots ◽  
...  
Keyword(s):  
Heart Failure ◽  
Cardiovascular Disease ◽  
Renal Function ◽  
Ejection Fraction ◽  
Renal Dysfunction ◽  
Left Ventricular Diastolic Dysfunction ◽  
Left Ventricular ◽  
Preserved Ejection Fraction ◽  
Lifestyle Risk Factors ◽  
Lifestyle Risk

Abstract Background and Aims Impaired kidney function increase the risk of cardiovascular disease. However, it remains unclear whether this crosstalk between organs already exists at early stages in the disease trajectory and whether this risk varies with age and other factors. We aim to investigate the association between renal dysfunction and early structural and functional cardiac abnormalities in a cohort of participants referred to a cardiology outpatient department. Method We included participants from HELPFul (i.e. HEart failure with Preserved ejection Fraction in patients at risk for cardiovascular disease), a case-cohort study at Dutch cardiology outpatient clinics, who were aged 45 years and older without history of cardiovascular disease. A random sample of participants enriched with cases (defined as an early filling (E) to early diastolic mitral annular velocity (e’) (E/e’) ratio of ≥8 measured with echocardiography) was included in our study. Routine care measurements, including echocardiography and laboratory testing at the outpatient clinic were collected for all participants. An expert panel decided on presence or absence of heart failure with preserved ejection fraction (HFpEF), and left ventricular diastolic dysfunction (LVDD), guided by available international guidelines. The association between renal function, in terms of estimated glomerular filtration rate (eGFR) categories, and diagnosis of HFpEF and LVDD was assessed with multivariable logistic regression analyses, adjusted for cardiovascular and lifestyle risk factors. The association between renal function, in terms of creatinine and cystatin C levels, and echocardiographic parameters, including E/e’ ratio, LAVI (Left atrial volume index), LVMI (left ventricular mass index), and E/A (early (E) to late (A) ventricular filling ratio, was assessed with multivariable linear regression analyses, adjusted for age, sex, cardiovascular and lifestyle risk factors. Adjusted odds ratios (OR) were reported and the corresponding 95% confidence interval (95%CI). Results 777 participants were included, mean age 62.9 (SD: 9.3) years, 67.3% were female. Hundred and fifty-six (20.1%) participants had mild renal dysfunction (eGFR: 60-89 ml/min/1.73 m2), and 24 (3.1%) moderate renal dysfunction (eGFR: 30-59 ml/min/1.73 m2). HFpEF and LVDD was more common in participants with moderate renal dysfunction (13% and 33%, respectively) than in those with normal renal function (6% and 16%, respectively). In the multivariable regression model. participants with both mild and moderate renal dysfunction had a higher likelihood of being diagnosed with HFpEF (OR: 2.82, 95%CI: 1.32 to 5.91; and OR: 5.37, 95%CI: 1.11 to 19.88, respectively), LVDD (OR: 2.08, 95%CI: 1.28 to 3.36; and OR: 2.92, 95%CI: 1.04 to 7.55, respectively), compared with participants with a normal renal function. However, no significant association between creatinine or cystatin C with E/e’, LAVI, LVMI, and E/A ratio was found after adjustment for age, sex, and cardiovascular risk and lifestyle factors. Conclusion Mild renal dysfunction is related to both LVDD and HFpEF, however, this might be partly explained by a higher age in patients with renal dysfunction. Further studies are warranted to determine if preventive cardiac treatment in patients with early renal dysfunction will benefit clinical outcomes.

scholarly journals CARDIAC SYMPATHETIC ACTIVITY, MYOCARDIAL PERFUSION AND HEART CONTRACTILITY IN PATIENTS WITH ISCHAEMIC AND NON-ISCHAEMIC HEART FAILURE

2018 ◽  
Vol 33 (2) ◽  
pp. 35-41
Author(s):  
A. I. Mishkina ◽  
K. V. Zavadovskiy ◽  
M. O. Gulya ◽  
V. V. Saushkin ◽  
D. I. Lebedev ◽  
...  
Keyword(s):  
Heart Failure ◽  
Myocardial Perfusion ◽  
Ejection Fraction ◽  
Sympathetic Activity ◽  
Left Ventricular ◽  
Washout Rate ◽  
Ventricular Ejection Fraction ◽  
Cardiac Sympathetic Activity ◽  
Heart Failure Patients ◽  
Heart To Mediastinum Ratio

Purpose:to assess the cardiac sympathetic activity, perfusion and contractility in ischemic and nonischemic chronic heart failure patients by using a radionuclide methods.Material and Methods.The study included 33 heart failure patients with NYHA class III and ischemic (n=13.39%) and non-ischemic (n=20.61%) heart failure. All patients underwent123I-MIBG imaging, myocardial perfusion imaging with  99mTc-MIBI and gated blood-pool single-photon emission computed tomography. Based on123I-MIBG study heart to mediastinum ratio as well as123I-MIBG washout rate were calculated. According to the myocardial perfusion imaging, Summed Rest Score was evaluated. Systolic and diastolic functions and ejection fraction as well as mechanical intraventricular dyssynchrony of both ventricles were analyzed by gated blood-pool single-photon emission computed tomography.Results.There was no statistically significant difference of hemodynamic parameters between the groups. In the first group, which include patients with ischemic heart failure, there were found the following correlations: washout rate and left ventricular end-diastolic volume (0.75; p<0.05), washout rate and left ventricular end-systolic volume (0.68; p<0.05), heart to mediastinum ratio and right ventricular ejection fraction (–0.57; p<0.05). In the group of patients with non-ischemic heart failure there were the following correlation: heart to mediastinum ratio and left ventricular end-systolic volume (–0.77; p<0.05), heart to mediastinum ratio and left ventricular ejection fraction (0.77, p<0.05), heart to mediastinum ratio and right ventricular ejection fraction (0.62, p<0.05), washout rate and left ventricular interventricular dyssynchrony (0.6; p<0.05).Conclusion.It was found out that heart failure patients were characterized by a correlation between sympathetic activity and volumes, hemodynamics and contractility of heart ventricles. The relationship between the cardiac sympathetic activity and myocardial perfusion as well as contractility depend on the etiology of chronic heart failure.

Prognostic significance of cardiac sympathetic innervation and contractility in heart failure patients submitted to cardiac resynchronization therapy

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
A Mishkina ◽  
K.V Zavadovsky ◽  
V.V Saushkin ◽  
D.I Lebedev ◽  
Y.U.B Lishmanov
Keyword(s):  
Heart Failure ◽  
Sympathetic Activity ◽  
Sympathetic Innervation ◽  
Cardiac Resynchronization ◽  
Resynchronization Therapy ◽  
Cardiac Sympathetic Activity ◽  
Cardiac Sympathetic Innervation ◽  
Heart Failure Patients ◽  
Lv Dyssynchrony ◽  
Crt Response

Abstract Introduction In chronic heart failure patients, cardiac resynchronization therapy (CRT) does not lead to the expected result in 30% of cases. There is a lack of prognostic data related to the cardiac sympathetic activity and contractility assessment in ischemic (IHF) and non-ischemic (CHF) heart failure patients. Purpose To assess the prognostic value of radionuclide cardiac sympathetic innervation and contractility assessment in IHF and NIHF patients submitted to CRT. Methods This study included 38 HF patients (24 male; mean age of 56±11 years), who were submitted to CRT: NYHA class II/III (n=10/28), mean QRS=159.3±17.9ms. The etiology of HF was ischemic in 16 patients and non-ischemic in 22 of them. Before CRT all patients underwent 123I-metaiodobenzylguanidine (123I-MIBG) imaging for cardiac sympathetic activity evaluating. The following indexes were estimated: early and delayed heart to mediastinum ratio (eH/M and dH/M), summed MIBG Score (eSMS and dSMS). Moreover all patients underwent gated myocardial perfusion scintigraphy with the assessments of LV dyssynchrony indexes: standard deviation (SD) and histogram bandwidth (HBW). In addition, all patients underwent gated blood-pool SPECT with both ventricles ejection fraction (EF) and stroke volume (SV) assessment. Results One year after CRT all patients were divided into two groups: responders (IHF group n=11; NIHF group n=15) and non-responders (IHF group n=5; NIHF group n=7). Among baseline scintigraphic parameters the following ones showed significant differences between responders vs. non-responders. In IHF patients - HBW: 162 (115.2–180) degree vs. 115.2 (79.2–136.8) degree, p&lt;0.05; RV_EF: 54.5 (41–56)% vs. 44.5 (37–49.5)%, p&lt;0.05; RV_SV: 80 (69–101)ml vs. 55.5 (50–72.5)ml, p&lt;0.05. In group of NIHF patients responders and non-responders were significantly differed in the following preoperative parameters: eH/M: 2.27 (2.02–2.41) vs. 1.64 (1.32–2.16), p&lt;0.05; dH/M: 2.18 (2.11–2.19) vs. 1.45 (1.23–1.61), p&lt;0.05; eSMS: 7 (5–7) vs. 15.5 (10–28.5), p&lt;0.05; dSMS: 10 (10–13) vs. 16.5 (15.5–29), p&lt;0.05, SD: 54.3 (43–58) degree vs. 65 (62–66) degree, p&lt;0.05; HBW: 179.5 (140–198) degree vs. 211 (208–213) degree, p&lt;0.05. Univariate logistic regression in IHF patients showed that LV dyssynchrony indexes – SD (OR=1.55; 95% CI 1.09–2.2; p&lt;0.5) and HBW (OR=1.13; 95% CI 1.02–1.24; p&lt;0.5), as well as RV indexes – RV_EF (OR=1.11; 95% CI 1.001–1.23; p&lt;0.5), RV_SV (OR=1.07; 95% CI 1.003–1.138; p&lt;0.5) were predictors of CRT response. In the group of NIHF patients, dH/M (OR=1.47; 95% CI 1.08–2; p&lt;0.5), SD (OR=0.83; 95% CI 0.73–0.95; p&lt;0.5), HBW (OR=0.96; 95% CI 0.93–0.99; p&lt;0.5) showed the predictive value in terms of CRT response. Conclusion(s) The positive response to CRT in IHF patients showed a link with LV dyssynchrony and preserved RV contractility. Whereas in NIHF patients the functional state of cardiac sympathetic activity, as well as LV dyssynchrony, were associated with CRT response. Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): Russian Foundation for Basic Research

scholarly journals Renal Function in Relation to Cardiac 123I-MIBG Scintigraphy in Patients with Chronic Heart Failure

2012 ◽  
Vol 2012 ◽  
pp. 1-8 ◽  
Author(s):  
Derk O. Verschure ◽  
G. Aernout Somsen ◽  
Berthe L. F. van Eck-Smit ◽  
Hein J. Verberne
Keyword(s):  
Heart Failure ◽  
Renal Function ◽  
Chronic Heart Failure ◽  
Cardiac Death ◽  
Sympathetic Innervation ◽  
Myocardial Uptake ◽  
Mibg Scintigraphy ◽  
Chi Square ◽  
Cardiac Sympathetic Innervation ◽  
Cox Proportional Hazard Regression

The aim of this study was to explore if estimates of renal function could explain variability of 123I-metaiodobenzylguanidine (123I-MIBG) assessed myocardial sympathetic activity. Furthermore estimates of renal function were compared to 123I-MIBG as predictors of cardiac death in chronic heart failure (CHF). Semi-quantitative parameters of 123I-MIBG myocardial uptake and washout were calculated using early heart/mediastinum ratio (H/M), late H/M and washout. Renal function was calculated as estimated Creatinine Clearance (e-CC) and as estimated Glomerular Filtration Rate (e-GFR). Thirty-nine patients with CHF (24 males; age: 64.4±10.5 years; NYHA II/III/IV: 17/20/2; LVEF: 24.0±11.5%) were studied. Variability in any of the semi-quantitative 123I-MIBG myocardial parameters could not be explained by e-CC or e-GFR. During follow-up (60±37 months) there were 6 cardiac deaths. Cox proportional hazard regression analysis showed that late H/M was the only independent predictor for cardiac death (Chi-square 3.2, regression coefficient: −4.095; standard error: 2.063; hazard ratio: 0.17 [95% CI: 0.000–0.950]). Addition of estimates of renal function did not significantly change the Chi-square of the model. Semi-quantitative 123I-MIBG myocardial parameters are independent of estimates of renal function. In addition, cardiac sympathetic innervation assessed by 123I-MIBG scintigraphy seems to be superior to renal function in the prediction of cardiac death in CHF patients.

Direct Myocardial Implantation of Human Fetal Stem Cells in Heart Failure Patients: Long-term Results

2010 ◽  
Vol 13 (1) ◽  
pp. 31 ◽  
Author(s):  
Federico Benetti ◽  
Ernesto Pe�herrera ◽  
Teodoro Maldonado ◽  
Yan Duarte Vera ◽  
Valvanur Subramanian ◽  
...  
Keyword(s):  
Heart Failure ◽  
Stem Cells ◽  
Cardiac Function ◽  
Nyha Class ◽  
Left Ventricular ◽  
Long Term Results ◽  
Walk Test ◽  
The Mean ◽  
6 Minute Walk Test ◽  
Minute Walk

Background: End-stage heart failure (HF) is refractory to current standard medical therapy, and the number of donor hearts is insufficient to meet the demand for transplantation. Recent studies suggest autologous stem cell therapy may regenerate cardiomyocytes, stimulate neovascularization, and improve cardiac function and clinical status. Although human fetal-derived stem cells (HFDSCs) have been studied for the treatment of a variety of conditions, no clinical studies have been reported to date on their use in treating HF. We sought to determine the efficacy and safety of HFDSC treatment in HF patients.Methods and Results: Direct myocardial transplantation of HFDSCs by open-chest surgical procedure was performed in 10 patients with HF due to nonischemic, nonchagasic dilated cardiomyopathy. Before and after the procedure, and with no changes in their preoperative doses of medications (digoxin, furosemide, spironolactone, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, betablockers), patients were assessed for New York Heart Association (NYHA) class, performance in the exercise tolerance test (ETT), ejection fraction (EF), left ventricular end-diastolic dimension (LVEDD) via transthoracic echocardiography, performance in the 6-minute walk test, and performance in the Minnesota congestive HF test. All 10 patients survived the operation. One patient had a stroke 3 days after the procedure, and although she later recovered, she was unable to perform the follow-up tests. Another male patient experienced pericardial effusion 3 weeks after the procedure. Although it resolved spontaneously, the patient abandoned his control tests and died 5 months after the procedure. An autopsy of the myocardium suggested that new young cells were present in the cardiomyocyte mix. At 40 months, the mean (SD) NYHA class decreased from 3.4 0.5 to 1.33 0.5 (P = .001); the mean EF increased 31%, from 26.6% 4% to 34.8% 7.2% (P = .005); and the mean ETT increased 291.3%, from 4.25 minutes to 16.63 minutes (128.9% increase in metabolic equivalents, from 2.46 to 5.63) (P < .0001); the mean LVEDD decreased 15%, from 6.85 0.6 cm to 5.80 0.58 cm (P < .001); mean performance in the 6-minute walk test increased by 43.2%, from 251 113.1 seconds to 360 0 seconds (P = .01); the mean distance increased 64.4%, from 284.4 144.9 m to 468.2 89.8 m (P = .004); and the mean result in the Minnesota test decreased from 71 27.3 to 6 5.9 (P < .001).Conclusion: Although these initial findings suggest direct myocardial implantation of HFDSCs is feasible and improves cardiac function in HF patients at 40 months, more clinical research is required to confirm these observations.

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