scholarly journals 348 Uric acid is associated with acute heart failure and cardiogenic shock at presentation in acute coronary syndrome patients

2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Alessandro Maloberti ◽  
Paola Rebora ◽  
Marco Centola ◽  
Nuccia Morici ◽  
Alice Sacco ◽  
...  
Keyword(s):  
Heart Failure ◽  
Uric Acid ◽  
Cardiogenic Shock ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Cross Sectional ◽  
Ventricular Ejection Fraction ◽  
Coronary Syndrome ◽  
Non Invasive Ventilation ◽  
Coronary Syndromes

Abstract Aims we focused on the role of Uric Acid (UA) as a possible determinant of Heart Failure (HF) related issues in Acute Coronary Syndromes (ACS) patients. Main outcome were acute HF and cardiogenic shock at admission, secondary outcomes were the need of Non Invasive Ventilation (NIV) use and the admission Left Ventricular Ejection Fraction (LVEF). Methods and results we consecutively enrolled 1269 ACS patients admitted to the cardiological Intensive Care Unit of the Niguarda and San Paolo hospitals (Milan, Italy) from June 2016 to June 2019. Hyperuricaemia was defined as a value higher than 6 mg/dl for females and 7 mg/dl for males. All the evaluated outcomes occurred more frequently in the hyperuricemic subjects (n = 292): acute HF 35.8 vs. 11.1% (P < 0.0001), cardiogenic shock 10 vs. 3.1% (P < 0.0001), NIV 24.1 vs. 5.1% (P < 0.0001) with lower admission LVEF (42.9 ± 12.8 vs. 49.6 ± 9.9, P < 0.0001). By multivariable analyses, UA was confirmed to be significantly associated with all the outcomes with the following odds ratio (OR): acute HF OR = 1.119; 95% CI: 1.019–1.229; cardiogenic shock OR = 1.157; 95% CI: 1.001–1.337; NIV use OR = 1.208; 95% CI: 1.078–1.354; LVEF β = −0.999; 95% CI: −1.413 to − 0.586. Conclusions The main result of our study was the finding of a significant association between UA and acute HF, cardiogenic shock, NIV use and LVEF. Due to the cross-sectional nature of our study no definite answer on the direction of these relationship can be drawn and further longitudinal study on UA changes over time during an ACS hospitalization are needed.

scholarly journals New onset of atrial fibrillation in cardiogenic shock

2021 ◽  
Vol 10 (Supplement_1) ◽  
Author(s):  
H Santos ◽  
T Vieira ◽  
J Fernandes ◽  
AR Ferreira ◽  
M Rios ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Cardiogenic Shock ◽  
Linear Regression Analysis ◽  
Clinical Signs ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Coronary Syndrome ◽  
The Impact ◽  
New Onset

Abstract Funding Acknowledgements Type of funding sources: None. Introduction The development of cardiogenic shock (CS) is associated with worse prognosis, and can produce several hemodynamic manifestations. Then, is not surprised the manifestation of new-onset atrial fibrillation (AF) in these patients. Purpose Evaluate the impact of cardiovascular previous history, clinical signs and diagnosis procedures at admission as predictors of new-onset of AF in CS. Methods Single-centre retrospective study, engaging patients hospitalized for CS between 1/01/2014-30/10/2018. 222 patients with CS are included, 40 of them presented new onset of AF. Chi-square test, T-student test and Mann-Whitney U test were used to compare categorical and continuous variables. Multiple linear regression analysis was performed to evaluate predictors of new-onset AF in CS patients. Results CS patients without AF had a mean age of 61.08 ± 13.77 years old, on the other hand new-onset of AF patients in the setting of CS had a mean age of 67.02 ± 14.21 years old (p = 0.016). Nevertheless, no differences between the two groups was detected regarding the sex cardiovascular history (namely arterial hypertension, diabetes, dyslipidemia, obesity, smoker status, alcohol intake, previous acute coronary syndrome, history of angina, previous cardiomyopathy), neoplasia history, cardiac arrest during the CS, clinical signs at admission (like heart rate, blood pressure, respiratory rate), blood results (hemoglobin, leukocytes, troponin, creatinine, C-Reactive protein), left ventricular ejection fraction and the culprit lesion. New-onset of AF in CS patient had not impact in mortality rates. Multiple logistic regression reveals that only age was a predictor of new onset of AF in CS patients (odds ratio 1.032, confident interval 1.004-1.060, p = 0.024). Conclusions Age was the best predictor of new-onset AF in CS patients. The presence of this arrhythmia can have a hemodynamic impact, however, seems not influenced the final outcome.

Usefulness of the society for cardiovascular angiography and intervention classification for predicting in-hospital mortality in patients with acute decompensated heart failure

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
L Burgos ◽  
L Talavera ◽  
R Baro Vila ◽  
A Acosta ◽  
M Cabral ◽  
...  
Keyword(s):  
Heart Failure ◽  
Hospital Mortality ◽  
Acute Decompensated Heart Failure ◽  
Decompensated Heart Failure ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Coronary Syndrome ◽  
Vasoactive Medication ◽  
Staging Classification

Abstract Introduction Recently a multidisciplinary group of the Society for Cardiovascular Angiography and Interventions (SCAI) derived a new classification schema for cardiogenic shock (CS), simple, clinically based and suitable for rapid assessment at the bedside but also arbitrary. Validation in different clinical datasets, specifically in patients with acute decompensated heart failure (ADHF), is necessary to establish the utility of this proposed classification schema. Purpose We aimed to evaluate the ability of a new SCAI CS staging classification to predict in-hospital mortality in patients with ADHF. Methods We conducted a single-center cohort study, performing a retrospective analysis of prospectively collected data of consecutive patients admitted with ADHF as a primary diagnosis between January 2015 and January 2019. We excluded patients who were hospitalized for an acute coronary syndrome. Patients were assigned to the modified SCAI Classification for CS: Stage A is “at risk” for CS, stage B is “beginning” shock, stage C is “classic”, stage D is “deteriorating”, and E is “extremis”, and in-hospital mortality was evaluated for each group. All-cause mortality was compared across SCAI stages using Kaplan-Meier analysis and log-rank test. Cox proportional hazards models were used to determine the association between SCAI stages and in-hospital mortality after adjusting for age, gender, left ventricular ejection fraction, use of vasoactive medication, mechanical circulatory assist devices, mechanical ventilation, percutaneous coronary intervention and cardiac surgery. Results Among 668 patients with a mean age of 74.9±12 years, 63.9% were male. In-hospital mortality was 11.2%. According to SCAI classification, the proportion of patients in stages A through E was 51.7%, 26.7%, 14.4%, 4.6% and 2.5%. The unadjusted mortality in each stages was: A 0.6%, B 4.5%, C 32.3%, D 61.3%, and E 88.2% (Log Rank P<0.0001). After multivariable adjustment, each SCAI shock stage remained associated with increased in-hospital mortality (all P<0.001 compared to stage A). Compared with SCAI shock stage A, adjusted hazard ratio (HR) values in SCAI shock stages B through E were 5.2, 31, 107, and 185, respectively (Figure). Conclusion In this large clinical cohort of patients with ADHF exclusively, the new SCAI CS staging classification was associated with in-hospital mortality. This finding supports the rationale of the classification in this setting, further prospective trials are needed to validate these findings. Adjusted in-hospital Mortality as a Func Funding Acknowledgement Type of funding source: None

scholarly journals The subclinical hypothyroid state might predict 30-day readmission in patients admitted with acute heart failure syndrome and reduced left ventricular ejection fraction

2020 ◽  
Vol 14 ◽  
pp. 175394472097774
Author(s):  
Muhammad Saad ◽  
Andrisael Garcia Lacoste ◽  
Pooja Balar ◽  
Aiyi Zhang ◽  
Timothy J. Vittorio
Keyword(s):  
Heart Failure ◽  
Left Ventricular Ejection Fraction ◽  
Ejection Fraction ◽  
Hospital Readmission ◽  
Left Ventricular ◽  
Ventricular Ejection ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Coronary Syndrome ◽  
All Cause Mortality

Introduction: Thyroid hormone (TH) has an essential role on the functional capability of cardiac muscle with its gene modulation and induction of vasodilatory effects. There is considerable evidence to suggest the role of TH in patients with acute coronary syndrome, but less is known about its prognostic role in heart failure (HF) patients. We aim to evaluate the association between subclinical hypothyroid state (SCHS) and event rates including 30-day all-cause and HF readmission in patients with an index hospitalization for acute HF syndrome (AHFS). Methodology: A retrospective chart review analysis of 2335 patients admitted with the diagnosis of AHFS between 1 January 2007 and 31 December 2017 was conducted. SCHS was defined as thyroid-stimulating hormone (TSH) level >4.50 mIU/L with a normal thyroxine (T4) level. Patients with pre-existing thyroid disease or receiving thyroid replacement therapy were excluded. HF with preserved ejection fraction (HFpEF) was defined as left ventricular ejection fraction (LVEF) >40% and HF with reduced ejection fraction (HFrEF) was defined as having LVEF ⩽40%. Percentage of 30-day, 3-month and 6-month all-cause readmission and mortality rates were calculated in both cohorts of AHFS (HFpEF and HFrEF) with and without SCHS. Results: The mean age of the 2335 AHFS population was 65 (±14.8) years. Of the 2335 patients admitted with AHFS, 1228 (52.6%) patients were found to have HFrEF and 1107 (47.4%) with HFpEF. There were 170 (7.3%) patients with AHFS found to have SCHS. There were more males than females (54% versus 46%). The percentage of hospital readmission within 30 days was higher for patients with SCHS compared with those without SCHS in the HFrEF group (42% versus 30%, p = 0.001). Hospital readmission within 30 days for patients with SCHS compared with those without SCHS in the HFpEF group did not differ (36.5% versus 31%, p = 0.47). Additionally, all-cause mortality was higher among patients with SCHS compared with patients without SCHS in the HFrEF group (18.7% versus 7.0%, p < 0.001). All-cause mortality was found similar in both arms of the HFpEF group (9.5% versus 7.7%, p = 0.73). Conclusion: During an index hospital admission for AHFS, SCHS was an independent predictor of readmission in 30 days in patients with HFrEF but not in patients with HFpEF. Additionally, it was related to adverse outcome such as all-cause mortality in HFrEF patients but not in HFpEF patients. Further studies regarding the concept of tissue thyroid and the potential for a therapeutic target are warranted.

scholarly journals Pheochromocytoma-Induced Takotsubo Cardiomyopathy

2019 ◽  
Vol 46 (2) ◽  
pp. 124-127 ◽  
Author(s):  
Majed Afana ◽  
Rishi J. Panchal ◽  
Rebecca M. Simon ◽  
Amal Hejab ◽  
Sharon W. Lahiri ◽  
...  
Keyword(s):  
Heart Failure ◽  
Cardiogenic Shock ◽  
Takotsubo Cardiomyopathy ◽  
Adrenal Mass ◽  
Severe Heart Failure ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Biochemical Tests ◽  
Ventricular Ejection Fraction ◽  
Hemodynamic Compromise

Pheochromocytoma, a rare catecholamine-secreting tumor, typically manifests itself with paroxysmal hypertension, tachycardia, headache, and diaphoresis. Less often, symptoms related to substantial hemodynamic compromise and cardiogenic shock occur. We report the case of a 66-year-old woman who presented with abdominal pain. Examination revealed a large right adrenal mass, cardiogenic shock, and severe heart failure in the presence of normal coronary arteries. Within days, the patient's hemodynamic status and left ventricular ejection fraction improved markedly. Results of imaging and biochemical tests confirmed the diagnosis of pheochromocytoma-induced takotsubo cardiomyopathy. Medical therapy and right adrenalectomy resolved the patient's heart failure, and she was asymptomatic postoperatively. We recommend awareness of the link between pheochromocytoma and takotsubo cardiomyopathy, and we discuss relevant diagnostic and management principles.

Maximal Dynamic Inspiratory Pressure Evaluation in Heart Failure: A Comprehensive Reliability and Agreement Study

2020 ◽  
Vol 100 (12) ◽  
pp. 2246-2253
Author(s):  
Fabiola M F da Silva ◽  
Gerson Cipriano ◽  
Alexandra C G B Lima ◽  
Joanlise M L Andrade ◽  
Eduardo Y Nakano ◽  
...  
Keyword(s):  
Heart Failure ◽  
Intraclass Correlation ◽  
Left Ventricular ◽  
Inspiratory Muscle ◽  
Inspiratory Pressure ◽  
Peak Oxygen Consumption ◽  
Left Ventricular Ejection ◽  
Cross Sectional ◽  
Ventricular Ejection Fraction ◽  
Index Measure

Abstract Objective The purpose of this study was to analyze the reliability (interrater and intrarater) and agreement (repeatability and reproducibility) properties of tapered flow resistive loading (TFRL) measures in patients with heart failure (HF). Methods For this cross-sectional study, participants were recruited from the cardiopulmonary rehabilitation program at the University of Brasilia from July 2015 to July 2016. All patients participated in the study, and 10 were randomly chosen for intrarater and interrater reliability testing. The 124 participants with HF (75% men) were 57.6 (SD = 1.81) years old and had a mean left ventricular ejection fraction of 38.9% (SD = 15%) and a peak oxygen consumption of 13.05 (SD = 5.3) mL·kg·min−1. The main outcome measures were the maximal inspiratory pressure (MIP) measured with a standard manovacuometer (SM) and the MIP and maximal dynamic inspiratory pressure (S-Index) obtained with TFRL. The S-Index reliability (interrater and intrarater) was examined by 2 evaluators, the S-Index repeatability was examined with 10 repetitions, and the reproducibility of the MIP and S-Index was measured with SM and TFRL, respectively. Results The reliability analysis revealed high S-Index interrater and intrarater reliability values (intraclass correlation coefficients [ICCs] of 0.89 [95% CI = 0.58–0.98] and 0.97 [95% CI = 0.89–0.99], respectively). Repeatability analyses revealed that 8 maneuvers were required to reach the maximum S-Index in 75.81% (95% CI = 68.27–83.34) of the population. The reproducibility of TFRL measures (S-Index = 68.8 [SD = 32.8] cm H2O; MIP = 66 [SD = 32.3] cm H2O) was slightly lower than that of the SM measurement (MIP = 70.1 [SD = 35.9] cm H2O). Conclusions The TFRL device provided a reliable intrarater and interrater S-Index measure in patients with HF and had acceptable repeatability, requiring 8 maneuvers to produce a stable S-Index measure. The reproducibilities of the S-Index, MIP obtained with SM, and MIP obtained with TRFL were similar. Impact TRFL is a feasible method to assess both MIP and the S-index as measures of inspiratory muscle strength in patients with HF and can be used for inspiratory muscle training, making the combined testing and training capabilities important in both clinical research and the management of patients with HF.

scholarly journals Quality of Life for Saudi Patients With Heart Failure: A Cross-Sectional Correlational Study

2015 ◽  
Vol 8 (3) ◽  
pp. 49 ◽  
Author(s):  
Mohannad Eid AbuRuz ◽  
Fawwaz Alaloul ◽  
Ahmed Saifan ◽  
Rami Masa'deh ◽  
Said Abusalem
Keyword(s):  
Quality Of Life ◽  
Heart Failure ◽  
Saudi Arabia ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Cross Sectional ◽  
Ventricular Ejection Fraction ◽  
Patients With Heart Failure ◽  
Saudi Patients

<p><strong>INTRODUCTION:</strong> Heart failure is a major public health issue and a growing concern in developing countries, including Saudi Arabia. Most related research was conducted in Western cultures and may have limited applicability for individuals in Saudi Arabia. Thus, this study assesses the quality of life of Saudi patients with heart failure.</p> <p><strong>MATERIALS &amp; METHODS:</strong><em> </em>A cross-sectional correlational design was used on a convenient sample of 103 patients with heart failure. Data were collected using the Short Form-36 and the Medical Outcomes Study-Social Support Survey.</p> <p><strong>RESULTS:</strong> Overall, the patients’ scores were low for all domains of Quality of Life. The Physical Component Summary and Mental Component Summary mean scores and SDs were (36.7±12.4, 48.8±6.5) respectively, indicating poor Quality of Life. Left ventricular ejection fraction was the strongest predictor of both physical and mental summaries.</p> <p><strong>CONCLUSION:</strong> Identifying factors that impact quality of life for Saudi heart failure patients is important in identifying and meeting their physical and psychosocial needs.</p>

scholarly journals Cardiogenic Shock due to Kounis Syndrome following Cobra Bite

2019 ◽  
Vol 2019 ◽  
pp. 1-3 ◽  
Author(s):  
W. D. D. Priyankara ◽  
E. M. Manoj ◽  
A. Gunapala ◽  
A. G. R. M. A. Ranaweera ◽  
K. S. Vithanage ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Cardiogenic Shock ◽  
Cell Activation ◽  
Left Ventricular ◽  
Clinical Syndrome ◽  
Mast Cell Activation ◽  
Left Ventricular Ejection ◽  
Kounis Syndrome ◽  
Ventricular Ejection Fraction ◽  
Coronary Syndrome

Kounis syndrome is associated with mast cell activation resulting in acute coronary syndrome secondary to an allergic insult. Various drugs such as antibiotics, analgesics, and environmental exposures such as bee, wasp sting, and poison ivy are known to induce Kounis syndrome. A 68-year-old man admitted with a cobra bite on both hands to emergency care unit and sustained cardiorespiratory arrest. Electrocardiogram, taken 6 hours after the cardiac arrest, showed ST elevations in leads V2 to V5 suggestive of anterior ST elevation myocardial Infarction (STEMI). Serum Troponin was 10 ng/ml (control= <0.5). Serum IgE levels were significantly high (19155IU/ml, baseline 100). 2-Dimensional echocardiogram showed anterior and apical-septal hypokinesia with left ventricular ejection fraction of 30-35%. Coronary angiogram was normal. He remained hypotensive requiring inotropic and vasopressor support during ICU stay. This was a case of Kounis syndrome leading to cardiogenic shock secondary to Cobra (naja naja) bite. This is the only reported case of cobra bite causing Kounis syndrome and cardiogenic shock. Identification of the cause of myocardial infarction in snake envenomation is useful in the management as some of the drugs like adrenaline, morphine, and beta blockers may worsen the clinical syndrome if it is due to Kounis syndrome.

scholarly journals Elevated Lactate Levels as a Predictor of Early Mortality in Patients with Severe LV Dysfunction without Shock or Hypoxemia

2019 ◽  
Vol 04 (02) ◽  
pp. 068-071
Author(s):  
Shravan Kumar Chetti ◽  
Sandeep Moode ◽  
Indrani Garre ◽  
Lalita Nemani
Keyword(s):  
Heart Failure ◽  
Cardiogenic Shock ◽  
Blood Lactate ◽  
Left Ventricular ◽  
Early Mortality ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Study Population ◽  
Lactate Levels ◽  
Elevated Lactate

Abstract Background Hyperlactatemia in intensive coronary care unit (ICCU) admitted patients who are critically ill must be considered to be related to tissue hypoxia/hypoperfusion. The routine measurement of lactate levels and its significance is still unclear in ICCU patients with left ventricular ejection fraction (LVEF) < 35% without hypotension and/or hypoxia. Methods and Materials A prospective study was conducted for six months between January 2018 and June 2018 in our institute. Age ≥18 years who admitted to the ICCU with LVEF less than 35% were included. Results Total of 104 patients were included after met inclusion and exclusion criteria and consented to enrolment in the study. The most common age group involved was between 50 and 70 years (46.2% of the patients) with a mean age of 52.5 ± 16.3 years. Mean lactate levels in the study population were 1.9 mmol/L. Mortality was noted in five patients (4%) in whom there were mean lactate levels of 2.58 ± 0.37 mmol/L. In the present study population, the patients with elevated lactate levels had early mortality with a p-value of 0.005 (95% CI for difference = 0.604–1.596). The average duration of stay in ICCU in the study population was 3.3 ± 1.2 days, which was in correlation with elevated serum lactate levels. The mean pH of the study population was 7.2 ± 0.19, and mean pH in the mortality group was 7.06 ± 0.21, which was not statistically significant with those of the study population. Conclusions From our study, patients without signs of heart failure and cardiogenic shock had increased mortality when blood lactate level was over or equal to 2.5 mmol/L. So it may be used as an adjunct in identifying patients with a higher risk of mortality even without signs of heart failure, cardiogenic shock. In conclusion, according to our data, ICCU admitted patients with LVEF < 35%, blood lactate is a prognostic marker for early mortality.

scholarly journals SLE strikes the heart! A rare presentation of SLE myocarditis presenting as cardiogenic shock

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Jaydeep J. Raval ◽  
Christina Rodriguez Ruiz ◽  
James Heywood ◽  
Jason J. Weiner
Keyword(s):  
Heart Failure ◽  
Cardiogenic Shock ◽  
Lupus Erythematosus ◽  
De Novo ◽  
Left Ventricular ◽  
Diagnostic Methods ◽  
Cardiac Biomarkers ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Diagnostic Uncertainty

Abstract Background Although systemic lupus erythematosus (SLE) can affect the cardiovascular system in many ways with diverse presentations, a severe cardiogenic shock secondary to SLE myocarditis is infrequently described in the medical literature. Variable presenting features of SLE myocarditis can also make the diagnosis challenging. This case report will allow learners to consider SLE myocarditis in the differential and appreciate the diagnostic uncertainty. Case presentation A 20-year-old Filipino male presented with acute dyspnea, pleuritic chest pain, fevers, and diffuse rash after being diagnosed with SLE six months ago and treated with hydroxychloroquine. Labs were notable for leukopenia, non-nephrotic range proteinuria, elevated cardiac biomarkers, inflammatory markers, low complements, and serologies suggestive of active SLE. Broad-spectrum IV antibiotics and corticosteroids were initiated for sepsis and SLE activity. Blood cultures were positive for MSSA with likely skin source. An electrocardiogram showed diffuse ST-segment elevations without ischemic changes. CT chest demonstrated bilateral pleural and pericardial effusions with dense consolidations. Transthoracic and transesophageal echocardiogram demonstrated reduced left ventricular ejection fraction (LVEF) 45% with no valvular pathology suggestive of endocarditis. Although MSSA bacteremia resolved, the patient rapidly developed cardiopulmonary decline with a repeat echocardiogram demonstrating LVEF < 10%. A Cardiac MRI was a nondiagnostic study to elucidate an etiology of decompensation given inability to perform late gadolinium enhancement. Later, cardiac catheterization revealed normal cardiac output with non-obstructive coronary artery disease. As there was no clear etiology explaining his dramatic heart failure, endomyocardial biopsy was obtained demonstrating diffuse myofiber degeneration and inflammation. These pathological findings, in addition to skin biopsy demonstrating lichenoid dermatitis with a granular “full house” pattern was most consistent with SLE myocarditis. Furthermore, aggressive SLE-directed therapy demonstrated near full recovery of his heart failure. Conclusion Although myocarditis during SLE flare is a well-described cardiac manifestation, progression to cardiogenic shock is infrequent and fatal. As such, SLE myocarditis should be promptly considered. Given the heterogenous presentation of SLE, combination of serologic evaluation, advanced imaging, and myocardial biopsies can be helpful when diagnostic uncertainty exists. Our case highlights diagnostic methods and clinical course of a de novo presentation of cardiogenic shock from SLE myocarditis, then rapid improvement.

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