scholarly journals Impact of renal dysfunction on the management and outcome of acute heart failure: results from the French prospective, multicentre, DeFSSICA survey

BMJ Open ◽  
2019 ◽  
Vol 9 (1) ◽  
pp. e022776 ◽  
Author(s):  
Dominique Dos Reis ◽  
Laurie Fraticelli ◽  
Adrien Bassand ◽  
Stéphane Manzo-Silberman ◽  
Nicolas Peschanski ◽  
...  
Keyword(s):  
Heart Failure ◽  
Renal Function ◽  
Renal Dysfunction ◽  
Acute Heart Failure ◽  
Clinical Signs ◽  
Academic Community ◽  
Close Monitoring ◽  
Early Assessment ◽  
Group 2 ◽  
Group 1

ObjectivesCardiorenal syndrome (CRS) is the combination of acute heart failure syndrome (AHF) and renal dysfunction (creatinine clearance (CrCl) ≤60 mL/min). Real-life data were used to compare the management and outcome of AHF with and without renal dysfunction.DesignProspective, multicentre.SettingTwenty-six academic, community and regional hospitals in France.Participants507 patients with AHF were assessed in two groups according to renal function: group 1 (patients with CRS (CrCl ≤60 mL/min): n=335) and group 2 (patients with AHF with normal renal function (CrCl >60 mL/min): n=172).ResultsDifferences were observed (group 1 vs group 2) at admission for the incidence of chronic heart failure (56.42% vs 47.67%), use of furosemide (60.9% vs 52.91%), insulin (15.52% vs 9.3%) and amiodarone (14.33% vs 4.65%); additionally, more patients in group 1 carried a defibrillator (4.78% vs 0%), had ≥2 hospitalisations in the last year (15.52% vs 5.81%) and were under the care of a cardiologist (72.24% vs 61.63%). Clinical signs were broadly similar in each group. Brain-type natriuretic peptide (BNP) and BNP prohormone were higher in group 1 than group 2 (1157.5 vs 534 ng/L and 5120 vs 2513 ng/mL), and more patients in group 1 were positive for troponin (58.2% vs 44.19%), had cardiomegaly (51.04% vs 37.21%) and interstitial opacities (60.3% vs 47.67%). The only difference in emergency treatment was the use of nitrates, (higher in group 1 (21.9% vs 12.21%)). In-hospital mortality and the percentage of patients still hospitalised after 30 days were similar between groups, but the median stay was longer in group 1 (8 days vs 6 days).ConclusionsRenal impairment in AHF should not limit the use of loop diuretics and/or vasodilators, but early assessment of pulmonary congestion and close monitoring of the efficacy of conventional therapies is encouraged to allow rapid and appropriate implementation of alternative therapies if necessary.

Abstract 278: Phenomapping of Worsening Renal Function During Hospitalization for Acute Heart Failure

2020 ◽  
Vol 13 (Suppl_1) ◽  
Author(s):  
Ryuichiro Yagi ◽  
Shun Kosaka ◽  
Makoto Takei ◽  
Ayaka Endo ◽  
Naoki Hirata ◽  
...  
Keyword(s):  
Heart Failure ◽  
Renal Function ◽  
Acute Heart Failure ◽  
Clustering Analysis ◽  
Distinct Population ◽  
Worsening Renal Function ◽  
Significant Difference ◽  
Group 2 ◽  
The Impact ◽  
Group 1

Background: Worsening renal function (WRF) during the hospitalization has been recognized as a predictor for worse outcomes in patients with acute heart failure (AHF). However, in recent years, elevation of serum creatinine during the acute phase of the treatment is accepted as a sign of efficient decongestion. Herein, we aimed to evaluate the phenotypic difference in this heterogeneous phenomenon by using clustering analysis. Methods: A total of 4000 patient data from the West-Tokyo Heart Failure Registry, a multicenter, prospective registry for consecutive AHF hospitalization were analyzed. Within 632 patients identified to have WRF (17%; defined as elevation of eGFR over 20 percent during the hospitalization), we applied two-step clustering analysis of phenotypic data (37 variables) to define and characterize phenotypically distinct population. After identification of phenotypically distinct subgroups, survival analysis with Cox proportional hazard was conducted to elucidate the impact of the classification on composite outcomes of heart failure re-hospitalization and all cause death. Results: The analysis identified four distinct populations (group 1-4) that distinctly differed in terms of clinical characteristics: Group1 composed of patients with reduced ejection fraction (EF), while group 2 to 4 were composed of patients with mid-range and preserved EF. Group 1 patients also had lowest eGFR and blood pressure at the time of admission. Group 1 and 2 patients were younger, but had higher plasma BNP compared to 3 and 4. Among these subgroups, group 1 had the worst, and group 2 had the most favorable prognosis. The difference in prognosis between these two groups was significant after adjustments with known prognostic factors (hazard ratio, 0.58; 95 percent confidence interval, 0.35-0.97). Conclusion: WRF represents heterogeneous condition; our clustering analysis revealed four phenotypically distinct population with significant difference in their prognosis. Further investigation is needed to assess its therapeutic implication.

Early Spot Urinary Sodium and Diuretic Efficiency in Acute Heart Failure and Concomitant Renal Dysfunction

2020 ◽  
Vol 10 (5) ◽  
pp. 362-372
Author(s):  
Gema Miñana ◽  
Pau Llàcer ◽  
Ignacio Sanchis ◽  
Sergio García-Blas ◽  
Clara Bonanad ◽  
...  
Keyword(s):  
Heart Failure ◽  
Renal Dysfunction ◽  
Acute Heart Failure ◽  
Linear Regression Analysis ◽  
Urinary Sodium ◽  
Coefficient Of Determination ◽  
Multivariate Linear Regression Analysis ◽  
Early Assessment ◽  
Diuretic Efficiency ◽  
Glomerular Filtrate

Objective: In acute heart failure (AHF), early assessment of spot urinary sodium (UNa) has emerged as a useful biomarker for risk stratification and monitoring. The objective of this study was to investigate (a) whether early spot UNa predicts 24-h diuretic efficiency and (b) the clinical factors associated with early spot UNa in patients with AHF and concomitant renal dysfunction (RD). Methods: This is a post hoc analysis of the IMPROVE-HF trial, in which 160 patients with AHF and RD (estimated glomerular filtrate rate [eGFR] <60 mL/min/1.73 m2) were included. Diuretic efficiency was calculated as the net fluid output produced per 40 mg of furosemide equivalents in 24 h. The association between early spot UNa and diuretic efficiency and clinical variables associated with UNa were evaluated using multivariate linear regression analysis. The contribution of the exposures in the predictability of the models was assessed with the coefficient of determination (R2). Results: The mean age of the study population was 78 ± 8 years. The median (interquartile range) diuretic efficiency, early spot UNa, aminoterminal pro-brain natriuretic peptide, and eGFR were 747 (490–1,167) mL, 90 mmol/L (65–111), 7,765 pg/mL (3,526–15,369), and 33.7 ± 11.3 mL/min/1.73 m2, respectively. In a multivariate setting, lower UNa was significantly and nonlinearly associated with lower diuretic efficiency (p = 0.001), explaining the 44.4% of the model predictability. Natremia and surrogates of congestion emerged as the main factors related to UNa. Conclusions: In patients with AHF and RD at presentation, early spot UNa was inversely related to 24-h diuretic efficiency.

scholarly journals Clinical value of soluble suppression of tumourigenicity 2 (sST2) in addition to NTproBNP measurements in a general cardiac outpatient population

2021 ◽  
Author(s):  
Camille Ammann ◽  
Christophe Wyss ◽  
Oliver Gämperli ◽  
Peter Martin Wenaweser ◽  
Roberto Corti ◽  
...  
Keyword(s):  
Heart Failure ◽  
Independent Predictor ◽  
Clinical Signs ◽  
Left Atrial Volume ◽  
Atrial Volume ◽  
Clinical Value ◽  
Group 4 ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

BACKGROUND AND AIMS: The soluble form of suppression of tumourigenicity 2 (sST2), a recently introduced biomarker, is a strong and NTproBNP-independent predictor of outcome in heart failure patients. This study sought to evaluate the added clinical value of sST2 in addition to NTproBNP in a heterogeneous cardiac outpatient population. METHODS: A total of 297 all-comer patients visiting the outpatient clinic of Heart Clinic Zurich, Switzerland, from January to December 2018 were included. Patients were divided into four groups depending on their sST2 and NTproBNP levels: group 1 (n = 91, 30.6% of all patients) with normal levels of both biomarkers, group 2 (n = 41, 13.8%) with isolated elevation of sST2 but normal NTproBNP, group 3 (n = 97, 32.7%) with elevated NTproBNP but normal sST2 levels, and group 4 (n = 68, 22.9%) with elevation of both biomarkers. Differences between groups, Spearman’s correlations and linear and multiple regression analysis for sST2 were calculated. RESULTS: The median age was 74 ± 19 years and 41.8% were women. NTproBNP levels continuously increased across the groups (medians in pg/ml: group 1 123.0, group 2 152.0, group 3 990.0 and group 4 2610.0), whereas sST2 levels did not (medians in ng/ml: 28.7, 58.9, 28.4 and 63.7 for groups 1 to 4, respectively). In patients with normal NTproBNP (groups 1 and 2), elevation of sST2 (group 2) was associated with significantly higher rates of coronary artery disease, peripheral vascular disease and renal dysfunction. In patients with elevated NTproBNP (groups 3 and 4), the additional elevation of sST2 (group 4) was associated with clinical signs of heart failure, higher EuroScore II and worse left ventricular ejection fraction (LVEF group 3 58.0% vs group 4 53.3%, p = 0.022). Correlation of sST2 was overall weak and weaker than of NTproBNP with most clinical variables. Soluble ST2 significantly correlated with EuroScore II (R = 0.280), kidney function (R = −0.259), C-reactive protein (R = 0.248), right ventricular function (R = 0.213) and left atrial volume (R = 0.199), all p ≤0.001. In multiple regression analysis, left atrial volume was the strongest independent predictor of sST2 elevation (p = 0.002). CONCLUSION: In this all-comer cardiology population, the added clinical value of sST2 measurements in addition to NTproBNP was small. In patients with elevated NTproBNP, the simultaneous elevation of sST2 was associated with clinical signs of heart failure. Soluble ST2 measurements could thus be beneficial in patients with uncertain signs of heart failure and confounding factors for NTproBNP elevation. Surprisingly, this study found elevated sST2 levels in a substantial number of a patients with normal NTproBNP levels, pointing to an additional pathway of sST2 elevation independent of heart failure.

scholarly journals Effects of the Adenosine A1 Receptor Antagonist Rolofylline on Renal Function in Patients With Acute Heart Failure and Renal Dysfunction

2011 ◽  
Vol 57 (19) ◽  
pp. 1899-1907 ◽  
Author(s):  
Adriaan A. Voors ◽  
Howard C. Dittrich ◽  
Barry M. Massie ◽  
Paul DeLucca ◽  
George A. Mansoor ◽  
...  
Keyword(s):  
Heart Failure ◽  
Renal Function ◽  
Receptor Antagonist ◽  
Renal Dysfunction ◽  
Acute Heart Failure ◽  
Adenosine A1 Receptor ◽  
Adenosine A1 ◽  
A1 Receptor

Association of Serum Renal Function Levels with Heart Failure Disease in Iraqi Patients

2021 ◽  
pp. 2464-2466
Author(s):  
Jinan Hussein Murtadha ◽  
Iman Hashim Abdul Razzaq
Keyword(s):  
Heart Failure ◽  
Renal Function ◽  
Uric Acid ◽  
Serum Uric Acid ◽  
Failure Group ◽  
Heart Failure Patients ◽  
Group 2 ◽  
Renal Function Tests ◽  
Effect Of Age ◽  
Group 1

Renal function tests are commonly used in clinical practice to look for renal disease, the most common includes the serum urea, uric acid and creatinine. Heart failure patients have a higher incidence of renal function test abnormalities than individuals who do not have heart failure disease. Fifty subjects of adults (male) were divided in to two groups, 25 subjects (healthy) as control (group1) and 25 subjects with heart failure (group 2). Our results indicate that serum uric acid, urea, and creatinine values were significantly elevated (P≤0.05) in patients group (2) compared with healthy group (1). The results also showed, the effect of age categories on uric acid blood urea nitrogen and creatinine values (P≤0.05) and there were no significant differences between age (41-60) years and (61-80) years. This study also shows a strong correlation between serum uric acid, urea and creatinine values (P≤0.05) in heart failure patients. Conclusion: It concluded from the above finding that there was effect of heart failure disease on renal function levels.

scholarly journals Experience of introducing a new form of organization of medical care for patients with heart failure in the Russian Federation

Kardiologiia ◽  
2021 ◽  
Vol 61 (3) ◽  
pp. 42-51
Author(s):  
I. V. Fomin ◽  
N. G. Vinogradova ◽  
D. S. Polyakov ◽  
V. A. Pogrebetskaya
Keyword(s):  
Heart Failure ◽  
Acute Decompensated Heart Failure ◽  
Clinical Signs ◽  
Decompensated Heart Failure ◽  
Place Of Residence ◽  
Short Period ◽  
Duration Of Hospitalization ◽  
Group 2 ◽  
Group 1

Aim    To present clinical characteristics of patients after hospitalization for acute decompensated heart failure (ADHF) and to analyze hemodynamic indexes and compliance with the treatment at two years depending on the conditions of outpatient follow-up.Material and methods    The study included 942 patients with chronic heart failure (CHF) older than 18 years who had been hospitalized for ADHF. Based on patients’ decisions, two groups were isolated: patients who continued the outpatient follow-up at the Center of CHF (CCHF) (group 1, n=510) and patients who continued the follow-up in outpatient multidisciplinary clinics (OMC) at their place of residence (group 2, n=432). The clinical portrait of patients was evaluated after ADHF, and hemodynamic parameters were evaluated on discharge from the hospital. Also, the patient compliance with the treatment was analyzed during two years of follow-up. Statistical analysis was performed with Statistica 7.0 for Windows.Results    The leading causes for CHF included arterial hypertension, ischemic heart disease, atrial fibrillation, and type 2 diabetes mellitus. With the mean duration of hospitalization of 11 inpatient days, 88.1 % and 88.4 % of patients of groups 1 and 2 were discharged with complaints of shortness of breath; 62 % and 70.4 % complained of palpitations; and 73.6 % and 71.8 % complained of general weakness. On discharge from the hospital, the following obvious signs of congestion remained: peripheral edema in 54.3 % and 57.9 %; pulmonary rales in 28.8 % and 32.4 %; orthopnea in 21.4 % and 26.2 %; and cough in 16,5 % and 15.5 % of patients of groups 1 and 2, respectively. For the time of hospitalization, CHF patients did not achieve their targets of systolic BP (SBP), diastolic BP (DBP) and heart rate (HR). Patients of group 1 achieved the recommended values of SBP, DBP and HR already at one year of the follow-up at CCHF. Patients of group 2 had no significant changes in hemodynamic indexes. At one and two years of the follow-up, group 2 showed a considerable impairment of the compliance with the basis therapy for CHF compared to group 1.Conclusions    During the short period of hospitalization (11 inpatient days), the patients retained pronounced symptoms of HF and clinical signs of congestion and did not achieve their hemodynamic targets. The patients who were followed up for a long time at CCHF were more compliant with the basis therapy, which resulted in improvement of hemodynamic indexes, compared to the patients who were managed in OMS at the place of residence.

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