51 Plasma MMP-3: A Novel Indicator of Left Ventricle Remodelling and Adverse Outcomes in Patients with Acute Heart Failure

Heart ◽  
2014 ◽  
Vol 100 (Suppl 3) ◽  
pp. A29.2-A30 ◽  
Author(s):  
Hafid Narayan ◽  
Leong Ng ◽  
Iain Squire ◽  
Noor Mohammed ◽  
Pauline Quinn
Keyword(s):  
Heart Failure ◽  
Left Ventricle ◽  
Acute Heart Failure ◽  
Adverse Outcomes ◽  
Left Ventricle Remodelling

Life-threatening Takotsubo Cardiomyopathy

2011 ◽  
Vol 9 (2) ◽  
pp. 119 ◽  
Author(s):  
Karen Mrejen-Shakin ◽  
Ricardo Lopez ◽  
Mohandas M Shenoy ◽  
◽  
◽  
...  
Keyword(s):  
Heart Failure ◽  
Left Ventricle ◽  
Acute Heart Failure ◽  
Takotsubo Cardiomyopathy ◽  
Stress Test ◽  
Systolic Dysfunction ◽  
Apical Ballooning ◽  
Assisted Ventilation ◽  
Two Dimensional ◽  
Life Threatening

Objective:To report a case of seizure-induced takotsubo cardiomyopathy with rare etiology and rarer complications.Methods:A 50-year-old woman had multiple epileptic seizures and later developed acute heart failure complicated by ventricular fibrillation and shock. A two-dimensional echocardiogram revealed apical ballooning of the left ventricle resembling a takotsubo (a Japanese fisherman's pot used to trap octopi). The apex was also hypokinetic.Results:The hemodynamic abnormalities normalized with defibrillation, assisted ventilation, inotropic support, and pressor agents. More importantly, the apical ballooning deformity and systolic dysfunction reversed. The echocardiogram normalized three months later. A nuclear treadmill stress test was negative for ischemia.Conclusions:Apical ballooning of the left ventricle and hypokinesis are typical echocardiographic features in takotsubo cardiomyopathy, a stress-induced heart disease. It may follow severe emotional, physical, and neurologic stressors, in our rare case, grand mal seizures (0.2 % of all takotsubo disease patients). Also rare are life-threatening complications. Based on these observations, in a case with severe stress followed by acute heart failure, takotsubo cardiomyopathy should be a major diagnostic consideration. The dramatic initial triggering event, in our case an epileptic seizure, should not mask the possibility of coexisting takotsubo cardiomyopathy. Awareness of this disease, anticipation of complications, and two-dimensional echocardiography will help channel the management in the right direction.

scholarly journals Intravenous morphine use in acute heart failure increases adverse outcomes: a meta-analysis

2021 ◽  
Vol 22 (3) ◽  
pp. 865
Author(s):  
Yaowang Lin ◽  
Yang Chen ◽  
Jie Yuan ◽  
Xinli Pang ◽  
Huadong Liu ◽  
...  
Keyword(s):  
Heart Failure ◽  
Acute Heart Failure ◽  
Meta Analysis ◽  
Adverse Outcomes ◽  
Intravenous Morphine

scholarly journals Potential Role of Natriuretic Response to Furosemide Stress Test During Acute Heart Failure

2021 ◽  
Vol 14 (6) ◽  
Author(s):  
Pedro Caravaca Pérez ◽  
Jorge Nuche ◽  
Laura Morán Fernández ◽  
David Lora ◽  
Zorba Blázquez-Bermejo ◽  
...  
Keyword(s):  
Heart Failure ◽  
Acute Heart Failure ◽  
Potential Role ◽  
Stress Test ◽  
Adverse Outcomes ◽  
Sample Median ◽  
Diuretic Treatment ◽  
Diuretic Response ◽  
Worse Prognosis

Background: Poor natriuresis has been associated with a poorer response to diuretic treatment and worse prognosis in acute heart failure. Recommendations on how and when to measure urinary sodium (UNa) are lacking. We aim to evaluate UNa quantification after a furosemide stress test (FST) capacity to predict appropriate decongestion during acute heart failure hospitalization. Methods: Patients underwent an FST on day-1 of admission, and UNa was measured 2 hours after, dividing patients into low or high UNa based on the sample median value. A semiquantitative composite congestive score (CCS; 0–9) and NT pro-BNP (N-terminal pro-B-type natriuretic peptide) quantification were assessed before the FST and at day 5 after the FST. Results: Median UNa after FST in the 65 patients included was 113 (97–122) mmol/L. At day 5, a lower proportion of patients with a low UNa reached a 30% decrease in NT-proBNP levels (21 [66%] for low UNa versus 31 [94%] for high UNa; P =0.005) and an appropriate grade of decongestion (CCS<3) (20 [62%] for low UNa versus 32 [97%] for high UNa; P <0.001). A UNa>83 mmol/L 2 hours after FST had a 96% sensitivity to predict an NT-proBNP reduction ≥30% and 95% to predict a CCS<3 at day 5. Low UNa patients presented a lower cumulative diuresis and weight loss and presented more often with prolonged hospitalization, worsening heart failure, and readmission because of acute heart failure or death at 6 months. Conclusions: Low natriuresis after an FST identified patients at a higher risk of an inadequate diuretic response and an inappropriate decongestion. FST-guided diuretic treatment might help to improve decongestion, shorten hospitalizations, and to reduce adverse outcomes.

scholarly journals Factors associated with plasma antigen carbohydrate 125 and amino-terminal pro-B-type natriuretic peptide concentrations in acute heart failure

2020 ◽  
Vol 9 (5) ◽  
pp. 437-447 ◽  
Author(s):  
Gema Miñana ◽  
Rafael de la Espriella ◽  
Anna Mollar ◽  
Enrique Santas ◽  
Eduardo Núñez ◽  
...  
Keyword(s):  
Heart Failure ◽  
Left Ventricle ◽  
Ejection Fraction ◽  
Acute Heart Failure ◽  
Natriuretic Peptide ◽  
Tricuspid Regurgitation ◽  
Left Ventricle Ejection Fraction ◽  
Factors Associated ◽  
Amino Terminal ◽  
Main Factors

Background: Plasma amino-terminal pro-B-type natriuretic peptide and antigen carbohydrate 125 levels are positively associated with a higher risk of adverse clinical outcomes in acute heart failure. As a proxy of congestion, antigen carbohydrate 125 has also been proposed as a right-sided heart failure marker. Thus, we aimed to determine in this population the main factors – including echocardiographic right-sided heart failure parameters – associated with antigen carbohydrate 125 and amino-terminal pro-B-type natriuretic peptide. Methods and results: We prospectively included 2949 patients admitted with acute heart failure. Amino-terminal pro-B-type natriuretic peptide and antigen carbohydrate 125 were used as dependent variables in a multivariable linear regression analysis. The mean age of the sample was 73.9±11.1 years; 48.9% were female, 35.8% showed ischaemic aetiology, and 51.6% exhibited heart failure with preserved ejection fraction. The median (interquartile range) for amino-terminal pro-B-type natriuretic peptide and antigen carbohydrate 125 were 4840 (2111–9204) pg/ml and 58 (26–129) U/ml, respectively. In a multivariable setting, and ranked in order of importance (R2), estimated glomerular filtration rate (43.7%), left ventricle ejection fraction (15.1%), age (12.4%) and high-sensitivity troponin T (10.9%) emerged as the most important factors associated with amino-terminal pro-B-type natriuretic peptide. The five main factors associated with antigen carbohydrate 125 were, in order of importance: the presence of pleural effusion (36.8%), tricuspid regurgitation severity (25.1%), age (11.9%), amino-terminal pro-B-type natriuretic peptide (6.5%) and peripheral oedema (4.3%). Conclusion: In patients with acute heart failure the main factors associated with amino-terminal pro-B-type natriuretic peptide were renal dysfunction, left ventricle ejection fraction and age. For antigen carbohydrate 125, clinical parameters of congestion and the severity of tricuspid regurgitation were the most important predictors. These results endorse the value of antigen carbohydrate 125 as a useful marker of right-sided heart failure.

scholarly journals Evaluation of Procalcitonin Levels in Patients with Various Forms of Acute Coronary Syndrome, Depending on the Presence of Adverse Hospital Outcomes

2021 ◽  
Vol 17 (3) ◽  
pp. 456-461
Author(s):  
O. M. Drapkina ◽  
V. A. Zakharova
Keyword(s):  
Heart Failure ◽  
Acute Coronary Syndrome ◽  
Unstable Angina ◽  
Acute Heart Failure ◽  
Cardiovascular Death ◽  
Adverse Outcomes ◽  
Hospital Outcomes ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
Informed Consent Form

Aim. to study the levels of procalcitonin in patients with various forms of acute coronary syndrome (ACS), depending on the presence of adverse hospital outcomes.Materials and Methods. The study included 222 patients admitted to the emergency cardiology department with a diagnosis of ACS in the period from March 2014. until January 2017. Of these, 106 (47.7 %) patients were diagnosed with unstable angina (NS) and 116 (52.3%) with myocardial infarction (MI). Non ST segment elevation MI (NSTEMI) was diagnosed in 47 (40.5%) patients with MI, and ST elevation MI (STEMI) – in 69 (59.5%) patients with MI. After the assessment of the patient's compliance with the criteria for inclusion/exclusion in the study, the procedure for signing the patient's informed consent form was carried out. The protocol of the study was approved by the local Ethics committee of the M. E. Zhadkevich State Clinical Hospital. In each study subgroup, the presence of adverse outcomes during the current hospitalization was assessed: cardiovascular death, nonfatal MI, nonfatal acute cerebrovascular accident, acute heart failure, as well as a combined endpoint, including all of the listed adverse outcomes. All patients, in addition to routine laboratory methods of investigation, were examined for the level of procalcitonin at admission to the hospital, on 2-3 and 4-5 days.Results. Patients with MI compared to patients with NS were characterized by a large number of registered endpoints in general (24.1% vs. 6.6%, p<0.001), while in the group of patients with MI, cardiovascular death was more often recorded (10.3% vs. 0.9%, p<0.001) and acute heart failure (12.9% vs. 5.6%, p=0.009). Patients with MI, in particular with STEMI, who had adverse hospital outcomes, were characterized by statistically significantly higher levels of procalcitonin compared to patients without adverse hospital outcomes. Patients with STEMI showed significantly higher levels of procalcitonin at all stages of the disease, and patients with MI-only at 2-3 and 4-5 days. There were no statistically significant differences in the level of procalcitonin at all stages of the disease in patients with NSTEMI and with unstable angina, depending on the hospital outcomes.Conclusion. Elevated procalcitonin levels in patients with MI, in particular with STEMI, are associated with adverse hospital outcomes; for other forms of ACS, no statistically significant differences were observed with different hospital outcomes.

scholarly journals CORRELATION BETWEEN SERUM LEVEL GALECTIN-3 AND EARLY REMODELLING INDICATOR OF LEFT VENTRICLE IN PATIENT WITH ACUTE MYOCARDIAL INFARCTION DURING PRE-PERCUTANEOUS CORONARY INTERVENTION

2019 ◽  
Vol 40 (1) ◽  
Author(s):  
I Nyoman Indrawan Mataram ◽  
Wayan Aryadana ◽  
AA Wiradewi Lestari
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Acute Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Left Ventricle ◽  
Acute Heart Failure ◽  
Coronary Intervention ◽  
Timi Flow ◽  
Percutaneous Coronary ◽  
Galectin 3

Background: Coronary heart disease (CHD) is a leading cause of death worldwide. Acute coronary syndrome (ACS) is a spectrum of CHD. Left ventricle remodelling is one of the complication with the bad outcome either short-term or long term. Early remodelling process (within 0-72 hours) post infarction can be assessed by circulating biomarker (Galectin-3), echocardiography, coronary angiography, and clinically. Objective: The aim of study is to know the correlation between serum level of Galectin-3 and early remodelling indicator in patient with acute myocardial infarction during pre-percutaneous coronary intervention. The parameters are LVEDV, LVEF, diastolic function component, TIMI flow, MBG, and presence of acute heart failure. Materials and Methods: This cross sectional study was conducted in Sanglah General Hospital during March-May 2018. A 62 sample was determined consecutively. Results: Bivariate analysis with Spearman correlation shows Galectin-3 correlated with LVEDV (r = 0,808; p= 0,000), E/e’ average (r = 0,297; p = 0,019), E/A ratio (r = 0,261; p= 0,041), and MBG (QuBE) (r = 0,647; p = 0,000). No correlation was found between Galectin-3 and LVEF Teich (r = -0,213; p= 0,097), LVEF Biplane (r = -0,226; p = 0,077), LAVI (r = 0,301; p = 0,170), e’septal (r = -0,079; p = 0,539), e’lateral (r = -0,092; p = 0,476), and TR Vmax (r=0,068; p=0,600). Chi square analysis shows no association between Galectin-3 and diastolic dysfunction left ventricle (OR= 1,032, p= 0,966, CI95%= 0,239-4,462), TIMI flow (OR= 1,032, p= 0,966, CI95%= 0,239-4,462), MBG score (OR= 0,264, p= 0,197, CI95%= 0,031-2,259), and acute heart failure (OR=0,577, p= 0,476, CI95%= 0,127-2,617). Multivariat analysis with multiple linear regression shows an increase in Galectin-3 has been proven associated independently with LVEDV, LAVI, E/e’ average, and E/A ratio. Multiple logistic regression shows Galectin-3 has not been proven independently with diastolic dysfunction, TIMI flow, MBG score, and acute heart failure. LVEDV is the best outcome that can be explained as its value influenced by constant, BMI, and Galectin-3 (R2 = 0,509). Conclusion: Galectin-3 correlated with LVEDV, average E/e’, E/A ratio, and MBG (QuBE). There is an independent association between Galectin-3 and LVEDV, LAVI, average E/e, and E/A ratio. Early remodelling process within 0-72 hours post infarction was happened pre-PCI. Anti-remodelling (including anti failure) during early phase is strongly recommended in order to prevent worse outcome in short and long term. Keywords: Galectin-3, early remodelling left ventricle, acute myocardial infarction, percutaneous coronary intervention.

Abstract 13386: Individualized Risk Score Interpretation to Aid Clinical Decisions and Transitions of Care for Acute Heart Failure Patients

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Claire Y Zhao
Keyword(s):  
Heart Failure ◽  
Decision Making ◽  
Acute Heart Failure ◽  
Risk Score ◽  
Complex Disease ◽  
Adverse Outcomes ◽  
Transitions Of Care ◽  
Risk Scores ◽  
Clinical Decisions ◽  
Clinical Measurements

Acute heart failure (AHF) is a complex disease with heterogeneous manifestations and adverse outcomes. The interpretation of machine-learning risk scores is vital to support clinical decisions. Individualized Feature Importance (IFI) was designed to attribute changes in risk scores to clinical features and help contrast decision trajectory for a patient against those of patient subgroups that received distinct clinical decisions. Score Confidence Interval (SCI) was developed to quantify certainty in the prediction, which further encourages clinicians’ interpretation. Study was based on retrospective data from 25 hospitals in the US of 20,640 adult patients, with 87% discharged home (Class 0) and 13% transferred to the ICU or died in hospital (Class 1). IFI is based on Shapley Value, based on which SCI was designed to capture the variation in score if input features are missing. These methods were applied to previously developed risk score for AHF patients in the wards; however, they can be applied to any risk score. The SCI is wide at the beginning of the stay and narrows down towards the end as more clinical measurements become available, indicating the risk score is relatively certain at the end (Fig. 1a). IFI values (Fig. 1b) show how selected features drive changes in the risk score. To aid decision-making at the latest time, top missing features are prompted (Fig. 1c). Decision trajectories show the way top features drive the risk score (Fig. 1d), that this patient is at higher risk to discharge (Fig. 1e) and is more similar to ICU-transfers (Fig. 1f). Fig. 1g shows SCI improves risk score performance by abstaining uncertain cases from decision-making. IFI apportions risk score to clinical measurements. SCI reduces false alarm rates. By providing clinical context, they have the potential to enhance incorporation of risk scores in the clinical workflow to aid medical decisions by identifying patients at risk for deterioration and determining appropriate levels of care.

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