scholarly journals Acute Systolic Heart Failure Associated with Complement-Mediated Hemolytic Uremic Syndrome

2015 ◽  
Vol 2015 ◽  
pp. 1-3
Author(s):  
John L. Vaughn ◽  
Jared M. Moore ◽  
Spero R. Cataland
Keyword(s):  
Heart Failure ◽  
Hemolytic Uremic Syndrome ◽  
Complement Activation ◽  
Systolic Heart Failure ◽  
Stable Condition ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Hypoxemic Respiratory Failure ◽  
Ventricular Ejection Fraction ◽  
Uremic Syndrome

Complement-mediated hemolytic uremic syndrome (otherwise known as atypical HUS) is a rare disorder of uncontrolled complement activation that may be associated with heart failure. We report the case of a 49-year-old female with no history of heart disease who presented with microangiopathic hemolytic anemia, thrombocytopenia, and acute kidney injury. Given her normal ADAMSTS13 activity, evidence of increased complement activation, and renal biopsy showing evidence of thrombotic microangiopathy, she was diagnosed with complement-mediated HUS. She subsequently developed acute hypoxemic respiratory failure secondary to pulmonary edema requiring intubation and mechanical ventilation. A transthoracic echocardiogram showed evidence of a Takotsubo cardiomyopathy with an estimated left ventricular ejection fraction of 20%, though ischemic cardiomyopathy could not be ruled out. Treatment was initiated with eculizumab. After several failed attempts at extubation, she eventually underwent tracheotomy. She also required hemodialysis to improve her uremia and hypervolemia. After seven weeks of hospitalization and five doses of eculizumab, her renal function and respiratory status improved, and she was discharged in stable condition on room air and independent of hemodialysis. Our case illustrates a rare association between acute systolic heart failure and complement-mediated HUS and highlights the potential of eculizumab in stabilizing even the most critically-ill patients with complement-mediated disease.

Emerging Cardiac Resynchronisation Therapy Indications

2011 ◽  
Vol 7 (1) ◽  
pp. 29
Author(s):  
Charlotte Eitel ◽  
Gerhard Hindricks ◽  
Christopher Piorkowski ◽  
◽  
◽  
...  
Keyword(s):  
Heart Failure ◽  
Systolic Heart Failure ◽  
Cardiac Resynchronisation Therapy ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Current Evidence ◽  
Class Iii ◽  
Ventricular Ejection Fraction ◽  
Cardiac Resynchronisation ◽  
Resynchronisation Therapy

Cardiac resynchronisation therapy (CRT) is an efficacious and cost-effective therapy in patients with highly symptomatic systolic heart failure and delayed ventricular conduction. Current guidelines recommend CRT as a class I indication for patients with sinus rhythm, New York Heart Association (NYHA) functional class III or ambulatory class IV, a QRS duration ≥120ms, and left ventricular ejection fraction (LVEF) ≤35%, despite optimal pharmacological therapy. Recent trials resulted in an extension of current recommendations to patients with mild heart failure, patients with atrial fibrillation, and patients with an indication for permanent right ventricular pacing with the aim of morbidity reduction. The effectiveness of CRT in patients with narrow QRS, patients with end-stage heart failure and cardiogenic shock, and patients with an LVEF >35% still needs to be proved. This article reviews current evidence and clinical applications of CRT in heart failure and provides an outlook on future developments.

ACCESSMENT OF RIGHT VENTRICULAR SYSTOLIC FUNCTION USING TAPSE

2011 ◽  
pp. 62-70
Author(s):  
Lien Nhut Nguyen ◽  
Anh Vu Nguyen
Keyword(s):  
Heart Failure ◽  
Left Ventricular Ejection Fraction ◽  
Ejection Fraction ◽  
Right Ventricular ◽  
Systolic Function ◽  
Systolic Heart Failure ◽  
Left Ventricular ◽  
Ventricular Ejection ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction

Background: The prognostic importance of right ventricular (RV) dysfunction has been suggested in patients with systolic heart failure (due to primary or secondary dilated cardiomyopathy - DCM). Tricuspid annular plane systolic excursion (TAPSE) is a simple, feasible, reality, non-invasive measurement by transthoracic echocardiography for evaluating RV systolic function. Objectives: To evaluate TAPSE in patients with primary or secondary DCM who have left ventricular ejection fraction ≤ 40% and to find the relation between TAPSE and LVEF, LVDd, RVDd, RVDd/LVDd, RA size, severity of TR and PAPs. Materials and Methods: 61 patients (36 males, 59%) mean age 58.6 ± 14.4 years old with clinical signs and symtomps of chronic heart failure which caused by primary or secondary DCM and LVEF ≤ 40% and 30 healthy subject (15 males, 50%) mean age 57.1 ± 16.8 were included in this study. All patients and controls were underwent echocardiographic examination by M-mode, two dimentional, convensional Dopler and TAPSE. Results: TAPSE is significant low in patients compare with the controls (13.93±2.78 mm vs 23.57± 1.60mm, p<0.001). TAPSE is linearly positive correlate with echocardiographic left ventricular ejection fraction (r= 0,43; p<0,001) and linearly negative correlate with RVDd (r= -0.39; p<0.01), RVDd/LVDd (r=-0.33; p<0.01), RA size (r=-0.35; p<0.01), TR (r=-0.26; p<0.05); however, no correlation was found with LVDd and PAPs. Conclusions: 1. Decreased RV systolic function as estimated by TAPSE in patients with systolic heart failure primary and secondary DCM) compare with controls. 2. TAPSE is linearly positive correlate with LVEF (r= 0.43; p<0.001) and linearly negative correlate with RVDd (r= -0.39; p<0.01), RVDd/LVDd (r=-0.33; p<0.01), RA size (r=-0.35; p<0.01), TR (r=-0.26; p<0.05); however, no correlation is found with LVDd and PAPs. 3. TAPSE should be used routinely as a simple, feasible, reality method of estimating RV function in the patients systolic heart failure DCM (primary and secondary).

scholarly journals Evaluation of arterial stiffness in systolic heart failure

2021 ◽  
Vol 67 (2) ◽  
pp. 86-89
Author(s):  
Lajos Fehérvári ◽  
István Adorján Szabó ◽  
Lóránd Kocsis ◽  
Attila Frigy
Keyword(s):  
Heart Failure ◽  
Arterial Stiffness ◽  
Statistical Significance ◽  
Systolic Heart Failure ◽  
Intima Media Thickness ◽  
Carotid Intima Media Thickness ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Chi Square ◽  
Ventricular Ejection Fraction

Abstract Objective: Micro- and macrovascular changes can occur in heart failure, and could influence its prognosis and management. In a prospective study, we proposed the evaluation of arterial stiffness (macrovascular function) and its correlations in patients with systolic heart failure. Methods: 40 patients (32 men, 8 women, mean age 63±2.9 years), with hemodynamically stable systolic heart failure (left ventricular ejection fraction, EF<40%) were enrolled in the study. In every patient, beyond routine explorations (ECG, cardiac and carotid ultrasound, laboratory measurements), arterial stiffness was assessed by measuring pulse wave velocity (PWV). The correlations of PWV with clinical and echo-cardiographic characteristics were studied using t-test and chi-square test (p<0.05 being considered for statistical significance). Results: The average PWV was 8.55±2.2 m/s, and 16 patients had increased PWV (>10 m/s). We found significantly higher PWV values in patients older than 65 years (p<0.001), in patients with eGFR <60 ml/min/1.73 m2 (p<0.001), hypertension (p=0.006), and increased (>1 mm) carotid intima-media thickness (p=0.016). PWV was found to be significantly lower when EF was <30% (p=0.049). Furthermore, the presence of an increased PWV was correlated significantly with age (p<0.001), and (with borderline significance) with eGFR <60 ml/min/1.73 m2 and, inversely, with EF<30%. Conclusions: Increased arterial stiffness reflected by high PWV is frequently present in patients with systolic heart failure, and is mainly correlated with general risk factors of arterial involvement. Low EF, due to low stroke volume and decreased systolic arterial wall tension can influence the values and the interpretation of PWV.

Abstract 13259: Electrophysiologic Mapping Identifies Stable Organized Tachyarrhythmias ("Rotors") in Both Atria during Spontaneous Atrial Fibrillation with Systolic Heart Failure

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Rangadham Nagarakanti ◽  
April Slee ◽  
Sanjeev Saksena
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Regional Distribution ◽  
Systolic Heart Failure ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Activation Patterns ◽  
Ventricular Ejection Fraction ◽  
Contact Mapping ◽  
Premature Beats

Introduction: Stable organized atrial tachyarrhythmias (ATs) /"rotors" that maintain AF have been identified in patients (pts) with paroxysmal atrial fibrillation (PAF) & persistent AF (PRAF) with no or minimal heart disease. Hypothesis: Biatrial ATs occur in AF pts with systolic heart failure (HF). Methods: We performed simultaneous contact catheter mapping of the RA & LA using 3 D non-contact mapping ) in 83 refractory AF pts during spontaneous AF episodes.Spontaneous atrial premature beats (APBs) & triggered ATs were analyzed. We also compared regional distribution of ATs & activation patterns in pts with & without HF. Results: 24 HF pts, mean age of 62±9 years, 75% male with mean left ventricular ejection fraction (LVEF) 45.5±9% and mean left atrial (LA) size 4.35±0.8 cm were mapped. They had 42 APBs that triggered 26 distinct organized stable ATs/"rotors". Each pt had 1 to 4 RA or LA regions showing triggering APBs (mean 1.75/pt) initiating AT. APBs arose predominantly from the RA or LA septum (45%) & superior LA/PV (24%) regions (Fig 1a). A biatrial distribution of the stable ATs/"rotors" occcurred in HF pts (Fig 1b) with few focal ATs. Compared to pts without HF (n=59), HF pts (n=24) trended to have more PRAF (83% vs 66%, p=0.18). 78 organized stable ATs/"rotors" were compared for regional distribution in PRAF pts with HF (n=16) & without HF (n=32). Stable ATs with focal LA/PV origin were uncommon in both groups (7% vs. 15%). LA ATs/"rotors" were similar (26% vs. 17%; p=0.58) as were typical RA flutter and atypical RA ATs/"rotors" in both groups (Fig 1c). Conclusions: 1. A majority of APBs initiating AF in HF pts originated from the septal and superior LA/PV regions. 2. While triggers are still frequently present with the LA/PV origin in HF pts, stable ATs/"rotors" had biatrial distribution & a lesser frequency of focal LA/PV ATs. 3. This spectrum of ATs/"rotors" was similar to PRAF pts without HF, potentially supporting similar ablative interventions in both pt groups.

scholarly journals Predictors of one-year outcomes in chronic heart failure: the portrait of a middle income country

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Luciana Gioli-Pereira ◽  
Fabiana G. Marcondes-Braga ◽  
Sabrina Bernardez-Pereira ◽  
Fernando Bacal ◽  
Fábio Fernandes ◽  
...  
Keyword(s):  
Heart Failure ◽  
Blood Pressure ◽  
Systolic Blood Pressure ◽  
Systolic Heart Failure ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Major Public Health Problem ◽  
Ventricular Ejection Fraction ◽  
One Year ◽  
Overall Mortality

Abstract Background Heart failure (HF) is a major public health problem with increasing prevalence worldwide. It is associated with high mortality and poor quality of life due to recurrent and costly hospital admissions. Several studies have been conducted to describe HF risk predictors in different races, countries and health systems. Nonetheless, understanding population-specific determinants of HF outcomes remains a great challenge. We aim to evaluate predictors of 1-year survival of individuals with systolic heart failure from the GENIUS-HF cohort. Methods We enrolled 700 consecutive patients with systolic heart failure from the SPA outpatient clinic of the Heart Institute, a tertiary health-center in Sao Paulo, Brazil. Inclusion criteria were age between 18 and 80 years old with heart failure diagnosis of different etiologies and left ventricular ejection fraction ≤50% in the previous 2 years of enrollment on the cohort. We recorded baseline demographic and clinical characteristics and followed-up patients at 6 months intervals by telephone interview. Study data were collected and data quality assurance by the Research Electronic Data Capture tools. Time to death was studied using Cox proportional hazards models adjusted for demographic, clinical and socioeconomic variables and medication use. Results We screened 2314 consecutive patients for eligibility and enrolled 700 participants. The overall mortality was 6.8% (47 patients); the composite outcome of death and hospitalization was 17.7% (123 patients) and 1% (7 patients) have been submitted to heart transplantation after one year of enrollment. After multivariate adjustment, baseline values of blood urea nitrogen (HR 1.017; CI 95% 1.008–1.027; p < 0.001), brain natriuretic peptide (HR 1.695; CI 95% 1.347–2.134; p < 0.001) and systolic blood pressure (HR 0.982;CI 95% 0.969–0.995; p = 0.008) were independently associated with death within 1 year. Kaplan Meier curves showed that ischemic patients have worse survival free of death and hospitalization compared to other etiologies. Conclusions High levels of BUN and BNP and low systolic blood pressure were independent predictors of one-year overall mortality in our sample. Trial registration Current Controlled Trials NTC02043431, retrospectively registered at in January 23, 2014.

scholarly journals Effects of Vitamin D on Left Ventricular Ejection Fraction in Patients with Systolic Heart Failure: A Double-Blind Randomized Clinical Trial

2020 ◽  
Vol 18 (3) ◽  
Author(s):  
Reza Hassanzadeh-Makoui ◽  
Maziar Jamei ◽  
Masoud Hassanzadeh-Makoui ◽  
Hamid Khederlou
Keyword(s):  
Heart Failure ◽  
Vitamin D ◽  
Placebo Group ◽  
Ejection Fraction ◽  
Vitamin D Deficiency ◽  
Intervention Group ◽  
Systolic Heart Failure ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction

Background: Heart failure is a pathophysiologic state in which the cardiac output is not able to supply the body with enough oxygen and nutrients. The prevalence of heart failure has increased dramatically over the last decades. Vitamin D levels in patients with chronic heart failure are lower than healthy controls, and vitamin D deficiency has a direct relationship with mortality. Objectives: This study aimed to evaluate the effect of vitamin D on the improvement of left ventricular ejection fraction in patients with systolic heart failure. Methods: In this case-control clinical trial, 142 patients with chronic systolic heart failure were identified. Based on the inclusion and exclusion criteria, 114 patients were enrolled in the study and randomly divided into two groups. One group (n = 58) received 50,000 units of vitamin D capsules weekly for eight weeks, and the patients in the other group (n = 56) received a placebo. After excluding 15 patients from the placebo group and 17 patients from the intervention group during the study, according to the exclusion criteria, 41 patients were evaluated in both groups for ejection fraction changes after two months. Results: According to the results of this research, there were no statistically significant differences in the baseline parameters between the two studied groups. The intervention group consisted of 18 female and 23 male patients with a mean age of 61.68 ± 19.8 years. Moreover, the placebo group included 21 female and 20 male patients with a mean age of 62.12 ± 18.2 years. After a 2-month follow-up, the intervention group showed statistically significant changes in ejection fraction, end-diastolic volume, and heart failure class compared to the placebo group. Also, the serum level of albumin and vitamin D in the intervention group was significantly higher than the placebo group. Conclusions: The results of this study show that vitamin D treatment can improve the ejection fraction and functional ability of patients with vitamin D deficiency. If more comprehensive studies support this hypothesis, vitamin D deficiency assessment and correction in patients with chronic heart failure may be recommended.

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