scholarly journals Etiology and Prognosis of Cardiogenic Shock in a Secondary Center without Surgical Back-Up

2019 ◽  
Vol 2019 ◽  
pp. 1-7 ◽  
Author(s):  
Laurent Bonello ◽  
Marc Laine ◽  
Etienne Puymirat ◽  
Victoria Ceccaldi ◽  
Mélanie Gaubert ◽  
...  
Keyword(s):  
Heart Failure ◽  
Chronic Heart Failure ◽  
Cardiogenic Shock ◽  
Left Ventricular ◽  
Rank Test ◽  
First Episode ◽  
Common Cause ◽  
Secondary Center ◽  
Acute Decompensation

Background. Cardiogenic shock (CS) remains a major challenge in contemporary cardiology. Data regarding CS etiologies and their prognosis are limited and mainly derived from tertiary referral centers. Aims. To investigate the current etiologies of cardiogenic shock and their associated short- and long-term outcomes in a secondary center without surgical back-up. Methods. We performed an observational prospective monocenter study. All patients admitted for a first episode of CS related to left ventricular dysfunction were enrolled. The definition of CS was consistent with the European Society of Cardiology guidelines. Patients were followed for 6 months. Etiologies were analyzed, and survival rates derived from Kaplan-Meier estimates were compared with the log-rank test. Results. Between January 2015 and January 2016, 152 patients were included. The first most common cause of CS was acute decompensation of chronic heart failure (CHF). Acute coronary syndromes (ACS) were the second most common cause of CS (35.4%). At one month, the all-cause mortality rate was 39.5% and was similar between ACS and CHF (43% vs 35%, respectively; p=0.7). In a landmark analysis between 1 and 6 months, we observed a significantly higher mortality in patients with CHF than in patients with ACS (18% vs. 0%; p=0.01). Conclusions. In the present registry, acute decompensation of chronic heart failure was the most common cause of CS, while ACS complicated by CS was the second most common cause. Of importance, acute decompensation of CHF was associated with a significantly worse outcome than ACS in the long term.

scholarly journals Epidemiology and long-term outcome in outpatients with chronic heart failure in Northwestern Europe

Heart ◽  
2019 ◽  
Vol 105 (16) ◽  
pp. 1252-1259 ◽  
Author(s):  
Hanna Fröhlich ◽  
Niklas Rosenfeld ◽  
Tobias Täger ◽  
Kevin Goode ◽  
Syed Kazmi ◽  
...  
Keyword(s):  
Heart Failure ◽  
Chronic Heart Failure ◽  
Ejection Fraction ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Term Survival ◽  
Period 2 ◽  
Wide Range ◽  
Ambulatory Patients

ObjectiveTo describe the epidemiology, long-term outcomes and temporal trends in mortality in ambulatory patients with chronic heart failure (HF) with reduced (HFrEF), mid-range (HFmrEF) or preserved ejection fraction (HFpEF) from three European countries.MethodsWe identified 10 312 patients from the Norwegian HF Registry and the HF registries of the universities of Heidelberg, Germany, and Hull, UK. Patients were classified according to baseline left ventricular ejection fraction (LVEF) and time of enrolment (period 1: 1995–2005 vs period 2: 2006–2015). Predictors of mortality were analysed by use of univariable and multivariable Cox regression analyses.ResultsAmong 10 312 patients with stable HF, 7080 (68.7%), 2086 (20.2%) and 1146 (11.1%) were classified as having HFrEF, HFmrEF or HFpEF, respectively. A total of 4617 (44.8%) patients were included in period 1, and 5695 (55.2%) patients were included in period 2. Baseline characteristics significantly differed with respect to type of HF and time of enrolment. During a median follow-up of 66 (33–105) months, 5297 patients (51.4%) died. In multivariable analyses, survival was independent of LVEF category (p>0.05), while mortality was lower in period 2 as compared with period 1 (HR 0.81, 95% CI 0.72 to 0.91, p<0.001). Significant predictors of all-cause mortality regardless of HF category were increasing age, New York Heart Association functional class, N-terminal pro-brain natriuretic peptide and use of loop diuretics.ConclusionAmbulatory patients with HF stratified by LVEF represent different phenotypes. However, after adjusting for a wide range of covariates, long-term survival is independent of LVEF category. Outcome significantly improved during the last two decades irrespective from type of HF.

Abstract 2395: Treatment of Nocturnal Cheyne - Stokes - Respiration by Adaptive Servoventilation Improves Sleep Disordered Breathing and Cardiopulmonary Function in Patients with Chronic Heart Failure

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Olaf Oldenburg ◽  
Thomas Bitter ◽  
Anke Schmidt ◽  
Birgit Wellmann ◽  
Roman Lehmann ◽  
...  
Keyword(s):  
Heart Failure ◽  
Chronic Heart Failure ◽  
Left Ventricular ◽  
Peak Oxygen Consumption ◽  
Left Ventricular Ejection ◽  
Apnea Hypopnea Index ◽  
Adaptive Servoventilation ◽  
Ventricular Ejection Fraction ◽  
Before And After

Cheyne - Stokes respiration (CSR) is common in patients (pts) with chronic heart failure (CHF) and accompanied by an impaired prognosis. Nocturnal adaptive servoventilation (ASV) was recently introduced to treat CSR in CHF. Aim of this study was the investigation of long-term ASV effects on CSR and CHF parameters. In 41 pts with CHF treated according to current guidelines (39 male; 64.8 ± 10years, NYHA ≥ II, LV-EF ≤ 40%) cardiorespiratory polygraphy (PG), cardiopulmonary exercise (CPX) testing and echocardiography was performed before and after 11.6 ± 5.9 months (median 10.3 months) of ASV treatment (AutoSet CS ™ 2, ResMed). In our cohort, mean duration of ASV usage during night was 6:25 ± 1:08 h, while the device was used in 82 ± 21% of possible nights. Apnea-hypopnea-index and apnea-index were reduced from 38.2 ± 11/h to 5.5 ± 7/h and 24.2 ± 14/h to 2.5 ± 5/h, respectively (both p < 0.001). Minimum oxygen saturation rose from 81.4 ± 4.9% to 85.6 ± 4.3% (p < 0.001) while mean oxygen desaturation was reduced from 6.8 ± 2.5% to 4.6 ± 1.8% (p < 0.001). Peak oxygen consumption (VO 2 ) during CPX testing increased from 15.2 ± 3.7ml/kg/min to 17.1 ± 4.7ml/kg/min and predicted peak VO 2 from 60.1 ± 13% to 68.5 ± 18% (both p < 0.05). Left ventricular ejection fraction increased from 29.9 ± 6.6% to 33.3 ± 10.6% (p < 0.05). In selected and compliant pts with CHF and CSR, addition of nocturnal ASV therapy to standard heart failure therapy is able to abolish CSR and improve cardiac function. Whether this improvement in SDB and CHF parameters is accompanied with an improvement in CHF prognosis is not yet known.

scholarly journals In-hospital and long-term mortality in patients with arrhythmic storm

2021 ◽  
Vol 10 (Supplement_1) ◽  
Author(s):  
D Garcia-Arribas ◽  
E Lopez De Sa ◽  
S Rosillo ◽  
J Caro ◽  
E Armada ◽  
...  
Keyword(s):  
Heart Failure ◽  
Cardiac Arrest ◽  
Hospital Mortality ◽  
Cardiogenic Shock ◽  
Cause Of Death ◽  
First Episode ◽  
Term Survival ◽  
Long Term Mortality

Abstract Funding Acknowledgements Type of funding sources: Foundation. Main funding source(s): Beca para la Formación e Investigación en Cuidados Críticos Cardiológicos concedida por la Asociación de Cardiopatía Isquémica y Cuidados Críticos Cardiológicosde la SEC Introduction Available data on arrhythmic storm (AS) is usually obtained from retrospective observational studies based on series of patients (pts) with ICD or who undergo ablation. Therefore, selection bias limits the evidence regarding mortality and prognosis of this entity. Purpose/ Methods Describe in-hospital and long-term mortality of pts admitted between 2006 and 2020 for AS in the Acute Cardiac Care Unit (ACCU) of 2 tertiary hospitals in Spain. Results A total of 190 episodes of AS in 169 pts were retrospectively analysed. Baseline characteristics are depicted in Table 1. In-hospital mortality was 18.9%. Mortality in STEMI related AS was 44.2%, while in the rest of aetiologies was 6.1% (p &lt; 0.001). In-hospital cause of death was heart failure or cardiogenic shock (32.4%), refractory AS (20.6%), cardiac arrest due to pulseless activity (8.8%), severe postanoxic encephalopathy (14.7%), septic shock (8.8%), others (14.7%). long-term follow-up was obtained in 154 pts. Among those patients who survived after the first episode of AS, median follow up was 2.85 years. Long term mortality was 49.7%. Long-term survival did not differ among STEMI related AS (8.30 years, 95% CI 5.62 to 10.98) and the rest of aetiologies (6.91 years, 95% CI 5.75 to 8.07), Log rank 0.33. Kapplan-Meier survival curves are presented in Figure 1. Long-term cause of death was AS (8.3%), heart failure or cardiogenic shock (14.6%), cardiac arrest due to pulseless activity (4.2%), STEMI (2.1%), stroke (8.3%), cancer (10.4%), pneumonia and sepsis (22.9%) and unknown (29.2%). Conclusion In-hospital mortality in patients with AS requiring admission to an ACCU differs depending on the aetiology being worst in STEMI related AS. Long term mortality remains high and do not depend on the ethiology. Baseline CharacteristicsAge (SD) years66.5 (13.3)Male gender (%)141 (83.4)Previous VT ablation38 (22.4)Previous LVEF (SD)37.9 (13.1)Previous coronary artery disease (%)77 (45.5)Hypertrophic myocardiopathy (%)4 (23.7)Dilated myocardiopathy (%)24 (14.2)Previous Myocarditis (%)1 (0.6)Ventricular dysplasia (%)2 (1.2)Canalopathy (%)3 (1.8)ICD carrier (%)95 (55.6)Abstract Figure 1

scholarly journals Natriuretic Peptides: Role in Current Cardiology

2015 ◽  
Vol 70 (5) ◽  
pp. 568-572 ◽  
Author(s):  
G. A. Burnasheva ◽  
D. A. Napalkov
Keyword(s):  
Heart Failure ◽  
Natriuretic Peptides ◽  
Left Ventricular ◽  
Term Therapy ◽  
Patients With Heart Failure ◽  
Acute Decompensation ◽  
Definition Of ◽  
Long Term Therapy ◽  
The Cost

Natriuretic peptides were discovered in 50–70s of the XX century. BNP was more diagnostically and prognostically significant, as it is secreted directly into the ventricles of the heart. The studies demonstrated a high predictive value of increasing the level of BNP in acute decompensation of heart failure and in patients with chronic heart failure in a study of Val-HeFT. It was demonstrated that monitoring the level of NT-proBNP can be used for the selection of optimal therapy, affect the course and outcome of the disease, and reduce the cost of treatment. The next step in learning BNP was to undertake attempts of their use in the therapy of heart failure. Long-term therapy BNP (drug nesiritide) improved left ventricular remodelling in patients with stable heart failure. Currently the definition of the levels of BNP and NT-proBNP is used for the diagnosis and management of patients with heart failure.

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