Role of Pulsatile Hemodynamics in Acute Heart Failure: Implications for Type 1 Cardiorenal Syndrome

Abstract Background The presence of acute kidney injury in the setting of acute heart failure is very common occurrence and was termed cardiorenal syndrome 1 (CRS1). In CRS1 the diagnosis of acute kidney damage is often delayed by creatinine and urine output following KDIGO standards (Kidney Disease Improving Global Outcomes). Cystatin C is one of the earliest markers of worsening renal function. We studied the value of plasma Cystatin C in the diagnosis of cardiorenal syndrome type 1. Purpose This study was aimed: (1) to decribe clinical, subclinical characteristics, prevalence of CRS1; (2) to evaluate the diagnostic efficacy of Cystatin C in diagnosis of CRS1. Materials and method There were 139 patients with acute heart failure or acute decompensated heart failure (ADHF) in the Department of cardiovascular resuscitation and Interventional cardiology at 115 Ho Chi Minh City People's Hospital from September 2018 to June 2019. This is a prospective cohort study. Results There were 48 cases (rate 34.5%) with CRS1, medium age 66.12±15.77, men accounted for 50.4%. The optimal cut-off Cystatin C for diagnosing CRS1 is >1.81 mg/dl, AUC is 0.787 (95% CI 0.71–0.85, p<0.001), sensitivity 75%, specificity 83.52%, positive predictive value 70.6%, negative predictive value 86.4%. Building the optimal regression model by the BMA (Bayesian Model Average) method with only one variable Cystatin C: Odds Ratio = ey, while y = −2.75 + 1.11x Cystatin C. Moreover, a nomogram with variable Cystatin C was designed to predict the likelihood of CRS1 with AUC 0.842. Ultimately, a confusion matrix was constructed to determine model accuracy 81.82%, sensitivity 78.26%, specificity 100%, positive predictive value 100%, negative predictive value 47.37%. Conclusions Cystatin C is quite good value in the diagnosis of CRS1 in patients with acute heart failure or ADHF. A predictive model based on Cystatin C may help early diagnose CRS1 in patients with acute heart failure or ADHF. FUNDunding Acknowledgement Type of funding sources: None.

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Acute Heart Failure: Acute Cardiorenal Syndrome and Role of Aggressive Decongestion

Clinical Cardiology ◽

10.1002/clc.22337 ◽

2014 ◽

Vol 37 (12) ◽

pp. 773-778 ◽

Cited By ~ 9

Author(s):

Elias B. Hanna ◽

Eliana Hanna Deschamps

Keyword(s):

Heart Failure ◽

Acute Heart Failure ◽

Cardiorenal Syndrome

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Nomogram Model to Predict Cardiorenal Syndrome Type 1 in Patients with Acute Heart Failure

Kidney & Blood Pressure Research ◽

10.1159/000495815 ◽

2018 ◽

Vol 43 (6) ◽

pp. 1832-1841 ◽

Cited By ~ 2

Author(s):

Zeyuan Fan ◽

Yang Li ◽

Hanhua Ji ◽

Xinwen Jian

Keyword(s):

Heart Failure ◽

Acute Heart Failure ◽

Cardiorenal Syndrome ◽

Syndrome Type

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Abstract 13758: The Value of Plasma Neutrophil Gelatinase Associated Lipocalin in the Diagnosis of Cardiorenal Syndrome Type 1

Circulation ◽

10.1161/circ.142.suppl_3.13758 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Hao T Phan

Keyword(s):

Heart Failure ◽

Positive Predictive Value ◽

Negative Predictive Value ◽

Acute Heart Failure ◽

Predictive Value ◽

Cardiorenal Syndrome ◽

Syndrome Type ◽

Neutrophil Gelatinase Associated Lipocalin ◽

Neutrophil Gelatinase

Introduction: The presence of acute kidney injury in the setting of acute heart failure is very common occurrence and was termed cardiorenal syndrome 1 (CRS1). In CRS1 the diagnosis of acute kidney damage is often delayed by creatinine and urine output following KDIGO standards (Kidney Disease Improving Global Outcomes). Neutrophil gelatinase-associated lipocalin (NGAL) in the blood and urine is one of the earliest markers of acute kidney damage due to anemia or nephrotoxicity. Hypothesis: Plasma NGAL has good value in the diagnosis of cardiorenal syndrome type 1. Methods: There were 139 patients with acute heart failure or acute decompensated heart failure (ADHF) in the Department of cardiovascular resuscitation and Interventional cardiology at our hospital from September 2018 to June 2019. This is a prospective cohort study Results: There were 48 cases (rate 34.5%) with CRS1, medium age 66.12 ± 15.77, men accounted for 50.4%. The optimal cut-off for diagnosing NGAL CRS1 is > 353.23 ng/ml, AUC is 0.732 (95% CI 0.65-0.80, p <0.001), sensitivity 74.47%, specificity 68.48%, positive predictive value 54.7%, negative predictive value 84%. Building the optimal regression model by the BMA (Bayesian Model Average) method with 2 variables NGAL and creatinin day 1: Odds Ratio= e^y while y = - 2.39 + 0.0037 x NGAL + 0.17 x CreatininD1. Moreover, a nomogram with 2 variables NGAL and creatinin day 1 was designed to predict the likelihood of CRS1 with AUC 0.79 and validated on a testing set (consiting of 40 % of the data) by 10-cross-validation method with accuracy 79.82%. Ultimately, a confusion matrix was constructed to determine model accuracy 75.93%, sensitivity 76.74%, specificity 72.73%, positive predictive value 91.67%, negative predictive value 44.44%. Conclusions: Plasma NGAL is quite good value in the diagnosis of CRS1 in patients with acute heart failure or ADHF. A predictive model based on NGAL may help early diagnose CRS1 in patients with acute heart failure or ADHF.

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588 The prognostic role of anemia in acute heart failure. Data from the Italian survey on acute heart failure

European Journal of Heart Failure Supplements ◽

10.1016/s1567-4215(06)80385-1 ◽

2006 ◽

Vol 5 (1) ◽

pp. 134-134

Author(s):

L SCELSI ◽

L TAVAZZI ◽

A MAGGIONI ◽

D LUCCI ◽

G CACCIATORE ◽

...

Keyword(s):

Heart Failure ◽

Acute Heart Failure ◽

Prognostic Role ◽

Failure Data ◽

Italian Survey

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Assessment of acute heart failure prognosis: the promising role of prognostic models and biomarkers

Heart Failure Reviews ◽

10.1007/s10741-021-10122-9 ◽

2021 ◽

Author(s):

Nikolaos P. E. Kadoglou ◽

John Parissis ◽

Apostolos Karavidas ◽

Ioannis Kanonidis ◽

Marialena Trivella

Keyword(s):

Heart Failure ◽

Acute Heart Failure ◽

Prognostic Models ◽

Failure Prognosis

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108 Long term pronostic role of lipoprotein-associated phospholipase A2 levels in patients with acute heart failure without acute coronary syndrome

Archives of Cardiovascular Diseases Supplements ◽

10.1016/s1878-6480(11)70110-0 ◽

2011 ◽

Vol 3 (1) ◽

pp. 35

Author(s):

Jean-Christophe Charniot ◽

Randa Bittar ◽

Jean-Paul Albertini ◽

P. Giral ◽

C. Cherfils ◽

...

Keyword(s):

Heart Failure ◽

Acute Coronary Syndrome ◽

Phospholipase A2 ◽

Acute Heart Failure ◽

Coronary Syndrome

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Effects of levosimendan in patients with acute heart failure and cardiorenal syndrome

European Heart Journal Acute Cardiovascular Care ◽

10.1093/ehjacc/zuab020.028 ◽

2021 ◽

Vol 10 (Supplement_1) ◽

Author(s):

M Ribeiro Da Silva ◽

G Santos Silva ◽

D Caeiro ◽

M Passos Silva ◽

C Guerreiro ◽

...

Keyword(s):

Heart Failure ◽

Acute Heart Failure ◽

Natriuretic Peptides ◽

Angiotensin Receptor Blockers ◽

Cardiorenal Syndrome ◽

Baseline Serum ◽

Beneficial Effects ◽

Funding Sources ◽

Tertiary Center ◽

Short Term Mortality

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Cardiorenal syndrome (CRS) is common in patients with acute heart failure (AHF) and is associated with poor prognosis. Levosimendan (LVS) is an inodilator used in AHF and has beneficial effects on renal function (RF). However, its effects on RF in CRS patients are not established. Purpose To evaluate whether LVS could improve RF in AHF patients with or without CRS. Methods Retrospective study that included patients with AHF treated with LVS in a cardiac intensive care unit of a tertiary center, between January 2015 and June 2018. Baseline serum creatinine (SCr) was recorded and SCr and glomerular filtration rate (GFR) were accessed before and within 5 days after LSV use. CRS was defined as an increase in SCr > 0,3 mg/dL over baseline (before LVS use). RF improvement was defined as a decrease in SCr after LVS use. We evaluate outcomes at 1-year. Results 61 patients were included, 84% males, mean age 65 years, ejection fraction ≤40% in 87%. INTERMACS 4 and hemodynamic profile C were the most frequent presentation. LSV was administered in 24h, without bolus, in most patients. CRS was present in 44,3% of patients. Basal characteristics were similar between CRS and no-CRS patients, including prevalence of chronic kidney disease, baseline SCr or natriuretic peptides (p> 0,05 for all). CRS patients had a significant improvement in RF after LVS use (SCr 2,08 to 1,65 mg/dL, p< 0,001 and GFR 40,4 to 54,6 mL/min/m2, p< 0,001), while no-CRS patients had no significant improvement in RF (SCr 1,33 to 1,32 mg/dL and GFR 64,1 to 64,5 mL/min/m2, p> 0,05 for all). Also, there was a significant decrease in natriuretic peptides after LVS in CRS patients (NT-proBNP 13527,5 to 10708,8 pg/mL, p= 0,006), without significant differences in no-CRS patients. It is noteworthy that at discharge, CRS patients were more likely to titrate HF optimal medical therapy (OMT) compared with no-CRS patients (p= 0,039). There was a lower tendency to suspend angiotensin-converting enzyme (ACE-I) and angiotensin receptor blockers (ARB) in CRS patients (p= 0,05). At discharge CRS patients received more furosemide than at admission (77,2 mg/day to 97,1 mg/day, p= 0,019) compared with no-CRS patients (89,6 mg/day to 97,0 mg/day, p= 0,469), receiving similar doses at discharge. In CRS patients, RF improvement was associated with a decrease in intra-hospital mortality (p= 0,043) and a tendency to decrease 30-day mortality (p= 0,060), but without differences in one-year mortality. Conclusion In CRS patients, LVS improved RF and NT-proBNP, allowed to titrate OMT and decreased the need to suspend ACE-I or ARB and was associated to a decrease in short-term mortality.

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