Abstract 15161: Impact of Malnutrition Score Index on Short-term Clinical Outcome in Patients with Acute Decompensated Heart Failure

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Naotsugu Iwakami ◽  
Toshiyuki Nagai ◽  
Yasuo Sugano ◽  
Takafumi Yamane ◽  
Tatsuhiro Shibata ◽  
...  
Keyword(s):  
Heart Failure ◽  
Adverse Events ◽  
Serum Sodium ◽  
Sodium Level ◽  
Serum Sodium Level ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Hospital Death ◽  
Short Term ◽  
Conut Score

Backgrounds: Recent studies have elucidated the association between malnutrition and poor long-term prognosis in patients with chronic heart failure (HF), using controlling nutritional status (CONUT) score, a simple and useful index for evaluating malnutrition. In this study, we aim to investigate the prognostic significance of CONUT score in patients with acute decompensated HF. Methods: We examined 320 consecutive patients in our prospective acute decompensated HF registry database from January 2013 to January 2014. Patients with acute coronary syndrome, in-hospital death, and without complete data-set at discharge were excluded. Finally, we selected 206 patients as a study population and malnutrition was defined as CONUT score above 3 at discharge. Results: 112 (54%) patients showed malnutrition at discharge. Patients with malnutrition had higher age, serum creatinine and plasma brain natriuretic peptide levels, and lower serum sodium level at discharge than those without. There were no significant differences between the groups in terms of sex, blood pressure, heart rate, left ventricular ejection fraction, etiology of HF and cardiovascular medications at discharge. During the median follow-up of 192 days (interquartile range = 109-260 days), malnutrition was associated with higher short-term adverse events including death and HF admission (P = 0.008, Figure). Cox proportional-hazards model analysis demonstrated that malnutrition was independently associated with adverse events (HR 2.00, 95% CI 1.01-4.17, P = 0.047), even after adjustment among variables including age (HR 1.04, 95% CI 1.00-1.08, P = 0.03) and serum sodium level (HR 0.93, 95% CI 0.88-1.00, P = 0.04). Conclusions: In patients with acute decompensated HF, malnutrition at discharge was independently associated with worse short-term clinical outcomes. These findings suggest that earlier intensive nutrition management might need to be considered.

4332Benefit of sinus rhythm restoration in acute decompensated heart failure patients with atrial tachyarrhythmia treated with landiolol

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
M Sakai ◽  
A Suzuki ◽  
T Shiga ◽  
Y Tanaka ◽  
E Kouno ◽  
...  
Keyword(s):  
Heart Failure ◽  
Sinus Rhythm ◽  
Acute Decompensated Heart Failure ◽  
Decompensated Heart Failure ◽  
Left Ventricular ◽  
Rhythm Control ◽  
Control Treatment ◽  
Left Ventricular Ejection ◽  
Hospital Death ◽  
Ventricular Ejection Fraction

Abstract Background Atrial tachyarrhythmias (ATA), such as atrial fibrillation / atrial tachycardia are frequently observed in patients with acute decompensated heart failure (ADHF). Because ATA leads to clinical deterioration and worsen HF, the conversion and prevention of ATA is important of ADHF with ATA. Landiolol, an ultrashort-acting intravenous beta-1 blocker, was developed and has been used for the treatment of ATA. Purpose We evaluated the acute effect of landiolol treatment on heart rate or blood pressure (BP), also the rates and benefits of sinus rhythm (SR) restoration among AHF patients with ATA treated with landiolol. Methods We studied 67 consecutive HF patients with ATA (age: 67±12 years, 36 male) treated with landiolol from 2015 to December 2017 at our University Hospital. They were compared with 50 paired subjects, matched for gender, age and baseline BP who developed HF with ATA from HIJ-HF 2 study (consisted of HF patients hospitalized between 2013 and 2014). Results At the start of landiolol treatment, mean left ventricular ejection fraction (LVEF) was 41±14%. The median maintenance dose of landiolol was 3.0 (1.0–12.0) μ/kg/min and the median treatment duration of landiolol was 5 (1–24) days. After 6 hours from administration of landiolol, mean HR decreased significantly from 140±18 to 100±21 bpm (p<0.05), whereas BP was not difference during landiolol treatment. Sinus rhythm was restored spontaneously in 15 (22%), and by electrical or pharmacological cardioversion in 5 (7%) during a treatment with intravenous landiolol. Furthermore, sinus rhythm was restored in 22 patients using additional rhythm control treatment, such as amiodarone or catheter ablation after intravenous landiolol treatement. Eight patients experienced in-hospital death. Forty-one (69%) of 59 patients discharged alive were in SR. During the follow-up period of 16±12 months, 4 patients died and 12 patients experienced rehospitalization due to worsening HF after hospital discharge. There was a significant higher rate of death or HF rehospitalization in patients without SR restoration than patients with SR restoration (44% vs. 20%, p<0.05) (Figure A). Compared with 50 paired subjects from HIJ-HF 2 study, those who treated with landiolol developed a significant higher rate of SR restoration (68% vs. 20%, p<0.05) (Figure B). Figure 1 Conclusion This study demonstrated that landiolol treatment was effective for both rate control and conversion to sinus rhythm in ADHF patient with ATA. We should consider that the benefits of rhythm control in ADHF patients with ATA during and after landiolol treatment.

Comparison of the Effects of Levosimendan Dobutamine and Vasodilator Therapy on Ongoing Myocardial Injury in Acute Decompensated Heart Failure

2016 ◽  
Vol 22 (2) ◽  
pp. 153-158 ◽  
Author(s):  
Erkan Gencer ◽  
Volkan Doğan ◽  
Müjgan Tek Öztürk ◽  
Aydın Nadir ◽  
Ahmet Musmul ◽  
...  
Keyword(s):  
Heart Failure ◽  
Myocardial Injury ◽  
Cell Damage ◽  
Acute Decompensated Heart Failure ◽  
Decompensated Heart Failure ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Systolic Pulmonary Artery Pressure ◽  
Short Term ◽  
Ventricular Ejection Fraction

Background: Cardiac troponins (cTn) are reliable and the most sensitive biomarker in the setting of acute decompensated heart failure (ADHF). Acute decompensated heart failure is usually associated with worsening chronic heart failure, and it may be caused by ongoing minor myocardial cell damage that may occur without any reported precipitating factors. Methods: We compared the short-term effect of levosimendan (LEV), dobutamine (DOB), and vasodilator treatment (nitroglycerin [NTG]) on myocardial injury with hemodynamic, neurohumoral, and inflammatory indicators. One hundred twenty-two patients with a mean age of 66 ± 9 years were treated with LEV (n = 40), DOB (n = 42), and NTG (n = 40) and examined retrospectively. Blood samples (cTnI, N-terminal probrain natriuretic peptide [NT-proBNP], highly sensitive C-reactive protein [HsCRP], and others), left ventricular ejection fraction (LVEF), systolic pulmonary artery pressure (sPAP), and 6-minute walk distance (6MWD) were compared before and after treatment. Results: At admission, detectable levels of cTnI were observed in 53% of patients (≥0.05 ng/mL). Serial changes in the mean cTnI levels were not significantly different between the groups (LEV 0.04 ± 0.01 to 0.03 ± 0.01 ng/mL; DOB 0.145 ± 0.08 to 0.08 ± 0.03 ng/mL; NTG 0.1 ± 0.03 to 0.09 ± 0.02 ng/mL; overall P = .859). Favourable effects on the NT-proBNP, sPAP values, LVEF, 6MWD, and HsCRP were observed overall, especially in the LEV groups. Conclusion: Beneficial effects of short-term use of LEV, DOB, and NTG on ongoing myocardial injury were demonstrated. These findings can be attributed to the anti-ischemic properties as well as the hemodynamic, neurohumoral, and functional benefits from the positive inotropes, especially LEV, in patients with ADHF.

Abstract 15469: Malnutrition and Cognitive Dysfunction in the Elderly Patients With Acute Heart Failure

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Michiaki NAGAI ◽  
Keigo Dote ◽  
Masaya Kato ◽  
Noboru Oda ◽  
Eiji Kunita ◽  
...  
Keyword(s):  
Heart Failure ◽  
Nutritional Status ◽  
Elderly Patients ◽  
Cognitive Dysfunction ◽  
Mmse Score ◽  
The Elderly ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Stable Phase ◽  
Conut Score

Introduction: Malnutrition, cognitive decline and heart failure (HF) frequently coexist in the elderly. A recent systematic review revealed that malnutrition was a possible contributing factor of cognitive impairment. Although several studies reported the association of malnutrition with poor HF prognosis, the underlying pathophysiology has been unclear. Hypothesis: We assessed the hypothesis that malnutritional status might be associated with cognitive dysfunction in the elderly with HF. In addition, we investigated whether left ventricular ejection fraction (LVEF) moderates that relationship or not. Methods: Nutritional status and cognitive function were evaluated using the geriatric nutritional risk index (GNRI), controlling nutritional status (CONUT) score and mini-mental state examination (MMSE) in 245 elderly inpatients in stable phase of HF (82.9±6.0 years old, male 49.4%). Echocardiography was performed at admission. HF with preserved EF (HFpEF) was defined according to LVEF more than 50% (n=129). Results: According to the quartile of MMSE score (< 19, ≥19 to 27≤, >27), significant associations of MMSE score were observed with GNRI (89.1 vs 95.4 vs 95.5, p=0.004) and CONUT score (3.50 vs 2.71 vs 2.61, p=0.039) among three groups. In the logistic regression analysis adjusted for the confounders including age, gender, LVEF, brain natriuretic peptide level, systolic blood pressure at admission, diuretics and antihypertensive medication use, GNRI (β=0.96, 95%CI:0.93 to 0.99, p=0.008) and CONUT score (β=1.18, 95%CI:1.01 to 1.37, p=0.03) each was significantly associated with cognitive dysfunction (defined as MMSE score <19). According to the HF phenotype, GNRI (β=0.93, 95%CI:0.88 to 0.98, p=0.01) and CONUT (β=1.55, 95%CI:1.19 to 2.02, p=0.001) each had a significant relationship with cognitive dysfunction only in the group without HFpEF. Conclusions: In conclusion , lower GNRI and higher CONUT score were shown to be significant indicators of cognitive dysfunction in the elderly HF patients. These results highlight the importance of stratifying by nutritional status for a clinical intervention of cognitive dysfunction in the elderly patients without HFpEF.

scholarly journals Prognosis and risk stratification in patients with decompensated heart failure receiving inotropic therapy

Open Heart ◽  
2018 ◽  
Vol 5 (2) ◽  
pp. e000923
Author(s):  
Clara Gomes ◽  
Caíque Bueno Terhoch ◽  
Silvia Moreira Ayub-Ferreira ◽  
Germano Emilio Conceição-Souza ◽  
Vera Maria Cury Salemi ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Risk Stratification ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Hospital Death ◽  
Inotropic Therapy ◽  
Ventricular Ejection Fraction ◽  
Advanced Therapies

ObjectivesThe prognostic significance of transient use of inotropes has been sufficiently studied in recent heart failure (HF) populations. We hypothesised that risk stratification in these patients could contribute to patient selection for advanced therapies.MethodsWe analysed a prospective cohort of adult patients admitted with decompensated HF and ejection fraction (left ventricular ejection fraction (LVEF)) less than 50%. We explored the outcomes of patients requiring inotropic therapy during hospital admission and after discharge.ResultsThe study included 737 patients, (64.0% male), with a median age of 58 years (IQR 48–66 years). Main aetiologies were dilated cardiomyopathy in 273 (37.0%) patients, ischaemic heart disease in 195 (26.5%) patients and Chagas disease in 163 (22.1%) patients. Median LVEF was 26 % (IQR 22%–35%). Inotropes were used in 518 (70.3%) patients. In 431 (83.2%) patients, a single inotrope was administered. Inotropic therapy was associated with higher risk of in-hospital death/urgent heart transplant (OR=10.628, 95% CI 5.055 to 22.344, p<0.001). At 180-day follow-up, of the 431 patients discharged home, 39 (9.0%) died, 21 (4.9%) underwent transplantation and 183 (42.4%) were readmitted. Inotropes were not associated with outcome (death, transplant and rehospitalisation) after discharge.ConclusionsInotropic drugs are still widely used in patients with advanced decompensated HF and are associated with a worse in-hospital prognosis. In contrast with previous results, intermittent use of inotropes during hospitalisation did not determine a worse prognosis at 180-day follow-up. These data may add to prognostic evaluation in patients with advanced HF in centres where mechanical circulatory support is not broadly available.

Abstract 14878: Relationship of Serum Erythropoietin Level to Clinical Outcome in Acute Heart Failure Patients without Anemia

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Takehiro Homma ◽  
Toshiyuki Nagai ◽  
Yasuo Sugano ◽  
Takafumi Yamane ◽  
Tatsuhiro Shibata ◽  
...  
Keyword(s):  
Heart Failure ◽  
Clinical Outcome ◽  
Adverse Events ◽  
Serum Creatinine ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Data Set ◽  
Ventricular Ejection Fraction ◽  
Coronary Syndrome ◽  
Serum Erythropoietin

BACKGROUND: Elevation of serum erythropoietin (EPO) level is frequently observed in heart failure (HF) patients, and higher serum EPO level has been reported to be associated with worse clinical outcome in chronic HF. However, serum EPO level was highly influenced by the presence of anemia and its prognostic significance in acute HF (AHF) patients without anemia remains unknown. METHODS: We examined 320 consecutive AHF patients who admitted to our institution between January 2013 and January 2014 from prospective registry. Patients who had anemia defined as a hemoglobin concentration < 13g/dl (males) and <12 g/dl (females) based on the WHO criteria, acute coronary syndrome and without complete data-set at admission were excluded. Finally, 92 patients were divided into two groups according to higher serum EPO level (above 25.7 mIU/ml, the median) or lower serum EPO level (below 25.7 mIU/ml) at admission. Adverse events were defined as worsening HF and death within 90 days after admission. RESULTS: Adverse events were occurred in 10 patients (11 %). Higher EPO group had significantly higher incidence of adverse events compared with lower EPO group (19.6% vs 10.9%, P<0.01, Figure). Patients with higher EPO level had higher serum creatinine and plasma brain natriuretic peptide (BNP) levels on admission than those without. There were no significant differences between the two groups in terms of age, gender, oxygen saturation, NYHA class, cardiovascular medications, left ventricular ejection fraction (LVEF), reticulocyte count on admission. Multivariate logistic regression analyses showed that higher serum EPO level (OR 10.6, 95% CI 1.7-204.9, P<0.01) was an independent determinant for adverse events within 90 days after admission, among variables including age, gender, LVEF, serum creatinine, hemoglobin and plasma BNP levels on admission. CONCLUSIONS: Higher serum EPO level might be a predictor for worse short-term clinical outcome in AHF patients without anemia.

scholarly journals Renal function, serum sodium level, and outcomes in hospitalized systolic heart failure patients

Medicine ◽  
2016 ◽  
Vol 95 (25) ◽  
pp. e3898 ◽  
Author(s):  
Jin Joo Park ◽  
In-Ho Chae ◽  
Dong-Ju Choi ◽  
Seok-Min Kang ◽  
Byung-Su Yoo ◽  
...  
Keyword(s):  
Heart Failure ◽  
Renal Function ◽  
Serum Sodium ◽  
Sodium Level ◽  
Serum Sodium Level ◽  
Systolic Heart Failure ◽  
Heart Failure Patients
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