scholarly journals Beta-blockers for post-acute coronary syndrome mid-range ejection fraction: a nationwide retrospective study

2019 ◽  
Vol 8 (7) ◽  
pp. 599-605 ◽  
Author(s):  
Fernando Montenegro Sá ◽  
Rita Carvalho ◽  
Catarina Ruivo ◽  
Luís Graça Santos ◽  
Alexandre Antunes ◽  
...  
Keyword(s):  
Heart Failure ◽  
Acute Coronary Syndrome ◽  
Ejection Fraction ◽  
Beta Blocker ◽  
Survival Benefit ◽  
Positive Impact ◽  
Inhospital Mortality ◽  
Invasive Strategy ◽  
Coronary Syndrome ◽  
Group 3

Background: Patients with mid-range ejection fraction (40–49%) are in focus due to the newly defined entity of heart failure with mid-range ejection fraction. Acute coronary syndromes are a major aetiology for heart failure with mid-range ejection fraction. We aim to evaluate which therapeutic decisions are associated with inhospital survival benefit in post-acute coronary syndrome patients categorised according to the ejection fraction. Methods and results: The authors analysed a cohort of a multicentre national registry enrolling acute coronary syndrome patients between 2010 and 2016, classified according to their ejection fraction before hospital discharge. Patients with previously known heart failure or with no ejection fraction evaluation were excluded. A total of 9429 patients were included and categorised in three groups: (a) ejection fraction of 50% or greater ( n=6113, 65%); (b) ejection fraction of 40–49% ( n=1926, 20%); and (c) ejection fraction less than 40% ( n=1390, 15%). The primary endpoint was inhospital mortality. To eliminate confounding factors, a multivariate logistic regression analysis was conducted, including acute coronary syndrome type, baseline characteristics, pharmacological treatment, clinical data, laboratory data and coronary anatomy when known. The overall inhospital mortality was 2.8% ( n=263): 0.9% ( n=53) in group 1, 2.4% ( n=37) in group 2 and 11.4% ( n=159) in group 3. After multivariate analysis, an invasive strategy had a positive impact in all groups, inhospital beta-blocker administration had a positive impact for groups 2 and 3, and angiotensin-converting enzyme inhibitor/angiotensin receptor blocker and spironolactone had a positive impact on group 3. Conclusion: Post-acute coronary syndrome mid-range ejection fraction patients represent an intermediate risk group in which beta-blocker administration was associated with inhospital survival benefit. An invasive strategy was a survival predictor for all groups, regardless of ejection fraction category.

Outcome of Allogeneic Stem Cell Transplantation in Patients with Low Ventricular Ejection Fraction

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 3306-3306
Author(s):  
Ziad U. Khan ◽  
Rima M Saliba ◽  
Suhail Qureshi ◽  
Chitra Hosing ◽  
Sergio A Giralt ◽  
...  
Keyword(s):  
Heart Failure ◽  
Congestive Heart Failure ◽  
Acute Coronary Syndrome ◽  
Stem Cell ◽  
Ejection Fraction ◽  
Stem Cell Transplantation ◽  
Cardiac Toxicity ◽  
Hematologic Malignancies ◽  
Ventricular Ejection Fraction ◽  
Coronary Syndrome

Abstract BACKGROUND: High-dose therapy and Allogeneic stem cell transplantation (allo SCT) is a potentially curative treatment for patients with hematologic malignancies. A high risk of regimen-related toxicity limits this treatment only for patients with excellent organ-system function. A low left ventricular ejection fraction (LVEF) of ≤ 45% is considered to be a major risk factor for post-transplant cardiac toxicity and nonrelapse mortality (NRM). However, several patients with advanced hematologic malignancies and low LVEF can potentially benefit from this therapy. To address this issue, we evaluated the frequency of cardiac toxicity and NRM in 56 patients with low LVEF undergoing allo SCT. METHODS: We performed a retrospective analysis on 56 patients with baseline low LVEF who received allo SCT between January 2000 and February 2006 at our institution. Pre-transplant evaluation included an electrocardiogram and bidimensional echocardiogram or gated cardiac scan. Cardiac toxicity was defined as congestive heart failure (CHF), atrial/ventricular arrhythmia or an acute coronary syndrome. Of the 56 patients, 22 received a myeloablative regimen (16 busulfan-based, 6 total body irradiation-based) while 34 patients received a fludarabine-based reduced intensity conditioning regimen. RESULTS: Twenty-three patients (41%) received allo SCT from an unrelated donor. Acute leukemia was the reason for allo SCT in 32 (57%) patients. Baseline LVEF within 30 days pre-transplant ranged 20 to 45%. At their 6 month follow-up, cardiac toxicity was seen in 7 (12%) patients. Toxicity included congestive heart failure (CHF) in 4 (7%) and atrial fibrillation (AF) in 4 (7%). One patient had both CHF and AF. There were no documented episodes of acute coronary syndrome. Cumulative incidence of NRM at 100 days was 12%; none of the deaths were attributable to cardiac causes. These results were comparable to allo SCT performed in patients with normal LVEF. Variables such as age, LVEF, type of transplant, or the underlying disease did not emerge as significant predictors of post-transplant cardiac toxicity or NRM. CONCLUSION: Patients with low LVEF (<45%) are acceptable candidates for allo SCT. A prospective study with stratification of cardiac risk factors is warranted in patients with low LVEF.

scholarly journals LV Mechanical Dyssynchrony in Heart Failure With Preserved Ejection Fraction Complicating Acute Coronary Syndrome

2011 ◽  
Vol 4 (4) ◽  
pp. 348-357 ◽  
Author(s):  
Alex Pui-Wai Lee ◽  
Qing Zhang ◽  
Gabriel Yip ◽  
Fang Fang ◽  
Yu-Jia Liang ◽  
...  
Keyword(s):  
Heart Failure ◽  
Acute Coronary Syndrome ◽  
Ejection Fraction ◽  
Mechanical Dyssynchrony ◽  
Preserved Ejection Fraction ◽  
Coronary Syndrome

scholarly journals Sacubitril-valsartan in Heart Failure With Preserved Ejection Fraction Following Acute Coronary Syndrome

2021 ◽  
Author(s):  
Zhi-hua Han ◽  
Chang-qian Wang ◽  
Jun-feng Zhang ◽  
Jun Gu
Keyword(s):  
Heart Failure ◽  
Acute Coronary Syndrome ◽  
Ejection Fraction ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Angiotensin Ii Receptor Blocker ◽  
Preserved Ejection Fraction ◽  
Ventricular Ejection Fraction ◽  
Clinical Prognosis ◽  
Coronary Syndrome

Abstract BackgroundIt was indicated that sacubitril-valsartan could improve the clinical prognosis in specific phenotype of heart failure with preserved ejection fraction (HFpEF) patients compared with valsartan. However, there is lack of evidence of the comparative effectiveness in HFpEF patients following acute coronary syndrome (ACS). The aim of this study was to evaluate whether the selection between sacubitril-valsartan and angiotensin-converting enzyme inhibitor (ACEI)/angiotensin II receptor blocker (ARB) in HFpEF after ACS confered a prognostic benefit. MethodsUsing a propensity score matching of 1:2 ratio, this retrospective claims database study compared sacubitril-valsartan prescription (n=85) and ACEI/ARB therapy (n=170) in patients with HFpEF following ACS. Cox regression analysis was performed to assess the association between treatment and composite endpoints (all-cause mortality or hospitalization for heart failure). ResultsWith a follow-up of 2 years, 52 patients (20.4%) either died from any cause or were hospitalized for heart failure, in which 10 patients (11.8%) with prescribed with sacubitril-valsartan and 42 patients (24.7%) treated with ACEI/ARB (P=0.016). Sacubitril-valsartan therapy was beneficial in N-terminal Pro-B-type natriuretic peptid (NT-proBNP) reduction as well as left ventricular ejection fraction (LVEF) change. And Cox proportional hazards regression model revealed that sacubitril-valsartan prescription (HR 0.473, 95% CI: 0.233-0.961, P=0.038) was associated with a reduced risk of the occurrence of composite endpoints.ConclusionLong-term sacubitril-valsartan exposure was associated with protective effects in terms of the incidence of cardiovascular events in patients with HFpEF following ACS.

scholarly journals PROBLEMS AND SPECIFICITY OF DIAGNOSTICS OF ACUTE HEART FAILURE IN PATIENTS WITH INTERMEDIATE EJECTION FRACTION AT THE НОSPITAL STAGE

2018 ◽  
Vol 19 (1) ◽  
pp. 16-19 ◽  
Author(s):  
E. G. Skorodumova ◽  
V. A. Kostenko ◽  
E. A. Skorodumova ◽  
A. V. Rysev
Keyword(s):  
Heart Failure ◽  
Acute Coronary Syndrome ◽  
Ejection Fraction ◽  
Acute Heart Failure ◽  
Diagnostic Errors ◽  
Coronary Syndrome ◽  
Acute Decompensation

We analyzed ambulance diagnoses of patients with acute decompensation of heart failure with the background of the intermediate ejection fraction. In this category of patients acute decompensation of heart failure was diagnosed in-hospital, not associated with acute coronary syndrome, or other cardiological diseases. 78 variants of different diagnoses of referral of patients to the hospital at the prehospital stage were found, with a true diagnosis of acute decompensation of heart failure being established in only patients. All diagnoses were divided into 6 groups with the subsequent analysis of the causes of diagnostic errors.

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