scholarly journals Biomarker sST2 in Adults with Transposition of the Great Arteries Palliated by Mustard Procedure

2020 ◽  
Vol 3 ◽  
Author(s):  
Haley Ferguson ◽  
Hugo Martinez ◽  
Melanie Pride ◽  
Roger Hurwitz ◽  
Mark Payne
Keyword(s):  
Heart Failure ◽  
Nyha Class ◽  
Mechanical Strain ◽  
Functional Class ◽  
Control Group ◽  
Class Iii ◽  
Healthy Individuals ◽  
Mustard Operation ◽  
Lipid Panel ◽  
Mustard Procedure

Background: Transposition of the great arteries (TGA) is a congenital heart defect (CHD) in which the aorta and pulmonary artery are transposed; it requires urgent surgical intervention. The Mustard procedure was an early surgery allowing survival into adulthood. However, this procedure is associated with long-term adverse effects including arrhythmias and heart failure (HF). A key factor impairing HF management in adults with CHD is lack of biomarkers to predict outcome. Soluble ST2 (sST2) is a protein secreted by myocytes in response to mechanical strain and fibrosis. No studies have focused specifically on sST2 in TGA individuals that underwent a Mustard procedure.  In this study, we hypothesized adults with TGA palliated with a Mustard procedure would have higher levels of sST2 than healthy individuals, and this would correlate with functional class status.      Methods: We screened the Pediatric Cardiology database for D-TGA subjects and Mustard operation. Healthy controls were recruited from clinic and the community. Patients were matched by age to a control group of 21 healthy individuals.  Severity of symptoms was assessed by NYHA functional classification. sST2 levels were obtained using Critical Diagnostics Presage ST2 Assay kit. Additionally, cTnI, BNP, lipid panel, insulin, glucose, and EKG and echocardiography (TGA) were obtained at IUSM clinical laboratories.      Results: We identified 45 patients with D-TGA and Mustard operation. 19 patients were included in analysis: 12 male and 7 female subjects aged 18 to 46, mean of 34.9 years. In the Mustard group, 9 subjects were assigned to NYHA class II, and 9 to class III. The control group was asymptomatic. sST2 levels in the Mustard group were elevated in 53%, while only 29% in the controls. Of the Mustard subjects with elevated sST2, 67% had elevated cTnI, 80% arrhythmias, 70% EKG T-wave abnormalities, and 80% took cardiac medications.  90% of these patients had low HDL, 40% high LDL, and 40% low insulin.      Conclusion: This study demonstrates patients with Mustard operation averaged higher sST2 levels than healthy subjects. Importantly, of the patients with elevated levels, there was a significant association of sST2 with biomarker abnormalities and clinical heart failure signs.  This suggests in patients with D-TGA palliated with Mustard procedure, sST2 may add predictive value to cardiac related morbidity and mortality.  

scholarly journals Increased Interleukin-11 Levels Are Correlated with Cardiac Events in Patients with Chronic Heart Failure

2019 ◽  
Vol 2019 ◽  
pp. 1-8 ◽  
Author(s):  
Jing Ye ◽  
Zhen Wang ◽  
Di Ye ◽  
Yuan Wang ◽  
Menglong Wang ◽  
...  
Keyword(s):  
Heart Failure ◽  
Plasma Concentrations ◽  
Heart Association ◽  
Functional Class ◽  
Control Group ◽  
Class Iii ◽  
Cardiac Events ◽  
Nyha Functional Class ◽  
Interleukin 11

Background. Interleukin-11 (IL-11) is an important inflammatory cytokine and has been demonstrated to participate in cardiovascular diseases. However, there have been no studies about the role of IL-11 in heart failure (HF). The present study is aimed at investigating whether IL-11 levels are associated with the cardiac prognosis in patients with HF. Methods. The plasma concentrations of IL-11 were measured in 240 patients with chronic HF (CHF) and 80 control subjects without signs of significant heart disease. In addition, we prospectively followed these CHF patients to endpoints of cardiac events. Results. Compared with the control group, the plasma IL-11 concentrations were significantly increased in the CHF patients and gradually increased in the New York Heart Association (NYHA) functional class II group, the NYHA functional class III group, and the NYHA functional class IV group. The receiver operating characteristic (ROC) curve revealed that the predictive role of IL-11 in HF is not as good as N-terminal B-type natriuretic peptide (BNP), although IL-11 has a certain value in predicting cardiac events. In addition, the CHF patients were divided into 3 groups according to the plasma IL-11 concentration category (low, T1; middle, T2; and high, T3). The multivariate Cox hazard analysis showed that the high plasma IL-11 concentrations were independently associated with the presence of cardiac events after adjustment for confounding factors. Furthermore, the CHF patients were divided into two groups based on the median plasma IL-11 concentrations. The Kaplan-Meier analysis revealed that the patients with high IL-11 concentrations had a higher risk of cardiac events compared with those with low IL-11 concentrations. Conclusions. Higher plasma IL-11 levels significantly increase the presence of cardiac events and suggest a poor outcome; although the diagnostic value of IL-11 in CHF is not as good as BNP, there is a certain value in predicting cardiac events in CHF.

Abstract 12680: Efficacy and Safety of Edoxaban Compared With Warfarin in Patients With Atrial Fibrillation and Heart Failure: Insights From Engage-AF TIMI 48

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Giulia Magnani ◽  
Robert P Giugliano ◽  
Christian T Ruff ◽  
Sabina A Murphy ◽  
Francesco Nordio ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Vitamin K Antagonists ◽  
Nyha Class ◽  
Functional Limitation ◽  
Factor Xa ◽  
Functional Class ◽  
Efficacy And Safety ◽  
Class Iii ◽  
History Of

BACKGROUND: Atrial fibrillation (AF) and heart failure (HF) have emerged as the two epidemics of cardiovascular (CV) disease. The prevalence of AF increases with the severity of HF and contributes to HF disability. Among patients treated with vitamin K antagonists (VKAs), symptomatic HF is an independent risk factor for lower time in therapeutic range (TTR), which reduces the efficacy and safety of VKAs. METHODS: In the ENGAGE AF-TIMI 48 trial, both once-daily regimens of the direct oral factor Xa inhibitor edoxaban [high (HDE) and low dose (LDE)], were non inferior to warfarin (W) for prevention of stroke and systemic embolic events (SEE) in patients with AF and were associated with lower rates of bleeding. We evaluated the safety and the efficacy of edoxaban compared with W in patients with HF presenting with different severity of functional limitation (NYHA class). RESULTS: Among 21,105 patients enrolled 8,981(43%) had no history of HF, 9,489 (45%) had history of HF and a NYHA class I-II, whereas 2,635 (13%) had symptomatic HF with NYHA class III-IV. Patients with more severe HF symptoms had higher rates of stroke SEE, CV death and CV hospitalization (p<0.0005 for all) and among those treated with W we observed a lower mean TTR (62.6% vs. 70.0%, p<0.001). Compared with W, the efficacy of both edoxaban doses in reducing stroke or SEE was similar between patients with and without HF (HDE vs. W, p int=0.96; LDE vs. W, p int=0.63, Fig.) and there were no differences between NYHA classes. CV hospitalization was significantly reduced with HDE relative to W, without heterogeneity by different NYHA classes (p int=0.5, Fig.). Both edoxaban regimens reduced consistently major bleeding and intracranial hemorrhage, regardless of HF severity (Fig.). CONCLUSION: The relative efficacy and safety of both edoxaban regimens, compared to well-managed W in AF patients with HF, was consistent irrespective of the severity of functional class.

NT-proBNP levels and their relationship with systemic ventricular impairment in adult patients with transposition of the great arteries long after Mustard or Senning procedure

2015 ◽  
Vol 53 (8) ◽  
Author(s):  
Karel Kotaska ◽  
Jana Popelova ◽  
Richard Prusa
Keyword(s):  
Nyha Class ◽  
Right Ventricular Ejection Fraction ◽  
Functional Class ◽  
Adult Patients ◽  
Control Group ◽  
Healthy Individuals ◽  
Ventricular Ejection Fraction ◽  
Atrial Switch ◽  
Senning Operation ◽  
The Relationship

AbstractThe aim of the study was to investigate serum NT-proBNP levels in adult patients with transposition of the great arteries (d-TGA) corrected by atrial switch procedures (Mustard or Senning) operation and to assess the relationship with ventricular impairment and NYHA class.Serum NT-proBNP levels were measured in a group of 81 consecutive adult patients (59 males, mean age 27 years and 22 females, mean age 28 years) with transposition of the great arteries (TGA) after surgical correction in childhood, and in a control group of 25 healthy individuals (16 males, mean age 32 years, and 9 females, mean age 29 years). Age-matched correlation of NT-proBNP concentrations in TGA patients after Mustard or Senning correction was performed, but this correlation was considered not significant (p=0.08).Concentrations of NT-proBNP in patients with TGA were significantly elevated compared to the control group of healthy individuals (203 ng/L vs. 41 ng/L, p<0.0001). Patients after the Mustard repair had significantly higher NT-proBNP values than patients after the Senning operation (234 ng/L vs. 148 ng/L, p=0.0023). NT-proBNP correlated negatively with the systemic right ventricular ejection fraction with the greatest significance in patients after Mustard correction (r=–0.32, p<0.0001). The concentration of NT-proBNP was also associated with NYHA functional class (p=0.0035) with the greatest significance in patients with Mustard correction (p=0.028).Elevated levels of NT-proBNP appear to be a useful tool in assessing heart failure in patients with transposition of the great arteries after atrial switch correction.

Arterial embolisation and coiling for high-output heart failure and pulmonary hypertension ınduced by hepatic arteriovenous fistula in a patient with hereditary hemorrhagic telengiectasia

Open Medicine ◽  
2009 ◽  
Vol 4 (3) ◽  
pp. 369-373
Author(s):  
Sadık Açikgöz ◽  
Gülten Taçoy ◽  
Baran Önal ◽  
Beytullah Yıldırım ◽  
Atiye Çengel
Keyword(s):  
Heart Failure ◽  
New York ◽  
Pulmonary Hypertension ◽  
Arteriovenous Fistula ◽  
Arteriovenous Malformations ◽  
Nyha Class ◽  
Severe Heart Failure ◽  
Heart Association ◽  
Functional Class ◽  
Class Iii

AbstractHereditary hemorrhagic telangiectasia (HHT) is a genetic vascular disorder characterised by epistaxis, telangiectases, and visceral arteriovenous malformations. Hyperdynamic blood flow associated with arteriovenous malformations may lead to pulmonary hypertension, global heart failure, and valvular insufficiencies. We report a patient who had HHT with severe heart failure (New York Heart Association [NYHA] class III-IV) and pulmonary hypertension caused by an hepatic arteriovenous fistula. After successful transarterial embolisation of the right branch of the hepatic artery with polyvinyl alcohol (PVA) particles and coils, 4 to 7 mm in size, the patient was discharged with functional class II (NYHA) heart failure.

scholarly journals Anemia in chronic heart failure patients: comparison between invasive and non-invasive prognostic markers

2005 ◽  
Vol 64 (2) ◽  
Author(s):  
Monica Ceresa ◽  
Soccorso Capomolla ◽  
GianDomenico Pinna ◽  
Eleonora Aiolfi ◽  
Maria Teresa La Rovere ◽  
...  
Keyword(s):  
Heart Failure ◽  
Regression Analysis ◽  
Chronic Heart Failure ◽  
Nyha Class ◽  
Functional Class ◽  
Prognostic Models ◽  
Class Iii ◽  
Cardiac Events ◽  
Non Invasive ◽  
Peak Vo2

Background: The prognosis of chronic heart failure (CHF) remains poor despite advances in medical management. Several different variables determine prognosis. Recently anemia has emerged as an independent prognostic variable in the evaluation of CHF. It is therefore important to analyze the role of anemia in patients with mild to severe CHF already well characterized by hemodynamic, echo- Doppler, and cardiopulmonary exercise testing. Objective: We performed this study to evaluate, in a large general cohort of CHF patients, the frequency of anemia and its correlation with their clinical profile. We assessed the prognostic value of anemia in relation to other known prognostic variables. Methods: Two-dimensional echocardiography, right heart catheterization, cardiopulmonary tests and laboratory examinations were performed in a population of 980 consecutive patients with CHF (53±9.4 years, 85% male, LVEF 25±8%; 45% with NYHA class III-IV). A hemoglobin (Hb) concentration less than 12 g/dl was used to define anemic patients. The primary end point was cardiac death or urgent heart transplantation. Results: Nineteen percent of patients were anemic. These patients had a lower body mass index (24±3 vs. 25±4 Kg/m2 p &lt;0.0004), a worse functional class (64% were in NYHA class III-IV vs 41% in the non-anemic group, p &lt;0.0001), poorer exercise capacity (12.4 vs. 14.8 ml/kg/min peak VO2, p &lt;0.0001) and increased right (7±5 vs. 5±4 mmHg, p &lt;.0004) and left (21±9 vs. 19±10 p &lt;0.007) ventricular filling pressures. During a 3-year follow-up cardiac deaths occurred in 236 (24%) and 52 (5%) of patients received an urgent heart transplant. On univariate regression analysis anemia was significantly correlated with these “hard” cardiac events (39% of anemic patients vs 27% of non-anemic patients). By multivariate logistic regression analysis different prognostic models were identified using non-invasive, with or without peak VO2, or invasive parameters. The prognostic model including anemia (AUCROC: 0.720) showed similar accuracy in predicting cardiac events to other prognostic models with peak VO2 (AUCROC: 0.719) or invasive variables (AUCROC: 0.719). Conclusions: The present study demonstrates that anemia in CHF patients is associated with prognosis, worse NYHA functional class, exercise capacity and hemodynamic profiles. The relationship between anemia and mortality is independent of other simple non-invasive prognostic factors. Prognostic models with more complex or invasive independent predictors did not increase the accuracy to predict cardiac mortality or the need for urgent transplantation.

scholarly journals Prevalence of co-morbid conditions in Heart failure: an experience at tertiary care hospital

2018 ◽  
Vol 6 (2) ◽  
pp. 35-41
Author(s):  
Sahadeb Prasad Dhungana ◽  
Ankit Chaparia ◽  
Sanjib Kumar Sharma
Keyword(s):  
Heart Failure ◽  
Nyha Class ◽  
Tertiary Care ◽  
Functional Class ◽  
Chronic Obstructive ◽  
Care Hospital ◽  
Class Iii ◽  
Cross Sectional ◽  
Co Morbidity ◽  
Morbid Conditions

Introduction: Patients with heart failure (HF) have various co-morbidities that complicate management and may adversely affect outcomes. HF guidelines provide little discussion on this topic and evidence is sparse.Material and Methods: This is a descriptive cross-sectional study on 240 consecutive patients with HF admitted from September 2016 to July 2017 at B.P. Koirala Institute of Health Sciences (BPKIHS), Nepal. All patients admitted with diagnosis of HF with reduced or preserved ejection fraction (NYHA functional class III/IV) based on Framingham Criteria and echocardiography assessments were included. Pre-defined co-morbid conditions were assessed.Results: Mean age of patients was 53.5 years and 53% were female. Most patients were in NYHA class III or IV (25% and 75% respectively) and 28.3% had ischemia as a cause of HF. Among co-morbidities, 85% of patients with HF had at least one co-morbidity. Anemia (68.3%), coronary artery disease (30.4%), hypertension (26.6%), diabetes (18.7%) and chronic kidney disease (7.5%) were the co-morbidities with the highest prevalence. Chronic obstructive pulmonary disease (3.7%), sleep apnea (2.5%), hypothyroidism (2.5%) and stroke (2.5%) were less common. Of all patients, only 15% had no co-morbidity, 40% had one co-morbidity, 22% had two co-morbidities, and 13 % had three or more co-morbidities.Conclusion: Co-morbidities are common problems and anemia is the most common in our scenario which could be of multi-factorial etiology. Careful attention to the diagnosis and management of specific co-morbidities may help to improve outcomes in patients with HF. Journal of Nobel Medical CollegeVolume 6, Number 2, Issue 11 (July-December, 2017) Page:35-41

Abstract 16744: Impact of Wireless Pulmonary Artery Pressure Monitoring on Heart Failure Hospitalizations and All-Cause 30-Day Readmissions in Medicare-Eligible Patients With NYHA Class III Heart Failure: Results From the CHAMPION Trial

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Philip B Adamson ◽  
William T Abraham ◽  
Jordan Bauman ◽  
Jay Yadav
Keyword(s):  
Heart Failure ◽  
Quality Of Care ◽  
Treatment Group ◽  
Pulmonary Artery ◽  
Pulmonary Artery Pressure ◽  
Nyha Class ◽  
Control Group ◽  
Class Iii ◽  
Artery Pressure

Introduction: Heart failure (HF) is the most frequent discharge diagnosis for hospitalized Medicare beneficiaries. Readmission after a HF hospitalization (HFH) is an important metric for quality of care. Under the Hospital Readmissions Reduction Program (HRRP), hospitals with excess all-cause 30-day readmissions may be penalized for inadequate quality of care. Results from the CHAMPION trial confirmed that HF management using pulmonary artery pressure (PAP) monitoring from an implanted sensor in patients with NYHA Class III HF reduced HFH rates compared to standard management. However, the impact of this strategy on HFH rates and all-cause 30-day readmissions in Medicare-eligible patients is unknown. Methods: Retrospective analyses of patients 65 years or older at baseline in the CHAMPION trial were performed. HFH rates and 30-day readmissions in this subgroup were compared. Excess readmission ratios reported by the HRRP were then compared with the CHAMPION readmission ratio resulting from PAP monitoring. Results: 245 patients in CHAMPION (45%) were 65 years or older at the time of PA sensor implantation (120 in the Treatment group and 125 in the Control group). Patients in the Treatment group managed with PAP monitoring had a significantly lower HFH rate (60 HFH, 0.34/year) compared to the Control group (117 HFH, 0.67/year) (IRR 0.51, 95% CI 0.37-0.70, p<0.0001). The Treatment group had a significantly reduced 30-day readmissions rate (13 readmissions, 0.07/year) compared to the Control group (31 readmissions, 0.18/year) (IRR 0.42, 95% CI 0.20-0.82, p=0.006). Using index HFH as the unit of observation for 30-day readmissions, the Treatment group ratio (13 readmissions/56 index HFH, 23.2%) was lower than the Control group ratio (31 readmissions/99 index HFH, 31.3%). PAP monitoring resulted in a CHAMPION readmission ratio (23.2%/31.3%, 0.74) that was lower than all hospital excess readmission ratios reported in the 2011 HRRP dataset. Conclusions: HF management incorporating PAP monitoring significantly reduced HFH rates and all cause 30-day readmissions in Medicare-eligible patients. Adoption of this treatment strategy at hospitals struggling with HFH and 30-day readmissions could help address an unmet need within the US health care system.

scholarly journals Machine Learning for Predicting Heart Failure Progression in Hypertrophic Cardiomyopathy

2021 ◽  
Vol 8 ◽  
Author(s):  
Ahmed S. Fahmy ◽  
Ethan J. Rowin ◽  
Warren J. Manning ◽  
Martin S. Maron ◽  
Reza Nezafat
Keyword(s):  
Machine Learning ◽  
Heart Failure ◽  
Hypertrophic Cardiomyopathy ◽  
High Risk ◽  
Nyha Class ◽  
Functional Class ◽  
Class I ◽  
Study Cohort ◽  
Correct Identification ◽  
Class Iii

Background: Development of advanced heart failure (HF) symptoms is the most common adverse pathway in hypertrophic cardiomyopathy (HCM) patients. Currently, there is a limited ability to identify HCM patients at risk of HF.Objectives: In this study, we present a machine learning (ML)-based model to identify individual HCM patients who are at high risk of developing advanced HF symptoms.Methods: From a consecutive cohort of HCM patients evaluated at the Tufts HCM Institute from 2001 to 2018, we extracted a set of 64 potential risk factors measured at baseline. Only patients with New York Heart Association (NYHA) functional class I/II and LV ejection fraction (LVEF) by echocardiography &gt;35% were included. The study cohort (n = 1,427 patients) was split into three disjoint subsets: development (50%), model selection (10%), and independent validation (40%). The least absolute shrinkage and selection operator was used to select the most influential clinical variables. An ensemble of ML classifiers, including logistic regression, was used to identify patients with high risk of developing a HF outcome. Study outcomes were defined as progression to NYHA class III/IV, drop in LVEF below 35%, septal reduction procedure, and/or heart transplantation.Results: During a mean follow-up of 4.7 ± 3.7 years, advanced HF occurred in 283 (20% out of 1,427) patients. The model features included patients' sex, NYHA class (I or II), HCM type (i.e., obstructive or not), LV wall thickness, LVEF, presence of HF symptoms (e.g., dyspnea, presyncope), comorbidities (atrial fibrillation, hypertension, mitral regurgitation, and systolic anterior motion), and type of cardiac medications. The developed risk stratification model showed strong differentiation power to identify patients at advanced HF risk in the testing dataset (c-statistics = 0.81; 95% confidence interval [CI]: 0.76, 0.86). The model allowed correct identification of high-risk patients with accuracy 74% (CI: 0.70, 0.78), sensitivity 80% (CI: 0.77, 0.83), and specificity 72% (CI: 0.68, 0.76). The model performance was comparable among different sex and age groups.Conclusions: A 5-year risk prediction of progressive HF in HCM patients can be accurately estimated using ML analysis of patients' clinical and imaging parameters. A set of 17 clinical and imaging variables were identified as the most important predictors of progressive HF in HCM.

scholarly journals Myeloperoxidase-Related Chlorination Activity Is Positively Associated with Circulating Ceruloplasmin in Chronic Heart Failure Patients: Relationship with Neurohormonal, Inflammatory, and Nutritional Parameters

2015 ◽  
Vol 2015 ◽  
pp. 1-10 ◽  
Author(s):  
Aderville Cabassi ◽  
Simone Maurizio Binno ◽  
Stefano Tedeschi ◽  
Gallia Graiani ◽  
Cinzia Galizia ◽  
...  
Keyword(s):  
Heart Failure ◽  
Nitrosative Stress ◽  
Defense Mechanism ◽  
Nyha Class ◽  
Protein Nitration ◽  
Class Iii ◽  
Oxidative And Nitrosative Stress ◽  
Radical Production ◽  
Antioxidant Function ◽  
The Relationship

Rationale. Heart failure (HF) is accompanied by the development of an imbalance between oxygen- and nitric oxide-derived free radical production leading to protein nitration. Both chlorinating and peroxidase cycle of Myeloperoxidase (MPO) contribute to oxidative and nitrosative stress and are involved in tyrosine nitration of protein. Ceruloplasmin (Cp) has antioxidant function through its ferroxidase I (FeOxI) activity and has recently been proposed as a physiological defense mechanism against MPO inappropriate actions.Objective. We investigated the relationship between plasma MPO-related chlorinating activity, Cp and FeOxI, and nitrosative stress, inflammatory, neurohormonal, and nutritional biomarkers in HF patients.Methods and Results. In chronic HF patients (n=81, 76±9 years, NYHA Class II (26); Class III (29); Class IV (26)) and age-matched controls (n=17, 75±11 years, CTR), plasma MPO chlorinating activity, Cp, FeOxI, nitrated protein, free Malondialdehyde, BNP, norepinephrine, hsCRP, albumin, and prealbumin were measured. Plasma MPO chlorinating activity, Cp, BNP, norepinephrine, and hsCRP were increased in HF versus CTR. FeOxI, albumin, and prealbumin were decreased in HF. MPO-related chlorinating activity was positively related to Cp (r= 0.363,P<0.001), nitrated protein, hsCRP, and BNP and inversely to albumin.Conclusions. Plasma MPO chlorinated activity is increased in elderly chronic HF patients and positively associated with Cp, inflammatory, neurohormonal, and nitrosative parameters suggesting a role in HF progression.

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