scholarly journals Monitoring of Kidney Functions, Electrolytes and Volemia Analyzed by Application Example of Artificial Intelligence in Patients with Heart Failure

2021 ◽  
Author(s):  
Danijela Tasić ◽  
Katarina Đorđević ◽  
Slobodanka Galović ◽  
Draško Furudžić ◽  
Zorica Dimitrijević ◽  
...  
Keyword(s):  
Heart Failure ◽  
Renal Function ◽  
Ejection Fraction ◽  
Cystatin C ◽  
Fuzzy Inference ◽  
Heart Function ◽  
Diuretic Therapy ◽  
Inference System ◽  
Intelligent Approach ◽  
And Control

Abstract Basal renal function is a predictor of response to diuretic therapy and marker of poor prognosis. Simultaneous changes in renal function, sodium, potassium values and their interdependence are key parameters in addition to volemia for the assessment of cardiorenal balance. In our paper, an analysis of volemia, electrolytes, and renal function in heart failure was performed using an algorithm based on the ANFIS (Adoptive Neural Fuzzy Inference System), an intelligent approach to renal and heart function monitoring. The study included 90 subjects who were divided into two groups: clinical (n-80) and control (n-10). The base is composed of parameters B-type natriuretic peptide (NT-proBNP), sodium (Na), potassium (K), ejection fraction (EF), EPI creatinine-cystatin C formula and ANFIS expert system combined in neural network and fuzzy logic network. The results showed that the overall trend of data verification in the network with NT-proBNP, Na and K that we formed is approximately 15%, with which subjects can be classified according to the severity of hypervolemia, electrolyte disturbance and renal function. NT-proBNP (pg/mL) had the most influence on the EPI creatinine-cystatin C formula. Serum sodium (Na) has the most influence on the ejection fraction (EF).

scholarly journals Effects of Liraglutide on Worsening Renal Function Among Patients With Heart Failure With Reduced Ejection Fraction

2020 ◽  
Vol 13 (5) ◽  
Author(s):  
Brahim Redouane ◽  
Stephen J. Greene ◽  
Marat Fudim ◽  
Muthiah Vaduganathan ◽  
Andrew P. Ambrosy ◽  
...  
Keyword(s):  
Heart Failure ◽  
Logistic Regression ◽  
Renal Function ◽  
Ejection Fraction ◽  
Cystatin C ◽  
Regression Models ◽  
Reduced Ejection Fraction ◽  
Logistic Regression Models ◽  
Patients With Heart Failure ◽  
Rank Score

Background: The FIGHT (Functional Impact of GLP-1 [glucagon-like peptide-1] for Heart Failure Treatment) trial randomized 300 patients with heart failure with reduced ejection fraction (HFrEF) and a recent hospitalization for heart failure to liraglutide versus placebo. While there was no difference in the primary outcome (rank score of time to death, time to rehospitalization for heart failure, and change in NT-proBNP [N-terminal pro-B-type natriuretic peptide]), there was a significant increase in cystatin C among patients randomized to liraglutide raising concern of adverse renal outcomes. We performed a post hoc analysis of FIGHT to investigate whether liraglutide was associated with worsening renal function (WRF). Methods: The relationship between randomization to liraglutide and WRF was evaluated using logistic regression models. Two hundred seventy-four patients (91%) had complete data to assess for WRF defined as: increase in SCr ≥0.3 mg/dL, or ≥25% decrease in estimated glomerular filtration rate, or an increase in cystatin C ≥0.3 mg/L from baseline to 180-days. Results: Patients with WRF (n=113, 41%), compared with those without, were older, had more comorbidities, and lower utilization of guideline-directed medical treatment. Logistic regression models showed that age and baseline cystatin C levels were associated with WRF. In adjusted models, liraglutide was not associated with excess risk of WRF compared with placebo (odds ratio, 1.02 [95% CI, 0.62–1.67]). There was also no difference in the rank score when WRF was added as a fourth-tier outcome. Conclusions: Liraglutide was not associated with WRF among patients with HFrEF and a recent hospitalization for heart failure. These data support the relative renal safety profile of liraglutide among patients with HFrEF. Registration: URL: http://www.clinicaltrials.gov . Unique identifier: NCT01800968.

scholarly journals Levosimendan use in patients with acute heart failure and reduced ejection fraction with or without severe renal dysfunction in critical cardiac care units: a multi-institution database study

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Cze-Ci Chan ◽  
Kuang-Tso Lee ◽  
Wan-Jing Ho ◽  
Yi-Hsin Chan ◽  
Pao-Hsien Chu
Keyword(s):  
Heart Failure ◽  
Renal Function ◽  
Ejection Fraction ◽  
Acute Heart Failure ◽  
Cardiac Care ◽  
Chang Gung Memorial Hospital ◽  
Research Database ◽  
Cohort Entry ◽  
Reduced Ejection Fraction ◽  
Abnormal Renal Function

Abstract Background Acute heart failure is a life-threatening clinical condition. Levosimendan is an effective inotropic agent used to maintain cardiac output, but its usage is limited by the lack of evidence in patients with severely abnormal renal function. Therefore, we analyzed data of patients with acute heart failure with and without abnormal renal function to examine the effects of levosimendan. Methods We performed this retrospective cohort study using data from the Chang Gung Research Database (CGRD) of Chang Gung Memorial Hospital (CGMH). Patients admitted for heart failure with LVEF ≤ 40% between January 2013 and December 2018 who received levosimendan or dobutamine in the critical cardiac care units (CCU) were identified. Patients with extracorporeal membrane oxygenation (ECMO) were excluded. Outcomes of interest were mortality at 30, 90, and 180 days after the cohort entry date. Results There were no significant differences in mortality rate at 30, 90, and 180 days after the cohort entry date between the levosimendan and dobutamine groups, or between subgroups of patients with an estimated glomerular filtration rate (eGFR) ≥ 30 mL/min/1.73 m2 and eGFR < 30 mL/min/1.73 m2 or on dialysis. The results were consistent before and after propensity score matching. Conclusions Levosimendan did not increase short- or long-term mortality rates in critical patients with acute heart failure and reduced ejection fraction compared to dobutamine, regardless of their renal function. An eGFR less than 30 mL/min/1.73 m2 was not necessarily considered a contraindication for levosimendan in these patients.

Worsening Renal Function during Index Hospitalization Does Not Predict Prognosis in Heart Failure with Preserved Ejection Fraction Patients

Cardiology ◽  
2021 ◽  
pp. 1-8
Author(s):  
Ravi Rasalingam ◽  
Rachel Parker ◽  
Katherine E. Kurgansky ◽  
Luc Djousse ◽  
David Gagnon ◽  
...  
Keyword(s):  
Heart Failure ◽  
Renal Function ◽  
Ejection Fraction ◽  
Left Ventricular ◽  
Incidence Density ◽  
Preserved Ejection Fraction ◽  
Index Hospitalization ◽  
Risk Of Death ◽  
Worsening Renal Function ◽  
Group 1

<b><i>Introduction:</i></b> Worsening renal function (WRF) predicts poor prognosis in patients with left ventricular systolic dysfunction. The effect of WRF in heart failure with preserved ejection fraction (HFpEF) is unclear. <b><i>Objective:</i></b> The objective of this study was to determine whether WRF during index hospitalization for HFpEF is associated with increased death or readmission for heart failure. <b><i>Methods:</i></b> National Veterans Affairs electronic medical data recorded between January 1, 2002, and December 31, 2014, were screened to identify index hospitalizations for HFpEF using an iterative algorithm. Patients were divided into 3 groups based on changes in serum Cr (sCr) during this admission. WRF was defined as a rise in sCr ≥0.3 mg/dL. Group 1 had no evidence of WRF, group 2 had transient WRF, and group 3 had persistent WRF at the time of discharge. <b><i>Results:</i></b> A total of 10,902 patients with index hospitalizations for HFpEF were identified (mean age 72, 97% male). Twenty-nine percent had WRF during this hospital admission, with 48% showing recovery of sCr and 52% with no recovery at discharge. The mortality rate over a mean follow-up duration of 3.26 years was 72%. Compared to group 1, groups 2 and 3 showed no significant difference in risk of death from any cause (hazard ratio [HR] = 0.95 [95% confidence interval [CI]: 0.87, 1.03] and 1.02 [95% CI: 0.93, 1.11], respectively), days hospitalized for any cause (incidence density ratio [IDR] = 1.01 [95% CI: 0.92, 1.11] and 1.01 [95% CI: 0.93, 1.11], respectively), or days hospitalized for heart failure (IDR = 0.94 [95% CI: 0.80, 1.10] and 0.94 [95% CI: 0.81, 1.09], respectively) in analyses adjusted for covariates affecting renal function and outcomes. <b><i>Conclusions:</i></b> While there is a high incidence of WRF during index hospitalizations for HFpEF, WRF is not associated with an increased risk of death or hospitalization. This suggests that WRF alone should not influence decisions regarding heart failure management.

scholarly journals Comparative Assessment of Short-Term Adverse Events in Acute Heart Failure With Cystatin C and Other Estimates of Renal Function

2015 ◽  
Vol 3 (1) ◽  
pp. 40-49 ◽  
Author(s):  
W.H. Wilson Tang ◽  
Matthias Dupont ◽  
Adrian F. Hernandez ◽  
Adriaan A. Voors ◽  
Amy P. Hsu ◽  
...  
Keyword(s):  
Heart Failure ◽  
Renal Function ◽  
Adverse Events ◽  
Acute Heart Failure ◽  
Cystatin C ◽  
Comparative Assessment ◽  
Short Term

scholarly journals Arterial hypertension as a trigger for the development of cardiorenal failure in patients of different genders

2019 ◽  
Vol 34 (3) ◽  
pp. 114-121
Author(s):  
E. A. Lopina ◽  
N. P. Grishina ◽  
R. A. Libis
Keyword(s):  
Heart Failure ◽  
Glomerular Filtration Rate ◽  
Chronic Heart Failure ◽  
Ejection Fraction ◽  
Arterial Hypertension ◽  
Glomerular Filtration ◽  
Cystatin C ◽  
Filtration Rate ◽  
Left Ventricular ◽  
Left Ventricular Ejection

Aim. To study the peculiarities of changes in the functional state of the kidneys and heart muscle in patients with arterial hypertension.Materials and Methods. A total of 88 patients with arterial hypertension were included in the study. Chronic kidney disease was detected based on glomerular filtration rate, albuminuria, and cystatin levels in serum and urine. The stage of chronic heart failure was determined according to Strazhesko–Vasilenko classification with functional class according to NYHA; functional class of chronic heart failure was determined based on six-minute walking test. Patient inclusion criteria were the presence of essential hypertension of degree 1–3 and the age from 50 to 70 years. Patients underwent anthropometry, biochemical blood tests, six-minute walking test, and standard echocardiography.Results. Arterial hypertension of degree 1–2 was diagnosed in 50 patients including 33 women and 17 men. Grade 3 arterial hypertension was found in 38 patients (28 women and 10 men). Patients were divided into two groups according to gender. The groups with arterial hypertension degree 1–2 differed in their blood pressure levels. Echocardiography data showed the formation of heart failure with preserved ejection fraction. The groups differed in the values of left ventricular ejection fraction and end-systolic and end-diastolic sizes of the left ventricle. The levels of cystatin C in serum were elevated in both groups. The serum and urine creatinine levels and glomerular filtration rates differed between groups. Women had more significant decreases in the values of glomerular filtration rate, cystatin C, and urine creatinine. Correlation relationships were found between systolic blood pressure and glomerular filtration rate (r = 0.27, p < 0.05) and between systolic blood pressure and left ventricular back wall thickness (r = 0.41, p < 0.05). Inverse relationship was found between left ventricular ejection fraction and albuminuria (r = –0.31, p < 0.05). Cystatin C level had inverse relationship with glomerular filtration rate (r = –0.47, p < 0.05) and direct relationship with left ventricular myocardial mass index (r =  0.24, p  <  0.05).Discussion. Chronic kidney disease and chronic heart failure with preserved left ventricular ejection fraction were detected in patients at early stages. In the group of women, more pronounced changes in the renal and cardiac functions were found. Cystatin C is a marker of kidney function reduction and an alternative marker of chronic heart failure. The study showed that the level of cystatin C in blood serum of patients was increased, which correlated with the functional activities of the kidneys and the heart.Conclusion. In case of arterial hypertension in the presence of chronic kidney disease, the development of the left ventricular hypertrophy and heart failure with preserved ejection fraction was found. Women had more significant changes in the renal and cardiac functions compared with those in men. 

New continuum surgical robot based on hybrid concentric tube-tendon driven mechanism

2021 ◽  
pp. 095440622110424
Author(s):  
Mohammed Abdel-Nasser ◽  
Omar Salah
Keyword(s):  
Inverse Kinematics ◽  
High Performance ◽  
Analytical Study ◽  
Fuzzy Inference ◽  
Closed Form Solution ◽  
Form Solution ◽  
Robot Arm ◽  
Inference System ◽  
Neuro Fuzzy ◽  
Intelligent Approach

Robotics technology is used widely in minimally invasive surgery (MIS) which provides high performance and accuracy. The most famous robot arm mechanisms, which are used in MIS, are tendon-driven mechanism (TDM), and concentric tube mechanism (CTM). Unfortunately, these mechanisms until now have some limitations, i.e. making friction with the tissue during extracting and retracting and strain limits, for TDM and CTM respectively. A new hybrid concentric tube-tendon driven mechanism (HCTDM) is proposed to overcome these limitations. HCTDM enables the end-effector to get close to and get away from the surgical area during the operation without harming the tissue and with more flexibility. In addition to that, the workspace increases as a result of this combination, too. This benefit serves MIS, especially endoscopic surgeries (ESs). We did an analytical study of this idea and got the forward kinematics. In the inverse kinematics, an intelligent approach which is called an adaptive neuro-fuzzy inference system (ANFIS) is used because the closed-form solution is more complicated for such these mechanisms. Finally, HCTDM is analyzed and evaluated by using a computer simulation. The simulation results show that the workspace becomes wider and has more dexterity than use TDM or CTM individually. Furthermore, various trajectories are used to test the mechanism and the kinematic analysis, which show the mechanism can follow and track the trajectories with maximum mean error 1.279, 0.7027, and [Formula: see text] for X, Y, and Z axes respectively.

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