scholarly journals Determinants of Elevated D-Dimer Levels and Long-Term Outcome in Elderly Patients With End-Stage Heart Failure

2021 ◽  
Author(s):  
Aiju Tian ◽  
Chengzhi Yang ◽  
Shengfeng Weng ◽  
Xiaoli Chen ◽  
Hong Liu ◽  
...  
Keyword(s):  
Heart Failure ◽  
Elderly Patients ◽  
Functional Class ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Cell Counts ◽  
End Stage Heart Failure ◽  
End Stage ◽  
D Dimer

Abstract Background Previous studies have shown that heart failure is associated with hemostatic abnormalities and hypercoagulable state. Plasma D-dimer levels reflect both fibrin formation and degradation, and elevated D-dimer levels have been associated with poor prognosis in patients with heart failure. However, little is known about their roles in elderly patients with end-stage HF. In present study, we aimed to explore the clinical significance and determinants of plasma D-dimer in elderly patients with end-stage heart failure. Methods A total of 177 patients with heart failure at Beijing Geriatric Hospital from November 1, 2015 to December 30, 2018 were enrolled. All hospitalized patients were obtained D-dimer levels within the first 24 h following admission after obtaining informed consent. Primary endpoint was all-cause mortality. Results A total of 60 patients had elevated D-dimer levels. Blood urea nitrogen (β = 1.106, 95% CI: 1.029–1.190, p = 0.006), NYHA functional class (β = 2.179, 95% CI: 1.170–4.056, p = 0.014) and white blood cell counts (β = 1.188, 95% CI: 1.040–1.358, p = 0.011) were independent risk factors for elevated D-dimer in elderly patients with end-stage heart failure. Albumin (β = 0.803, 95% CI: 0.728–0.885, P ༜ 0.001) was negative risk factor for elevated D-dimer in elderly patients with end-stage heart failure. Elevated D-dimer level was independently associated with increased risk of long-term all-cause mortality (P = 0.048). Conclusions For elderly patients with end-stage heart failure, D-dimer levels were associated with white blood cell counts, blood urea nitrogen, albumin and NYHA functional class and elevated D-dimer level was independently associated with poor long-term outcome.

scholarly journals Determinants of Elevated D-dimer Levels and Long-Term Outcome in Elderly Patients with End-Stage Heart Failure

2021 ◽  
Author(s):  
Aiju Tian ◽  
Chengzhi Yang ◽  
Shengfeng Weng ◽  
Xiaoli Chen ◽  
Hong Liu ◽  
...  
Keyword(s):  
Heart Failure ◽  
Elderly Patients ◽  
Functional Class ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Cell Counts ◽  
End Stage Heart Failure ◽  
End Stage ◽  
D Dimer

Abstract Background: Previous studies have shown that heart failure is associated with hemostatic abnormalities and hypercoagulable state. Plasma D-dimer levels reflect both fibrin formation and degradation, and elevated D-dimer levels have been associated with poor prognosis in patients with heart failure. However, little is known about their roles in elderly patients with end-stage HF. In present study, we aimed to explore the clinical significance and determinants of plasma D-dimer in elderly patients with end-stage heart failure. Methods: A total of 177 patients with heart failure at Beijing Geriatric Hospital from November 1, 2015 to December 30, 2018 were enrolled. All hospitalized patients were obtained D-dimer levels within the first 24 h following admission after obtaining informed consent. Primary endpoint was all-cause mortality. Results: A total of 60 patients had elevated D-dimer levels. Blood urea nitrogen (β=1.106, 95% CI: 1.029-1.190, p = 0.006), NYHA functional class (β=2.179, 95% CI: 1.170-4.056, p = 0.014) and white blood cell counts (β = 1.188, 95% CI: 1.040-1.358, p = 0.011) were independent risk factors for elevated D-dimer in elderly patients with end-stage heart failure. Albumin (β=0.803, 95% CI: 0.728-0.885, P ＜ 0.001) was negative risk factor for elevated D-dimer in elderly patients with end-stage heart failure. Elevated D-dimer level was independently associated with increased risk of long-term all-cause mortality (P = 0.048). Conclusions: For elderly patients with end-stage heart failure, D-dimer levels were associated with white blood cell counts, blood urea nitrogen, albumin and NYHA functional class and elevated D-dimer level was independently associated with poor long-term outcome.

Heart transplantation

2019 ◽  
pp. 165-182
Author(s):  
Finn Gustafsson ◽  
Kasper Rossing
Keyword(s):  
Heart Transplantation ◽  
Conventional Treatment ◽  
Immunosuppressive Drugs ◽  
Pharmacological Therapy ◽  
Cardiac Allograft ◽  
Term Outcome ◽  
Long Term Outcome ◽  
End Stage Heart Failure ◽  
End Stage

Heart transplantation remains the treatment of choice for end-stage heart failure refractory to conventional treatment. Long-term outcome is excellent, and median survival currently exceeds 13 years. The main causes of death late after transplantation are cardiac allograft vasculopathy and cancer. Medical therapy after transplantation is complex, including immunosuppressive therapy to reduce the risk of graft rejection and prophylaxis against viral and protozoal infections, as well as adjunctive therapy to treat common comorbidities, for instance hypertension. Pharmacological therapy of comorbid conditions requires specific consideration to clinically important interactions with immunosuppressive drugs.

Heart transplantation

2019 ◽  
pp. 165-182
Author(s):  
Finn Gustafsson ◽  
Kasper Rossing
Keyword(s):  
Heart Transplantation ◽  
Conventional Treatment ◽  
Immunosuppressive Drugs ◽  
Pharmacological Therapy ◽  
Cardiac Allograft ◽  
Term Outcome ◽  
Long Term Outcome ◽  
End Stage Heart Failure ◽  
End Stage

Heart transplantation remains the treatment of choice for end-stage heart failure refractory to conventional treatment. Long-term outcome is excellent, and median survival currently exceeds 13 years. The main causes of death late after transplantation are cardiac allograft vasculopathy and cancer. Medical therapy after transplantation is complex, including immunosuppressive therapy to reduce the risk of graft rejection and prophylaxis against viral and protozoal infections, as well as adjunctive therapy to treat common comorbidities, for instance hypertension. Pharmacological therapy of comorbid conditions requires specific consideration to clinically important interactions with immunosuppressive drugs.

scholarly journals Systolic blood pressure and outcome in patients admitted with acute heart failure: a pooled analysis from 4 randomized clinical trials

2021 ◽  
Vol 10 (Supplement_1) ◽  
Author(s):  
J Grand ◽  
K Miger ◽  
A Sajadieh ◽  
L Kober ◽  
C Torp-Pedersen ◽  
...  
Keyword(s):  
Heart Failure ◽  
Composite Endpoint ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Term Outcome ◽  
Ventricular Ejection Fraction ◽  
Long Term Outcome ◽  
All Cause Mortality ◽  
Short And Long Term

Abstract Funding Acknowledgements Type of funding sources: Foundation. Main funding source(s): The Danish Heart Foundation Background In acute heart failure (AHF), low systolic blood pressure (SBP) has been associated with poor outcome. Less is known of the risk related to normal versus elevated SBP and interaction with left ventricular ejection fraction. Purpose The aim of the present study was to assess the association between baseline SBP and short- and long-term outcome in a large cohort of AHF-patients. Methods A pooled cohort of four randomized controlled trials investigating the vasodilator serelaxin versus placebo in patients admitted with AHF and an SBP from 125 to 180 mmHg. Endpoints were 180-day all-cause mortality and a short-term composite endpoint (worsening heart failure, all-cause mortality or hospital readmission for HF through Day 14). Left ventricular ejection fraction (LVEF) was categorized into HFrEF (<40%) and HFpEF (= >40%). Multivariable Cox regression was used and adjusted for age, sex, baseline body mass index, HFrEF, serum estimated glomerular filtration rate, allocated treatment (placebo/serelaxin), diabetes mellitus, ischemic heart disease, and atrial fibrillation/flutter. Measurements and Main Results A total of 10.533 patients with a mean age of 73 (±12) years and median SBP of 140 (130-150) mmHg were included within mean 8.2 hours from admission. LVEF was assessed in 8493 (81%), and of these, 4294 (51%) had HFrEF. Increasing SBP as a continuous variable was inversely associated with 180-day mortality (HRadjusted: 0.93 [0.88-0.98], p = 0.004 per 10 mmHg increase) and with the composite endpoint (HRadjusted: 0.90 [0.85-0.95], p < 0.0001 per 10 mmHg increase). A significant interaction was observed regarding LVEF, revealing that SBP was not associated with mortality in patients with HFpEF  (HRadjusted: 1.01 [0.94-1.09], p = 0.83 per 10 mmHg increase), but SBP was associated with increased mortality in HFrEF (HRadjusted: 0.80 [0.73-0.88], p < 0.001 per 10 mmHg increase) (Figure). Conclusions Elevated SBP is independently associated with favorable short- and long-term outcome in AHF-patients. The association between SBP and mortality was, however, not present in patients with preserved LVEF. Abstract Figure. Survival plots by SBP and LVEF

scholarly journals Complications and outcome of the long-term use of the intra-aortic balloon pump in patients with end-stage heart failure

2021 ◽  
Vol 10 (Supplement_1) ◽  
Author(s):  
M Stratinaki ◽  
E Bousoula ◽  
I Malakos ◽  
M Zymatoura ◽  
E Fountas ◽  
...  
Keyword(s):  
Heart Failure ◽  
Pharmacological Therapy ◽  
Circulatory Support ◽  
Intra Aortic Balloon Pump ◽  
Funding Sources ◽  
Iabp Support ◽  
End Stage Heart Failure ◽  
The Mean ◽  
End Stage

Abstract Funding Acknowledgements Type of funding sources: None. Background Intra-aortic balloon pump (IABP) can be used as circulatory support in order to stabilize haemodynamically compromised patients as either a bridge to therapy or to further mechanical support. Based on the current literature its use should be limited to up to two weeks and there are not enough data regarding its long term use’s efficacy and possible complications. Purpose To review the possible complications of the long-term use of IABP Methods We restrospectively analysed the data from 24 consecutive patients with end-stage heart failure (ESHF) who received long-term IABP support and recorded the complications during their hospitalization as well as their outcome. Results 24 patients (14 male and 10 female) were included. In 5 of them ESHF was attributed to ischemic cardiomyopathy and the in 19 to dilated cardiomyopathy. Their mean age was 45.6+/-14 years. The mean duration of IABP support was 70.2 days (minimum 30days maximum 192 days). The mean ejection fraction (EF) was 20%. Regarding the pharmacological therapy, 12/24 patients were on dobutamine, 4/24 on dobutamine and milrinone and 8/24 on dobutamine and noradrenaline. Regarding the clinical course of these patients, 7/24 underwent heart transplantation, 2/24 managed to wean from IABP, 5/24 received left lentrivular assist device (LVAD), 6/24 received biventricular assist veice (BiVAD) and 4/24 died. In terms of complications they were recorded as following : infection 7/24, bleeding 3/24, thrombosis 4/24, heparin-induced thrombocytopenia(HIT) 5/24, hematoma 4/24, ischemia 0/24 and rupture 1/24. Conclusions   Although not indicated by the current guidelines, long term IABP can be used as a relatively safe  circulatory support method.

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