scholarly journals EFFECT OF LEVOSIMENDAN ON SHORT TERM AND LONG TERM CLINICAL COURSE OF PATIENTS WITH ACUTELY DECOMPENSATED HEART FAILURE IN INDIAN POPULATION

2020 ◽  
Vol 8 (9) ◽  
pp. 1378-1379
Author(s):  
Seshi Vardhan Janjirala ◽  
Keyword(s):  
Heart Failure ◽  
Placebo Group ◽  
Symptomatic Relief ◽  
Cardiac Contractility ◽  
Decompensated Heart Failure ◽  
Functional Class ◽  
Treatment Groups ◽  
Acutely Decompensated Heart Failure ◽  
All Cause Mortality ◽  
And Function

We evaluated the efficacy of levosimendan, a positive inodilator, given intravenously to patients with acutely decompensated heart failure (ADHF). Methods: Patients admitted with ADHF received placebo or IV levosimendan for 24 hr in addition to standard treatment. The primary endpoint was a composite that evaluated changes in clinical and laboratory status at 30th day and at 180th day.secondary end point is all cause mortality. Results: In the 125-patient trial, more levosimendan than placebo patients were improved at discharge, whereas fewer levosimendan patients experienced clinical worsening at 6 months. The functional class, cardiac contractility ( FS,EF) were better in simenda group at 3rd month both neumerically and statistically.All-cause mortality at 180 days occurred in 5% patients in the levosimendan group and 28%patients in the placebo group. The levosimendan group had greater decreases in Brain Natriuretric peptide level at 24 hours. There were no statistical differences between treatment groups for the other secondary end points (all-cause mortality at 31 days, number of days alive and out of the hospital, patient global assessment, patient assessment of dyspnea at 24 hours, and cardiovascular mortality at 180 days). There was a higher incidence of cardiac failure in the placebo group. There were higher incidences of atrial fibrillation, hypokalemia, and headache in the levosimendan group Conclusions: In patients with ADHF, intravenous levosimendan provided rapid and durable symptomatic relief and levosimendan improved haemodynamic performance more effectively than placebo. 6MHWD, quality of life, worsening of heart failure, cardiac structure and function were statistically and numerically improved in simenda group for first 3monthsHowever the results were not consistent for 180 days.This benefit was accompanied by lower mortality in the levosimendan group than in the placebo group for up to 180 days.

scholarly journals Lack of Diuretic Efficiency (but Not Low Diuresis) Early in An Acutely Decompensated Heart Failure Episode Is Associated with Increased 180-Day Mortality

2017 ◽  
Vol 7 (2) ◽  
pp. 137-149 ◽  
Author(s):  
João Pedro Ferreira ◽  
Nicolas Girerd ◽  
Pedro Bettencourt Medeiros ◽  
Miguel Bento Ricardo ◽  
Tiago Almeida ◽  
...  
Keyword(s):  
Heart Failure ◽  
Emergency Room ◽  
Decompensated Heart Failure ◽  
University Hospital ◽  
Acutely Decompensated Heart Failure ◽  
All Cause Mortality ◽  
Diuretic Efficiency ◽  
Relevant Variables ◽  
Emergency Room Admission

Introduction: The assessment of the amount of urine produced by the dose of administered diuretic has been proposed as the main signal of interest in diuretic responsiveness - diuretic efficiency (DE). The main aim of our study is to determine if a low DE is associated with 180-day all-cause mortality (ACM). Methods: During a 3-year period, we retrospectively studied patients with acutely decompensated heart failure (ADHF) and respiratory insufficiency admitted to the emergency room of a tertiary university hospital in Porto, Portugal. A total of 170 patients (age 76.2 ± 10.3 years) were included. The outcome of ACM occurred in 43 (25.3%) patients during the 180-day follow-up period. DE was evaluated for a maximum of 3 h after emergency room admission. The lowest DE was defined as ≤140 mL of diuresis per 40 mg of furosemide equivalents. Results: No significant differences in age, comorbidities, baseline HF symptoms, or disease-modifying medication were found between the lowest and highest DE groups. The lowest DE group had higher blood urea and lower estimated glomerular filtration rate (eGFR) levels (41.3 ± 24.5 vs. 56.7 ± 23.2 mL/min/1.73 m2, p < 0.001). The patients with the lowest DE had significantly higher rates of ACM during the 180-day follow-up, even after adjustment for other clinically relevant variables: hazard ratio (HR) [95% CI] = 2.31 [1.16-4.58], p = 0.016. The lowest diuresis (≤300 mL) and the highest intravenous furosemide dose (>80 mg) alone were not significantly associated with the outcome. After adjustment for N-terminal prohormone of brain natriuretic peptide, the association between the lowest DE and the outcome lost strength (HR [95% CI] = 1.53 [0.75-3.13], p = 0.240). Conclusion: A low DE (≤140 mL/40 mg of furosemide) in the first 3 h after an ADHF episode was associated with increased mid-term mortality rates.

P5451Catestatin and chronic heart failure patients with an acute decompensation event: clinical characteristics and 30-day all-cause mortality

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
J A Borovac ◽  
D Glavas ◽  
Z Susilovic Grabovac ◽  
D Rusic ◽  
L Stanisic ◽  
...  
Keyword(s):  
Heart Failure ◽  
Clinical Characteristics ◽  
Troponin I ◽  
High Sensitivity ◽  
Decompensated Heart Failure ◽  
Functional Class ◽  
P Value ◽  
Ckd Stage ◽  
All Cause Mortality ◽  
Acute Decompensation

Abstract Background Catestatin (CST) is a cardiovascular regulator with pleiotropic systemic functions that might affect the course of acutely decompensated heart failure (ADHF). Purpose To determine the association of serum CST with the 30-day all-cause mortality and to compare clinical and laboratory parameters between ADHF patients within the lowest vs. highest quartile of CST concentration. Methods Eighty-two consecutive ADHF patients, as adjudicated per ESC 2016 HF criteria, were enrolled in the study during 2018–2019. Results Mean age of the enrolled cohort was 70.8±9.3 years and 54.9% were women. Seventy percent of patients were in NYHA III functional class and nearly half had a reduced LVEF. Median CST value was 5.6 ng/mL (IQR 3, 12). During the 30-day follow-up, ten patients died (12.2%) due to all causes. CST levels were significantly higher among patients that died compared to survivors (21.9±6.3 vs. 10.2±1.5 ng/mL, p=0.0139, respectively). Patients in the highest CST quartile had higher mortality and disease burden accompanied by more prominent laboratory abnormalities, compared to patients in the lowest CST quartile. Compared groups did not significantly differ in terms of dosages and type of baseline HF pharmacotherapy. Table 1. Clinical characteristics Variable Lowest CST quartile (<3 ng/mL) Highest CST quartile (>12 ng/mL) p-value Age, years 72.8±8.3 70.0±7.9 0.281 Women, % 45.0 60.0 0.342 LVEF, biplane Simpson, % 39.0 41.0 0.645 30-day all-cause mortality, % 0.0 20.0 0.035 Mean NYHA functional class 2.83±0.38 3.21±0.42 0.007 Mean CKD stage, CKD-EPI 2.37±0.83 3.06±0.99 0.029 Mean arterial pressure, mmHg 99.7±17.8 100.1±19.2 0.953 NT-proBNP, pmol/L 535.3±522.4 1550.0±992.2 0.040 C-reactive protein, mg/L 9.37±7.47 32.90±18.35 0.015 High-sensitivity cardiac Troponin I, ng/L 20.60±18.05 30.02±27.38 0.256 Creatinine, μmol/L 102.9±38.9 150.6±91.2 0.038 Urea, mmol/L 9.6±3.5 14.3±7.1 0.012 Neutrophil-to-lymphocyte ratio 3.6±1.9 5.4±3.1 0.045 Hemoglobin, g/L 137.3±17.4 124.6±18.8 0.038 Figure 1. CST and 30-day mortality Conclusions Higher levels of catestatin measured during the hospitalization event among ADHF patients are associated with 30-day all-cause mortality and worse in-hospital profile thus might facilitate short-term prognosis. Acknowledgement/Funding None

scholarly journals P803 Myocardial work in acutely decompensated heart failure patients differs between HFrEF and HFpEF

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
F Sahiti ◽  
C Morbach ◽  
C Henneges ◽  
M Hanke ◽  
R Ludwig ◽  
...  
Keyword(s):  
Heart Failure ◽  
Blood Pressure ◽  
Ejection Fraction ◽  
Longitudinal Strain ◽  
Global Longitudinal Strain ◽  
Decompensated Heart Failure ◽  
Left Ventricular ◽  
Future Research ◽  
Lv Function ◽  
Acutely Decompensated Heart Failure

Abstract OnBehalf AHF Registry Background & Aim A novel echocardiographic method to non-invasively determine left ventricular (LV) myocardial work (MyW) based on speckle-tracking derived longitudinal strain and blood pressure has recently been validated against invasive reference measurements. MyW is considered less load-dependent than LV ejection fraction (EF) and LV longitudinal strain. We investigated MyW indices in patients with reduced ejection fraction (LVEF &lt;40%; HFrEF) and patients with preserved ejection fraction (LVEF ≥50%, HFpEF) admitted for acutely decompensated heart failure (AHF). Methods The AHF registry is a monocentric prospective follow-up study that comprehensively phenotypes consecutive patients hospitalized for AHF. Echocardiography was performed on the day of admission. MyW assessment was performed off-line using EchoPAC (GE, version 202). Here we present MyW indices and performed two-sided t-tests to analyze differences in numerical baseline covariates. Results We analyzed the echocardiograms of 94 AHF patients (72 ± 10 years; 36% female). 46 patients (49%) had an LVEF &lt;40%, while 48 patients (51%) presented with LVEF ≥50%. HFrEF patients were younger, less often female, and hat lower blood pressure (table). Consistent with lower LVEF, HFrEF patients had less negative global longitudinal strain and lower global constructive work, when compared to HFpEF patients. Since HFrEF patients also had higher global wasted work, this yielded a lower myocardial work efficiency compared to HFpEF patients (table). Conclusions This analysis in patients with AHF exhibited marked differences in MyW indices according to subgroups with HFrEF and HFpEF, thus adding information to the classical measures of LV function. Future research has to determine whether constructive and/or wasted MyW are valuable diagnostic or therapeutic targets in patients with AHF. Abstract P803 Figure.

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