Effect of transplantation of cord blood total nucleated cells on the manifestation and prognosis of refractory congestive heart failure

2016 ◽  
Vol 4 (1) ◽  
pp. 10-13
Author(s):  
O. Usenko ◽  
A. Yakushev ◽  
M. Kostylyev ◽  
V. Onischenko
Keyword(s):  
Heart Failure ◽  
Congestive Heart Failure ◽  
Cord Blood ◽  
Exercise Tolerance ◽  
Severe Heart Failure ◽  
Functional Class ◽  
Control Group ◽  
Observation Study ◽  
Death Risk ◽  
Increased Risk

The results of a prospective non-randomized observation study without control group to assess the course of heart failure in patients who underwent of cord blood total nucleated cells (CB TNCs) transplantation combined with traditional drug therapy have been presented. Materials. The study included 20 patients with congestive heart failure (CHF) IIA-IIB stage, functional class III-IV by the NYHA. CB TNCs transplantation was performed by a single intravenous dose of cell product "Cryopreserved human cord blood". Before and 1, 3, 6 and 9 months after CB TNC transplantation patients underwent echocardiographic study, the results of tests with the 6-minute walk determined exercise tolerance. The concentration of brain natriuretic peptide precursor (NT-proBNP) in blood was determined. The cardiovascular death risk was calculated using the scale MAGGIC. Results. Initial patients’ status was characterized by the presence of severe heart failure with reduced contractility of the myocardium and increased risk of 1- and 3-year death. Traditional conservative therapy (beta blockers, ACE inhibitors, diuretics) was not effective. After CB TNC transplantation there was registered a significant improvement of general condition of patients, an increase in exercise tolerance and, therefore, reduce of HF functional class by NYHA (before transplantation average FC was 3.2, in the post-transplant period – from 2.1 to 2, 8). Also after TNCs transplantation levels of biochemical markers of HF significantly decreased (before CB TNCs transplantation the level of NT-proBNP was 2370.3 ± 448.9 pg/mL, after CB TNCs transplantation – from 1198,6 ± 396,3 to 2300,7 ± 403,0 pg/mL ) and the same was estimated death risk from HF (1-year – 10.1-37.4 %, 3 years - 9.1-42.3 % relative to the data of the initial state). Reduced HF manifestations after CB TNCs transplantation allowed to reduce significantly the diuretics dose. Conclusion. Thus, transplantation of cord blood total nucleated cells in complex treatment of congestive heart failure has led to a greater efficiency of therapy and a significant reduce of CHF manifestations in patients.

scholarly journals CHANGES IN CLINICAL MANIFESTATION OF CONGESTIVE HEART FAILURE AT THE BACKGROUND OF REGULAR RAMIPRIL INTAKE

2014 ◽  
Vol 13 (4) ◽  
pp. 41-46
Author(s):  
A. G. Kuzmin ◽  
V. V. Gorbunov ◽  
O. V. Kuzmina
Keyword(s):  
Heart Failure ◽  
Congestive Heart Failure ◽  
Diastolic Function ◽  
Exercise Tolerance ◽  
Clinical Signs ◽  
Life Quality ◽  
Functional Class ◽  
Functional Changes ◽  
One Year ◽  
Systolic And Diastolic Function

Aim. To study dynamics in clinical signs of congestive heart failure (CHF) while taking ramipril regularly.Material and methods. Totally 135 patients studied (124 men, 11 women), mean age 60±8,7, with Q-MI in anamnesis of different location 3 years ago, with clinical signs of CHF III NYHA. One year after hospitalization the adherence to therapy was evaluated by Moricki-Greene test. The parameters studied: life quality, signs of CHF, exercise tolerance, morphology and systolic and diastolic function of LV and RV, respiratory system parameters, and of kidneys.Results. By the Moricki-Greene test results all patients were divided into 2 groups: I group — non-adherent patients, II — compliant. In 1 year of follow-up in those of II group the positive dynamic observed. Functional class changed to II, clinical signs of CHF decreased, life quality improved, exercise tolerance increased, intra- and transventricular dyssynchrony decreased, dyspnea regressed from 3 to 2 by Modified Medical Research Council Scale, the NT-proBNP concentration, sudden death risk, BP and HR stabilized at normal values, microalbuminuria decreased, GFR increased. Also we marked the regress of LV and RV volumes, increase of EF, improvement of diastolic function, increase of heart rate variability by the decrease of sympathetic activity.Conclusion. Clinical signs of CHF after Q-MI with III NYHA are presupposed by morpho-functional changes in the heart, cardiopulmonary and cardiorenal continuum, that have common engine for progressing and showing worse outcomes. Therapy adherence with the usage of ramipril makes possible CHF compensation and decreases the chance for exacerbation and progressing of comorbidity. 

scholarly journals Features of coagulation hemostasis and anticoagulation system in patients with chronic heart failure due to ischemic heart disease

2015 ◽  
Vol 96 (5) ◽  
pp. 716-722 ◽  
Author(s):  
G Kh Mirsaeva ◽  
N N Mironchuk
Keyword(s):  
Heart Failure ◽  
Congestive Heart Failure ◽  
Heart Disease ◽  
International Normalized Ratio ◽  
Main Group ◽  
Functional Class ◽  
Control Group ◽  
General Group ◽  
Cofactor Activity ◽  
D Dimer

Aim. To study the features of coagulant and anticoagulant systems in patients with varoious functional classes of congestive heart failure secondary to coronary heart disease (according to New York Heart Association criteria) and to determine the most informative method for diagnosing the hemostasis disorders. Methods. 82 patients with congestive heart failure, who had previously survived myocardial infarction with Q-wave formation, and left ventricle ejection fraction (by Simpson) less than 50%, were included. Average age was 54.0 [50.0-64.0] years. Control group of 30 healthy people was formed. All patients were allocated to two groups. 1st group included patients with I-II functional class of congestive heart failure (n=57), 2nd group - patients with III-IV functional class of congestive heart failure (n=25). Activated partial thromboplastin time, prothrombin and fibrinogen levels, international normalized ratio, heparin cofactor activity of antithrombin, D-dimer level were measured in blood serum. Results. Only D-dimer level and heparin cofactor activity of antithrombin were changed in the main group compared to the controls. D-dimer level in patients of the general group was 0.2 [0.2-0.4] mg/L versus 0.2 [0.2-0.2] mg/L in control group (p=0.000064). There was no obvious deficit of heparin cofactor activity of antithrombin in patients with congestive heart failure, but the values were lower in the main group - 90.5 [82,7-100,4]% compared to the control group - 102 [90,0-104,0]% (p=0.0068). In subgroups, there were indicators (prothrombin, international normalized ratio, D-dimer) that changed according to the functional class. The lowest values of prothrombin were found in patients with III-IV functional class, the highest - in patients with I-II functional class. Indicators (prothrombin, INR, D-dimer) which changing with the growth of CHF FC were identified by separating the patients into subgroups. FC, the largest - in patients with FC I-II. Serum D-dimer level increased in accordance with congestive heart failure functional class (р1-2=0.0065). Conclusion. Congestive heart failure contributes to prothrombotic changes in hemostasis. The severity increases with increasing congestive heart failure functional class. D-dimer is the most sensitive marker of hemostasis activation at congestive heart failure. This parameter should be included in the routine hemostasis testing in patients with congestive heart failure.

Biochemical Markers in Patients with Readmission for Congestive Heart Failure

2018 ◽  
Vol 69 (7) ◽  
pp. 1687-1691
Author(s):  
Razan Al Namat ◽  
Mihai Constantin ◽  
Ionela Larisa Miftode ◽  
Andrei Manta ◽  
Antoniu Petris ◽  
...  
Keyword(s):  
Heart Failure ◽  
Congestive Heart Failure ◽  
Rural Areas ◽  
Discharge Planning ◽  
Difficult Problem ◽  
Uncontrolled Hypertension ◽  
Medical Attention ◽  
Family Doctors ◽  
Increased Risk ◽  
Risk Patients

Repetitive or recurrent hospitalizations are a general major health issue in patients with chronic disease. Congestive heart failure, is associated with a high incidence and presence of early rehospitalization, but variables in order to identify patients at increased risk and also an analysis of potentially remediable factors contributing to readmission have not been previously reported and it remains still a difficult problem. We retrospectively assessed 100 patients aged between 48-85 years old, of which 75% were men, who had been hospitalized with documentation of congestive heart failure in St. Spiridon County Emergency Hospital. They were hospitalized between 2010-2017. Even if recurrent heart failure was the most common cause for readmission or rehospitalization, other cardiac disorders and noncardiac illnesses were also accounted for readmission. Predictive factors of an increased probability of readmission included prior patient�s medical heart failure history, heart failure decompensation precipitated or accelerated by an ischaemic episode, atrial fibrillation or uncontrolled hypertension. Factors contributing to preventable readmissions included noncompliance with medications or diet, inadequate discharge planning or follow-up, failure of both social support system and the seek of a promp medical attention when symptoms reappeared. We also identified an inappropriate colaboration with family doctors especially for the patients from rural areas. Patients were more likely to cite side effects of prescribed medications rather than nonadherence as a precipitating factor for readmission. Thus, we can appreciate that early rehospitalization in patients with congestive heart failure may be avoidable in up to 50% of cases. Identification of high risk patients is possible and also necessary shortly after admission in order to identify nonpharmacological interventions designed to decrease readmission frequency.

Short- and long-term outcomes of preterm spontaneous twin anemia-polycythemia sequence

2020 ◽  
Vol 48 (4) ◽  
pp. 329-334
Author(s):  
Soo Jin Han ◽  
Seung Mi Lee ◽  
Sohee Oh ◽  
Subeen Hong ◽  
Jeong Won Oh ◽  
...  
Keyword(s):  
Cord Blood ◽  
Neonatal Morbidity ◽  
Adverse Outcomes ◽  
Control Group ◽  
Long Term Outcomes ◽  
Neurodevelopmental Outcomes ◽  
Monochorionic Twin ◽  
Increased Risk ◽  
Study Population

AbstractBackgroundIn monochorionic twin pregnancy, placental anastomosis and inter-twin blood transfusion can result in specific complications, such as twin-twin transfusion syndrome (TTTS) and twin anemia-polycythemia sequence (TAPS). It is well established that adverse outcomes are increased in TTTS, but reports on the neonatal and long-term outcomes of TAPS are lacking. The objective of this study was to evaluate the neonatal and neurodevelopmental outcomes in spontaneous TAPS.MethodsThe study population consisted of monochorionic twin pregnancies with preterm birth (24–37 weeks of gestation) between November 2003 and December 2016 and in which cord blood was taken at the time of delivery. According to the result of hemoglobin in cord blood, the study population was divided into two groups: a spontaneous TAPS group and a control group. Neonatal and neurodevelopmental outcomes were compared between the two groups.ResultsDuring the study period, 11 cases were diagnosed as spontaneous TAPS (6.4%). The TAPS group had lower gestational age at delivery and had a higher risk for cesarean delivery. However, neonates with TAPS were not at an increased risk for neonatal mortality and significant neonatal morbidity. In addition, the frequency of severe cerebral lesion during the neonatal period and the risk of cerebral palsy at 2 years of age were not different between the two groups.ConclusionThe spontaneous TAPS diagnosed by postnatal diagnostic criteria was not associated with the increased risk of adverse neonatal and neurodevelopmental outcomes. Further studies are needed to evaluate the morbidity of antenatally diagnosed TAPS.

scholarly journals A simple nomogram to predict contrast-induced acute kidney injury in patients with congestive heart failure undergoing coronary angiography

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
L Lei ◽  
Y He ◽  
Z Guo ◽  
B Liu ◽  
J Liu ◽  
...  
Keyword(s):  
Heart Failure ◽  
Congestive Heart Failure ◽  
Acute Kidney Injury ◽  
Coronary Angiography ◽  
Prediction Models ◽  
Validation Cohort ◽  
Kidney Injury ◽  
Class Ii ◽  
Functional Class ◽  
Killip Class

Abstract Background Patients with congestive heart failure (CHF) are vulnerable to contrast-induced acute kidney injury (CI-AKI), but few prediction models are currently available. Objectives We aimed to establish a simple nomogram for CI-AKI risk assessment for patients with CHF undergoing coronary angiography. Methods A total of 1876 consecutive patients with CHF (defined as New York Heart Association functional class II-IV or Killip class II-IV) were enrolled and randomly (2:1) assigned to a development cohort and a validation cohort. The endpoint was CI-AKI defined as serum creatinine elevation of ≥0.3 mg/dL or 50% from baseline within the first 48–72 hours following the procedure. Predictors for the nomogram were selected by multivariable logistic regression with a stepwise approach. The discriminative power was assessed using the area under the receiver operating characteristic (ROC) curve and was compared with the classic Mehran score in the validation cohort. Calibration was assessed using the Hosmer–Lemeshow test and 1000 bootstrap samples. Results The incidence of CI-AKI was 9.06% (n=170) in the total sample, 8.64% (n=109) in the development cohort and 9.92% (n=61) in the validation cohort (p=0.367). The simple nomogram including four predictors (age, intra-aortic balloon pump, acute myocardial infarction and chronic kidney disease) demonstrated a similar predictive power as the Mehran score (area under the curve: 0.80 vs 0.75, p=0.061), as well as a well-fitted calibration curve. Conclusions The present simple nomogram including four predictors is a simple and reliable tool to identify CHF patients at risk of CI-AKI, whereas further external validations are needed. Figure 1 Funding Acknowledgement Type of funding source: None

Impact of Underlying Congestive Heart Failure on In-Hospital Outcomes in Patients with Septic Shock

2021 ◽  
pp. 088506662110614
Author(s):  
Mohinder R. Vindhyal ◽  
Liuqiang (Kelsey) Lu ◽  
Sagar Ranka ◽  
Prakash Acharya ◽  
Zubair Shah ◽  
...  
Keyword(s):  
Heart Failure ◽  
Septic Shock ◽  
Congestive Heart Failure ◽  
Hospital Mortality ◽  
Secondary Analysis ◽  
Kidney Injury ◽  
Cross Sectional ◽  
Increased Risk ◽  
Icd 10 ◽  
Nationwide Readmission Database

Purpose: Septic shock (SS) manifests with profound circulatory and cellular metabolism abnormalities and has a high in-hospital mortality (25%-50%). Congestive heart failure (CHF) patients have underlying circulatory dysfunction and compromised cardiac reserve that may place them at increased risk if they develop sepsis. Outcomes in patients with CHF who are admitted with SS have not been well studied. Materials and Method: Retrospective cross sectional secondary analysis of the Nationwide Readmission Database (NRD) for 2016 and 2017. ICD-10 codes were used to identify patients with SS during hospitalization, and then the cohort was dichotomized into those with and without an underlying diagnosis of CHF. Results: Propensity match analyses were performed to evaluate in-hospital mortality and clinical cardiovascular outcomes in the 2 groups. Cardiogenic shock patients were excluded from the study. A total of 578,629 patients with hospitalization for SS were identified, of whom 19.1% had a coexisting diagnosis of CHF. After propensity matching, 81,699 individuals were included in the comparative groups of SS with CHF and SS with no CHF. In-hospital mortality (35.28% vs 32.50%, P < .001), incidence of ischemic stroke (2.71% vs 2.53%, P = .0032), and acute kidney injury (69.9% vs 63.9%, P = .001) were significantly higher in patients with SS and CHF when compared to those with SS and no CHF. Conclusions: This study identified CHF as a strong adverse prognosticator for inpatient mortality and several major adverse clinical outcomes. Study findings suggest the need for further investigation into these findings’ mechanisms to improve outcomes in patients with SS and underlying CHF.

Abstract 16010: Congestive Heart Failure and Coronavirus Disease 2019 Illness Severity

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Max Ruge ◽  
Joanne Michelle D Gomez ◽  
Gatha G Nair ◽  
Setri Fugar ◽  
Jeanne du Fay de Lavallaz ◽  
...  
Keyword(s):  
Heart Failure ◽  
At Risk ◽  
Congestive Heart Failure ◽  
Case Fatality ◽  
Severity Of Illness ◽  
Severe Infection ◽  
Severe Illness ◽  
Increased Risk ◽  
History Of ◽  
Male Sex

Introduction: The coronavirus disease 2019 (COVID-19) pandemic has killed hundreds of thousands worldwide. Those with cardiovascular disease represent a vulnerable population with higher risk for contracting COVID-19 and worse prognosis with higher case fatality rates. Congestive heart failure (CHF) may lead to worsening COVID-19 symptoms. However, it is unclear if CHF is an independent risk factor for severe COVID-19 infection or if other accompanying comorbidities are responsible for the increased risk. Methods: From March to June 2020, data was obtained from adult patients diagnosed with COVID-19 infection who were admitted in the Rush University System for Health (RUSH) in Illinois. Heart failure patients, determined by ICD code assignments extracted from the electronic medical records, were identified. Multivariable logistic regression was performed between predictor variables and a composite outcome of severe infection consisting of Intensive Care Unit (ICU) admission, intubation, or in-hospital mortality. Results: In this cohort (n=1136), CHF [odds ratio (OR) 1.02] alone did not predict a more severe illness. Prior myocardial infarction [(MI), OR 3.55], history of atrial fibrillation [(AF), OR 2.14], and male sex (OR 1.55) were all significantly (p<0.001) associated with more severe COVID-19 illness course when controlling for CHF (Figure 1). In the 178 CHF patients, more advanced age (68.8 years vs. 63.8 years; p<0.05) and female sex (54.5% vs. 39.1%; p<0.05) were associated with increased severity of illness. Conclusions: Prior MI, history of AF, and male sex predicted more severe COVID-19 illness course in our cohort, but pre-existing heart failure alone did not. However, CHF patients who are females and older in age are at risk for severe infection. These findings help clinicians identify patients with comorbidities early at risk for severe COVID-19 illness.

Sign in / Sign up

Export Citation Format

Share Document