scholarly journals Prevalence of renal dysfunction and its influence on functional capacity in elderly patients with stable chronic heart failure

2012 ◽  
Vol 69 (10) ◽  
pp. 840-845 ◽  
Author(s):  
Dragana Stanojevic ◽  
Svetlana Apostolovic ◽  
Ruzica Jankovic-Tomasevic ◽  
Sonja Salinger-Martinovic ◽  
Milan Pavlovic ◽  
...  
Keyword(s):  
Heart Failure ◽  
Chronic Heart Failure ◽  
Renal Dysfunction ◽  
Functional Capacity ◽  
Exercise Tolerance ◽  
Nyha Class ◽  
The Elderly ◽  
Left Ventricular ◽  
Walking Distance ◽  
Left Ventricular Ejection

Bacground/Aim. Chronic heart failure (CHF) is highly prevalent and constitutes an important public health problem around the world. In spite of a large number of pharmacological agents that successfully decrease mortality in CHF, the effects on exercise tolerance and quality of life are modest. Renal dysfunction is extremely common in patients with CHF and it is strongly related not only to increased mortality and morbidity but to a significant decrease in exercise tolerance, as well. The aim of our study was to investigate the prevalence and influence of the renal dysfunction on functional capacity in the elderly CHF patients. Methods. We included 127 patients aged over 65 years in a stable phase of CHF. The diagnosis of heart failure was based on the latest diagnostic principles of the European Society of Cardiology. The estimated glomerular filtration rate (eGRF) was determined by the abbreviated Modification of Diet in Renal Disease (MDRD2) formula, and patients were categorized using the Kidney Disease Outcomes Quality Initiative (K/DOQI) classification system. Functional capacity was determined by the 6 minute walking test (6MWT). Results. Among 127 patients, 90 were men. The average age was 72.5 ? 4.99 years and left ventricular ejection fraction (LVEF) was 40.22 ? 9.89%. The average duration of CHF was 3.79 ? 4.84 years. Ninty three (73.2%) patients were in New York Heart Association (NYHA) class II and 34 (26.8%) in NYHA class III. Normal renal function (eGFR ? 90 mL/min) had 8.9% of participants, 57.8% had eGFR between 60-89 mL/min (stage 2 or mild reduction in GFR according to K/DOQI classification), 32.2% had eGFR between 30-59 mL/min (stage 3 or moderate reduction in GFR) and 1.1% had eGFR between 15-29 mL/min (stage 4 or severe reduction in GFR). We found statistically significant correlation between eGFR and 6 minute walking distance (6MWD) (r = 0.390, p < 0.001), LVEF (r = 0.268, p < 0.05), NYHA class (? = -0.269, p < 0.05) and age (r = - 0.214, p < 0.05). In multiple regression analysis only patients? age was a predictor of decreased 6MWD < 300 m (OR = 0.8736, CI = 0.7804 - 0.9781, p < 0.05). Conclusion. Renal dysfunction is highly prevalent in the elderly CHF patients. It is associated with decreased functional capacity and therefore with poor prognosis. This study corroborates the use of eGFR not only as a powerful predictor of mortality in CHF, but also as an indicator of the functional capacity of cardiopulmonary system. However, clinicians underestimate a serial measurement of eGFR while it should be the part of a routine evaluation performed in every patient with CHF, particularly in the elderly population.

scholarly journals Effects of canagliflozin in patients with type 2 diabetes and chronic heart failure: a randomized trial (CANDLE)

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
A Tanaka ◽  
I Hisauchi ◽  
I Taguchi ◽  
A Sezai ◽  
S Toyoda ◽  
...  
Keyword(s):  
Heart Failure ◽  
Type 2 Diabetes ◽  
Chronic Heart Failure ◽  
Primary Endpoint ◽  
Nyha Class ◽  
Left Ventricular ◽  
Percentage Change ◽  
Left Ventricular Ejection ◽  
Funding Source

Abstract Background Little is known about the impacts of sodium glucose co-transporter 2 inhibitors on cardiac functional parameters, such as natriuretic peptides, in type 2 diabetes (T2D) patients with concomitant chronic heart failure (CHF). Purpose To compare the effect of canagliflozin with glimepiride, based on changes in N-terminal pro-brain natriuretic peptide (NT-proBNP), in that patient population. Methods This trial was an investigator-initiated, multicenter, prospective, randomized, open-label, blinded-endpoint trial at 34 centers in Japan. Patients with T2D and clinically stable CHF excluding NYHA class IV, randomized to receive canagliflozin 100 mg or glimepiride (starting dose: 0.5 mg), were examined using the primary endpoint of non-inferiority of canagliflozin versus glimepiride, defined as a margin of 1.1 in the upper-limit of the 2-sided 95% confidence interval (95% CI) for the group ratio of percentage change in NT-proBNP at 24 weeks. Results Data analysis of 233 patients (mean age 68.6±10.1 yrs; 75% male) showed mean left ventricular ejection fraction (LVEF) at randomization was 57.6±14.6%, with 71% of patients having a preserved LVEF (≥50%). The ratio of NT-proBNP percentage change was 0.48 (95% CI, −0.13 to 1.59, P=0.226), and therefore did not meet the prespecified non-inferiority margin. However, data stratified according to baseline NT-proBNP levels showed a trend that canagliflozin treatment reduced NT-proBNP levels to a greater extent than in subgroups with elevated levels of NT-proBNP (Figure A). Furthermore, NT-proBNP levels in the canagliflozin group did show a nonsignificant trend lower in the subgroup with preserved LVEF (Figure B), but not in the subgroup with reduced LVEF (Figure C). Additionally, the changes in the NYHA class were comparable between groups (P=0.061) in the overall cohort, whereas in the subgroup with a preserved LVEF canagliflozin caused a significant improvement in NYHA classes compared to that found for glimepiride treatment (P=0.027). Conclusions This trial did not meet the predefined primary endpoint of changes in NT-proBNP levels, with 24 weeks of treatment with canagliflozin relative to glimepiride which together with other recent studies would question the value of continuing to monitor NT-proBNP levels after the initial diagnosis of heart failure. Nevertheless, in a subgroup with preserved LVEF, there was a non-significant trend for canagliflozin treatment to reduce NT-proBNP levels and improve symptoms even in stable HF patients. Further research is therefore warranted to determine whether patients with preserved LVEF, regardless of diabetes status, could potentially benefit from treatment with SGLT2 inhibitors. Changes in NT-proBNP Funding Acknowledgement Type of funding source: Private company. Main funding source(s): Mitsubishi Tanabe Pharma Corporation

scholarly journals Parathyroid Hormone Response to Vitamin D Insufficiency in Elderly Males With Chronic Heart Failure

2011 ◽  
pp. S155-S163 ◽  
Author(s):  
B. BOZIC ◽  
G. LONCAR ◽  
N. PRODANOVIC ◽  
T. LEPIC ◽  
Z. RADOJICIC ◽  
...  
Keyword(s):  
Heart Failure ◽  
Vitamin D ◽  
Chronic Heart Failure ◽  
Physical Performance ◽  
Nyha Class ◽  
Vitamin D Insufficiency ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Vitamin D Levels

Secondary hyperparathyroidism (SHPT) may contribute to the systemic illness that accompanies chronic heart failure (CHF). Healthy elderly with vitamin D deficiency who did not develop hyperparathyroidism (functional hypoparathyroidism, FHPT) had lower mortality than those who did. This study was designed to examine determinants of the PTH response in the vitamin D insufficient CHF patients. Sixty five vitamin D insufficient males with NYHA class II and III and 20 control subjects age ≥ 55 years were recruited. Echocardiography, physical performance, NT-pro-BNP, PTH, 25-hydroxyvitamin D (25(OH)D), adiponectin and bone activity surrogate markers (OPG, RANKL, OC, β-CTx) were assessed. Increased NYHA class was associated with SHPT, while physical performance was inferior compared to FHPT. SHPT was associated with lower left ventricular ejection fraction (LVEF) and flow mediated dilatation, but with higher left heart dimensions, left ventricular mass index and right ventricular systolic pressure. CHF patients with SHPT had increased NT-pro-BNP, adiponectin and bone markers, but decreased 25(OH)D compared to those with FHPT. Independent determinants for SHPT in CHF patients with vitamin D insufficiency were LVEF, adiponectin and β-CTx, irrespective of renal function and serum vitamin D levels. In conclusion, increased PTH levels, but not low vitamin D, demonstrated close relation to CHF severity.

scholarly journals PREDICTORS OF WEIGHT LOSS IN PATIENTS WITH CHRONIC HEART FAILURE AND REDUSED LEFT VENTRICULAR EJECTION FRACTION

2019 ◽  
Vol 5 ◽  
pp. 3-11
Author(s):  
Kateryna Voitsekhovska ◽  
Leonid Voronkov
Keyword(s):  
Heart Failure ◽  
Weight Loss ◽  
Chronic Heart Failure ◽  
Left Ventricular Ejection Fraction ◽  
Ejection Fraction ◽  
Nyha Class ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Vasodilator Response

Chronic heart failure (CHF) is a heterogeneous syndrome with a poor prognosis. Aim of the work – to define predictors of body weight (BW) loss in patients with CHF and a reduced left ventricular ejection fraction (LVEF). Materials and methods. 120 patients with stable CHF and LVEF ≤35 %, II-IV NYHA class were examined. Patients were divided into two groups according to the value of BW loss for 6 months: the first group - loss of BW <6 %, the second - ≥ 6 %. Results. Out of the 120 patients who were studied, a BW loss of ≥ 6 % occurred in 59 (49.2 %) patients. According to the results of binary logistic regression, predictors of BW loss of ≥6 % in patients with CHF and LVEF ≤ 35 % were: age, coronary heart disease, anaemia, and the number of hospitalizations over the last year. People with poorer quality of life, bigger number of points on the Beck depression scale and DEFS, with lower levels of physical activity and worse endothelium-dependent vasodilator response; higher sizes of the right atrium, right ventricle, and pulmonary artery systolic pressure, E / E '. Higher levels of C-reactive protein (CRP), uric acid are associated with a risk of losing BW≥6 %. Conclusions. Weight loss ≥ 6 % is observed in 49.2 % of patients with CHF and LVEF≤35 %. According to multivariate analysis, independent predictors of BW loss of ≥6 % in patients with CHF and LVEF≤35 % are age, CRP level, III-IV NYHA class, lower cholesterol levels, as well as lower rates of flow-dependent vasodilator response and hip circumference.

Abstract 2703: Clinical and neurohormonal correlates and prognostic value of Kansas City Cardiomyopathy Questionnaire in patients with chronic heart failure

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Maria Nikolaou ◽  
John Parissis ◽  
Dimitrios Farmakis ◽  
Vasiliki Bistola ◽  
Koula Venetsanou ◽  
...  
Keyword(s):  
Physical Activity ◽  
Heart Failure ◽  
Chronic Heart Failure ◽  
Immune Activation ◽  
Prognostic Value ◽  
Kansas City ◽  
Left Ventricular ◽  
Walking Distance ◽  
Left Ventricular Ejection ◽  
Kansas City Cardiomyopathy Questionnaire

Chronic heart failure (CHF) is characterized by limited exercise activity, enhanced immune activation, and increased morbidity and mortality. Although quality of life and physical activity assessed by Kansas City Cardiomyopathy Questionnaire (KCCQ functional and overall) have been used for the clinical evaluation of CHF patients, the prognostic value as well as the relationship of this questionnaire with neurohormonal/immune activation remain uknown. Methods: One hundred thirty seven consecutive stable CHF patients (aged 64 ± 12 yrs, mean NYHA class: 2.9 ± 0.6, mean left ventricular ejection fraction: 26±7% ) were evaluated by the above questionnaire, Zung 20-item self rating and Beck Depression Inventory (BDI) scales, Duke physical activity score, plasma BNP, plasma cytokines (IL-6, IL-10 and TNF-a) and 6-min walking test. Patients were monitored for a 8-month follow-up period for disease progression defined as death and/or hospitalization. Results: The mean KCCQ functional and overall scores were 44±20% and 33±19%, respectively. Patients (n=41) with KCCQ overall score <50% had significantly higher Zung (46±10 vs 34±9, p<0.01) and BDI (18±10 vs 8±6, p<0.01) scales, plasma BNP (900±801 vs 543±374 pg/ml, p<0.05) and plasma IL-6 (12.7±7 pg/ml vs 8.5±6.4 pg/ml, p<0.05) as well as lower DUKE score (15±10 vs 28±13, p<0.01), 6-min walking distance (259±200 vs 363±113 m, p<0.001) and plasma anti-inflammatory cytokine IL-10 (6.1±3.2 pg/ml vs 9.4±5.4 pg/ml, p <0.05) as compared to those (n=96) with score >50%. KCCQ overall score was significantly corellated with plasma BNP levels (r=-0.42, p<0.01), 6-min walking distance (r=0.47, p<0.01) and BDI scale (r=-0.61, p<0.001). Finally, patients with KCCQ overall score >50% had longer event-free survival (182±13 vs 122±15 days, p<0.05) than those with score <50%. Conclusion: KCCQ is a valuable tool for the evaluation of severity of clinical and emotional symptoms of CHF patients, closely related with their neurohormonal/immune activation and seems to have important prognostic value in CHF.

Renal Dysfunction - a Possible Marker of Severity of Heart Failure

2018 ◽  
Vol 69 (6) ◽  
pp. 1435-1440
Author(s):  
Mirela Zaharie ◽  
Doina Carstea ◽  
Costin Teodor Streba ◽  
Paul Mitrut ◽  
Adina Dorina Glodeanu ◽  
...  
Keyword(s):  
Heart Failure ◽  
Renal Dysfunction ◽  
Nyha Class ◽  
Clinical Status ◽  
Left Ventricular ◽  
Functional Class ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
The Mean ◽  
Prevalence Of Diabetes Mellitus

Heart failure (HF) and renal dysfunction are frequent associated in the same patient. The purpose of our study was to assess the prevalence of renal dysfunction and the clinical status in admitted patients for decompensated HF. Material and Methods. 397 patients succesively hospitalized for decompensated HF, NYHA III or IV functional class, with left ventricular ejection fraction (LVEF) � 45% were included in the study. Renal dysfunction was defined by glomerular filtration rate (GFR) [ 60 mL/min/1.73 m 2. The mean GFR in patients with HF was 63.89 � 21.5 mL/min/1.73 m2 .The prevalence of renal dysfunction was 49.6%. Patients with GFR [ 60 mL/min/1.73m2, compared with those with preserved renal function were significantly more frequent older (75.37 � 6.84 vs. 71.33 � 8.08 years; p [0.001), females (53,8% vs. 43.5%; p = 0.04), had a significantly higher prevalence of diabetes mellitus (50.2% vs. 28.5%; p [0.001), atrial fibrillation (53.8% vs 46.2%, p = 0.04) and anemia (47.7% vs. 29.5% ; p [0.001). Also, patients with renal dysfunction had more severe HF than those without renal dysfunction (NYHA class IV: 65% vs 45%, p [0.001, clinical congestion: 78.2% vs 68%, p = 0.02, LVEF [35%: 47.21% vs � 35%, p [0.001). Renal dysfunction can be considered an additional marker of severe cardiac dysfunction along with NYHA IV class and low LVEF. The presence of both renal dysfunction and anemia could represent prognostic markers in HF patients with reduced LVEF.

scholarly journals CORRELATION BETWEEN CONCENTRATION OF PATHOLOGICAL CYTOKINES AND ERYTHROPOIETIN IN PATIENTS WITH CHRONIC HEART FAILURE WITH ANEMIC SYNDROME

2015 ◽  
Vol 69 (1-2) ◽  
pp. 32-37
Author(s):  
K. Kh. Zahidova
Keyword(s):  
Heart Failure ◽  
New York ◽  
Chronic Heart Failure ◽  
Nyha Class ◽  
Heart Association ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
New York Heart Association ◽  
Erythropoietin Treatment

Aim: to study correlation between concentration of pathological cytokines and erythropoietin in patients with chronic heart failure with anemic syndrome and also to prove importance of this communication for need of appointment erythropoietin excitants. Patients and methods: 94 patients with chronic heart failure of New York Heart Association (NYHA) class ІІІ–ІV a left ventricular ejection fraction of 40% or less with anemia w ere included in investigation (58 males, 36 females). Anemia was detected when hemoglobin (Hb) was less than 120 g/l in males and less than 110 g/l in females. 46 patients received traditional treatment of CHF (І group) and 48 patients were treated additionally with erythropoietin (EPO) (ІІ group). Percutaneous EPO 50 IU monthly to patients without iron deficiency for a period of 6 months. Echocardiography parameters, plasma NT and pro-BNP, cytokines, EPO, ferritin and 6-minute walking test were assessed at baseline and after treatment. Results: in patients with CHF and anemia in ІІ group erythropoietin treatment increased Hb levels by 22,4% (p IL 6 by 54,3% (p α by 48,3% (p increase of LVEF by 19,04% (p Conclusions: Correction of anemia in patients with chronic heart failure with percutaneous erythropoietin injections 50 IU monthly for 6 month period to improve erythropoietin deficit and cytokines aggression and associated anemia, symptoms and quality of life.

Fetal stem cells in combined treatment of chronic heart failure and their effect on morphofunctional parameters of the left ventricle myocardium

2014 ◽  
Vol 2 (1) ◽  
pp. 20-24
Author(s):  
M. Klunnyk ◽  
N. Sych ◽  
I. Matiyaschuk ◽  
O. Ivankova ◽  
M. Demchuk ◽  
...  
Keyword(s):  
Heart Failure ◽  
Stem Cells ◽  
Chronic Heart Failure ◽  
Left Ventricle ◽  
Combined Treatment ◽  
Left Ventricular ◽  
Walking Distance ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Fetal Stem Cells

Fetal stem cells treatment (FSCT) is assumed to be a new direction in a combined therapy for the patients with the severe chronic heart failure (CHF).Material and methods. 20 patients (average age of 50.1 ± 1.1 yrs.) with CHF functional class III-IV (FC) undergoing the transplantation of the cryopreserved cells of the fetal liver and heart obtained from 5-8 weeks gestation embryos were examined. The control group (CG) of 20 patients was compared by gender and age with the main group (MG).Results. Within 6 months after FSC therapy CHF patients reported a significant improvement of the contractile activity of the left ventricle (LV) heart muscle in echocardiography (EchoCG) findings (left ventricular ejection fraction (LVEF) increased by 20.9 % being 2-fold higher than in patients without FSCT, p<0.05) and in features of LV remodeling (left ventricle end diastolic volume (LV EDV) decreased by 20.5 %, p < 0.05). Serum NT-proBNP significantly raised within 1 month after FSCT by 33.8 %, 50 % and 65.1 % in 1, 3 and 6 months respectively (p<0.001) and was significantly lower after a month of treatment compared with CG (р<0.05).As a result of general condition improvement in CHF patients significant elevation in 6 minute walking distance (6MWD) test was observed and the distance walked increased 7.3-fold (p<0.001), 10.3-fold (p<0.001) and 12.5-fold (p<0.001) vs. the baseline in 1, 3 and 6 months, respectively, which was generally 2-fold higher than in patients of the CG. DASI score increased by 54.6 %, after 3 months — by 63.2 %, after 6 months — by 66.4 %, which is significantly higher than the baseline (p<0.05 vs. baseline).Conclusion. It has been proven that combined treatment of CHF patients using FSCs along with the standard therapy increases the LV myocardial contractility, lowering the blood serum NT-proBNP level and results in overall life quality improvement among the patients.

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