scholarly journals A New Biomarker in Acute-Decompensated Heart Failure. Preliminary Study

2019 ◽  
Vol 16 (3) ◽  
pp. 7-14
Author(s):  
Mădălina Ababei ◽  
Alexandru Câmpeanu ◽  
Diana Nistorescu ◽  
Ondin Zaharia ◽  
Paul Portelli ◽  
...  
Keyword(s):  
Heart Failure ◽  
Acute Decompensated Heart Failure ◽  
Decompensated Heart Failure ◽  
Normal Weight ◽  
Ca 125 ◽  
Significant Difference ◽  
Obese Subjects ◽  
Males And Females ◽  
The Mean ◽  
Better Than

AbstractBackground. It is well known that the NT-proBNP in obese subjects is much lower than in normal weight subjects, making difficult to interpret it. In current practice the patients are frequently obese. In these conditions, a new biomarker, not influenced by weight, could be useful in acute-decompensated heart failure (ADHF).Aim. To determine CA-125 changes in obese and normal weight patients with ADHF.Method. The study group included 110 patients (mean age 72±10 years, 63% men) with ADHF caused by ischemic cardiomyopathy. The subjects were clinically, ecocardiographically and biologically (NT-proBNP, CA-125) evaluated.Results. The mean BMI was 27.6±5.8 kg/m2 and 35 (33%) subjects were obese. CA-125 at admission was 53±33 U/mL and decreased at discharge to 34±17 U/mL, without any difference between males and females.There was a significant difference between NT-proBNP at admission in obese versus normoponderal patients (3207±1432 pg/mL versus 4457±2737 pg/mL (p=0.02)), which was maintained at discharge (1711±816 pg/mL versus 2674±1475 pg/mL (p=0.03)).In the same time, the CA-125 did not show statistically significant differences between obese and normoponderal subjects at admission (56±29 U/mL versus 51±20 U/mL (p=0.63)) and discharge (36±20 U/mL versus 33±16 U/mL (p=0.56)).Conclusions. CA-125 could be an useful biomarker in monitoring the obese patients with ADHF, better than NT-proBNP.

scholarly journals Ca-125, A Biomarker in Acute-Decompensated Heart Failure. Preliminary Study.

2018 ◽  
Vol 15 (3) ◽  
pp. 7-16
Author(s):  
M. Ababei ◽  
A. Câmpeanu ◽  
D. Nistorescu ◽  
O. Zaharia ◽  
P Portelli ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Acute Decompensated Heart Failure ◽  
Left Ventricular ◽  
Left Ventricular Filling ◽  
Ca 125 ◽  
Oxidative Stress Marker ◽  
Significant Difference ◽  
The Mean ◽  
Ventricular Filling

AbstractBackground. CA-125 is a tumor antigen expressed on the surface of ovarian cells, used to monitor the treatment of ovarian cancer (normal upper limit is 35U/mL), but it seems also to have a role as biomarker in heart failure (HF).Aim. To determine CA-125 changes in acute-decompensated HF (ADHF) patients.Method. The study group included 110 patients (mean age 72±10 years, 63% men) with ADHF caused by ischemic cardiomyopathy. The subjects were clinically, ecocardiographically and biologically (NT-proBNP, PCR, serum uric acid (sUA), CA-125) evaluated.Results. CA-125 at admission was 53±33 U/mL and decreased at discharge to 34±17 U/mL, without any difference between males and females. The mean level of CA-125 was significantly higher in patients with pleural effusion.There was a significant difference between NT-proBNP at admission in obese versus normoponderal patients, which was maintained at discharge. In the same time, the CA-125 did not show significant differences between obese and normoponderal subjects at admission and discharge. The mean level of CA-125 was significantly higher for subjects with reduced ejection fraction and with elevated left ventricular filling pressures versus subjects with preserved ejection fraction and normal left ventricular filling pressures.The CA-125 correlated with LVEF (R=-0.221, p=0.02), with NT-proBNP (R=0.371, p<0.001), with the inflammation marker - PCR (R=0.284, p=0.003) and oxidative stress marker - sUA (R=0.234, p=0.015).Conclusions. The wide availability of CA-125, its relatively low cost, its correlation with known prognostic markers in HF and the additional information provided make it a valuable biomarker that can be used in monitoring ADHF patients.

scholarly journals Oral Metolazone Versus Intravenous Chlorothiazide as an Adjunct to Loop Diuretics for Diuresis in Acute Decompensated Heart Failure With Reduced Ejection Fraction

2018 ◽  
Vol 54 (6) ◽  
pp. 351-357 ◽  
Author(s):  
Brian C. Bohn ◽  
Rim M. Hadgu ◽  
Hannah E. Pope ◽  
Jerrica E. Shuster
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Acute Decompensated Heart Failure ◽  
Decompensated Heart Failure ◽  
Oral Formulation ◽  
Loop Diuretics ◽  
Reduced Ejection Fraction ◽  
Significant Difference ◽  
Patients With Heart Failure ◽  
Total Urine

Background: Thiazide diuretics are often utilized to overcome loop diuretic resistance when treating acute decompensated heart failure (ADHF). In addition to a large cost advantage, several pharmacokinetic advantages exist when administering oral metolazone (MTZ) compared with intravenous (IV) chlorothiazide (CTZ), yet many providers are reluctant to utilize an oral formulation to treat ADHF. The purpose of this study was to compare the increase in 24-hour total urine output (UOP) after adding MTZ or CTZ to IV loop diuretics (LD) in patients with heart failure with reduced ejection fraction (HFrEF). Methods and Results: From September 2013 to August 2016, 1002 patients admitted for ADHF received either MTZ or CTZ in addition to LD. Patients were excluded for heart failure with preserved ejection fraction (HFpEF) (n = 469), <24-hour LD or UOP data prior to drug initiation (n = 129), or low dose MTZ/CTZ (n = 91). A total of 168 patients were included with 64% receiving CTZ. No significant difference was observed between the increase in 24-hour total UOP after MTZ or CTZ initiation (1458 [514, 2401] mL vs 1820 [890, 2750] mL, P = .251). Conclusions: Both MTZ and CTZ similarly increased UOP when utilized as an adjunct to IV LD. These results suggest that while thiazide agents can substantially increase UOP in ADHF patients with HFrEF, MTZ and CTZ have comparable effects.

Abstract P302: Lack of Obesity Paradox in 30 Day and Annual Cumulative Acute Decompensated Heart Failure Readmissions

Circulation ◽  
2016 ◽  
Vol 133 (suppl_1) ◽  
Author(s):  
Ravinder Valadri ◽  
Namrata Singhania ◽  
Deborah Deborah ◽  
Richard English ◽  
LeYu Naing ◽  
...  
Keyword(s):  
Heart Failure ◽  
Acute Decompensated Heart Failure ◽  
Decompensated Heart Failure ◽  
Obesity Paradox ◽  
Normal Weight ◽  
Study Cohort ◽  
Data Sets ◽  
Index Hospitalization ◽  
Unplanned Hospitalizations ◽  
End Stage

Background: Recent study demonstrated paradoxical relationship between body mass Index (BMI) and all cause mortality in patients with acute decompensated heart Failure (ADHF), where higher BMI was associated with decreased mortality. We sought to test whether this relationship exists between BMI and ADHF readmissions Methods: Consecutive patients presented to the emergency department from March 2014 to July 2015 with the diagnosis of ADHF were analyzed in a retrospective cohort study. Cohort was grouped in to prespecified BMI categories; normal weight (BMI <26 Kg/m2 ), Over weight (BMI 25-30 Kg/m2 ) and Obese (BMI >30 Kg/m2 and above). Primary endpoints were incidence of 30 day ADHF readmission and time to first ADHF readmission from the index hospitalization. Patients with end stage COPD on home O2, cirrhosis and end stage renal failure on dialysis were excluded. Unplanned hospitalizations due to other cause than ADHF were excluded. ADHF hospitalizations were adjudicated by an independent blinded clinician Results: Cohort (N=188) consisted 51(27.1%) normal weight, 61 (32.4%) over weight and 76 (40.4%) obese patients. Females were 63% (N=119), patients with heart failure with preserved ejection fraction were 47% (N=90), Obese [BMI 31(28-38) Kg/m2; Median (IQR)] patients were younger (median age; 77 years vs 83 years; P=0.002), whereas other covariates were similar between groups. In median follow up of 1.2 years, total 30 day ADHF readmissions were 32 and total ADHF admissions were 214. Incidence of both 30 day and total ADHF readmissions were similar in all 3 BMI categories; ANOVA P=0.18 (30 day ADHF readmissions) and P= 0.62 (total ADHF readmissions). Obesity was neither associated with risk for 30 day readmission; OR=0.64 (CI: 0.20 - 2.0; P= 0.45) nor with the time to first ADHF readmission from the index hospitalization; log rank P=0.5 (Figure 1) Conclusions: Higher BMI is not protective against ADHF readmissions in patients with ADHF. Further studies are needed in larger data sets to validate our findings.

scholarly journals The serum angiotensin-converting enzyme 2 and angiotensin-(1-7) concentrations after optimal therapy for acute decompensated heart failure with reduced ejection fraction

2020 ◽  
Vol 40 (6) ◽  
Author(s):  
Shinji Hisatake ◽  
Shunsuke Kiuchi ◽  
Takayuki Kabuki ◽  
Takashi Oka ◽  
Shintaro Dobashi ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Angiotensin Converting Enzyme ◽  
Acute Decompensated Heart Failure ◽  
Decompensated Heart Failure ◽  
Converting Enzyme ◽  
Healthy Individuals ◽  
Reduced Ejection Fraction ◽  
Optimal Therapy ◽  
Significant Difference

Abstract Objective: Elucidation of the role of angiotensin-converting enzyme (ACE) 2 (ACE2)/angiotensin (Ang)-(1-7)/Mas receptor axis in heart failure is necessary. No previous study has reported serial changes in ACE2 and Ang-(1-7) concentrations after optimal therapy (OT) in acute heart failure (AHF) patients. We aimed to investigate serial changes in serum ACE2 and Ang-(1-7) concentrations after OT in AHF patients with reduced ejection fraction (EF). Methods: ACE2 and Ang-(1-7) concentrations were measured in 68 AHF patients with reduced EF immediately after admission and 1 and 3 months after OT. These parameters were compared with the healthy individuals at three time points. Results: In the acute phase, Ang-(1-7) and ACE2 concentrations was statistically significantly lower and higher in AHF patients than the healthy individuals (2.40 ± 1.11 vs. 3.1 ± 1.1 ng/ml, P&lt;0.005 and 7.45 ± 3.13 vs. 4.84 ± 2.25 ng/ml, P&lt;0.005), respectively. At 1 month after OT, Ang-(1-7) concentration remained lower in AHF patients than the healthy individuals (2.37 ± 1.63 vs. 3.1 ± 1.1 ng/ml, P&lt;0.05); however, there was no statistically significant difference in ACE2 concentration between AHF patients and the healthy individuals. At 3 months after OT, there were no statistically significant differences in Ang-(1-7) and ACE2 concentrations between AHF patients and the healthy individuals. Conclusion: ACE2 concentration was equivalent between AHF patients and the healthy individuals at 1 and 3 months after OT, and Ang-(1-7) concentration was equivalent at 3 months after OT.

scholarly journals Gender disparities among hospitalised patients with acute myocardial infarction, acute decompensated heart failure or pneumonia: retrospective cohort study

BMJ Open ◽  
2019 ◽  
Vol 9 (1) ◽  
pp. e022782 ◽  
Author(s):  
Mouaz Alsawas ◽  
Zhen Wang ◽  
M Hassan Murad ◽  
Mohammed Yousufuddin
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Acute Myocardial Infarction ◽  
Cohort Study ◽  
Retrospective Cohort ◽  
Acute Decompensated Heart Failure ◽  
Decompensated Heart Failure ◽  
Men And Women ◽  
Hospitalised Patients ◽  
Significant Difference

ObjectiveTo assess gender disparity in outcomes among hospitalised patients with acute myocardial infarction (AMI), acute decompensated heart failure (ADHF) or pneumonia.DesignA retrospective cohort study.SettingA tertiary referral centre in Midwest, USA.ParticipantsWe evaluated 12 265 adult patients hospitalised with ADHF, 15 777 with AMI and 12 929 with pneumonia, from 1 January 1995 through 31 August 2015. Patients were selected using International Classification of Diseases, Ninth Revision, Clinical Modification codes.Primary and secondary outcome measuresPrevalence of comorbidities, 30-day mortality and 30-day readmission. Comorbidities were chosen from the 20 chronic conditions, specified by the Office of the Assistant Secretary for Health. Logistic regression analysis was conducted adjusting for multiple confounders.ResultsPrevalence of comorbidities was significantly different between men and women in all three conditions. After adjusting for age, length of stay, multicomorbidities and residence, there was no significant difference in 30-day mortality between men and women in AMI or ADHF, but men with pneumonia had slightly higher 30-day mortality with an OR of 1.19 (95% CI 1.06 to 1.34). There was no significant difference in 30-day readmission between men and women with AMI or pneumonia, but women with ADHF were slightly more likely to be readmitted within 30 days with OR 0.90 (95% CI 0.82 to 0.99).ConclusionGender differences in the distribution of comorbidities exist in patients hospitalised with AMI, ADHF and pneumonia. However, there is minimal clinically meaningful impact of these differences on outcomes. Efforts to address gender difference may need to be diverted towards targeting overall population health, reducing race/ethnicity disparity and improving access to care.

scholarly journals Statistical Analysis of Birth Weight and Gender of Newborn Infants

2018 ◽  
pp. 1-7
Author(s):  
Jide Onyekwelu ◽  
Chike H. Nwankwo ◽  
I. C. A. Oyeka
Keyword(s):  
Birth Weight ◽  
Adult Life ◽  
Normal Weight ◽  
High Birth Weight ◽  
Normal Birth Weight ◽  
Weight Category ◽  
Normal Birth ◽  
Significant Difference ◽  
Males And Females ◽  
The Mean

Introduction: Birth weight is an important determinant of infant morbidity and mortality. Its effect extends upto adult life and may explain some non-communicable diseases that may occur in adult life. In general, males weigh more than females. Birth weight is categorised into three levels, viz., low, normal and high. This study analysed the relationship between gender and the categories of birth weights. Materials and Methods: Data on babies’ gender and birth weights from 961 term life deliveries in a private general practice hospital were analysed. Test on equality of the mean weight of males and females at the three categorical levels were done using z test and t-tests, as necessary. Results: Mean birth weight was found to be 3.30 ± 0.495 kg. Males weighed significantly heavier than females at mean weights of 3.343 ± 0.495 kg and 3.258 ± 0.490 kg, respectively. In the low birth weight category, males weighed 1.844 ± 0.297 kg and females weighed 1.992 ± 0.397 kg. There was no significant difference. Similarly, the mean weight of males and females in the high birth weight category were 4.462 ± 0.343 kg and 4.342 ± 0.219 kg, respectively with no significant difference. In the normal weight category, males weighed significantly more than the females with the mean weight of 3.30 ± 0.359 kg and 3.248 ± 0.392 kg, respectively. Conclusion: Male babies weighed more than female babies only in the normal birth weight category. The factor that selectively affected the birth weight of male babies must be acting under the category of normal birth weight only. More studies are necessary to identify the factors and the reasons, for which they act only at the level of the normal birth weight.  

Effect of Levosimendan on the short-term clinical efficacy of patients with acute decompensated heart failure

2021 ◽  
Vol 7 (6) ◽  
pp. 6572-6584
Author(s):  
Wang Huping ◽  
Wang Shidong ◽  
Rong A ◽  
Xie Xueliang
Keyword(s):  
Heart Failure ◽  
Heart Disease ◽  
Clinical Efficacy ◽  
Adverse Reactions ◽  
Heart Function ◽  
Acute Decompensated Heart Failure ◽  
Decompensated Heart Failure ◽  
Control Group ◽  
Clinical Effects ◽  
Significant Difference

OBJECTIVE To observe the effect of levosimendan on the clinical efficacy of patients with acute decompensated heart failure (ADHF). METHODS Collected 124 patients with acute decompensated heart failure who were admitted to the cardiology department of our hospital from October 2019 to October 2020. According to the random number table method, they were divided into control group and levosimendan group. The control group was given traditional anti-heart failure treatment, and the levosimendan group was added with levosimendan injection on the basis of the control group. The clinical efficacy indicators, functional indicators, incidence of adverse reactions, mortality during hospitalization, rehospitalization rates and combined endpoint events within 3 months of follow-up were compared before and after treatment. RESULT The results of clinical efficacy comparison showed that the number of significant effective number in the controlgroup was less than that of the levosimendan group, and there was no difference in the number of effective, ineffective and total effective groups; the improvement of dyspnea after treatment in the levosimendan group was better than that of the control group; cardiac color Doppler ultrasound LVEF in control group is higher than Levosimendan group, LVEDV and LVESV are lower than control group; The BNP control group was higher than the levosimendan group. There was no significant difference in renal function between the two groups.The urine output of the control group was less than that of the levosimendan group.There was no statistically significant difference in adverse reactions, rehospitalization rates within 3 months, and mortality between the two groups of patients, and the combined endpoint event (death or rehospitalization) was significantly lower than that of the control group. CONCLUSION Levosimendan in the treatment of patients with acute decompensated heart failure can achieve significant clinical effects, and effectively improve the patient's hemodynamic indicators and increase renal perfusion.With the deepening of the aging of the population in China, the incidence of decompensated heart failure in the elderly population is higher, which seriously affects the normal life. Acute decompensated heart failure (ADHF), a kind of heart disease, is a clinical syndrome characterized by dyspnea with sudden onset and rapid peak based on abnormal heart function (11. It is typical of the late stage of heart disease, usually on the basis of chronic heart failure. The disease is complex and difficult to treat. In addition, the mortality rate of patients is high [2], which endangers the health of patients and threatens their life safety, and is the key disease of current clinical attention. At present, drug therapy is mainly adopted in the clinical treatment to stabilize the hemodynamic level of patients. Clinical practice shows that it is not significantthe to adopt conventional symptomatic treatment effect/which demands a new effective treatment scheme. Levosimendan .a new type of positive inotropic drug, -can increase myocardial contractility and has significant effects in improving heart failure which will reduce mortality, improve the incidence of arrhythmia and bring hope to patients [3]. This study took 124 cases admitted to our hospital as the research object, and analyzed the therapeutic effect of levosimendan. The report are as follows.

Acute heart failure in bone marrow transplantation: Impact of intravenous immune globulin as adjuvant therapy

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 16512-16512
Author(s):  
P. Salcedo ◽  
E. Shpall ◽  
W. Yusuf ◽  
S. Roberson ◽  
M. Woods ◽  
...  
Keyword(s):  
Heart Failure ◽  
Bone Marrow ◽  
Bone Marrow Transplantation ◽  
Acute Heart Failure ◽  
Marrow Transplantation ◽  
Acute Decompensated Heart Failure ◽  
Nyha Class ◽  
Decompensated Heart Failure ◽  
The Mean ◽  
Post Therapy

16512 Background: Little is known regarding management or treatment of cardiac failure after bone marrow transplantation. We investigated the management, treatment and outcome of new onset acute decompensated heart failure (ADHF) after bone marrow transplantation (BMT) with beta blockers, ace-inhibitors and adjuvant intravenous immune globulin (IVIG) therapy. Methods: We retrospectively examined 25 patients with ADHF. Eleven of these patients developed congestive heart failure within 100 days of BMT. Baseline echocardiograms were normal prior to admission and all patients were hospitalized and evaluated for left ventricular ejection fraction (LVEF), and New York Heart Association (NYHA) class. Patients with acute heart failure were treated with standard heart failure medications and patients post-BMT were treated with standard heart failure therapy plus adjuvant (IVIG) (500mg/Kg/day) for 48 hours. Baseline LVEF and NYHA class of 11 patients pre- and post-BMT were compared with LVEF and NYHA class of 14 patients with ADHF that did not receive a BMT. Results: The baseline diagnosis for all patients in the BMT group was NYHA class 4 and post-therapy improved to class 1.2. The baseline diagnosis for all patients in the non-BMT group were NYHA class 3.7 and improved to class 1.2 with medical therapy. The mean LVEF in the BMT group at diagnosis of ADHF was 27.5% and the mean post-therapy with IVIG was 57.6%. The mean baseline LVEF in the group not undergoing BMT and at diagnosis of ADHF was 28.2% and improved post-therapy to 45.2%. Conclusions: Acute decompensated heart failure in the cancer patient is highly treatable with aggressive medical management. Patients with ADHF after BMT and treated with IVIG may have potential clinical benefits with IVIG and standard medical therapy. Significant improvement in LVEF and NYHA were present in the BMT group versus the non-BMT group. These data suggest that BMT outcomes may be improved with routine heart failure management. Further randomized studies should be conducted. [Table: see text] No significant financial relationships to disclose.

P4523Impact of comorbiditity on the predictive value of acute kidney injury in patients admitted for acute decompensated heart failure: a prospective study

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
K Kayama ◽  
T Yamada ◽  
T Morita ◽  
Y Furukawa ◽  
S Tamaki ◽  
...  
Keyword(s):  
Heart Failure ◽  
Acute Kidney Injury ◽  
Acute Decompensated Heart Failure ◽  
Kidney Injury ◽  
Decompensated Heart Failure ◽  
Absolute Increase ◽  
Increased Risk ◽  
Significant Difference ◽  
Comorbidity Burden ◽  
The Impact

Abstract Background Comorbidities are associated with poor clinical outcome in patients with chronic heart failure, and acute kidney injury (AKI) also provides prognostic information in patients with heart failure. However, there is no information available on the impact of comorbidities on the prognostic value of AKI in patients admitted for acute decompensated heart failure (ADHF). Methods We prospectively studied 357 consecutive ADHF patients with survival discharge. Patients with hemodialysis were excluded. Comorbidity was measured with the Age-adjusted Charlson comorbidity index (ACCI) which is commonly used for the evaluation of the comorbid condition which is weighted and scored, with additional points added for age. AKI was defined as an absolute increase in serum creatinine of 0.3mg/dl or more during hospitalization. The endpoint was all-cause death (ACD). Results During a follow-up period of 2.2±1.4 years, 97 patients had ACD. At multivariate Cox analysis, ACCI (p<0.0001) and AKI (p=0.0061) were significantly and independently associated with ACD. Patients with high ACCI (≥5: determined by ROC analysis) had a significantly greater risk of ACD (39% vs 16%). In the subgroup of high ACCI, patients with AKI had a significantly higher risk of ACD (60% vs 35%), whereas there was no significant difference in the risk of ACD between with and without AKI (15% vs 16%) in the subgroup of low ACCI. Conclusions The presence of AKI was associated with the increased risk of mortality in ADHF patients with higher comorbidity burden but not in those without them.

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