scholarly journals Impact of Acute Hemoglobin Falls in Heart Failure Patients: A Population Study

2020 ◽  
Vol 9 (6) ◽  
pp. 1869
Author(s):  
Cristina Lopez ◽  
Jose Luis Holgado ◽  
Antonio Fernandez ◽  
Inmaculada Sauri ◽  
Ruth Uso ◽  
...  
Keyword(s):  
Heart Failure ◽  
Kidney Injury ◽  
First Episode ◽  
Heart Failure Patients ◽  
Risk Of Mortality ◽  
All Cause Mortality ◽  
The Impact ◽  
Worse Prognosis ◽  
Significant Mortality

Aims: This study assessed the impact of acute hemoglobin (Hb) falls in heart failure (HF) patients. Methods: HF patients with repeated Hb values over time were included. Falls in Hb greater than 30% were considered to represent an acute episode of anemia and the risk of hospitalization and all-cause mortality after the first episode was assessed. Results: In total, 45,437 HF patients (54.9% female, mean age 74.3 years) during a follow-up average of 2.9 years were analyzed. A total of 2892 (6.4%) patients had one episode of Hb falls, 139 (0.3%) had more than one episode, and 342 (0.8%) had concomitant acute kidney injury (AKI). Acute heart failure occurred in 4673 (10.3%) patients, representing 3.6/100 HF patients/year. The risk of hospitalization increased with one episode (Hazard Ratio = 1.30, 95% confidence interval (CI) 1.19–1.43), two or more episodes (HR = 1.59, 95% CI 1.14–2.23, and concurrent AKI (HR = 1.61, 95% CI 1.27–2.03). A total of 10,490 patients have died, representing 8.1/100 HF patients/year. The risk of mortality was HR = 2.20 (95% CI 2.06–2.35) for one episode, HR = 3.14 (95% CI 2.48–3.97) for two or more episodes, and HR = 3.20 (95% CI 2.73–3.75) with AKI. In the two or more episodes and AKI groups, Hb levels at the baseline were significantly lower (10.2–11.4 g/dL) than in the no episodes group (12.8 g/dL), and a higher and significant mortality in these subgroups was observed. Conclusions: Hb falls in heart failure patients identified those with a worse prognosis requiring a more careful evaluation and follow-up.

Abstract 15114: Paradoxical Association of Ventricular Tachyarrhythmias and All-Cause Mortality in Patients With Renal Impairment: a MADIT-CRT Substudy

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Usama Daimee ◽  
Arthur Moss ◽  
Ilan Goldenberg ◽  
Martin Ruwald ◽  
Wojciech Zareba ◽  
...  
Keyword(s):  
Heart Failure ◽  
Renal Function ◽  
Renal Dysfunction ◽  
Lower Risk ◽  
Ventricular Tachyarrhythmias ◽  
Heart Failure Patients ◽  
Mild Heart Failure ◽  
All Cause Mortality ◽  
The Impact

Background: The risk of ventricular tachyarrhythmias (VTAs) in mild heart failure patients with renal dysfunction receiving cardiac resynchronization therapy plus an implantable cardioverter-defibrillator (CRT-ICD) or an ICD alone is not well understood. Hypothesis: We assessed the hypothesis that baseline renal function affects risk of VTAs and all-cause mortality as well as benefit derived from CRT-ICD during in-trial follow-up. Methods: We evaluated the impact of renal function in 1274 patients with mild heart failure and left-bundle branch block enrolled in MADIT-CRT. Patients with BUN>70 mg/dl or creatinine>3.0 mg/dl were excluded from the trial. Two subgroups were created based on the estimated glomerular filtration rate (GFR): GFR<60 and GFR≥60 ml/min/1.73 m2. Patients were studied over 3.3 years of follow-up for endpoints of ventricular tachycardia ≥200 beats per minute or ventricular fibrillation (fast VT/VF) and all-cause mortality. Results: The 413 patients with GFR<60 ml/min/1.73 m2 (mean 48.1±8.3) experienced lower risk of fast VT/VF (HR: 0.63, 95% CI: 0.44-0.90, p=0.012) but increased risk of death (HR: 2.43, 95% CI: 1.67-3.57, p<0.001), relative to those in the GFR≥60 group (mean 79.6±16.0) [Figure]. For both, CRT-ICD relative to ICD-only treatment was associated with lower likelihood of fast VT/VF (GFR<60: HR=0.46, 95% CI: 0.24-0.86, p=0.016; GFR≥60: HR=0.54, 95% CI: 0.38-0.76, p<0.001) without a significant effect on death (GFR<60: HR=0.62, 95% CI: 0.38-1.04, p=0.065; GFR≥60: HR=0.78, 95% CI: 0.45-1.36, p=0.379). There was no significant treatment interaction for the endpoints (p>0.10). Conclusion: In conclusion, in mild heart failure patients, moderate renal dysfunction is associated with lower risk of VTAs but greater risk of all-cause mortality relative to mildly impaired-to-normal renal function. In both groups, similar benefit from CRT-ICD was found in reducing risk of VTAs.

Long-term systolic blood pressure and all-cause mortality in heart failure with preserved ejection fraction: an analysis of the TOPCAT trial

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
P Huang ◽  
C Liu
Keyword(s):  
Heart Failure ◽  
Blood Pressure ◽  
Ejection Fraction ◽  
Funding Source ◽  
Preserved Ejection Fraction ◽  
Risk Of Mortality ◽  
All Cause Mortality ◽  
History Of

Abstract Background Lower systolic blood pressure (SBP) at admission or discharge was associated with poor outcomes in patients with heart failure and preserved ejection fraction (HFpEF). However, the optimal long-term SBP for HFpEF was less clear. Purpose To examine the association of long-term SBP and all-cause mortality among patients with HFpEF. Methods We analyzed participants from the Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist (TOPCAT) study. Participants had at least two SBP measurements of different times during the follow-up were included. Long-term SBP was defined as the average of all SBP measurements during the follow-up. We stratified participants into four groups according to long-term SBP: &lt;120mmHg, ≥120mmHg and &lt;130mmHg, ≥130mmHg and &lt;140mmHg, ≥140mmHg. Multivariable adjusted Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CI) for all-cause mortality associated with SBP level. To assess for nonlinearity, we fitted restricted cubic spline models of long-term SBP. Sensitivity analyses were conducted by confining participants with history of hypertension or those with left ventricular ejection fraction≥50%. Results The 3338 participants had a mean (SD) age of 68.5 (9.6) years; 51.4% were women, and 89.3% were White. The median long-term SBP was 127.3 mmHg (IQR 121–134.2, range 77–180.7). Patients in the SBP of &lt;120mmHg group were older age, less often female, less often current smoker, had higher estimated glomerular filtration rate, less often had history of hypertension, and more often had chronic obstructive pulmonary disease and atrial fibrillation. After multivariable adjustment, long-term SBP of 120–130mmHg and 130–140mmHg was associated with a lower risk of mortality during a mean follow-up of 3.3 years (HR 0.65, 95% CI: 0.49–0.85, P=0.001; HR 0.66, 95% CI 0.50–0.88, P=0.004, respectively); long-term SBP of &lt;120mmHg had similar risk of mortality (HR 1.03, 95% CI: 0.78–1.36, P=0.836), compared with long-term SBP of ≥140mmHg. Findings from restricted cubic spline analysis demonstrate that there was J-shaped association between long-term SBP and all-cause mortality (P=0.02). These association was essentially unchanged in sensitivity analysis. Conclusions Among patients with HFpEF, long-term SBP showed a J-shaped pattern with all-cause mortality and a range of 120–140 mmHg was significantly associated with better outcomes. Future randomized controlled trials need to evaluate optimal long-term SBP goal in patients with HFpEF. Funding Acknowledgement Type of funding source: Foundation. Main funding source(s): China Postdoctoral Science Foundation Grant (2019M660229 and 2019TQ0380)

Twin peaks diversity with sacubitril/valsartan treatment responses in cardiomyopathic heart failure patients of non-ischemic compared to ischemic etiologies

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
H.Y Chang ◽  
W.R Chiou ◽  
P.L Lin ◽  
C.Y Hsu ◽  
C.T Liao ◽  
...  
Keyword(s):  
Heart Failure ◽  
Primary Endpoint ◽  
Ischemic Cardiomyopathy ◽  
Ventricular Remodeling ◽  
Left Ventricular Ejection ◽  
Funding Source ◽  
Heart Failure Patients ◽  
Twin Peaks ◽  
All Cause Mortality

Abstract Background Ischemic cardiomyopathy (ICM) has been associated with increased mortality when compared with non-ischemic cardiomyopathy (NICM) from several heart failure (HF) cohorts. Instead, PARADIGM study demonstrated similar event rates of cardiovascular (CV) death, all-cause mortality and HF readmissions between ICM and NICM patients. Although the beneficiary effect of sacubitril/valsartan (SAC/VAL) compared to enalapril on these endpoints was consistent across etiologic categories, PARADIGM study did not analyze the effect of ventricular remodeling of SAC/VAL on patients with different HF etiologies, which may significantly affect treatment outcomes. Purpose We aim to compare alterations of left ventricular ejection fraction (LVEF) following SAC/VAL treatment and its association with clinical outcomes in patients with different HF etiologies. Methods Treatment with angiotensin receptor neprilysin inhibitor for Taiwan heart failure patients (TAROT-HF) study is a multicenter study which enrolled 1552 patients with LVEF &lt;40%, whom had been on SAC/VAL treatment from 9 hospitals between 2017 and 2018. After excluding patients without having follow-up echocardiographic studies, patients were grouped by HF etiologies and by LVEF changes following treatment for 8-month period. LVEF improvement ≥15% was defined as “significant improvement”, 5–15% as “marginal improvement”, and &lt;5% or worse as “lack of improvement”. The primary endpoint was a composite of CV death or a first hospitalization for HF. Mean follow-up period was 726 days. Results A total of 1230 patients were analyzed. Patients with ICM were significantly older, more male, and prone to have associated hypertension and diabetes. On the other hand, patients with NICM had lower LVEF and higher likelihood of atrial fibrillation. LVEF increase was significantly greater in patients with NICM compared to those with ICM (11.2±12.4% vs. 6.9±9.8, p&lt;0.001). The effect of ventricular remodeling of SAC/VAL on patients with NICM showed twin peaks diversity (Significant improvement 37.1%, lack of improvement 42.3%), whereas in patients with ICM the proportions of significant, marginal and lack of improvement groups were 19.4%, 28.2% and 52.4%, respectively. The primary endpoint showed twin peaks diversity also in patients with NICM in line with LVEF changes: adjusted HR for patients with NICM and significant improvement was 0.41 (95% CI 0.29–0.57, p&lt;0.001), for patients with NICM and lack of improvement was 1.54 (95% CI 1.22–1.94, p&lt;0.001). Analyses for CV death, all-cause mortality, and HF readmission demonstrated consistent results. Conclusion Patients with NICM had higher degree of LVEF improvement than those with ICM following SAC/VAL treatment, and significant improvement of LVEF in NICM patients may indicate favorable outcome. NICM patients without response to SAC/VAL treatment should serve as an indicator for poor clinical outcome and warranted meticulous HF management. Funding Acknowledgement Type of funding source: Private hospital(s). Main funding source(s): Cheng Hsin General Hospital

Evaluation of a multimarker panel in chronic heart failure: a 10-year follow-up

2021 ◽  
Author(s):  
Susanne Bauer ◽  
Christina Strack ◽  
Ekrem Ücer ◽  
Stefan Wallner ◽  
Ute Hubauer ◽  
...  
Keyword(s):  
Heart Failure ◽  
Prognostic Role ◽  
Blood Samples ◽  
Kaplan Meier ◽  
Risk Of Mortality ◽  
Patients With Heart Failure ◽  
All Cause Mortality ◽  
Long Time

Aim: We assessed the 10-year prognostic role of 11 biomarkers with different pathophysiological backgrounds. Materials & methods/results: Blood samples from 144 patients with heart failure were analyzed. After 10 years of follow-up (median follow-up was 104 months), data regarding all-cause mortality were acquired. Regarding Kaplan–Meier analysis, all markers, except TIMP-1 and GDF-15, were significant predictors for all-cause mortality. We created a multimarker model with nt-proBNP, hsTnT and IGF-BP7 and found that patients in whom all three markers were elevated had a significantly worse long-time-prognosis than patients without elevated markers. Conclusion: In a 10-year follow-up, a combination of three biomarkers (NT-proBNP, hs-TnT, IGF-BP7) identified patients with a high risk of mortality.

Sarcopenia and Frailty in PD: Impact on Mortality, Malnutrition, and Inflammation

2018 ◽  
Vol 38 (6) ◽  
pp. 447-454 ◽  
Author(s):  
Yuka Kamijo ◽  
Eiichiro Kanda ◽  
Yoshitaka Ishibashi ◽  
Masayuki Yoshida
Keyword(s):  
Muscle Mass ◽  
Secondary Outcome ◽  
Related Factors ◽  
Clinical Frailty Scale ◽  
Risk Of Mortality ◽  
All Cause Mortality ◽  
Comorbidity Index ◽  
The Relationship ◽  
Worse Prognosis

Background It is known that sarcopenia is related to malnutrition-inflammation-atherosclerosis (MIA) syndrome and is an important problem in dialysis patients. The notion of frailty includes various physical, psychological, and social aspects. Although it has been reported that sarcopenia is associated with poor prognosis in patients with hemodialysis, reports on peritoneal dialysis (PD) patients are rare. In this study, we examined the morbidity and mortality of sarcopenia and frailty in PD patients. We also investigated the MIA-related factors. Methods We evaluated 119 patients cross-sectionally and longitudinally. The Asian Working Group for Sarcopenia criteria and the Clinical Frailty Scale (CFS) were used to diagnose sarcopenia and frailty. The primary outcome is all-cause mortality with sarcopenia and frailty. The secondary outcome is the relationship between various MIA-related factors. Results Morbidity of sarcopenia and frailty in PD patients was 8.4% and 10.9%, respectively. Old age, high values of Barthel Index, Charlson Comorbidity Index, CFS, and low values of body mass index (BMI), muscle strength, muscle mass, and slow walking were associated with sarcopenia. Interleukin-6, albumin, and prealbumin were significantly correlated with muscle mass. During follow-up, the presence of sarcopenia or frailty was associated with the risk of mortality. In multivariate analysis, CFS was related to the mortality rate of PD patients. Conclusions The presence of sarcopenia or frailty was associated with a worse prognosis.

P5453Cardiorenal biomarker N-acteyl-beta-D-glucosaminidase (NAG) potentially predicts mortality in chronic heart failure - A 10 year follow up

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
A D Schober ◽  
C Strack ◽  
S Bauer ◽  
U Hubauer ◽  
A L Schober ◽  
...  
Keyword(s):  
Heart Failure ◽  
Chronic Heart Failure ◽  
Kidney Injury ◽  
Secondary Endpoint ◽  
Youden Index ◽  
All Cause Mortality ◽  
Long Term Follow Up ◽  
Prospective Longitudinal

Abstract Background The strong relation between chronic heart failure (CHF) and chronic kidney disease (CKD) is well known as cardiorenal syndrome (CRS). The current study focused on the impact of novel markers of kidney injury next to the established cardiac marker NT-proBNP as predictors for mortality in patients with CHF in a long term follow up. Methods We conducted a prospective longitudinal study. The novel renal biomarkers kidney injury molecule-1 (KIM-1), N-acteyl-β-D-glucosaminidase (NAG) and Neutrophil Gelatinase-Associated Lipocalin (NGAL) were assessed from urine samples. Additionally, blood levels of NT-proBNP were determined. The primary endpoint all-cause mortality was evaluated after a median follow-up of 104 months (interquartile range 42–117 months). Results 149 adolescents (mean age 62±12 years) with CHF (mean ejection fraction 32±9%) were enrolled. 79 (53%) patients died. The secondary endpoint was reached by 104 patients (70%). The renal marker NAG (HR 1.02, p=0.002) was a significant and independent predictor for all-cause mortality next to the established cardiac biomarker NTproBNP (HR 1.0, p<0,001) using Cox regression analysis, opposite to KIM-1 as well as NGAL (each p=n.s.). Similar results were obtained for the combined endpoint of all-cause mortality and hospitalization for heart failure. In a multivariate analysis model with biomarkers and clinical parameters NAG (HR 1.02, p=0.036) remained a significant predictor for all-cause mortality next to NT-proBNP (HR 1.0, p=0.027, older age (HR 1.04, p=0.004), the lack of diabetes mellitus (HR 0.39, p<0.001), reduced EF (HR 0.97, p=0.034) and creatinine (HR 1.45, p=0.026). Again similar results were obtained for the secondary endpoint. Patients were stratified into groups with markers above and below Youden Index to calculate Kaplan-Meier analysis. A combined analysis of NT-proBNP (< and ≥1906 pg/mL) and NAG (< and ≥10 U/gUCr) revealed an increase of the predictive value of each marker: patients with all three markers above Youden index had the highest mortality rate (79%) compared to patients with one (43%) or none (26%) marker above Youden Index. All-cause Mortality Conclusion The current 10-years long-term follow-up suggests that the tubular biomarker NAG as cardiorenal biomarker in combination with NT-proBNP may allow to discriminate a high-risk collective of chronic heart failure patients. These findings emphasize the close relationship of kidney injury and renal function in patients with CHF.

Abstract P029: Is Non-Ischemic Cardiomyopathy (NICM) Associated With Better Prognosis Than Ischemic Cardiomyopathy (ICM) in Heart Failure Patients?

Circulation ◽  
2014 ◽  
Vol 129 (suppl_1) ◽  
Author(s):  
Deepakraj Gajanana ◽  
Abel Romero-Corral ◽  
Mahek Shah ◽  
Parichart Junpapart ◽  
Vincent M Figueredo ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ischemic Cardiomyopathy ◽  
Clinical Characteristics ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Heart Failure Management ◽  
Heart Failure Patients ◽  
Significant Difference ◽  
All Cause Mortality

Background: Past data suggest ischemic cardiomyopathy (ICM) is associated with worse prognosis when compared to non-ischemic cardiomyopathy(NICM). With advances in heart failure management, this relationship deserves a fresh look. We hypothesize that all cause mortality from NICM is lower when compared to ICM over five year period. Methods: We retrospectively studied consecutive heart failure patients with left ventricular ejection fraction(EF) less than 35% admitted to Einstein Medical Center Philadelphia between 01/01/2007 to 12/31/2007. Data pertaining to patient demographics and clinical characteristics were obtained. All cause mortality was obtained at 5 years using hazard ratio to account for time to event. Results: The final cohort consisted of 360 patients of which 63%(224 of 360) had NICM. Mean age was 61±16 years for NICM and 66±11 yrs for ICM. African Americans constituted 83%(185 of 224) of NICM and 59%(80 of 136) of ICM. The clinical characteristics are as shown in the table. There were 160 deaths over the follow up period. Age, CKD, dyslipidemia and EF were significant predictors of mortality. ICM cohort had 81 deaths out of 136(60%) as compared to 85 out of 185((39%) in NICM over the follow up period. However, when adjusted for age, DM, CKD and days of follow-up, there was no statistically significant difference in mortality between the two groups over the five year follow up period. Conclusions: In this study, there was no significant mortality difference between ICM and NICM. We also found that despite advances in heart failure management in the last two decades, in clinical practice they are under-utilized.

Abstract 13918: Prognostic Value of Plasma Ngal in the 12-month All-cause Mortality of Acute Heart Failure or Acute Decompensated Heart Failure

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Hao T Phan
Keyword(s):  
Heart Failure ◽  
Acute Heart Failure ◽  
Prognostic Value ◽  
Acute Decompensated Heart Failure ◽  
Kidney Injury ◽  
Decompensated Heart Failure ◽  
Plasma Ngal ◽  
Kaplan Meier ◽  
All Cause Mortality

Introduction: The presence of acute kidney injury in the setting of acute heart failure (AHF) or acute decompensated heart failure (ADHF) is very common occurrence and was termed cardiorenal syndrome 1 (CRS1). Renal dysfunction is common in patients with AHF or ADHF and is associated with significant early and late morbidity and mortality. Neutrophil gelatinase-associated lipocalin (NGAL) is an early predictor of acute kidney injury and adverse events in various diseases; however, in AHF or ADHF patients, its significance remains poorly understood. This study was aimed to evaluate the 12 month prognostic value of plasma NGAL in AHF or ADHF patients Hypothesis: plasma NGAL has value in prognosis of 12-month all-cause mortality of Acute Heart Failure or Acute Decompensated Heart Failure Methods: This was a prospective cohort study Results: there were 46 all-cause mortality cases (rate 33.1%) 12 months follow up after discharge. There were 11 cases (rate 7.9%) lost to follow-up; mean age 66.12 ± 15.77, men accounted for 50.4%. The optimal cut-off of NGAL for 12-month all-cause mortality prognosis was > 383.74 ng/ml, AUC 0.632 (95% CI 0.53-0.74, p = 0.011), sensitivity 58.7 %, specificity 68.29 %, positive predictive value 50.9%, negative predictive value 74.7%. Kaplan-Meier analysis revealed that the high plasma NGAL (≥ 400 ng/ml) group exhibited a worse prognosis than the low plasma NGAL (< 400 ng/ml) group in 12-month all-cause death (Hazard Ratio 2.56; 95%CI 1.35-4.84, P=0.0039. Independent predictors of 12-month all-cause-mortality were identified using multivarable Cox proportional-hazards regression models with backward-stepwise selection method consisted of two variables: level of NGAL, mechanical ventialtion at admission. Conclusions: Plasma NGAL and mechanical ventilation at admission were independent predictors of 12-month all-cause mortality in patients with AHF or ADHF. The survival probability 12-month follow-up of high level NGAL (≥ 400 ng/ml) groups were lower than that of low level NGAL (<400 ng/ml,), difference was statistically significant χ2 = 8.31; p = 0.0047 by Kaplan-Meier curves.

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