scholarly journals Usefulness of Serial Multiorgan Point-of-Care Ultrasound in Acute Heart Failure: Results from a Prospective Observational Cohort

Medicina ◽  
2022 ◽  
Vol 58 (1) ◽  
pp. 124
Author(s):  
Marta Torres-Arrese ◽  
Gonzalo García de Casasola-Sánchez ◽  
Manuel Méndez-Bailón ◽  
Esther Montero-Hernández ◽  
Marta Cobo-Marcos ◽  
...  
Keyword(s):  
Heart Failure ◽  
Acute Heart Failure ◽  
Point Of Care ◽  
Femoral Vein ◽  
Common Disease ◽  
Point Of Care Ultrasound ◽  
High Morbidity ◽  
Major Health Problem ◽  
Study Results ◽  
The Impact

Background and Objectives: Acute heart failure (AHF) is a common disease and a cause of high morbidity and mortality, constituting a major health problem. The main purpose of this study was to determine the impact of multiorgan ultrasound in identifying pulmonary hypertension (PH), a major prognostic factor in patients admitted due to AHF, and assess whether there are significant changes in the venous excess ultrasonography (VE × US) score or femoral vein Doppler at discharge. Materials and Methods: Patients were evaluated with a standard protocol of lung ultrasound, echocardiography, inferior vena cava (IVC) and hepatic, portal, intra-renal and femoral vein Doppler flow patterns at admission and on the day of discharge. Results: Thirty patients were enrolled during November 2021. The mean age was seventy-nine years (Standard Deviation–SD 13.4). Seven patients (23.3%) had a worsening renal function during hospitalization. Regarding ultrasound findings, VE × US score was calculated at admission and at discharge, unexpectedly remaining unchanged or even worsened (21 patients, 70.0%). The area under the curve for the lung score was 83.9% (p = 0.008), obtaining a cutoff value of 10 that showed a sensitivity of 82.6% and a specificity of 71.4% in the identification of intermediate and high PH. It was possible to monitor significant changes between both exams on the lung score (16.5 vs. 9.3; p < 0.001), improvement in the hepatic vein Doppler pattern (2.4 vs. 2.1; p = 0.002), improvement in portal vein Doppler pattern (1.7 vs. 1.4; p = 0.023), without significant changes in the intra-renal vein Doppler pattern (1.70 vs. 1.57; p = 0.293), VE × US score (1.3 vs. 1.1; p = 0.501), femoral vein Doppler pattern (2.4 vs. 2.1; p = 0.161) and IVC collapsibility (2.0 vs. 2.1; p = 0.420). Conclusions: Our study results suggest that performing serial multiorgan Point-of-Care ultrasound can help us to better identify high and intermediate probability of PH patients with AHF. Currently proposed multi-organ, venous Doppler scanning protocols, such as the VE × US score, should be further studied before expanding its use in AHF patients.

scholarly journals Usefulness of Serial Multiorgan Point-of-Care Ultrasound in Acute Heart Failure: Results from a Prospective Observational Cohort

2021 ◽  
Author(s):  
Marta Torres-Arrese ◽  
Gonzalo García de Casasola-Sánchez ◽  
Manuel Méndez-Bailón ◽  
Esther Montero-Hernández ◽  
Marta Cobo-Marcos ◽  
...  
Keyword(s):  
Heart Failure ◽  
Acute Heart Failure ◽  
Point Of Care ◽  
Vena Cava ◽  
Common Disease ◽  
Point Of Care Ultrasound ◽  
High Morbidity ◽  
Major Health Problem ◽  
Study Results ◽  
The Impact

Background and Objectives: Acute Heart Failure (AHF) is a common disease and a cause of high morbidity and mortality, constituting a major health problem. The main purpose of this study was to determine the impact of multiorgan ultrasound in identifying the pulmonary hypertension (PH) in patients admitted due to AHF, predict the evolution of the disease during hospitalization and identify areas of improvement in the care of patients with AHF. Materials and Methods: Patients were evaluated with a standard exam of lung ultrasound, echocardiography, inferior vena cava (IVC) and femoral, renal, hepatic, portal venous Doppler flow patterns at admission and on the day of discharge. Results: Thirty patients were enrolled during November 2021. The mean age was seventy-nine years (Standard Deviation &ndash; SD 13,4). Seven patients (23.3%) had a renal function worsening. Regarding ultrasound findings, venous excess ultrasonography score (VExUS) score was calculated at admission and at discharge, surprisingly remaining unchanged or even worsened in most of them (21 patients, 70.0%). The area under the curve for the Lung Score was 83.9% (p = 0.008), obtaining a cutoff value of 10 that showed a sensitivity of 82.6% and a specificity of 71.4% in the identification of intermediate and high PH. It was possible to monitor significant changes between both exams on the lung score (p &amp;lt;0.001), hepatic vein Doppler (p &amp;lt;0.001), portal vein Doppler (p = 0.030), intra-renal vein Doppler (p = 0.025) and VExUS score (p = 0.023), remaining similar the femoral vein Doppler (p = 0.177) and IVC (p = 0.132). Conclusions: Our study results suggest that performing serial multiorgan Point-of-Care ultrasound can help us to better identify high and intermediate probability of PH patients with AHF. Currently proposed multi-organ, venous Doppler scanning protocols, such as the VExUS score, should be further studied in different populations before expanding its use in AHF patients.

scholarly journals A Case Report of Acute Heart Failure Due to Infective Aortic Endocarditis Diagnosed by Point-of-care Ultrasound

2020 ◽  
Vol 4 (2) ◽  
pp. 193-196
Author(s):  
Ryan Gallagher ◽  
Michelle Wilson ◽  
Pamela Hite ◽  
Bradley Jackson
Keyword(s):  
Heart Failure ◽  
Case Report ◽  
Aortic Valve ◽  
Acute Heart Failure ◽  
Point Of Care ◽  
Point Of Care Ultrasound ◽  
Complication Rates ◽  
Threatening Condition ◽  
Valve Insufficiency ◽  
Life Threatening

Introduction: Infective endocarditis (IE) is a life-threatening condition with significant morbidity and mortality, and can require surgical repair. Case Report: A 36-year-old man presented to the emergency department for worsening dyspnea and chest pain. Point-of-care echocardiography demonstrated a mobile oscillating mass on the aortic valve with poor approximation of the valve leaflets, suggesting aortic valve insufficiency secondary to IE as the cause of acute heart failure. The patient underwent emergent aortic valve replacement within 24 hours. Discussion: While point-of-care echocardiography has been well documented in identifying tricuspid vegetations, aortic valve involvement and subsequent heart failure is less well described. Earlier recognition of aortic valve vegetations and insufficiency can expedite surgical intervention, with decreased complication rates linked to earlier antimicrobial therapy. Conclusion: This case report highlights the ability of point-of-care ultrasound to identify aortic vegetations, allowing for the earlier diagnosis and therapy.

scholarly journals The role of point-of-care ultrasound in the diagnosis of pericardial effusion: a single academic center retrospective study

2021 ◽  
Vol 13 (1) ◽  
Author(s):  
Matthew G. Hanson ◽  
Barry Chan
Keyword(s):  
Pericardial Effusion ◽  
Point Of Care ◽  
Physical Exam ◽  
Right Atrial ◽  
Point Of Care Ultrasound ◽  
X Ray ◽  
Average Systolic Blood Pressure ◽  
Time To Diagnosis ◽  
Clinically Significant ◽  
The Impact

Abstract Background Symptomatic pericardial effusion (PCE) presents with non-specific features and are often missed on the initial physical exam, chest X-ray (CXR), and electrocardiogram (ECG). In extreme cases, misdiagnosis can evolve into decompensated cardiac tamponade, a life-threatening obstructive shock. The purpose of this study is to evaluate the impact of point-of-care ultrasound (POCUS) on the diagnosis and therapeutic intervention of clinically significant PCE. Methods In a retrospective chart review, we looked at all patients between 2002 and 2018 at a major Canadian academic hospital who had a pericardiocentesis for clinically significant PCE. We extracted the rate of presenting complaints, physical exam findings, X-ray findings, ECG findings, time-to-diagnosis, and time-to-pericardiocentesis and how these were impacted by POCUS. Results The most common presenting symptom was dyspnea (64%) and the average systolic blood pressure (SBP) was 120 mmHg. 86% of people presenting had an effusion > 1 cm, and 89% were circumferential on departmental echocardiogram (ECHO) with 64% having evidence of right atrial systolic collapse and 58% with early diastolic right ventricular collapse. The average time-to-diagnosis with POCUS was 5.9 h compared to > 12 h with other imaging including departmental ECHO. Those who had the PCE identified by POCUS had an average time-to-pericardiocentesis of 28.1 h compared to > 48 h with other diagnostic modalities. Conclusion POCUS expedites the diagnosis of symptomatic PCE given its non-specific clinical findings which, in turn, may accelerate the time-to-intervention.

Abstract 15507: Trajectories of Point of Care B-type Natriuretic Peptide (bnp) and Its Role as a Predictor of All-cause Mortality Among Hiv and Non-hiv Heart Failure Patients in Uganda

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Samson Okello ◽  
Fardous C Abeya
Keyword(s):  
Heart Failure ◽  
Renal Failure ◽  
Acute Heart Failure ◽  
Natriuretic Peptide ◽  
Point Of Care ◽  
Antiplatelet Agents ◽  
Infected People ◽  
Serial Measurement ◽  
All Cause Mortality ◽  
Hiv Serostatus

Introduction: The usefulness of serial measurement of BNP to reduce hospitalization or mortality in patients with HIV and heartfailure is unknown. Hypothesis: We sought to describe changes in B-type natriuretic peptide (BNP) and estimate the effect of HIV on BNP over a week of observation in an acute heart failure cohort of 40 HIV-infected adults (≥18 years) on antiretroviral therapy (ART) and 175 HIV-uninfected hospitalized patients in Uganda. Methods: We measured BNP using i-STAT BNP (Abbott point of care, Princeton, New Jersey) and compared changes by HIV serostatus, and evaluated BNP as a predictor of all-cause mortality at 30 days from hospitalization using multilevel mixed and competitive risk regression models respectively. Results: Overall HIV-infected participants had a higher mean BNP than HIV-uninfected counterparts. After initial declines in BNP in both groups between day 0 and day 3, BNP moderately increased among the HIV-infected on day 7 and continued to decline in the HIV-uninfected group. Each 1 pg/mL increase in baseline BNP from 400 pg/mL increased the risk of all-cause mortality within 30 days by 1% (adjusted standardized hazard ratio (aSHR) 1.01, 95%CI 1.01, 1.01). Other predictors of increased 30-day all-cause mortality included smoking (aSHR 1.99, 95%CI 1.04, 3.84), hypotension (aSHR 1.69, 95%CI 1.26, 2.26) and renal failure stage 3 (aSHR 2.06, 95%CI 1.34, 3.18), and renal failure stage 5 (aSHR 2.02, 95%CI 1.30, 3.13). We found a lower risk of 30-day all-cause mortality of 38% (95%CI 20%, 73%) for those receiving loop diuretics and 74% (95%CI 56%, 99%) for antiplatelet agents. Conclusions: Over a week of observation, HIV-infected people hospitalized with acute heart failure in Uganda have higher BNP levels than HIV-uninfected counterparts. Increases in BNP above the upper bound of the normal predicted heightened risk of all-cause mortality within 30 days of hospitalization.

scholarly journals New Drugs for Acute Heart Failure

2012 ◽  
Vol 7 (1) ◽  
pp. 35-38
Author(s):  
Mohammad Salman ◽  
Syed Allahsan ◽  
Manzoor Mahmood ◽  
Md Khairul Anam ◽  
Shahed Mohammad Anwar ◽  
...  
Keyword(s):  
Heart Failure ◽  
Renal Failure ◽  
Acute Heart Failure ◽  
Health Problem ◽  
Standard Therapy ◽  
New Drugs ◽  
European Medicines Agency ◽  
Major Health Problem ◽  
Major Health ◽  
Long Time

Acute heart failure is a major health problem responsible for several million hospitalizations worldwide each year. Standard therapy has not changed for long time and includes diuretics and variable use of vasodilators or inotropes. Recently Nesiritide and Levosimendan are two drugs for the treatment of acute heart failure which have been approved by the Food and Drug Administration (FDA) and European Medicines Agency (EMEA), respectively. There was little concern that Nesiritide can worsen the renal failure but recent trials had abolished this concern. DOI: http://dx.doi.org/10.3329/uhj.v7i1.10208 UHJ 2011; 7(1): 35-38

scholarly journals Creatinine Levels at Admission as Predictors of In-Hospital Major Adverse Cardiovascular Events in Acute Heart Failure Patient

2020 ◽  
Vol 6 (1) ◽  
pp. 16-22
Author(s):  
Farida Hanum Margolang ◽  
Refli Hasan ◽  
Abdul Halim Raynaldo ◽  
Harris Hasan ◽  
Ali Nafiah ◽  
...  
Keyword(s):  
Heart Failure ◽  
Acute Heart Failure ◽  
Roc Curve ◽  
Cardiovascular Events ◽  
Major Adverse Cardiovascular Events ◽  
High Morbidity ◽  
Roc Curve Analysis ◽  
Heart Failure Patients ◽  
Long Term Prognosis

Background: Acute heart failure is a global health problem with high morbidity and mortality. Short term and long term prognosis of these patients is poor. Therefore, early identification of patients at high risk for major adverse cardiovascular events (MACEs) during hospitalization was needed to improve outcome. Creatinine levels at admission could be used as predictors of major adverse cardiovascular events in acute heart failure patients because creatinine is a simple and routine biomarker of renal function examined in patients with acute heart failure. This study aimed to determine whether creatinine can be used as a predictor of major adverse adverse cardiovascular events in patients with acute heart failure.Methods: This study is a prospective cohort study of 108 acute heart failure patients treated at H. Adam Malik Hospital from July 2018 to January 2019. Creatinine cut-off points were determined using the ROC curve, then bivariate and multivariate analyzes were performed to determine predictors of major adverse cardiovascular events during hospitalization.Results: From 108 study subjects, 24 (22.2%) subjects experienced major adverse cardiovascular events during hospitalization. The subjects who died were 20 people (83.4%), subjects with arrhythmia were 2 people (8.3%), and those who had stroke were 2 people (8.3 %). Through the ROC curve analysis, we found creatinine cut-off values of ≥1.7 mg / dl (AUC 0.899, 95% CI 0.840- 0.957, p <0.05). Creatinine ≥1.7 mg/dl could predict major adverse cardiovascular events with a sensitivity of 87.5% and specificity of 79.5%. Multivariate analysis showed that creatinine ≥1.7 mg / dl was an independent factor to predict MACEs during hospitalization in this study (OR 18,310, p 0.001) as well as creatinine clearance and heart rate.Conclusion: Creatinine levels at admission is an independent predictor for major adverse cardiovascular events during hospitalization in acute heart failure patients.

Abstract 330: Serum Mir-129 and Mir-21 Predict 100-day Mortality in Acute Heart Failure Patients

2015 ◽  
Vol 117 (suppl_1) ◽  
Author(s):  
Lichan Tao ◽  
Yihua Bei ◽  
Shutong Shen ◽  
Jin Li ◽  
Rongrong Gao ◽  
...  
Keyword(s):  
Heart Failure ◽  
Acute Heart Failure ◽  
Common Disease ◽  
Predictive Values ◽  
Circulating Micrornas ◽  
Chain Reactions ◽  
Polymerase Chain Reactions ◽  
Novel Biomarkers ◽  
Polymerase Chain

Background: Heart failure is a common disease worldwide and it could be divided as chronic heart failure (CHF) and acute heart failure (AHF). Circulating microRNAs (miRNAs, miRs) have been reported to be novel biomarkers of diagnostic, prognostic and predictive values in cardiovascular diseases. However, little is know about using circulating miRNAs as biomarkers for mortality in AHF patients. Methods and results: A total of 151 AHF patients were enrolled in this study. Ten miRNAs involved in the regulation of AHF including miR-129, miR-675, miR-622, miR-146a, miR-155, miR-21, miR-18b, miR-92b, miR-126 and miR-22 were determined by reverse transcription polymerase chain reactions using total RNA isolated from serum of those 151 patients with AHF enrolled in our center. After a follow-up period of 100 days, 16 patients died and based on that, we found that expression levels of serum miR-129 (p=0.032) and miR-21-5p (p=0.001) were significantly lower in those patients died within 100 days. The kaplan cumulative survival analysis confirmed that patients with higher levels of miR-129 (p=0.036) and miR-21 (p=0.001) had significantly higher survival rate. Conclusion: Serum low levels of miR-129 and miR-21 predict 100-day mortality in AHF patients.

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