Nutritional and Non-Nutritional Predictors of Low Spot Urinary Creatinine Concentration in Patients with Heart Failure

Low spot urinary creatinine concentration (SUCR) is a marker of muscle wasting and clinical outcome. The risk factors for low SUCR in heart failure (HF) remain poorly understood. We explored the risk factors for low SUCR related to poor outcomes. In 721 HF patients (age: 52.3 ± 11 years, female: 14%, NYHA: 2.7 ± 0.7) SUCR and Dexa body composition scans were performed. BMI prior HF-onset, weight loss, and appendicular muscle mass were obtained. Each patient was classified as malnutrition or normal by GLIM criteria and three other biochemical indices (CONUT, PNI, and GRNI). Sarcopenia index (SI) as creatinine to cystatin C ratio was also calculated. Within 1 year, 80 (11.1%) patients died. In ROC curve we identified a SUCR value of 0.628 g/L as optimally discriminating surviving from dead. In low SUCR group more advanced HF, higher weight loss and catabolic components of weight trajectory (CCWT), more frequent under-nutrition by GLIM, and lower SI were observed. In multivariate analysis the independent predictors of low SUCR were SI, CCWT, and GNRI score. In conclusion: the risk of low SUCR was associated with a worse outcome. Low SUCR was associated with greater catabolism and sarcopenia but not with biochemical indices of malnutrition.

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POOR OUTCOMES ASSOCIATED WITH DIGOXIN DISCONTINUATION IN PATIENTS WITH HEART FAILURE WITH REDUCED EJECTION FRACTION (HFREF) MAY DIFFER BY BETA-BLOCKER USE

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(20)31598-9 ◽

2020 ◽

Vol 75 (11) ◽

pp. 971

Author(s):

Ravi Masson ◽

Awais Malik ◽

Phillip Hong Lam ◽

Hans Joseph Moore ◽

Prakash Deedwania ◽

...

Keyword(s):

Heart Failure ◽

Ejection Fraction ◽

Beta Blocker ◽

Reduced Ejection Fraction ◽

Patients With Heart Failure ◽

Poor Outcomes

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Abstract 19944: Targeted Therapy of Pulmonary Hypertension in Patients With Heart Failure and Preserved Ejection Fraction: Safety and Efficacy in Comparison to IPAH in Compera

Circulation ◽

10.1161/circ.132.suppl_3.19944 ◽

2015 ◽

Vol 132 (suppl_3) ◽

Author(s):

Stephan Rosenkranz ◽

Marius M Hoeper ◽

Doerte Huscher ◽

David Pittrow ◽

Christian F Opitz

Keyword(s):

Risk Factors ◽

Heart Failure ◽

Pulmonary Hypertension ◽

Ejection Fraction ◽

Preserved Ejection Fraction ◽

Evidence Based Treatment ◽

Patients With Heart Failure ◽

Venous Oxygen Saturation ◽

Initial Ph ◽

Pulmonary Arterial

Background: While targeted therapies are available for idiopathic pulmonary arterial hypertension (IPAH), evidence based treatment recommendations for pulmonary hypertension (PH) associated with heart failure and preserved ejection fraction (HFpEF) are lacking. Methods and Results: Out of 5,935 patients in the prospective COMPERA registry, we analyzed patients with “typical” IPAH (n=421, ≤2 of the following risk factors: BMI >30 kg/m2, hypertension, CAD, diabetes and atrial fibrillation at the time of diagnosis), “atypical” IPAH (n=139, >2 risk factors) or PH-HFpEF (n=226) who received targeted PH therapies. Patients with PH-HFpEF, when compared to “typical” and “atypical” IPAH were older (73±8 vs. 62±17 and 71±9 years), had a higher BMI (30 vs. 26 and 32 kg/m2), and more comorbidities (98% vs. 73% and 100%, all p<0.001), respectively. However, mean PAP (46±9 vs. 47±13 and 44±11 mmHg), cardiac index (2.2±0.7 vs. 2,3±0,8 and 2,2±0,8 l/min), and mixed venous oxygen saturation (62±7 vs. 62±10 and 63±9%, all ns) were almost identical. As compared to “typical” and “atypical” IPAH, PH-HFpEF patients had a higher PAWP (20±4 vs. 9±3 and 10±4 mmHg), resulting in a lower calculated PVR (559±270 vs. 861±477 and 784±844 dyn.s.cm-5). Survival at 1, 2 and 3 years post diagnosis was not different between groups. PDE-5 inhibitors were the most common form of initial PH treatment in PH-HFpEF (94%), and combination therapy was less common compared to “typical” or “atypical” IPAH at 1 year (7% vs. 44% and 26%). All 3 groups responded to targeted PH therapies at 12 months, while treatment effects were less pronounced in PH-HFpEF: Compared to baseline, the median increase of the 6MWD at 1 year was 29, 50, and 60 m, respectively. Treatment discontinuations occurred more frequently in patients with PH-HFpEF than in IPAH, either because of side effects or lack of improvement. Conclusions: Despite almost identical alterations of pulmonary artery pressure and cardiac output, patients with PH-HFpEF differed with respect to age, comorbidities and certain hemodynamic features when compared to “typical” or “atypical” IPAH. All groups responded to targeted PH therapy, however tolerability and efficacy of PH drugs were reduced in patients with PH-HFpEF while survival was not different.

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Risk Factors for Poor Outcomes in Children Hospitalized With Acute Decompensated Heart Failure

The Journal of Heart and Lung Transplantation ◽

10.1016/j.healun.2018.01.1006 ◽

2018 ◽

Vol 37 (4) ◽

pp. S391

Author(s):

B. Hong ◽

J. Friedland-Little ◽

E. Albers ◽

N. Jorgensen ◽

R. Mazor ◽

...

Keyword(s):

Risk Factors ◽

Heart Failure ◽

Acute Decompensated Heart Failure ◽

Decompensated Heart Failure ◽

Poor Outcomes

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Effect of Weight Loss on Renal Function in Overweight and Obese Patients with Heart Failure

Journal of Cardiac Failure ◽

10.1016/j.cardfail.2015.06.176 ◽

2015 ◽

Vol 21 (8) ◽

pp. S53-S54

Author(s):

Marjan Motie ◽

Lorraine Evangelista

Keyword(s):

Heart Failure ◽

Weight Loss ◽

Renal Function ◽

Obese Patients ◽

Patients With Heart Failure

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Right ventricular speckle tracking in patients with heart failure – a comparison of right ventricular measures

European Heart Journal ◽

10.1093/ehjci/ehaa946.0145 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

I.J Lundorff ◽

M Sengeloev ◽

S Pedersen ◽

D Modin ◽

N.E Bruun ◽

...

Keyword(s):

Risk Factors ◽

Heart Failure ◽

Right Ventricular ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Funding Source ◽

Private Company ◽

Ventricular Ejection Fraction ◽

Risk Of Mortality ◽

Patients With Heart Failure

Abstract Background RV dysfunction is associated with increased mortality and morbidity in patients with heart failure. Due to the complex shape and position of the RV, assessing RV function from echocardiographic images remains a challenge. Purpose We have previously found that global longitudinal strain from 2DSTE is superior to left ventricular ejection fraction (LVEF) in identifying HFrEF patients with high risk of mortality. In this study we wanted to examine RV 2DSTE in patients with HFrEF and compare its prognostic value to conventional RV measures. Methods and results Echocardiographic examinations were retrieved from 701 patients with HFrEF. RV estimates were analysed offline, and end point was all-cause mortality. During follow-up (median 39 months) 118 patients (16.8%) died. RV GLS and RV FWS remained associated with mortality after multivariable adjustment, independent of TAPSE (RV GLS: HR 1.07, 95% CI 1.02–1.13, p=0.010, per 1% decrease) (RV FWS: HR 1.05, 95% CI 1.01–1.09, p=0.010, per 1% decrease). This seemed to be caused by significant associations in men as TAPSE remained as the only independent prognosticator in women. All RV estimates provided prognostic information incremental to established risk factors and significantly increased C-statistics (TAPSE: 0.74 to 0.75; RVFAC: 0.74 to 0.75; RVFWS: 0.74 to 0.77; RVGLS: 0.74 to 0.77). Conclusions RV strain from 2DSTE was associated with mortality in patients with HFrEF, independent of TAPSE and established risk factors. Our results indicate that RV strain is particularly valuable in male patients, whereas in women TAPSE remains a stronger prognosticator. RV GLS and the risk of mortality Funding Acknowledgement Type of funding source: Private company. Main funding source(s): PGJ reports receiving lecture fee from Novo Nordisk.

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