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.

Association of Physical Activity and Prognostic Parameters in Elderly Patients With Heart Failure

2011 ◽  
Vol 19 (1) ◽  
pp. 1-15 ◽  
Author(s):  
Melissa Jehn ◽  
Arno Schmidt-Trucksäss ◽  
Henner Hanssen ◽  
Tibor Schuster ◽  
Martin Halle ◽  
...  
Keyword(s):  
Physical Activity ◽  
Heart Failure ◽  
Nyha Class ◽  
Clinical Status ◽  
Heart Association ◽  
Left Ventricular ◽  
Functional Class ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Patients With Heart Failure

Objective:Assessment of habitual physical activity (PA) in patients with heart failure.Methods:This study included 50 patients with heart failure (61.9 ± 4.0 yr). Seven days of PA were assessed by questionnaire (AQ), pedometer, and accelerometer and correlated with prognostic markers including VO2peak, percent left-ventricular ejection fraction, N-terminal pro-B-type natriuretic peptide, and New York Heart Association (NYHA) functional class.Results:Accelerometry showed a stronger correlation with VO2peak and NYHA class (R = .73 and R = −.68; p < .001) than AQ (R = .58 and R = −.65; p < .001) or pedometer (R = .52 and R = −.50; p < .001). In the multivariable regression model accelerometry was the only consistent independent predictor of VO2peak (p = .002). Moreover, when its accuracy of prediction was tested, 59% of NYHA I and 95% of NYHA III patients were correctly classified into their assigned NYHA classes based on their accelerometer activity.Conclusion:PA assessed by accelerometer is significantly associated with exercise capacity in patients with heart failure and is predictive of disease severity. The data suggests that PA monitoring can aid in evaluating clinical status.

scholarly journals Clinical outcome after MitraClip procedure: role of right ventricle

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
A Barosi ◽  
E Gherbesi ◽  
S Colombo ◽  
A Giavarini ◽  
I Cusmano ◽  
...  
Keyword(s):  
Heart Failure ◽  
Clinical Outcome ◽  
Nyha Class ◽  
Left Ventricular ◽  
Functional Class ◽  
Left Ventricular Ejection ◽  
Lv Function ◽  
Ventricular Ejection Fraction ◽  
Mitraclip System

Abstract Background MitraClip system is a device for percutaneous edge-to-edge repair of the mitral valve in symptomatic patients with severe mitral regurgitation (MR) not eligible for surgery, but frequently heart failure symptoms remain substantial on mid-term follow-up. Recently, right ventricular (RV) to pulmonary arterial (PA) coupling has emerged as a relevant prognostic predictor in heart failure but little is known about its prognostic role in patients after MitraClip implantation. Purpose To identify echocardiographic predictors of clinical outcome after MitraClip procedure, with a particular focus on RV-PA coupling. Methods We retrospectively analyzed the data of patients with severe MR who underwent MitraClip implantation between April 2015 and October 2019 at our Institution. Echocardiographic data were assessed at baseline, 3 and 12 months after the procedure; RV to PA coupling was assessed using the ratio between tricuspid annular plane systolic excursion (TAPSE) and pulmonary artery systolic pressure (PASP). Functional class was assessed at 12 months of follow-up. Significance level was set to 0.05 and SPSS was used for statistical analysis. Results 41 patients were included (age 77.1±7.3, 71% male, BMI 25.8±5.5). MR was primary, functional and mixed in 22, 76 and 2% of patients, respectively. 1/2/3 mitraclips were implanted in 39/56/5% of patients, respectively. Echocardiographic data at baseline, at 3 and 12 months follow-up are shown in Table. NYHA class at 12 months significantly correlated with TAPSE and PASP at 3 months follow-up echocardiogram (beta coefficient −0.83 and 0.78 respectively). On the contrary, NYHA class did not show a correlation with left ventricular ejection fraction (LVEF) or residual MR grade. At 12 months 44% of patients showed an improvement in NYHA class; these patients had a better TAPSE (22.7±1.3 vs 19.4±4.6 mm), a lower PASP (37.9±10.2 vs 48.5±12.9 mmHg) and a better TAPSE/PASP (0.61±0.2 vs 0.42±0.2) compared to patients who did not improve their functional class, while LVEF and residual MR did not differ. Conclusion In this sample of significant MR undergoing repair with MitraClip System, patients with functional class improvement at 12 months follow-up showed a better RV-coupling without difference in LV function and residual MR. FUNDunding Acknowledgement Type of funding sources: None. Table 1

P1418Heart failure and atrial fibrillation: clinical, prognostic and echocardiographic outcome

EP Europace ◽  
2020 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
C La Greca ◽  
A Cirasa ◽  
D Pecora ◽  
A Sorgato ◽  
U Simoncelli ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Nyha Class ◽  
Left Ventricular ◽  
Functional Class ◽  
Left Ventricular Ejection ◽  
P Value ◽  
Cardiac Events ◽  
Ventricular Ejection Fraction ◽  
Probability Of Death

Abstract Background Catheter ablation (CA) for atrial fibrillation (AF) in heart failure (HF) patients is  associated with a lower rate of cardiac events compared to medical therapy. Purpose This study deals with the clinical, echocardiographic and prognostic outcomes in these patients. Methods From a single center 47 patients with AF, HF and left ventricular ejection fraction (LVEF)   &lt;50%, underwent CA. The primary endpoints were NYHA functional class, LVEF and MAGGIC  (Meta-Analysis Global Group in Chronic Heart Failure) Risk score before the procedure and after 12  months.  Results The median age of patients was 59 years; 49% had paroxysmal AF. At 12-month a  significant improvement of NYHA class (median before II [interquartile range (IQR) II-III] vs  median after I [IQR I-II]) and of LVEF (median before 44% [IQR 37-47] vs median after 55%  [IQR49-57]) was observed (p-value 0.000). The MAGGIC 1-year and 3-year probability of death was  estimated before (mean score 13 [IQR 11-17]) and at 12-month (mean score 11 [IQR 8-13]) showing  a significant decrease in the probability of death (p-value 0.000). At 12-month patients with reduced  LVEF before the ablation had more HF hospitalizations than HF mid-range patients (p-value 0.035).  Coronary artery disease (CAD) (HR 5, p-value 0.035) and MAGGIC score (HR 1.2, p-value 0.030)  were predictors of HF hospitalization. Conclusion CA for AF in HF patients was associated with a significant improvement of NYHA  functional class and LVEF and a higher life expectation. CAD history, LVEF &lt;40% and MAGGIC  score before ablation were predictors of HF hospitalization at 12-month follow-up.

P1491Cardiac contractility modulation in patients with chronic heart failure and atrial fibrillation: 6 months of follow-up

EP Europace ◽  
2020 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
O Sapelnikov ◽  
T M Uskach ◽  
D I Cherkashin ◽  
I R Grishin ◽  
D F Ardus ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Nyha Class ◽  
Cardiac Contractility ◽  
Left Ventricular ◽  
Functional Class ◽  
Left Ventricular Ejection ◽  
Walk Test ◽  
Ventricular Ejection Fraction

Abstract Background Heart failure is developed in 30% of patients with atrial fibrillation (AF). It significantly worsens the prognosis and evaluates the fatal risks for patients. Cardiac Contractility Modulation (CCM) is a new therapeutic device for heart failure, which is used in patients with narrow QRS complexes who are refractory to medical therapy.  Purpose The aim of current study is to demonstrate the effects of CCM on patients with heart failure and AF, influencing on NT-proBNP dynamics and 6 min walk test (6-MWT).  Methods Fourty patients (40) with symptomatic heart failure (II-III NYHA class), persistent/paroxysmal AF and reduced left ventricular ejection fraction (LVEF ≤ 40%) were included. The average age was 60 ± 6 years. MeanLA-volume was 120± 22 ml and NT-proBNP level was 1336 ± 278pg/ml.A 6-MWT was 246 ± 33 m. All patients were implanted with a CCM Optimizer according to the protocol of implantation without an atrial lead. The study compared the mean state changes from baseline to 6 months’ follow-up. Results In 6 months’ follow-up we observed a significant improvement in functional and symptomatic parameters. NT-proBNP level was 1021 ± 153 pg/ml and mean 6 MWT values were 300 ± 26 m. NYHA improved by at least 1 functional class. MeanLA-volume after 6 months of follow-up was 104,5± 18 ml. Conclusions CCM is an effective and safe technology for patients with symptomatic HF. It significantly improves functional parameters, including a 6-minute walk test and NYHA functional class. CCM may prevent HF progression and may influence the outcome.

scholarly journals Self-care in heart failure patients

2015 ◽  
Vol 23 (4) ◽  
pp. 578-586 ◽  
Author(s):  
Ana Paula da Conceição ◽  
Mariana Alvina dos Santos ◽  
Bernardo dos Santos ◽  
Diná de Almeida Lopes Monteiro da Cruz
Keyword(s):  
Heart Failure ◽  
Self Care ◽  
Left Ventricular ◽  
The Self ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Failure Index ◽  
Joint Monitoring ◽  
The Mean ◽  
Care Behavior

AbstractObjective: to describe self-care behavior and its associated factors in a sample of heart failure Brazilian patients.Method: descriptive cross-sectional study with non-probabilistic sample of 116 ambulatory patients undergoing heart failure treatment. Self-care was evaluated using the Self-Care of Heart Failure Index, (scores ≥70 points=appropriate self-care). Association tests were applied, considering a descriptive level of 0.05.Results: the mean age of participants was 57.7 (SD =11.3) years; 54.3% were male; the mean schooling was 5.5 (SD = 4.0) years; and 74.1% had functional class II-III. The mean scores on the subscales of the Self-Care of Heart Failure Index indicated inappropriate self-care (self-care maintenance: 53.2 (SD =14.3), selfcare management: 50.0 (SD = 20.3) and self-care confidence: 52.6 (SD=22.7)) and it was found low frequencies of participants with appropriate self-care (self-care maintenance, 6.9%), self-care management (14.7%) and self-care confidence (19%). Higher scores of the Self-Care of Heart Failure Index were associated with: reduced left ventricular ejection fraction (p=0.001), longer time of experience with the disease (p=0.05) and joint monitoring by physician and nurse (p=0.007).Conclusion: investments are needed to improve the self-care behavior and the nursing can play a relevant role in this improvement.

scholarly journals Incidence of Cardiotoxicity and Validation of the Heart Failure Association- International Cardio-Oncology Society risk stratification Tool in Patients Treated with Trastuzumab for HER2-Positive Early Breast Cancer.

2021 ◽  
Author(s):  
Nicolò Matteo Luca Battisti ◽  
Maria Sol Andres ◽  
Karla A Lee ◽  
Tharshini Ramalingam ◽  
Tamsin Nash ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Heart Failure ◽  
Early Breast Cancer ◽  
Nyha Class ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Class Iii ◽  
Her2 Positive ◽  
Ventricular Ejection Fraction ◽  
Very High

Abstract PurposeTrastuzumab improves survival in patients with HER2+ early breast cancer. However, cardiotoxicity remains a concern, particularly in the curative setting, and there are limited data on its incidence outside of clinical trials. We retrospectively evaluated the cardiotoxicity rates (left ventricular ejection fraction [LVEF] decline, congestive heart failure [CHF], cardiac death or trastuzumab discontinuation) and assessed the performance of a proposed model to predict cardiotoxicity in routine clinical practice.MethodsPatients receiving curative trastuzumab between 2011-2018 were identified. Demographics, treatments, assessments and toxicities were recorded. Fisher’s exact test, chi-squared and logistic regression were used.Results931 patients were included in the analysis. Median age was 54 years (range 24-83) and Charlson comorbidity index 0 (0-6), with 195 patients (20.9%) aged 65 or older. 228 (24.5%) were smokers. Anthracyclines were given in 608 (65.3%). Median number of trastuzumab doses was 18 (1-18). The HFA-ICOS cardiovascular risk was low in 401 patients (43.1%), medium in 454 (48.8%), high in 70 (7.5%) and very high in 6 (0.6%).Overall, 155 (16.6%) patients experienced cardiotoxicity: LVEF decline≥10% in 141 (15.1%), falling below 50% in 55 (5.9%), CHF NYHA class II in 42 (4.5%) and class III-IV in 5 (0.5%) and discontinuation due to cardiac reasons in 35 (3.8%). No deaths were observed.Cardiotoxicity rates increased with HFA-ICOS score (14.0% low, 16.7% medium, 30.3% high/very high; p=0.002). ConclusionsCardiotoxicity was relatively common (16.6%), but symptomatic heart failure on trastuzumab was rare in our cohort. The HFA-ICOS score identifies patients at high risk of cardiotoxicity

scholarly journals His-optimized cardiac resynchronization therapy in a patient with heart failure and right bundle branch block: a case report

2021 ◽  
Vol 5 (8) ◽  
Author(s):  
Dmytro Volkov ◽  
Dmytro Lopin ◽  
Stanislav Rybchynskyi ◽  
Dmytro Skoryi
Keyword(s):  
Heart Failure ◽  
Cardiac Resynchronization Therapy ◽  
Right Bundle Branch Block ◽  
Clinical Status ◽  
Left Ventricular ◽  
Cardiac Resynchronization ◽  
Left Ventricular Ejection ◽  
Resynchronization Therapy ◽  
Bundle Branch Block ◽  
Ventricular Ejection Fraction

Abstract Background  Cardiac resynchronization therapy (CRT) is an option for treatment for chronic heart failure (HF) associated with left bundle branch block (LBBB). Patients with HF and right bundle branch block (RBBB) have potentially worse outcomes in comparison to LBBB. Traditional CRT in RBBB can increase mortality and HF deterioration rates over native disease progression. His bundle pacing may improve the results of CRT in those patients. Furthermore, atrioventricular node ablation (AVNA) for rate control in atrial fibrillation (AF) can be challenging in patients with previously implanted leads in His region. Case summary  We report the case of 74-year-old gentleman with a 5-year history of HF, permanent AF with a rapid ventricular response, and RBBB. He was admitted to the hospital with complaints of severe weakness and shortness of breath. Left ventricular ejection fraction (LVEF) was decreased (41%), right ventricle (RV) was dilated (41 mm), and QRS was prolonged (200 ms) with RBBB morphology. The patient underwent His-optimized CRT with further left-sided AVNA. As a result, LVEF increased to 51%, RV dimensions decreased to 35 mm with an improvement of the clinical status during a 6-month follow-up. Discussion  Patients with AF, RBBB, and HF represent the least evaluated clinical subgroup of individuals with less beneficial clinical outcomes according to CRT studies. Achieving the most effective resynchronization could require pacing fusion from sites beyond traditional with the intention to recruit intrinsic conduction pathways. This approach can be favourable for reducing RV dilatation, improving LVEF, and maximizing electrical resynchronization.

Abstract P232: Screening Past B-Type Natriuretic Peptide (BNP) Values to Identify Candidates for Treatment of Systolic Dysfunction

2011 ◽  
Vol 4 (suppl_1) ◽  
Author(s):  
Parisa Gholami ◽  
Shoutzu Lin ◽  
Paul Heidenreich
Keyword(s):  
Heart Failure ◽  
Left Ventricular Ejection Fraction ◽  
Ejection Fraction ◽  
Left Ventricular ◽  
Ventricular Ejection ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Significant Difference ◽  
The Mean

Background: BNP testing is now common though it is not clear if the test results are used to improve patient care. A high BNP may be an indicator that the left ventricular ejection fraction (LVEF) is low (<40%) such that the patient will benefit from life-prolonging therapy. Objective: To determine how often clinicians obtained a measure of LVEF (echocardiography, nuclear) following a high BNP value when the left ventricular ejection fraction (LVEF) was not known to be low (<40%). Methods and Results: We reviewed the medical records of 296 consecutive patients (inpatient or outpatient) with a BNP values of at least 200 pg/ml at a single medical center (tertiary hospital with 8 community clinics). A prior diagnosis of heart failure was made in 65%, while 42% had diabetes, 79% had hypertension, 59% had ischemic heart disease and 31% had chronic lung disease. The mean age was 73 ± 12 years, 75% were white, 10% black, 15% other and the mean BNP was 810 ± 814 pg/ml. The LVEF was known to be < 40% in 84 patients (28%, mean BNP value of 1094 ± 969 pg/ml). Of the remaining 212 patients without a known low LVEF, 161 (76%) had a prior LVEF >=40% ( mean BNP value of 673 ± 635 pg/ml), and 51 (24%) had no prior LVEF documented (mean BNP 775 ± 926 pg/ml). Following the high BNP, a measure of LVEF was obtained (including outside studies documented by the primary care provider) within 6 months in only 53% (113 of 212) of those with an LVEF not known to be low. Of those with a follow-up echocardiogram, the LVEF was <40% in 18/113 (16%) and >=40% in 95/113 (84%). There was no significant difference in mean initial BNP values between those with a follow-up LVEF <40% (872 ± 940pg/ml), >=40% (704 ± 737 pg/ml), or not done (661 ± 649 pg/ml, p=0.5). Conclusions: Follow-up measures of LVEF did not occur in almost 50% of patients with a high BNP where the information may have led to institution of life-prolonging therapy. Of those that did have a follow-up study a new diagnosis of depressesd LVEF was noted in 16%. Screening of existing BNP and LVEF data and may be an efficient strategy to identify patients that may benefit from life-prolonging therapy for heart failure.

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