scholarly journals Peritoneal Ultrafiltration in Refractory Heart Failure: A Cohort Study

2014 ◽  
Vol 34 (1) ◽  
pp. 64-70 ◽  
Author(s):  
Silvio V. Bertoli ◽  
Claudio Musetti ◽  
Daniele Ciurlino ◽  
Carlo Basile ◽  
Emilio Galli ◽  
...  
Keyword(s):  
Heart Failure ◽  
New York ◽  
Hospital Admissions ◽  
Systolic Pressure ◽  
Heart Association ◽  
Decompensated Heart Failure ◽  
Pulmonary Artery Systolic Pressure ◽  
Refractory Heart Failure ◽  
Stage Renal Disease ◽  
End Stage

IntroductionAcutely decompensated heart failure (HF) in patients with diuretic resistance is often treated with extracorporeal ultrafiltration. Peritoneal ultrafiltration (PUF) has been proposed for the long-term management of severe HF after resolution of the acute episode. The aim of the present study was to evaluate the use of PUF in the treatment of chronic refractory HF in patients without end-stage renal disease.MethodsThis multicenter (10 nephrology departments throughout Italy) retrospective observational study included patients with severe HF refractory to maximized drug treatment. The patients were proposed for PUF because they had experienced at least 3 hospital admissions in the preceding year for acutely decompensated HF requiring extracorporeal ultrafiltration.ResultsOf the 48 study patients (39 men, 9 women; mean age 74 ± 9 years), 30 received 1 nocturnal icodextrin exchange, 5 required 2 daily exchanges, and 13 received 2 – 4 sessions per week of automated peritoneal dialysis. During the first year, renal function remained stable (initial: 20.8 ± 10.0 mL/min/1.73 m2; end: 22.0 ± 13.6 mL/min/1.73 m2), while pulmonary artery systolic pressure declined to 40 ± 6.09 mmHg from 45.5 ± 9.18 mmHg ( p = 0.03), with a significant concomitant improvement in New York Heart Association functional status. Hospitalizations decreased to 11 ± 17 days/patient–year from 43 ± 33 days/ patient–year before the start of PUF ( p < 0.001). The incidence of peritonitis was 1 episode in 45 patient–months. Patient survival was 85% at 1 year and 56% at 2 years.ConclusionsThis study confirms the satisfactory results of using PUF for chronic HF in elderly patients.

scholarly journals It is easy to see, but it is better to foresee: a case report on the favourable alliance between CardioMEMS and levosimendan

2020 ◽  
Vol 4 (4) ◽  
pp. 1-5
Author(s):  
Valeria Visco ◽  
Cristina Esposito ◽  
Paolo Vitillo ◽  
Carmine Vecchione ◽  
Michele Ciccarelli
Keyword(s):  
Heart Failure ◽  
Hospital Admissions ◽  
Systolic Pressure ◽  
Pulmonary Artery Systolic Pressure ◽  
Optimal Management ◽  
Reduced Ejection Fraction ◽  
The Past ◽  
Case Summary ◽  
Pressure Profiles ◽  
Patients With Heart Failure

Abstract Background In the past years, different devices have been investigated to help in identifying early decompensation events in patients with heart failure (HF) and reduced ejection fraction (EF), reducing hospital admissions. In this report, we present the first patient experience with levosimendan infusion led by CardioMEMS. Case summary A 68-year-old man with HF and reduced EF with more than 20 hospitalizations for exacerbation of HF was enrolled in our HF Clinic from October 2017. Echocardiogram showed a dilated left ventricle with severely reduced EF (29%) and increased pulmonary artery systolic pressure (40 mmHg). From October 2017 to May 2019, the patient went through numerous hospitalizations, despite optimal medical therapy; subsequently, was adopted a strategy of levosimendan infusions guided by CardioMEMS. Levosimendan infusions improved haemodynamic and pressure profiles. The patient was monitored daily by CardioMEMS, and from June to December 2019, he had only two hospitalizations scheduled for levosimendan infusion and none for HF exacerbation. Discussion Our case supports the combination of CardioMEMS and levosimendan for the optimal management of patients with advanced HF. These results further strengthen the development of a randomized clinical trial to demonstrate the clinical usefulness of this device in combination with the levosimendan infusion programme in advanced HF patients.

Defining the nutritional status and dietary intake of older heart failure patients

2007 ◽  
Vol 6 (3) ◽  
pp. 178-183 ◽  
Author(s):  
Rosemary J.G. Price ◽  
Miles D. Witham ◽  
Marion E.T. Mcmurdo
Keyword(s):  
Heart Failure ◽  
New York ◽  
Dietary Intake ◽  
Dietary Intervention ◽  
Handgrip Strength ◽  
Heart Association ◽  
Decompensated Heart Failure ◽  
Class Iii ◽  
Heart Failure Patients ◽  
Meal Preparation

Background Little information exists about diet in the management of heart failure. Aims To describe the nutritional and biochemical status, and the dietary intake of older heart failure patients. Methods Stable outpatients and patients with recent hospitalisation for decompensated heart failure were recruited. Anthropometric measurements, handgrip strength, biochemical values and echocardiography were recorded. Patients kept 7-day food diaries and completed questionnaires concerning food provision. Results Forty-five patients with a mean (S.D.) age of 80.8 (6.8) years were studied and classed according to the New York Heart Association (NYHA) (11% Class I, 27% Class II and 62% Class III). Mean (S.D.) body mass index (BMI) was 27.1 (5.4) kg/m2 with 7% of patients having a BMI<20 kg/m2 and 56% with a BMI above 25 kg/m2. 64% of participants failed to achieve the estimated average requirements for energy intake; 82% took more than 2 mg of sodium daily; and 18% had a potassium intake above 3500 mg/day. Only 29% of individuals did not need assistance with food shopping, whilst 58% required assistance with meal preparation. Conclusion Possible targets for dietary intervention in older heart failure patients have been identified but whether such changes would be beneficial to patients is unknown.

scholarly journals Ventricular-arterial coupling parameters and its prognostic value in patients with decompensated heart failure

2020 ◽  
Vol 25 (1) ◽  
pp. 39-45
Author(s):  
Z. D. Kobalava ◽  
O. I. Lukina ◽  
I. Meray ◽  
S. V. Villevalde
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Prognostic Value ◽  
Systolic Pressure ◽  
Decompensated Heart Failure ◽  
Left Ventricular ◽  
Pulmonary Artery Systolic Pressure ◽  
Arterial Elastance ◽  
Increased Risk ◽  
All Cause Mortality

Aim. To assess ventricular-arterial coupling (VAC) parameters and their prognostic value in patients with decompensated heart failure (HF).Material and methods. VAC parameters were evaluated upon admission using two-dimensional echocardiography in 355 patients hospitalized with decompensated HF. VAC was expressed as the ratio between arterial elastance (Ea) and end-systolic LV elastance (Ees). The optimal VAC range was considered 0,6-1,2. Parameters of left ventricular (LV) efficacy were calculated using the appropriate formulas. Differences were considered significant at p<0,05.Results. The median values of Ea, Ees and VAC were 2,2 (1,7;2,9) mmHg/ml, 1,8 (1,0;3,0) mmHg/ml and 1,32 (0,75;2,21) respectively. In 63% of patients, VAC disorders were detected: 55% of patients had VAC >1,2 (predominantly patients with HF with reduced ejection fraction (HFrEF)-79%), 8% of patients had VAC <0,6 (all patients with HF with preserved ejection fraction (HFpEF)). Normal VAC was observed in 78%, 42%, and 1% of patients with HFpEF, HF with mid-range EF and HFrEF, respectively. There was significant correlation between Ea/Ees ratio and levels of NTproBNP (R=0,35), hematocrit (R=-0,29), hemoglobin (R=-0,26), pulmonary artery systolic pressure (PAPs) (R=0,18), dimensions of left atrium (R=0,32) and right ventricle (RV) (R=0,32). After 6 months, rehospitalization with decompensated HF was recorded in 72 (20,3%) patients, 42 (11,8%) patients died. Ea decrease <2,2 mmHg/ml and PAPs increase >45 mmHg increased the risk of rehospitalization with decompensated HF and all-cause mortality 2,5 and 3,7 times, respectively.Conclusion. Impaired VAC was diagnosed in 63% of patients with decompensated HF. However, the increased risk of all-cause mortality and rehospitalization with decompensated HF over the 6 months was associated with Ea decrease <2,2 mmHg/ml and PAPs increase >45 mmHg.

The Pharmacotherapy Implications of Ventricular Assist Device in the Patient With End-Stage Heart Failure

2012 ◽  
Vol 25 (2) ◽  
pp. 232-249 ◽  
Author(s):  
Serena A. S. Von Ruden ◽  
Margaret A. Murray ◽  
Jennifer L. Grice ◽  
Amy K. Proebstle ◽  
Karen J. Kopacek
Keyword(s):  
Heart Failure ◽  
New York ◽  
Heart Association ◽  
Functional Class ◽  
Neurological Dysfunction ◽  
Ventricular Assist Devices ◽  
Circulatory Support ◽  
Ventricular Assist ◽  
End Stage Heart Failure ◽  
End Stage

Advances in mechanical circulatory support, such as the use of ventricular assist devices (VADs), have become a means for prolonging survival in end-stage heart failure (HF). VADs decrease the symptoms of HF and improve quality of life by replacing some of the work of a failing heart. They unload the ventricle to provide improved cardiac output and end-organ perfusion, resulting in improvement in cardiorenal syndromes and New York Heart Association functional class rating. VADs are currently used as a bridge to heart transplantation, a bridge to recovery of cardiac function, or as destination therapy. Complications of VAD include bleeding, infections, arrhythmias, multiple organ failure, right ventricular failure, and neurological dysfunction. Patients with VAD have unique pharmacotherapeutic requirements in terms of anticoagulation, appropriate antibiotic selection, and continuation of HF medications. Pharmacists in acute care and community settings are well prepared to care for the patient with VAD. These patients require thorough counseling and follow-up with regard to prevention and treatment of infections, appropriate levels of anticoagulation, and maintenance of fluid balance. A basic understanding of this unique therapy can assist pharmacists in attending to the needs of patients with VAD.

Inpatient management of acute decompensated heart failure

2019 ◽  
Vol 96 (1131) ◽  
pp. 33-42
Author(s):  
Leah Raj ◽  
Samuel David Maidman ◽  
Bhavin B. Adhyaru
Keyword(s):  
Heart Failure ◽  
Hospital Admissions ◽  
American Heart ◽  
Acute Decompensated Heart Failure ◽  
Symptom Relief ◽  
Heart Association ◽  
Decompensated Heart Failure ◽  
Short Term ◽  
Inpatient Management ◽  
Poor Outcomes

Acute decompensated heart failure (ADHF) is the leading cause of hospital admissions in patients older than 65 years. These hospitalisations are highly risky and are associated with poor outcomes, including rehospitalisation and death. The management of ADHF is drastically different from that of chronic heart failure as inpatient treatment consists primarily of haemodynamic stabilisation, symptom relief and prevention of short-term morbidity and mortality. In this review, we will discuss the strategies put forth in the most recent American College of Cardiology/American Heart Association and Heart Failure Society of America guidelines for ADHF as well as the evidence behind these recommendations.

scholarly journals Addition of a β1-Blocker to Milrinone Treatment Improves Cardiac Function in Patients with Acute Heart Failure and Rapid Atrial Fibrillation

Cardiology ◽  
2019 ◽  
Vol 142 (4) ◽  
pp. 195-202
Author(s):  
Shigeki Kobayashi ◽  
Takeki Myoren ◽  
Toshiro Kajii ◽  
Michiaki Kohno ◽  
Takuma Nanno ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
New York ◽  
Cardiac Function ◽  
Acute Decompensated Heart Failure ◽  
Stroke Volume Index ◽  
Heart Association ◽  
Decompensated Heart Failure ◽  
Left Ventricular ◽  
Volume Index

Background: Tachycardia worsens cardiac performance in acute decompensated heart failure (ADHF). We investigated whether heart rate (HR) optimization by landiolol, an ultra-short-acting β1-selective blocker, in combination with milrinone improved cardiac function in patients with ADHF and rapid atrial fibrillation (AF). Methods and Results: We enrolled9 ADHF patients (New York Heart Association classification IV; HR, 138 ± 18 bpm; left ventricular [LV] ejection fraction, 28 ± 8%; cardiac index [CI], 2.1 ± 0.3 L/min–1/m–2; pulmonary capillary wedge pressure [PCWP], 24 ± 3 mm Hg), whose HRs could not be reduced using standard treatments, including diuretics, vasodilators, and milrinone. Landiolol (1.5–6.0 µg/kg–1/min–1, intravenous) was added to milrinone treatment to study its effect on hemodynamics. The addition of landiolol (1.5 µg/kg–1/min–1) significantly reduced HR by 11% without changing systolic blood pressure (BP) and resulted in a significant decrease in PCWP and a significant increase in stroke volume index (SVI), suggesting that HR reduction restores incomplete LV relaxation. Administration of more than 3.0 µg/kg–1/min–1 of landiolol decreased BP, CI, and SVI. Conclusion: The addition of landiolol at doses of <3.0 µg/kg/min to milrinone improved cardiac function in decompensated chronic heart failure with rapid atrial fibrillation by selectively reducing HR.

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