Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 5 de 5
Filtrar
1.
JACC Heart Fail ; 12(4): 695-706, 2024 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-38430084

RESUMEN

BACKGROUND: Incomplete treatment of congestion often leads to worsening heart failure (HF). The remote dielectric sensing (ReDS) system is an electromagnetic energy-based technology that accurately quantifies changes in lung fluid concentration noninvasively. OBJECTIVES: This study sought to assess whether an ReDS-guided strategy during acutely decompensated HF hospitalization is superior to routine care for improving outcomes at 1 month postdischarge. METHODS: ReDS-SAFE HF (Use of ReDS for a SAFE discharge in patients with acute Heart Failure) was an investigator-initiated, multicenter, single-blind, randomized, proof-of-concept trial in which 100 patients were randomized to a routine care strategy, with discharge criteria based on current clinical practice, or an ReDS-guided decongestion strategy, with discharge criteria requiring an ReDS value of ≤35%. ReDS measurements were performed daily and at a 7-day follow-up visit, with patients and treating physicians in the routine care arm blinded to the results. The primary outcome was a composite of unplanned visits for HF, HF rehospitalization, or death at 1 month after discharge. RESULTS: The mean age was 67 ± 14 years, and 74% were male. On admission, left ventricular ejection fraction was 37% ± 16%, and B-type natriuretic peptide was 940 pg/L (Q1-Q3: 529-1,665 pg/L). The primary endpoint occurred in 10 (20%) patients in the routine care group and 1 (2%) in the ReDS-guided strategy group (log-rank P = 0.005). The ReDS-guided strategy group experienced a lower event rate, with an HR of 0.094 (95% CI: 0.012-0.731; P = 0.003), and a number of patients needed to treat of 6 to avoid an event (95% CI: 3-17), mainly resulting from a decrease in HF readmissions. The median length of stay was 2 days longer in the ReDS-guided group vs the routine care group (8 vs 6; P = 0.203). CONCLUSIONS: A ReDS-guided strategy to treat congestion improved 1-month prognosis postdischarge in this proof-of-concept study, mainly because of a decrease of the number of HF readmissions. (Use of ReDS for a SAFE discharge in patients with acute Heart Failure [ReDS-SAFE HF]; NCT04305717).


Asunto(s)
Insuficiencia Cardíaca , Humanos , Masculino , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Femenino , Alta del Paciente , Volumen Sistólico , Método Simple Ciego , Cuidados Posteriores , Función Ventricular Izquierda
2.
ESC Heart Fail ; 6(6): 1161-1166, 2019 12.
Artículo en Inglés | MEDLINE | ID: mdl-31701680

RESUMEN

AIMS: Sacubitril/valsartan is safe when initiated during hospitalization in a clinical trial setting. Its safety in real-life population is not stablished. We compared the initiation of sacubitril/valsartan during hospitalization in a non-selected population, in the PIONEER-HF trial, and in non-selected outpatients. METHODS AND RESULTS: Multicentre registry included 527 patients: 100 were started on sacubitril/valsartan during hospitalization (19.0%) and 427 as outpatients (81.0%). Compared with those in the pivotal trial, inpatients in our cohort were older (71 ± 12 vs. 61 ± 14 years; P < 0.001); had more frequently Functional Class II (41 [41.0%] vs. 100 [22.7%]; P < 0.001), higher levels of N-terminal pro-B type natriuretic peptide (4044 [1630-8680] vs. 2013 [1002-4132] pg/mL; P < 0.001), better glomerular filtration rate (63.5 [51.0-80.0] vs. 58.4 [47.5-71.5] mL/min; P = 0.01), and higher systolic blood pressure (121 [110-136] vs. 118 [110-133] mmHg; P = 0.03); and received angiotensin-converting enzyme inhibitors/angiotensin receptor blockers more frequently (92 [92.0%] vs. 208 [52.7%]; P < 0.001). Compared with non-selected outpatients, inpatients were older (71 ± 12 vs. 68 ± 12 years, P = 0.02), had more frequent Functional Class III-IV (58 [58.0%] vs. 129 [30.3%], P < 0.001), had higher levels of N-terminal pro-B type natriuretic peptide (4044 [1630-8680] vs. 2182 [1134-4172]; P < 0.001), and were receiving angiotensin-converting enzyme inhibitors/angiotensin receptor blockers target dose less frequently (55 [55.0%] vs. 335 [78.5%]; P < 0.001). They also started sacubitril/valsartan with a low dose (50 mg/12 h) more frequently (80 [80.0%] vs. 209 [48.8%], P < 0.001). The initiation of sacubitril/valsartan in outpatients was an independent predictor of high-dose use (OR 3.1; 95% confidence interval 1.7-5.6, P < 0.001). The follow-up time in both cohorts, including all patients enrolled, was similar (7.0 ± 0.1 vs. 7.2 ± 2.6 months, P = 0.72). All-cause admissions during follow-up were more frequent in inpatients (30 [30.0%] vs. 68 outpatients [15.9%], P = 0.001), with no relevant differences in all-cause mortality. There was no significant difference in sacubitril/valsartan withdrawal rate (17 inpatients [17.0%] vs. 49 outpatients [11.5%], P = 0.13). The incidence of adverse effects was also similar: hypotension (16 inpatients [16.0%] vs. 71 outpatients [16.7%], P = 0.88), worsening renal function (7 inpatients [7.0%] vs. 29 outpatients [6.8%], P = 0.94), and hyperkalaemia (1 inpatient [1.0%] vs. 21 outpatients [4.9%], P = 0.09). We did not register any case of angioedema. CONCLUSIONS: It is safe to initiate sacubitril/valsartan during hospitalization in daily clinical practice. Inpatients have a higher risk profile and receive low starting doses more frequently than outpatients.


Asunto(s)
Aminobutiratos/efectos adversos , Antagonistas de Receptores de Angiotensina/efectos adversos , Insuficiencia Cardíaca/tratamiento farmacológico , Hospitalización/estadística & datos numéricos , Tetrazoles/efectos adversos , Anciano , Anciano de 80 o más Años , Aminobutiratos/uso terapéutico , Antagonistas de Receptores de Angiotensina/uso terapéutico , Compuestos de Bifenilo , Presión Sanguínea/fisiología , Combinación de Medicamentos , Femenino , Insuficiencia Cardíaca/mortalidad , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Volumen Sistólico/fisiología , Tetrazoles/uso terapéutico , Valsartán
3.
Cardiovasc Ther ; 36(6): e12465, 2018 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-30191652

RESUMEN

AIMS: Optimal diuretic treatment of patients with refractory congestive heart failure (CHF) remains to be elucidated. In this work, we aimed to evaluate the serial changes of functional class and surrogates of fluid overload (weight and antigen carbohydrate 125) after addition of oral acetazolamide in patients with refractory CHF. Likewise, serial changes in renal function, serum electrolytes and pH were evaluated. METHOD: This is an observational retrospective study in which 25 ambulatory patients with refractory CHF that received acetazolamide in addition to standard intensive diuretic strategy were evaluated. Longitudinal assessment of New York Heart Association (NYHA) functional class and biomarkers was analyzed using joint modelling of longitudinal and survival data. RESULTS: All patients showed NYHA class III/IV at baseline. After prescription of acetazolamide, a total of 125 outpatient visits were recorded [median visits per patient: 6 (IQR = 3-7)] during a median follow-up of 152 days (IQR = 80-353). A significant decrease in NYHA class, weight, and antigen carbohydrate 125 was observed. On the other hand, estimated glomerular filtration rate increased over time. No significant changes in systolic blood pressure, serum sodium, potassium, amino-terminal pro-brain natriuretic peptide, and pH occurred. CONCLUSION: In a cohort of patients with refractory CHF treated with an intensive diuretic treatment, the addition of acetazolamide was associated with improvement in functional class and surrogates of fluid overload.


Asunto(s)
Acetazolamida/administración & dosificación , Diuréticos/administración & dosificación , Insuficiencia Cardíaca/tratamiento farmacológico , Acetazolamida/efectos adversos , Administración Oral , Anciano , Anciano de 80 o más Años , Biomarcadores/sangre , Antígeno Ca-125/sangre , Diuréticos/efectos adversos , Estudios de Factibilidad , Femenino , Tasa de Filtración Glomerular/efectos de los fármacos , Insuficiencia Cardíaca/sangre , Insuficiencia Cardíaca/diagnóstico , Insuficiencia Cardíaca/fisiopatología , Humanos , Masculino , Recuperación de la Función , Estudios Retrospectivos , Resultado del Tratamiento , Equilibrio Hidroelectrolítico/efectos de los fármacos , Pérdida de Peso/efectos de los fármacos
4.
Rev Port Cardiol ; 35(3): 133-8, 2016 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-26919889

RESUMEN

INTRODUCTION AND OBJECTIVES: To investigate the incidence and clinical relevance of the presence of mobile echogenic images (MEI) during transesophageal echocardiography (TEE) for monitoring of transcatheter aortic valve implantation (TAVI). METHODS: Consecutive patients referred to our center for transfemoral or transapical TAVI were included. The procedure was monitored by three-dimensional (3D) TEE and images were analyzed by two independent experts. In-hospital follow-up was carried out and correlated with imaging findings. RESULTS: A total of 104 patients were included. MEI were visualized in 11 patients during the procedure (11%) and in over 50% of cases were identified as thrombi, however no differences in periprocedural stroke were found in follow-up. CONCLUSIONS: Visualization of MEI during 3D TEE monitoring of TAVI is relatively common (11%) and in over 50% of cases they are identified as thrombi. The clinical implications of this finding are uncertain, as despite their frequency, the incidence of clinical stroke in this patient population was no higher. 3D TEE is a useful tool for diagnosis of MEI and can alert the operator to their presence.


Asunto(s)
Estenosis de la Válvula Aórtica/diagnóstico , Ecocardiografía Transesofágica , Implantación de Prótesis de Válvulas Cardíacas , Válvula Aórtica/cirugía , Estenosis de la Válvula Aórtica/cirugía , Humanos , Imagenología Tridimensional , Incidencia
SELECCIÓN DE REFERENCIAS
DETALLE DE LA BÚSQUEDA