Trajectories of Kidney Function in Heart Failure Over a 15-Year Follow-Up: Clinical Profiling and Mortality.

BACKGROUND: Limited data are available on the long-term trajectory of estimated glomerular filtration rate (eGFR) in patients with chronic heart failure. OBJECTIVES: The authors evaluated eGFR dynamics using the 2009 Chronic Kidney Disease Epidemiology Collaboration equation and its prognostic significance in a real-world cohort over a 15-year follow-up. METHODS: A prospective observational registry of ambulatory heart failure outpatients was conducted, with regular eGFR assessments at baseline and on a 3-month schedule for ≤15 years. Urgent kidney function assessments were excluded. Locally weighted error sum of squares curves were plotted for predefined subgroups. Multivariable longitudinal Cox regression analyses were conducted to assess associations with all-cause and cardiovascular death. RESULTS: A total of 2,672 patients were enrolled consecutively between August 2001 and December 2021. The average age was 66.8 ± 12.6 years, and 69.8% were men. Among 40,970 creatinine measurements, 28,634 were used for eGFR analysis, averaging 10.7 ± 8.5 per patient. Over the study period, a significant decline in eGFR was observed in the entire cohort, with a slope of -1.70 mL/min/1.73 m2 per year (95% CI: -1.75 to -1.66 mL/min/1.73 m2 per year). Older patients, those with diabetes, a preserved ejection fraction, a higher baseline eGFR, elevated hospitalization rates, and those who died during follow-up experienced more pronounced decreases in the eGFR. Moreover, the decrease in kidney function correlated independently with all-cause mortality and cardiovascular death. CONCLUSIONS: These findings highlight the sustained decline in eGFR over 15 years in patients with heart failure, with variations based on clinical characteristics, and emphasize the importance of regular eGFR monitoring in this population.

Clinical and prognostic implications of left ventricular dilatation in heart failure.

AIMS: To assess the agreement between left ventricular end-diastolic diameter index (LVEDDi) and volume index (LVEDVi) to define LV dilatation and to investigate the respective prognostic implications in patients with heart failure (HF). METHODS AND RESULTS: Patients with HF symptoms and LV ejection fraction (LVEF) < 50% undergoing cardiac magnetic resonance were evaluated retrospectively. LV dilatation was defined as LVEDDi or LVEDVi above the upper normal limit according to published reference values. Patients were followed up for the combined endpoint of cardiovascular death or HF hospitalization during 5 years. A total of 564 patients (median age 64 years; 79% men) were included. LVEDDi had a modest correlation with LVEDVi (r = 0.682, P < 0.001). LV dilatation was noted in 84% of patients using LVEDVi-based definition and in 73% using LVEDDi-based definition, whereas 20% of patients displayed discordant definitions of LV dilatation. During a median follow-up of 2.8 years, patients with both dilated LVEDDi and LVEDVi had the highest cumulative event rate (HR 3.00, 95% CI 1.15-7.81, P = 0.024). Both LVEDDi and LVEDVi were independently associated with the primary outcome (hazard ratio 3.29, 95%, P < 0.001 and 2.8, P = 0.009; respectively). CONCLUSION: The majority of patients with HF and LVEF < 50% present both increased LVEDDi and LVEDVi whereas 20% show discordant linear and volumetric definitions of LV dilatation. Patients with increased LVEDDi and LVEDVi have the worst clinical outcomes suggesting that the assessment of these two metrics is needed for better risk stratification.

A new option for monitoring heart failure. First experience in Spain with CardioMEMS / Una nueva opción de monitorizar la insuficiencia cardiaca. Primera experiencia en España con CardioMEMS(TM)

INTRODUCTION: The CardioMEMS device is inserted into the pulmonary artery and allows monitorization of pulmonary artery pressure in heart failure patients. Previous studies have shown a reduction in hospitalizations for heart failure and an improvement in quality of life in the group of patients monitored with the device. PATIENTS AND METHODS: Eleven patients managed in a multidisciplinary heart failure clinic implanted with the sensor were consecutively included from June 2019 to February 2020. This is the first experience with a cardioMEMS device published in Spain. RESULTS: The device was successfully implanted in all cases without severe complications or sensor failures, allowing precise adjustment of medical treatment that led to very few heart failure readmissions. DISCUSSION: Wireless pulmonary artery pressure monitoring will probably become an essential component in the management of selected HF patients

INTRODUCCIÓN: El dispositivo CardioMEMS(TM) se inserta en la arteria pulmonar, y permite la monitorización de la presión arterial pulmonar en los pacientes con insuficiencia cardiaca. Los estudios previos han reflejado una reducción de las hospitalizaciones por insuficiencia cardiaca, así como una mejora de la calidad de vida en el grupo de pacientes monitorizados con el dispositivo. Pacientes and métodos: Se incluyó consecutivamente a 11 pacientes tratados en una clínica multidisciplinar para insuficiencia cardiaca, que tuvieron implantado el sensor de junio de 2019 a febrero de 2020. Esta es la primera experiencia con el dispositivo CardioMEMS(TM) que se publica en España. RESULTADOS: Se implantó exitosamente el dispositivo en todos los casos, sin complicaciones graves ni fallos del sensor, lo cual permitió el ajuste preciso del tratamiento médico, que redundó en pocos reingresos por insuficiencia cardiaca. DISCUSIÓN: La monitorización de la presión arterial pulmonar sin cables se convertirá probablemente en un componente esencial del tratamiento de los pacientes de insuficiencia cardiaca seleccionados