RESUMEN
BACKGROUND: Worsening Heart Failure (WHF) is associated with adverse prognosis. Identifying novel prognostic markers in WHF is crucial. Gait speed (GS), a validated frailty index, is an easily obtainable parameter that may aid in reclassifying the risk of HF patients. We assessed the independent prognostic role of GS in WHF patients. METHODS: We studied 171 patients with chronic HF with worsening congestion symptoms and inadequate response to standard therapies, requiring intravenous diuretic treatment. The primary outcome was a composite of all-cause mortality or HF hospitalization. We assessed the association and the incremental value of GS, as compared to other clinical confounders, with the primary outcome. RESULTS: The mean age was 76±11 years, 66 % were male, median BNP was 481 pg/ml, and median ejection fraction was 40 %. Over a median follow-up of 11.3 months, 71 events occurred. Lower GS was significantly associated with a higher risk of events (HR of 4.03, 95 % CI 2.25-7.21), along with neutrophil to lymphocyte ratio, BNP, QRS duration, natremia, and previous myocardial infarction. When added to the MAGGIC risk score and the other significant confounders identified, GS significantly enhanced the model risk prediction (Harrell's C-index 0.75 vs 0.71, p < 0.001). At Classification And Regression Tree analysis, GS≤0.8 m/s was the first parameter to be considered to risk stratify the population. CONCLUSIONS: GS, an easily obtainable marker of frailty, may contribute to improve the risk stratification of patients with WHF.
RESUMEN
Right ventricular dysfunction is a prognostic factor for morbidity and mortality across a broad spectrum of cardiovascular diseases. While the role of the right ventricle in surgical patients has emerged, the prognostic impact of right ventricular dysfunction remains unclear in a large cardiac surgery population. We reviewed the existing literature about the role of right ventricular dysfunction in adults undergoing different kinds of cardiac surgery either present before or developed after surgery itself. Pre- and post-operative right ventricular dysfunction has demonstrated substantial prognostic implications. However, there remains a lack of consensus regarding its definition and diagnostic criteria. The available literature is limited to small-sized studies, underscoring the need for studies with larger populations.
RESUMEN
Although the literature demonstrates that cardiac autonomic control (CAC) might be impaired in patients with chronic pulmonary diseases, the interplay between CAC and disease severity in end-stage lung disease has not been studied yet. We investigated the effects of end-stage lung disease on CAC through the analysis of heart rate variability (HRV) among patients awaiting lung transplantation. Forty-nine patients on the waiting list for lung transplantation (LTx; 19 men, age 38 ± 15 years) and 49 healthy non-smoking controls (HC; 22 men, age 40 ± 16 years) were enrolled in a case-control study at Policlinico Hospital in Milan, Italy. LTx patients were divided into two groups, according to disease severity evaluated by the Lung Allocation Score (LAS). To assess CAC, electrocardiogram (ECG) and respiration were recorded at rest for 10 min in supine position and for 10 min during active standing. Spectral analysis identified low and high frequencies (LF, sympathetic, and HF, vagal). Symbolic analysis identified three patterns, i.e., 0V% (sympathetic) and 2UV% and 2LV% (vagal). Compared to HCs, LTx patients showed higher markers of sympathetic modulation and lower markers of vagal modulation. However, more severely affected LTx patients, compared to less severely affected ones, showed an autonomic profile characterized by loss of sympathetic modulation and predominant vagal modulation. This pattern can be due to a loss of sympathetic rhythmic oscillation and a subsequent prevalent respiratory modulation of heart rate in severely affected patients.