Remodeling of Retinal Arterioles and Carotid Arteries in Heart Failure Development-A Preliminary Study.

Current data indicate that heart failure (HF) is associated with inflammation and microvascular dysfunction and remodeling. These mechanisms could be involved in HF development and progression, especially in HF with preserved ejection fraction (HFpEF). We aimed to compare structural changes in retinal arterioles and carotid arteries between HF patients and patients without heart failure. This preliminary, retrospective, case-control study included 28 participants (14 patients with HFpEF and 14 age- and sex-matched healthy controls). Carotid intima-media thickness to lumen ratio (cIMTLR) was assessed using B-mode ultrasonography. Retinal arterioles wall- to-lumen ratio (rWLR) was assessed by adaptive optics camera rtx1. The HF patients had higher IMTLR (Δmedian [HFpEF-control group] 0.07, p = 0.01) and eWLR (Δmedian 0.03, p = 0.001) in comparison to patients without HF. In the whole study group, rWLR correlated significantly with IMTLR (r = 0.739, p = 0.001). Prevalence of arterial hypertension was similar in both groups, however, patients with HF had a significantly lower office, central and 24-h ambulatory blood pressure (systolic Δmedian -21 to -18 mmHg; diastolic Δmedian -23 to -10 mmHg). Our data suggests gradual and simultaneous progression of vascular remodeling in both retinal arterioles and carotid arteries in HFpEF patients. This process could be a marker of HF development. Significantly lower blood pressure values in HF group may indicate that vascular remodeling could be independent of BP control. Nevertheless, further and larger prospective studies allowing to reduce the impact of confounding and address temporality are warranted.

An alternative to airborne droplet transmission route of SARS-CoV-2, the feco-oral route, as a factor shaping COVID-19 pandemic.

The Chinese scenario, a rapid increase in the frequency of SARS-CoV-2 infections and sudden decline, is uncommon worldwide. Enormous differences in COVID-19 severity among individual countries are the striking findings of the pandemics. It has been demonstrated that a mild course of COVID-19 is associated with gastrointestinal symptoms, less inflammatory response, and better prognosis. The presence of SARS-CoV-2 was observed longer in the gastrointestinal tract than in respiratory swabs, promoting feco-oral transmissions and mild virus attenuation. The spread of the pandemic and its severity might, consequently, depends on the dominant environmental route of infection and emerging immunity. We hypothesize that the feco-oral SARS-CoV-2 transmission may help to achieve the long-term immunity against COVID-19, since it enables the continuous contact with viral antigens in the gastrointestinal tract, resulting in lower mortality rate. To conclude, countries producing rice through traditional methods developed rapidly emerging long-lasting population immunity, possibly through increased SARS-CoV-2 antigen exposure in the gastrointestinal tract. Our hypothesis brings attention to this potential route of herd immunity against SARS-CoV-2 which warrants further investigation in the future.

To Curb the Progression of Fatal COVID-19 Course-Dream or Reality.

PURPOSE OF REVIEW: To analyze the impact of sodium retention states on the course of COVID-19 and propose possible interventions to curb disease progression. RECENT FINDINGS: Numerous data confirm a positive association of non-communicable diseases, aging, and other sodium-retaining states, including iatrogenic ones, with more severe sometimes fatal clinical course of COVID-19. Reasons for this effect could include increased angiotensin signaling via the AT1R receptor. The endothelial glycocalyx also plays an important role in infection, leading to a vicious cycle of inflammation and tissue sodium retention when damaged. RAS inhibitors may help restore glycocalyx function and prevent severe organ damage. Anticoagulants, especially heparin, may also have therapeutic applications due to antithrombotic, anti-inflammatory, glycocalyx-repairing, and antialdosteronic properties. The ambiguous influence of some diuretics on sodium balance was also discussed. Abnormal sodium storage and increased angiotensin-converting enzyme activity are related to the severity of COVID-19. Inducing sodium removal and reducing intake might improve outcomes.

Sodium-induced inflammation-an invisible player in resistant hypertension.

The purpose of this review was to discuss the role of sodium and inflammation in the pathophysiology of hypertension and the observed different hemodynamic effects of drugs. The Pathway-2 study revealed that similar reductions in vascular resistance after spironolactone and doxazosin resulted in opposite effects on sodium balance, water retention, and hemodynamic parameters. These and other clinical findings were bridged to recent experimental and physiological data. Tissue sodium accumulation in salt-sensitive individuals due to endothelial glycocalyx dysfunction causes macrophage infiltration, vascular inflammation, and local changes in angiotensin-2 and aldosterone concentrations. This inflammatory cascade leads to factor XII-related coagulation disorders with neutrophil extracellular trap formation (NETosis). This model of sodium-induced microcirculation impairment was used to explain the differences in central hemodynamic parameters after spironolactone or doxazosin treatment in resistant hypertension. Hypertension treatment by induced sodium removal or reduced sodium intake should reduce endothelial glycocalyx dysfunction, inflammation, NETosis, and coagulation disorders, leading to improved vascular health and cardiac diastolic function.

Prognostic significance of red cell distribution width and its relation to increased pulmonary pressure and inflammation in acute heart failure.

BACKGROUND: Red cell distribution width (RDW) in acute heart failure (AHF) is accepted as a prognostic indicator with unclear pathophysiological ties. The aim of this study was to evaluate the prognostic value of RDW in AHF patients in relation to clinical and echocardiographic data. METHODS: 170 patients with AHF were retrospectively studied. All patients had laboratory testing and an echocardiogram performed within 24 h of admission to the Cardiology Department. RESULTS: During the mean 193 ± 111 days of follow-up, 33 patients died. More advanced age, high RDW and low peak early diastolic velocity of the lateral mitral annulus (MVe') were independent predictors of all-cause mortality with hazard ratios of: 1.05 (95% CI 1.02-1.09), p < 0.005, 1.40 (95% CI 1.22-1.60), p < 0.001, and 0.77 (95% CI 0.63-0.93), p < 0.007, respectively. In a stepwise multiple linear regression model, RDW was correlated with hemoglobin concentration (standardized b = -0.233, p < 0.001), mean corpuscular volum (standardized b = -0.230, p < 0.001), mean corpuscular hemoglobin concentration (standardized b = -0.207, p < 0.007), the natural logarithm of C-reactive protein (CRP) (standardized b = 0.184, p < 0.004) and tricuspid regurgitation peak gradient (TRPG) values (standardized b = 0.179, p < 0.006), whereas MVe' was correlated with atrial fibrillation (standardized b = 0.269, p < 0.001). CONCLUSIONS: The present data demonstrates a novel relation between higher levels of RDW and elevated TRPG and high sensitivity CRP values in patients with AHF. These findings suggest that RDW, the most important mortality predictor, is independently associated with elevated pulmonary pressure and systemic inflammation in patients with AHF. Moreover, in AHF patients, more advanced age and decreased MVe' are also independently associated with total mortality risk.

Assessment of right and left ventricular diastolic functions with tissue Doppler echocardiography in congestive heart failure patients with coexisting acute pulmonary embolism.

BACKGROUND: Acute pulmonary embolism (APE), despite improvements in diagnostic methods, often remains undiagnosed. Recently, systolic dysfunction has also been described as assessed by new echocardiographic techniques, such as tissue Doppler imaging (TDI). OBJECTIVES: In our study we have attempted to assess diastolic function within the mitral and tricuspid annuli in congestive heart failure (CHF) patients with coexisting APE. MATERIAL AND METHODS: The study included 39 patients with CHF with sinus rhythm, 20 patients with confirmed APE (PE+), and 19 patients with excluded APE (PE-). APE was confirmed or excluded on the result of spiral chest computed tomography. Tissue Doppler imaging (TDI) was performed to measure early diastolic velocity (Em), late diastolic velocity (Am) of both examined annuli, and Em/AmLV and Em/AmRV ratios. RESULTS: PE+ subjects were found to have lower EmRV than PE- subjects [4.2 (2.0-14) vs. 6.5 (0.8-14) cm/s; p = 0.006]. The AmLV was higher in the PE+ vs. PE- group [8.4 (3.0-15.2) vs. 3.0 (1.0-14.8), p = 0.0038]. Em/AmLV and Em/AmRV were significantly lower in the PE + vs. PE- group [0.55 (0.2-1.4) vs. 1.6 (0.16-5.4), p = 0.0089 and 0.41 (0.17-2.5) vs. 1.5 (0.05-5.5), p = 0.0069]. For the APE diagnosis, the area under the ROC curve calculated for AmLV and Em/AmLV was 0.771 (95% CI 0.509-0.890) and 0.742 (95% CI 0.577-0.868) respectively. For the APE diagnosis, the sensitivity, specificity, positive and negative predictive values for AmLV = 4.9 cm/s were: 95%, 68.4%, 76% and 92.9%, respectively and for Em/AmLV = 1.0 were: 95%, 63.2%, 73.1% and 92.3%, respectively. CONCLUSIONS: TDI reveals changes in mitral and tricuspid annular velocities in CHF patients with confirmed APE. These patients exhibit a reduced EmRV and increased AmLV.

The significance of mitral and tricuspid valve systolic lateral annular velocities in the diagnosis of acute pulmonary embolism in patients with chronic heart failure.

INTRODUCTION: The diagnosis of acute pulmonary embolism (APE) in patients with chronic heart failure (CHF) remains a difficult task, despite the refinement of imaging techniques. The goal of this study was to assess the value of measuring tricuspid and mitral valve systolic annular velocities in CHF patients with suspected PE by tissue Doppler imaging (TDI). MATERIAL AND METHODS: The study included 75 patients with previously diagnosed CHF, admitted due to resting dyspnea, with a maximum tricuspid regurgitation pressure gradient (TRPG) of ≥ 35 mm Hg and positive D-dimer assay. Spiral computed tomography (sCT) was performed on all subjects to confirm APE. Acute pulmonary embolism was diagnosed in 35 patients (PE+), and excluded in 40 others (PE-). Tissue Doppler imaging was performed to measure maximum systolic lateral annular velocities in the mitral (SmLV) and tricuspid (SmRV) valves, as well as the SmRV/SmLV ratio. RESULTS: PE+ subjects were found to have higher SmLV than PE- subjects (6.0 cm/s (2.0-13.8 cm/s) vs. 4.2 cm/s (1.3-9.1 cm/s), p = 0.003). SmRV/SmLV ratios were 1.05 (0.50-2.50) and 1.56 (0.62-4.30), respectively (p < 0.0001). Areas under ROC curves for diagnosis of APE were 0.700 for SmLV and 0.789 for SmRV/SmLV. In multivariate logistic regression analysis, only SmRV/SmLV was statistically significant, with an odds ratio for APE of 6.26 (95% CI: 1.53-25.59; p = 0.009). CONCLUSIONS: Tissue Doppler imaging of the lateral tricuspid and mitral annuli is a useful clinical tool that can help identify PE in CHF patients. Those patients who fulfill these criteria should be considered for further diagnostic studies to confirm PE.

Impact of anticoagulation on the effectiveness of loop diuretics in heart failure with cardiorenal syndrome and venous thromboembolism.

The limitations of diuretics in the treatment of acute decompensated heart failure (ADCHF) are progressive worsening of renal function and resistance to up-titrated doses. The occurrence of resistance to loop diuretics in patients with ADCHF is associated with worsening prognosis and increased mortality. In this study, we report two patients with ADCHF and resistance to loop diuretics suspected for venous thromboembolism, suggesting that heparin administered to ADCHF patients treated for venous thromboembolism with cardiorenal syndrome decreases right-ventricular overload and improves renal function. To our knowledge, these are the first reported cases describing restored responsiveness to loop diuretics in ADCHF patients after additional heparin administration.

Identification of clinical risk factors of atrial fibrillation in congestive heart failure.

BACKGROUND: Factors associated with the development of atrial fibrillation (AF) in general population have been described, but it is still unknown whether the same risk factors apply to heart failure (HF) patients. The aim of this study was to identify clinical factors related to various forms of AF in HF patients. METHODS: The clinical and echocardiographic characteristics were assessed in 155 HF patients: 50 with sinus rhythm, 52 with non-permanent AF, and 53 with permanent AF. RESULTS: Multivariate logistic regression analysis showed that the increase in the NYHA class was an independent risk factor for both forms of AF. The occurrence of permanent AF in comparison to sinus rhythm group was independently associated with hs-C-reactive protein (CRP) elevation above 1 mg/dL (OR 1.87, 95% CI 1.05-3.35), left atrial dimension above 4 cm (OR 3.78, 95% CI 1.29-11.06) and tricuspid maximal pressure gradient elevation above 35 mm Hg (OR 5.01, 95% CI 1.38-18.27). The presence of coronary disease was independently associated with less frequent occurrence of permanent AF in comparison to sinus rhythm group (OR 0.21, 95% CI 0.06-0.67). CONCLUSIONS: More advanced congestive HF was associated with presence of both types of AF. Non-ischemic etiology of HF and elevated CRP are independently associated with permanent AF compared to sinus rhythm. Left ventricular diastolic dysfunction indicators (increased tricuspid maximal pressure gradient and left artial dimension) are independently associated with permanent AF.

The influence of acute pulmonary embolism on early and delayed prognosis for patients with chronic heart failure.

BACKGROUND: Patients with acute pulmonary embolism (APE) with concomitant chronic heart failure (CHF) are characterized by higher mortality rates than APE patients without CHF. The aim of this study is to evaluate the potential impact of APE on early and long-term prognosis in patients with CHF. METHODS: This study included 87 patients with CHF with suspected APE. Patients were divided into two groups according to spiral computed tomography results: one group with confirmed APE and one with excluded APE. Total and cardiovascular mortality in patients of both groups during a 6- and 36-month follow up period was assessed. Potential risk factors for mortality in patients with CHF in short and long-term observations were identified. RESULTS: APE was diagnosed in 35 patients, and excluded in the remaining 52 patients. Total and cardiovascular 6-month mortality was higher in APE patients than in patients without APE: 34.3% and 28.5% vs. 13.4% and 11.5%, p = 0.02, p = 0.02, respectively. In 6-month follow-up the only independent risk factor for mortality was the presence of APE (HR = 2.7, 95% CI 1.1-24.4, p = 0.04). However, in the 36-month follow-up APE had no effect on mortality. CONCLUSIONS: Patients with CHF and acute episode of PE are characterized by a higher 6-month total and cardiovascular mortality rate following discharge from hospital compared to patients hospitalized due to acute CHF decompensation. Moreover, recent episode of PE in patients with CHF is an independent risk factor for early mortality in a 6-month follow-up.

Characteristics of the heart failure population in Poland: ZOPAN, a multicentre national programme.

BACKGROUND: It is difficult to define the optimal management of elderly heart failure (HF) patients with complex comorbidities. Thus, comprehensive characterisation of HF patients constitutes a crucial pre-condition for the successful management of this fragile population. AIM: To analyse the 'real life' HF patients, including the evaluation of their health conditions, management and their use of public health resources. METHODS AND RESULTS: We examined 822 consecutive patients diagnosed with HF in NYHA classes II-IV in primary care practices. The mean age was 68.5 years, and 56% were male. Only 23% of the patients who were of pre-retirement age remained professionally active. Ischaemic or hypertension aetiology was found in 90% of participants. Nearly all patients had multiple comorbidities. Most patients received converting enzyme inhibitors (88%) and beta-blockers (77%), 60% of them both, although dosing was frequently inadequate. During the six months preceding the study, 31% had cardiovascular hospitalisation and 66% required unscheduled surgery visits. CONCLUSIONS: The real life HF population differs from trial populations. Most of the real life patients who had not yet reached retirement age were professionally inactive, mainly due to a disability caused by cardiovascular conditions. Moreover, extremely few participants were free from any comorbidity. Compared to 20th century Polish data, there has been an improvement in the overall quality of HF-recommended pharmacotherapy. It must be stressed, however, that the percentage of those on optimal dosage remains unsatisfactory.

[The role of tissue Doppler imaging in diagnosis of pulmonary embolism]. / Znaczenie badania echokardiograficznego metoda doplera tkankowego w rozpoznaniu zatorowosci plucnej.

Pulmonary embolism (PE), despite improvement of diagnostic methods often remains undiagnosed. Importantly, the lack of correct diagnosis is one of major factors negatively influencing the prognosis of PE for patients. Echocardiography is frequently performed on patients suspected of PE. However, the majority of signs reported by echocardiography only indirectly indicate PE. However, new parameters characteristic of pulmonary embolism by means of novel echo-cardiographic methods may increase the probability of a correct diagnosis, thus improving the prognosis in this group of patients. The aim of this study was to present a potential role of echo-cardiography with tissue Doppler imaging in diagnosing pulmonary embolism. Tissue Doppler echocardiography (TDE) is a based on the Doppler effect in order to assess movements of the heart structures. Due to a selective measurements of the velocities of selected fragments of myocardium, TDE allows for a fully quantitative and objective assessment of the regional myocardial function. One of the new parameters helpful in PE diagnosis is M-index, which is ratio of early diastolic mitral inflow velocity and right ventricular Tei index. M-index < 112, showed 92% sensitivity and 92% specificity for the PE diagnosis. Another parameter V-index, which is the ratio of right ventricular Tei index to left ventricular Tei index was assessed in PE diagnosis in patients with pulmonary hypertension (PH). The value of V-index > 1.2 confirmed PE with a sensitivity of 82% and a specificity of 83%. In our study, it was shown that patients with PE manifest hyperkinetic left ventricular function. Peak systolic velocity of the mitral annulus lateral portion (SmLV) = 5.5 cm/s had a sensitivity of 60% and a specificity of 86% in diagnosing PE in patients with congestive heart failure (CHF), whereas the ratio of peak systolic velocity of the tricuspid annulus to peak systolic velocity of the mitral annulus (SmRV/LV) = 1.2 showed a sensitivity of 76% and a specificity of 93% in diagnosing PE. The mentioned above date showing that echocardiography combined with tissue Doppler imaging may be useful in diagnosing PE.

The effect of an evening dose of a long-acting beta-blocker on the autonomic tone in patients with congestive heart failure.

BACKGROUND: Heart rate variability (HRV) indices are accepted markers of cardiac autonomic activity and have been used as indicators of beta-blockade effects in congestive heart failure (CHF) patients. In view of the high frequency of sudden cardiac death in the morning, there is a question whether the evening beta-blocker administration would be more efficient than a morning dose. AIM: To compare HRV indices after morning or evening long-acting beta-blocker administration. METHODS: The study group consisted of 52 CHF patients (NYHA class II/III) in sinus rhythm. Time domain (TD) and frequency domain (FD) HRV analyses were performed for daytime, nighttime and a 24-hour period: first after the morning bisoprolol administration, and then after the same evening dose. RESULTS: After the evening dose the mean heart rate was significantly lower (p = 0.01), nighttime normal R-R intervals were significantly prolonged (p = 0.008) and the low frequency (LF)/high frequency (HF) ratio was significantly lower for: 24 h (p = 0.0002); daytime (p = 0.003) and nighttime (p = 0.008) with higher HF values in the 24-hour period (p = 0.0007) and in the daytime interval (p = 0.006). CONCLUSION: An evening dose of a beta-blocker is more effective than a morning dose in reversing adverse changes in the autonomic nervous system activity in CHF patients.

Relationship between inflammatory markers and clinical patterns of atrial fibrillation in patients with congestive heart failure.

BACKGROUND: Occurence of atrial fibrillation (AF) adversely affects left atrial size and cardiac function. This arrhythmia is also associated with an increase of plasma CRP and fibrinogen concentration. It is not clear whether elevated levels of inflammatory markers in patients with congestive heart failure (CHF) are associated with AF, clinical symptoms or adverse cardiac remodelling. AIM: To investigate the association between levels of inflammatory markers and selected clinical and echocardiographic parameters as well as used treatment in the population of CHF patients with various forms of AF. METHODS: The cross-sectional study included 99 patients with CHF divided into 3 groups. Group I included patients with sinus rhythm. Group II consisted of patients admitted to hospital with AF and discharged with sinus rhythm (the category of paroxysmal and persistent AF). Group III comprised patients with permanent AF. In all patients plasma CRP and fibrinogen concentrations were measured and echocardiographic examination was carried out. Left atrial dimension (LA), ejection fraction (LVEF) and right ventricular systolic pressure (RVSP) were assessed. RESULTS: Mean CRP concentration in group III (5.83+/-5.36 mg/l) was significantly higher than in group I (p=0.001) and group II (p=0.033). In the group with permanent AF mean fibrinogen concentration was elevated to a higher level (391.0+/-77.3 mg/dl) than in group II (p=0.007) and group I (p=0.099). Mean LA and RV dimensions and RVSP in group III were significantly higher than in group I and group II. Multivariable analysis revealed that plasma CRP concentration was significantly associated with the presence of arterial hypertension (p <0.001) and LA enlargement (p=0.007). A significant association between fibrinogen level and CRP level (p=0.038), presence of permanent AF (p=0.045) and metabolic syndrome (p <0.05) was found. Values of ln CRP were significantly correlated with LA diameter (r=0.24; p=0.015). CONCLUSIONS: Increased plasma CRP level in patients with CHF were significantly associated with arterial hypertension and LA enlargement. Permanent form of AF and CRP level have been shown to be significantly associated with increased plasma fibrinogen concentration in the course of CHF.

Analysis of selected risk factors of coronary artery disease in a healthy population aged 35-55 years.

BACKGROUND: This report comprises an analysis of results of examinations performed as a part of a cardiovascular disease prevention programme funded by the National Health Fund. AIM: To determine the relationship between body mass index (BMI) and blood pressure, blood glucose and lipid metabolism abnormalities in an ethnically homogeneous population of males and females aged 35 to 55 years with sense of full health without prior diagnosis of cardiovascular disease or diabetes. METHODS: The study was carried out in the population of a 175,000-resident city during 9 months, involving 1080 subjects (696 females and 384 males) aged 35 to 55 years (mean age - 47.2+/-5.4). The following variables were assessed: systolic and diastolic blood pressure, body weight and height, BMI, fasting blood glucose, total cholesterol, triglycerides and HDL cholesterol levels. RESULTS: The studied male population had significantly higher blood pressure, blood glucose, total cholesterol, triglycerides and lower HDL cholesterol levels compared to age-matched females. The female population was found to have a more prominent relationship between increased BMI and blood pressure, blood glucose and serum cholesterol levels than males. Significant differences in favour of females regarding systolic blood pressure, blood glucose and serum cholesterol failed to be present in the obese women subgroup (no statistically significant differences were found compared to obese males). In females aged 45 to 55 years, significantly higher body weight, blood pressure as well as blood glucose, cholesterol and triglyceride levels were observed than in younger women (35-45 years old). CONCLUSIONS: Overweight and obesity are associated with increase of arterial blood pressure, lipid metabolism disturbances and elevation of blood glucose. The relationship between BMI and studied risk factors was influenced by age and gender. Menopause is associated with increasing body weight and unfavourable evolution of studied risk factors.

The role of tissue colour Doppler imaging in diagnosis of segmental pulmonary embolism in congestive heart failure patients.

BACKGROUND: Tissue Doppler imaging enables qualitative and quantitative assessment of myocardial function of the left and right ventricles. AIM: To compare systolic longitudinal mitral and tricuspid annular velocities in a congestive heart failure (CHF) patient group with clinical suspicion of pulmonary embolism (PE). METHODS: Fifty-five consecutive CHF patients with a history of abrupt onset of resting dyspnoea, elevated >35 mmHg right ventricular systolic pressure (RVSP) and positive D-dimer test were included in the study. Patients underwent standard echocardiography and tissue colour Doppler imaging with post-processing analysis (Echopack 6.3, GE Vingmed) and spiral computed tomography (SCT) within 24 hours from admission. Mitral and tricuspid annular longitudinal systolic and diastolic velocities were measured at their lateral sites in a 4-chamber apical view. According to the results of the SCT examination patients were classified into groups: PE positive (group 1 - 25 patients) and PE negative (group 2 - 30 patients). RESULTS: Tricuspid annular lateral systolic velocity (SmRV) was 6.5+/-2.6 cm/s in group 1 and 7.0+/-2.5 cm/s in group 2 (p=NS). Mitral annular lateral systolic velocity (SmLV) was 6.4+/-3.0 cm/s and 4.3+/-2.0 cm/s in group 1 and group 2 respectively (p= 0.003). Patients diagnosed as PE cases showed statistically significant higher mitral annular lateral systolic velocity. Using a cut-off value of >5.5 cm/s derived from receiver operating characteristics curve analysis, patients were separated from those without PE with sensitivity of 60% and specificity of 86.7%. The ratio of SmRV/SmLV was 1.1+/-0.4 and 1.73+/-0.87 in group 1 and group 2, respectively (p=0.001). Using a cut-off value ratio of

Impact of clinical and echocardiographic parameters assessed during acute decompensation of chronic heart failure on 3-year survival.

BACKGROUND: It is unclear whether established risk factors affecting the prognosis of chronic heart failure (CHF) have the same predictive value when assessed during acute haemodynamic decompensation of CHF. AIM: To investigate the impact of selected clinical and echocardiographic parameters assessed in patients with CHF during emergency admission due to acute CHF decompensation, on 3-year survival. METHODS: This retrospective study involved 100 consecutive patients with CHF (60 women and 40 men at the mean age of 70.4+/-9.8 years), admitted to hospital due to angina pectoris symptoms or pulmonary oedema. In the echocardiographic study performed within the first 48 hours of in-hospital stay, standard parameters as well as right ventricular systolic pressure (RVSP) were evaluated. In order to identify biological, clinical and echocardiographic factors affecting 3-year survival, both uni- and multivariable Cox proportional hazards regression analyses were carried out. RESULTS: Forty-four patients died during 3-year follow-up. Univariate regression analysis revealed that age >60 years, sodium serum concentration <140 mmol/L, RVSP >35 mmHg and reduced left ventricular ejection fraction <50% were associated with an increased risk of death. However, multivariate regression analysis showed that only age and sodium concentration were independent risk factors. CONCLUSIONS: Age of over 60 years and sodium concentration below 140 mmol/L seen during acute decompensation were found to be independent predictors of unfavourable outcome in terms of mortality in 3-year follow-up of patients with CHF.