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1.
Monaldi Arch Chest Dis ; 90(1)2020 Mar 27.
Artículo en Inglés | MEDLINE | ID: mdl-32225996

RESUMEN

Exercise oscillatory ventilation (EOV) is an ominous sign in heart failure due to reduced left ventricular ejection fraction (HFrEF) whatever it is represented. But EOV is detected also in normal healthy individuals and in other cardiovascular disease (CVD) patients, however, its prevalence in these is not completed clear. The aim was to describe the occurrence of EOV in healthy subjects and the overall population all CVD patients who performing symptom limited cardiopulmonary exercise testing (CPET). Healthy subjects were divided in athletes and normal subjects, while, CVD patients were subdivided into: i) t hose with preserved left ventricular ejection fraction (LVEF); ii) those with mild to moderate impairment of LVEF (41-49%); iii) those with severe impairment of LVEF (≤40%); iv) HFrEF or with preserved LVEF (HFpEF); and iv) patients after heart transplantation (HXT). EOV was observed only in CVD patients and in those with depressed LVEF; the prevalence of EOV was observed 1.9% (3/55) those with mild to moderate impairment of LVEF (41-49%), 3.4% (56/1613) those with severe impairment of LVEF (≤40%), and 7.3% (214/2903) in HFrEF); no EOV was observed in CVD with preserved LVEF. Kremser's EOV was observed in patients, and, particularly, in those with systolic function impairment. Moreover, as EOV impacts prognosis in HFrEF, its occurrence can modify prognostic-decision models. Even though, EOV prevalence was derived from largest single center population, more studies are needed to tackle the EOV prevalence in different CVD conditions and in normal subjects.


Asunto(s)
Enfermedades Cardiovasculares , Respiración de Cheyne-Stokes/etiología , Insuficiencia Cardíaca , Disfunción Ventricular Izquierda , Atletas , Enfermedades Cardiovasculares/diagnóstico , Enfermedades Cardiovasculares/fisiopatología , Estudios de Casos y Controles , Técnicas de Apoyo para la Decisión , Prueba de Esfuerzo , Insuficiencia Cardíaca/diagnóstico , Insuficiencia Cardíaca/fisiopatología , Humanos , Consumo de Oxígeno , Pronóstico , Volumen Sistólico , Disfunción Ventricular Izquierda/complicaciones , Disfunción Ventricular Izquierda/diagnóstico , Función Ventricular Izquierda
2.
BMC Med Genet ; 21(1): 37, 2020 02 19.
Artículo en Inglés | MEDLINE | ID: mdl-32075597

RESUMEN

BACKGROUND: The Mucopolysaccharidosis type VI (MPS VI), also known as Maroteaux-Lamy syndrome (OMIM 253200) is an autosomal recessive lysosomal disorder, caused by the deficiency of the enzyme N-acetylgalactosamine 4-sulfatase (also known as arylsulfatase B) due to mutations of the ARSB gene. Cardiologic features are well recognized, and are always present in MPS VI patients. Generally, the onset and the progression of the cardiologic symptoms are insidious, and just a few patients have developed a rapidly progressive disease. Cardiac involvement in MPS VI is a common and progressive feature. For MPS patients, cardiac evaluations are recommended every 1 to 2 years, including blood pressure measurement, electrocardiography and echocardiography. However, congestive heart failure and valvular surgical repair are not frequently seen, and if so, they are performed in adults. Here we report on an atypical MPS VI case with ascites fetalis and a rapidly progressive cardiac disease. CASE PRESENTATION: A 6-month-old Brazilian male, only child of a Brazilian healthy non-consanguineous couple. During pregnancy, second trimester ultrasonography observed fetal ascites and bilateral hydrocele. Physical exam at 6 months-old revealed a typical gibbus deformity and MPS was suspected. Biochemical investigation revealed a diagnosis of MPS type VI, confirmed by molecular test. Baseline echocardiogram revealed discrete tricuspid regurgitation and a thickened mitral valve with posterior leaflet prolapse, causing moderate to severe regurgitation. The patient evolved with mitral insufficiency and congestive heart failure, eventually requiring surgical repair by the first year of age. CONCLUSIONS: We report the first case of MPS VI whose manifestations started in the prenatal period with fetal ascites, with severe cardiac valvular disease that eventually required early surgical repair. Moreover, in MPS with neonatal presentation, including fetal hydrops, besides MPS I, IVA and VII, clinicians should include MPS VI in the differential diagnosis.


Asunto(s)
Insuficiencia Cardíaca/genética , Corazón/fisiopatología , Mucopolisacaridosis VI/genética , N-Acetilgalactosamina-4-Sulfatasa/genética , Ascitis , Brasil/epidemiología , Progresión de la Enfermedad , Corazón/diagnóstico por imagen , Insuficiencia Cardíaca/diagnóstico , Insuficiencia Cardíaca/diagnóstico por imagen , Insuficiencia Cardíaca/fisiopatología , Humanos , Lactante , Masculino , Mucopolisacaridosis VI/diagnóstico por imagen , Mucopolisacaridosis VI/fisiopatología , Mutación , Fenotipo
3.
Vasc Health Risk Manag ; 16: 41-51, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32021227

RESUMEN

This review aims to elucidate the optimal dosing of angiotensin receptor-neprilysin inhibitor (ARNI) therapy in the heart failure (HF) treatment paradigm through examination of the trial population characteristics and the mortality benefit observed in the Prospective Comparison of ARNI with angiotensin-converting enzyme inhibitor (ACEI) to Determine Impact on Global Mortality and Morbidity in Heart Failure (PARADIGM-HF; NCT01035255) trial. Considerations regarding the initiation and titration of sacubitril/valsartan, a first-in-class ARNI, will also be addressed. The approval of sacubitril/valsartan heralded the first novel pharmacological class in over a decade for the treatment of heart failure with reduced ejection fraction (HFrEF). The PARADIGM-HF trial showed that treatment with valsartan/valsartan reduced the risk of first occurrence of either cardiovascular death or HF-related hospitalization (composite primary endpoint) by 20% compared with enalapril in patients with HFrEF. The incremental benefits of treatment with valsartan/valsartan over enalapril demonstrated in the PARADIGM-HF trial led to strong recommendations for its use over ACEIs or angiotensin receptor blockers to further reduce morbidity and mortality in the 2016 and 2017 American College of Cardiology/American Heart Association/Heart Failure Society of America updates to the guidelines for the management of HF. Although the optimal timing for the initiation of valsartan/valsartan has yet to be determined, its early use is likely to have a positive impact on patient outcomes.


Asunto(s)
Aminobutiratos/uso terapéutico , Bloqueadores del Receptor Tipo 1 de Angiotensina II/uso terapéutico , Insuficiencia Cardíaca/tratamiento farmacológico , Inhibidores de Proteasas/uso terapéutico , Tetrazoles/uso terapéutico , Aminobutiratos/efectos adversos , Bloqueadores del Receptor Tipo 1 de Angiotensina II/efectos adversos , Ensayos Clínicos como Asunto , Insuficiencia Cardíaca/diagnóstico , Insuficiencia Cardíaca/mortalidad , Insuficiencia Cardíaca/fisiopatología , Humanos , Neprilisina/antagonistas & inhibidores , Inhibidores de Proteasas/efectos adversos , Factores de Riesgo , Tetrazoles/efectos adversos , Factores de Tiempo , Resultado del Tratamiento
4.
Rev Med Liege ; 75(2): 130-135, 2020 Feb.
Artículo en Francés | MEDLINE | ID: mdl-32030940

RESUMEN

The «Prospective Comparison of ARNI with ARB Global Outcomes in HF with Preserved Ejection Fraction¼ (PARAGON HF) trial is a multicenter, randomized, double-blind study comparing the incidence of heart failure hospitalization and cardiovascular mortality in patients with heart failure with preserved ejection fraction (HFpEF) treated with sacubitril/valsartan (Entresto®) versus valsartan alone. After a median follow-up of 35 months, the primary endpoint was reduced by 13 % in the sacubitril/valsartan group compared to the valsartan group (relative risk: 0.87, 95 % IC: 0.753-1.005, p = 0.058). Despite this lack of significance, the incidence of hospitalizations for heart failure was reduced (RR 0.85, 95 % CI: 0.72-1.00), whereas no benefit was observed on cardiovascular mortality. A subgroup analysis suggested that women and patients with an intermediate ejection fraction could get more benefit from the treatment. Concerning secondary criteria, a significant improvement in quality of life and in heart failure symptoms was observed in the group sacubitril/valsartan. There was a greater incidence of arterial hypotension and angioneurotic edema, but a lower incidence of hyperkalemia in the group sacubitril/valsartan.


Asunto(s)
Antagonistas de Receptores de Angiotensina , Insuficiencia Cardíaca , Hospitalización , Volumen Sistólico , Método Doble Ciego , Femenino , Insuficiencia Cardíaca/complicaciones , Insuficiencia Cardíaca/diagnóstico , Insuficiencia Cardíaca/mortalidad , Humanos , Estudios Prospectivos , Calidad de Vida , Resultado del Tratamiento
5.
J Thorac Cardiovasc Surg ; 159(3): 865-896, 2020 03.
Artículo en Inglés | MEDLINE | ID: mdl-31983522
6.
Mayo Clin Proc ; 95(1): 124-133, 2020 01.
Artículo en Inglés | MEDLINE | ID: mdl-31902407

RESUMEN

OBJECTIVES: To delineate the impact of diabetes mellitus (DM) on the development of cardiovascular diseases in a community population. PATIENTS & METHODS: Cross-sectional survey of residents randomly selected through the Rochester Epidemiology Project, 45 years or older, of Olmsted County as of June 1, 1997, through September 30, 2000. Responders (2042) underwent assessment of systolic and diastolic function using echocardiography. The current analyses included all participants with DM and were compared with a group of participants without DM matched 1:2 for age, sex, hypertension, and coronary artery disease. Baseline characteristics and laboratory and echocardiography findings between groups were compared along with rates of mortality due to various cardiovascular conditions. RESULTS: We identified 116 participants with DM and 232 matched participants without DM. Those with DM had a higher body mass index and plasma insulin and serum glucose levels. Although left ventricular ejection fractions were similar, E/e' ratio (9.7 vs 8.5; P=.001) was higher in DM vs non-DM. During a follow-up of 10.8 (interquartile range, 7.8-11.7) years, participants with DM had a higher incidence of heart failure (HF); hazard ratio, 2.1; 95% confidence limits, 1.2-3.6; P=.01) and 10-year Kaplan-Meier rate of 21% (22 of 116) vs 12% (24 of 232) compared with those without DM. We also examined the subgroup of participants without diastolic dysfunction. In this subgroup, those with DM had an increased risk for HF; hazard ratio, 2.5; 95% confidence limits, 1.0-6.3; P=.04). CONCLUSION: In this cohort, participants with DM have an increased incidence of HF over a 10-year follow-up period even in the absence of underlying diastolic dysfunction. These findings suggest that DM is an independent risk factor for the development of HF and supports the concept of DM cardiomyopathy.


Asunto(s)
Diabetes Mellitus , Insuficiencia Cardíaca , Volumen Sistólico , Función Ventricular Izquierda , Glucemia/análisis , Índice de Masa Corporal , Estudios Transversales , Diabetes Mellitus/sangre , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/epidemiología , Ecocardiografía Doppler/métodos , Ecocardiografía Doppler/estadística & datos numéricos , Femenino , Insuficiencia Cardíaca/diagnóstico , Insuficiencia Cardíaca/epidemiología , Humanos , Incidencia , Insulina/análisis , Estimación de Kaplan-Meier , Masculino , Persona de Mediana Edad , Minnesota/epidemiología , Mortalidad , Sistema de Registros/estadística & datos numéricos , Factores de Riesgo
7.
Mymensingh Med J ; 29(1): 1-4, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31915328

RESUMEN

This cross sectional study was carried out in the Department of Biochemistry, Mymensingh Medical College in collaboration with the Department of Cardiology, Mymensingh Medical College Hospital, Mymensingh, Bangladesh from January 2018 to December 2018. The aim of the study was to explore the relationship of serum NT-pro BNP in heart failure (HF) patients as a means to monitor the possibility of management of these patients. A total of 120 subjects were included in this study. Among them 60 were diagnosed HF patients denoted as case group and 60 were normal healthy individuals denoted as control group. Serum NT-pro BNP concentration was measured by Fluorescence Immunoassay (FIA) from each sample. Statistical analysis was performed by SPSS windows package, version 21. Among the study group the mean serum NT-pro BNP levels were 4931.93±7229.36 and 999.47±49.99 pg/ml in case and control group respectively. Analysis showed that the mean serum NT-pro BNP level was highly significant (p<0.001) increased in heart failure patients comparison to that of control group.


Asunto(s)
Insuficiencia Cardíaca/diagnóstico , Péptido Natriurético Encefálico/sangre , Bangladesh , Biomarcadores/sangre , Estudios de Casos y Controles , Estudios Transversales , Insuficiencia Cardíaca/sangre , Humanos
8.
Phys Ther ; 100(1): 14-43, 2020 01 23.
Artículo en Inglés | MEDLINE | ID: mdl-31972027

RESUMEN

The American Physical Therapy Association (APTA), in conjunction with the Cardiovascular and Pulmonary Section of APTA, have commissioned the development of this clinical practice guideline to assist physical therapists in their clinical decision making when managing patients with heart failure. Physical therapists treat patients with varying degrees of impairments and limitations in activity and participation associated with heart failure pathology across the continuum of care. This document will guide physical therapist practice in the examination and treatment of patients with a known diagnosis of heart failure. The development of this clinical practice guideline followed a structured process and resulted in 9 key action statements to guide physical therapist practice. The level and quality of available evidence were graded based on specific criteria to determine the strength of each action statement. Clinical algorithms were developed to guide the physical therapist in appropriate clinical decision making. Physical therapists are encouraged to work collaboratively with other members of the health care team in implementing these action statements to improve the activity, participation, and quality of life in individuals with heart failure and reduce the incidence of heart failure-related re-admissions.


Asunto(s)
Insuficiencia Cardíaca/rehabilitación , Fisioterapeutas , Fisioterapia , Ejercicios Respiratorios/métodos , Terapia Combinada/métodos , Terapia por Estimulación Eléctrica/métodos , Ejercicio , Insuficiencia Cardíaca/clasificación , Insuficiencia Cardíaca/diagnóstico , Insuficiencia Cardíaca/fisiopatología , Entrenamiento de Intervalos de Alta Intensidad , Humanos , Educación del Paciente como Asunto , Readmisión del Paciente , Fisioterapia/organización & administración , Entrenamiento de Resistencia , Medición de Riesgo , Disfunción Ventricular Izquierda/fisiopatología
9.
J Cardiothorac Surg ; 15(1): 15, 2020 Jan 13.
Artículo en Inglés | MEDLINE | ID: mdl-31931857

RESUMEN

INTRODUCTION: N-terminal pro-brain natriuretic peptide (NT-pro-BNP) is used as an important biomarker for heart failure in children and adults. Previous researches have shown the value of NT-pro-BNP in various congenital heart defects (CHD). However, the level of NT-pro-BNP in patients with anomalous left coronary artery from the pulmonary artery (ALCAPA) has not been determined. MATERIALS AND METHODS: Plasma NT-pro-BNP was measured in 23 patients diagnosed with ALCAPA before operation. Echocardiogram was also recorded for each patient. RESULTS: Patients with NT-pro-BNP above 300 pg/mL showed a statistically significant decrease in LVEF (p < 0.0001) and in age (p < 0.0001) compared to patients with NT-pro-BNP below 300 pg/mL. Age (r = 0.399, p = 0.012) and LVEF (r = 0.403, p = 0.011) showed a statistically significant correlation with NT-pro-BNP in linear regression when NT-pro-BNP more than 300 pg/mL. A negative correlation was shown between NT-pro-BNP and LVEF (r = 0.570, p < 0.0001) in all the patients. No significant correlation was observed between mitral regurgitation (MR) grade and NT-pro-BNP in a Spearman correlation test (r = 0.383; P = 0.071). CONCLUSIONS: In patients with ALCAPA, NT-pro-BNP levels showed a negative correlation with age and LVEF when NT-pro-BNP above 300 pg/mL and no correlation with age and LVEF when NT-pro-BNP under 300 pg/ml. Further studies are needed to determine whether there is a correlation between MR grade and NT-pro-BNP levels.


Asunto(s)
/sangre , Síndrome de Bland White Garland/sangre , Péptido Natriurético Encefálico/sangre , Fragmentos de Péptidos/sangre , Adolescente , Adulto , Biomarcadores/sangre , Niño , Preescolar , Ecocardiografía , Femenino , Insuficiencia Cardíaca/diagnóstico , Humanos , Masculino , Persona de Mediana Edad , Arteria Pulmonar/anomalías , Análisis de Regresión , Adulto Joven
11.
Herz ; 45(1): 65-78, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-29700556

RESUMEN

BACKGROUND: The present meta-analysis examined the diagnostic value of novel biomarkers for heart failure (HF), including copeptin, galectin-3, hs-cTnT, MR-proANP, MR-proADM, and ST2. METHODS: English (EMBASE, Cochrane, and PubMed) and Chinese (Wanfang data, CNKI, SinoMed) databases were searched to identify suitable studies that were published before 1 December 2016. Data were extracted using standard forms. Pooled diagnostic statistics were calculated using DerSimonian-Laird random-effects models. RESULTS: The analysis comprised 45 studies. The pooled sensitivities of all biomarkers were 0.80-0.86, along with pooled specificities of 0.60-0.82, positive predictive values (PPVs) of 0.52-0.80, and negative predictive values (NPVs) of 0.70-0.87. Among them, hs-cTnT had the highest sensitivity (0.86 [95% CI: 0.84-0.88]), specificity (0.82 [95% CI: 0.79-0.84]), PPV (0.80 [95% CI: 0.77-0.83]), and NPV (0.87 [95% CI: 0.85-0.89]), while MR-proADM had the lowest sensitivity (0.80 [95% CI: 0.75-0.84]), specificity (0.60 [95% CI: 0.56-0.64]), and PPV (0.52 [95% CI: 0.47-0.56]). Copeptin had the lowest NPV (0.70 [95% CI: 0.66-0.74]). The positive likelihood ratio (LR+) of all biomarkers ranged from 1.97 to 3.21, and the negative likelihood ratio (LR-) from 0.20 to 0.36. MR-proADM had the lowest LR+ and highest LR-; galectin-3 had the highest LR+ and MR-proANP had the lowest LR-. The area under the curve (AUC) was as low as 0.68 for MR-proADM, while AUCs for the other biomarkers ranged from 0.83 to 0.89. CONCLUSION: The overall diagnostic accuracy of copeptin, galectin-3, hs-cTnT, MR-proANP, and ST2 was relatively good. MR-proADM had a poor capacity to confirm or exclude HF. Improving the diagnostic accuracy of HF by a combination of biomarkers could be considered in the future.


Asunto(s)
Biomarcadores , Insuficiencia Cardíaca , Insuficiencia Cardíaca/diagnóstico , Humanos , Sensibilidad y Especificidad
12.
Heart Fail Clin ; 16(1): 1-9, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31735307

RESUMEN

The effects of hyperthyroidism and hypothyroidism on the heart and cardiovascular system are well documented. It has also been shown that various forms of heart disease including but not limited to congenital, hypertensive, ischemic, cardiac surgery, and heart transplantation cause an alteration in thyroid function tests including a decrease in serum liothyronine (T3). This article discusses the basic science and clinical data that support the hypothesis that these changes pose pathophysiologic and potential novel therapeutic challenges.


Asunto(s)
Insuficiencia Cardíaca/complicaciones , Enfermedades de la Tiroides/etiología , Hormonas Tiroideas/sangre , Biomarcadores/sangre , Ecocardiografía , Insuficiencia Cardíaca/sangre , Insuficiencia Cardíaca/diagnóstico , Humanos , Lipoproteínas/sangre , Índice de Severidad de la Enfermedad , Enfermedades de la Tiroides/sangre
13.
Heart Fail Clin ; 16(1): 33-44, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31735313

RESUMEN

Heart failure (HF) and chronic obstructive pulmonary disease (COPD) are both common causes of breathlessness and often conspire to confound accurate diagnosis and optimal therapy. Risk factors (such as aging, smoking, and obesity) and clinical presentation (eg, cough and breathlessness on exertion) can be very similar, but the treatment and prognostic implications are very different. This review discusses the diagnostic challenges in individuals with exertional dyspnea. Also highlighted are the prevalence, clinical relevance, and therapeutic implications of a concurrent diagnosis of COPD and HF.


Asunto(s)
Disnea/etiología , Insuficiencia Cardíaca/fisiopatología , Enfermedad Pulmonar Obstructiva Crónica/fisiopatología , Comorbilidad , Disnea/diagnóstico , Disnea/fisiopatología , Electrocardiografía , Salud Global , Insuficiencia Cardíaca/diagnóstico , Insuficiencia Cardíaca/epidemiología , Humanos , Prevalencia , Enfermedad Pulmonar Obstructiva Crónica/diagnóstico , Enfermedad Pulmonar Obstructiva Crónica/epidemiología , Radiografía Torácica , Factores de Riesgo , Espirometría
14.
Heart Fail Clin ; 16(1): 53-60, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31735315

RESUMEN

Pulmonary hypertension (PH) often complicates chronic left-sided heart failure, with a remarkable impact on quality of life, exercise capacity, and survival. PH in chronic left-sided heart failure (PH-LHD) is not only caused by backward transmission of pressures but also involves impairment of atrial function, inflammation, and vasoconstriction. Once the left atrium loses its reservoir capacity, usually pulmonary vascular resistances increase. Right atrial dilation commonly represents the first sign of PH-LHD, before right ventricle dilatation and systolic dysfunction develop, leading to right heart insufficiency, and ultimately, right heart failure.


Asunto(s)
Insuficiencia Cardíaca/complicaciones , Hipertensión Pulmonar/etiología , Presión Esfenoidal Pulmonar/fisiología , Resistencia Vascular/fisiología , Función Ventricular Izquierda/fisiología , Ecocardiografía , Insuficiencia Cardíaca/diagnóstico , Insuficiencia Cardíaca/fisiopatología , Humanos , Hipertensión Pulmonar/diagnóstico , Hipertensión Pulmonar/fisiopatología , Imagen por Resonancia Cinemagnética , Pronóstico , Calidad de Vida
15.
Vasc Health Risk Manag ; 15: 533-538, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31824165

RESUMEN

Purpose: Real-world data may provide insight into relationships between high triglycerides (TG), a modifiable cardiovascular (CV) risk factor, and increased heart failure (HF) risk. Patients and methods: This retrospective administrative claims analysis included statin-treated patients aged ≥45 years with diabetes and/or atherosclerotic CV disease enrolled in 2010 and followed for ≥6 months to March 2016. Patients with TG ≥150 mg/dL and a comparator cohort with TG <150 mg/dL and high-density lipoprotein cholesterol >40 mg/dL were included. A sub-analysis was conducted in patients with TG 200-499 mg/dL. Hazard ratios (HR) were calculated from multivariate analyses controlled for patient characteristics and comorbidities using Cox proportional hazard modeling. New diagnosis of HF required diagnosis in the follow-up period without prior evidence of HF. Results: Multivariate analyses revealed a 19% higher rate of new HF diagnosis in the TG ≥150 mg/dL cohort (HR=1.192; 95% confidence interval [CI]=1.134-1.252; P<0.001; n=24,043) and a 24% higher rate in the TG 200-499 mg/dL sub-cohort (HR=1.235; 95% CI=1.160-1.315; P<0.001; n=11,657), each versus the comparator cohort (n=30,218). Conclusion: In a real-world analysis of statin-treated patients with high CV risk, elevated and high TG were significant predictors of new HF diagnosis.


Asunto(s)
Dislipidemias/diagnóstico , Insuficiencia Cardíaca/diagnóstico , Triglicéridos/sangre , Reclamos Administrativos en el Cuidado de la Salud , Anciano , Biomarcadores/sangre , Bases de Datos Factuales , Dislipidemias/sangre , Dislipidemias/tratamiento farmacológico , Dislipidemias/epidemiología , Femenino , Insuficiencia Cardíaca/sangre , Insuficiencia Cardíaca/epidemiología , Humanos , Inhibidores de Hidroximetilglutaril-CoA Reductasas/uso terapéutico , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Pronóstico , Estudios Retrospectivos , Medición de Riesgo , Factores de Riesgo , Estados Unidos/epidemiología , Regulación hacia Arriba
16.
Emergencias (Sant Vicenç dels Horts) ; 31(6): 413-416, dic. 2019. tab
Artículo en Español | IBECS | ID: ibc-185140

RESUMEN

Objetivo. Estudiar la frecuencia de fragilidad física y si su presencia se asocia con la presencia de resultados adversos en el primer año en los pacientes mayores con insuficiencia cardiaca aguda (ICA) dados de alta desde urgencias. Método. Estudio observacional de cohortes prospectivo que incluyó a los pacientes de 75 o más años con ICA dados de alta desde un servicio de urgencias. Se definió la fragilidad física como la presencia de 7 puntos en el Short Physical Performance Battery. La variable de resultado fue la aparición de un evento compuesto (revisita o reingreso por insuficiencia cardiaca y mortalidad por cualquier causa) en los primeros 365 días tras el alta de urgencias. Resultados. Se incluyeron 86 pacientes [edad media: 84 (DE 6 años); 59,3% mujeres]. La presencia de fragilidad se documentó en 49 (57%) pacientes. La frecuencia de la variable de resultado compuesta a los 365 días tras el alta de urgencias fue de un 46,5%. La fragilidad física fue un factor pronóstico independiente de presentar la variable resultado (OR ajustada = 3,6; IC 95% 1,0-12,9; p = 0,047). Conclusiones. La presencia de fragilidad física en los pacientes mayores con ICA dados de alta desde urgencias podría ser un factor pronóstico de malos resultados durante el primer año


Objective. To study the frequency of physical frailty and explore whether its presence in older patients with acute heart failure (AHF) is associated with adverse outcomes in the year after discharge from a emergency department (ED). Methods. Prospective observational cohort study in patients with AHF aged 75 years or older who were discharged from our ED. Physical frailty was defined by a score of 7 or less on the Short Physical Performance Battery. The outcome was the development of a composite event (ED revisit for AHF, hospital readmission for AHF, or all-cause mortality) within 365 days of discharge from the ED. Results. Eighty-six patients with a mean (SD) age of 84 (6) years were included; 59.3% were women. Frailty was identified in 49 patients (57%). The composite outcome was observed in 46.5% within 365 days. Physical fragility was an independent predictor of the outcome (adjusted odds ratio, 3.6; 95% CI, 1.0-12.9; P=.047). Conclusions. Frailty in older patients with AHF may predict a poor outcome during the year following discharge from an emergency department


Asunto(s)
Humanos , Masculino , Femenino , Anciano , Anciano de 80 o más Años , Insuficiencia Cardíaca/diagnóstico , Anciano Frágil , Pronóstico , Alta del Paciente , Servicios Médicos de Urgencia , Estudios de Cohortes , Estudios Prospectivos
17.
Ther Adv Cardiovasc Dis ; 13: 1753944719894509, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31854243

RESUMEN

BACKGROUND: It is known that once heart failure occurs in older patients with diabetes, the overall prognosis is extremely poor. We investigated whether early initiation of SGLT2 inhibitor therapy after admission was beneficial for diabetic patients requiring inpatient treatment for acute heart failure. METHODS: We retrospectively assessed consecutive patients with comorbid diabetes who were admitted to the Department of Cardiology in Tosei General Hospital for treatment of acute heart failure. Patients were divided into two groups: those who initiated SGLT2 inhibitor therapy (SGLT2 inhibitor group; mean age: 73 ± 9 years) and those who did not receive the inhibitors during hospitalization (conventional treatment group; mean age: 75 ± 10 years). RESULTS: No intergroup differences were observed in the distribution of either the severity or classes of heart failure on admission. Glycosylated hemoglobin levels were significantly higher in the SGLT2 inhibitor group (HbA1c: 8.1% ± 0.8%) than in the conventional treatment group (HbA1c: 7.1% ± 0.8%) (p = 0.003). After admission, patients in both groups recovered equally well, and in almost the same period of time, before discharge. The rate of diuretics use at the time of discharge in the SGLT2 inhibitor group (n = 8, 67%) was significantly lower than that in the conventional treatment group (n = 19, 100%) (p = 0.016). In particular, the dose of loop diuretics in the conventional treatment group was 34 ± 4 mg/day while that in the SGLT2 inhibitor group was significantly lower at 13 ± 5 mg/day (p = 0.008). During hospitalization, the incidence of acute kidney injury was significantly higher in the conventional treatment group (n = 11, 58%) than in the SGLT2 inhibitor group (n = 2, 16%) (p = 0.031). CONCLUSIONS: For the treatment and management of heart failure in patients with diabetes, early initiation of SGLT2 inhibitor therapy appears to be effective.


Asunto(s)
Glucemia/efectos de los fármacos , Diabetes Mellitus Tipo 2/tratamiento farmacológico , Insuficiencia Cardíaca/tratamiento farmacológico , Inhibidores del Simportador de Cloruro Sódico y Cloruro Potásico/administración & dosificación , Inhibidores del Cotransportador de Sodio-Glucosa 2/administración & dosificación , Enfermedad Aguda , Lesión Renal Aguda/epidemiología , Lesión Renal Aguda/prevención & control , Anciano , Anciano de 80 o más Años , Biomarcadores/sangre , Glucemia/metabolismo , Comorbilidad , Diabetes Mellitus Tipo 2/sangre , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/epidemiología , Femenino , Hemoglobina A Glucada/metabolismo , Insuficiencia Cardíaca/diagnóstico , Insuficiencia Cardíaca/epidemiología , Insuficiencia Cardíaca/fisiopatología , Humanos , Japón/epidemiología , Masculino , Persona de Mediana Edad , Admisión del Paciente , Supervivencia sin Progresión , Recuperación de la Función , Estudios Retrospectivos , Factores de Riesgo , Inhibidores del Simportador de Cloruro Sódico y Cloruro Potásico/efectos adversos , Inhibidores del Cotransportador de Sodio-Glucosa 2/efectos adversos , Factores de Tiempo
18.
Artículo en Inglés | MEDLINE | ID: mdl-31875779

RESUMEN

BACKGROUND: Heart Failure (HF) is accompanied by a high cost of care and gloomy prognosis despite recent advances in its management. Therefore, efforts to minimize HF rehospitalizations is a major focus of several studies. METHODS: We conducted a retrospective cohort study of 140 patients 18 years and above who had baseline clinical parameters, echocardiography, NT-ProBNP, troponin I and other laboratory parameters following a 3-year electronic medical record review. Patients with coronary artery disease, preserved ejection fraction, pulmonary embolism, cancer, and end-stage renal disease were excluded. RESULTS: Of the 140 patients admitted with HF with reduced Ejection Fraction (HFrEF) secondary to non-ischemic cardiomyopathy, 15 were re-hospitalized within 30 days of discharge while 42 were rehospitalized within 6 months after discharge for decompensated HF. Receiver operating characteristic (ROC) cutoff points were obtained for NT-ProBNP at 5178 pg/ml and serum troponin I at 0.045 ng/ml. After Cox regression analysis, patients with HFrEF who had higher hemoglobin levels had reduced odds of re-hospitalization (p = 0.007) within 30 days after discharge. NT-ProBNP and troponin I were independent predictors of re-hospitalization at 6 months after discharge (p = 0.047 and p = 0.02), respectively, after Cox regression analysis. CONCLUSION: Troponin I and NT-ProBNP at admission are the best predictors of re-hospitalization 6 months after discharge among patients with HFrEF. Hemoglobin is the only predictor of 30 -day rehospitalization among HFrEF patients in this study. High-risk patients may require aggressive therapy to improve outcomes.


Asunto(s)
Cardiomiopatías/complicaciones , Insuficiencia Cardíaca/sangre , Insuficiencia Cardíaca/etiología , Péptido Natriurético Encefálico/sangre , Fragmentos de Péptidos/sangre , Troponina I/sangre , Anciano , Anciano de 80 o más Años , Biomarcadores/sangre , Femenino , Insuficiencia Cardíaca/diagnóstico , Insuficiencia Cardíaca/fisiopatología , Hospitalización , Humanos , Masculino , Persona de Mediana Edad , Pronóstico , Estudios Retrospectivos , Volumen Sistólico
19.
Nan Fang Yi Ke Da Xue Xue Bao ; 39(11): 1273-1279, 2019 Nov 30.
Artículo en Chino | MEDLINE | ID: mdl-31852642

RESUMEN

OBJECTIVE: To investigate the diagnostic value of plasma growth and differentiation factor-15 (GDF-15) level, GDF-15 mRNA expression in circulating mononuclear cells (MNCs), and plasma pro-B-type natriuretic peptide (NT-proBNP) level for heart failure in patients with different underlying cardiac diseases, namely dilated cardiomyopathy (DCM) and coronary artery heart disease (CAD), and assess their value in predicting the severity of heart failure and long-term cardiovascular disease (CVD) events. METHODS: Fasting venous blood samples were collected from 261 patients with DCM and 251 patients with CAD admitted in our hospital between January, 2018 and January, 2019, with 132 healthy individuals serving as the control group. The plasma level of GDF-15 was measured by enzyme-linked immunosorbent assay (ELISA), and the expression of GDF-15 mRNA in the MNCs was measured by real-time PCR. We also analyzed the expression of GDF-15 in patients with different NYHA classes, and the ROC curve was used to evaluate the predictive power of GDF-15 mRNA for CVD events. RESULTS: The plasma levels of GDF-15 and GDF-15 mRNA in the MNCs were significantly higher in patients with DCM and CAD than in the control group (P < 0.01). Plasma GDF-15 levels were significantly higher in NYHA class Ⅳ patients than in class Ⅱ and Ⅲ patients, and GDF-15 mRNA expressions in the MNCs were much higher in class Ⅲ and Ⅳ patients than class Ⅱ patients (P < 0.01). ROC curve analysis showed that for predicting CVD events, the area under the curve (AUC) was 0.73 (95% CI: 0.69-0.77, P < 0.001) for NT-proBNP alone, as compared with 0.83 (95% CI: 0.79-0.86, P < 0.001) for GDF-15 mRNA in the MNCs combined with NT-proBNP. CONCLUSIONS: Plasma GDF-15 level and GDF-15 mRNA expression level in the MNSc can both be used as biomarkers for heart failure. Plasma level of GDF-15 is more sensitive for predicting NYHA class Ⅳ patients with heart failure, while GDF-15 mRNA level in the MNCs better predicts class Ⅱ patients. The combination of NT-proBNP with GDF-15 mRNAlevel in the MNCs can more accurately predict the risk of long-term CVD events.


Asunto(s)
Factor 15 de Diferenciación de Crecimiento/sangre , Insuficiencia Cardíaca , Péptido Natriurético Encefálico/sangre , Fragmentos de Péptidos/sangre , Biomarcadores , Enfermedades Cardiovasculares , Insuficiencia Cardíaca/diagnóstico , Humanos , Valor Predictivo de las Pruebas , Pronóstico
20.
Tex Heart Inst J ; 46(3): 199-202, 2019 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-31708703

RESUMEN

Substantial technological advances in mechanical circulatory support have caused a shift in the management of end-stage heart failure. From the 1970s through the 1990s, heterotopic heart transplantation was routinely performed in patients in whom orthotopic transplantation was likely to fail. Heterotopic heart transplantation is now performed less often because modern mechanical circulatory assist devices are routinely used as bridges to orthotopic transplantation; regardless, the operation has helped numerous patients who would not otherwise have received adequate allografts. We describe the case of a man with idiopathic nonischemic cardiomyopathy who, at age 17, was given an ABO- and size-matched heterotopic allograft that was a complete human leukocyte antigen mismatch. The graft functioned normally for 20 years until the patient had a myocardial infarction that necessitated placement of a coronary artery stent. Subsequent treatments involved many interventions, including insertion of an intra-aortic balloon pump, medical therapy for heart failure, implantation of a total artificial heart, and, ultimately, orthotopic transplantation. To our knowledge, our patient is the longest surviving recipient of a heterotopic heart transplant, with a remarkable 25-year graft survival despite poor histocompatibility and an almost complete lack of native heart function. The strategies used for his treatment make him a living case study that can add valuable information to the history of cardiac support.


Asunto(s)
Insuficiencia Cardíaca/terapia , Trasplante de Corazón/métodos , Corazón Auxiliar , Contrapulsador Intraaórtico/métodos , Adolescente , Estudios de Seguimiento , Supervivencia de Injerto , Insuficiencia Cardíaca/diagnóstico , Humanos , Masculino , Factores de Tiempo , Tomografía Computarizada por Rayos X , Trasplante Heterotópico
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