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1.
Intern Med ; 60(17): 2807-2809, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34470986

RESUMO

Sacubitril/valsartan has demonstrated its prognostic advantageousness over enalapril in patients with heart failure with a reduced ejection fraction. However, the optimal therapeutic strategy using sacubitril/valsartan in real-world practice, particularly among a Japanee cohort, remains uncertain. A 75-year-old man with systolic heart failure and chronic kidney disease was administered sacubitril/valsartan. Plasma B-type natriuretic peptide transiently increased, accompanied by an increase in the urine volume, which allowed us to terminate loop diuretics. The estimated glomerular filtration rate as well as heart failure symptom improved at the one-month follow-up. Sacubitril/valsartan might be a promising option to preserve the renal function and improve clinical outcomes when the dose of concomitant diuretics can be decreased, although further large-scale studies are warranted to validate our hypothesis.


Assuntos
Insuficiência Cardíaca Sistólica , Insuficiência Cardíaca , Insuficiência Renal Crônica , Idoso , Aminobutiratos/uso terapêutico , Antagonistas de Receptores de Angiotensina/uso terapêutico , Compostos de Bifenilo , Combinação de Medicamentos , Insuficiência Cardíaca/complicações , Insuficiência Cardíaca/tratamento farmacológico , Insuficiência Cardíaca Sistólica/tratamento farmacológico , Humanos , Japão , Masculino , Neprilisina , Insuficiência Renal Crônica/complicações , Insuficiência Renal Crônica/tratamento farmacológico , Volume Sistólico , Tetrazóis/uso terapêutico , Resultado do Tratamento , Valsartana/uso terapêutico
2.
J Int Med Res ; 49(9): 3000605211016208, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34510958

RESUMO

OBJECTIVE: This retrospective multicentre observational study was performed to assess the predictors of acute kidney injury (AKI) in patients with acute decompensated heart failure (ADHF) in emergency departments in China. METHODS: In total, 1743 consecutive patients with ADHF were recruited from August 2017 to January 2018. Clinical characteristics and outcomes were compared between patients with and without AKI. Predictors of AKI occurrence and underdiagnosis were assessed in multivariate regression analyses. RESULTS: Of the 1743 patients, 593 (34.0%) had AKI. AKI was partly associated with short-term all-cause mortality and cost. Cardiovascular comorbidities such as coronary heart disease, diabetes mellitus, and hypertension remained significant predictors of AKI in the univariate analysis. AKI was significantly more likely to occur in patients with a lower arterial pH, lower albumin concentration, higher creatinine concentration, and higher N-terminal pro-brain natriuretic peptide (NT-proBNP) concentration. Patients treated with inotropic agents were significantly more likely to develop AKI during their hospital stay. CONCLUSION: This study suggests that cardiovascular comorbidities, arterial pH, the albumin concentration, the creatinine concentration, the NT-proBNP concentration, and use of inotropic agents are predictors of AKI in patients with ADHF.


Assuntos
Injúria Renal Aguda , Insuficiência Cardíaca , Doença Aguda , Injúria Renal Aguda/diagnóstico , Biomarcadores , Serviço Hospitalar de Emergência , Insuficiência Cardíaca/complicações , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/epidemiologia , Humanos , Peptídeo Natriurético Encefálico , Fragmentos de Peptídeos , Prognóstico , Estudos Retrospectivos
3.
Soins Gerontol ; 26(151): 24-27, 2021.
Artigo em Francês | MEDLINE | ID: mdl-34462108

RESUMO

Acute cardiogenic pulmonary oedema in the elderly does not differ fundamentally from that seen in the young patient. Appropriate pathways must be established, with regular nursing follow-up, to enable rapid detection and treatment of episodes of acute heart failure. The paramedical team plays an essential role in liaising with families, providing nursing care and listening to the patient at the bedside.


Assuntos
Insuficiência Cardíaca , Edema Pulmonar , Idoso , Insuficiência Cardíaca/complicações , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/terapia , Humanos , Edema Pulmonar/diagnóstico , Edema Pulmonar/etiologia , Edema Pulmonar/terapia
4.
Bratisl Lek Listy ; 122(9): 636-642, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34463109

RESUMO

PURPOSE: The geriatric nutritional risk index (GNRI) is a simple and objective nutritional assessment tool for elderly patients. Lower GNRI values are associated with a worse prognosis in heart failure with reduced ejection fraction (HFrEF). Our aim is to investigate the relationship between malnutrition and follow-up cardiovascular (CV) events in HFrEF. METHODS: A retrospective study was performed on 362 patients with HFrEF. The baseline GNRI was calculated at the first visit. The patients were divided into three groups according to the GNRI: >98, no-risk group; 92 to ≤98, low risk group; 82 to <92, moderate­to­high­risk group. The study endpoint was a composite of follow-upCV events, including all-cause mortality, non-valvular atrial fibrillation (NVAF) , need for cardioverter defibrillator (ICD) therapy, HfrEF­related hospitalizations and need for percutaneous coronary interventions (PCIs). RESULTS: Follow-up data showed that the group with moderate-to-high risk had a significantly higher incidence of NVAF, PCIs and all-cause mortality compared to other groups (p<0.001, p: 0.026 and p0.05). Mean GNRI value was 83.3 in NVAF patients and 101.1 in patients without NVAF (p<0.001). Kaplan Meier survival analysis showed that patients from the group with moderate-to-high risk had a significantly worse survival rate (p < 0.001). In the multivariate Cox regression analysis, the group with moderate-to­high risk (HR=3.872) and ICD implantations (HR=4.045) were associated with increased mortality. CONCLUSION: The GNRI value may have a potential role for predicting future events, especially NVAF in patients with HfrEF (Tab. 4, Fig. 2, Ref. 27).


Assuntos
Fibrilação Atrial , Insuficiência Cardíaca , Idoso , Fibrilação Atrial/complicações , Fibrilação Atrial/epidemiologia , Fibrilação Atrial/terapia , Avaliação Geriátrica , Insuficiência Cardíaca/complicações , Insuficiência Cardíaca/epidemiologia , Insuficiência Cardíaca/terapia , Humanos , Prognóstico , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Volume Sistólico
5.
Zhong Nan Da Xue Xue Bao Yi Xue Ban ; 46(7): 689-696, 2021 Jul 28.
Artigo em Inglês, Chinês | MEDLINE | ID: mdl-34382584

RESUMO

OBJECTIVES: Tumor necrosis factor α stimulated gene 6 (TSG-6) protein is an inflammation-inducing protein. In recent years, TSG-6 protein has been found to play an anti-inflammatory and anti-fibrosis role in a variety of disease models. The level of TSG-6 protein in circulating blood is considered to be a biological indicator for the evaluation of acute coronary syndrome, severe infection, and other diseases, and it is closely related to the prognosis. The clinical correlation between TSG-6 protein and dilated cardiomyopathy (DCM) patients with heart failure has not been reported. This study aims to investigate the changes of plasma TSG-6 protein levels in cardiomyopathy patients with heart failure and its correlation with cardiac function, myocardial fibrosis, and prognosis. METHODS: Based on the prospective studies, a number of 90 DCM patients with heart failure were selected as a DCM heart failure group from Dec.1, 2019 to Sept.1, 2020. Thirty-nine healthy people were served as a control group. Plasma TSG-6, Collagen Ⅰ, Collagen III, and α-smooth muscle actin (α-SMA) were measured with ELISA test. Echocardiography was used to evaluate the structure and function of the heart. DCM patients with heart failure were followed up for 3 months. The patients were assigned into 2 groups according to whether they had major adverse cardiovascular events (MACE). The general clinical data, plasma TSG-6, Collagen Ⅰ, Collagen III, and α-SMA protein levels were compared between the control group and the DCM heart failure group. At the same time, the correlation between plasma TSG-6 protein level and cardiac function grade, myocardial fibrosis or prognosis of patients in the DCM heart failure group was analyzed. RESULTS: Compared with the control group, the heart rate, TSG-6, Collagen Ⅰ, Collage III, α-SMA, hemoglobin, atrial natriuretic peptide (NT-proBNP), hypersensitive C-reactive protein, aspartate aminotransferase, serum creatinine, lactate dehydrogenase, and left ventricular end diastolic diameter (LVEDD) increased significantly (all P<0.001). High-density lipoprotein, left ventricular short axis shortening rate (LVFS), and left ventricular ejection fraction (LVEF) decreased significantly in the DCM heart failure group (all P<0.001). Plasma levels of TSG-6 were positively correlated with NT-proBNP, Collagen Ⅰ, Collagen III, α-SMA, and LVEDD (all P<0.001), while they were negatively correlated with LVFS and LVEF (all P<0.001). With the increase of NYHA heart function classification, plasma levels of TSG-6, Collagen Ⅰ, Collagen III, and α-SMA increased significantly (all P<0.001). The increases in plasma levels of NT-proBNP and TSG-6 was associated with poor prognosis in DCM patients with heart failure (all P<0.05). The sensitivity and specificity of plasma NT-proBNP for evaluating the prognosis of DCM heart failure were 76.2% and 68.1%, respectively. The sensitivity and specificity of plasma TSG-6 for evaluating the prognosis of DCM heart failure were 95.2% and 66.7%, respectively. The sensitivity and specificity of plasma TSG-6 combined with NT-proBNP for prognostic evaluation of DCM heart failure were 85.7% and 81.2%, respectively. The specificity of plasma TSG-6 combined with NT-proBNP for the prognosis of heart failure was better than that of NT-proBNP or TSG-6 alone (P<0.001). CONCLUSIONS: The plasma levels TSG-6 in DCM patients with heart failure increase significantly, and the plasma levels TSG-6 could be used as a new predictor for cardiac function, myocardial fibrosis, and prognosis.


Assuntos
Cardiomiopatia Dilatada , Moléculas de Adesão Celular/sangue , Insuficiência Cardíaca , Miocárdio/patologia , Cardiomiopatia Dilatada/complicações , Cardiomiopatia Dilatada/diagnóstico , Fibrose , Insuficiência Cardíaca/complicações , Insuficiência Cardíaca/diagnóstico , Humanos , Peptídeo Natriurético Encefálico , Fragmentos de Peptídeos , Prognóstico , Estudos Prospectivos , Volume Sistólico , Função Ventricular Esquerda
6.
Medicine (Baltimore) ; 100(32): e26892, 2021 Aug 13.
Artigo em Inglês | MEDLINE | ID: mdl-34397913

RESUMO

ABSTRACT: There was no previous report on the prognostic impact of new-onset or improved anemia after discharge from acute decompensated heart failure (ADHF).We analyzed 771 patients with ADHF and who were followed in multicenters in Japan was divided into 4 groups based on the hemoglobin values at discharge and 6-month index visit: 373 patients (48.4%) with persistent anemia, 87 patients (11.3%) with new-onset anemia, 91 patients (11.8%) with improved anemia, and 220 patients (28.5%) without anemia.The primary outcome measure was a composite of all-cause death or HF hospitalization after index visit. The cumulative 6-month incidences of the primary outcome measure were 25.2% for persistent anemia, 18.5% for new onset anemia, 9.0% for improved anemia, and 9.2% for no anemia (log-rank P < .001). Compared with the no anemia group, the excess risk for the primary outcome measure remained significant in the persistent anemia group [hazard ratio (HR) 2.70, 95% confidence interval (95% CI), 1.45-5.44, P = .001] and in the new-onset anemia group (HR 2.73, 95% CI 1.19-6.25, P = .02), while it was not significant in the improved anemia group (HR 1.69, 95% CI 0.68-4.03, P = .25).Persistent and new-onset anemia at 6-month visit were associated with a subsequent higher risk for all-cause death or HF hospitalization in patients with ADHF, suggesting the importance of detecting anemia during follow-up.


Assuntos
Anemia/epidemiologia , Insuficiência Cardíaca/complicações , Volume Sistólico/fisiologia , Doença Aguda , Idoso , Idoso de 80 Anos ou mais , Anemia/etiologia , Feminino , Seguimentos , Insuficiência Cardíaca/fisiopatologia , Humanos , Japão/epidemiologia , Masculino , Prognóstico , Estudos Prospectivos
7.
Medicine (Baltimore) ; 100(32): e26919, 2021 Aug 13.
Artigo em Inglês | MEDLINE | ID: mdl-34397933

RESUMO

BACKGROUND: Nearly half of patients with heart failure (HF) have preserved ejection fraction (EF) and the mortality and morbidity of patients with HF with preserved EF (HFpEF) are high. However, there is no established therapy to improve survival in these patients. HFpEF patients are often elderly and their primary chronic symptom is severe exercise intolerance. Thus, improvement of exercise capacity presents another important clinical outcome in HFpEF patients. Iron deficiency is common in HF patients, and the presence of iron deficiency, regardless of concomitant anemia, is associated with worse symptoms, impaired exercise capacity, and higher mortality and hospitalization in these patients. Several meta-analyses of randomized controlled trials reported that iron administration improved HF symptoms, exercise capacity, and clinical outcomes in iron-deficiency patients with HF with reduced EF. However, there is insufficient evidence as to the effect of iron administration in iron-deficiency HFpEF patients. METHODS AND RESULTS: This meta-analysis will include randomized controlled trials on the effects of iron administration on HF symptoms, exercise capacity, and health-related quality of life in iron-deficiency HFpEF patients. Information of studies will be collected from PubMed, Web of Science, Cochrane Library, and ClinicalTrials.gov. The primary outcome will be exercise capacity (6-minute walking distance). The secondary outcomes will be HF symptoms, health-related quality of life, and mortality and hospitalization rates. CONCLUSION: This meta-analysis will evaluate the effect of iron therapy in iron-deficiency HFpEF patients, providing evidence as to the iron administration in these patients. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42020205297.


Assuntos
Anemia Ferropriva/terapia , Insuficiência Cardíaca/terapia , Ferro/uso terapêutico , Volume Sistólico/fisiologia , Função Ventricular Esquerda/fisiologia , Anemia Ferropriva/complicações , Insuficiência Cardíaca/complicações , Insuficiência Cardíaca/fisiopatologia , Humanos , Qualidade de Vida
8.
Medicine (Baltimore) ; 100(33): e26875, 2021 Aug 20.
Artigo em Inglês | MEDLINE | ID: mdl-34414939

RESUMO

BACKGROUND: Elevated homocysteine (Hcy) levels showed increasing significance as the predisposing factor for the pathogenesis of atherosclerotic sequelae, including cardiovascular mortality, coronary artery disease, and stroke. There is increasing evidence linking plasma Hcy levels and heart failure (HF). The association between the elevated level of plasma Hcy and HF was examined by meta-analysis and systematic review in this study. METHODS: The PubMed and ScienceDirect databases until April 2020 were utilized to collect previous literature on plasma Hcy levels and the potential relation to HF. The pooled effects were evaluated depending on standardized mean differences (SMDs) with 95% confidence intervals (CIs), and the calculation was performed using Stata 12 software. Potential sources of heterogeneity were assessed with subgroup analysis and sensitivity analysis. RESULTS: A total of 12 research projects including 5506 subjects were selected. For pooled effect, the results confirmed that patients with HF had higher Hcy levels than the control subjects (SMD,1.148 and 95%CI, [0.715, 1.581]). Based on the classification of New York Heart Association (NYHA), the Hcy levels for the group of NYHA I or II (SMD, 1.484 and 95% CI, [0.442, 2.527]) and the group of NYHA III or IV (SMD, 3.361 and 95% CI, [1.902, 4.820]) were significantly increased compared to controls, while the increase was more intensive for the group of NYHA III or IV. Subgroup analyses revealed similar results. CONCLUSION: Our meta-analysis identified that plasma Hcy levels were significantly elevated in HF patients compared to control subjects, which is positively related to the advancement of NYHA class.


Assuntos
Insuficiência Cardíaca/sangue , Insuficiência Cardíaca/complicações , Homocisteína/sangue , Humanos
9.
Biomed Res Int ; 2021: 6733341, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34337047

RESUMO

The study is aimed at investigating the changes in expressions of heat shock protein 27 (HSP27), HSP70, and soluble glycoprotein (SGP) in heart failure (HF) rats complicated with pulmonary edema and exploring their potential correlations with cardiopulmonary functions. The rat model of HF was established, and the rats were divided into HF model group (model group, n = 15) and normal group (n = 15). After successful modeling, MRI and ECG were applied to detect the cardiac function indexes of the rats. The myocardial function indexes were determined, the injury of myocardial tissues was observed via hematoxylin and eosin (HE) staining, and the content of myeloperoxidase (MPO), matrix metalloproteinase-9 (MMP-9), and tumor necrosis factor-alpha (TNF-α) in the blood was measured. The partial pressure of oxygen (PaO2) and oxygenation index (OI) were observed, and the airway resistance and lung compliance were examined. Moreover, quantitative polymerase chain reaction (qPCR) and Western blotting assay were performed to detect the gene and protein expression levels of HSP27, HSP70, and SGP130. The levels of serum creatine kinase (CK), creatine (Cr), and blood urea nitrogen (BUN) were increased markedly in model group (p < 0.05). Model group had notably decreased fractional shortening (FS) and ejection fraction (EF) compared with normal group (p < 0.05), while the opposite results of left ventricular end-diastolic diameter (LVEDD) and left ventricular end-systolic diameter (LVESD) were detected. In model group, the content of serum MPO, MMP-9, and TNF-α was raised remarkably (p < 0.05), OI and PaO2 were reduced notably (p < 0.05), the airway resistance was increased (p < 0.05), and the lung compliance was decreased (p < 0.05). Obviously elevated gene and protein expression levels of HSP27, HSP70, and SGP130 were detected in model group (p < 0.05). The expressions of HSP27, HSP70, and SGP130 are increased in HF rats complicated with pulmonary edema, seriously affecting the cardiopulmonary functions of the rats.


Assuntos
Regulação da Expressão Gênica , Glicoproteínas/genética , Proteínas de Choque Térmico HSP27/genética , Proteínas de Choque Térmico HSP70/genética , Insuficiência Cardíaca/complicações , Insuficiência Cardíaca/fisiopatologia , Edema Pulmonar/complicações , Edema Pulmonar/fisiopatologia , Resistência das Vias Respiratórias , Animais , Nitrogênio da Ureia Sanguínea , Complacência (Medida de Distensibilidade) , Creatina Quinase/sangue , Creatinina/sangue , Glicoproteínas/metabolismo , Proteínas de Choque Térmico HSP27/metabolismo , Proteínas de Choque Térmico HSP70/metabolismo , Insuficiência Cardíaca/sangue , Insuficiência Cardíaca/genética , Metaloproteinase 9 da Matriz/metabolismo , Oxigênio/metabolismo , Pressão Parcial , Peroxidase/metabolismo , Edema Pulmonar/sangue , Edema Pulmonar/genética , Ratos Sprague-Dawley , Solubilidade , Fator de Necrose Tumoral alfa/metabolismo
10.
Am J Nurs ; 121(9): 25, 2021 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-34438427

RESUMO

Dapagliflozin (Farxiga) is now approved to reduce the risk of declining kidney function, kidney failure, cardiovascular death, and hospitalization for heart failure in adults with chronic kidney disease with or without type 2 diabetes.


Assuntos
Compostos Benzidrílicos/uso terapêutico , Complicações do Diabetes/prevenção & controle , Diabetes Mellitus Tipo 2/tratamento farmacológico , Glucosídeos/uso terapêutico , Insuficiência Cardíaca/prevenção & controle , Hipoglicemiantes/uso terapêutico , Inibidores do Transportador 2 de Sódio-Glicose/uso terapêutico , Insuficiência Cardíaca/complicações , Humanos , Nefropatias , Fatores de Tempo
11.
FP Essent ; 506: 27-30, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34264590

RESUMO

When evaluating patients for left-sided heart failure (HF), physicians should consider right-sided HF as well. There is significant crossover in symptoms, and these conditions frequently are seen together. Common causes of acute right-sided HF include pulmonary embolism and hypoxemia. Pulmonary hypertension is a common cause of chronic right-sided HF. Given the physiology of the right side of the heart, management of underlying conditions is vital to restoring function regardless of whether the right-sided HF is acute or chronic. It is important to consider fluid status, preload and afterload, in management. In situations in which medical management is ineffective, temporary mechanical circulatory support can be considered, as well as evaluation for heart and/or lung transplantation.


Assuntos
Insuficiência Cardíaca , Hipertensão Pulmonar , Doença Crônica , Insuficiência Cardíaca/complicações , Insuficiência Cardíaca/terapia , Humanos , Hipertensão Pulmonar/complicações , Hipertensão Pulmonar/diagnóstico , Hipertensão Pulmonar/terapia
12.
Acta Biomed ; 92(3): e2021195, 2021 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-34212936

RESUMO

Background Frailty is a multifactorial physiological syndrome most often associated with age but which has received increasing recognition as a component of chronic illnesses such as heart failure. Patients with heart failure are likely to be frail, irrespective of their age. Adipokine dysregulation, which is associated with frailty, occurs in patients with heart failure. In this study, we tested the hypothesis that adipokines are associated with frailty in patients with heart failure. Methods Thirty-five patients with heart failure (age, 67 ± 14 years; 25 males; left ventricular ejection fraction, 45 ± 19%) were included. Serum adipokine levels, physical performance, and body composition were measured. Results Adiponectin and leptin were inversely correlated with grip strength. Adiponectin was inversely correlated with bone mineral density. Leptin was positively correlated with fat mass. Adipokines were not correlated with skeletal muscle mass. Conclusions Adipokines were associated with frailty in patients with heart failure. Adipokine dysregulation may play a role in the development of frailty in heart failure.


Assuntos
Adipocinas , Fragilidade , Insuficiência Cardíaca , Idoso , Idoso de 80 Anos ou mais , Feminino , Fragilidade/complicações , Insuficiência Cardíaca/complicações , Humanos , Leptina , Masculino , Pessoa de Meia-Idade , Volume Sistólico , Função Ventricular Esquerda
13.
Tex Heart Inst J ; 48(3)2021 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-34243189

RESUMO

Aortic insufficiency with recirculation can be difficult to diagnose echocardiographically in patients who have continuous-flow left ventricular assist devices. Transthoracic and transesophageal echocardiography can underestimate its severity; moreover, transesophageal echocardiography necessitates general anesthesia. We report the case of a 58-year-old man with obesity and end-stage nonischemic cardiomyopathy who, after 3 months of support with a continuous-flow left ventricular assist device, underwent intracardiac echocardiography to evaluate complications potentially associated with the device. The findings ruled out aortic insufficiency, preventing an unnecessary valvular intervention.


Assuntos
Ecocardiografia/métodos , Insuficiência Cardíaca/diagnóstico , Ventrículos do Coração/diagnóstico por imagem , Coração Auxiliar , Obesidade/complicações , Função Ventricular Esquerda/fisiologia , Progressão da Doença , Insuficiência Cardíaca/complicações , Insuficiência Cardíaca/terapia , Ventrículos do Coração/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Desenho de Prótese , Índice de Gravidade de Doença
14.
Am J Cardiol ; 155: 72-77, 2021 09 15.
Artigo em Inglês | MEDLINE | ID: mdl-34274114

RESUMO

A recent study suggested that the CHA2DS2-VASc score can risk stratify heart failure (HF) patients without atrial fibrillation (AF) for stroke. We performed a retrospective analysis using the national Veteran Affairs database to externally validate the findings. Crude incidence rates of end points were calculated. A Cox proportional model was used to study the association between the CHA2DS2-VASc score and outcomes. In HF patients with AF (n = 17,481) and without AF (n = 36,935), the 1 year incidence rate for ischemic stroke, thromboembolism, thromboembolism (without MI), and death were 2.7 and 2.0%; 10.3 and 7.9%; 4.1 and 3.1%; and 19.2 and 26.0%, respectively, with higher rates with increasing CHA2DS2-VASc scores both with and without AF. CHA2DS2-VASc score predicted strokes in HF patients without AF (1-year C-statistic 0.62, 95% CI 0.60-0.64; NPV 85.4%, 95% CI 83.4-87.4%) with similar predictive ability to those with AF (C-statistic 0.59, 95% CI 0.56-0.62; NPV 86.4%, 95% CI 82.6-90.2%). Among patients with HF, there was an increased risk of stroke, thromboembolism, and death with increasing CHA2DS2-VASc scores regardless of AF status. Our findings support the use of the CHA2DS2-VASc score as a prognostic tool in HF.


Assuntos
Fibrilação Atrial/complicações , Insuficiência Cardíaca/complicações , Medição de Risco/métodos , Acidente Vascular Cerebral/epidemiologia , Idoso , Fibrilação Atrial/diagnóstico , Feminino , Seguimentos , Insuficiência Cardíaca/diagnóstico , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/etiologia , Taxa de Sobrevida/tendências , Estados Unidos/epidemiologia
15.
Am J Cardiol ; 155: 78-85, 2021 09 15.
Artigo em Inglês | MEDLINE | ID: mdl-34275590

RESUMO

The prevalence of diabetes mellitus (DM) in hospitalized heart failure (HF) patients is increasing over time. However, the effect of DM on short-term readmissions for HF is not well established. We investigated the effects of DM on readmissions of HF patients. All adult hospitalizations with a primary diagnosis of HF were identified in the National Readmission Database (NRD) for 2018 and were categorized into those with and without a secondary diagnosis of DM. The primary outcome was to assess risk difference in 30 and 90-day all-cause readmissions. Multivariate Cox survival analysis and multivariate Cox regression were performed to estimate the readmission risk difference in HF patients with and without DM. Of 925,637 HF hospitalizations that met the inclusion criteria, 441,295 (47.6%) had concomitant DM. Diabetics hospitalized for HF had higher prevalence of obesity (37.3% vs 19.5%), kidney disease (58.4% vs 29.2%) and coronary disease (61.1% vs 51.0%), compared to HF hospitalizations without DM. In adjusted analyses, DM was associated with higher hazards for all-cause [hazards ratio (HR), 30 days: 1.04 (1.02-1.06); 90 days: 1.07 (1.05-1.09)], HF [HR, 30 days: 1.05 (1.02-1.07); 90 days: 1.08 (1.05-1.10)] and myocardial infarction (MI) [HR, 30 days: 1.26 (1.12-1.41); 90 days: 1.38 (1.25-1.52)] readmissions. In conclusion, in patients with HF-related hospitalizations, the presence of DM was associated with a higher risk of 30 and 90-day all-cause, HF and MI readmissions.


Assuntos
Diabetes Mellitus/epidemiologia , Insuficiência Cardíaca/complicações , Readmissão do Paciente/tendências , Adolescente , Adulto , Idoso , Causas de Morte/tendências , Feminino , Seguimentos , Insuficiência Cardíaca/terapia , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Retrospectivos , Taxa de Sobrevida/tendências , Fatores de Tempo , Estados Unidos/epidemiologia , Adulto Jovem
16.
Am J Cardiol ; 155: 96-102, 2021 09 15.
Artigo em Inglês | MEDLINE | ID: mdl-34315571

RESUMO

In patients with moderate aortic stenosis (AS), heart failure (HF) symptoms are often unrelated to the AS severity, and the causes of HF symptoms are often unclear. Hypertension is known as one of the most common comorbidities in degenerative AS. Therefore, we assessed the impact of systolic blood pressure (BP) on HF symptoms in patients with moderate AS. We retrospectively analyzed 317 patients with moderate AS (mean transaortic pressure gradient 20 to 39 mm Hg) and preserved left ventricular ejection fraction (left ventricular ejection fraction ≥50%). We classified patients according to the presence or absence of HF symptoms. One hundred patients (32%) had HF symptoms. Symptomatic patients had higher systolic BP (141±21 versus 129±21 mm Hg; p<0.001) and mean transaortic pressure gradient, and lower aortic valve area than asymptomatic patients. In the multivariable analysis after adjustment for age, atrial fibrillation, Charlson comorbidity index, brain natriuretic peptide, and the use of diuretics, HF symptoms in patients with moderate AS were independently associated with systolic BP (odds ratio, 1.43 per 10 mm Hg increase in systolic BP; 95% confidence interval, 1.14-1.78; p=0.001) and left atrial volume index (odds ratio, 1.04 per 1 mL/m2 increase in left atrial volume index; 95% confidence interval, 1.00-1.08; p=0.026). Receiver operating characteristics curve analysis identified systolic BP 133 mm Hg as the cutoff value associated with HF symptoms. In conclusion, systolic BP as well as left atrial volume index were independent correlates of HF symptoms in patients with moderate AS.


Assuntos
Estenose da Valva Aórtica/complicações , Pressão Sanguínea/fisiologia , Insuficiência Cardíaca/fisiopatologia , Ventrículos do Coração/fisiopatologia , Hipertensão/fisiopatologia , Idoso , Idoso de 80 Anos ou mais , Estenose da Valva Aórtica/fisiopatologia , Feminino , Seguimentos , Insuficiência Cardíaca/complicações , Humanos , Hipertensão/etiologia , Masculino , Estudos Retrospectivos , Fatores de Risco , Volume Sistólico/fisiologia
17.
BMJ ; 373: n1421, 2021 06 30.
Artigo em Inglês | MEDLINE | ID: mdl-34193442

RESUMO

OBJECTIVES: To define prevalence, long term outcome, and treatment standards of secondary mitral regurgitation (sMR) across the heart failure spectrum. DESIGN: Large scale cohort study. SETTING: Observational cohort study with data from the Viennese community healthcare provider network between 2010 and 2020, Austria. PARTICIPANTS: 13 223 patients with sMR across all heart failure subtypes. MAIN OUTCOME MEASURES: Association between sMR and mortality in patients assigned by guideline diagnostic criteria to one of three heart failure subtypes: reduced, mid-range, and preserved ejection fraction, was assessed. RESULTS: Severe sMR was diagnosed in 1317 patients (10%), correlated with increasing age (P<0.001), occurred across the entire spectrum of heart failure, and was most common in 656 (25%) of 2619 patients with reduced ejection fraction. Mortality of patients with severe sMR was higher than expected for people of the same age and sex in the same community (hazard ratio 7.53; 95% confidence interval 6.83 to 8.30, P<0.001). In comparison with patients with heart failure and no/mild sMR, mortality increased stepwise with a hazard ratio of 1.29 (95% confidence interval 1.20 to 1.38, P<0.001) for moderate and 1.82 (1.64 to 2.02, P<0.001) for severe sMR. The association between severe sMR and excess mortality was consistent after multivariate adjustment and across all heart failure subgroups (mid-range ejection fraction: hazard ratio 2.53 (95% confidence interval 2.00 to 3.19, P<0.001), reduced ejection fraction: 1.70 (1.43 to 2.03, P<0.001), and preserved ejection fraction: 1.52 (1.25 to 1.85, P<0.001)). Despite available state-of-the-art healthcare, high volume heart failure, and valve disease programmes, severe sMR was rarely treated by surgical valve repair (7%) or replacement (5%); low risk transcatheter repair (4%) was similarly seldom used. CONCLUSION: Secondary mitral regurgitation is common overall, increasing with age and associated with excess mortality. The association with adverse outcome is significant across the entire heart failure spectrum but most pronounced in those with mid-range and reduced ejection fractions. Despite these poor outcomes, surgical valve repair or replacement are rarely performed; similarly, low risk transcatheter repair, specifically in the heart failure subsets with the highest expected benefit from treatment, is seldom used. The current data suggest an increasing demand for treatment, particularly in view of an expected increase in heart failure in an ageing population.


Assuntos
Insuficiência Cardíaca/complicações , Insuficiência da Valva Mitral/etiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Áustria/epidemiologia , Bases de Dados Factuais , Feminino , Seguimentos , Insuficiência Cardíaca/mortalidade , Humanos , Masculino , Pessoa de Meia-Idade , Insuficiência da Valva Mitral/diagnóstico , Insuficiência da Valva Mitral/epidemiologia , Insuficiência da Valva Mitral/terapia , Prevalência , Sistema de Registros , Fatores de Risco , Índice de Gravidade de Doença , Análise de Sobrevida , Resultado do Tratamento
18.
Georgian Med News ; (314): 107-110, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-34248037

RESUMO

Anemia and iron deficiency (ID) are important and common comorbidities that often coexist in patients with heart failure (HF). Both conditions, together or independently, are associated with poor clinical status and worse outcomes. The aim of our research was to study prevalence and clinical impact of ID and anemia in HF patients attending cardiology department of our hospital. We studied 133 patients with HF who have been admitted to hospital since September 2019: 78 (58.6%) patient had ID, 55 (42.4%) with HF and without ID were included in the control group. Patient baseline assessment included a standardized HF history regarding HF etiology (classified as ischemic or non-ischemic) and co-morbidities. All patients underwent a standardized clinical evaluation, including physical examination, determination of NYHA class. Blood samples were drawn for the assessment of a full blood count and clinical chemistry, including iron and serum ferritin and kidney function (creatinine). Assessment of exercise capacity was performed by a 6-min walk test. ID was present in 78(58.6%) patients. 70(52.6%) patients from 133 presented with anemia. Most patients in both groups are men, patients with ID were elderly, in both groups, most patients had arterial hypertension, more patients with ID had diabetes mellitus, HF etiology was predominantly ischemic in both groups, most patients were with NYHA class III, patients with ID had significantly low LVEF. No differences were recorded for body weight, diastolic blood pressure, platelets, eGFR or serum creatinine, no such differences were found regarding hypertension and chronic obstructive pulmonary disease. There was a highly significant association between hemoglobin and serum ferritin in patients with ID, but in patients without ID, this association was only of borderline significance. The presence of anemia, ID, or both was associated with significantly higher NYHA class. We found that gender, NYHA class, LVEF, the presence of anemia, eGFR all predicted lower exercise capacity.


Assuntos
Anemia Ferropriva , Anemia , Insuficiência Cardíaca , Idoso , Anemia/complicações , Anemia/epidemiologia , Anemia Ferropriva/complicações , Anemia Ferropriva/epidemiologia , Insuficiência Cardíaca/complicações , Insuficiência Cardíaca/epidemiologia , Hospitais , Humanos , Masculino , Prevalência
19.
Intern Med ; 60(13): 2093-2095, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34193775

RESUMO

Hyperkalemia is a challenging comorbidity to manage in patients with heart failure and chronic kidney disease, particularly when administering renin-angiotensin-aldosterone system inhibitors. We encountered an 88-year-old woman with hypertensive heart failure and chronic kidney disease. A mineralocorticoid receptor antagonist was able to be safely administered despite persistent hyperkalemia when sodium zirconium cyclosilicate, a non-absorbed, non-polymer zirconium silicate compound that preferentially exchanges hydrogen and sodium for potassium and ammonium ions in the gastrointestinal tract, was concomitantly administered. Sodium zirconium cyclosilicate might be a promising therapeutic tool to use in order to administer mineralocorticoid receptor antagonist safely in patients with heart failure, chronic kidney disease, and hyperkalemia.


Assuntos
Insuficiência Cardíaca , Hiperpotassemia , Idoso de 80 Anos ou mais , Feminino , Insuficiência Cardíaca/complicações , Insuficiência Cardíaca/tratamento farmacológico , Humanos , Hiperpotassemia/tratamento farmacológico , Antagonistas de Receptores de Mineralocorticoides/uso terapêutico , Potássio , Sistema Renina-Angiotensina , Silicatos/uso terapêutico
20.
Int Heart J ; 62(4): 843-849, 2021 Jul 30.
Artigo em Inglês | MEDLINE | ID: mdl-34276009

RESUMO

The DAPA-HF trial demonstrated that sodium-glucose cotransporter 2 inhibitors (SGLT2i) reduced worsening heart failure (HF) events in chronic HF patients with or without type 2 diabetic mellitus (T2DM). However, it remains unclear whether the effectiveness of SGLT2i is also observed in patients with decompensated HF irrespective of HbA1c level. Eighty-one T2DM patients hospitalized due to decompensated HF were enrolled and divided into 2 groups according to their HbA1c levels (group H, HbA1c 6.9-13.0%, n = 41; group L, HbA1c < 6.9%, n = 40). After the initial management of HF, one of the SGLT2i (canagliflozin 100 mg/day or dapagliflozin 5 mg/day or empagliflozin 10 mg/day) was non-randomly administered, and clinical parameters associating with HF and T2DM were followed for 7 days. No symptomatic hypoglycemia was observed in any patient. In both groups, urine glucose excretion was increased significantly after the administration of SGLT2i. However, its amount was greater in group H than group L. Urine volume was increased significantly at day 1 in both groups. Urine volume returned to the baseline after one week in group L. In contrast, the increase in urine volume persisted at least for one week in group H. Of note, a decrease in B-type natriuretic peptide levels after the initiation of SGLT2i was observed in both groups similarly despite differences in urine output and excretion of urine glucose. In conclusion, SGLT2i can improve decompensated HF in patients with T2DM irrespective of the HbA1c level.


Assuntos
Diabetes Mellitus Tipo 2/tratamento farmacológico , Hemoglobina A Glicada/metabolismo , Insuficiência Cardíaca/tratamento farmacológico , Inibidores do Transportador 2 de Sódio-Glicose/uso terapêutico , Idoso , Idoso de 80 Anos ou mais , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/urina , Feminino , Insuficiência Cardíaca/sangue , Insuficiência Cardíaca/complicações , Insuficiência Cardíaca/urina , Humanos , Masculino , Estudos Prospectivos
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