- Acute kidney injury: a clinical issue in hospitalized heart failure patients with mid-range ejection fraction. [Journal Article]
- PAPol Arch Intern Med 2018 Nov 09
- Introduction Acute kidney injury (AKI) during hospitalization is associated with a mortality increase in patients with acute heart failure (AHF). In 2016, the European Society of Cardiology introduce...
Introduction Acute kidney injury (AKI) during hospitalization is associated with a mortality increase in patients with acute heart failure (AHF). In 2016, the European Society of Cardiology introduced the category of HF with mid-range ventricular ejection fraction (HFmrEF) as a distinct stratum, between the HF conditions with preserved ejection fraction (HFpEF) and reduced ejection fraction (HFrEF). Objectives Evaluating the AKI-associated in-hospital mortality risk in AHF patients, with a focus on the HFmrEF group. Patients and methods A total of 365 health records of patients with a primary diagnosis of acute decompensated heart failure (ADHF) were reviewed and evaluated. AKI was defined according to Acute Kidney Injury Network criteria. HF was diagnosed based on the Framingham criteria. ADHF patients were evaluated as three separate groups, based on their ventricular ejection fraction: HFpEF ( 50%), HFmrEF (40 - 49%), and HFrEF (< 40%). Risk and survival analyses were conducted on de-identified data. Results The AKI-associated in-hospital mortality ORs for the HFmrEF and HFrEF groups were high and statistically significant: 4.55 (95%CI 1.46 - 14.18) and 2.59 (95%CI 1.05 - 6.41), respectively, with a highly significant difference between these two ejection fraction strata (Mantel-Haenszel test; p=0.002). Cox proportional hazards modeling HRs were: 4.79 (95%CI 1.54 - 14.96) and 2.94 (95%CI 1.27 - 6.80) for HFmrEF and HFrEF groups, respectively. Conclusions AKI was significantly associated with higher risk of mortality in patients with HFmrEF when compared to those with HFrEF condition, suggesting a stronger prognostic impact of AKI in the HFmrEF borderline condition.
- History of Atrial Fibrillation and Trajectory of Decongestion in Acute Heart Failure. [Journal Article]
- JHJACC Heart Fail 2018 Nov 05
- CONCLUSIONS: More than half of the patients admitted with AHF had a history of AF/AFL. History of AF/AFL was independently associated with a blunted course of in-hospital decongestion. Further research is required to understand the utility of specific therapies targeting AF/AFL during hospitalization for AHF.
- Elevated coagulation factor levels affect the tissue factor-threshold in thrombin generation. [Journal Article]
- TRThromb Res 2018 Oct 25; 172:104-109
- CONCLUSIONS: Our findings support a mediating role for the TF-threshold in the association between high procoagulant factor levels and the risk for VTE. Furthermore, elevated levels of anticoagulants may have a protective effect on the development of VTE.
- Comparison of Characteristics and 3-Year Outcomes in Patients With Acute Heart Failure With Preserved, Mid-Range, and Reduced Ejection Fraction. [Journal Article]
- CJCirc J 2018 Nov 06
- CONCLUSIONS: Each LVEF subgroup of AHF patients was a heterogeneous population with diverse characteristics, which have a significant effect on the clinical outcomes. This finding suggested that focused phenotyping of AHF patients could help identify the optimal management strategy and develop novel effective therapies.
- VA-ECMO Support in Nonsurgical Patients With Refractory Cardiogenic Shock: Pre-Implant Outcome Predictors. [Journal Article]
- AOArtif Organs 2018 Nov 06
- Refractory cardiogenic shock (RCS) is associated with a high mortality. Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is increasingly used as acute cardiopulmonary support but selection...
Refractory cardiogenic shock (RCS) is associated with a high mortality. Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is increasingly used as acute cardiopulmonary support but selection of VA-ECMO candidates remains challenging. There are limited data on which pre-VA-ECMO variables that predict outcome. The aim of this study was to identify pre-VA-ECMO predictors of 90-day mortality. We retrospectively analyzed 76 consecutive patients (median age 52; interquartile range [IQR]: 37-60) supported with VA-ECMO due to RCS. The association between pre-implant variables and all-cause mortality at 90 days was analyzed with multivariable logistic regression. Main etiologies of RCS were acute myocardial infarction 51% and other AHF etiologies 49%. Cardiopulmonary resuscitation was performed in 54% of patients before initiation of VA-ECMO. Median duration of VA-ECMO was 5 days (IQR: 2-11). The 90-day overall mortality was 49% and in-hospital mortality was 50%; 46% died on VA-ECMO, 37% were successfully weaned, 13% were bridged to heart transplantation, and 4% to left ventricular assist device. Multivariable logistic regression analysis identified arterial lactate (odds ratio [OR] per mmol/L: 1.15; 95% confidence interval [CI]: 1.06-1.24; P = 0.001) and number of inotropes and vasopressors (OR per agent: 2.14; 95% CI: 1.26-3.63; P = 0.005) as independent predictors of 90-day mortality. In RCS patients arterial lactate level and number of inotropes and vasopressors were identified as independent pre-VA-ECMO predictors of 90-day mortality. Thus, the severity of cardiogenic shock expressed as levels of lactate and vasoactive agents just before start of VA-ECMO may be more predictive of outcome than the specific etiology of cardiogenic shock.
- Cancer antigen-125 and outcomes in acute heart failure: a systematic review and meta-analysis. [Journal Article]
- HAHeart Asia 2018; 10(2):e011044
- CONCLUSIONS: Our meta-analysis found that high CA125 levels are associated with AHF symptoms, heart failure-related hospital readmissions and all-cause mortality. Therefore, CA125 emerges as a useful risk stratification tool for identifying high-risk patients with more severe fluid overload, as well as for monitoring following an AHF episode.
- 9-Year Trend in the Management of Acute Heart Failure in Japan: A Report From the National Consortium of Acute Heart Failure Registries. [Journal Article]
- JAJ Am Heart Assoc 2018 Sep 18; 7(18):e008687
- Background Acute heart failure ( AHF ) is a heterogeneous condition, and its characteristics and management patterns differ by region. Furthermore, limited evidence is available on AHF outside of Wes...
Background Acute heart failure ( AHF ) is a heterogeneous condition, and its characteristics and management patterns differ by region. Furthermore, limited evidence is available on AHF outside of Western countries. A project by the National Consortium of Acute Heart Failure Registries was designed to evaluate the trends over time in patient backgrounds, in-hospital management patterns, and long-term outcomes of patients with AHF over 9 years in Japan. Methods and Results Between 2007 and 2015, registry data for patients with AHF were collected from 3 large-scale quality AHF registries ( ATTEND / WET - HF / REALITY - AHF ). Predefined end points were trends over time in age, sex, and clinical outcomes, including short- and long-term mortality and readmission for heart failure. The final data set consisted of 9075 patients with AHF . No significant differences in patient backgrounds and laboratory findings (eg, anemia or renal function) were observed, with the exception of patient age; mean age became substantially higher over 9 years (71.6-77.0 years; P for trend, <0.001). On the contrary, length of hospital stay became shorter (mean, 26-16 days). These changes were not associated with in-hospital mortality (4.7-7.5%) or 30-day heart failure readmission rate (4.8-5.4%), as well as 1-year mortality and heart failure readmission rate (20.1-23.3% and 23.6-26.2%, respectively). Conclusions Length of hospital stay in patients with AHF shortened over the 9-year period despite the increasing age of the patients. However, short- and long-term outcomes do not seem to be affected; continuous efforts to monitor clinical outcomes in patients with AHF are needed.
- Diagnostic and prognostic value of plasma volume status at emergency department admission in dyspneic patients: results from the PARADISE cohort. [Journal Article]
- CRClin Res Cardiol 2018 Oct 28
- CONCLUSIONS: Higher ePVS values determined from first blood sample at admission are associated with a higher probability of AHF and in-hospital mortality in patients admitted in the ED for acute dyspnea.
- Prognostic implications of prealbumin level on admission in patients with acute heart failure referred to a cardiac intensive care unit. [Journal Article]
- JCJ Cardiol 2018 Oct 23
- CONCLUSIONS: Prealbumin level on admission may be useful in the risk stratification of patients with AHF in an acute care setting.
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- Botulinum Toxin Injections and Electrical Stimulation for Spastic Paresis Improve Active Hand Function Following Stroke. [Journal Article]
- TToxins (Basel) 2018 Oct 25; 10(11)
- Botulinum toxin type A (BTX-A) injections improve muscle tone and range of motion (ROM) among stroke patients with upper limb spasticity. However, the efficacy of BTX-A injections for improving activ...
Botulinum toxin type A (BTX-A) injections improve muscle tone and range of motion (ROM) among stroke patients with upper limb spasticity. However, the efficacy of BTX-A injections for improving active function is unclear. We aimed to determine whether BTX-A injections with electrical stimulation (ES) of hand muscles could improve active hand function (AHF) among chronic stroke patients. Our open-label, pilot study included 15 chronic stroke patients. Two weeks after BTX-A injections into the finger and/or wrist flexors, ES of finger extensors was performed while wearing a wrist brace for 4 weeks (5 days per week; 30-min sessions). Various outcomes were assessed at baseline, immediately before BTX-A injections, and 2 and 6 weeks after BTX-A injections. After the intervention, we noted significant improvements in Box and Block test results, Action Research Arm Test results, the number of repeated finger flexions/extensions, which reflect AHF, and flexor spasticity. Moreover, significant improvements in active ROM of wrist extension values were accompanied by marginally significant changes in Medical Research Council wrist extensor and active ROM of wrist flexion values. In conclusion, BTX-A injections into the finger and/or wrist flexors followed by ES of finger extensors improve AHF among chronic stroke patients.