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.

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.

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.

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.