Acute Diastolic Heart Failure Research Articles

Association of chronic or acute systolic and diastolic heart failure with incidence rates of pneumonia, sepsis, and septic shock in patients with lung cancer.

e24005 Background: Systolic heart failure (SHF) and diastolic heart failure (DHF) can lead to volume overload and cause pulmonary venous congestion and pulmonary edema. While an association between lung cancer (LC) and increased infection rates is well established, we investigated whether chronic SHF or DHF, as well as acute SHF or DHF in concomitance with LC, influenced the incidence of pneumonia (PNA), sepsis, and septic shock. Methods: A retrospective study was conducted by obtaining patients with LC by applying specific ICD 10 codes (C34.0 - C34.9 including all sub-codes) from the National Inpatient Sample 2019-2020. Among this cohort, patients with acute and chronic SHF or DHF were further identified by applying specific ICD 10 codes ((I50.1 - I50.4 including all sub-codes). Pneumonia, sepsis, and septic shock outcomes were compared between LC patients with each of these types of heart failures versus those without using multivariate regression analysis (MVRA), adjusting for demographic factors, hospital-specific characteristics, common comorbidities and alcohol, smoking, or substance use. Results: 802,230 patients were identified with LC. 48.7% were female. 77.9% were Caucasian, 12.8% were African American, 4.6% were Hispanic, and 3.5% belonged to other ethnicities. Patients with LC and chronic SHF (n = 25880) had no significant difference in rates of PNA [Adjusted (Ad) odds ratio (OR): 0.9, p = 0.13] and sepsis (Ad OR: 0.9, p = 0.59) but had higher rates of septic shock (Ad OR: 1.4, p < 0.001) compared to those LC patients without any heart failure (HF). Patients with LC who had acute SHF (n = 22295) showed higher rates of PNA (Ad OR: 1.4, p < 0.001), sepsis (Ad OR: 1.5, p < 0.001), as well as septic shock (Ad OR: 1.6, p < 0.001) versus those without any HF. Patients with LC and concurrent chronic DHF (n = 31580) had similar rates of PNA (Ad OR: 1, p = 0.64), sepsis (Ad OR: 1.1, p = 0.62) and septic shock (Ad OR: 1, p = 0.77) compared to LC patients without any HF. However, acute DHF (n = 24080) led to a higher incidence of PNA (Ad OR: 1,4, p < 0.001) and sepsis (Ad OR: 1.2, p = 0.05) in patients with LC, but no difference in the incidence of septic shock (Ad OR: 0.8, p = 0.072). Conclusions: Chronic SHF led to an increased incidence of septic shock, whereas acute SHF was associated with accentuated rates of PNA, sepsis, and septic shock in patients with LC. Chronic DHF did not predict an increased risk of infections; however, acute DHF was associated with enhanced rates of PNA and sepsis. Future investigations may focus on the effect of SHF or DHF on outcomes beyond hospitalization in patients with LC and the subtypes of LC and infection risk. Based on this signal-finding analysis, it may be postulated that early inter-disciplinary collaboration between oncology and cardiology may be crucial in managing patients with heart failure and LC and potentially lead to better patient outcomes.

Prevalence and clinical outcomes of acute heart failure among patients with mediastinal radiation exposure: A propensity score matched analysis.

e24029 Background: Radiation therapy (RT) for malignancy in mediastinal region is associated with radiation-induced heart disease in subsequent years, including coronary, valvular, myocardial, pericardial and conduction system disease. Although increased risk of diastolic heart failure (DHF) has been established, there is limited data on the prevalence, trends and outcomes of acute DHF admissions in patients with prior mediastinal RT. Methods: We extracted data from the National Inpatient Sample (NIS) Database from 2016 to 2020. We included all admissions ≥18 years old with a principal diagnosis of acute DHF with and without history of RT for mediastinal cancer using International Classification of Diseases Tenth Revision (ICD-10) codes. Propensity score matching was performed to balance hospital characteristics, patient demographics and comorbidities between the two groups. Univariate logistic regression was performed in the balanced cohorts. The primary outcome was inpatient mortality. Analysis was performed using STATA-MP, version 14.2. Results: A total of 2,356,025 admissions for acute DHF were identified between 2016 to 2020, of which 15,435 (0.65%) had prior mediastinal RT. During the study period, we found an increasing trend in the number of admissions for acute DHF (p trend < 0.01) along with an increased proportion of patients with prior mediastinal RT. (0.55% in 2016 to 0.78% in 2020, p trend < 0.01). After propensity score matching, there was no difference in in-hospital mortality (odds ratio [OR] 1.12, 95% CI 0.79-1.58, p = 0.537), or complications such as cardiogenic shock, respiratory failure, stroke, venous thromboembolism, or acute kidney injury between the two cohorts. There was no difference in length of stay, however, cohort with history of mediastinal RT had higher hospital charges ($26,634 vs $31,511, p < 0.01). Conclusions: Exposure to mediastinal RT represents a minority but growing number of hospital admission with DHF. The mortality and complications of RT associated DHF does not differ significantly from those with traditional etiologies of DHF.

Kiosk 3Q-FA-04 - Calcified Amorphous Tumor in a Young Female Patient Presenting with Acute Diastolic Heart Failure

Kiosk 3Q-FA-04 - Calcified Amorphous Tumor in a Young Female Patient Presenting with Acute Diastolic Heart Failure

Abstract 17089: In Hospital Cardiovascular Outcomes of Patients With End Stage Renal Disease and Septic Shock a Propensity Matched Analysis

Background: Sepsis affects approximately 1.7 million adults in the US every year, and progression to septic shock (SS) leads to an increase in cardiovascular disease (CVD) and a 26% increase in mortality. Patients with end stage renal disease (ESRD) on dialysis are at an increased risk of developing SS and CVD. The increase in mortality with SS is well established in the literature, however, there is limited data determining the impact of ESRD on SS. This study aims to identify the impact of ESRD on in-hospital mortality and CVD outcomes among patients with SS. Methods: The 2020 National Readmissions Database was analyzed. Patients with SS and ESRD were identified using relevant ICD-10 codes. Nearest propensity matching was conducted using a 1:1 ratio for several demographic, social and clinical variables. Subsequently, in-hospital outcomes were compared between patients with and without ESRD using t-test and chi-squared test as appropriate. Results: A total of 822,321 patients were included in this study, with a mean age of 65 years. Majority of patients in this study with and without ESRD respectively were male (54.39% and 50.83%, p <0.001). In- hospital mortality for patients with SS, with and without ESRD, were 38.68% and 30.01%, respectively. Among patients with SS, mortality with and without ESRD was 38.36% and 30.01% (p < 0.001) respectively. Other significant cardiovascular events among patients with and without ESRD, respectively were ischemic stroke (3.82% vs. 3.28%, p <0.001), atrial fibrillation (11.85% vs. 10.2%, p <0.001), Endocarditis (4.06% vs. 2.24%, p <0.001), and acute diastolic heart failure (10.17% vs. 9.41%, p =0.001). Conclusions: SS in patients with ESRD is associated with an increased frequency of in-hospital mortality and worse cardiovascular outcomes when compared to patients without ESRD. Further research is needed to help establish and identify the causative factors in determining the association between SS and ESRD.

A Pressing Matter: Compressive Postoperative Hematoma Causing Acute Diastolic Heart Failure

BackgroundCardiopulmonary complications in the postoperative period can lead to significant morbidity and mortality. Many of the complications in the postoperative period occur after discharge from the hospital, and up to 25% of patients will require readmission. In postoperative patients presenting to the emergency department (ED), it is important to consider that postoperative complications can affect a multitude of organ systems, including those that are adjacent to where the surgery was performed. Case ReportWe present the case of a 54-year-old woman presenting to the ED with shortness of breath in the setting of recent Nissen fundoplication revision. Pulmonary angiography was significant for a large hiatal hernia and negative for pulmonary embolism. She was discharged and returned to the ED a few days later due to worsening symptoms. Further diagnostic studies demonstrated an esophageal hematoma causing compression of the left atrium, leading to acute diastolic heart failure. Why Should an Emergency Physician Be Aware of This?It is important to consider alternative etiologies for common complaints in the postoperative patient presenting to the ED. Early involvement of the operative team in the patient's care can assist in directing diagnostic approach and management of the postoperative patient.

Abstract 8889: Predictors of 30-Day Readmission in Nonagenarians Presenting With Acute Diastolic Heart Failure: Nationwide Analysis

Background: Acute diastolic heart failure (DHF) is a common but poorly studied diagnosis in hospitalized nonagenarians. Objective: To identify predictors of 30-day readmission in nonagenarians hospitalized with acute DHF. Methods: We queried National Readmission Database (NRD) of years 2016-2018 for patients aged 90 or above admitted with acute or acute on chronic DHF. ICD-10 was used to identify diagnoses. We excluded patients discharged in December and those who died in index admission. Univariate regression was performed on each variable. Variables with p value of < 0.2 were included in our multivariate regression model (figure 1). Results: From a total of 45393 index admissions, 43646 (96.2%) survived to discharge. A total of 7437 (16.4%) patients had a 30-day readmission. Mean cost of readmission was 43265 USD per patient. Significant predictors of 30-day readmission were chronic ischemic heart disease (OR=1.11, 95%CI [1.01-1.22], P=0.023), chronic kidney disease stage 3 or above (OR=1.19, 95%CI [1.07-1.34], P=0.002), complicated diabetes (OR=1.22, 95%CI [1.07-1.38], P=0.003), and length of stay (LOS) > 2 days (OR=1.20, 95% CI [1.09-1.32], P=0.000). Female sex (OR=0.90, 95% CI [0.83-0.99], P=0.030) and palliative care visit (OR=0.27, 95% CI [0.21-0.34], P=0.000) were associated with lower odds of readmission. Conclusion: In nonagenarians hospitalized with acute DHF, 30-day readmission is common and costly. Chronic comorbidities and LOS >2 days were predictors of readmission. Palliative care visit was strongly associated with lower risk of readmission. Further strategies need to be developed to improve the quality of care and prevent readmission in this age group.

Frailty and Post-hospitalization Outcomes in Patients With Heart Failure With Preserved Ejection Fraction

Given the role of comorbid conditions in the pathophysiology of HFpEF, we aimed to identify and rank the importance of comorbid conditions associated with post-hospitalization outcomes of older adults hospitalized for HFpEF. We examined data from 4,605 Medicare beneficiaries hospitalized in 2007-2014 for HFpEF based on ICD-9-CM codes for acute diastolic heart failure (428.31 or 428.33). To identify characteristics with high importance for prediction of mortality, all-cause rehospitalization, rehospitalization for heart failure, and composite outcome of mortality or all-cause rehospitalization up to 1 year, we developed boosted decision tree ensembles for each outcome, separately. For interpretability, we estimated hazard ratios (HRs) and 95% confidence intervals (CI) using Cox proportional hazards models. Age and frailty were the most important characteristics for prediction of mortality. Frailty was the most important characteristic for prediction of rehospitalization, rehospitalization for heart failure, and the composite outcome of mortality or all-cause rehospitalization. In Cox proportional hazards models, a 1-SD higher frailty score (0.1 on theoretical range of 0 to 1) was associated with a HR of 1.27 (1.06 to 1.52) for mortality, 1.16 (1.07 to 1.25) for all-cause rehospitalization, 1.24 (1.14 to 1.35) for HF rehospitalization, and 1.15 (1.07 to 1.25) for the composite outcome of mortality or all-cause rehospitalization. In conclusion, frailty is an important predictor of mortality and rehospitalization in adults aged ≥66 years with HFpEF.

ASSOCIATION OF ACUTE HEART FAILURE AND FEMORAL FRACTURES: A PROPENSITY-WEIGHTED ANALYSIS OF NATIONAL INPATIENT SAMPLE

SESSION TITLE: Cardiovascular Disease SESSION TYPE: Original Investigation Posters PRESENTED ON: October 18-21, 2020 PURPOSE: Heart failure in the setting of acute trauma is poorly understood. Associated large scale catecholamine surge is known to have a multitude of effects on the cardiovascular system. At our level 1 trauma center, we attempted to better characterize the correlation between acute heart failure and femoral fractures. METHODS: A composite database of National Inpatient Sample (NIS) for 2016 and 2017 was queried using ICD-10 codes to identify patients with femur fracture among a cohort of patients with acute heart failure. A propensity weighted logistic regression analysis was performed controlling for age, gender, and comorbidities. Propensity weighted cohorts were compared for correlation with acute HF [in each category of acute HF (acute, acute on chronic) and HF subtype (systolic, diastolic, combined systolic/diastolic, right heart, and takotsubo cardiomyopathy)]. RESULTS: Among a cohort of 815,899 patients with acute heart failure, a total of 3,792 patients were identified with a concurrent diagnosis of femoral fracture. Population average age was 82.19+8.8 years, 63.58% of whom were female. A propensity weighted logistic regression model using each acute heart failure subtype as a dependent variable was performed using Stata 16.1 controlling for age, gender, and comorbidity (presence of AICD, Pacemaker, history of chronic heart failure, diabetes, ischemic stroke, COPD, PVD, CKD, OSA, hypertension, CAD). Acute diastolic heart failure [OR 1.578, 95% CI(1.278-1.947), p < 0.001] and takotsubo cardiomyopathy [OR 2.041, 95% CI(1.622-2.567), p < 0.001] were found to have a strong positive correlation to femoral fracture. CONCLUSIONS: In our study, we focused on the comparison of patients with acute heart failure and the propensity for concurrent femoral fracture. A strong positive correlation with acute diastolic heart failure and takotsubo cardiomyopathy was found with femoral fractures. Patients with heart failure should be considered at higher risk for femoral fracture than the average healthy population. The increased risk can be attributed to comorbid conditions as well as the intrinsic risk posed by the pathophysiology of HF itself. Hip fractures may be an important, yet underreported contributor of mortality in HF patients. CLINICAL IMPLICATIONS: Patients with femoral fracture should be monitored closely for acute heart failure. DISCLOSURES: No relevant relationships by Krishna Akella, source=Web Response No relevant relationships by Charles Arcoleo, source=Web Response No relevant relationships by Akella Chendrasekhar, source=Web Response No relevant relationships by Priscilla Chow, source=Web Response No relevant relationships by Kashif Hussain, source=Web Response No relevant relationships by Samer Ibrahim, source=Web Response No relevant relationships by Gunjan Joshi, source=Web Response No relevant relationships by Ghulam Mujtaba, source=Web Response No relevant relationships by Rajoo Patel, source=Web Response No relevant relationships by Heidi Roppelt, source=Web Response No relevant relationships by Nandini Seshan, source=Web Response No relevant relationships by Howard Sklarek, source=Web Response No relevant relationships by Liana Tatarian, source=Web Response No relevant relationships by Daisy Young, source=Web Response

ASSOCIATION OF TRAUMATIC BRAIN INJURY AND HEART FAILURE: A PROPENSITY WEIGHTED ANALYSIS OF THE NATIONAL INPATIENT SAMPLE

SESSION TITLE: Critical Care Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: October 18-21, 2020 PURPOSE: The most common cause of death among trauma patients is traumatic brain injury (TBI). Although the exact cause of death is not well understood, it is thought to be a result of cerebral herniation. Associated catecholamine surge commonly precipitates heart failure (HF). We attempted to better characterize the correlation, if any, between TBI and HF. METHODS: A composite database of National Inpatient Sample (NIS) for 2016 and 2017 was queried using ICD-10 codes to identify patients with acute HF among a cohort of patients with TBI. A propensity weighted logistic regression analysis was performed controlling for age, gender, and comorbidities. Propensity weighted cohorts were compared for correlation with HF by age category. RESULTS: Among a cohort of 111,280 patients with traumatic brain injury, mean age was 58.3 +/- 0.15 years, of whom 39.61% were female. A propensity weighted logistic regression model was performed controlling for age, gender, and comorbidity (presence of AICD, Pacemaker, history of chronic heart failure, diabetes, ischemic stroke, COPD, PVD, CKD, OSA, hypertension, CAD). Acute diastolic HF was found to be associated with concussion [OR 1.549, 95% CI (1.002-2.394), p=0.049)]; Takotsubo cardiomyopathy was associated with diffuse TBI [OR 1.840, 95% CI (1.037-3.263), p=0.037)], traumatic cerebral edema in patients 40 years or older [OR 2.311, 95% CI (1.387-3.851), p=0.001)], and subarachnoid hemorrhage [OR 1.510, 95% CI (1.108-2.058), p=0.009)]. CONCLUSIONS: Patients with TBI should be monitored closely for HF development. CLINICAL IMPLICATIONS: Patients with TBI should be monitored closely for HF development. DISCLOSURES: No relevant relationships by Krishna Akella, source=Web Response No relevant relationships by Charles Arcoleo, source=Web Response No relevant relationships by Akella Chendrasekhar, source=Web Response No relevant relationships by Priscilla Chow, source=Web Response No relevant relationships by Kashif Hussain, source=Web Response No relevant relationships by Samer Ibrahim, source=Web Response No relevant relationships by Gunjan Joshi, source=Web Response No relevant relationships by Ghulam Mujtaba, source=Web Response No relevant relationships by Haaris Naji, source=Web Response No relevant relationships by Rajoo Patel, source=Web Response No relevant relationships by Heidi Roppelt, source=Web Response No relevant relationships by Nandini Seshan, source=Web Response No relevant relationships by Howard Sklarek, source=Web Response No relevant relationships by Liana Tatarian, source=Web Response No relevant relationships by Daisy Young, source=Web Response

OBSTRUCTIVE SLEEP APNEA IS ASSOCIATED WITH ACUTE DIASTOLIC HEART FAILURE IN A NATIONAL INPATIENT SAMPLE

Obstructive Sleep Apnea (OSA) is known to increase the risk of diastolic dysfunction (DHF) and incidence of acute heart failure in men. The impact of OSA on hospitalization with acute diastolic heart failure is not well described We analyzed data from the National Inpatient Sample (NIS), Health

Acute pulmonary edema secondary to a hidden hypertensive emergency

Severe stenosis of the subclavian artery is a rare clinical finding, even more so for bilateral existence of the condition. Subclavian artery stenosis leads to erroneously normal or even low blood pressure values when measured at the brachial artery on the ipsilateral side. The poor control of blood pressure may cause cardiovascular complications such as heart failure and acute pulmonary edema without the patient having high blood pressure in the arms. Widespread clinical reliance on a sole brachial measurement of blood pressure, particularly in the emergency room setting, may result in inappropriate clinical management in patients with conditions that alter brachial blood pressure. We report a case of acute diastolic heart failure secondary to hypertensive emergency hidden due to bilateral stenosis of both subclavian arteries in a patient with severe atherosclerosis, cerebrovascular disease, and symptoms of subclavian steal syndrome.<Learning objective: We present a case of acute pulmonary edema with hidden hypertensive emergency in the measures at upper limbs made in the emergency department due to severe bilateral subclavian stenosis. Knowledge of this entity and suspicion in patients at high cardiovascular risk is important in patients who often have complications from poorly controlled hypertension. The measurement of blood pressure in all four limbs is a useful measure in patients at high cardiovascular risk.>

Abstract 14239: Trends and Outcomes in Hospitalizations With Acute Diastolic Heart Failure, 2003 to 2012

Introduction: Hospitalizations for heart failure with preserved ejection fraction (HFpEF) are increasing. There is limited data examining contemporary trends and outcomes in patients hospitalized with HFpEF. Hypothesis: Outcomes in patients hospitalized with HFpEF are improving over time. Methods: We examined all hospitalizations with acute heart failure (n=5,829,546) in 2003-2012 using the Nationwide Inpatient Database. Based on ICD-9 codes, we identified 2,329,391 (~40%) as acute diastolic heart failure without concurrent systolic heart failure, or HFpEF. Patient characteristics, in-hospital mortality rates, and length of stay (LOS) were examined. Results: Compared to those with heart failure with reduced ejection fraction (HFrEF), those with HFpEF were older (mean 76±13 vs 72±14 years), more likely female (64% vs 42%), and more likely to have hypertension (67% vs 64%), atrial fibrillation (43% vs 39%), chronic pulmonary disease (38% vs 32%), renal failure (36% vs 35%), and anemia (34% vs. 26%) (all p&lt;0.001). Over time, HFpEF comprised increasing proportions of men and patients aged ≥75. Compared to HFrEF, in-hospital mortality rate was lower (4.3% vs 5.1%), and mean LOS was higher in HFpEF (7.0 vs 6.8 days) (both p&lt;0.001). The in-hospital mortality rate for HFpEF declined by 13% from 2003 to 2012 (4.8% to 4.2%, p-for-trend &lt;0.001), reflecting improved survival in females and those aged ≥65 years (both p-for-trend&lt;0.01). Mean LOS declined by 8% (7.4 to 6.8 days, p-for-trend&lt;0.001). Adjusting for potential confounders using multivariate regression analysis, pulmonary circulation disease (OR 1.90, 95%CI [1.86 to 1.94]), liver disease (OR 1.57, CI [1.52-1.63]), and renal failure (OR 1.35, CI [1.33-1.37]) were independent predictors of in-hospital mortality. Whereas atrial fibrillation (OR 1.07 [CI 1.06-1.08]) was mildly associated with in-hospital mortality, traditional factors of hypertension (OR 0.64 [CI 0.63-0.65]), diabetes (OR 0.77 [CI 0.76-0.78]), and CAD (OR 0.79 [CI 0.78-0.80]) were inversely related (all p&lt;0.001). Conclusions: Hospitalizations for HFpEF place a significant burden on the U.S. health care system. Our study, which represents the largest cohort of HFpEF to date, shows that outcomes have improved between 2003 and 2012.

Trastuzumab induced diastolic heart failure

Background: Trastuzumab-induced cardiotoxicity has been well accepted. Cardiotoxicity especially with concomitant or sequential use of anthracycline has been clinically identified as decreased left ventricular ejection fraction with or without symptoms of heart failure. Acute diastolic heart failure has not been reported. Case report : A 62-year-old female patient with HER2 + positive breast cancer presented to the emergency room with acute heart failure symptoms after trastuzumab use. Chest X-ray and CT demonstrated acute pulmonary edema. Echocardiography showed normal left ventricular ejection fraction, elevated left ventricular filling pressure, and moderate pulmonary hypertension, which are consistent with acute diastolic heart failure. The patient symptoms resolved quickly with diuretic therapy and Trastuzumab was discontinued. A follow-up echocardiography showed normal left and right ventricular function and a follow-up right heart catheterization demonstrated normal cardiac filling pressure and normal cardiac index. Conclusions: Trastuzumab induced cardiac toxicity could occur in a spectrum - from transient diastolic heart failure to systolic heart failure. The monitoring of both diastolic and systolic function during the course of trastuzumab treatment with or without other chemotherapy agents should be considered. Normal 0 false false false EN-US ZH-CN X-NONE

Anthrax lethal toxin induces acute diastolic dysfunction in rats through disruption of the phospholamban signaling network

Anthrax lethal toxin (LT), secreted by Bacillus anthracis, causes severe cardiac dysfunction by unknown mechanisms. LT specifically cleaves the docking domains of MAPKK (MEKs); thus, we hypothesized that LT directly impairs cardiac function through dysregulation of MAPK signaling mechanisms. In a time-course study of LT toxicity, echocardiography revealed acute diastolic heart failure accompanied by pulmonary regurgitation and left atrial dilation in adult Sprague-Dawley rats at time points corresponding to dysregulated JNK, phospholamban (PLB) and protein phosphatase 2A (PP2A) myocardial signaling. Using isolated rat ventricular myocytes, we identified the MEK7-JNK1-PP2A-PLB signaling axis to be important for regulation of intracellular calcium (Ca(2+)(i)) handling, PP2A activation and targeting of PP2A-B56α to Ca(2+)(i) handling proteins, such as PLB. Through a combination of gain-of-function and loss-of-function studies, we demonstrated that over-expression of MEK7 protects against LT-induced PP2A activation and Ca(2+)(i) dysregulation through activation of JNK1. Moreover, targeted phosphorylation of PLB-Thr(17) by Akt improved sarcoplasmic reticulum Ca(2+)(i) release and reuptake during LT toxicity. Co-immunoprecipitation experiments further revealed the pivotal role of MEK7-JNK-Akt complex formation for phosphorylation of PLB-Thr(17) during acute LT toxicity. Our findings support a cardiogenic mechanism of LT-induced diastolic dysfunction, by which LT disrupts JNK1 signaling and results in Ca(2+)(i) dysregulation through diminished phosphorylation of PLB by Akt and increased dephosphorylation of PLB by PP2A. Integration of the MEK7-JNK1 signaling module with Akt represents an important stress-activated signalosome that may confer protection to sustain cardiac contractility and maintain normal levels of Ca(2+)(i) through PLB-T(17) phosphorylation.

USE OF BETA-BLOCKERS AND REDUCTION IN ALL-CAUSE MORTALITY IN HOSPITALIZED MEDICARE BENEFICIARIES WITH ACUTE DIASTOLIC HEART FAILURE: A PROPENSITY-MATCHED STUDY OF THE OPTIMIZE-HF

Abstract Category: 21. Myocardial Function/Heart Failure—Clinical Pharmacological TreatmentSession-Poster Board Number: 1017-43Authors: Ali Ahmed, Yan Zhang, Marjan Mujib, Tarun Arora, Margaret Feller, Meredith Kilgore, Inmaculada Aban, Thomas Love, Richard Allman, Gregg Fonarow, UAB, Birmingham, AL, VAMC, Birmingham, ALBackground: Beta-blockers (BB) reduce mortality in systolic heart failure (HF). However, evidence of their beneits is unclear in diastolic HF. We tested the hypothesis that BB use would lower mortality in diastolic HF enrolled into the OPTIMIZE-HF (Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients With Heart Failure) registry.Methods: Of the 9165 unique OPTIMIZE-HF patients hospitalized with acute diastolic HF (LVEF ≥45%) linked with Medicare outcomes data, 5434 (59%) were prescribed BBs at discharge. Propensity scores for BB use were estimated for each of the 9165 patients and were used to assemble a cohort of 3382 pairs of patients receiving and not receiving BBs who were balanced on 38 baseline characteristics.Results: Patients (n=6764) had a mean (SD) age of 78 (11) years, 65% were women, 12% were African American, and a mean (SD) LVEF of 0.58 (0.09) %. During ~6 years of follow-up, all-cause mortality occurred in 69% and 72% of matched patients receiving and not receiving BBs respectively (HR when BB use was compared with its non-use, 0.90; 95% CI, 0.85-0.96; p<0.001; Figure). The association was unchanged when we repeated the analysis using a multivariable Cox regression model adjusting for the same 38 variables among the 6614 pre-match patients (HR, 0.90; 95% CI, 0.85-0.94; p<0.001).Conclusions: Discharge prescription of BB was associated with signiicant lower risk of all-cause mortality in Medicare beneiciaries hospitalized with acute decompensated diastolic HF.

Effect of Nesiritide on Renal Function in Patients With Decompensated Diastolic Heart Failure

Background and Objective: Patients with acute diastolic heart failure (HF) exacerbation often have deterioration of renal function secondary to use of diuretics. There are no previous studies about the role of nesiritide in diastolic HF patients. The aim of this study was to examine the effect of nesiritide on renal function at three days, day of discharge and one month after administration of nesiritide in patients with decompensated diastolic HF. Methods: We conducted a retrospective study of 658 patients with heart failure and normal LV systolic function documented by transthoracic echocardiogram.

Sleep Disordered Breathing Is Very Common in Patients with Acute Diastolic Heart Failure

Sleep Disordered Breathing Is Very Common in Patients with Acute Diastolic Heart Failure

Acute heart failure and near-syncope associated with giant left atrial ball thrombus occluding left ventricular inflow tract

A 70-year-old female patient was admitted to our department with symptoms and signs of acute heart failure and near syncope. After hospitalization, both transthoracic echocardiography (TTE) and subsequent transesophageal echocardiography (TEE) demonstrated a giant (4.9 x 3.9 cm) mobile, irregular, bright left atrial mass consistent with left atrial ball thrombus (LABT). The mass was found to occlude the left ventricular inflow tract (LVIT) above the mitral orifice (supravalvular) in the presence of normal mitral leaflets. After emergent surgical excision, the pathology of the left atrial mass was found to be consistent with thrombus. The case presented here suffered acute diastolic heart failure and near-syncope due to obstruction of the LVIT above the mitral orifice by a giant LABT.

Characterization of Left Ventricular Filling Abnormalities and Its Relation to Elevated Plasma Brain Natriuretic Peptide Level in Acute to Chronic Diastolic Heart Failure

Although Doppler left ventricular (LV) filling abnormalities have been extensively analyzed in patients with systolic heart failure (SHF), they have not yet been well characterized in patients with acute to chronic diastolic heart failure (DHF) in the light of plasma brain natriuretic peptide (BNP) levels. In 25 patients presenting with acute DHF and 25 with acute SHF, echo Doppler parameters and plasma BNP levels were obtained on admission and in the chronic stage. The mitral E/A ratio was lower in DHF patients than in SHF patients in the acute stage (1.3 +/-0.4 vs 1.8+/-0.9, p<0.05), and in the chronic stage of DHF the ratio decreased with plasma BNP level, but plasma BNP level was still greater than 100 pg/ml in 15 patients (60%). Among patients with DHF the plasma BNP level did not correlate with the mitral E/A ratio or deceleration time (r=0,25, p=NS; r=0,23, p=NS), but did with estimated pulmonary artery systolic pressure (r=0.64, p<0.01). A restrictive mitral flow velocity pattern is observed in only 25% of patients with DHF, so it is particularly important to recognize pseudonormalization in those with possible DHF. Persistently elevated plasma BNP level is not primarily caused by LV diastolic dysfunction, but by secondary alteration for hemodynamic adjustment (elevated LV end-diastolic pressure) in patients with DHF.

Analysis of Left Ventricular Systolic Function Using Midwall Mechanics in Patients >60 Years of Age With Hypertensive Heart Disease and Heart Failure

Normal ejection fraction (EFs) is often equated with normal systolic function. However, midwall mechanics reveal systolic dysfunction in hypertensive heart disease accompanied by hypertrophic remodeling. Midwall mechanics are unstudied in patients with acute diastolic heart failure (HF). This study analyzed left ventricular (LV) midwall stress-shortening relations in 61 patients aged >60 years with hypertensive heart disease, HF, and normal EF. Sixty-one hypertensive patients (mean age 78 +/- 10 years) who presented with HF, each with an EF >50%, underwent echocardiography. Midwall mechanics were compared with those of 79 controls (mean age 75 +/- 8 years) without structural heart disease. Relative wall thickness (0.63 +/- 0.11 vs 0.46 +/- 0.10 mm) and LV mass (237 +/- 67 vs 177 +/- 57 g) were significantly greater in patients with HF compared with controls. Mean EFs were similar in patients with HF and controls (64 +/- 9% vs 67 +/- 9%). Although mean endocardial fractional shortening (35 +/- 7% vs 37 +/- 7%) was not significantly different, midwall shortening in patients with HF was significantly less compared with controls (16 +/- 2% vs 19 +/- 3%, p <0.05). Eighteen of the 61 patients with HF (30%) had midwall shortening that was <95% confidence intervals of the normal midwall stress-shortening relations. By this criterion, these patients had systolic dysfunction despite normal EF; they had smaller LV chambers (in dimension and volume), greater relative wall thickness, and smaller stroke volumes. In conclusion, almost 1/3 of patients hospitalized with diastolic HF had systolic dysfunction, characterized by abnormal midwall stress-shortening relations.