Symptoms Of Acute Heart Failure Research Articles

Traumatic Aortic Valve Rupture: A Case Report

Non penetrating blunt chest trauma due to motor vehicle accidents are a daily occurrence in society. However, it is rare for patients to develop traumatic valve regurgitation in isolation [1]. We describe a case of a 22-year-old gentleman who presented with chest pain and acute heart failure symptoms following a motor vehicle accident. Initial ECHO showed a ruptured non coronary cusp of the aortic valve, with severe aortic valve regurgitation. Operation done through a midline sternotomy confirmed the findings, which was duly replaced with a bioprosthetic valve. Early detection, which might be difficult due to masking from coexistent injuries and prompt planning for a surgical repair yields a high success rate, and ensures safe outcome with excellent recovery.

Right ventricular pulmonary artery uncoupling independently associated with 5 year outcome following AHF hospitalisation

Abstract Background Right ventricular pulmonary artery (RV-PA) uncoupling is associated with poor outcome across a range of conditions, but its role in acute heart failure (AHF) remains incompletely investigated. Purpose To investigate if RV-PA uncoupling is independently associated with mortality following hospitalisation for AHF. Methods 418 patients were recruited. 391/418 (93.5%) had measurable TAPSE and SPAP and were followed up for 5 years to assess for all-cause mortality. Patients were recruited if they displayed signs and symptoms of AHF, had point-of-care brain-natriuretic peptide >100pg/ml and had evidence of HF on TTE. We identified a study-specific cut-off for TAPSE/SPAP of 0.24mm/mmHg on ROC analysis and performed univariate analysis to assess for an association with outcome. 30 covariates encompassing comorbidities, medications, echo parameters and observations were assessed and logistic regression analysis performed including variables associated with outcome. Results Patient average age at presentation was 79 years, 53.3% were male, 55.5% had hypertension, 30.7% had diabetes and 36.8% had CAD with a mean LVEF of 42.6% and BNP of 1363pg/ml. The mean TAPSE was 15.6mm and SPAP of 52.5mmHg. The average TAPSE/SPAP was 0.34mm/mmHg. 252/391 (64.5%) presented with TAPSE/SPAP <0.24mm/mmHg. These individuals were at higher risk of 5-year mortality compared to >0.24mm/mmHg: HR 1.94 (95% CI 1.49-2.54 [p<0.0001]), which persisted when adjusted for significant covariates – HR 1.35 (95% CI 1.02-1.80 [p<0.0395]). Conclusion TAPSE/SPAP ratio is an independent predictor of mortality in patients admitted with AHF. Our cut-off, a lower value than others have suggested in the literature for chronic conditions such as pulmonary hypertension, could identify those at risk of poor outcome in the acute setting. This may offer an exciting therapeutic target and help risk stratify patients. These results should focus the attention of those managing AHF patients onto the RV, pulmonary pressures and their interrelationship. It is time we moved beyond the LVEF.

A-021 Evaluation of a Novel N Terminal Pro B Type Natriuretic Peptide Assay as an aid in the Diagnosis of Acute Heart Failure in the Emergency Department

Abstract Background The signs and symptoms of acute heart failure (AHF) may overlap with other conditions and lead to diagnostic difficulty in the undifferentiated patient with dyspnea. The particularly high negative predictive value (NPV) of natriuretic peptides (NPs) in excluding AHF have rendered these assays especially useful in evaluating dyspnea in acute care setting. This study was conducted to assess the diagnostic performance of a novel N-terminal pro-B type natriuretic peptide (NT-proBNP) assay in the intended use patient population in the emergency department (ED). Methods A multicenter study was conducted in the U.S. on individuals presenting to the ED with dyspnea and a suspicion of AHF. Blood specimens were collected and tested using the Beckman Coulter Access NT-proBNP assay on the DxI 9000 Immunoassay Analyzer. Test results were compared to an adjudicated diagnosis clinical endpoint performed by an independent Clinical Events Committee blinded to the Access NT-proBNP result. Performance included NPV and sensitivity of an age-independent cut point of <300 ng/L to exclude AHF, and the positive predictive value (PPV) of the age-dependent cut points of >450, >900, and >1800 ng/L for ages <50 years, 50-75 years, and >75 years, respectively, for the diagnosis of AHF. The sample size required to achieve a 95% two tailed confidence interval (CI) was 150 subjects per age group to provide clinical performance at 90% (±10%) sensitivity. Sample size was based upon CLSI EP24-A2, Assessment of the Diagnostic Accuracy of Laboratory Tests Using Receiver Operating Characteristic Curves. Sensitivity and specificity were calculated at a series of cutoff points and plotted in separate receiver operation curves (ROC) for an overall age-independent rule-out analysis and for individual age-dependent groups separately. Area under the receiver operator characteristic curve (AUROC) was reported with 95% 2-sided CI. NPV and PPV with respective 95% 2-sided score CI was computed for the overall age-independent cut point and for each age group cohort. Results Of 490 enrolled patients, 41% were adjudicated with AHF with a median (Q1, Q3) age of 60 (47-76) years, and distributions of 46.1% female, 60.8% White and 38.2% Black. The assay had an AUROC for AHF of 0.88 (P<0.001), comparable to other commercially available NT-proBNP assays. The rule-out cut point of <300 ng/L had 96% sensitivity and NPV of 95%. Age-dependent cut points had sensitivity of 84%, 90%, and 87%, specificity of 81%, 70% and 61%, and PPV of 72%, 62%, and 74%, respectively. Conclusions The Access NT-proBNP assay demonstrated high clinical performance in the diagnosis and exclusion of acute HF in the undifferentiated dyspneic patient population and performed similarly well to validated assays used in current clinical practice. Given the continued increase in importance and reach of natriuretic peptide testing, these results are useful to extend availability of this assay to a larger audience.

Revisiting Peripartum Cardiomyopathy: A Case Report and Review

Peripartum cardiomyopathy (PPCM) is a rare and idiopathic disease characterized by left ventricular dilation and systolic dysfunction, that occurs late in pregnancy or during the postpartum period. Diagnosis is typically achieved through transthoracic echocardiography and cardiac magnetic resonance imaging (MRI). Management includes standard heart failure therapies such as beta-blockers, ACE inhibitors, and diuretics, with the addition of bromocriptine to target the prolactin pathway involved in PPCM pathophysiology. This report presents a case of a 31-year-old female with a history of acute lymphoblastic leukemia who, following an uncomplicated pregnancy, presented with acute heart failure symptoms. Initial evaluations suggested pulmonary embolism, but further diagnostic workup, including echocardiography and cardiac MRI, confirmed PPCM. The patient was treated with diuretics, ACE inhibitors, and beta blockers. Significant improvement was observed, with complete resolution and normal cardiac function at the 6-month follow-up.

The Respiratory Rate, Age, and Mean Arterial Pressure (RAM) Index: A Novel Prognostic Tool to Predict Mortality among Adult Patients with Acute Heart Failure in the Emergency Department.

Background and Objectives: Acute heart failure (AHF) is a life-threatening condition frequently encountered in the emergency department (ED). Identifying reliable prognostic indicators for in-hospital mortality is crucial for risk stratification and the appropriate management of AHF patients. This study aimed to assess the most effective method for predicting in-hospital mortality among various physiological parameters in patients with AHF presenting to the ED. Additionally, the study evaluated the effectiveness of the RAM index-respiratory rate (RR), age, and mean arterial pressure (MAP)-derived from the shock index (SI) by replacing heart rate with RR, as a novel prognostic tool. This was compared with the SI and its other derivatives to predict in-hospital mortality in adult patients with AHF presenting to the ED. Materials and Methods: This is a retrospective study conducted in the ED of an urban medical center, enrolling adult patients with signs and symptoms of AHF, who met the epidemiological diagnosis criteria, between January 2017 and December 2021. Baseline physiological parameters, including the RR, heart rate, systolic blood pressure, and diastolic blood pressure, were recorded upon ED admission. The RAM index was calculated as the RR multiplied by the age divided by the MAP. Statistical analysis was performed, including univariate analysis, logistic regression, and receiver operating characteristic (ROC) curve analysis. Results: A total of 2333 patients were included in the study. A RAM index > 18.6 (area under ROC curve (AUROC): 0.81; 95% confidence interval (CI): 0.79-0.83) had a superior mortality discrimination ability compared to an SI > 0.77 (AUROC: 0.75; 95% CI: 0.72-0.77), modified shock index > 1.11 (AUROC: 0.75; 95% CI: 0.73-0.77), age shock index > 62.7 (AUROC: 0.74; 95% CI: 0.72-0.76), and age-modified shock index > 79.9 (AUROC: 0.75; 95% CI: 0.73-0.77). A RAM index > 18.6 demonstrated a 7.36-fold higher risk of in-hospital mortality with a sensitivity of 0.80, specificity of 0.68, and negative predictive value of 0.97. Conclusions: The RAM index is an effective tool to predict mortality in AHF patients presenting to the ED. Its superior performance compared to traditional SI-based parameters suggests that the RAM index can aid in risk stratification and the early identification of high-risk patients, facilitating timely and aggressive treatment strategies.

Evaluation of the Blood Urea Nitrogen-to-Left Ventricular Ejection Fraction Ratio in Predicting Mortality in Patients Presenting to the Emergency Department with Heart Failure Symptoms.

Heart failure is a clinical syndrome. In this study, the significance of the blood urea nitrogen-to-left ventricular ejection fraction (BUNLVEF) ratio in predicting short-term mortality in patients with heart failure symptoms was evaluated. This retrospectively designed study was conducted by evaluating the records of patients with a history of heart failure who presented to the emergency department with heart failure symptoms and signs from 01 January 2018 to 01 January 2020. One hundred and seventy-three patients were included in the sample within the last six months presented to the emergency department with the symptoms of acute heart failure. Blood urea nitrogen (BUN) and the BUNLVEF ratio had a significant relationship with mortality (p=0.004 and <0.010, respectively). In patients with a known history of heart failure presenting to the emergency department with heart failure symptoms, it would be more appropriate to evaluate poor outcomes with the BUNLVEF ratio rather than the LVEF or BUN value alone. Key Words: Blood urea nitrogen, Prognosis, Left ventricular dysfunction.

Ultrasound Findings with Bedside Ultrasound of Heart Failure with Preserved LVEF

Heart failure with preserved ejection fraction (HFpEF), formerly termed diastolic heart failure, constitutes nearly half the heart failure cases. Patients may exhibit acute heart failure symptoms, yet bedside echocardiograms might indicate normal left ventricular systolic function, potentially leading to the premature exclusion of heart failure as a differential diagnosis. This review delves into fundamental echocardiographic principles associated with diastolic dysfunction, crucial for recognition in HFpEF patients. Specifically, it explores the VALVE protocol, a stepwise approach tailored for the exigent nature of emergency departments. Acquiring accurate imaging windows in acutely ill patients poses a challenge, emphasizing the significance of precise measurements to avoid errors. Techniques such as E-point septal separation (EPSS) must be meticulously positioned for ejection fraction determinations. The discussion focuses on key metrics outlined in the VALVE protocol, encompassing ventricular function, annular tissue Doppler imaging (TDI) measurements, left atrium volume, mitral valve velocities, and the E/e0 ratio as indicators of diastolic dysfunction in HFpEF.

Pedunculated left endoventricular thrombosis complicated by cerebral stroke in patient with suspected peripartum cardiomyopathy: A case report

Peripartum cardiomyopathy (PPMC) is an infrequent form of cardiomyopathy, whose main presentation is characterized by systolic dysfunction that commonly emerges in the early postpartum period. Acute heart failure symptoms such as congestion and dyspnea are common manifestations of PPMC. Here, we present a case of a 32-year-old female who, after hospitalization, manifested dyspnea and thoracic pain linked to the findings a left endoventricular thrombus. After the admission to the intensive cardiovascular care unit, heart failure and anticoagulant therapies as well as non-steroidal anti-inflammatory drugs were administered, leading to initial improvement of the left ventricular global function. Five days after the treatment, the patient experienced aphasia and right hemiplegia. The cerebral angiography documented an M1 segment occlusion. After treating the occlusion with stent retriever thrombectomy, the symptoms regressed and she attained full recovery. Therefore, surgical thrombectomy should be prioritized as the treatment approach to removing the pedunculated left ventricular thrombus, considering the apical morphology of the pedunculated left ventricular thrombus and if the anticoagulant therapy gives rise to side effects.

Impact of sleep-disordered breathing on overnight changes in arterial stiffness in patients with acute heart failure.

Overnight increases in arterial stiffness associated with sleep-disordered breathing may adversely affect patients with acute heart failure. Thus, we investigated overnight changes in arterial stiffness and their association with sleep-disordered breathing in patients hospitalized for acute heart failure. Consecutive patients with acute heart failure were enrolled. All participants underwent overnight full polysomnography following the initial improvement of acute signs and symptoms of acute heart failure. The arterial stiffness parameter, cardio-ankle vascular index (CAVI), was assessed before and after polysomnography. Overall, 60 patients (86.7% men) were analyzed. CAVI significantly increased overnight (from 8.4 ± 1.6 at night to 9.1 ± 1.7 in the morning, P < 0.001) in addition to systolic and diastolic blood pressure (from 114.1 mmHg to 121.6 mmHg, P < 0.001; and from 70.1 mmHg to 78.2 mmHg, P < 0.001, respectively). Overnight increase in CAVI (ΔCAVI ≥ 0) was observed in 42 patients (70%). The ΔCAVI ≥ 0 group was likely to have moderate-to-severe sleep-disordered breathing (i.e., apnea-hypopnea index ≥15, 55.6% vs 80.9%, P = 0.047) and greater obstructive respiratory events (29.4% vs 58.5%, P = 0.041). In multivariable analysis, moderate-to-severe sleep-disordered breathing and greater obstructive respiratory events were independently correlated with an overnight increase in CAVI (P = 0.033 and P = 0.042, respectively). In patients hospitalized for acute heart failure, arterial stiffness, as assessed by CAVI, significantly increased overnight. Moderate-to-severe sleep-disordered breathing and obstructive respiratory events may play an important role in the overnight increase in cardio-ankle vascular index.

Mortality after radial-only balloon aortic valvuloplasty: a long-term follow-up and a bridge-to-TAVI analysis

Abstract Background The benefits of distal radial balloon aortic valvuloplasty were recently reported: same efficacy as the classical femoral approach, with no vascular complications. The long-term outcomes for these patients remain unknown. Methods We retrospectively analyzed the long-term mortality and the impact of TAVI in a cohort of 30 patients who underwent distal radial (DR) BAV. Results The mean age was 78.3 ± 7.14 years and the median follow-up was 22.8 months. The indication for BAV was stable aortic stenosis in 70% of patients, while 23% of patients had concomitant acute heart failure symptoms and 6.6% of patients were in cardiogenic shock. A total of 16 patients (53.3%) received TAVI during follow-up after their BAV procedure while the remainder only received BAV. All-cause mortality was 20%, with only 1 death (6.3%) in the “BAV + TAVI” group compared to 5 deaths (35.7%) in the “BAV only” group (p = 0.089). All of the TAVI procedures were performed within 7 months after BAV. Cumulative incidence of TAVI was 40.0% at 5 months and 50.0% at 10 months. Cumulative incidence of death was 6.7% at 5 months, 13.3% at 10 months, 16.7% at 15 months, and 20.0% at 25 months. The probability of being alive without TAVI decreased from 53.3% at 5 months to 30.0% at 25 months. Conclusion In the present study, we could show that half of the patients undergoing BAV eventually need TAVI, most of them within 5 months after BAV, and that BAV remains associated with high mortality after the procedure, with 35% of those undergoing isolated BAV dying during short-term follow-up.

HiSorb sorptive extraction for determining salivary short chain fatty acids and hydroxy acids in heart failure patients

Variations in salivary short-chain fatty acids and hydroxy acids (e.g., lactic acid, and 3-hydroxybutyric acid) levels have been suggested to reflect the dysbiosis of human gut microbiota, which represents an additional factor involved in the onset of heart failure (HF) disease. The physical–chemical properties of these metabolites combined with the complex composition of biological matrices mean that sample pre-treatment procedures are almost unavoidable. This work describes a reliable, simple, and organic solvent free protocol for determining short-chain fatty acids and hydroxy acids in stimulated saliva samples collected from heart failure, obese, and hypertensive patients. The procedure is based on in-situ pentafluorobenzyl bromide (PFB-Br) derivatization and HiSorb sorptive extraction coupled to thermal desorption and gas chromatography-tandem mass spectrometry. The HiSorb extraction device is completely compatible with aqueous matrices, thus saving on time and materials associated with organic solvent-extraction methods. A Central Composite Face-Centred experimental design was used for the optimization of the molar ratio between PFB-Br and target analytes, the derivatization temperature, and the reaction time which were 100, 60 °C, and 180 min, respectively. Detection limits in the range 0.1–100 µM were reached using a small amount of saliva (20 µL). The use of sodium acetate-1-13C as an internal standard improved the intra- and inter-day precision of the method which ranged from 10 to 23%. The optimized protocol was successfully applied for what we believe is the first time to evaluate the salivary levels of short chain fatty acids and hydroxy acids in saliva samples of four groups of patients: i) patients admitted to hospital with acute HF symptoms, ii) patients with chronic HF symptoms, iii) patients without HF symptoms but with obesity, and iv) patients without HF symptoms but with hypertension. The first group of patients showed significantly higher levels of salivary acetic acid and lactic acid at hospital admission as well as the lowest values of hexanoic acid and heptanoic acid. Moreover, the significant high levels of acetic acid, propionic acid, and butyric acid observed in HF respect to the other patients suggest the potential link between oral bacteria and gut dysbiosis.

PO-05-054 CHRONIC (90 DAY) SAFETY AND PERFORMANCE OUTCOMES WITH A NOVEL EXTRAVASCULAR ICD LEAD

A novel extravascular (EV) ICD lead (AtaCor Medical, San Clemente, CA) is under development for sensing and defibrillation of ventricular tachyarrhythmias (VF) using DF-4 compatible ICD pulse generator (PG) connected to the extravascular lead placed in the anterior mediastinum through an intercostal space. The purpose of this analysis is to characterize 90-Day safety and performance of a novel EV-ICD lead connected to a commercially available ICD PG. Subjects (n=18) enrolled in the non-randomized, single-center SECURE EV Study (NCT05099289) were concurrently implanted with two ICD systems (see Figure 1): (1) the Research EV-ICD System with the investigational extravascular ICD lead placed in the anterior mediastinum and tunneled subcutaneously to the lateral ICD pocket and; (2) a standard Permanent TV-ICD System with the pulse generator placed in a left pectoral pocket and programmed according to the standard of care. Research EV-ICD systems were programmed in a “recording only” mode to store events without the risk of delivering therapy. Detection zone programming was matched between the two systems to allow for comparison of stored events. Research EV-ICD Systems remained implanted for up to 90 days. A test of induced VF conversion with submaximal energy was performed at 30- and 90-day study visits to confirm appropriate chronic sensing and defibrillation. The EV Lead implant procedure was successful in 16/18 subjects. The median follow-up duration with an EV-ICD Lead implant was 90 days (mean = 71 days). Twelve (12) subjects completed the 90-day visit per protocol and 4 exited the study early due to: pneumothorax (day 5); wound dehiscence (day 22); elective removal to understand removal procedure (41), and; viral death (unrelated to study on day 33). Twenty-two (22) conversion tests in 13 subjects were performed at submaximal energy (26 to 30 J delivered) at 30- and/or 90-day visits, with successful conversion in all 22 (100%). One (1) test in 1 subject with acute heart failure symptoms was performed at maximum energy (35 J delivered with successful defibrillation) clinically limiting the number of potential rescue shocks. Sensing and detection of induced VF by the ICD was appropriate in all 23 chronic episodes (100%). A left, anterior parasternal EV ICD lead inserted via an intercostal space was safe and effective at automatically sensing and detecting induced VT/VF up to 90 days after implantation.

Clinical observation of Qiliqiangxin capsule combined with recombinant human brain natriuretic peptide in patients with acute heart failure

Objective: To observe the clinical effect of Qiliqiangxin capsule combined with recombinant human brain natriuretic peptide in acute left heart failure patients 7 days after onset as well as the effects of plasma MDA and ET-1. Methods: In total, 240 hospitalized patients with acute left heart failure from October 2017 to May 2021 were selected from the Department of Emergency and Critical Care Center of Beijing Anzhen Hospital, Capital Medical University and the Department of Cardiology of the Jilin Provincial People's Hospital. They were randomly divided into routine treatment group and combined treatment group, with 120 cases in each group. The routine treatment group was treated with vasodilation, diuresis, cardiotonic and recombinant human brain natriuretic peptide. The combined treatment group was treated with Qiliqiangxin capsules based on the routine treatment group. One week later, the changes in clinical efficacy, ejection fraction, left ventricular commoid diameter, and plasma BNP, MDA, and ET-1 were compared between the two groups before and after treatment. SPSS 11.5 statistical software was used. The measurement data was expressed in x¯±s, the independent sample t-test was used for comparison between groups, and the paired t-test was used for comparison before and after treatment within groups. Counting data was expressed as case (%), and the rank sum test was used for inter-group comparison. Result: In terms of clinical efficacy, the total effective rate of the combined treatment group was significantly higher than that of the conventional treatment group, and the difference was statistically significant (P<0.05). Compared with the routine treatment group, the left ventricular ejection fraction in the combined treatment group was significantly increased (P<0.05). The levels of plasma BNP, MDA and ET-1 were significantly decreased (P<0.05). Conclusion: Qiliqiangxin capsule combined with rhBNP treatment can effectively improve the clinical symptoms of acute heart failure, as well as reduce the lipid peroxidation product MDA content and endothetin ET-1 level in blood. The clinical application value of the Qiliqiangxin capsule needs to be further confirmed by further trials.

Cyclic nucleotide phosphodiesterases as therapeutic targets in cardiac hypertrophy and heart failure.

Cyclic nucleotide phosphodiesterases (PDEs) modulate the neurohormonal regulation of cardiac function by degrading cAMP and cGMP. In cardiomyocytes, multiple PDE isozymes with different enzymatic properties and subcellular localization regulate local pools of cyclic nucleotides and specific functions. This organization is heavily perturbed during cardiac hypertrophy and heart failure (HF), which can contribute to disease progression. Clinically, PDE inhibition has been considered a promising approach to compensate for the catecholamine desensitization that accompanies HF. Although PDE3 inhibitors, such as milrinone or enoximone, have been used clinically to improve systolic function and alleviate the symptoms of acute HF, their chronic use has proved to be detrimental. Other PDEs, such as PDE1, PDE2, PDE4, PDE5, PDE9 and PDE10, have emerged as new potential targets to treat HF, each having a unique role in local cyclic nucleotide signalling pathways. In this Review, we describe cAMP and cGMP signalling in cardiomyocytes and present the various PDE families expressed in the heart as well as their modifications in pathological cardiac hypertrophy and HF. We also appraise the evidence from preclinical models as well as clinical data pointing to the use of inhibitors or activators of specific PDEs that could have therapeutic potential in HF.

Identification of Deterioration caused by AHF, MADS or CE by RR and QT Data Classification

A sharp deterioration of the patient’s condition against the backdrop of the development of life-threatening arrhythmias with symptoms of acute heart failure (AHF), multiple organ dysfunction syndrome (MODS) or cerebral edema (CE) can lead to the death of the patient. Since the known methods of automated diagnostics currently cannot accurately and promptly determine that the patient is in a life-threatening condition leading to the fatal outcome caused by AHF, MODS or CE, there is a need to develop appropriate methods. One of the ways to identify predictors of such a state is to apply machine learning methods to the collected datasets. In this article, we consider using data analysis methods to test the hypothesis that there is a predictor of death risk assessment, which can be derived from the previously obtained values of the ECG intervals, which gives a statistically significant difference for the ECG of the two groups of patients: those who suffered deterioration leading to the fatal outcome caused be MODS, AHF or CE, and those with favorable outcome. A method for unifying ECG data was proposed, which allow, based on the sequence of RR and QT intervals, to the construct of a number that is a characteristic of the patient's heart condition. Based on this characteristic, the patients are classified into groups: the main (patients with fatal outcome) and control (patients with favorable outcome). The resulting classification method lays the potential for the development of methods for identifying the patient's health condition, which will automate the detection of its deterioration. The novelty of the result lies in the confirmation of the hypothesis stated above, as well as the proposed classification criteria that allow solving the urgent problem of an automatic detection of the deterioration of the patient's condition.

Echocardiographic characteristics of patients admitted with acute heart failure with a previous history of cancer: a single-centre observational study

Abstract Funding Acknowledgements Type of funding sources: None. Background Cancer and heart failure frequently co-exist, with cancer and chemotherapy exerting a number of pathological effects on the myocardium. Despite this, our understanding of the clinical impact of previous history of cancer in acute heart failure remains unclear. We therefore performed a retrospective cohort study to identify the echocardiographic characteristics in patients admitted with acute heart failure with and without a diagnosis of solid organ cancer. Methods Consecutive patients with signs and/or symptoms of acute heart failure admitted over a period of 33 weeks (7th January – 28th August 2020) were identified. Discharge summaries, electronic notes and shared care networks were manually searched to determine baseline demographics, admission bloods, comorbidities, cancer diagnoses, imaging and echocardiography. Univariate and multivariate Cox regression analysis was performed to identify clinical and biochemical predictors of mortality. Results In total, 478 patients were admitted with acute heart failure over the study period (mean age 80 ± 11 years, 53.6% were male and mean NT pro-BNP was 9106). 386 had echocardiography available for review. Of these, 64 (16.6%) had a past or current history of solid organ cancer. Patients with a past or current history of solid organ cancer had a significantly higher ejection fraction (48% (±9%) vs 44% (±11%), p = 0.003), higher incidence of heart failure with preserved ejection fraction (57.8% vs 33.5%, p &amp;lt; 0.001) and lower incidence of right ventricular impairment (defined using both visual inspection and TAPSE measurements) (25.0% vs 47.8%, p &amp;lt; 0.001). There were no significant differences in any valvular pathologies between groups (overall prevalence 71.9% vs 71.7%, p = 0.982) No difference was observed between the rate of prior myocardial infarction (28.1% vs 26.0%, p = 0.727) or lung disease (34.4% vs 37.0%, p = 0.692). Overall, mortality at six months follow up was significantly higher in the group with a current or previous cancer diagnosis (43.4% vs 32.0%, p = 0.046) compared to the group without. Conclusion Patients admitted with acute heart failure and a past or current history of cancer have a significantly higher ejection fraction and lower prevalence of right ventricular impairment. Despite the higher ejection fraction their prognosis is worse. Further work is needed to determine potential mechanisms for this, as well as its clinical implications. Abstract Figure. Six Month Survival Kaplan Meier Graph Abstract Figure. Echocardiogrpahic Features

Ведення пацієнта з гострим коронарним синдромом без підйому сегмента ST: акцент на антитромботичну терапію

У статті описано клінічний випадок хворого з гострим коронарним синдромом без підйому сегмента ST з багатосудинним ураженням коронарних артерій, ускладнений явищами гострої серцевої недостатності. Розглянуто підходи до лікування таких хворих відповідно до сучасних рекомендацій і протоколів.

ОСТРАЯ И ХРОНИЧЕСКАЯ СЕРДЕЧНАЯ НЕДОСТАТОЧНОСТЬ ПОСЛЕ ИНФАРКТА МИОКАРДА: КЛИНИЧЕСКИЕ И ФУНКЦИОНАЛЬНЫЕ МАРКЕРЫ

Вackground. The last decade has seen an increase in the number of people who have had myocardial infarction (MI). This phenomenon contributes to an increase in the long-term incidence of chronic cardiovascular diseases, including chronic heart failure. Purpose of the study. To identify the most significant clinical and functional indicators characterizing acute and chronic heart failure after myocardial infarction. Patient Characterization and Research Methods. This analysis included 186 patients who had myocardial infarction from January 2019 to January 2020: 86 people, the main subgroup, with signs of CHF above FC 2 (NYHA) (mean age 64.3 g) and 100 people, the comparison subgroup, without signs of CHF or had CHF 1 FC (NYHA) (mean age 62.6 l). After 1 year, clinical outcomes were assessed: cardiovascular death, repeated hospitalizations due to decompensation of CHF, death from other causes, stroke, repeated myocardial infarction, unplanned coronary revascularization. Results. In the acute period of myocardial infarction in the main subgroup (MI + CHF more than 2cl NYHA), all patients had symptoms of acute heart failure (AHF) in the form of Killip II and Killip III. Predictors of the development of chronic heart failure were the presence of a history of ischemic heart disease, confirmed in accordance with the recommendations, before myocardial infarction; decreased fraction of the left ventricle, detected before discharge and on the 30th day of myocardial infarction; the presence of atrial fibrillation (AF). One-year unfavorable outcomes in the main group were significantly more frequent. Subanalysis of long-term drug therapy showed that cardiovascular death was significantly less common in the subgroup of patients taking ARNI than in the subgroup of enalapril. Conclusion. In the present study, we studied postinfarction myocardial remodeling, which is realized in the form of the formation of a syndrome of acute and chronic heart failure. It has been shown that immediate reperfusion and restriction of the necrosis zone, as well as long-term use of drugs that inhibit SAS and RAAS, stimulating NPP, can inhibit the development of AHF and death. The CHF problem requires further fundamental research in order to develop new approaches that can affect more subtle mechanisms, such as the expression of specific genes involved in the disease, in order to reduce the persisting excess mortality for this pathology.

From combined heart-kidney to kidney transplantation program: what nephrologists should know about dilated cardiomyopathy.

A 42-year-old hemodialysis (HD) patient was investigated in our department for symptomatic heart failure (HF) despite daily home dialysis. He had a history of living donor kidney transplantation at the age of 18 that lasted 7 years. Home dialysis was then started. At the age of 40, he developed acute heart failure symptoms. Echocardiography revealed severe dilated cardiomyopathy (DCM). Coronarography and myocardial perfusion scintigraphy showed no abnormal findings. Betablockers were administrated, and RAAS inhibitor dosing was optimized. Dyspnea persisted, and patient was referred to our department. At admission, blood pressure was 116/82 mmHg, and pulse 68 beats/min. No peripheral edema was observed. Dry weight was 62.5 kg. Patient was anuric. Hemoglobin level was 9.8 g/dl, highly sensitive troponin level was 62 ng/ml, and BNP level was 1527 ng/ml. The liver enzyme levels were normal. C-reactive protein was 4.2 mg/ml. Vitamin level, zinc levels, and thyroid function were normal.

From combined heart-kidney to kidney transplantation program: What nephrologists should know about dilated cardiomyopathy.

A 42-year-old hemodialysis (HD) patient was investigated in our department for symptomatic heart failure (HF) despite daily home dialysis. He had a history ofliving donor kidney transplantation at the age of 18that lasted 7years. Home dialysis was then started. At the age of 40, he developed acute heart failure symptoms. Echocardiography revealed severe dilated cardiomyopathy (DCM). Coronarography and myocardial perfusion scintigraphy showed no abnormal findings. Betablockers were administrated and RAAS inhibitor dosing was optimized. Dyspnea persisted and patient was referred to our department. At admission, blood pressure was 116/82mmHg, and pulse 68 beats/min. No peripheral edema was observed. Dry weight was 62.5kg. Patient was anuric. Hemoglobin level was 9.8g/dl, highly sensitive troponin level was 62ng/ml and BNP level 1527ng/ml. The liver enzymes levels as were normal. C-reactive protein was 4.2mg/ml. Vitamin level, zinc levels and thyroid function were normal.