Diagnosis Of Congestive Heart Failure Research Articles

An Integrated Machine Learning Approach for Congestive Heart Failure Prediction.

Congestive heart failure (CHF) is one of the primary sources of mortality and morbidity among the global population. Over 26 million individuals globally are affected by heart disease, and its prevalence is rising by 2% yearly. With advances in healthcare technologies, if we predict CHF in the early stages, one of the leading global mortality factors can be reduced. Therefore, the main objective of this study is to use machine learning applications to enhance the diagnosis of CHF and to reduce the cost of diagnosis by employing minimum features to forecast the possibility of a CHF occurring. We employ a deep neural network (DNN) classifier for CHF classification and compare the performance of DNN with various machine learning classifiers. In this research, we use a very challenging dataset, called the Cardiovascular Health Study (CHS) dataset, and a unique pre-processing technique by integrating C4.5 and K-nearest neighbor (KNN). While the C4.5 technique is used to find significant features and remove the outlier data from the dataset, the KNN algorithm is employed for missing data imputation. For classification, we compare six state-of-the-art machine learning (ML) algorithms (KNN, logistic regression (LR), naive Bayes (NB), random forest (RF), support vector machine (SVM), and decision tree (DT)) with DNN. To evaluate the performance, we use seven statistical measurements (i.e., accuracy, specificity, sensitivity, F1-score, precision, Matthew's correlation coefficient, and false positive rate). Overall, our results reflect our proposed integrated approach, which outperformed other machine learning algorithms in terms of CHF prediction, reducing patient expenses by reducing the number of medical tests. The proposed model obtained 97.03% F1-score, 95.30% accuracy, 96.49% sensitivity, and 97.58% precision.

Short-Term Mortality in Hospitalized Patients with Congestive Heart Failure: Markers of Thrombo-Inflammation Are Independent Risk Factors and Only Weakly Associated with Renal Insufficiency and Co-Morbidity Burden.

Congestive heart failure (CHF) is associated with significant morbidity and mortality. There has been renewed interest in using thrombo-inflammatory markers as prognostic tools in patients with CHF. To determine if thrombo-inflammatory markers are independent risk factors for 28-day mortality in hospitalized CHF patients, we retrospectively analyzed admission data extracted from 2008 consecutive patients admitted with a diagnosis of CHF to Zigong Fourth People's Hospital. Multivariate Cox proportional hazards analysis demonstrated that the thrombo-inflammatory markers thrombin time, platelet/lymphocyte ratio (PLR), and D-dimer level were independent predictors of mortality. In addition, variables reflecting the severity of CHF (New York Heart Association class > 2), impaired renal function (elevated serum creatinine [SCr]), impaired organ perfusion (elevated BUN), and chronic liver disease were also independent predictors of mortality. Thrombo-inflammatory biomarkers were only weakly associated with SCr and the burden of co-morbidity, suggesting that thrombo-inflammation may in large part be attributable to CHF itself and that, moreover, its presence may confer an increased risk of mortality. Further large-scale prospective studies are needed to determine the existence and the consequences of a thrombo-inflammatory phenotype among patients with CHF.

A Rare Case Report of Cardiac Sarcoidosis with Pulmonary Hypertension

Introduction: Cardiac sarcoidosis (CS) is a rare granulomatous disorder in which white blood cells form clusters on the myocardium. The clinical presentations of CS are varied, as is its etiology. Multiple diagnostic approaches to determine the cause of persistent dyspnea may fail, as cardiac sarcoidosis can mimic many other diseases.Case Report: A 47-year-old woman presented with a sudden onset of dyspnea and a history of chronic thrombo-embolic pulmonary hypertension (CTEPH). Multiple diagnostic approaches were employed, including a CT scan of the thorax with contrast, CT pulmonary angiography, CT coronary angiography, and a Ventilation/Perfusion test, but the results were inconclusive. A Cardiac MRI was ultimately performed, which led to a diagnosis of cardiac sarcoidosis.Case Discussion: The patient had been stable and asymptomatic over the years, despite her history of CTEPH, until she developed a sudden onset of dyspnea. The presence of pitting edema, ECG results, and echocardiography data initially suggested a diagnosis of congestive heart failure. However, tests from the pulmonary system and cardiac coronary were normal. This highlights the elusive nature of cardiac sarcoidosis, which can often go unnoticed and be frequently misdiagnosed. Given the inconclusive results from previous tests, a Cardiac MRI was performed to further characterize the pathology. This led to the findings of Late Gadolinium Enhancement (LGE) and the diagnosis of CS.Conclusion: Cardiac sarcoidosis is a master imitator of many diseases, with patients sometimes presenting with only dyspnea. In such cases, Cardiac MRI plays a pivotal role as a diagnostic test, especially when results from other diagnostic workups are nonspecific.

Prevalence, sex differences, and implications of pulmonary hypertension in patients with apical hypertrophic cardiomyopathy.

Apical hypertrophic cardiomyopathy (ApHCM) is a subtype of hypertrophic cardiomyopathy (HCM) that affects up to 25% of Asian patients and is not as well understood in non-Asian patients. Although ApHCM has been considered a more "benign" variant, it is associated with increased risk of atrial and ventricular arrhythmias, apical thrombi, stroke, and progressive heart failure. The occurrence of pulmonary hypertension (PH) in ApHCM, due to elevated pressures on the left side of the heart, has been documented. However, the exact prevalence of PH in ApHCM and sex differences remain uncertain. We sought to evaluate the prevalence, risk associations, and sex differences in elevated pulmonary pressures in the largest cohort of patients with ApHCM at a single tertiary center. A total of 542 patients diagnosed with ApHCM were identified using ICD codes and clinical notes searches, confirmed by cross-referencing with cardiac MRI reports extracted through Natural Language Processing and through manual evaluation of patient charts and imaging records. In 414 patients, echocardiogram measurements of pulmonary artery systolic pressure (PASP) were obtained at the time of diagnosis. The mean age was 59.4 ± 16.6 years, with 181 (44%) being females. The mean PASP was 38 ± 12 mmHg in females vs. 33 ± 9 mmHg in males (p < 0.0001). PH as defined by a PASP value of > 36 mmHg was present in 140/414 (34%) patients, with a predominance in females [79/181 (44%)] vs. males [61/233 (26%), p < 0.0001]. Female sex, atrial fibrillation, diagnosis of congestive heart failure, and elevated filling pressures on echocardiogram remained significantly associated with PH (PASP > 36 mmHg) in multivariable modeling. PH, when present, was independently associated with mortality [hazard ratio 1.63, 95% CI (1.05-2.53), p = 0.028] and symptoms [odds ratio 2.28 (1.40, 3.71), p < 0.001]. PH was present in 34% of patients with ApHCM at diagnosis, with female sex predominance. PH in ApHCM was associated with symptoms and increased mortality.

National Trends in 30-Day Readmission Following Transoral Robotic Surgery for Oropharyngeal Squamous Cell Carcinoma

As the incidence of oropharyngeal squamous cell carcinoma (OPSCC) continues to rise in the US, an increasing number of patients are being treated with transoral robotic surgery (TORS). Readmission following surgery can potentially delay initiation of adjuvant treatment and affect survival outcomes. To identify risk factors for 30-day postoperative readmission in patients undergoing TORS for OPSCC. This retrospective, population-based cohort study used data from the Nationwide Readmissions Database from 2010 to 2017. All patients undergoing TORS for OPSCC were identified using International Classification of Diseases codes and included. Exclusion criteria were age younger than 18 years or incomplete information regarding index admission or readmission. The analysis was performed from April to October 2023. TORS for OPSCC. Univariate and multivariate analyses were performed to determine factors associated with 30-day readmission. Covariates included demographics and medical comorbidities, socioeconomic factors, hospital characteristics, and surgical details. Trends in readmission over time, reasons for readmission, and characteristics of the readmission were also examined. A weighted total of 5544 patients (mean [SD] age, 60.7 [0.25] years; 4475 [80.7%] male) underwent TORS for OPSCC. The overall readmission rate was 17.5% (n = 971), and these rates decreased over the study period (50 of 211 patients [23.7%] in 2010 vs 58 of 633 patients [9.1%] in 2017). Risk factors associated with readmission included male sex (adjusted odds ratio [AOR], 1.54; 95% CI, 1.07-2.20) and a diagnosis of congestive heart failure (AOR, 2.42; 95% CI, 1.28-4.58). Factors associated with decreased rate of readmission included undergoing concurrent selective neck dissection (AOR, 0.30; 95% CI, 0.22-0.41). Among the 971 readmissions, the most common readmission diagnoses were bleeding (151 [15.6%]), electrolyte and digestive problems (44 [4.5%]), pneumonia (44 [4.5%]), and sepsis (26 [2.7%]). In this cohort study, readmission rates following TORS for oropharynx cancer decreased over time; however, a subset of patients required readmission most commonly related to bleeding, infection, and electrolyte imbalance. Concurrent neck dissection may be protective against readmission. Elucidation of risk factors for readmission after TORS for OPSCC offers opportunities for evidence-based shared decision-making, quality improvement initiatives, and improved patient counseling.

NTproBNP values for diagnosis of congestive heart failure in old patients regarding atrial fibrillation

NTproBNP values for diagnosis of congestive heart failure in old patients regarding atrial fibrillation

Speckle Tracking Echocardiography for the Diagnosis and Prognosis of Light Chain Cardiac Amyloidosis

Background Cardiac amyloidosis was thought to be a rare disease, but the data shows that its prevalence rate is increasing, and the light chain (AL) cardiac amyloidosis are the most common and worst [1]. Because of the lack of symptoms specificity in the preliminary stages of AL cardiac amyloidosis, resulting in underdiagnosis or severe delays in diagnosis, patients are often delayed in the optimal timing of treatment. A considerable proportion of patients are diagnosed after the onset of symptoms of heart failure which progresses rapidly and results in poor prognosis and high mortality. Patients have a mortality rate of up to 50% within 4-6 months after diagnosis of congestive heart failure and the median survival of these patients were less than 12 months [2]. Therefore, early diagnosis and treatment are particularly important for them. Speckle tracking echocardiography has a good imaging analysis of cardiac amyloidosis, which remains the most often used imaging tool. This study aimed to explore the use of speckle tracking echocardiographic parameters to build models which improve the diagnostic rate of patients with suspected AL cardiac amyloidosis and assess the prognosis of patients with AL cardiac amyloidosis. Methods We studied twenty-four patients of pathologically confirmed amyloidosis from March 2017 to February 2023 at the First Affiliated Hospital of Soochow University. According to the criteria for organ involvement, patients were divided into two groups based on whether the heart was involved or not and SPSS 26.0 was used to analyze data. The differences of characteristics and various parameters of Speckle tracking echocardiography between two groups were compared and the indicators with statistical difference were selected for single factor analysis and multivariate analysis. Statistically significant factors were used to establish diagnosis and prognosis assessment models as below. Result In this study, the rate of cardiac involvement was 62.5%. Until June 30 th, 2023, median follow-up time of twenty-four patients was 31 months, and the 5-year survival rate was 74% in CA group and 85.7% in non-CA group. Characteristics The results showed that CA group has lower baseline blood pressure, and the levels of NT-pro BNP and dFLC were significantly higher in the CA group compared to the non-CA group. In speckle tracking echocardiography parameters, CA group has significantly increased IVSd, LVPWd, RWT, E/e and decreased EF, interventricular septum e', lateral wall e' and left ventricular global strain. Diagnosis The results showed that CA group is more likely to be involved in the heart when monoclonal proteins are formed in the peripheral blood （OR=0.031, 95%CI 0.003-0.365, P=0.002）. In univariate analysis, E/e&amp;gt;10.85, interventricular septum e‘&amp;lt;5.25 cm/s, lateral wall e‘&amp;lt;6.05 cm/s, |left ventricular global strain|&amp;lt;16.3% and left ventricular diastolic function ≥Class II have the effect on CA group with statistically significant. Incorporating them into variables to construct a multivariate logistic regression model showed that: the model was built successfully (Omnibus test: P&amp;lt;0.001) and the goodness of fit model is well (Hosmer-Leme show test: P=1). 88.9% of the study subjects who were CA patients were predicted by the model to be CA patients, while 92.9% of the study subjects who were not CA patients were predicted by the model to be not CA patients, but the 5 factors had no significant effect on cardiac amyloidosis (P &amp;gt; 0.05). Prognosis assessment The result of the study shows that IVPWd&amp;gt;13.5mm, RWT&amp;gt; 0.51, NT pro-BNP&amp;gt;6614pg/mL and dFLC&amp;gt;142.35mg/L are elevated risk factors for prognosis with statistically significant. (Figure1). They were included in the variables to construct a multi-factor Cox proportional hazards model and it turns out: the model was built successfully (Omnibus test: P&amp;lt;0.05), but these 4 factors had no significant effect on cardiac amyloidosis (P &amp;gt; 0.05). Conclusion Speckle tracking echocardiography is of great value in the diagnosis and prognosis of patients with cardiac amyloidosis. The combined analysis of echocardiography parameters and serological abnormalities can help in the diagnosis and prognostic assessment of the disease, it also helps to identify patients with poor prognosis early and increasing the possibility of future treatment strategies based on risk stratification.

Clinical and Socio Demographic Aspects of Congestive Heart Failure Patients

Background: Congestive heart failure (CHF) is a growing issue for healthcare systems throughout the developed world. Many factors have been linked to an increase in mortality in CHF patients. Despite heterogeneity in the research groups, several demographic and clinical variables appear to be consistently associated with a poor prognosis. Objective: To investigate the clinical and sociodemographic aspects of congestive heart failure patients. Materials and Methods: This study was a descriptive observational study conducted by the Department of Medicine at Narsingdi' 100- bed district hospital from July 2021 to June 2022. Purposive sampling was used to select 120 women and men with congestive heart failure from the cardiac center of 100-bed district hospital in Narsingdi, Bangladesh. Daily consecutive admissions were screened to identify eligible patients who arrived in the cardiac emergency room; Department of Cardiology required an admission diagnosis of congestive heart failure and was enrolled in this study on the basis of inclusion and exclusion criteria with a history of at least one well documented hospitalization for congestive heart failure. Results: Rhematic heart disease was identified in 38(31.7%), cardiomyopathy was found in 30(25.0%), hypertension was found in 21(17.5%), pericardial disease was found in 16(13.3%), and ischemaic heart disease was found in 3(2.5%). Factors related with congestive heart failure were 25 (20.8%) inadequate therapy, 25 (20.8%) arrhythmia, 23 (19.2%) respiratory, 17 (14.2%) anaemia, and 23 (19.2%) infective endocarditis. The majority of patients (75.5%) had NYHA class II, 38.7% had class III, and 5.8% had class IV. Conclusion: In conjunction with medical and demographic characteristics, major socio-environmental factors increased the likelihood of readmission due to congestive heart failure.

NTproBNP values for the diagnosis of congestive heart failure in dyspneic old patients regarding age

Abstract Background The diagnosis of heart failure (HF) in elderly patients is often difficult, due to overlap of typical signs and symptoms with those of comorbidities. Plasma N-Terminal Pro-Brain Natriuretic Peptide(NTproBNP) is known to increase with age and according to comorbidities. However, the diagnostic performance of this biomarker is unclear in those patients. Aims This study sought to define the diagnostic accuracy of plasma NTproBNP in patients over 75 yo in a large population referred for acute dyspnea in the Assistance Publique-Hôpitaux de Paris. Methods and Results In this retrospective, longitudinal multicenter cohort study, we collected data from 12,974 patients aged 75 years or older who were hospitalized for acute dyspnea with NTproBNP measurement in the 48 hours after admission between 2011 and 2021 in geriatrics, cardiology and pulmonology departments. The final diagnosis was classified with the International Classification of Diseases, 10th Revision (ICD 10) as either "AHF" or "other acute respiratory failure" (OARF), represented by pulmonary embolism, COPD and pneumonia. The Mean (SD) age of our population was 84.4 (6.1) years old, and 52.7% of patients were women. 8,385 (64.6%) patients had an AHF diagnosis at discharge. Regarding age of patients, NT-proBNP threshold values was higher in patients over 85 yo, 2530 ng/L, compared to that of patients &amp;lt; 85 yo, 1680 ng/L. The NTproBNP threshold for ‘ruling-out’ AHF had a 79% sensitivity in patient &amp;gt; 85 YO and 82% sensitivity in patient 75- 85 YO. In patients &amp;gt; 85 compared with patient 75-85 yo, predictive positive value was 85 and 86 %, specificity was 65% and 75% and AUC was 0.77 and 0.84. Finally, despite the consideration of other clinical and biological parameters, NTproBNP level remain more discriminating for the diagnosis of AHF in old patients with comorbidities. Conclusion In patients 75-85 and over 85 years of age referred for acute dyspnea with NTproBNP dosage at admission, a cutoff of 1680 and 2530 ng/L respectively allow for an accurate diagnosis of AHF.

NTproBNP values for diagnosis of congestive heart failure in old patients regarding kidney failure

Abstract Background The diagnosis of heart failure (HF) in old patients is often difficult, due to overlap of typical symptoms and comorbidities. Plasma N-Terminal Pro-Brain Natriuretic Peptide(NTproBNP) is known to increase with age and according to comorbidities particularly in chronic kidney failure. However, the diagnostic performance of this biomarker is unclear in those patients with kidney failure. Aims This study sought to define the diagnostic accuracy of plasma NTproBNP in patients over 75 yo in a large population referred for acute dyspnea in the Assistance Publique-Hôpitaux de Paris. Methods and Results In this retrospective, longitudinal multicenter cohort study, we collected data from 12,974 patients aged 75 years or older who were hospitalized for acute dyspnea with NTproBNP measurement in the 48 hours after admission between 2011 and 2021 in geriatrics, cardiology and pulmonology departments. The final diagnosis was classified with the International Classification of Diseases, 10th Revision (ICD 10) as either "AHF" or "other acute respiratory failure" (OARF), represented by pulmonary embolism, COPD and pneumonia. The Mean (SD) age of our population was 84.4 (6.1) years old, and 52.7% of patients were women. 8,385 (64.6%) patients had an AHF diagnosis at discharge. Regarding creatinine clearance (CrCl) of patients, NT-proBNP threshold values was lower in patients with CrCl ≥40 ml/min compared to that of patients CrCl &amp;lt;40 ml/min, 1681 and 2238 ng/L respectively. The NTproBNP threshold for ‘ruling-out’ AHF had 81% sensitivity in patient with CrCl ≥40 ml/min and 87% sensitivity in patient with CrCl &amp;lt;40 ml/min. In patients with CrCl ≥40 ml/min compared with patient with CrCl &amp;lt;40 ml/min, predictive positive value was 82 and 89 %, specificity was 70% and 45% and AUC was 0.81 and 0.69. The other comorbidities that statistically change NTproBNP cutpoint diagnostic value were atrial fibrillation, age and sex. Conclusion In old patients referred for acute dyspnea with NTproBNP dosage at admission with kidney failure, cutpoint values of 1681 and 2238 ng/L according to CrCl allow for an accurate diagnosis of AHF.

Impact of Clostridioides difficile infection in heart failure hospitalizations: analysis from the national inpatient sample database

Abstract Background Congestive heart failure (CHF) patients are at greater risk of nosocomial infections such as Clostridioides difficile infection (CDI) due to higher comorbidities, readmission rates, and prolonged hospital stays. Further, hypovolemia and sympathetic drive may aggravate myocardial dysfunction due to demand mismatch and worsen clinical outcomes. Purpose To assess the impact of CDI in congestive heart failure (CHF) hospitalizations nationally in the US. Methods The National Inpatient Sample database from 2016 to 2019 was queried to identify patients with a primary diagnosis of CHF. Subsequently, the sample was stratified based on the presence of CDI as a secondary diagnosis. The adjusted odds ratios (aOR) of in-hospital outcomes were calculated using chi-square statistics in software STAT v.17. Results Of 1,270,414 weighted hospitalizations with CHF, 8275 were diagnosed with CDI (0.65%). On adjusted analysis, patients with CHF and CDI had significantly higher in-hospital mortality (aOR 3.58, 95% CI 3.28-4.51, p&amp;lt;0.001), cardiac arrest (aOR 3.89, 95% CI 2.79-5.41, p&amp;lt;0.001), AMI (aOR 1.37, 95% CI 1.08-, p=0.007), MCS (aOR 5.16, 95% CI 3.91-6.8, p&amp;lt;0.001), stroke (aOR 1.85, 95% CI 1.09-3.14, p=0.022) and MACE (aOR 2.54, 95% CI 2.21-2.91, p&amp;lt;0.001), (Figure 1). Additionally, HF patients with CDI are associated with longer lengths of stay (12±16 vs. 5±6 ) and adjusted total charge ($133,045±291,290 vs. $51,919±133,303) compared to HF patients without CDI (Table 1). Conclusions CDI in CHF hospitalizations have adverse in-hospital outcomes with higher rates of in-hospital mortality, AMI, stroke, and MACE. This highlights the importance of early detection and aggressive infection prevention strategies in this high-risk population.Figure 1Table 1

Abstract 18054: Contemporary In-Hospital Outcomes of Congestive Heart Failure With Multiple Myeloma; a Regression Matched Analysis

Introduction: Multiple myeloma (MM) is a disease commonly found in elderly individuals and is associated with a high burden of cardiovascular comorbidity. Various disease manifestations in MM, including amyloidosis, anemia, hyperviscosity, hypercalcemia, intramedullary arteriovenous fistula formations, and chemotherapy-related complications, contribute to an increased risk of congestive heart failure (CHF). The objective of this study was to examine the clinical outcomes of MM patients admitted with CHF. Methods: The National Inpatient Sample database from 2016-2020 was queried to identify patients with a primary diagnosis of CHF and stratified based on the presence of MM. The primary outcome measured was in- hospital mortality. The adjusted odds ratio (aOR) of in-hospital outcomes were calculated using software STAT v.17. Results: Of the 536,700 primary hospitalizations with CHF, 1,965 (0.36%) had MM. On adjusted analysis, the CHF-MM cohort had a higher odds of cardiac arrest (aOR 2.5, 95% CI 1.2-5.5), need for new hemodialysis (aOR 2.4, 95% CI 1.6-3.6) and GI bleeding (aOR 2.1, 95% CI 1.1-3.8) However, there was no statistically significant difference in the odds of in-hospital mortality, stroke, AMI or major bleeding. Furthermore, the presence of MM in CHF related hospitalizations was not associated with higher length of stay and adjusted total cost. Conclusion: Our study reveals that MM patients admitted with CHF have an increased risk of cardiac arrest, new hemodialysis, and GI bleeding. To optimize cardiovascular outcomes in this high-risk patient population, a multidisciplinary approach involving hemato-oncologists and cardiologists is necessary.

Utility of vertebral left atrial size and vertebral heart size to aid detection of congestive heart failure in dogs with respiratory signs.

Differentiating cardiogenic vs noncardiogenic causes of respiratory signs can be challenging when echocardiography is unavailable. Radiographic vertebral left atrial size (VLAS) and vertebral heart size (VHS) have been shown to predict echocardiographic left heart size, with VLAS specifically estimating left atrial size. Compare the diagnostic accuracy of VLAS and VHS to predict left-sided congestive heart failure (CHF) in dogs presenting with respiratory signs. One-hundred fourteen dogs with respiratory signs and radiographic pulmonary abnormalities. Retrospective cross-sectional study. Dogs had to have an echocardiogram and thoracic radiographs obtained within 24 hours. Diagnosis of CHF was confirmed based on the presence of respiratory signs, cardiac disease, LA enlargement, and cardiogenic pulmonary edema. Fifty-seven dogs had CHF and 57 did not have CHF. Compared to VHS (area under the curve [AUC] 0.85; 95% confidence interval [CI], 0.77-0.91), VLAS was a significantly (P = .03) more accurate predictor of CHF (AUC, 0.92; 95% CI, 0.85-0.96). Optimal cutoff for VLAS was >2.3 vertebrae (sensitivity, 93.0%; specificity, 82.5%). Murmur grade (P = .02) and VLAS (P < .0001) were independently associated with CHF and VHS was not. Increased VHS (54%) was significantly (P = .01) more common than increased VLAS (24%) in dogs without CHF. Results were similar in a subsample of older and smaller dogs. When echocardiography is unavailable, VLAS and murmur grade have clinically utility to aid in differentiating cardiogenic from noncardiogenic respiratory signs. These findings might be especially useful to help rule out CHF in dogs with increased VHS that present with respiratory signs.

Caso antemortem de insuficiência valvar atrioventricular em dragão barbudo (Pogona vitticeps) – relato de caso

An atrioventricular valve insufficiency is a common form of cardiac disorder in mammals, whereas it has rarely been reported in reptiles. A two-year-old male bearded dragon (Pogona vitticeps) was presented with acute onset of lethargy, inappetence and general weakness, increased respiratory effort, dark skin color, and arched back. A gastrointestinal foreign body was suspected, but radiography showed coelomic fluid accumulation. Ultrasound heart examination revealed turbulent blood flow at the level of the atrioventricular valves. Electrocardiography by modified Einthoven lead system (lead configuration 1) as described for Squamata, did not show significant changes. A tentative diagnosis of congestive heart failure as a result of valvulopathy was made. Treatment consisted of parenteral furosemide and fluid administration and assisted feeding with appropriate food intended for adult bearded dragons. The patient was weekly evaluated and successfully recovered over the four months. Echocardiography and electrocardiography were repeated 12 months later. The prescribed treatment was successful with complete resolution of clinical signs, and long-term surveillance of the bearded dragon (Pogona vitticeps).

Radiographic lung congestion scores in dogs with acute congestive heart failure caused by myxomatous mitral valve disease.

In humans, lung congestion scores are predictive of recurrence of acute congestive heart failure (CHF) and are superior to cardiac biomarkers in predicting survival. The primary aim of this retrospective study was to determine if a modified lung congestion score (LCS) in dogs diagnosed with acute CHF because of myxomatous mitral valve disease was associated with time until recurrence or death. Complete medical records were available for a total of 94 dogs between 2010 and 2019, but only 35 dogs fulfilled the criteria for inclusion. This retrospective study used descriptive statistics to describe the cumulative and corrected LCS. Correlations were used to examine the association of the corrected LCS and time until recurrence or death, selected echocardiographic variables, and timing of furosemide administration. The mean LCS was 8.4 (SD 3.3) and corrected LCS was 0.48 (SD 0.19). The pattern was predominantly symmetric (40% of dogs) and focal (caudal) but more commonly right-sided when asymmetric (40% vs 20%). The median number of days after initial diagnosis of acute CHF to readmission and death was 150 days (range 4-572), and 266 days (range 5-965), respectively. No significant association between the dog's corrected LCS and number of days until readmission (r = .173, P = .42) nor survival (r = .109, P = .56) was found. There was a negative significant correlation (r = -.71, P < .001) between the time interval of furosemide administration and corrected LCS.

Preventing Avoidable Rehospitalizations through Standardizing Management of Chronic Conditions in Skilled Nursing Facilities

ObjectivesThis study evaluated the impact of standardized care protocols, as a part of a quality improvement initiative (J10ohns Hopkins Community Health Partnership, J-CHiP), on hospital readmission rates for patients with a diagnosis of congestive heart failure (CHF) and/or chronic obstructive pulmonary disease (COPD) after being discharged to skilled nursing facilities (SNFs). DesignA retrospective study comparing 30-day hospital readmission rates the year before and 2 years following the implementation of the care protocol interventions. Settings and ParticipantsPatients discharged from Johns Hopkins Hospital or Johns Hopkins Bayview Medical Center to the participating SNFs diagnosed with CHF and/or COPD. MethodsThe standardized protocols included medical provider or nurse assessments on SNF admission, multidisciplinary care planning, and medication management to avoid unplanned readmissions to the hospital. Descriptive analyses were conducted to illustrate the 30-day readmission rates before and after protocol implementation. ResultsThere were 1128 patients in the pre-J-CHiP cohort and 2297 patients in the J-CHiP cohort. About half of the patients with a recorded diagnosis of CHF without COPD had the standardized protocol initiated, whereas 47% of the patients with a recorded diagnosis of COPD without CHF had the standardized protocol initiated. Of patients with recorded diagnoses of COPD and CHF, 49% had both protocols initiated. A reduction in the readmission rate was observed for patients with COPD protocols, from 23.5% in 2011 to 12.1% in 2015. However, fluctuations in the readmission rates were observed for patients who initiated the CHF protocols. Conclusions and ImplicationsThere were improvements in the readmission rates in this study, especially for patients who had initiated standardized care protocols in the SNFs. Our findings demonstrate great value in standardizing care management and strengthening collaboration with chronic care settings to facilitate a smooth transition of medically complex patients discharged from large health care systems. Future interventions could consider assessing nonclinical factors that may impact preventable hospital readmissions.

Right ventricular failure due to acute pulmonary embolism associated with Graves’ disease: A case report

Background Graves' disease is a prevalent endocrine disorder characterized by diverse clinical manifestations affecting multiple organs, exhibiting varying degrees of severity. Cardiovascular system involvement is one of the most common manifestations, which include palpitation, tachycardia, cardiomyopathy, atrial fibrillation, pulmonary hypertension, or heart failure. Additionally, excessive thyroid hormone can lead to a hypercoagulable state, increasing the risk of venous thrombosis. However, thrombotic events, particularly deep vein thrombosis, cerebral venous thrombosis, or pulmonary embolism, are rare complications of Graves’ disease. Case presentation In this report, we present the case of a 53 years old woman who presented with progressively worsening dyspnea, orthopnea, paroxysmal nocturnal dyspnea, bilateral leg edema, and jaundice for 2 weeks. She had also reported a weight loss of 4 kilograms within 3 months. Upon admission to our hospital, she initially received a diagnosis of congestive heart failure with atrial fibrillation and thyrotoxicosis. Following diuretic therapy, the patient developed hypotension and severe hypoxemia. Subsequent investigation revealed acute right ventricular failure due to an acute sub-segmental pulmonary embolism, which was confirmed by computed tomography of the pulmonary artery. The patient's condition improved after resuscitation involving intravenous fluid administration to increase right ventricular preload, intravenous vasopressor infusion to elevate systemic blood pressure, management of severe thyrotoxicosis, and intravenous administration of heparin. Conclusion Graves’ disease, accompanied by hemodynamic disturbances due to acute right ventricular failure, necessitates admission to the intensive care unit for resuscitation and close monitoring. Although acute pulmonary embolism is an uncommon condition associated with Graves’ disease, it should be considered, particularly in patients who develop acute right ventricular failure.

Initial Management Strategy and Long-Term Outcomes in 186 Cases of Spontaneous Coronary Artery Dissection

Spontaneous coronary artery dissection (SCAD) is a rare but important nonatherosclerotic cause of acute coronary syndrome. Indications for revascularization and long-term outcomes of SCAD remain areas of active investigation. We report our experience with initial management strategy and long-term outcomes in SCAD. We reviewed all patients treated at our institution from 1996-2021 with a SCAD diagnosis. Demographics, comorbidities, clinical presentations, angiography findings, and management strategies were obtained by chart review. The primary outcome was a composite of cardiac death, recurrent/progressive SCAD, subsequent diagnosis of congestive heart failure, or subsequent/repeat revascularization after the initial management. Unadjusted Kaplan-Meier survival analysis was performed. Of 186 patients with a SCAD diagnosis treated at our institution, 149 (80%) were female. Medical management was the initial treatment in 134 (72.0%) patients, percutaneous coronary intervention (PCI) in 43 (23.1%), and coronary artery bypass grafting in 9 (4.8%). Surgery/PCI intervention was associated with younger age (38.8 vs 47.7 years, P = 0.01), ST elevation myocardial infarction on presentation (67.0% vs 34.0%, P < 0.001), lower ejection fraction (45.0% vs 55.0%, P = 0.002), and left anterior descending coronary artery dissection (75.0% vs 51.0%, P = 0.006). Ten-year freedom from our composite outcome was similar between revascularized patients and those managed with medical therapy (P = 0.36). Median follow-up time was 4.5 years. SCAD in the setting of ST elevation myocardial infarction, left anterior descending coronary artery involvement, or decreased cardiac function suggests greater ischemic insult and was associated with initial percutaneous or surgical revascularization. Despite worse disease on initial presentation, long-term outcomes of patients undergoing revascularization are similar to medically managed patients with SCAD.

Assessment of the Clinical Utility of Interleukin-6 in Congestive Heart Failure

Objective: To determine the clinical utility of Interleukin-6 in Congestive heart failure by comparing its association with N terminal-pro brain natriuretic peptide (NT-pro BNP). Study Design: Diagnostic Accuracy Study. Place and Duration: Department of Chemical Pathology, Combined Military Hospital (CMH), Lahore, from 1st September 2022 to 30th November 2022. Methodology: Patients reporting to the CMH Lahore Emergency Department with symptoms suggestive of Congestive Heart Failure (CHF) and Left Ventricular Ejection Fraction (LVEF) &lt; 40% were included in the study after a detailed physical examination. Sample collection was done for analysis of N terminal-pro brain natriuretic peptide and interleukin-6. Standard echocardiography results were obtained from the patients. Their past medical history, the results of the clinical examination, and any additional findings were considered together when evaluating the data for diagnostic reasons. Results: The levels of N terminal-pro brain natriuretic peptide displayed a very weak positive correlation with interleukin-6 (r value=0.016; p value=0.859). Therefore, N terminal-pro brain natriuretic peptide and interleukin-6 were found to have a statistically insignificant association. Interleukin-6 was found to have sensitivity, specificity, and Area under Curve (AUC) (11.11%, 91.18%, and 0.482) respectively at a cut-off level of 65.6pg/ml, for the diagnosis of congestive heart failure. Conclusion: Interleukin-6 has a causative role in the progression and monitoring of congestive heart failure, however; we were unable to show its usefulness as a diagnostic marker of congestive heart failure. The positive correlation of interleukin-6 with N terminal-pro brain natriuretic peptide suggests that interleukin-6 can still be a target for therapeutics. Keywords: Interleukin-6, Diagnostic Accuracy, NT Pro-BNP (Gold Standard), Congestive Heart Failure, Biochemical Markers, Left Ventricular Ejection Fraction. How to Cite This: Saeed M, Rana MZ, Khan N, Anwar H, Awais H, Ahmed S. Assessment of the Clinical Utility of Interleukin-6 in Congestive Heart Failure. Isra Med J. 2023; 15(1): 7-10. DOI: https://doi.org/10.55282/imj.oa1380 This is an Open Access article distributed under the terms of the Creative Commons Attribution-Noncommercial 4.0 International License (http://creativecommons.org/licenses/by-nc/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Understanding risks and time to congestive heart failure following incident atrial fibrillation

Objectives: Evaluate how different comorbidities increase 3-year risk of incident congestive heart failure (CHF) in new atrial fibrillation (AF) patients and the time from diagnosis of AF to developing incident CHF while controlling for risk factors and treating death as a competing risk event. Methods: We utilized CMS Medicare 100% inpatient and outpatient claims data between 2013 and 2017. Patients with new AF diagnosis (without concurrent CHF at AF diagnosis) in 2014 who had 1-year continuous enrollment prior to their AF diagnosis (baseline period) and no prior diagnosis of AF or CHF in the baseline period were identified. Results: With every 1-year increase in age of incident AF patients, 3-year risk of CHF increases by 2.6%, presence of coronary artery disease, COPD, diabetes mellitus, peripheral artery disease, and cardiomyopathy increases 3-year risk of CHF by 22.1%, 30.2%, 31.9%, 15.2%, 44.8%, and 6.3% respectively. Blacks with incident AF had 6.9% higher 3-year risk CHF than Whites. For the average aged female patient in our cohort (78.5years) with no comorbidities and death as a competing risk, we found the probability of CHF within the first 3 years after AF diagnosis to be 23.5%, 17.5% within the first 2 years, and 10% within the first year. Conclusion: Various comorbidities affect the risk of CHF differently in incident AF patients. Cumulative risk of incident CHF appears to increase fastest within the first few years following incident AF diagnosis.