Diagnosis Of Systolic Heart Failure Research Articles

Diagnostic accuracy of plasma brain natriuretic peptide for evaluation of dyspnea NYHA-III and NYHA-IV in emergency department of tertiary care hospital.

To determine the diagnostic accuracy of breathing not properly (BNP) for evaluation of dyspnea NYHA III and IV due to systolic heart failure in emergency department patients keeping echocardiography as the gold standard. Cross-sectional validation study. Setting: Department of Accident and Emergency Duration of Study: 25 July 2022-25 January 2023. A total of 115 of both sexes presenting with acute onset of dyspnea and having NYHA Class III and IV were included. Emergency nursing staff had immediately taken a single venous blood sample for BNP and creatinine levels and a 2D echo was performed. Ejection fraction was recorded, and the diagnosis of systolic heart failure on the basis of an ejection fraction, that is less than or equal to 45% was documented. The age range in this study was from 18 to 65 years, with a mean age of 49.147±8.73 years. Mean BNP levels were 139.452±84.04pg/ml. Patients with NYHA class III was 67.8 and 32.2% belongs to NYHA class IV. BNP levels greater than or equal to 100pg/ml diagnosed 76 (66.1%) and echocardiography has diagnosed 68 (59.1%) patients with heart failure. BNP levels greater than or equal to 100pg/ml had shown sensitivity 94.1%, specificity 74.5%, and diagnostic accuracy 86%, positive predictive value 84.21%, negative prediction value 89.74%, likelihood positive ratio 3.68 and likelihood negative ratio was 0.08 in diagnosis of heart failure. BNP estimation is a sensible and particular procedure for diagnosing CHF in patients who present to the emergency department with acute dyspnea and may add extra advantages to the administration of patients with congestive heart failure (CHF) in our population.

Utilizing The Electronic Medical Record To Assess Optimal Medical Therapy In Heart Failure Patients

<h3>Intro</h3> As healthcare payment models continue to shift from fee-for-service to pay-for-performance, adequate tools to measure & manage population health will be critical. Heart failure (HF) remains a prevalent & costly chronic condition that has been difficult to manage on a population basis. Guideline-directed optimal medical therapy (OMT) improves HF outcomes, but significant limitations exist in assessing & improving physician/patient compliance with guideline-directed therapy in real world clinical practice. <h3>Hypothesis</h3> Creating an objective scoring system for HF OMT & integrating it into the EMR can benchmark current medical therapy in HF patients & identify gaps in guideline-directed care. <h3>Methods</h3> A small committee within a 100-physician cardiology practice worked to adapt a proposed HF OMT score published in a JACC:HF editorial to meet updated guidelines & specific practice goals. The different guideline-directed HF medications were assigned scores to be combined to a total HF OMT score for a specific patient. The score was integrated into EMR to calculate prospectively for all patient encounters in which there was a history of LVEF less than or equal to 40% or diagnosis of systolic heart failure without LVEF. The treating physician/APP was not alerted to the calculated score in order to truly assess the baseline use of OMT in HF pts. Results: The HF OMT score was calculated for 1,201 pts at the time of a physician/APP encounter over a one-month period. The average score for all visits was 2.8. Evaluation by medication class & dose reveals significant underutilization of MRA and SGLT2i in HF patients in our practice. <h3>Conclusion</h3> Active management & optimization of guideline driven OMT in HF pts across a population will be critical to improving outcomes & succeeding in the evolving pay-for-performance environment. Long term use of a standardized HF OMT score can identify gaps in care for specific medications, by specific physician/APPs, or related to specific patient factors (race/ethnicity, insurance status, gender). Additionally this score can be used to measure the success of future interventions targeting improved compliance with guideline-directed therapy.

Association of Ischemic Evaluation and Clinical Outcomes Among Patients Admitted With New-Onset Heart Failure.

BackgroundThe significant morbidity associated with systolic heart failure makes it imperative to identify patients with a reversible cause. We thus sought to evaluate the proportion of patients who received an ischemic evaluation after a hospitalization for new‐onset systolic heart failure.Methods and ResultsPatients admitted with a new diagnosis of heart failure and a reduction in left ventricular ejection fraction (≤40%) were identified in the VA Healthcare System from January 2006 to August 2017. Among those who survived 90 days without a readmission, we evaluated the proportion of patients who underwent an ischemic evaluation. We identified 9625 patients who were admitted with a new diagnosis of systolic heart failure with a concomitant reduction in ejection fraction. A minority of patients (3859, 40%) underwent an ischemic evaluation, with significant variation across high‐performing (90th percentile) and low‐performing (10th percentile) sites (odds ratio, 3.79; 95% CI, 2.90–4.31). Patients who underwent an evaluation were more likely to be treated with angiotensin‐converting enzyme inhibitors (75% versus 64%, P<0.001) or beta blockers (92% versus 82%, P<0.001) and subsequently undergo percutaneous (8% versus 0%, P<0.001) or surgical (2% versus 0%, P<0.001) revascularization. Patients with an ischemic evaluation also had a significantly lower adjusted hazard of all‐cause mortality (hazard ratio, 0.54; 95% CI, 0.47–0.61) compared with those without an evaluation.ConclusionsIschemic evaluations are underutilized in patients admitted with heart failure and a new reduction in left ventricular systolic function. A focused intervention to increase guideline‐concordant care could lead to an improvement in clinical outcomes.

Prevalence, Predictors and Prognostic Impact of Renal Dysfunction among Hospitalized Patients with Systolic Heart Failure

Background and Aim: The interaction between heart and kidneys has increased, and parts of the pathophysiological background for the cardiorenal syndrome have been established. This study aimed to determine the prevalence, predictors, and prognostic impact of Renal Dysfunction (RD) among hospitalized patients with systolic Heart Failure (HF). Methods: This cross-sectional study included 1559 patients, who were admitted with a diagnosis of systolic HF during the period from 1-March-2011 till 20-June- 2019 at Madinah cardiac center. RD was defined as estimated glomerular filtration rate < 60 mL/min/1.73 m2. Results: Of the total of 1559 patients, 67.2% were males, 51.3% were hypertensive, 56.1% were diabetic and 49.1% were anemic. 60.9% of patients had RD. HF patients with RD were significantly older (p

Ventricular systolic dysfunction with and without altered myocardial contractility: Clinical value of echocardiography for diagnosis and therapeutic decision-making

The inability of one of the two or both ventricles to contract normally and expel sufficient blood to meet the functional demands of the body results from a complex interplay between intrinsic abnormalities and extracardiac factors that limit ventricular pump function and is a major cause for heart failure (HF).Even if impaired myocardial contractile function was the primary cause for ventricular dysfunction, with the progression of systolic dysfunction, additionally developed diastolic dysfunction can also contribute to the severity of HF. Although at the first sight, the diagnosis of systolic HF appears quite easy because it is usually defined by reduction of the ejection fraction (EF), in reality this issue is far more complex because ventricular pumping performance depends not only on myocardial contractility, but also largely on loading conditions (preload and afterload), being also influenced by valvular function, ventricular interdependence, pericardial constraint, synchrony of ventricular contrac-tion and heart rhythm. Conventional echocardiography (ECHO) combined with new imaging techniques such as tissue Doppler and tissue tracking can detect early subclinical alteration of ventricular systolic function. However, no single ECHO parameter reveals alone the whole picture of systolic dysfunction. Multiparametric ECHO evaluation and the use of integrative approaches using ECHO-parameter combinations which include also the ventricular loading conditions appeared particularly useful especially for differentiation between primary (myocardial damage-induced) and secondary (hemodynamic overload-induced) systolic dysfunction.This review summarizes the available evidence on the usefulness and limitations of comprehensive evaluation of LV and RV systolic function by using all the currently available ECHO techniques.

Food Deserts and Risk for Rehospitalization in Heart Failure Patients

Introduction Rehospitalization represents a financial burden on the healthcare system, estimated to be 17.4 billion dollars amongst Medicare recipients in 2004. The leading diagnosis for thirty day readmissions is for patients with congestive heart failure. Living in a socioeconomically disadvantaged neighborhood has been independently linked to increased rates of rehospitalization, with equivalent risk to having a diagnosis of chronic obstructive pulmonary disease. Lack of access to fresh fruits and vegetables in low-income areas, so called food deserts, has been linked to higher obesity rates, a risk factor for the development of congestive heart failure. While sodium restriction remains a recommendation in the ACC/AHA guidelines for the management of heart failure, data is inconsistent regarding the role of diet in symptomatic control. We hypothesized that distance to fresh produce and proximity to fast food may increase rate of admission for heart failure. Methods We created a dataset of all patients with an admission or discharge diagnosis of systolic heart failure from December 1st, 2010 to December 1st, 2015 at the University of Illinois Hospital. These patients were confirmed by chart review to have a left ventricular ejection fraction Results and Conclusions Patients were stratified by number of admissions, either having one or more than one admission. Patients with multiple admissions were found to have a grocery store closer to their home address (p=0.023) as well as more stores in a 5 mile radius (p=0.012) than patients with only one admission. Patients with multiple admissions were also found to have a significantly higher number of fast food restaurants in a 5 mile radius when compared to patients with only one admission (p=0.014). Availability of low sodium foods may be only a small factor in heart failure patient's dietary choices as patients with multiple admissions had more grocery stores within 5 miles and were closer to a grocery store. Patients with multiple admissions had significantly more fast food restaurants closer to their home, suggesting that taste preference, price and convenience play a significant factor in patient's dietary choices. It should also be mentioned that patients in all groups had more than twice the number of fast food restaurants near their home than grocery stores.

Abstract 120: Effectiveness of a Pharmacist Population Health Intervention for Sacubitril/valsartan in Systolic Heart Failure

Purpose: Previous literature demonstrates higher prescribing rates by providers after contact with a pharmaceutical representative or after obtaining drug information from an external source. This study aims to evaluate the effectiveness of an Electronic Health Record (EHR), pharmacist-based, population health intervention on physician prescribing patterns of sacubitril/valsartan in patients at Michigan Medicine General Cardiology clinics. Methods: The institutional review board approved this prospective, cluster-randomized controlled study. Patients seen by providers at the General Cardiology clinics of Michigan Medicine between 3/21/2017 and 6/1/2018 were included. Twenty-seven cardiology providers were clustered based on specialty. Fourteen providers were included in the intervention group while 13 providers were included in the control group. Within each arm, study personnel prospectively screened patients by preliminarily filtering those with a diagnosis of systolic heart failure and a left ventricular ejection fraction (LVEF) of 40% or less. Practice-based guideline criteria were then used to determine final patient eligibility. Intervention notifications were sent by pharmacists to providers using the EHR inbox within two-weeks prior to the clinic visit. The primary endpoint for this study was the proportion of patients prescribed sacubitril/valsartan within three months following the appointment. Baseline demographic data was collected on intervention patients. Additionally, the reasons for ineligibility were collected on all patients. Results: A total of 1559 patients were included (intervention=763, control=796). Fifty-two patients met eligibility criteria for sacubitril/valsartan (intervention=16, control=36). Of eligible patients, two in the intervention group and one in the control group had sacubitril/valsartan initiated (12.5% vs. 2.8%, OR 5.0, 95% CI 0.42-59.7, p=0.22). Of the 14 interventions that were not accepted, there was a common provider and 79% of the messages were ignored. The main reasons for ineligibility were patients not taking a dose of angiotensin converting enzyme (ACE) inhibitor or angiotensin-receptor blocker (ARB) equivalent to enalapril 10 mg twice daily (92.6%) or not currently taking an ACE inhibitor or ARB (5.1%). Conclusion: Few patients met practice-based guideline criteria which reflected a conservative approach to initiating sacubitril/valsartan and limited sacubitril/valsartan initiation. EHR inbox interventions may be limited since most of the messages were ignored. Future research should explore tools to aid in optimizing medication therapy for patients with systolic heart failure which may lead to more successful pharmacist-based, population health interventions for this patient population.

Prescription of Potentially Harmful Drugs in Young Adults With Heart Failure and Reduced Ejection Fraction

According to national guidelines and statements drugs that can cause or exacerbate heart failure (HF) are considered potentially harmful and should be avoided if possible in patients with a diagnosis of heart failure with reduced ejection fraction (HFREF). To evaluate the prevalence of potentially harmful drug (PHD) prescription among patients with a diagnosis of systolic heart failure we conducted a retrospective cohort study using Truven Health MarketScan Commercial database from 2011 to 2014. Prescription of PHD as defined by American Heart Association Statement was examined among patients with a HFREF diagnosis in: (1) Two outpatient encounters, (2) One inpatient encounter as primary diagnosis and/or (3) one inpatient encounter any position and one outpatient encounter. Among 40,966 patients, 24.2% were prescribed with at least 1 drug with the potential to cause or exacerbate heart failure. Of the 9,954 patients prescribed with PHD, nonsteroidal anti-inflammatory agents were the most frequent category prescribed (67.4%), followed by antihypertensive (24%), diabetes mellitus (23.3%), neurological and psychiatric (21%) and antiarrhythmic medications (12.6%). After multivariable analysis female patients, the presence of a comorbidity associated with a PHD use and polypharmacy were more frequently prescribed a PHD. In conclusion almost ¼ of adult patients with a diagnosis of HFREF have a prescription of a drug with a potential to cause or exacerbate heart failure as defined by current heart failure guidelines.

Point-of-Care Ultrasound for the Diagnosis of Systolic Heart Failure

Point-of-Care Ultrasound for the Diagnosis of Systolic Heart Failure

Abstract 251: Gender Equity in Rates of Guideline-Directed Medical Therapy Prescription at Discharge for Hospitalized Heart Failure Patients

Background: Heart failure (HF) is an increasingly prevalent condition with significant morbidity and mortality. Guideline-directed medical therapy (GDMT) reduces morbidity and mortality in heart failure with reduced ejection fraction, but continues to be under-prescribed. There is a paucity of data on the impact of patient gender on the quality of HF care, although it has previously been shown that women with other cardiovascular conditions, such as coronary artery disease, receive less intensive treatment. We sought to determine whether there is a difference in rates of prescription of GDMT for patients hospitalized with heart failure by gender with the hypothesis that rates of GDMT prescription in women would be lower than that in men. Methods: Over a six month study window, we identified 246 patients discharged from an urban academic medical center with a primary discharge diagnosis of systolic heart failure. Systematic chart review was performed to identify whether patients were discharged with the following medications: angiotensin converting enzyme inhibitor (ACE-I), angiotensin receptor blocker (ARB), beta blocker (BB), mineralocorticoid receptor antagonist (MRA), hydralazine and a nitrate, and neprilysin inhibitor/ARB. Statistical analysis was performed to evaluate for an association between rates of GDMT prescription and gender. Regression analysis was then performed to adjust for age, weight, serum potassium, and 1/(discharge creatinine). Results: At the time of discharge, there was no statistically significant difference in the rate of GDMT prescription for females compared to males in either the unadjusted or adjusted models. ACE-I or ARB prescription rates were 59% in females and 50% in males (p=0.11); BB prescription rates were 89% in females and 84% in males (p=0.27); MRA prescription rates were 43% in females and 52% in males (p=0.19). Prescription rates of combination therapy of ACE-I or ARB with BB and MRA were 30% in females and 31% in males (p=0.78). There was a significant difference in 30 day all-cause unadjusted readmission rates in females (22%) compared to males (37%) (p&lt;0.05). Conclusions: In this sample of hospitalized heart failure patients, no difference was found in rates of GDMT prescription for women as compared to men. Readmission rates were significantly higher for men than women, consistent with national data. Further investigation will determine the extent to which equity in prescription rates translates into improved outcomes for women hospitalized with heart failure.

In-hospital use of non-steroidal anti-inflammatory drugs in patients withheart failure in academic centers intheUnited States.

Non-steroidal anti-inflammatory drugs are considered potentially harmful for patients with heart failure. To determine the prevalence of in-hospital NSAID use, their type, associated diagnosis and impact in clinical outcomes among patients with a diagnosis of heart failure. The University Health System Consortium Database was used to identify all first hospitalizations with an International Classification of Diseases-9 discharge diagnosis code of systolic heart failure as the primary diagnosis between January 1, 2011, and December 31st 2014. Among 65,902 patients admitted for a primary diagnosis of SHF, 2675 (4.1%) were exposed to NSAID. The most frequent NSAID used was ibuprofen (51.63%), followed by ketorolac (29.38%) naproxen (8.07%) celecoxib (5.61%), and others. On multivariable analyses, the length of stay of patients exposed to NSAID was longer compared to non-exposed (OR: 4.67, p < 0.001, 95% CI 4.10-5.25), but differences in mortality were not statistically different (OR: 0.90, p = 0.476, 95% CI 0.69-1.19). The use of NSAID in patients admitted with a primary diagnosis of systolic heart failure was low but was associated with longer length of stay. Further studies are needed to understand the impact of NSAID use in this patient population.

The relationship between serum lectin-like oxidized LDL receptor-1 levels and systolic heart failure.

Lectin-like oxidized low-density lipoprotein receptor-1 (LOX-1) appears to be involved in atherosclerotic plaque vulnerability and rupture. In this study, we aimed to evaluate the utility of serum LOX-1 levels in the diagnosis and assessment of left ventricular systolic HF and LOX-1’s relationship with serum pro-brain natriuretic peptide (NT-proBNP). This was a cross-sectional study of all eligible patients admitted to the department of cardiology of the University Hospital between July 2011 and April 2012. Fifty-five patients with a diagnosis of systolic heart failure and 25 patients without systolic HF were enrolled in this study. Serum C-reactive protein, NT-proBNP, and LOX-1 were studied. Serum LOX-1 and NT-proBNP levels were significantly higher in the heart failure group and showed a positive correlation with NT-proBNP and negative correlations with left ventricular ejection fraction (EF). In addition, LOX-1 levels in patients with ischaemic cardiomyopathy were significantly higher, while they were similar in patients with dilated cardiomyopathy compared to control subjects. Our study demonstrates the utility of the serum LOX-1 levels in the diagnosis of left ventricular systolic heart failure. LOX-1 may have a place in the diagnosis of heart failure, in particular in patients with ischaemic cardiomyopathy.

Epidemiologic surveillance on quality of life in patients with systolic heart failure after treatment with the selective heart rate inhibitor ivabradine

Background: Patients with systolic heart failure (HF) frequently have symptoms despite receiving standard treatment. The addition of the selective heart rate inhibitor ivabradine has been shown to improve their quality of life (QOL) in randomized trials but not under day-to-day practice conditions. Objective: The objective of the study was to assess changes in QOL after the addition of ivabradine to the standard treatment of patients with systolic HF, in daily clinical practice. Patients and Methods: In a multicenter surveillance protocol, patients with a diagnosis of systolic HF who were prospectively prescribed ivabradine 5–7.5 mg twice a day for 60 days were selected for surveillance on their QOL. Primary data on demographic and clinical characteristics, together with a change in QOL assessed by a visual analog scale, during a 60-day follow-up, were extracted for analysis from the case records of patients kept with the investigators. Results: In 594 patients with systolic HF who received ivabradine in addition to standard treatment for 60 days, intention to treat analysts showed that 465 (78.3%, 95% confidence interval (CI), 74.7–81.4) had improvement in QOL. The mean (95% CI) QOL score increased by 37.0% (35.1–39.1). Conclusion: These results confirm the observations of previous randomized trials that in day-to-day clinical practice, patients with systolic HF benefit from an improvement in QOL when ivabradine is added to their standard treatment.

The relationship between serum lectin-like oxidized LDL receptor-1 levels and systolic heart failure

Objectives Lectin-like oxidized low-density lipoprotein receptor-1 (LOX-1) appears to be involved in atherosclerotic plaque vulnerability and rupture. In this study, we aimed to evaluate the utility of serum LOX-1 levels in the diagnosis and assessment of left ventricular systolic HF and LOX-1’s relationship with serum pro-brain natriuretic peptide (NT-proBNP).Design and settings This was a cross-sectional study of all eligible patients admitted to the department of cardiology of the University Hospital between July 2011 and April 2012.Methods Fifty-five patients with a diagnosis of systolic heart failure and 25 patients without systolic HF were enrolled in this study. Serum C-reactive protein, NT-proBNP, and LOX-1 were studied.Results Serum LOX-1 and NT-proBNP levels were significantly higher in the heart failure group and showed a positive correlation with NT-proBNP and negative correlations with left ventricular ejection fraction (EF). In addition, LOX-1 levels in patients with ischaemic cardiomyopathy were significantly higher, while they were similar in patients with dilated cardiomyopathy compared to control subjects.Conclusion Our study demonstrates the utility of the serum LOX-1 levels in the diagnosis of left ventricular systolic heart failure. LOX-1 may have a place in the diagnosis of heart failure, in particular in patients with ischaemic cardiomyopathy.

Predictive Value of Radiographic Measurements as a Diagnostic Marker of Systolic Heart Failure in a Retrospective Study: An Old Method, a New Approach

Background:: A number of earlier studies have attempted to establish the validity of various radiological parameters for the assessment of cardiac enlargement, but these were not fully quantitative as echocardiographic measurements. Objectives:: In our study, we aimed to determine the diagnostic accuracy of certain radiological parameters including the cardiothoracic ratio (CTR), cardiac area (CA) and cardiac volume (CV), derived from posteroanterior (PA) and lateral chest X-rays (CXR) in patients with impaired left ventricular ejection fraction (LVEF) suffering from dyspnea by comparing them with echocardiographic measurements of left ventricular (LV) dimensions and LVEF. Patients and Methods:: This retrospective study included 374 patients (258 females and 116 males) aged 35 to 78 years with the complaint of dyspnea. CXR and echocardiographic examination were performed on each patient upon admission. Based on LVEF, the patients were divided into two groups: Group 1 consisted of patients with impaired LVEF (< 50%) and group 2 consisted of patients with normal LVEF (≥ 50%). The sensitivity, specificity, and cut-off points were evaluated by both receiver-operator characteristic (ROC) analyses and area under the ROC curve (AUC) to determine the diagnostic accuracy of CA, CV, and CTR. Results:: There was no significant relationship between CTR and LVEF, but CA and CV showed a strong correlation with LVEF (P < 0.001 and P < 0.00001, respectively). LV dimensions correlated better with CV than with CA (P < 0.00001 and P < 0.0001, respectively). According to the analysis of ROC curves, the best cut-off value for CV for the diagnosis of systolic heart failure was 825 mL. Conclusion:: The CV value correlated more closely with low LVEF and more accurately indicated an enlarged heart than CA or CTR. This may be due to the fact that an anteroposterior measurement of heart size is included in the former but not the latter two measurements. These study results may help quantify left heart enlargement with greater accuracy than may be obtained from standard CXR.

Levels of N-terminal-pro Brain Natriuretic Peptide (NT-pro-BNP) and associated risk factors in systolic heart failure consequential to ischaemic heart disease

Background Early identification of heart failure as a post-myocardial infarction is very important in a clinical setting. A study was planned to determine the levels of N-terminal NT-pro- Brain Natriuretic Peptide BNP in systolic heart failure consequential to ischaemic heart disease and to find out the risk factors in those patients.Material and methods The levels of NT-pro-BNP was determined in 100 patients admitted to Basaveshwar Teaching and General Hospital Kalaburagi with a diagnosis of systolic heart failure having an ejection fractionlt40 subsequent to ischaemic heart disease.Results The levels of NT-pro-BNP ranged between 358 pgml and 3000 pgml with a mean value of 2049 pgml and a median value of 1886 pgml. Conclusions NT-pro-BNP level had a good predictive value for heart failure p-0.03nbsp

Association between periodic limb movements and co-morbidities in heart failure

Introduction Periodic limb movements (PLMs) were shown to be associated with cardiovascular diseases. There are many factors that can potentially contribute to PLMs occurrence in heart failure (HF), however, the incidence, role and causes of PLMs in HF are not fully understood. The objective of this study was to assess the incidence, severity of PLMs and their relation with co-morbidities in moderate-severe chronic HF. Materials and methods Sixty-six patients were enrolled (57 males and 9 females), median age – 56.5 (27; 77) years, body mass index – 27.6 (18.9; 49.2) kg/m 2 . HF resulted from coronary heart disease in 46 (43 males and 3 females) subjects, and from different types of cardiomyopathy in 20 (14 males and 6 females) subjects. The main inclusion criteria were the diagnosis of systolic HF, verified by Simpson ejection fraction ⩽45% at heart ultrasound (GE Vivid 7, Norway, 2008), and increased N-terminal brain natriuretic pro-hormone level. All patients underwent full polysomnography (Embla N7000, Natus, US, 2007). Results According to the sleep study 33 subjects had no abnormal limb movements [27 males and 6 females, median age – 56 years (27; 71), median PLM index – 0.6 (0; 4.7) episodes per hour of sleep). The distribution of PLMs by severity in the left 33 patients was the following. Ten patients showed mild PLMs [9 males and 1 female, median age – 56 years (48; 67); median PLM index – 11.3 (7.3; 24.1) per hour]. Nine patients had moderate PLMs [8 males and 1 female; median age – 55 (39; 77) years; median PLM index – 37 (27.1; 49.6) per hour of sleep]. Eight subjects showed severe PLMs [7 males and 1 female; median age – 59 (31; 77) years; median PLM index – 67.2 (50.8; 80.4) per hour of sleep]. There was no significant association between PLMs and co-morbid disorders, including underlying heart disease ( χ 2 = 0.8; p > 0.05); varicose veins of lower limbs ( χ 2 = 0.06; p > 0.05); sleep disordered breathing ( χ 2 = 0.1; p > 0.05); sleep apnea type ( χ 2 = 1.3; p > 0.05). However, there was a tendency towards the higher prevalence of PLMs in patients with mild and severe sleep apnea ( χ 2 = 5.2; p = 0.07). There was no significant association between PLMs incidence and prescribed therapy, including calcium channel antagonists ( χ 2 2 = 0.8; p > 0.05), beta-blockers ( χ 2 2 = 1,5; p > 0.05), any kind of diuretic( χ 2 2 = 3.6; p > 0.05), acetazolamide ( χ 2 = 0.2; p > 0.05), and thiazide diuretics ( χ 2 2 = 0.1; p > 0.05). However, there was a trend towards higher incidence of PLMs in patients taking potassium saving diuretics ( χ 2 = 3.4; p = 0.06) and loop diuretics ( χ 2 = 2.9; p = 0.08). Conclusion PLMs are highly prevalent in patients with moderate-to-severe HF, and are likely to be associated with diuretic treatment; possible association between PLMs and electrolyte changes in HF patients and their impact on prognosis needs further investigation. Acknowledgements The research leading to these results has received funding from the European Union Seventh Framework Programme [FP7/2007–2013] under grant agreement no 241558 (SICA-HF). The research leading to these results has received funding from the Russian Ministry of Science and Education within the FTP ”R&D in priority fields of the S&T complex of Russia 2007–2012” under state contract no 02.527.11.0007.

012 Automated data capture from echocardiography reports to enhance heart failure population research

BackgroundAs IT dominates cardiology, the ability of centres to link clinical databases to perform outcome based research has increased significantly. Good quality research relies on the ability to accurately identify...

Influence de la fonction rénale sur la pertinence diagnostique du BNP chez l’insuffisant cardiaque âgé

Aim of the study BNP levels are accurate in the diagnosis of heart failure and useful in clinical practice. Relationship between BNP, heart failure (HF) and renal function are little known in the elderly. Renal function influence the optimal cut point of BNP in patients with a Glomerular Filtration Rate (eGFR) lesser than 60 ml/min/1.73 m 2. Methodology A total of 71 patients (mean age = 85 years) were admitted in a Cardiogeriatric Unit. We noted several parameters, age, gender, the presence or the absence of Systolic Heart Failure (clinical history and physical examination), the echographic measure of the left ventricular ejection fraction, the eGFR value calculated by simplified MDRD formula and the BNP value. We divided these patients into six groups according the presence of HF and eGFR value higher than 60ml/min/1.73m 2,or between 30 and 60 or between 15 and 30. Results Our results show that the BNP value is higher in all the three groups of patients with Heart Failure with or without diminution of the eGFR: for example, 1220 pg/ml in the presence of HF versus 788 pg/ml in the absence of HF in the two groups with the eGFR is calculated between 15 and 30 ml/min/1.73m 2. Conclusion BNP is a helpful tool in clinical practice for the diagnosis of Systolic Heart Failure in the presence of renal impairment in the elderly with a higher biomarker cut point.

Validez de los criterios clínicos de Framingham para el diagnóstico de insuficiencia cardíaca sistólica

To assess validity and clinical usefulness of the Framingham clinical criteria for the diagnosis of systolic heart failure. A descriptive cross-sectional trial. The study population was made up of the patients who went to the emergency Department at the Hospital de Elche, Elche, Spain, with cardiac dyspnoea. The method applied was a validation study in which a value of 0.45 of the left ventricular ejection fraction was taken as a sign of certitude and compared to the presence/absence of the Framingham clinical criteria. The study indicators were: sensitivity, specificity, positive predictive value, negative predictive value, positive probability quotient and negative probability quotient. The trial included 224 patients. The most frequent major criteria were: lung rales (93%), megalocardia (85.9%) and paroxysmal nocturnal dyspnoea or orthopnea (75.8%). The most important minor criteria were: exertional dyspnoea (89.2%), pleural effusion (82.8%) and lower limb oedemas (70.1%). The values that were considered as a sign of left ventricular systolic failure (0.45) proved to have good sensitivity and positive predictive value (96.4% and 97%, respectively). Clinical usefulness indicators obtained a positive probability quotient of 1.52 and a negative predictive value of 0.09. The Framingham clinical criteria have excellent sensitivity but poor specificity. The absence of these criteria totally excludes the diagnosis if the value of the left ventricular ejection fraction is 0.45 (A category) but their presence does not confirm the diagnosis because of the high amount of false-positive findings (D category).