Chronic Heart Failure Duration Research Articles

Experiences of patients and nurses with thirst in advanced chronic heart failure: a mixed methods study

Abstract Background Many patients with chronic heart failure (CHF) express thirst. Perceptions of thirst and strategies for reducing this symptom can differ between patients and nurses. Purpose As part of a study to develop and evaluate a nurse-based counselling intervention on thirst in patients with advanced CHF waiting for heart transplantation, we aimed to assess patients' and nurses' perceptions on thirst, possible strategies, as well as information needs and information transfer. Methods Mixed methods study consisting of semi-structured interviews with hospitalized patients waiting for a heart transplantation in Germany. Interviews focussed on experiences with thirst, needs and requirements, and experiences with the information provided by healthcare professionals. We also conducted focus groups and an online survey with German nurses with experiences in the care of cardiac patients. Topics of the focus groups were the perceptions and handling of the symptom in nursing practice as well as the provision of information and counselling. The survey was based on the results of the focus groups and current research findings. In addition to work-related data, we asked questions about the relevance of thirst, the causes of this symptom, recommended interventions and the need for counselling. We analysed quantitative data descriptively and qualitative data using content analysis. Results We conducted 10 interviews with patients (mean age: 43.5 years; 30% female; duration of CHF: 25 days to 21 years; length of stay: 7 to 116 days). All participants had a prescribed fluid restriction. Perceived thirst markedly differed between patients, with some reporting thirst to be very distressing. Most patients described that the feeling of thirst increased especially at mealtimes. Individual strategies for reducing thirst also differed between patients depended on disease durations and their therapeutic regiment. Some patients rated the information provision by healthcare professionals concerning thirst as insufficient. In addition, we conducted two focus groups with respectively 5 nurses from two university hospitals in Germany. 59 nurses participated in the survey. Nurses (81.4% working in a hospital; 54.2% already have at least 5 years of experience in care of cardiac patients) stated that the feeling of thirst in patients with CHF is of great importance in nursing practice, but only 44.1% specified to regularly assess thirst. The perceived most common cause of thirst was a prescribed fluid restriction (93.2%) and diuretics (79.7%). Among others, most nurses recommended ice cubes as intervention to reduce thirst and considered counselling interventions as important. Conclusion(s) The occurrence of thirst is an important issue for patients with advanced CHF. The perception of the symptom varies greatly. Individualised, evidence-based strategies for symptom management are required.

Clinical markers of cognitive impairment in patients with chronic heart failure of ischemic origin during out-patient regular follow-up: a cross-sectional study

Background: Cognitive impairment (CI) is present in 25–50% of chronic heart failure (CHF) patients. Doctors who monitor patients with cardiovascular disorders do not have clearly set criteria for their referral to a neurologist in case of suspected CI. Therefore, CHF patients do not receive treatment for CI on time.
 Aim: To identify significant clinical markers of CI in patients with CHF of ischemic origin.
 Materials and methods: This cross-sectional cohort study included 134 patients with CHF of ischemic origin (mean age 63.36 ± 10.63 years; men, 76.12%), who were regularly monitored in a municipal polyclinic. All patients were tested for CI with the Montreal Cognitive Assessment Scale (MoCA); basic hemodynamic parameters, lipid profile, brain natriuretic peptide (NT-proBNP) were assessed, and triglyceride-glucose index (TyG) and body mass index (BMI) were calculated. Cardio-ankle vascular index (CAVI) was measured, echocardiography and a 6-minute walk test (SMWТ) were performed and past history of CHF, arterial hypertension (AH) and diabetes mellitus (DM) was collected.
 Results: CI (MoCA score ≤ 25) was detected in 85 (63.43%) outpatients with CHF of ischemic origin; the group without CI (MoCA score 26) included 49 (36.67%) patients. There were significant correlations between MoCA and CAVI scores (partial correlation coefficient, r = -0.802, p 0.001; adjusted squared multiple correlation coefficient (adj. R2) = 0.881, p 0.001), MoCA and TyG (r = -0.357, p = 0.029; adj. R2 = 0.363, p 0.001), MoCA and SMWТ (r = -0.211, p = 0.037; adj. R2 = 0.696, p 0.001). The multivariate test for significance of planned comparisons between CAVI and MoCA scores (Wilks' lambda) was 0.005 (F = 4.74; p 0.001).
 Conclusion: CAVI, TyG and SMWТ values are the clinical markers of CI in patients with CHF of ischemic origin. There is a direct association between increased CAVI and the presence of CI, regardless of age, lipid metabolism parameters, structural and functional heart parameters, CHF duration, AH and DM. Identification of these markers could be an indication for an in-depth assessment of CHF patients by a neurologist.

Clinical and Echocardiographic Correlates of Iron Status in Chronic Heart Failure Patients: A Cross-Sectional Descriptive Study.

Chronic heart failure (HF) is one of the conditions commonly seen in the medical outpatient departments, and iron deficiency (ID) has been reported as the commonest nutritional deficiency in these patients. The presence of ID may interfere with the clinical parameters of chronic HF. The relationship between iron status and chronic HF needs more attention and should be given more consideration in the evaluation of patients with chronic HF. The aim of the study was to determine the relationship, if any, between iron status and clinical/echocardiographic variables in chronic HF. A cross-sectional descriptive study was carried out at the Lagos University Teaching Hospital (LUTH), Nigeria, where 88 patients with chronic HF were recruited to participate in this study. The participants underwent clinical and laboratory assessments. Iron status was assessed with full blood count parameters; serum ferritin and transferrin saturation (Tsat) and its relationship with clinical parameters among these participants were also studied. No correlations existed between the duration of chronic HF and iron status when compared using Tsat. However, a significant weak negative correlation was observed between the duration of HF and the serum ferritin levels. The clinical characteristics of the HF participants with and without ID were compared. There was no significant difference in the frequency of prior hospitalization in both groups. However, a higher proportion of participants with severe HF (New York Heart Association (NYHA) classes III/IV) (n = 14; 46.7%) were iron-deficient compared to those with moderate chronic HF (NYHA II) (n = 11; 36.7%). This relationship was statistically significant. Left ventricular ejection fraction (LVEF) was similar in the iron-deficient and iron-replete groups (using serum ferritin or Tsat) both when compared as means and when compared after categorizing LVEF as HF with preserved ejection fraction (HFpEF) vs HF with reduced ejection fraction (HFrEF). There was no statistically significant correlation between the severity of ID and LVEF. Conclusion: A spectrum of clinical changes occurs in patients with chronic HF. ID can make these changes more profound and the condition less amenable to standard HF treatments. These patients may therefore benefit from further evaluation for this nutritional deficiency. Laboratory measurements including Tsat and serum ferritin may help in further assessment of select patients with worse and/or non-responsiveclinical parameters.

SST2 Level at Decompensated Chronic Heart Failure in Patients with Dilated Cardiomyopathy

The purpose of the study was to evaluate the relationship between clinical and functional changes and sST2 levels in patients with dilated cardiomyopathy (DCM) admitted to the hospital due to decompensated chronic heart failure (CHF). Methods and Results: The study involved 64 DCM patients with clinical signs of decompensated CHF. According to the sST2 level, the patients were divided into two groups. Group 1 included 30 patients with sST2 level <35ng/ml; Group 2 included 34 patients with sST2 level ≥35ng/ml. All patients underwent the following examinations: collection of anamnestic data, physical examination, general clinical and laboratory blood tests, 12-lead ECG, conventional 2D echocardiography in M- and B-modes, the 6MWT, and the assessment of the quality of life according to the Minnesota Living with Heart Failure Questionnaire (MLHFQ). The serum level of sST2 was determined by enzyme immunoassay using the Presage ST2 Assay. The duration of CHF was significantly longer in Group 2 than in Group 1(48.7±6.5 mth versus 29.6±7 mth P<0.05), and the number of hospitalizations per year was more frequent. Group 2 patients were characterized by lower blood pressure levels and high heart rate (P<0.05). At the same time, the 6MWT value was lower and MLHFQ score was higher in Group 2 than in Group 1 (P<0.001 in both cases). In Group 1, LVEF was significantly higher and LVM was significantly lower than in Group 2 (P<0.001). All in all, Group 2 patients had more pronounced disorders in LV systolic dysfunction. The correlation analysis revealed an inverse correlation between the sST2 level and 6MWT (r=-0.69, P<0.01), as well as LVEF (r=-0.26, P<0.01). Statistically significant direct correlations were found between the sST2evel and the size and volume of the LV cavities. Conclusion: sST2 is a clinically relevant biomarker that reflects pathophysiological processes and provides prognostic information in the setting of DCM, especially in patients with HF.

The association between serum calcium and chronic heart failure: A cross-sectional observational study

Background: Chronic heart failure (CHF) is characterized by sustained activation of neurohormonal and cytokine systems leading to a series of end-organ changes within the myocardium referred to as left ventricular remodeling. Renin-Angiotensin system activation leading to secondary hyperaldosteronism is accompanied by ionized hypocalcemia with secondary hyperparathyroidism which causes dyshomeostasis of extra and intracellular calcium leading to cardiomyocyte necrosis. Objectives: To study the levels of serum calcium in patients of heart failure and its association with severity and duration of chronic heart failure. Methods: The study was conducted on 50 patients with CHF after taking informed consent. All patients met inclusion and exclusion criteria and underwent blood sampling, urine examination and other relevant investigations. Serum calcium levels were correlated with the severity and duration of CHF statistically. Results: Among the patients studied, 96% with ejection fraction (EF)≤ 35%, 87.5% with EF between 35-40% and 44.4% with EF ≥ 40% had low serum calcium values ≤9 mg/dl (p-value <0.001). All patients with duration of heart failure ≥ 2 years and 70.4% patients with duration of heart failure 1-2 years had low serum calcium levels ≤ 9 mg/dl (p value =0.001). Conclusion: There is a significant positive correlation of serum calcium levels with severity of heart failure as measured by EF and significant negative correlation with duration of CHF and NYHA functional grades. The degree of hypocalcemia correlates with severity of cardiomyocyte injury and extent of the neurohormonal response, and accordingly the corresponding risk of adverse cardiovascular events.

Biochemical profile and prognosis of patients with heart failure and diabetes

Aim. To study clinical and hemodynamic and laboratory parameters for the 2-year prognosis of patients with chronic heart failure (CHF) and type 2 diabetes mellitus (DM). Material and methods. The study included 90 patients (61,4±8,6 years old) with NYHA class II-IV CHF related to coronary artery disease and hypertension. All patients underwent clinical examination, resting 12-lead electrocardiography, transthoracic echocardiography, and blood chemistry testing. Two-year follow-up was conducted to determine the prognosis of patients with CHF and DM. Results. CHF duration in patients with DM was 17% more, despite a comparable average age of patients. Echocardiography showed significant left ventricular dilatation and, as a result, systolic dysfunction in patients of the I group (with DM). Hypoalbuminemia was detected in both groups, but it was more pronounced in patients with CHF and DM. With comparable average creatinine concentrations, patients with CHF and DM had higher blood urea levels (13,2±2,1 µmol/L and 9,4±2,6 µmol/L, respectively). Patients of group I had significantly lower glomerular filtration rate (GFR) compared to the comparison group (by 13%). In group I, there were 42 rehospitalizations during the follow-up period, while in the comparison group — 29. Acute cerebrovascular accident was recorded in 7% and 4% of cases, respectively. Myocardial infarction (MI), including recurrent MI, was registered 50% more often in patients with DM. The mortality rate in patients of the group I was 3,5 times higher than in the comparison group. Conclusion. Features of the course of CHF depending on the presence of concomitant type 2 DM were revealed. These include the relatively early manifestation of CHF symptoms, the prevalence of patients with moderate to severe CHF and severe left ventricular systolic dysfunction. The results of a biochemical study of the blood of group I patients were characterized by hypoalbuminemia, hypertriglyceridemia, and a significant decrease in GFR. It is noted that the presence of concomitant DM aggravates the course of CHF of ischemic and nonischemic genesis, which is manifested by an increase in the frequency of repeated hospitalizations and deaths during 2-year follow-up. 87

Клініко-інструментальна характеристика пацієнтів із хронічною серцевою недостатністю та зниженою фракцією викиду лівого шлуночка залежно від наявності цукрового діабету 2-го типу

Мета роботи – порівняти клініко-інструментальні показники в пацієнтів із хронічною серцевою недостатністю (ХСН) та зниженою фракцією викиду лівого шлуночка (ФВЛШ) залежно від наявності в них цукрового діабету (ЦД) 2-го типу.Матеріали і методи. Проаналізовано 490 історій хвороб пацієнтів, які спостерігалися у відділі серцевої недостатності в період з 2011 до 2018 р., з ХСН ІІ–ІV функціонального класу за NYHA, ФВЛШ ≤ 40 %, віком 40–80 років (медіана (верхній; нижній квартилі) – 64 (56,00; 69,00) роки). До досліджуваної групи увійшли переважно хворі з ішемічною хворобою серця (ІХС) у поєднанні з гіпертонічною хворобою (ГХ) – 403 (82,2 %) пацієнти, з ізольованою ІХС – 55 (11,2 %) та з ізольованою ГХ – 32 (6,6 %). Більшість хворих (278 (56,7 %) осіб) мали постійну форму фібриляції передсердь. Серед досліджуваних було 373 (76,1 %) чоловіки та 117 (23,9 %) жінок. Пацієнтів залучали в дослідження у фазу клінічної компенсації, тобто в еуволемічному стані. Для аналізу всіх пацієнтів з ХСН та зниженою ФВЛШ розподілили на дві групи: в І групу увійшли 338 (69 %) хворих без ЦД, ІІ групу становили 152 (31 %) пацієнти з діагностованим ЦД 2-го типу.Результати та обговорення. За результатами аналізу не виявлено статистично значущих відмінностей між досліджуваними групами за віком пацієнтів, загальними показниками гемодинаміки, середньодобовою частотою серцевих скорочень, функціональним класом ХСН за NYHA, частотою супутнього хронічного обструктивного захворювання легень та тривалістю існування ознак ХСН. Зафіксовано меншу частку пацієнтів з фібриляцією передсердь у ІІ групі, більший показник індексу маси тіла пацієнтів у І групі, показник Е/е΄ та індекс маси міокарда лівого шлуночка були більшими в пацієнтів без супутнього ЦД. У ході дослідження виявили значно вищий рівень сечової кислоти в пацієнтів із супутнім ЦД 2-го типу, за показниками оксидативного стресу та прозапальних маркерів, рівня NT-proBNP та інсуліну статистично значущої різниці між групами не встановлено. Також не спостерігали статистично значущої різниці між групами щодо значень потокозалежної вазодилатації. Показано, що поєднання ІХС та ЦД 2-го типу є основним фактором високої летальності в пацієнтів з ХСН. Утім не виявлено різниці щодо тривалості життя пацієнтів з ХСН та зниженою ФВЛШ із ЦД 2-го типу та без ЦД. Також виявлено статистично значуще гірше виживання пацієнтів з рівнем глікованого гемоглобіну понад 7,4 %.Висновки. П’ятирічна виживаність пацієнтів з ХСН зі зниженою ФВЛШ із ЦД 2-го типу та без ЦД статистично значуще не відрізнялася, тоді як у загальній групі гіршу 5-річну виживаність зареєстровано для тих хворих, які мали показник глікованого гемоглобіну понад 7,4 %.

Factors Associated with Depression among Heart Failure Patients at Cardiac Follow-Up Clinics in Northwest Ethiopia, 2017: A Cross-Sectional Study.

Background Depression is a comorbid disorder in patients with heart failure and it is a major public health problem worldwide. Little is known about the depression among heart failure patients in low-income countries, while, in Ethiopia, none was studied. Objective This study is to assess the prevalence of depression and associated factors among heart failure patients at cardiac follow-up clinics at Amhara Region Referral Hospitals, Northwest Ethiopia, 2017. Methods A hospital based cross-sectional study was conducted between March 30, 2017, and May 15, 2017, G.C., by using a systematic random sampling technique to select 422 of 1395 HF patients. Structured interviewer-administered questionnaires and patient card review with a checklist that incorporates the PHQ-9 tool for depression measurement were used. The collected data were checked, coded, and entered into Epi-info version 7 and exported to SPSS version 20. Bivariate logistic regression at p-value <0.2 was exported to multivariate logistic regressions and p-value <0.05 was considered statistically significant. Results A total of 403 were included with a response rate of 95.5%. Among the participants, 51.1% had depressive symptoms. Factors associated with depressive symptoms were poor self-care behavior 1.60 [AOR (95% CI=1.01, 2.55)], poor social support 1.90 [AOR (95% CI=1.16, 3.12)], being female 2.70 [AOR (95% CI=1.44, 5.07)], current smoking history 4.96 [AOR (95% CI=1.54, 15.98)], and duration of heart failure (>1 year) 1.64 [AOR (95% CI=1.04, 2.59)]. Conclusions Around half of the patients were depressive. The patients who had poor self-care behavior, were females, had poor social support, had a current history of smoking, and had duration of chronic heart failure >1 year need special attention. Therefore, all referral hospitals need efforts to focus on those problems and target improvements of depressive symptoms.

Predictors of renal dysfunction in patients with chronic heart failure and reduced left ventricular ejection fraction

The aim — to elucidate the predictors of renal dysfunсtion (RD) in patients with chronic heart failure (CHF) and reduced left ventricular ejection fraction (LVEF).Materials and methods. 134 patients were examined with stable CHF, II — IV NYHA functional class (FC), and LVEF < 40 %. Median age was 59.5 [54; 68] years. All patients underwent general clinical examination. Glomerular filtration rate was calculated. The levels of interleukin­6, insulin, NTproBNP, uric acid, blood urea nitrogen, levels of microalbuminuria were determined. Ultrasound diagnosis of the vasodilating function of the endothelium of the brachial artery was performed using a test with reactive hyperemia. The patients were treated according to the current guidelines of the Association of Cardiologists of Ukraine on the diagnosis and treatment of chronic heart failure.Results and discussion. RD was detected in 39.5 % of the patients examined. Older patients, women, patients with coronary heart disease (CHD), arterial hypertension (AH), diabetes mellitus, anemia, and also III — IV NYHA class have a greater chance of having RD. The presence of myocardial infarction (MI), atrial fibrillation (AF), smoking in the anamnesis did not reveal significance in calculating the odds ratio. None of the major hemodynamic and echocardiographic parameters was a predictor of PD. Among the laboratory indices, independent predictors of RD were detected levels of blood urea nitrogen, uric acid, and citrulline levels.The results obtained indicate the priority role of neuro­humoral activation, inflammation and oxidative stress in the formation of RD.Conclusions. The independent laboratory predictors of RD in 39.5 % of the patients with CHF and a reduced LVEF are the levels of blood urea nitrogen, uric acid and citrulline in the plasma. Its risk increases with age, NYHA class, the duration of CHF, and in the presence of such co­morbidities as AH, CHD, diabetes mellitus, anemia. The presence of RD is not associated with MI in anamnesis or the presence of AF, parameters of central hemodynamics, parameters of LV structural­functional states, level of microalbuminuria, ratio of albumin/creatinine, level of glucose, insulin, interleukin­6 and NTproBNP in plasma.

Duration of chronic heart failure affects outcomes with preserved effects of heart rate reduction with ivabradine: findings from SHIFT

In heart failure (HF) with reduced ejection fraction and sinus rhythm, heart rate reduction with ivabradine reduces the composite incidence of cardiovascular death and HF hospitalization. It is unclear whether the duration of HF prior to therapy independently affects outcomes and whether it modifies the effect of heart rate reduction. In SHIFT, 6505 patients with chronic HF (left ventricular ejection fraction of ≤35%), in sinus rhythm, heart rate of ≥70 b.p.m., treated with guideline-recommended therapies, were randomized to placebo or ivabradine. Outcomes and the treatment effect of ivabradine in patients with different durations of HF were examined. Prior to randomization, 1416 ivabradine and 1459 placebo patients had HF duration of ≥4 weeks and <1.5 years; 836 ivabradine and 806 placebo patients had HF duration of 1.5 years to <4 years, and 989 ivabradine and 999 placebo patients had HF duration of ≥4 years. Patients with longer duration of HF were older (62.5 years vs. 59.0 years; P < 0.0001), had more severe disease (New York Heart Association classes III/IV in 56% vs. 44.9%; P < 0.0001) and greater incidences of co-morbidities [myocardial infarction: 62.9% vs. 49.4% (P < 0.0001); renal dysfunction: 31.5% vs. 21.5% (P < 0.0001); peripheral artery disease: 7.0% vs. 4.8% (P < 0.0001)] compared with patients with a more recent diagnosis. After adjustments, longer HF duration was independently associated with poorer outcome. Effects of ivabradine were independent of HF duration. Duration of HF predicts outcome independently of risk indicators such as higher age, greater severity and more co-morbidities. Heart rate reduction with ivabradine improved outcomes independently of HF duration. Thus, HF treatments should be initiated early and it is important to characterize HF populations according to the chronicity of HF in future trials.

Bone Metabolism and Mineral Density in Chronic Heart Failure

to assess the state of bone metabolism and mineral density in outpatients with chronic heart failure (CHF). We examined 70 outpatients (30 men, 40 women, aged 56-88 years) with CHF and 40 outpatients without CHF (10 men, 30 women, aged 57-88 years). Examination included laboratory assessment, echocardiography, study of bone mineral density (BMD) in the lumbar spine and femoral neck using dual-energy X-ray absorptiometry. Osteoporosis was recorded in 61.4 and 32.4%, osteopenia - in 20 and 42.5%, normal BMD - in 18.6 and 25% of patients with and without CHF, respectively. A total of 24.3 and 7.5% of patients with and without CHF, respectively, experienced various bone fractures during mean follow up of 26.5 months. Significant correlation was established between osteoporosis and patient's age (r=0.36; p=0.002), CHF duration (r=0.26; p=0.039), falls (r=0.29; p=0.015), fractures (r=0.42; <0.001), chronic kidney disease - CKD (r=0.24; =0.048), N-proBNP (r=0.52; =0.007), GFR (r=-0.37; =0.010). In unifactorial analysis osteoporosis was associated with CKD (odds ratio [R] 3.1, 95% confidence interval [CI] 1.1-8.8, p=0.032 , N-proBNP (R 9.8, 95% CI 1.1-8.9, =0.043) and frequent alls (R 4.0, 95% CI 1.3-12.7; =0.019). Association of high N-proBNP level and abnormal renal function with lowered BMD allows to suggest that low BMD is an independent marker of CHF severity, and patients with CHF are at high risk of osteoporosis and related fractures.

8 Hepatic Function Predicts Hospitalisation and All Cause Death in Patients with Heart Failure

Introduction Hepatic dysfunction has always been considered as a sequel of chronic heart failure (CHF), however there has been recent interest in it being used as a marker of disease severity instead. Previous studies have demonstrated this among patients in clinical trial settings but no population based studies have been conducted thus far. We aim to determine the impact of hepatic dysfunction on a composite of all cause mortality and heart failure hospitalisation in patients treated for CHF. Methods We analysed data from the Systems BIOlogy Study to Tailored Treatment in Chronic Heart Failure (BIOSTAT-CHF) database which prospectively tracks treatment, comorbidity, blood investigations, hospitalisation and death information of patients with heart failure from Tayside and Fife. Cox proportional hazard models were used to assess the prognostic impact of liver dysfunction on heart failure outcomes, while controlling for covariates like treatment regime, previous history of myocardial infarctions, atrial fibrillation, renal disease and CHF duration. Results Out of a total 1805 patients, there were 1200 (66.5%) males, with a mean age of 73.6 (±10.7) years, and mean duration of HF 39.9 months with a total of 414 all cause death or heart failure hospitalisation. We found low serum albumin levels (less than 35 g/L) to be an independent predictor of CV death or hospitalisation with a hazard ratio of 2.05 (95% CI 1.51–2.79, p Conclusions Our findings demonstrate lower serum albumin, elevated total bilirubin and ALT were independent predictors of all cause death or hospitalisation among an unselected group of HF patients. These markers can be easily used to risk stratify ambulatory CHF patients in the clinic.

Chronic heart failure and mortality in patients with community-acquired Staphylococcus aureus bacteremia: a population-based cohort study.

BackgroundPatients with chronic heart failure (CHF) may experience higher mortality of Staphylococcus aureus bacteremia (SAB) than patients without CHF due to insufficient cardiovascular responses during systemic infection. We investigated 90-day mortality in SAB patients with and without CHF.MethodsUsing population-based medical databases, we conducted a cohort study of all adult patients with community-acquired SAB (CA-SAB) in Northern Denmark, 2000-2011. Ninety-day mortality after SAB for patients with and without CHF was estimated by the Kaplan-Meier method. Based on Cox regression analysis, we computed hazard ratios as estimates of mortality rate ratios (MRRs) overall and stratified by CHF-related conditions (e.g., cardiomyopathy and valvular heart disease), CHF severity (defined by daily dosage of loop-diuretics), and CHF duration while adjusting for potential confounders.ResultsAmong 2638 SAB patients, 390 (14.8 %) had a history of CHF. Ninety-day mortality was 45 % in patients with CHF and 30 % in patients without CHF, which yielded an adjusted MRR (aMRR) of 1.24 (95 % CI, 1.04-1.48). Compared to patients without CHF, the excess risk of death was most pronounced among patients with valvular heart disease (aMRR = 1.73 (95 % CI, 1.26–2.38)), patients with daily loop-diuretic dosages of 81–159 mg/day (aMRR = 1.55 (95 % CI, 1.11–2.14)) and ≥160 mg/day (aMRR = 1.62 (95 % CI, 1.21–2.18)), and among patients with <3 years of CHF duration (aMRR = 1.43 (95 % CI, 1.14–1.78)).ConclusionCA-SAB patients with CHF experienced increased 90-day mortality compared to patients without CHF.Electronic supplementary materialThe online version of this article (doi:10.1186/s12879-016-1570-7) contains supplementary material, which is available to authorized users.

GENE POLYMORPHISM IN ASSOCIATION WITH ATHEROSCLEROSIS DEVELOPMENT AND COGNITION DISORDERS IN PATIENTS WITH ISCHEMIC CHRONIC HEART FAILURE

Aim. To study the interrelation of polymorphic gene variants playing role in atherosclerosis development, with cognition disorders, central nervous system condition and chronic heart failure (CHF) course specifics in patients with ischemic heart disease. Material and methods. 40 patients with CHF I-IV functional class (NYHA) of ischemic origin underwent cognition testing, nuclear-magnetic resonance tomography of the brain, duplex brachiocephalic arteries scanning, gene APOC3, ABCA1 и PON1 polymorphism assessment, and lipid, homocystein, brain natriuretic peptide measurement (BNP). Results. The interrelations of polymorphic gene variants APOC3, ABCA1 и PON1 were found with morphological changes in the brain and cognition tests results. T allele at PON1 (polymorphism L55M A&gt;T) and allele A at PON1 (polymorphism Q192R A&gt;G) associated with the worsening of Burdone correction test, and T allele of APOC3 gene (polymorphism -482C&gt;T) was linked to the decrease of diffusion coefficients in gray as in white matters. There are statistically significant relations of the polymorphisms studied with the levels of plasma lipids, homocysteine and carotid arteries diameter and intima-media complex thickness. While studying relations of polymorphic genes ABCA1 и APOC3 variants (C3238G) and CHF duration, BNP level and end- systolic size of the left atrium it was found that the allele A of gene ABCA1 and allele G of gene APOC3 ^3238G) are associated with longer duration of CHF. The increase of the left atrium size and higher BNP levels were shown in patients — carriers of C allele gene APOC3 (polymorphism -428 C&gt;T). Conclusion. There is interrelation of gene polymorphism that are associated with lipid metabolism disorders, CHF course and cognition functioning and morphological changes in central nervous system in CHD patients.

Morning surge of ventricular arrhythmias in a new arrhythmogenic canine model of chronic heart failure is associated with attenuation of time-of-day dependence of heart rate and autonomic adaptation, and reduced cardiac chaos.

Patients with chronic heart failure (CHF) exhibit a morning surge in ventricular arrhythmias, but the underlying cause remains unknown. The aim of this study was to determine if heart rate dynamics, autonomic input (assessed by heart rate variability (HRV)) and nonlinear dynamics as well as their abnormal time-of-day-dependent oscillations in a newly developed arrhythmogenic canine heart failure model are associated with a morning surge in ventricular arrhythmias. CHF was induced in dogs by aortic insufficiency & aortic constriction, and assessed by echocardiography. Holter monitoring was performed to study time-of-day-dependent variation in ventricular arrhythmias (PVCs, VT), traditional HRV measures, and nonlinear dynamics (including detrended fluctuations analysis α1 and α2 (DFAα1 & DFAα2), correlation dimension (CD), and Shannon entropy (SE)) at baseline, as well as 240 days (240d) and 720 days (720d) following CHF induction. LV fractional shortening was decreased at both 240d and 720d. Both PVCs and VT increased with CHF duration and showed a morning rise (2.5-fold & 1.8-fold increase at 6 AM-noon vs midnight-6 AM) during CHF. The morning rise in HR at baseline was significantly attenuated by 52% with development of CHF (at both 240d & 720d). Morning rise in the ratio of low frequency to high frequency (LF/HF) HRV at baseline was markedly attenuated with CHF. DFAα1, DFAα2, CD and SE all decreased with CHF by 31, 17, 34 and 7%, respectively. Time-of-day-dependent variations in LF/HF, CD, DFA α1 and SE, observed at baseline, were lost during CHF. Thus in this new arrhythmogenic canine CHF model, attenuated morning HR rise, blunted autonomic oscillation, decreased cardiac chaos and complexity of heart rate, as well as aberrant time-of-day-dependent variations in many of these parameters were associated with a morning surge of ventricular arrhythmias.

Health-related quality of life in elderly patients hospitalized with chronic heart failure

BackgroundChronic heart failure is a very common condition in the elderly, characterized not only by high mortality rates, but also by a strong impact on health-related quality of life (HRQOL). Previous studies of HRQOL in elderly heart failure subjects have included mostly outpatients, and little is known about determinants of HRQOL in hospitalized elderly population, especially in Serbia. In this study, we tried to identify factors that influence HRQOL in elderly patients hospitalized with chronic heart failure in Serbia.MethodsThe study population consisted of 136 patients aged 65 years or older hospitalized for chronic heart failure. HRQOL was assessed using the Minnesota Living with Heart Failure questionnaire. Predictors of HRQOL were identified by multiple linear regression analysis.ResultsUnivariate analysis showed that patients with lower income, a longer history of chronic heart failure, and longer length of hospital stay, as well as those receiving aldosterone antagonists and digoxin, taking multiple medications, in a higher NYHA class, and showing signs of depression and cognitive impairment had significantly worse HRQOL. Presence of depressive symptoms (P<0.001), higher NYHA class (P=0.021), lower income (P=0.029), and longer duration of heart failure (P=0.049) were independent predictors of poor HRQOL.ConclusionDepressive symptoms, higher NYHA class, lower income, and longer duration of chronic heart failure are independent predictors of poor HRQOL in elderly patients hospitalized with chronic heart failure in Serbia. Further, there is an association between multiple medication usage and poor HRQOL, as well as a negative impact of cognitive impairment on HRQOL. Hence, measures should be implemented to identify such patients, especially those with depressive symptoms, and appropriate interventions undertaken in order to improve their HRQOL.

Effects of transluminal balloon angioplasty and stenting on the clinical course of ischemic chronic heart failure with preserved or reduced left ventricular ejection fraction: radionuclide 4D tomoventriculography data

Aim. To study the effects of transluminal balloon angioplasty (TLBAP) and stenting on right and left ventricular (RV, LV) hemodynamics, as well as on long-term clinical prognosis, in patients with ischemic chronic heart failure (CHF). Material and methods. In 20 patients with ischemic CHF, Functional Class (FC) II–III (NYHA), radionuclide 4D tomoventriculography (4D-RTVG) was performed at baseline and 6 and 12 months after TLBAP, in order to assess cardiac hemodynamics. Based on ejection fraction (EF) values, all participants were divided into two groups. Group I (n=10; mean age 57,2 (2,7) years) included men with EF &lt;45%, FC II–III CHF, and mean CHF duration of 3,1 (0,6) years. Group II (n=10; mean age 62,6 (2,7) years) included 5 men and 5 women with EF &gt;45%, FC II CHF, and CHF duration of 2 (0,4) years. Results. Twelve months after TLBAP, Group I demonstrated a significant increase in stroke volume (SV), LV EF, and RV EF, as well as an improvement in LV maximum ejection velocity (MEV), maximum filling velocity (MFV), and maximum filling time (MFT), as well as in LV and RV one-third filling fraction (1/3 FF) (p&lt;0,05). A decrease in LV enddiastolic volume (EDV), LV end-systolic volume (ESV), and RV ESV, some increase in RV EDV, and an improvement in RF MEV, MFV, and MFT were non-significant (p&gt;0,05). In Group II, an increase in LV SV and LV EF, as well as an improvement in RV 1/3FF and MFT, was statistically significant (p&lt;0,05). At the same time, an increase in RF SV, EF, EDV, and ESV, as well as an improvement in LV and RV MEV and MFV, LV 1/3FF and LV MFT, without any substantial changes in LV EDV and ESV, lacked statistical significance (p&gt;0,05). Cardiac hemodynamic changes were associated with improved quality of life (QoL) and reduced CHF FC and angina FC. Conclusion. TLBAP and stenting facilitated an increase in EF and SV, an improvement in LF and RF systolic and diastolic function, an improvement in QoL and exercise capacity, and a reduction in CHF FC and angina FC.

CLINICAL SIGNIFICANCE OF ANEMIC SYNDROME IN PATIENTS WITH CHRONIC HEART FAILURE

Aim. To evaluate the anemia prevalence and its impact on chronic heart failure (CHF) course. Methods. A total of 228 outpatients (86 women and 196 men, aged 39-85 y.o.) with clinically stable CHF (II-IV functional class according to NYHA) were studied. Anemia was defined by the WHO criteria (hemoglobin levels &lt;13 g/dl in men and &lt;12 g/dl in women). Results. Anemia was found in 18,8% of CHF patients. In all the cases anemia was mild (hemoglobin levels &gt;9 g/dl). Anemia rate did not differ significantly in patients with reduced (18,5%) and preserve (19,1%) or left ventricle ejection fraction (LV EF) (р=0,743). Anemic and non anemic patients were similar in terms of gender, NYHA functional class, heart rate and LV EF. The rate of anemic patients increased significantly up to 35,8% in creatinine clearance &lt;60ml/min. Anemic patients were older (p&lt;0,001), had longer CHF duration (p=0,014), lower body mass index (p=0,041), had diabetes more often (p=0,004, χ2=8,01) in comparison with non anemic patients. Deficiency of iron, vita￾min B12 or folic acid was a reason of anemia in 35,8%, 9,4% and 15,1% of patients, respectively. Anemia reason was not detected in 39,7% of patients. Conclusion. Anemia in patients with CHF is associated with age, impaired renal function, diabetes and high hospitalization rate because of CHF deterioration.

EFFECT OF MITRAL REGURGITATION ON CHRONIC HEART FAILURE COURSE AND STRUCTURE-FUNCTIONAL HEART STATE

Aim. To evaluate chronic heart failure (CHF) course, functional and structural heart changes in patients with functional mitral regurgitation (MR) of various degrees. Material and methods. A total of 104 outpatients (60-85 y. o.) with CHF of functional class II-IV by NYHA and functional MR of I-II degrees and MR of III-IV degrees were included into the study groups. Results: Patients in both groups were comparable in sex, age, CHF duration, body mass index, systolic and diastolic blood pressure, clinical state by the clinical state scale, quality of life, anxious and depressive status. The majority of patients with MR III had significant left ventricle (LV) systolic dysfunction (p=0,029), severe CHF course (p=0,034), received furosemide (p=0.004) and digoxin (p=0,004). They had significant increase in end-diastolic dimension (p&lt;0,001), end-systolic dimension (p&lt;0,001), left atrium (p=0,004), end-diastolic vol￾ume (p&lt;0,001), end-systolic volume (p&lt;0,001), pulmonary artery pressure (p&lt;0,001), decrease in LV relative wall thickness (p=0,021) and LV ejection fraction (p&lt;0,001). Patients of this group were hospitalized because of CHF decompensation and ischemic heart disease exacerbation more often (p=0,045). Conclusion. MR can be considered as one of sensitive predictors of LV geometry and function alteration in CHF patients and play an important role in symptoms development.

Plasma Adiponectin, Body Mass Index, and Mortality in Patients With Chronic Heart Failure

Recent studies have suggested that higher body mass index (BMI) is associated with improved prognosis in chronic heart failure (CHF). The adipocytokine adiponectin is inversely associated with BMI, and in healthy subjects, low adiponectin is a predictor of mortality. In a prospective study, we therefore evaluated the association between plasma adiponectin levels and mortality among patients with CHF. In 195 CHF patients (age 69.3+/-10.2 years, BMI 27.3+/-5.2 kg/m2, left ventricular ejection fraction 30+/-8.9%, mean+/-SD), plasma adiponectin and N-terminal pro brain natriuretic peptide (NT-proBNP) were measured at baseline. Adiponectin was positively associated with NT-proBNP (beta=0.47, P<0.001), and both biomarkers were negatively associated with BMI (beta=-0.43, P<0.001 for adiponectin and beta=-0.38, P<0.001 for NT-proBNP, respectively) During a median follow-up of 2.6 years, 46 (23.5%) of the patients died. After adjustment for clinical variables associated with CHF severity (age, systolic blood pressure, left ventricular ejection fraction <25%, duration of CHF, and creatinine clearance) and for NT-proBNP, the hazard ratio of mortality for values in the 2 upper tertiles relative to the lowest tertile of adiponectin was 3.23 (P=0.032). BMI predicted mortality independently of clinical parameters of CHF severity (hazard ratio=0.63, P=0.012), but this association became insignificant after additional adjustment for NT-proBNP (hazard ratio=0.74, P=0.13). A high adiponectin level was a predictor of mortality, independent of risk markers of CHF severity, presumably because of its role as a marker for wasting. BMI was also associated with mortality, but a part of this relation may be mediated by adiponectin and NT-proBNP levels.