Etiology Of Congestive Heart Failure Research Articles

Joint modeling of longitudinal change in pulse rate and survival time of heart failure patients treated at Arbaminch General Hospital, Southern Ethiopia.

Heart failure is a chronic progressive disease in which the heart muscle is unable to pump enough blood to meet the body's need. It is a severe health problem around the world with high re-hospitalization and death rates. The main aim of this study was to identify the factors associated with longitudinal change of pulse rate and survival time to death of congestive heart failure patients treated at Arba Minch General Hospital. A retrospective study design was undertaken on congestive heart failure patients admitted to the Arba Minch General Hospital from January 2017 to December 2020. Data was collected from a total of 199 patients. After evaluating the longitudinal data with a linear mixed model and the survival time to death data with cox proportional model, Bayesian joint model of both sub models was fitted in R software using JMbayes2 package. Findings from Bayesian joint model revealed that the estimated value for the association parameter was positive and statistically significant. This indicates that there is significant evidence of an association between the mean longitudinal change of pulse rate and the risk of death. Weight of patients at baseline, gender, chronic kidney disease, left ventricular ejection fraction, New York Heart Association classification, diabetes, tuberculosis, pneumonia and family history were statistically significant factors associated with mean evolution of pulse rate of congestive heart failure patients. Left ventricular ejection fraction, etiology of congestive heart failure, type of congestive heart failure, chronic kidney disease, smoking, family history, alcohol and diabetes were found to be statistically significant factors associated with survival time to death. To reduce the risk level, health professionals should give attention to congestive heart failure patients with high pulse rate, co-morbidities of chronic kidney disease, tuberculosis, diabetic, smoking status, family history, and pneumonia in the study area.

Etiology of Congestive Heart Failure in Children

Objective: To determine the frequency of common causes of congestive heart failure among children in a tertiary care hospital. Study Design: Cross-sectional study Place and Duration of Study: Department of Paediatrics Medicine, Services Hospital, Lahore from 1st January 2018 to 30th June 2018. Methodology: Ninety children were enrolled. Demographic information like name, age, gender, weight of child was noted. Complete blood count, echocardiography and chest X-ray were done. Children underwent assessment for presence of causes of congestive heart failure. Results: Fifty six (62.22%) were between 2-30 months of age whereas 34 (37.78%) were between 31-60 months of age with mean age 29.4±12.47 months. There were 40 (44.44%) males and 50 (55.56%) females. The causes of CCF were acute myocarditis in 39 (43.33%), congenital heart disease in 31 (34.44%) and severe anemia in 20 (22.33%). Conclusion: Acute myocarditis is one of the common causes of congestive heart failure in children aftersevere anemiaand congenital heart disease. Keywords: Congestive heart failure, Common causes, Acute myocarditis, Congenital heart disease, Severe anemia

Etiological aspects of congestive heart failure in hospital university Ibn Rochd (about 3412 patients)

Congestive heart failure (CHF) is a major and growing health problem around the world. In Africa, heart failure seems to be attributable mostly to systolic dysfunction and occurs as a major complication of high blood pressure. As a contribution to decreasing mortality of acute myocardial infarction and better treatment of high blood pressure as well as congestive heart failure the number of patients in heart failure have increased substantially. In contrast to the Framingham Study, nowadays coronary artery disease is the most prevalent etiology of congestive heart failure followed by hypertensive heart disease. The main objective of the study is to relate the principle causes leading to heart failure in our department. It is a transversal retrospective study conducted between May 2006 and June 2019 including all patients beyond the age of 14 with congestive heart failure followed-up in the therapeutic unit of heart failure of our department. The data were collected on Excel and analyzed using SPSS 2.0 software. We studied cardiovascular risk factors prevalence and causes repartition among these patients. The mean age was 64,92 ± 12,95 years, sex ratio H/F was 1,7, the prevalence of hypertension was 38,9%, 30,4% were diabetic, 31,9% were smokers, 9,9% were dyslipidemic. The leading cause of CHF among our patients was ischemic heart disease (76,81%), 13,47% dilated cardiomyopathy, 4,83% valvular heart disease, 2,38% cardiac toxicity, 0,9% of heart failure with preserved ejection fraction, 0,4% peripartum cardiomyopathy, 0,3% arrhythmia–induced cardiomyopathy. Our data show a high incidence of ischemic heart disease. Despite advances in our therapies for ischemic heart disease and hypertension, CHF remains a common and highly lethal condition. There is accumulating evidence that treatment of hypertension and ischemic heart disease can decrease the incidence of clinical CHF, related morbidity and mortality.

Prevalence and Patterns of Obstructive Sleep Apnea in Asian Indians With Congestive Heart Failure.

BackgroundSleep-disordered breathing (SDB) has a potential association with the pathogenesis of congestive heart failure (CHF). We assessed the prevalence and patterns of obstructive sleep apnea (OSA) in patients presenting with CHF.MethodThis was a prospective, observational, all-comers study of consecutive 77 confirmed cases of CHF. All these patients were clinically assessed and evaluated for OSA with sleep study after routine blood testing, electrocardiogram (ECG), chest X-ray, and echocardiography.ResultsOf 77 patients with CHF 38 (49.4%) had apnea-hypopnea index (AHI) <5 while 39 (50.6%) had AHI >5. Of these 39, 37 (94.8%) patients showed the clinical features of OSA. The majority (64.9%) of them were males. The majority of OSA (64.9%) had coronary artery disease (CAD) (p<0.05) as the etiology of CHF, followed by dilated cardiomyopathy (32.4%) and valvular heart disease (2.7%). The prevalence of OSA was higher amongst New York Heart Association (NYHA) class 2 (51.4%) as compared to NYHA class 3 (37.8%) and NYHA class 4 (10.8%). There were 12 (32.8%) patients, each having OSA with a heart rate between 71 and 80 bpm and 81 and 90 bpm. Twenty-two (59.5%) had systolic blood pressure (BP) more than 120 mmHg and 20 (54.1%) had diastolic BP more than 80 mmHg. The majority (64.9%) patients had the lowest O2 saturation between 80% and 90%. A significantly large number of patients (62.2%) had ejection fraction 21%-30% (p<0.05). The majority (62.16%) of patients with OSA had AHI between 5 and 15. With 5-15 AHI, 20 (87%) patients with OSA had a snoring, tiredness, observed apnea, high BP, BMI, age, neck circumference, and male gender (STOP-Bang) score between 3 and 7 with AHI 5-15 (p<0.05).ConclusionsIn our cohort, the prevalence of OSA in CHF was 50.6%. Predictors of OSA in CHF were left ventricular ejection fraction (LVEF) 20%-30% and NYHA class 2. The majority had AHI between 5 and 15. Sleep apnea screening should be routinely implemented in the evaluation and follow-up of heart failure patients.

Positive Tc-99m Pyrophosphate Scintigraphy Predicts Thromboembolic Risk in Patients with Congestive Heart Failure and Atrial Fibrillation

Background Tc-99m pyrophosphate scintigraphy (PYP) has unmasked a high community prevalence of wild-type transthyretin cardiac amyloidosis (ATTRwt-CA), which is an increasingly recognized etiology of congestive heart failure (CHF) in the elderly. CHF is a known component of the CHA2DS2-VASc score that predicts thromboembolic risk in atrial fibrillation (AF). However, the impact of ATTRwt-CA on thromboembolic risk in AF is unknown. Hypothesis We hypothesized that ATTRwt-CA independently predicts thromboembolism in CHF patients with atrial fibrillation. Methods We studied patients with underlying CHF who underwent PYP between 6/2015 and 6/2019. Positive PYP was defined as Perugini grade ≥2 along with heart-to-contralateral lung ratio of ≥ 1.5 on planar image, and diffuse myocardial tracer uptake on the SPECT. Those with positive PYP, negative serum studies for AL amyloidosis and no transthyretin gene mutation were diagnosed with ATTRwt-CA. We compared the prevalence of AF in patients with and without ATTRwt-CA and the incidence of thromboembolism (stroke, transient ischemic attack or systemic embolism) in AF patients with ATTRwt-CA (AF-ATTR) and without (AF-controls). Results Of 277 patients referred for PYP, 77 (28%) had ATTRwt-CA. The prevalence of AF was markedly higher in patients with ATTRwt-CA (n=68, 88%) compared to patients with negative PYP (n=77, 39%, p Conclusion ATTRwt-CA is a strong predictor of thromboembolism in patients with AF, independent of CHA2DS2-VASc score, septal thickness or left atrial size.

CATHETER ABLATION OF ATRIAL FIBRILLATION IN HEART FAILURE PATIENTS WITH OR WITHOUT OTHER ETIOLOGIES

Congestive heart failure (CHF) and arrythmia represented by atrial fibrillation (AF) often coexist and exacerbate each other. Arrythmia induced cardiomyopathy (AIC) is known as an etiology of CHF. Catheter ablation (CA) is one of the treatments of CHF and AF. This is a retrospective matched-pair

Congestive heart failure in cattle; etiology, clinical, and ultrasonographic findings in 67 cases.

Background and Aim:Congestive heart failure (CHF) is a clinical disorder that results from cardiac dysfunction with subsequent fatal outcomes in most cases. Several diseases are incriminated in occurrence of CHF. Therefore, the aims of this study were to identify CHF etiology and associated clinical findings in 67 cows and to investigate the relationship between CHF and the other body organs using ultrasonographic examination.Materials and Methods:Sixty-seven cows affected by CHF admitted to the clinic with a history of loss of appetite, decrease in milk production, constipation, and brisket edema were thoroughly investigated clinically and ultrasonographically. In addition, ten apparently healthy cows were used as a control group.Results:Clinically, cows with CHF manifested jugular engorgement and pulsation (88.1%), brisket and/or intermandibular edema (77.6%), and muffled heart sounds (76.1%). Based on the ultrasonographic examination, traumatic pericarditis (82.1%) was the most prevalent etiology of CHF. Extracardiac etiology of CHF identified were exudative pleurisy (10.4%) and mediastinal abscesses (7.5%). Hepatomegaly (88.1%) and pleural effusion (61.2%) were the most documented consequences.Conclusion:Both cardiac and extracardiac diseases could be associated with CHF in cattle. Ultrasonographic changes in liver and pleura secondary to CHF were the most common findings. Ultrasonography is a good tool for the diagnosis of cardiac and extracardiac etiologies of CHF in cattle.

Spare Ronnie from Drowning: Reducing Heart Failure Symptoms in Hospice Patients Utilizing a New Guideline-Directed Medical Therapy Algorithm (TH371C)

•Differentiate the various etiologies of congestive heart failure, and describe how this understanding impacts treatment.•Utilizing a newly introduced, vital sign-driven, heart failure treatment algorithm, the attendee will have the capacity to devise an anti-congestive medication strategy tailored to each hospice patient, and to any point in that patient's life trajectory.•Following the patient's response to the treatment algorithm, each attendee will have an improved capacity to prognosticate life expectancy for each heart failure patient. Guideline Directed Medical Therapy (GDMT) is the foundation of current heart failure treatment. However, in end-stage disease, upon hospice enrollment, these medications are often either abandoned, or simply cut-and-pasted into the patient's new drug regimen without scrutiny. Neither approach serves the hospice patient well. Optimal treatment entails first defining the etiology of each patient's congestive failure, (preserved or reduced ejection fraction, and the presence or absence of concomitant valvular heart disease and/or atrial fibrillation). Application then of a streamlined, tiered algorithm of GDMT, specifically adapted to the hospice setting, best achieves, and preserves, optimal symptom management. The algorithm is vital sign qualified; each different tier of therapy requires a different level of systolic blood pressure and/or heart rate to permit medication administration. This dynamic automatically establishes a hierarchy of importance for the different medication groups, assists with formulating a rational initial medication regimen tailored to each patient, and prevents drug administration when, because of either relative hypotension or bradycardia, the agent could be deleterious. It also aids prognostication, and the eventual transitioning of patients off GDMT to only comfort medications (opioids and benzodiazepines) at the immediate end of life. Comparing statistics drawn from a 12-month chart review of heart failure patients admitted to our in-patient hospice facility prior to implementation of this algorithm, to an ongoing data analysis of current patients with the same primary diagnosis. Statistics reveal a 31% improvement in BORG scale, and a 28% improvement in PPS. The live discharge rate to home* has risen by 39%, with patients living (comfortably) weeks longer. Improved symptom management of hospice-enrolled patients with a primary diagnosis of heart failure underpin this treatment algorithm, with ongoing patient review. *“home” may include assisted or skilled nursing facility

Study of some electrocardiographic and echocardiographic data in toddelers and children with primary glomerulonephropathy

Background and Objective: Primary glomerulonephropathy mainly acute poststreptococcal glomerulonephritis (APSGN) is the most common cause of hypertensive heart failure in the pediatric age as APSGN may involve various systems including cardiovascular system. There are few research publications on electrocardiographic (ECG) and echocardiographic (two-dimensional [2D]-echo) data in childrenwith primary glomerulonephropathy. The aim is to study some ECG and 2D-echo data in Egyptian pediatric patients with ANS). Subjects and Methods: Sixty children with ANS were included and subjected to clinical, laboratory, ECG for corrected QT (QTc) interval and 2D echocardiographic study on admission and repeated at 6 and 12 weeks using GE Vivid 7 (GE Medical System, Horten, Norway with a 3.5-MHz multifrequency transducer) to measure left ventricular ejection fraction (LVEF), left atrium to aorta ratio and E/A ratio. Results: Prolonged QTc interval was reported in 22 patients (37%), of whom 18 had hypertension. Fourteen of the 60 children had LVEF 2 and E/A ratio more than two. LVEF became within normal values by 1½ month (6 weeks) in 12 patients, two become normal by three months of follow-up. Four (28.6%) from 14 children with low LVEF had normal arterial blood pressure. All the 14 children had completely recovered on follow-up period of 3 months. Conclusion: Changes in ECG and echo data which were reported in the acute phase of ANS appear to be temporary (transient) as they became within normal values in almost all children by 12 weeks period of follow-up. Although elevated blood pressure was the most common etiology of congestive heart failure in children with ANS, the impact of primary myocardial functional disturbance could also be put into consideration.

Epidemiologic burden of hospitalisation for congestive heart failure among adults aged ≥19 years in the Philippines

ObjectivesThe study determined the prevalence of hospitalisation due to congestive heart failure (CHF) among adult patients aged 19 years and above in the Philippines and its 17 regions in 2014....

The Indian Consensus Document on cardiac biomarker

Despite recent advances, the diagnosis and management of heart failure evades the clinicians. The etiology of congestive heart failure (CHF) in the Indian scenario comprises of coronary artery disease, diabetes mellitus and hypertension. With better insights into the pathophysiology of CHF, biomarkers have evolved rapidly and received diagnostic and prognostic value. In CHF biomarkers prove as measures of the extent of pathophysiological derangement; examples include biomarkers of myocyte necrosis, myocardial remodeling, neurohormonal activation, etc. In CHF biomarkers act as indicators for the presence, degree of severity and prognosis of the disease, they may be employed in combination with the present conventional clinical assessments. These make the biomarkers feasible options against the present expensive measurements and may provide clinical benefits.

A study on prevalence and etiology of heart failure in qatari residents: data analysis from a tertiary hospital

Heart failure is a multi-faceted syndrome with diverse etiologies. Knowledge of the cause can be crucial to therapy and management including long term strategy planning. The aim of this study is to analyze the prevalence and etiology of heart failure present in Qatari residents, which is a mix of multiple ethnicities. Qatar is today one of the leading growing economies of the world and witnessing a population boom. It is currently undergoing major lifestyle changes, which comes with aplenty due to recently discovered vast natural resources. Enhanced knowledge of disease incidence/prevalence in the Qatari environment can have a prospect of developing and evaluating novel and more effective approaches for disease prevention, diagnosis and treatment in the future. Methods: Our study was conducted in a total of 50 patients over a period of 21 months in a tertiary care institute. Detailed clinical history, followed by examination and laboratory tests were performed to identify the etiology and data analyzed to study the prevalence. Results: Our study revealed that in all cases of HF admitted in our hospital, 52% were males and 48% were females. The occurrence of Congestive Heart Failure (CHF) was highest between 50 and 80 years in both males and females. The relation of CHF to various etiologies has been discussed. The data has also been compared with select international studies and the variations discussed. Conclusion: Major etiology of CHF was a combination of lifestyle disease, Hypertension, Diabetes Mellitus and Ischemic heart disease. Minor causes included Valvular heart disease, chronic arrhythmias, and myocarditis and conduction system disease.

Etiology of congestive heart failure in Indian population – An acute care study of 500 cases

ObjectiveHeart failure is a multi-faceted syndrome with diverse etiologies. Knowledge of the cause can be crucial to therapy. The prevalence and etiology of heart failure has been previously incompletely described in the Indian population and hence this study. MethodsOur study was conducted in a total of 500 patients over a period of 10 months in a tertiary care institute. Detailed clinical history, followed by examination and laboratory tests were performed to identify the etiology. Results310 (62%) were males and 190 (38%) were females. The occurrence of Congestive Heart Failure (CHF) was highest between 50 and 70 years in both males and females. The relation of CHF to various etiologies has been discussed. The Indian data has also been compared with select international studies and the variations discussed. ConclusionMajor etiology of CHF was a combination of CAD, Hypertension and Diabetes Mellitus, accounting for 23.4%. CAD was the single commonest etiology for heart failure.

Secular trends in the etiology and comorbidity of hospitalized patients with congestive heart failure: A single-center retrospective study

ObjectiveTo assess the secular trends in the etiology and comorbidity of patients hospitalized with congestive heart failure (CHF).MethodsData of 7,319 patients (mean age 59.6 years, 62.1% male) with a primary discharge diagnosis of CHF, hospitalized from January 1, 1993 to December 31, 2007 at the Chinese People's Liberation Army (PLA) General Hospital were extracted and analyzed. These patients were divided into three groups according to hospitalization period: 1993–1997 (n = 1623), 1998–2002 (n = 2444), and 2003–2007 (n = 3252). The etiological characteristics and comorbidities were assessed.ResultsOver the study period, the proportion of patients with ischemic heart disease (IHD) increased from 37.2% during the period 1993–1997 to 46.8% during the period 2003–2007, while that with valvular heart disease (VHD) decreased from 35.2% during the period 1993–1997 to 16.6% during the period 2003–2007 (both P < 0.05). Atrial fibrillation (AF) was the most common comorbidity of heart failure (23.2%, 23.0% and 20.6%, respectively, in the three periods). Compared to that of the period of 1993–1997 with that of, the proportion of patients with myocardial infarction, pneumonia, renal function impairment and hepatic cirrhosis of the period of 2003–2007 increased significantly (P < 0.05) and the proportion of patients with chronic obstructive pulmonary disease and atrial fibrillation decreased significantly (P < 0.05).ConclusionsThis study implies that IHD has became a more common etiology of CHF, while VHD has deceased as an etiology of CHF in Chinese patients during the last two decades.

Usefulness of routine surveillance endomyocardial biopsy 6 months after heart transplantation

Endomyocardial biopsy (EMB) remains the gold standard for detecting rejection episodes in orthotopic heart transplant (OTH) patients. Follow-up protocols vary widely between transplant centers. At our center, we have implemented a conservative strategy protocol and here we report our outcomes. Patients from 2 cohorts were used for comparison analysis. OHT recipients from 1990 to 1995 comprised the standard strategy group, and those from 2004 to 2009 comprised the conservative strategy group. Survival outcomes and rejection episodes were compared between groups. Mean age at OHT was 56 ± 10 years in the standard strategy group and 53 ± 10 years in the conservative strategy group. Both groups were predominantly composed of white men. The etiology of congestive heart failure was ischemic cardiomyopathy in more than 50% of the patients in both groups. From 6 to 12 months after OHT, we found that the number of episodes of rejection/total number of EMBs was 4.9% (8/163) in the standard group vs 2.0% (1/50) in the conservative group. From 12 to 24 months after transplant, the rate was 2.5% (8/320) in the standard group vs 11.9% (5/42) in the conservative group (p < 0.05). Surveillance EMB after 6 months post-OHT in patients receiving contemporary immunosuppression is associated with a low yield of EMB-confirmed rejection in the absence of a clinical indication or echocardiographic findings that support clinical rejection. Most episodes of cellular rejection are mild and do not warrant treatment or a change in immunosuppression. The frequency of EMBs did not correlate with an increased risk of cardiac allograft vasculopathy or death.

The Coexistence of Multiple Cardiovascular Diseases is an Independent Predictor of the 30‐Day Mortality of Hospitalized Patients With Congestive Heart Failure: A Study in Beijing

Congestive heart failure (CHF) has become a major clinical and public health challenge with the aging of the population in China. However, the effect of the coexistence of multiple cardiovascular diseases on the prognosis of hospitalized patients with CHF remains unclear. A comparative analysis was performed to explore the etiology and comorbidities of CHF and in-hospital mortality in patients with CHF. The coexistence of multiple cardiovascular diseases is an independent predictor of the 30-day mortality of hospitalized patients with CHF. All 6949 patients (4344 males, 2605 females) in the database with a principal ICD-9-CM discharge diagnosis of CHF were identified and divided into 5 groups according to the number of comorbidities. Cox proportional hazards regression was used to examine the association between the number of comorbidities and in-hospital mortality in patients with CHF. A single comorbidity was predominant in younger patients (18-39 years, P<0.001), whereas multiple comorbidities were predominant in the elderly (≥80 years, P<0.001). The most common single etiology was valvular heart disease, and the most common triple etiology was hypertension and diabetes mellitus complicated by coronary artery disease. Cox regression analysis showed a higher hospital mortality rate associated with an increased number of comorbidities (hazard ratio [HR] from 1.22 [95% CI: 0.89-1.68] to HR 3.49 [95% CI: 2.55-4.78], P<0.001). This study demonstrates the coexistence of multiple cardiovascular diseases is an independent predictor of the 30-day mortality of hospitalized patients with CHF.

What We Know and Do Not Know about Sex and Cardiac Disease

Cardiovascular disease (CVD) remains the single leading cause of death in both men and women. A large proportion of the population with CVD will die with a diagnosis of congestive heart failure (CHF). It is becoming increasingly recognized that sex differences exist in the etiology, development, and outcome of CHF. For example, compared to male counterparts, women that present with CHF are typically older and have systolic cardiac function that is not impaired. Despite a growing body of literature addressing the underlying mechanisms of sex dimorphisms in cardiac disease, there remain significant inconsistencies reported in these studies. Given that the development of CHF results from the complex integration of genetic and nongenetic cues, it is not surprising that the elucidation and subsequent identification of molecular mechanisms remains unclear. In this review, key aspects of sex differences in CVD and CHF will be highlighted with an emphasis on some of the unanswered questions regarding these differences. The contention is presented that it becomes critical to reference cellular mechanisms within the context of each sex to better understand these sex dimorphisms.

Exploring potential associations of suicidal ideation and ideas of self-harm in patients with congestive heart failure

To determine the factors, which are associated with suicidal ideation and ideas of self-harm in patients with congestive heart failure (CHF). We examined 294 patients with documented CHF, New York Heart Association (NYHA) functional class II-IV, in a cross sectional study at three cardiac outpatient departments. Measures included self-reports of suicidal ideation and self-harm (PHQ-9), depression (SCID), health-related quality of life (SF-36), multimorbidity (CIRS-G), consumption of alcoholic beverages, as well as comprehensive clinical status. Data were analyzed using logistic regression analyses. 50 patients (17.1%) reported experiencing suicidal ideation and/or ideas of self-harm on at least several days over the past two weeks. The final regression model revealed significant associations with health-related quality of life, physical component (odds ratio [OR] 0.56; 95% confidence interval [CI]: 0.35-0.91), and mental component (OR 0.50; 95% CI: 0.31-0.82), consumption of alcoholic beverages (OR 1.27; 95% CI: 1.05-1.54), first-episode depression (OR 3.92; 95% CI: 1.16-13.22), and lifetime depression (OR 10.89; 95% CI: 2.49-47.72). Age was only significant in the univariable (P=.03) regression analysis. NYHA functional class, left ventricular ejection fraction (LVEF), etiology of CHF, medication, cardiovascular interventions, multimorbidity, gender, and living situation were not significantly associated with suicidal ideation or ideas of self-harm. Lifetime depression, in particular, increases the risk of suicidal ideation and ideas of self-harm in CHF patients. Furthermore, the findings of our study underline the necessity of differentiating between first-episode and lifetime depression in CHF-patients in future research and clinical practice.

Sudden Cardiac Arrest in Patients With Severe Nonischemic Heart Failure: Risk Stratification With the Heart Failure Survival Score

The authors wanted to investigate whether the heart failure survival score (HFSS) is useful for sudden cardiac arrest (SCA) risk stratification and whether there is a difference with regard to congestive heart failure (CHF) etiology. Data of 712 severe CHF patients (New York Heart Association III/IV 58%/42%, mean age 62+/-8 years, mean left ventricular ejection fraction 26%+/-11%) during the period from 1993-2003 were analyzed. The HFSS was calculated using the Aaronson formula. SCA-free survival was calculated using Kaplan-Meier analysis according to the etiology of CHF: coronary artery disease (CAD) (n=317) vs no CAD (n=395). In regard to SCA risk, the authors found no significant overall difference between patients with or without CAD. Non-CAD HFSS high-risk patients had a significantly higher risk for SCA than all the other groups ( P<.001). The HFSS is useful for the detection of a subgroup of non-CAD severe CHF patients at very high risk for SCA.

Abstract 5927: Do Surgically Placed Left Ventricular Leads Provide the Same Benefit as Percutaneous Leads for Cardiac Resynchronization?

Objective : Cardiac resynchronization using a percutaneous left ventricular (LV) lead inserted via the coronary sinus improves symptoms of congestive heart failure (CHF), ejection fraction (EF), and survival. An epicardial LV lead is often placed surgically after failed percutaneous attempt, although it is unknown if they offer the same benefits. The objective of this study was to determine if patients with surgically placed LV leads derive the same therapeutic effect as those with percutaneously placed leads. Methods : Forty-five sequential patients who had surgically placed epicardial LV leads (via thoracotomy or thoracoscopy) after failed percutaneous lead attempt were 3:1 propensity score matched with 135 patients who had successful percutaneous placement. Patients’ scores were matched for the variables age, EF, and QRS interval using greedy methodology. Postoperative outcomes including mortality, CHF readmission, and New York Heart Association (NYHA) class were compared using standard univariate techniques. Results : Mean follow-up was 20±15 months. There were no differences in preoperative variables including age, EF, NYHA class, and etiology of CHF. No differences in 30-day mortality, long-term mortality, CHF readmission rate or EF % increase were identified between groups. Post-procedure complications of acute kidney injury (defined by creatinine increase &gt;1.0: 26.2% vs. 4.9%, P&lt;.001) and infection (11.9% vs. 2.4%, P=.026) were more common in the surgical group. Improvement in NYHA class was more common in the surgical group. Conclusions : Surgical LV lead placement offers functional benefits similar to percutaneous placement and possibly greater likelihood of NHYA class improvement. This comes with the greater risk of reversible acute kidney injury and post procedural infection.