Factor In Congestive Heart Failure Research Articles

Chronic kidney disease as a prognostic factor in congestive heart failure: A Moroccan series of 3412 patients.

The prevalence of CHF increases greatly as the patient's renal function deteriorates, and, at end-stage CKD, can reach 65–70%. There is evidence that CKD is a major contributor to severe cardiac damage. Purpose is to determine whether end-stage CKD is a prognostic factor in CHF. Transversal retrospective study conducted between May 2006 and June 2019 including patients beyond age of 14 with CHF followed-up in therapeutic unit of heart failure of our department. Data were collected on Excel and statistical analysis was made using SPSS statistics 2.0.We define 2 groups of patients. Group A with end-stage CKD and group B without end-stage CKD.We studied demographic, clinical and paraclinical characteristics among these 2 groups. We collected 3412 patients, 439 (12%) in group A and 2973 (82%) in group B. Main etiology of CHF was ischemic heart disease in both groups. Hypertension and dyslipidemia were more prevalent in group A. Diabetes was as prevalent in 2 groups. Comorbidities were more prevalent in group A as we observe more strokes (20% vs. 8%, P = 0,0001) and myocardial infarctions (31% vs. 28%, P = 0,0001). Group A patients were more symptomatic: stage III and IV NYHA in 30% vs. 19%, P = 0,0001. Patients of group A were more at risk of acute decompensated heart failure (21% vs. 9%, P = 0,005). Atrial fibrillation was more prevalent in group A (14% vs. 9%, P = 0,0001). Elevated left ventricle filling pressure was more prevalent in group A (40% vs. 34%, P = 0,003). Mean LVEF was 35,69 ± 12,56% in group A vs. 33,46 ± 10,42% in group B ( P = 0,63). Left ventricle was more dilated in group A (59,24 ± 8,2 mm vs. 57,91 ± 9,31 mm, P = 0,020). Cooperation between nephrologists and cardiologists may improve quality of care and subsequent prognosis for CHF and CKD.

PREDICTORS OF HEART FAILURE DEVELOPMENT IN ATRIAL FIBRILLATION PATIENTS WITH FUNCTIONAL MITRAL REGURGITATION

Functional mitral regurgitation (MR) can occur as a result of atrial dilatation in patients with atrial fibrillation (AF), and concomitant MR is associated with worse outcomes. However, risk factor of congestive heart failure (CHF) in AF patients with functional MR has not been determined. In

Advanced Congestive Heart Failure Associated With Disseminated Intravascular Coagulopathy.

Background. Disseminated intravascular coagulopathy (DIC) is a complication of an underlying disease and not a primary illness. It is most commonly associated with sepsis, trauma, obstetrical complications, and malignancies. There are very few cases in the literature illustrating the association between DIC and congestive heart failure. Findings. In this report, we present a case of severe congestive heart failure, leading to biventricular thrombi and subsequently DIC. Conclusion. We suggest that the association between congestive heart failure and DIC is an underrecognized one. Congestive heart failure continues to remain a major cause of morbidity and mortality despite advances in medical therapies. Thus far, the precise role of coagulation factors in congestive heart failure is unknown. Further investigations are needed to elucidate the pathophysiology of congestive heart failure and coagulation factors.

OP-032 Comparison of CETP Mass and Activity Levels Between Patients with Coronary Atherosclerosis and Healthy Subjects Although Having Higher HDL-C Levels

A B S T R A C T S the leading disease, follow by arrhythmia, then congestive heart failure. Congestive heart failure was diagnosed in 19,6% cases. Congenital heart diseases was diagnosed in 5,9% of studied population. The most diagnosed pathology was isolated ventricular septal defect and tetralogy of Fallot. Post-rheumatic valvulopathies and congenital heart diseases are the first aetiological factor of congestive heart failure in young. Results: Patients with severe hypertension, congestive heart failure, symptomatic arrhythmias were admitted for more investigations and proper care. After the compensation drug treatment, patient needed surgery, underwent surgical procedure. The hospital mortality rate was 0,2%. The poor compliance and limited finances gives the follow-up difficult. Conclusion: This study confirms that rheumatic heart disease still accounts for a major proportion of all cardiovascular diseases in children and young adults in African countries. Rapid urbanization and transition from agrarian life to the wage-earning economy of city life continue to fuel increases in average blood pressure levels and prevalence of hypertension.

Occurrence, aetiology and challenges in the management of congestive heart failure in sub-Saharan Africa: experience of the Cardiac Centre in Shisong, Cameroon.

The aim of the study was to investigate the occurrence, the aetiology and the management of congestive heart failure in the cardiac centre of the St. Elizabeth catholic general hospital Shisong in Cameroon. Between November 2002 and November 2008, a population of 8121 patients was consulted in the referral cardiac centre of St. Elizabeth Catholic General Hospital. Of these patients, 462 were diagnosed with congestive heart failure according to the modified Framingham criteria for the diagnosis of heart failure. Complementary investigations used to confirm and establish the aetiology of the disease were the chest X-ray, electrocardiography, bi-dimensional Doppler echocardiography. The results showed that the occurrence of congestive heart failure in our centre was 5.7%. Congestive heart failure was diagnosed in 198 females and 264 males, aged between 8 and 86 years old (42.5±18 years old). Post rheumatic valvulopathies (14.6%) and congenital heart diseases (1.9%) were the first aetiologic factor of congestive heart failure in the young, meanwhile cardiomyopathies (8.3%) in elderly followed by hypertensive cardiomyopathy (4.4%). Congestive heart failure was also seen in adults with congenital heart diseases in 0.01%. In this zone of Cameroon, we discovered that HIV cardiomyopathy (1.6%) and Cor pulmonale (8%) were represented, aetiological factors not mentioned in previous studies conducted in urban areas of Cameroon. The mean duration of hospital stay for the compensation treatment was thirteen days, ranging between 7 and 21 days), the mortality being 9.2%. All the medications recommended for the treatment of congestive heart failure are available in our centre but many patients are not compliant to the therapy or cannot afford them. Financial limitation is causing the exacerbation of the disease and premature death. Our data show a high incidence of congestive heart failure mainly due to post rheumatic valvulopathies in young patients in our centre. National program to fight against rheumatic fever and complications are of great urgency in our country. The compensation treatment of congestive heart failure is challenging in our milieu, characterized by poor compliance and financial limitations.

Evaluation of Right Ventricular Function

Right ventricular (RV) function is a powerful prognostic factor in congestive heart failure and pulmonary hypertension, but assessing RV function is a challenge because of the right ventricle's complex geometry, its extreme sensitivity to loading conditions, and a limited understanding of underlying mechanisms of right heart failure. At present, a single widely accepted and generally applicable index of RV function is not available. Current approaches to assessment of RV function include physical examination, catheterization, conventional contrast and radionuclide angiography, nuclear perfusion scintigraphy, cardiac CT, MRI, echocardiography, and positron emission tomography. This review will discuss assessment of RV function in the context of RV physiology.

Lipoprotein-Associated Phospholipase A 2 and Risk of Congestive Heart Failure in Older Adults

Background— Inflammation may be a causative factor in congestive heart failure (CHF). Lipoprotein-associated phospholipase A 2 (Lp-PLA 2 ) is an inflammation marker associated with vascular risk. One previous study showed an association of Lp-PLA 2 activity with CHF risk, but there were only 94 CHF cases and Lp-PLA 2 antigen, which is available clinically in the United States, was not measured. Methods and Results— We measured baseline Lp-PLA 2 antigen and activity in 3991 men and women without baseline CHF or cardiovascular disease who were participating in the Cardiovascular Health Study, a prospective observational study of adults 65 years or older. Cox proportional hazards models adjusted for age, sex, clinic site, race, low-density and high-density lipoprotein cholesterol, body mass index, systolic and diastolic blood pressure, hypertension, smoking status, pack-years, and diabetes were used to calculate hazard ratios and 95% CIs for incident CHF. Further models adjusted for coronary disease events during follow-up and C-reactive protein. Eight hundred twenty-nine participants developed CHF during 12.1 years. Adjusted hazard ratios for CHF with Lp-PLA 2 in the fourth compared with the first quartile were 1.44 (95% CI, 1.16 to 1.79) for Lp-PLA 2 antigen and 1.06 (95% CI, 0.84 to 1.32) for activity. Adjustment for incident coronary disease attenuated the hazard ratio for Lp-PLA 2 antigen to 1.26 (95% CI, 1.02 to 1.57), adjustment for C-reactive protein had minimal impact. Conclusions— Lp-PLA 2 antigen was associated with risk of future CHF in older people, independent of CHF and coronary risk factors, and partly mediated by coronary disease events. Further clinical and basic research is needed to better understand the role of Lp-PLA 2 in CHF.

Hyponatremia Is One of the Important Pognostic Factors in Acute Myocardial Infarction

Objectives: Hyponatremia has recently been recognized as one of the independent prognostic factors in congestive heart failure. The aim of this study was firstly to investigate the prognostic importance of hyponatremia in patients with acute myocardial infarction (AMI). and secondly to investigate contribution of arginine vasopressin (AVP) to hyponatremia in AMI. Methods: One hundred and forty consecutive patients with AMI who underwent revascularization by PCI within 24 hours from onset were divided into hyponatremic (HN) group and normonatremic group (NN) according to the serum sodium concentration at 72hrs after administration with cut-off level at 135mEq/l.

Homocysteine and Heart Failure: An Overview

An elevated plasma level of homocysteine (HCY) is associated with increased risk of thrombotic and atherosclerotic vascular disease. Several studies and recent patents have demonstrated that hyper-homocysteinemia (HHCY) is an independent risk factor for vascular disease. An elevated homocysteine level has been also reported to be a risk factor for the development of congestive heart failure (CHF) in individuals free of myocardial infarction. Animal studies showed that experimental HHCY induces systolic and diastolic dysfunction, as well as an increased BNP expression. Moreover, hyperhomocysteinemic animals exhibit an adverse cardiac remodeling characterized by accumulation of interstitial and perivascular collagen. The mechanisms leading from an elevated HCY level to reduced pump function and adverse cardiac remodeling are a matter of speculation. Existing data indicate that direct effects of HCY on the myocardium, as well as nitric oxide independent vascular effects, are involved. Preliminary data from small intervention trials have initiated the speculation that HCY lowering therapy by micronutrients may improve clinical as well as laboratory markers of CHF. In conclusion, HHCY might be a potential etiological factor in CHF. Future studies need to explore the exact pathomechanisms of HHCY in CHF. Moreover, larger intervention trials are needed to clarify whether modification of plasma HCY by B-vitamin supplementation improves the clinical outcome in CHF patients.

持久性運動習慣および月経周期が若年女性の頸動脈スティフネスに与える影響

Increased carotid arterial stiffness is associated with a risk factor of congestive heart failure. Thus factors that affect carotid arterial stiffness are of both physiological and clinical interest. The purpose of the present study was to examine the effects of regular aerobic exercise and menstrual cycle on carotid arterial stiffness in young female. The carotid β-stiffness index, an index of carotid arterial stiffness, was assessed in eight young female athletes (20.5 ± 0.4 years) and ten young female control subjects (21.3 ± 0.7 years). The carotid β-stiffness index was determined using ultrasound images of the common carotid artery with simultaneous recording of carotid arterial blood pressure by applanation tonometry. There was no difference in carotid β-stiffness index between the control and the athlete group both at the early follicular and the pre-ovulation phase of the menstrual cycle. On the other hand, the carotid β-stiffness index decreased from the early follicular phase to the pre-ovulation phase both in the control and the athlete group. These results suggest that carotid arterial stiffness in young females is not affected by regular aerobic exercise, but changes with the menstrual cycle, irrespective of exercise status.

The Role of Correction of Anemia in Patients With Congestive Heart Failure Associated with Chronic Kidney Failure

Patients with congestive heart failure (CHF) who are also anemic have more severe CHF and a higher mortality, morbidity, and hospitalization rate than those who are not anemic. However, it is not known if the anemia is actually contributing to the CHF or if it is merely comorbidity (ie a marker of increased inflammation or chronic kidney disease [CKD]). The only way to demonstrate that anemia is a causative factor is to correct it, independent of other CHF factors. In this paper we review the results of the published papers about correction of anemia in patients with CHF. Taken in sum, these reports show a quite consistent positive effect of erythropoietic stimulating agents (ESAs) along with oral or intravenous (IV) iron or even of IV alone on clinical indicators and clinical outcomes of patients with CHF. More work is needed to clarify the important relationship between anemia, CHF, and CKD.

Acute effects of biventricular pacing on right ventricular function assessed by tissue Doppler imaging

The benefits of cardiac resynchronization therapy (CRT) on functional status, left ventricular (LV) remodelling and survival in patients with drug-refractory congestive heart failure (CHF), LV systolic dysfunction, and wide QRS have been demonstrated in randomized trials. However, the impact of CRT on right ventricular (RV) function, an independent prognostic factor in CHF remains questionable. This study examined the acute effects of various pacing modes on RV function in recipients of CRT systems. Echocardiographic examinations were performed in 15 patients (median age: 67 years, range 49-78), to compare RV function during atrial (AAI), RV and LV pacing, and biventricular (BiV) pacing, in random order. At baseline, the median LV ejection fraction was 20% (range 10-35) and the median LV end-diastolic diameter was 78 mm (range 62-85). Right ventricular function was impaired, with a median 36% fractional shortening of RV surfaces (7-59). Tissue Doppler systolic peak of velocity (Sa) recorded at the tricuspid annulus increased significantly from 9.9 cm/s (range 4.7-16.5) during AAI pacing, 10 cm/s (range 5.4-20.3) during RV pacing, and 11.7 cm/s (range 4.6-16.7) during LV pacing to 12.6 cm/s (range 6.6-19.1) during BiV pacing (P < 0.01). Trends toward improvements in other indices of RV function, particularly myocardial performance index and systolic excursion of the tricuspid annulus, were also observed. This short-term study showed a significant improvement in RV systolic function during BiV pacing compared with AAI, RV, or LV pacing in CRT recipients.

Is age a risk factor of congestive heart failure (CHF) in patients receiving trastuzumab (H)? Results from two Belgian compassionate use programs in metastatic breast cancer (MBC) patients (pts)

838 Background: Age ≥60 years is considered among the possible risk factors of H related cardiac toxicity. Methods: Between 1/99 and 5/02 two compassionate use programs were run in Belgium to provide H to patients (pts) with HER2-overexpressing MBC. A total of 227 pts received at least one administration of weekly H, as single agent or in combination with chemotherapy, and were eligible for a retrospective analysis that aimed to evaluate the role of age as risk factor for H related CHF. Data on comorbidities (CO, i.e. hypertension, previous drugs-related cardiac toxicity, diabetes, hyperlipidemia), radiotherapy to left breast/chest wall, prior anthracyclines (A) cumulative dose, time interval from last A administration, cumulative dose and time on H were collected from medical files and analyzed as possible risk factors of CHF. Results: Pts median age was 53 years (range 22–82); 158 pts were < 60 years old and 69 were ≥60 years old (60+). In the latter group 25 pts were 70+. The two age groups differed in terms of presence of CO (higher in 60+) and administration of H, single agent vs combination regimens, (H alone > in 60+). None of the pts presented with an active CHF at the moment of the first H dose. CHF was reported in 8.9% (n=14), 7.2% (n=5) and 4% (n=1) of the patients aged <60, 60+, and 70+, respectively. The difference between the three age subgroups was not statistically significant. The presence of CO showed to be predictive of CHF, independently of the age cut-off (OR 9.22, 95% CI 3.4–24.97). Combining age with CO, i.e (a) age <60 and age 60+ and no CO vs (b) age 60+ and CO, (b) was associated to an odd ratio (OR)= 4.59 of CHF (95% CI 1.46–14.49, p=0.009). None of the other above-mentioned variables were found to be predictive of CHF. Conclusions: Preexisting morbidities rather than age were found to be associated to H related CHF. Fit elderly pts showed similar probability of developing CHF as younger pts and should not be denied this important treatment modality. Author Disclosure Employment or Leadership Consultant or Advisory Stock Ownership Honoraria Research Funding Expert Testimony Other Remuneration Hoffmann-La Roche Ltd. Hoffmann-La Roche Ltd. Hoffmann-La Roche Ltd.

Is age a risk factor of congestive heart failure (CHF) in patients receiving trastuzumab (H)? Results from two Belgian compassionate use programs in metastatic breast cancer (MBC) patients (pts)

838 Background: Age ≥60 years is considered among the possible risk factors of H related cardiac toxicity. Methods: Between 1/99 and 5/02 two compassionate use programs were run in Belgium to provide H to patients (pts) with HER2-overexpressing MBC. A total of 227 pts received at least one administration of weekly H, as single agent or in combination with chemotherapy, and were eligible for a retrospective analysis that aimed to evaluate the role of age as risk factor for H related CHF. Data on comorbidities (CO, i.e. hypertension, previous drugs-related cardiac toxicity, diabetes, hyperlipidemia), radiotherapy to left breast/chest wall, prior anthracyclines (A) cumulative dose, time interval from last A administration, cumulative dose and time on H were collected from medical files and analyzed as possible risk factors of CHF. Results: Pts median age was 53 years (range 22–82); 158 pts were < 60 years old and 69 were ≥60 years old (60+). In the latter group 25 pts were 70+. The two age groups differed in...

470 The influence of combined use of ripace and clopilet on inflammatory and coagulation factors in congestive heart failure

470 The influence of combined use of ripace and clopilet on inflammatory and coagulation factors in congestive heart failure

745 Noninvasively evaluated left ventricular pressure rise- prognostic factor in congestive heart failure

745 Noninvasively evaluated left ventricular pressure rise- prognostic factor in congestive heart failure

Review: no definite conclusions can be drawn as to the effect of psychological factors in congestive heart failure

Review: no definite conclusions can be drawn as to the effect of psychological factors in congestive heart failure

Chronic effects of an endothelin-converting enzyme inhibitor on cardiorenal and hormonal function in heart failure.

Endothelin (ET)-converting enzyme (ECE) is a rate-limiting step in ET-1 generation, and its expression and activity are increased significantly with the development of congestive heart failure (CHF). The selective enzymic inhibition of ET-1 formation thus seems to be a very important target in the prevention of CHF. We evaluated the chronic effects of a specific ECE inhibitor, FR901533 (0.3 mg x kg(-1) x h(-1), n=5) on cardiac, hormonal, and body fluid balance in dogs with CHF induced by rapid right ventricular pacing (270 beats/min, 22 days). Vehicle dogs were given placebo (n=5). Despite no significant difference in blood pressure, FR901533 decreased pulmonary capillary wedge pressure and increased cardiac output compared with the vehicle. FR901533 prevented the reduction of urine flow rate and urinary sodium excretion in association with an increase in the glomerular filtration rate and renal plasma flow compared with the vehicle. FR901533 also suppressed significantly the elevation of plasma atrial natriuretic peptide and aldosterone levels which is an established prognostic factor in CHF. These results indicate that the role of ECE in CHF is important and that chronic ECE inhibition could possess therapeutic potential in the treatment of CHF not only on haemodynamics but also in the prevention of fluid retention.

Norepinephrine induces action potential prolongation and early afterdepolarizations in ventricular myocytes isolated from human end-stage failing hearts.

Congestive heart failure is characterized by high levels of norepinephrine which is considered to be arrhythmogenic. It is unclear whether increased norepinephrine is only a marker of the severity of heart failure or whether it directly triggers ventricular arrhythmias. Ventricular myocytes were isolated from eight explanted hearts of patients with end-stage heart failure (ischaemic or dilated cardiomyopathy). With the whole-cell configuration of the patch-clamp technique the effect of 1 micromol x l(-1)norepinephrine on action potentials and membrane currents was studied. The cells had a membrane capacitance of 256 +/- 25 pF (n = 26) and action potential duration (APD90) during control conditions was 620 +/- 45 ms at 1 Hz (n = 14). Norepinephrine induced action potential prolongation in all cells and early afterdepolarizations in 50% of them. Norepinephrine significantly increased the calcium current but had no effect on the delayed rectifier current, the inward rectifier current or the transient outward current. Norepinephrine also significantly increased the steady-state calcium window-current measured between -40 and 0 mV. In contrast to many animal species, norepinephrine induces action potential prolongation in ventricular myocytes from human failing hearts, as well as early afterdepolarization, by an increase in both the calcium peak current and window current. Thus norepinephrine seems to be an important arrhythmogenic factor in congestive heart failure.

Novel neurohumoral factors in congestive heart failure: adrenomedullin.

Adrenomedullin is a 52-amino acid peptide that circulates in human plasma. The plasma concentrations of the peptide are increased in cardiovascular disease in proportion to the degree of hemodynamic impairment. Plasma adrenomedullin levels in heart failure, and in subjects with acute myocardial infarction, have been shown to convey independent prognostic information. Adrenomedullin has multiple biologic effects, but characteristically causes vasodilatation. The actions of adrenomedullin and the activation of this peptide in cardiovascular disease suggest it may have an important pathophysiologic role in heart failure. Manipulation of adrenomedullin or its receptor may have therapeutic potential.