Factor In Chronic Heart Failure Research Articles

Vitamin D deficiency and anemia is highly prevalent and dependent on the etiology of heart failure: A pilot study.

Anemia and vitamin D deficiency are common factors in chronic heart failure (CHF). The aim of this study was to assess vitamin D levels as well as its binding protein and anemia in relation to a cause of CHF: coronary heart disease, valvular disease and cardiomyopathy. One hundred and sixteen consecutive patients (36 females and 80 males) with CHF were admitted for percutaneous coronary interventions (PCI). Hemoglobin concentration, serum creatinine, B-type natriuretic peptide (BNP), 25-hydroxyvitamin D [25(OH)D] and its binding protein-VDBP were measured. The prevalence of anemia was 22%. BNP was the highest in the group with coronary artery disease. Ejection fraction was the lowest in cardiomyopathy group. 25(OH)D was lowest in valvular disease group, significantly lower than in the coronary artery group. A similar pattern of change showed vitamin D binding protein. The prevalence of vitamin D deficiency (level below 20 ng/mL) in the whole group was 95%, in 49% of the patients 25(OH)D was below 10 ng/mL. In univariate analysis 25(OH)D correlated with hemoglobin, red blood cell count, hematocrit, mean corpuscular volume and BNP in patients with CHF in the whole group. In multiple regression analysis, predictors of 25(OH)D were estimated, glomerular filtration rate, BNP and valvular disease. 25(OH)D deficiency is common in CHF patients. Valvular disease is associated the most severe vitamin D deficiency and worsened kidney function. A higher prevalence of anemia in CHF due to coronary heart disease may be associated with wider use of angiotensin converting enzyme inhibitors and acetylsalicylic acid. Heart and kidney function are predictors of 25(OH)D level in the patients of this study.

Effects of Exercise Training on Cardiac and Skeletal Muscle Functions in Patients with Chronic Heart Failure.

The primary symptom in patients with chronic heart failure (CHF) is exercise intolerance. Previous studies have reported that reduced exercise tolerance in CHF can be explained not only by cardiac output (a central factor) but also by reduced skeletal muscle aerobic capacity (a peripheral factor). Although exercise training in CHF improves exercise tolerance, few studies have evaluated the effects of exercise training on each specific central and peripheral factor in CHF. The aim of this study was to investigate the central and peripheral aerobic functions in CHF and the effects of exercise training in CHF on cardiac output and skeletal muscle deoxygenation during exercise. We assessed peak oxygen uptake (VO2) during cardiopulmonary exercise testing, peak cardiac output (CO) using noninvasive hemodynamic monitoring, and muscle oxygen saturation (SmO2) using near-infrared spectroscopy (NIRS). Patients with CHF were trained for 12weeks and performed ramp cycling exercise until exhaustion before and after the exercise training. Peak VO2, peak CO, and SmO2 changes from rest to peak exercise (ΔSmO2) were significantly lower in CHF than those in healthy subjects. As a result of exercise training, peak oxygen uptake in patients with CHF was improved and positively associated with change in ΔSmO2. In contrast, there was no change in peak cardiac output. The results of this study indicate that both cardiac and skeletal muscle functions in patients with CHF were lower than those in healthy subjects. Further, the results suggest that the improvement of exercise capacity in patients with CHF by exercise training was related to the improved utilization of oxygen (a peripheral factor) in skeletal muscle.

Qi Dan Li Xin pill improves chronic heart failure by regulating mTOR/p70S6k-mediated autophagy and inhibiting apoptosis

Myocardial remodeling represents a key factor in chronic heart failure (CHF) development, and is characterized by chronic death of cardiomyocytes. Cardiac function changes may be attributed to inflammation, apoptosis and autophagy. This study assessed the effects of Qi Dan Li Xin Pill (QD) on heart function, inflammatory factors, autophagy and apoptosis in cardiac remodeling in CHF rats upon myocardial infarction (MI) induction. Male SD rats underwent a sham procedure or left anterior descending coronary artery (LADCA) ligation, causing MI. Twenty-eight days after modeling, the animals were treated daily with QD, valsartan and saline for 4 weeks. Echocardiography after 4 weeks of drug intervention revealed substantially improved left ventricular remodeling and cardiac function following QD treatment. As demonstrated by decreased IL-1β, IL-6 and TNF-α amounts, this treatment also inhibited the apoptotic process and protected the viability of the myocardium. These outcomes may be attributed to enhanced autophagy in cardiomyocytes, which further reduced pro-inflammatory and pro apoptotic effects. This process may be achieved by QD regulation of the mTOR/P70S6K signaling pathway, suggesting that the traditional Chinese medicine Qi Dan Li Xin pill is effective in heart protective treatment, and is worth further investigation.

Optimization of Heart Failure Treatment by Heart Rate Reduction.

Heart failure (HF) treatment should be optimized in addition to guideline-directed and recommended drugs to achieve an appropriate heart rate (i.e. 50−60 bpm) by ivabradine in patients with a heart rate >70 bpm in sinus rhythm and with an ejection fraction ≤35%. Heart rate reduction was to reduce cardiovascular death and HF hospitalization dependent on baseline resting heart rate. In particular in patients at a heart rate >75 bpm, a reduction in cardiovascular death, all-cause death, HF death, HF hospitalization and all-cause hospitalization has been observed. The optimal heart rate achieved appears to be between 50−60 bpm, if well tolerated as in these patients the lowest event rate is observed on treatment. Heart rate reduction is, therefore, a treatable risk factor in chronic HF. Observational studies support the concept that it is a risk indicator in other cardiovascular and non-cardiovascular conditions. Whether heart rate reduction is also modifying risk in other conditions than chronic HF should be explored in prospective clinical trials.

Clinicopathological manifestations of myocarditis in a heart failure population.

Myocarditis continues to present challenges in diagnosis and management. The goal of this study is to determine the occurrence and manifestations of myocarditis in a heart failure (HF) population. The analyzed patients had acute or persistent HF and were referred over a 6-year period to a quaternary HF center for advanced HF therapies including mechanical circulatory support, left ventricular assist device (LVAD) implantation, and/or heart transplantation. The histopathological diagnosis of myocarditis was made based on the presence of an inflammatory infiltrate of the myocardium, typically with associated cardiomyocyte (CMC) damage, combined as indicated with immunohistochemical and molecular biology characterization. The pathological findings were correlated with a panel of clinical parameters and clinical course of the patients. Myocarditis was identified in 36 patients, with initial diagnoses made in 10 (40%) of 25 by endomyocardial biopsy (EMB), 1 by atrial biopsy (maze procedure), 7 (2.1%) of 331at LVAD implantation, and 18 (7.8%) of 229 in the explanted heart. There were 20 cases of lymphocytic myocarditis, 4 cases of giant cell myocarditis, 3 cases of eosinophilic myocarditis, and 9 cases of lymphohistocytic with granulomas myocarditis - cardiac sarcoidosis. EMB was performed in 25 patients and was positive in 10 (40%) of cases. Myocarditis was found in 23 explanted hearts including 18 cases de novo and 5 cases with a previously positive specimen. Of the 23 explanted hearts, 21 were nonischemic cardiomyopathy and 2 were ischemic cardiomyopathy. Our findings show that, in patients presenting to a quaternary medical center, myocarditis can be manifest as acute HF as well as a complicating factor in chronic HF.

Skeletal muscle wasting in chronic heart failure.

Patients suffering from chronic heart failure (CHF) show an increased prevalence (~20% in elderly CHF patients) of loss of muscle mass and muscle function (i.e. sarcopenia) compared with healthy elderly people. Sarcopenia, which can also occur in obese patients, is considered a strong predictor of frailty, disability, and mortality in older persons and is present in 5–13% of elderly persons aged 60–70 years and up to 50% of all octogenarians. In a CHF study, sarcopenia was associated with lower strength, reduced peak oxygen consumption (peak VO2, 1173 ± 433 vs. 1622 ± 456 mL/min), and lower exercise time (7.7 ± 3.8 vs. 10.22 ± 3.0 min, both P < 0.001). Unfortunately, there are only very limited therapy options. Currently, the main intervention remains resistance exercise. Specialized nutritional support may aid the effects of resistance training. Testosterone has significant positive effects on muscle mass and function, and low endogenous testosterone has been described as an independent risk factor in CHF in a study with 618 men (hazard ratio 0.929, P = 0.042). However, the use of testosterone is controversial because of possible side effects. Selective androgen receptor modulators have been developed to overcome these side effects but are not yet available on the market. Further investigational drugs include growth hormone, insulin‐like growth factor 1, and several compounds that target the myostatin pathway. The continuing development of new treatment strategies and compounds for sarcopenia, muscle wasting regardless of CHF, and cardiac cachexia makes this a stimulating research area.

Effects of Weight Loss in Outpatients With Mild Chronic Heart Failure: Findings From the J-MELODIC Study

Weight loss is a strong prognostic factor in chronic heart failure (CHF); however, little is known about its effects in patients with mild CHF. Therefore, we investigated the effects of weight loss in patients with mild CHF. We analyzed a total of 242 outpatients with mild CHF from the J-MELODIC study cohort. Weight loss was defined as ≥5% weight loss in 1 year. Twenty-seven patients (11.2%) lost ≥5% weight in 1 year. Weight loss was associated with higher rates of underweight and worsening renal function in 1 year compared with the absence of ≥5% weight loss. The predictors of weight loss included edema, B-type natriuretic peptide, and diabetes mellitus at baseline. Although weight loss was significantly associated with subsequent cardiovascular death or hospitalization for HF (log-rank P = .002) and subsequent death from any cause (log-rank P = .002), underweight was not associated with these outcomes (log-rank P = .356 and P = .168, respectively). Even after adjusting for covariates, weight loss was a significant and independent risk factor for subsequent cardiovascular death or hospitalization for HF (hazard ratio 3.22, 95% confidence interval 1.10-8.41; P = .034). In patients with mild CHF, ≥5% weight loss was a significant predictor for subsequent cardiovascular death or hospitalization for HF.

Prognostic factors in chronic heart failure in Niger

The aim of our work was to investigate the prognostic factors in chronic heart failure at the cardiology center of the National Hospital of Niamey This is a prospective, cross-sectional study including patients with chronic heart failure or acute flare-ups with altered LVEF during the period of December 21, 2015 to May 21, 2016. We study the following parameters: anthropological, clinical, electrical, echogardiographic, biological, therapeutic and outlook. The primary outcome measure was survival after hospitalization. Eighty-four patients were retained. The mean age was 51.39 ± 18.38 years with extremes of 18 and 85 years. The sex ratio was 1.4 in favor of women. Hypertensive heart disease is the most frequent etiology (42.9%) followed by ischemic heart disease (13.1%). The mortality rate at the end of the study was 39.28%. Prognostic factors were found: advanced age (≥ 55 years) and male sex were predictive of death and rehospitalization. Acute onset, tachycardia, low systolic blood pressure, arrhythmia and crackling rattle influenced mortality. The ischemic etiology has a worse prognosis than other causes. At the ECG, left branch block and ventricular extrasystole had an effect on mortality while rehospitalizations were inflamed by left branch block and lengthening the duration of the QRS complex. Cavity dilatation and LVEF < 30% influenced mortality and rehospitalization. For biological parameters, mortality was influenced by hyponatremia, hyperkalaemia and anemia; rehospitalization with hyponatremia, hypokalaemia, anemia and hyperleukocytosis. The research of prognostic factors is paramount in the management of patients with chronic heart failure.

Self-care ability and influencing factors in chronic heart failure patients

Objectives: To describe the self-care abilities and associated factors in chronic heart failure (CHF) patients. Methods: Participant characteristics, illness-related information, and self-care ability were investigated using self-report questionnaires and patient records for 91 CHF patients in Nantong University Affiliated Hospital, China. Results: On average, patients had medium- to low-level self-care abilities. Comprehensive self-care ability was positively influenced by higher education level, employment status, and income level. Patients who received health education and had sound heart function had better self-care abilities. Regression analysis showed that the factors influencing self-care ability included average monthly income, education level, and heart function grading. Conclusions: Self-care ability in CHF patients is, in general, in medium to low ranges, indicating that medical workers need to enhance self-care education for CHF patients to help them better understand their condition and help them gain the necessary skills for self-care. We conclude that, when conducting self-care education for patients, medical workers should tailor their approach based on the individual characteristics of the patient. Doing so would effectively promote patient knowledge, mobility, and treatment compliance.

Annual prognostic factors in chronic heart failure in patients over 80 years old.

In the elderly the most common cause of hospitalisation and the leading cause of death is heart failure (HF). The purpose was to determine prognostic factors in chronic HF (CHF) in octogenarians and nonagenarians. The analysis included 197 consecutive patients over 80 years old (mean age 83.63 ± 3.01 years; 46.19% men) hospitalised in 2010-2013 due to CHF. Sixty-two parameters were investigated, such as: age, gender, New York Heart Asso-ciation functional class, body mass index, blood pressure, other comorbidities, the parameters of the 12-lead resting electro-cardiography and the echocardiography, the results of basic laboratory tests, and selected biomarkers, including N-terminal pro-B-type natriuretic peptide, high-sensitive troponin T (hs-TnT), and high-sensitive C-reactive protein. Participants remained in a prospective follow-up for 12 months. We defined the primary endpoint as death due to cardiovascular causes and the composite endpoint, which consisted of: death due to cardiovascular causes and/or hospitalisation for exacerbation of CHF. Follow-up concerning the deaths was performed in 189 patients, composite endpoint in 168 and hospitalisation in 166. The uni- and multivariate logistic regression stepwise analysis was performed for the entire population, according to left ventricular ejection fraction (LVEF < 45% and ≥ 45%) and in the group with glomerular filtration rate (GFR) < 60 mL/min. Patients who died constituted 11.1% of the study population (21/189). In multivariate analysis four variables were independently associated with the primary endpoint: GFR (OR = 0.92), hypertension (OR = 0.19), lung diseases (OR = 9.36), and vascular diseases (OR = 6.07). In turn, in the group of patients who reached the composite endpoint (55/168; 32.7%), the only statistically significant independent variable was anaemia (OR = 4.71). In the subpopulation of patients with LVEF < 45% the prognostics for each endpoint were vascular diseases and lung diseases, and they increased the risk from 10- to 24-fold. In the subgroup of patients with LVEF ≥ 45% the independent variable associated with the composite endpoint was haemoglobin (OR = 0.61), in turn for death the prognostics were: white blood cell count, hs-TnT, and vascular diseases (respectively OR = 1.30; OR = 1.04; OR = 3.96). In the population with GFR < 60 mL/min variables with prognostic importance for the composite endpoint were red blood cell parameters: red blood cell distribution width (OR = 1.42) and anaemia (OR = 3.79), while for occurrence of death they were the same as for the entire population - vascular (OR = 5.16) and lung diseases (OR = 4.72). In patients over 80 years old with CHF, comorbidities are of important prognostic value for annual prognosis. The most aggravating factor in studied subgroups was lung disease.

Variations on a Precision Medicine Theme: One Size Fits Some.

Precision medicine, or personalized medicine, refers to the tailoring of therapy to the individual characteristics of patients. It can be applicable to patients with advanced disease and to preventative interventions as well. The impetus for this approach came from sequencing of the human genome and the anticipation that an individual’s sequence would inform treatment, aided perhaps by Big Data algorithms. In heart failure, advances in omics have occurred alongside other disciplines but from a practical standpoint, our ability to provide precision medicine remains more or less in the neutral position. In this article, we maintain that despite significant limitations on our ability to use genotyping or Big Data to impact real-world heart failure care in real time, we are in fact practicing a significant degree of precision medicine and can continue to do more of the same with relatively modest changes in approach to practice. The advent of angiotensin-converting enzyme inhibitors and β-blockers impacted heart failure therapeutics1,2 in a truly revolutionary way. They are recommended across all New York Heart Association classes for the management of patients with heart failure with reduced ejection fraction (EF).3 Although β-blockers have not been critically examined in patients with class I symptoms, we accept the notion that for these 2 classes of drugs, one size truly does fit all. We argue about dose, not whether we should use the drugs.4,5 We can also debate the duration of treatment in patients who have normalized their EF and the likelihood of recurrence of heart failure if those medications are stopped. Fundamentally, the importance of blockade of the renin–angiotensin system and adrenergic stimulation are fully accepted concepts that apply in young and old, symptomatic and asymptomatic, borderline low and very low EF, left ventricular failure and biventricular failure, in the …

28 Heart Rate is not Related to Survival in Patients with Heart Failure and Atrial Fibrillation

<h3>Introduction</h3> Atrial fibrillation (AF) is common in patients with chronic heart failure (CHF), and is associated with significant morbidity and mortality. Although there is robust evidence that heart rate is a risk factor in CHF and that reducing elevated heart rates improves survival in patients who are in sinus rhythm, the importance of strict heart rate control in AF is still not clear. This study sought to investigate the influence of resting ventricular rate on survival in CHF, comparing those who are in sinus rhythm to those in AF. <h3>Methods</h3> A total of 1415 CHF patients (mean age 76+-11 years, 36% females, 65% IHD, 41% NYHA II, 44% NYHA III, 14% NYHA IV), of whom 62% (n = 875) were in sinus rhythm and 38% (n = 540) in permanent AF were evaluated from the BIOSTAT-CHF Scotland study. Patients from both in-patient and out-patient settings were included. We analysed the heart rate and rhythm data recorded on a 12 lead ECG at the baseline review. Multivariate Cox proportional hazards models and Kaplan-Meier curves were used to assess the influence of heart rate on survival in CHF patients with AF or sinus rhythm. <h3>Results</h3> During a median per-person follow-up of 1.5 yrs (QIR 0.7–2.2), there were 330 (23%) all-cause deaths. Although Kaplan-Meier survival curves displayed significant differences between the AF and sinus rhythm groups (log-rank test p = 0.014), multivariate Cox survival models showed no significant difference between the 2 groups (hazard ratio [HR]: 0.98, 95% CI: 0.75–1.29; p = 0.9). When assessing the influence of heart rate, multivariate Cox models showed that higher heart rates (per 10 beats/min increments) were associated with worse survival in patients in sinus rhythm (HR: 1.14, 95% CI: 1.03–1.25; p = 0.008), but not for those in AF (HR: 0.98, 95% CI: 0.91–1.07, p = 0.7), for both preserved and reduced ejection fraction heart failure. When separated into two categories (heart rate &lt;80bpm vs. ≥80 bpm), those in sinus rhythm with a heart rate ≥80 bpm had a significantly worse survival than those with a heart rate &lt;80 bpm (HR: 1.57, 95% CI: 1.10–2.23, p = 0.012). <h3>Conclusion</h3> Although higher heart rate was associated with worse survival for CHF patients in sinus rhythm, it does not appear to be associated with survival in those who are in AF. These findings question the value of strict heart rate control in CHF patients with atrial fibrillation, thus necessitating further research in this area.

Serum cholinesterase is an important prognostic factor in chronic heart failure

We determine the importance of indicators of nutrition including lymphocyte, total protein, albumin, cholinesterase and body mass index, and compare the prognostic significance in chronic heart failure (CHF). We examined consecutive 465 CHF patients (376 males, age 62 ± 14 years) who underwent cardiopulmonary exercise testing, echocardiography and blood examination including indicators of nutrition at the same time in our hospital. The patients were followed up [median period 766 days (interquartile range 500-1060)] to register cardiac deaths and rehospitalization due to worsening heart failure. There were 180 cardiac events during the follow-up periods. Patients with cardiac events had lower cholinesterase level than those without events (P < 0.001). On the receiver operating characteristic analysis, the best cut-off value for cholinesterase was 240 U/l (area under the curve 0.720). In the Kaplan-Meier analysis, patients with cholinesterase <240 U/l had significantly higher cardiac event rates than those with cholinesterase >240 U/l. Multivariable Cox proportional hazards model demonstrated that NYHA class III [hazard ratio (HR): 1.688, 95 % confidence interval (CI) 1.062-2.684, P = 0.027], eGFR (HR: 0.983, 95 % CI 0.971-0.995, P = 0.006), sodium concentration (HR: 0.947, 95 % CI 0.897-0.999, P < 0.046), log BNP (HR: 1.880, 95 % CI 1.509-2.341, P < 0.001), cholinesterase (HR: 0.996, 95 % CI 0.993-0.998, P = 0.002) and exertional periodic breathing (HR: 1.619, 95 % CI 1.098-2.388, P = 0.015) were independent factors to predict adverse clinical outcomes. Serum cholinesterase level was an important prognostic factor in CHF.

The Prognositic Significance of Serial Renal Function Measurements in Chronic Heart Failure

Background: Impaired renal function is a strong prognostic factor in Chronic Heart Failure (CHF). Most studies of it, however, have assessed single measurements of renal function. Thus, the purpose of the present study was to determine the prognostic significance and importance of serial measurements of renal function before and after hospital discharge. Methods and results: A total of 542 consecutive patients admitted for worsening CHF (455 males, 60.6 ± 14.2 years) were studied. Estimated glomerular filtration rate (eGFR) was evaluated before discharge and 6 months later. Patients were followed-up to register cardiac death and rehospitalization due to worsening heart failure. We divided study subjects into four groups based on changes in renal function between before discharge and 6 months after. These were Group 1: normal to normal eGFR (≥60 mL/min/17.3m2), Group 2: reduced (<60 mL/min/17.3m2) to normal eGFR, Group 3: normal to reduced eGFR, and Group 4: reduced to reduced eGFR. Compared to Group 1, Groups 2, 3 and 4 had relative risks of 2.265-fold (P<0.05), 4.055-fold (P<0.001) and 3.974-fold (P<0.001), respectively, for adverse cardiac events after discharge. The multivariate Cox proportional hazard regression analysis demonstrated that log BNP at 6 months after discharge (hazard ratio [HR]: 1.768, P<0.001), peak VO2 (HR: 0.859, P<0.001) and eGFR <60 mL/min/1.73m2 at 6 months (HR: 1.854, P<0.05), but not eGFR at discharge, were independent predictors for cardiac events. Conclusion: Changes in renal function by serial measurements after discharge are important for the assessment of risk in CHF.

Diabetes mellitus is associated with adverse prognosis in chronic heart failure of ischaemic and non-ischaemic aetiology.

It is unclear whether diabetes mellitus (DM) is an adverse prognostic factor in chronic heart failure (CHF) of ischaemic and non-ischaemic aetiology managed with contemporary evidence-based care. In total, 1091 outpatients with CHF with reduced ejection fraction were prospectively observed for a mean of 960 days. Total and cardiovascular mortality was quantified after accounting for potential confounders. In total, 25.7% of patients had DM; this group was more likely to have CHF of ischaemic aetiology and was more symptomatic. Patients with DM received comparable medical- and device-based therapies, except for greater doses of loop diuretic. DM was associated with approximately doubled crude and adjusted risk of total and cardiovascular mortality. The association of diabetes with these outcomes in patients with ischaemic and non-ischaemic cardiomyopathies was of similar magnitude. In spite of advances in the management of CHF, DM remains a major adverse prognostic feature, irrespective of ischaemic/non-ischaemic aetiology.

Combined use of high-sensitivity cardiac troponin T and N-terminal pro-B type natriuretic peptide improves measurements of performance over established mortality risk factors in chronic heart failure

Heart failure still maintains a high mortality. Biomarkers reflecting different pathophysiological pathways are under evaluation to better stratify the mortality risk. The objective was to assess high-sensitivity cardiac troponin T (hs-cTnT) in combination with N-terminal pro-B type natriuretic peptide (NT-proBNP) for risk stratification in a real-life cohort of ambulatory heart failure patients. We analyzed 876 consecutive patients (median age 70.3 years, median left ventricular ejection fraction 34%) treated at a heart failure unit. A combination of biomarkers reflecting myocyte injury (hs-cTnT) and myocardial stretch (NT-proBNP) was used in addition to an assessment based on established mortality risk factors (age, sex, left ventricular ejection fraction, New York Heart Association functional class, diabetes, estimated glomerular filtration rate, ischemic etiology, sodium, hemoglobin, β-blocker treatment, and angiotensin converting enzyme inhibitor or angiotensin II receptor blocker treatment). During a median follow-up of 41.4 months, 311 patients died. In the multivariable Cox proportional hazards model, hs-cTnT and NT-proBNP were independent prognosticators (P = .003 each). The combined elevation of both biomarkers above cut-off values significantly increased the risk of death (HR 7.42 [95% CI, 5.23-10.54], P < .001). When hs-cTnT and NT-proBNP were individually included in a model with established mortality risk factors, measurements of performance significantly improved. Results obtained for hs-cTnT compared with NT-proBNP were superior according to comprehensive discrimination, calibration, and reclassification analysis (net reclassification indices of 7.7% and 1.5%, respectively). hs-cTnT provides significant prognostic information in a real-life cohort of patients with chronic heart failure. Simultaneous addition of hs-cTnT and NT-proBNP into a model that includes established risk factors improves mortality risk stratification.

Differential approach in selecting beta-adrenoblocker therapy for patients with chronic heart failure and anaemia

Currently, beta-adrenoblockers (β-AB) are regarded as one of the major medication classes in the treatment of patients with chronic heart failure (CHF). In several international studies, β -AB therapy of CHF patients was associated with reduced levels of haemoglobin (Hb) and development of new anaemia cases. Anaemia is known as an adverse prognostic factor in CHF. Aim. To study the effects of β -AB therapy on the anaemia clinical course among CHF patients. Material and methods. The study included 90 ambulatory patients with Functional Class (FC) II-IV CHF and anaemia. The participants were divided into 3 equally sized groups (n=30 per group) and treated with carvedilol, metoprolol, or nebivolol for 6 months. Results. By the end of the follow-up, baseline Hb levels increased in the nebivolol group (p=0,028), and were also significantly higher than in the other two groups. In the carvedilol group, the levels of haematocrit (Ht) and glomerular filtration rate (GFR) significantly decreased (p=0,017 and 0,06, respectively). In the metoprolol group, no substantial changes of laboratory parameters were observed. The maximal reduction in baseline CHF FC was registered in the patients receiving nebivolol (p=0,037). A significant improvement in myocardial contractility, based on the echocardiography data, was registered in the carvedilol and nebivolol groups. Conclusion. Nebivolol therapy was associated with a significantly more pronounced reduction in pro-BNP levels, compared to carvedilol or metoprolol treatment (p&lt;0,001). The nebivolol group also demonstrated the most pronounced improvement in quality of life of CHF patients (p&lt;0,001). These findings suggest that nebivolol could be recommended as a medication of choice in patients with CHF and anaemia.

Significance of Resting Heart Rate in Chronic Heart Failure: Data from Cardiac Insufficiency of Various Origin in Jeonbuk (CION-J) Registry

❙ABSTRACT❙ Background: Chronic heart failure (HF) is a leading cause of morbidity and mortality in industrialized countries. Raised resting heart rate (HR) is a marker of cardiovascular risk in general population, as well as in patients with hypertension and coronary artery disease. We studied the association between HR and cardiovascular events in patients with Cardiac Insufficiency of Various Origin in Jeonbuk (CION-J) registry. Methods: CION-J registry was a multicenter, prospective database for chronic HF. From January 2010 to December 2010, 356 HF patients who clinically stabilized at least 2 weeks were analyzed. According to resting HR, the patients divided into the tertile (lower tertile 80/min, n = 113). Clinical outcomes during 6-month period were compared by resting HR. Results: Patients with upper tertile revealed higher New York Heart Association (NYHA) class than in those with lower tertile. From the lower to the upper tertile, the incidence of composite events of death, non-fatal myocardial infarction, ischemic stroke, and hospitalization for HF were increased(3.1%, 4.4%, 16.8%, respectively; p 80/min, and ejection fraction 80/min) is a prognostic factor in chronic HF. Optimal treatment to reduce HR should be emphasized to improve prognosis of HF. (J Korean Soc Hypertens 2012;18(1):38-45)

Abstract 9207: Distinct Prognostic Factors in Patients with Chronic Heart Failure and Chronic Kidney Disease

Background: In chronic heart failure (CHF), impaired renal function is a strong predictor of mortality. However, the impact of chronic kidney disease (CKD) on prognostic factors in CHF has not been rigorously examined. Purpose: The purpose of this study was to compare prognostic factors between CHF patients with and without CKD. Methods: Consecutive 505 patients with CHF (226 males, age 60±14 years) who performed cardiopulmonary exercise testing before discharge were enrolled. Patients were divided into two groups: CKD group (estimated GFR&lt;60 mL/min/1.73m 2 , n=213) and non-CKD group (estimated GFR&gt;60 mL/min/1.73m 2 , n=292). Patients were followed up to register cardiac events including cardiac deaths and re-hospitalization due to worsening heart failure. Results: Patients with CKD had lower hemoglobin concentration, higher uric acid concentration, higher plasma brain natriuretic peptide levels, lower left ventricular ejection fraction, larger left atrium volumes, higher E/E’ rario, lower peak heart rate, lower peak VO 2 , and higher VE/VCO 2 slope than those without CKD (P&lt;0.01, for each). There were 115 events during follow-up period (746±238days), and cardiac event rate was higher in CKD group than in non-CKD group (34% vs. 14%, P&lt;0.001). In non-CKD group, multivariate Cox hazard analysis demonstrated that body mass index (hazard ratio (HR): 0.532, 95% confidence interval (CI): 0.322-0.879, P&lt;0.001), log BNP (HR: 3.300, CI: 1.634-6.661, P&lt;0.001), left atrial dimension (HR: 1.318, CI: 1.105-1.573, P&lt;0.05) and peak VO 2 (HR: 0.743, CI: 0.557-0.956, P&lt;0.05) were independent parameters to predict cardiac events after discharge. In contrast, serum concentration of sodium (HR: 0.876, CI: 0.767-0.999, P&lt;0.05), uric acid (HR: 1.345, CI: 1.062-1.705, P&lt;0.05), log BNP (HR 2.364, CI: 1.404-3.980, P&lt;0.001) and peak VO 2 (HR: 0.742, CI: 0.631-0.874, P&lt;0.001) were independent prognostic factors in CKD group. Conclusions: Prognostic factors were different between CHF patients with and without CKD, and this should be considered to manage CHF patients with CKD.

Distinct Prognostic Factors in Patients with Chronic Heart Failure and Chronic Kidney Disease

Background: In chronic heart failure (CHF), impaired renal function is a strong predictor of mortality. However, the impact of CKD on prognostic factors in CHF has not been rigorously examined. The purpose of this study was to compare prognostic factors between CHF patients with and without CKD. Methods: Consecutive 505 patients with CHF (226 males, age 60±14 years) who performed, cardiopulmonary exercise testing before discharge were enrolled. Patients were divided into two groups: CKD group (GFR<60 mL/min/1.73m2, n=213) and non-CKD group (GFR≥60 mL/min/1.73m2, n=292).