non-HF Group Research Articles

Impact of heart failure on outcome after percutaneous coronary intervention: is it the patient or the intervention?

Impact of heart failure on outcome after percutaneous coronary intervention: is it the patient or the intervention?

The first documented cardiac arrest rhythm in hospitalized patients with heart failure

Background Patients with heart failure (HF) have abnormal cellular anatomy and myocardial mechanics that may impact the initial rhythm and subsequent outcomes in cardiac arrest (CA). Hypothesis Patients with pre-existing HF are less likely to have ventricular fibrillation/pulseless ventricular tachycardia (VF/pVT) as the first documented rhythm in CA and have poorer survival than patients without pre-existing HF. Purpose Identify the first documented cardiac arrest rhythm (FDR) in hospitalized patients with and without a pre-existing history of HF. Methods We evaluated 60,389 consecutive, adult, index, pulseless CA events with documented initial rhythm in the National Registry of Cardiopulmonary Resuscitation. The primary endpoint was the FDR in patients with and without a history of pre-existing HF. Secondary endpoints were return of spontaneous circulation (ROSC), survival to discharge, and neurological outcome. Results Thirty three percent of patients had a pre-existing diagnosis of HF. HF patients were more likely to have VF/pVT (25.9 vs. 23.2%) and less likely to have asystole (34.4 vs. 35.3%, p = <.0001) than non-HF. There was no difference in survival to discharge (18.3 vs. 18.2%, p = .66), or good neurological outcomes (82.2 vs. 83.2%, p = .23) between the groups. Women were less likely to have VF/pVT as the first documented rhythm in both HF and non-HF groups. Conclusions Hospitalized patients with HF are more likely than those without HF to have VF/pVT as the FDR in CA, however the clinical magnitude of this difference is small. Overall survival and neurological outcomes are no different than hospitalized arrest patients without HF.

Coherent Averaging Improves the Evaluation of Left Ventricular Dyssynchrony by Conductance Catheter

Coherent averaging is a technique to recover the response to repetitively applied stimuli when that response is embedded in random noise. We derived novel indices for left ventricular dyssynchrony estimation from volume-catheter signals using coherent averaging procedure: mechanical dyssynchrony (DYSCoh) internal flow fraction (IFFCoh) and mechanical dispersion (DISPCoh). The percentage power of non-repetitive components in the volume signals (ResTotAvg) was also estimated. The aims of the study were to evaluate the indices, characterizing repetitive and non-recurrent components of the conductance-volume signals, and to assess the ability of these indices to detect the changes in dyssynchrony induced by biventricular pacing (BIV). We compared the results obtained in 20 heart failure patients indicated to BIV (HF Group) during spontaneous conduction with the results from 12 patients with preserved ventricular function (non-HF Group), and with those obtained during BIV. DISPCoh and ResTotAvg were significantly different in HF compared to non-HF group, and identified HF patients with high accuracy (area under curve at ROC analysis > 0.8). These indices also demonstrated significant differences after BIV (p = 0.047 and p = 0.037 respectively) and their baseline values correlated with the acute increase of stroke volume (r = 0.64 and r = 0.78, both with p < 0.005). Coherent averaging-based indices permit independent quantification and differentiation of repetitive components of ventricular dyssynchrony from non-recurrent mechanical non-uniformities, which seem associated with HF and conduction disturbances. These indices identified HF patients with high accuracy, and were able to describe the reversal of dyssynchrony caused by BIV and to predict the acute hemodynamic improvement.

Value of BNP and tumour marker CA125 in patients with heart failure

Objective — The objective was to study the association between B-type natriuretic peptide (BNP) and tumour markers and heart failure (HF) to evaluate the value of BNP and carbohydrate antigen 125 (CA125) in HF patients.Design and setting — A university hospital-based cross-over study of 285 subjects (157 men and 128 women) in HF, chronic obstructive pulmonary disease (COPD), mild-mid pulmonary hypertension patients and control subjects.Results — CA125 and BNP were significantly higher in the HF group than in the non-HF group and in severe HF than in mild HF (P< 0.01). No changes were observed in other tumour markers. CA125 and BNP decreased obviously after clinical improvement by aggressive treatment (P< 0.01). Left ventricular ejection fraction correlated positively with CA125 (r= 0.789, P < 0.01) and BNP (r= 0.730, P< 0.01) in left heart failure patients, but not in other patients. BNP and CA125 had better accuracy and positive predictive value in diagnosing HF from the characteristic receiver-operator curve.Conclusions — CA125 and BNP are markedly elevated in heart failure and closely reflect heart function. They are better markers in evaluating the efficiency of short-term therapy. Detecting BNP combined with CA125 may be more valuable than only detecting BNP or CA125 for diagnosing HF and evaluating the efficiency of treatment.

Optimal Noninvasive Assessment of Diastolic Heart Failure in Patients with Atrial Fibrillation: Comparison of Tissue Doppler Echocardiography, Left Atrium Size, and Brain Natriuretic Peptide

The aim of this study was to evaluate whether the ratio of early diastolic transmitral velocity to early diastolic mitral annular velocity (E/E') can be applied to identify diastolic heart failure (HF) noninvasively rather than using brain natriuretic peptide (BNP) or enlargement of left atrium (LA) in patients with atrial fibrillation (AF) by comparing the severity of HF symptoms. Moreover, we investigated the relationship between the changes in E/E' and the severity of HF or LA remodeling in the follow-up period. We examined 73 patients with nonvalvular AF disease and preserved left ventricular ejection fraction (>50%), ie, patients with diastolic HF accompanied with New York Heart Association (NYHA) functional class I to IV (n = 32, HF group) and those without HF (n = 41, non-HF group). No patients showed dyspnea caused by anemia, renal failure, lung disease, or other disease states except HF. We evaluated E, E', and E/E' by Doppler echocardiography, and the LA area (LAA) by 2-dimensional echocardiography. BNP levels were also examined. A follow-up study was performed in 18 of the 32 patients with HF. E/E', LAA, and BNP were higher in the HF group than in the non-HF group (E/E', 15 +/- 5 vs 9 +/- 2; LAA, 24 +/- 6 vs 20 +/- 6 cm(2); and BNP, 321 +/- 200 vs 140 +/- 76 pg/mL, each P < .01). Using the receiver operating characteristic curve for identification of symptomatic diastolic HF with NYHA functional class II to IV, the areas under the curves were: E/E', 0.96 (95% confidence interval 0.91-1.0); LAA, 0.77 (95% confidence interval 0.64-0.89); and BNP, 0.85 (95% confidence interval 0.75-0.95). In the HF group, 18 patients who were re-examined 17 +/- 9 weeks after were divided into two groups, depending on the improvement in NYHA functional class, ie, improved group (n = 10) and unchanged group (n = 8). In the follow-up period, E (112 +/- 20-94 +/- 21 cm/s), E/E' (17.1 +/- 5-13.1 +/- 3), and LAA (28 +/- 5-24 +/- 4) decreased in the improved group (each P < .05), but E' and BNP did not. E/E' could be useful in identifying symptomatic diastolic HF and evaluating the functional state in the process of HF in patients with AF. Moreover, E/E' is able to assess the improvement of diastolic HF in AF.

A Novel Activator of C-C Chemokine, FROUNT, is Expressed With C-C Chemokine Receptor 2 and its Ligand in Failing Human Heart

A novel activator of C-C chemokines, FROUNT, directly binds C-C chemokine receptor (CCR) 2 and plays a central role in the chemokine system. Activation of the chemokine system appears to be involved in the pathogenesis of congestive heart failure (CHF). The purpose of this study was to determine whether FROUNT is expressed with CCR2 and its ligand (CCL2) in failing human heart. We examined endomyocardial biopsy tissues obtained from 71 patients with CHF (HF group) and 20 subjects without CHF (non-HF group). FROUNT, CCR2, and CCL2 mRNA levels were higher in the HF group than in the non-HF group (P < .001). FROUNT mRNA levels were positively correlated with CCR2 and CCL2 mRNA levels in the HF group. FROUNT and CCL2 signal was seen in the cytoplasm of cardiac myocytes in failing hearts. Levels of FROUNT mRNA were negatively correlated with left ventricular ejection fraction. FROUNT, CCR2, and CCL2 mRNA levels were higher in the severe HF subgroup than in the mild HF subgroup. The expression of FOUNT-mediated CCL2/CCR2 may have important implications in the pathogenesis of CHF. The CCL2/CCR2 pathway via FROUNT may influence the clinical severity of CHF.

Depression and heart failure in patients with a new myocardial infarction

Heart failure (HF) is a disabling chronic illness that is increasing in prevalence. Despite advances in its medical treatment, little is known about its psychosocial correlates. This investigation compared the prevalence of depression in patients with and without HF who were hospitalized with myocardial infarction (MI) and also at high psychosocial risk. Baseline data from the 2444 participants in the ENRICHD clinical trial were used. Within 28 days of the MI, all patients were assessed for depression using Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria, for HF based upon left ventricular dysfunction or history of HF and for demographic and medical confounders. Eight hundred forty-seven patients (34.7%) met the criteria for HF. Major depression was observed in 43% in the HF group compared with 36% in the non-HF group (P < .001). Multivariate modeling showed a 38% increase in odds of HF for patients with major depression, after adjustment for sociodemographic factors and medical comorbidities (adjusted OR 1.38, 95% CI 1.09-1.76). These findings suggest that in patients with new MI who are at psychosocial risk, major depression is more prevalent in those who also have HF. Because major depression undermines adherence and lowers quality of life, special efforts to diagnose and treat it in post-MI patients with HF appear warranted.