Prognosis Of Congestive Heart Failure Research Articles

Prognostic value of red blood cell distribution width combined with chloride in predicting short- and long-term mortality in critically ill patients with congestive heart failure: Findings from the MIMIC-IV database

BackgroundHypochloremia and red blood cell distribution width (RDW) play important roles in congestive heart failure (CHF) pathophysiology, and they were associated with the prognosis of CHF. However, the prognostic value of chloride combined with RDW in patients with CHF remains unknown. MethodsWe retrospectively analyzed critically ill patients with CHF. The database was derived from the Medical Information Mart for Intensive Care IV v2.0 (MIMIC-IV-v2.0) database. ResultsIn the final analysis, 5376 critically ill patients with CHF were included, and 2428 patients (45.2 %) experienced 5-year mortality. The restricted cubic spline model revealed a positive correlation between RDW and 5-year mortality, whereas chloride showed a U-shaped correlation with 5-year mortality. The median values of RDW and chloride were used to classify patients into four groups: high chloride/low RDW, low chloride/low RDW, high chloride/high RDW, and low chloride/high RDW. We observed the prognostic value of RDW combined with chloride in the Cox proportional hazard model, in predicting 5-year mortality, in-hospital mortality and 1-year mortality. Furthermore, we discovered that patients with chronic kidney disease (CKD) had a higher 5-year mortality risk than patients without CKD. ConclusionWe found the translational potential role of chloride combined with RDW in prioritizing patients at high risk for short- and long-term mortality in a cohort of critically ill patients with CHF. Prospective multicenter investigations are warranted to validate our results.

Non-preferential, but detrimental accumulation of macrophages with clonal hematopoiesis-driver mutations in cardiovascular tissues

Abstract Background Clonal hematopoiesis of indeterminate potential (CHIP) is an acquired genetic risk factor of cardiovascular (CV) disease transmitted by myeloid cells. Harboring CHIP is associated with higher risk of coronary artery disease and worse prognosis of congestive heart failure. Studies show that circulating monocytes of CHIP carriers are more pro-inflammatory than those of non-carriers, but to what extend mutant monocytes and their progenies accumulate in the tissue of CV lesions remains unknown. First, we aimed to identify the frequencies of mutant macrophages in human carotid plaque and heart tissues relative to those of mutant monocytes in the patients’ blood. Second, we compared the gene expression profiles of circulating and tissue myeloid cells of CHIP carriers with those from non-carriers. Methods We recruited patients undergoing carotid endarterectomy and aortic valve replacement. Blood and CV tissue (carotid plaque or right atrium appendix) of patients who provided study consents were retrieved during the surgeries and immediately processed for the isolation of lymphocytes and myeloid cells. Whole blood DNA was subjected to CHIP mutation screening. DNA and RNA of eight DNMT3A or TET2 mutation carriers and eight matched non-carriers were isolated from sorted cells. We measured the frequencies of CHIP mutations in each sorted cell type using a droplet-digital PCR method. RNA of the sorted myeloid cells from the carriers and matched non-carriers were subjected to RNA sequencing. Results Our data showed that CHIP-mutant monocytes in the blood is similar to that of CHIP-mutant macrophages in both the plaque (ratio versus monocytes =1.2, p=0.44) and the heart (ratio versus monocytes=0.89, p=0.47), suggesting a comparable ability of mutant and non-mutant monocytes to accumulate in the cardiovascular lesions. Near absence of CHIP clones in lymphocytes (ratio versus monocytes=0.06, p<0.0001) confirmed the myeloid skewing driven by DNMT3A or TET2 mutations. Unexpectedly, we detected similar size of CHIP clones in CCR2-positive and CCR2-negative cardiac macrophages (ratio=0.95, p=0.77), challenging the current paradigm that CCR2-negative cardiac macrophages represent a resident population with minimal monocyte contribution. Transcriptomic profiles of blood and tissue monocytes/macrophages from these carriers were distinct from those of eight matched non-carriers, featuring differentially up-regulated cytokines (eg. IL1B, S100A9) and chemokines (eg. CXCL1, CCL3) in cells from the carriers. Myeloid cells from the carriers up-regulated genes enriching pathways related to immune activation and inflammation. Conclusion Our study manifested the presence of pro-inflammatory CHIP-mutant myeloid cells in human plaque and heart tissues. The equivalent size of CHIP clones in the circulation and tissue suggests a comparable ability of mutant and non-mutant monocytes to accumulate in CV lesions, but inflammation may mediate CHIP-associated CV diseases.

Hyponatremia Associated with Congestive Heart Failure: Involvement of Vasopressin and Efficacy of Vasopressin Receptor Antagonists

Hyponatremia is frequently found in patients with congestive heart failure. A reduction in effective circulatory blood volume in a volume-expanded patient with decreased cardiac output is linked to a baroreceptor-mediated non-osmotic release of arginine vasopressin (AVP). The increased production of AVP and salt and water retention in the proximal and distal tubules of the kidney by humoral, hemodynamic, and neural mechanisms increase circulatory blood volume and contribute to hyponatremia. Recent studies have indicated that hyponatremia predicts the short-term and long-term prognosis of heart failure by increasing cardiac death and rehospitalization. In addition, the early development of hyponatremia in acute myocardial infarction also predicts the long-term prognosis of worsening heart failure. AVP V2 receptor antagonism may relieve water retention, but it is unknown whether the V2 receptor inhibitor, tolvaptan, improves the long-term prognosis of congestive heart failure. The newly identified natriuretic factor in renal salt wasting has the potential of improving clinical outcomes when combined with a distal diuretic.

Abstract 13256: Prognosis of Congestive Heart Failure Due to Chagas Disease in Women and Men

Introduction: Chronic Chagas cardiomyopathy (CCC) is one of the leading causes of congestive heart failure (CHF) in Latin America and carries a high morbidity and mortality burden. Previously, it was believed that there was no epidemiological and clinical evidence of a gender-associated risk of death in patients with CCC. Hypothesis: to analyze the mortality of congestive heart failure due to CCC in women and men. Methods: From February 2017 to September 2020, we followed a cohort of patients with CHF due to CCC in a single-center outpatient clinic. Serologic tests defined Chagas disease. Baseline data included clinical characteristics and echocardiographic findings. Statistical analyses were performed with the Kaplan-Meier method and Cox proportional hazards methods. Results: We studied 733 patients, mean of 61.4 ± 12.3 years, and 381 (52%) males. At baseline, women were older (63.0±11.9 vs. 60±12.4 years; p=0.01), had a higher prevalence of CKD (9.7 vs. 5.1%; p=0.002), higher mean left ventricular ejection fraction (LVEF) (44.5±14.6% vs. 37.3±14.8%; p<0.001), and a lower left ventricular diastolic diameter (LVDD) (56.7±8.9 vs. 62.4±9.4 mm; p<0.001). Over a 3-years follow-up period, 294 patients died being 168 (57%) men and 126 (43%) women (log-rank; p=0.002). Women had more implantable pacemakers (26.1% vs. 16.5%; p=0.002) and men more implantable cardioverter-defibrillators (20.7% vs. 12.5%; p=0.003). Heart transplants occurred in 10.8% of men and 7.4% of women (p=NS). Cox regression for death adjusted for age, sex, previous myocardial infarction, diabetes, previous stroke, chronic kidney disease (CKD), atrial fibrillation, and LVEF showed men (HR=1.4; 95%CL:1.1-1.8), previous stroke (HR=2.4; 95%CL:1.5-3.6), diabetes (HR=2.0; 95%CL: 1.3-3.1), and CKD (HR=1.8; 95%CL:1.3-2.6) as the main predictors of death. Conclusions: women had a better prognosis than men. Treatment of comorbidities will significantly reduce the death rate in CHF due to CCC.

A Bayesian Dynamic Inference Approach Based on Extracted Gray Level Co-Occurrence (GLCM) Features for the Dynamical Analysis of Congestive Heart Failure

The adoptability of the heart to external and internal stimuli is reflected by heart rate variability (HRV). Reduced HRV can be a predictor of post-infarction mortality. In this study, we propose an automated system to predict and diagnose congestive heart failure using short-term heart rate variability analysis. Based on the nonlinear, nonstationary, and highly complex dynamics of congestive heart failure, we extracted multimodal features to capture the temporal, spectral, and complex dynamics. Recently, the Bayesian inference approach has been recognized as an attractive option for the deeper analysis of static features, in order to perform a comprehensive analysis of extracted nodes (features). We computed the gray level co-occurrence (GLCM) features from congestive heart failure signals and then ranked them based on ROC methods. This study focused on utilizing the dissimilarity feature, which is ranked as highly important, as a target node for the empirical analysis of dynamic profiling and optimization, in order to explain the nonlinear dynamics of GLCM features extracted from heart failure signals, and distinguishing CHF from NSR. We applied Bayesian inference and Pearson’s correlation (PC). The association, in terms of node force and mapping, was computed. The higher-ranking target node was used to compute the posterior probability, total effect, arc contribution, network profile, and compression. The highest value of ROC was obtained for dissimilarity, at 0.3589. Based on the information-gain algorithm, the highest strength of the relationship was obtained between nodes “dissimilarity” and “cluster performance” (1.0146), relative to mutual information (81.33%). Moreover, the highest relative binary significance was yielded for dissimilarity for 1/3rd (80.19%), 2/3rd (74.95%) and 3/3rd (100%). The results revealed that the proposed methodology can provide further in-depth insights for the early diagnosis and prognosis of congestive heart failure.

Diabetes mellitus and congestive heart failure

Congestive heart failure (CHF) is the final stage of cardiovascular disease and one of the leading causes of death. CHF develops in patients with the chronic coronary syndrome, hypertension, myocarditis, endocarditis, pericarditis, and other diseases. The prevalence of CHF in recent years is growing steadily and is about 2% in the adult population. Among the factors that worsen the prognosis of CHF is diabetes mellitus (DM). Type 2 DM is an independent risk factor for heart failure (HF), and fasting plasma glucose and increased glycated hemoglobin A1c are significantly associated with an increased risk of HF. This review article summarizes the existing literature on the current state of the problem of DM and CHF. In particular, there are considered the issues related to the features of myocardial damage in type 2 DM, DM as a risk factor for HF, subclinical myocardial disorders in diabetic patients, HF as a risk factor for DM; pathophysiological features of DM and HF; classification of CHF (according to the New York Heart Association, the American College of Cardiology Foundation/American Heart Association, the European Society of Cardiology); diagnosis of CHF with preserved, reduced and mildly reduced left ventricular ejection fraction; principles of pathogenetic therapy of HF in DM, in particular, the appointment of drugs that affect the renin-angiotensin-aldosterone system (angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers); sacubitril/valsartan; beta-adrenergic receptor blockers, mineralocorticoid receptor antagonists, sinus node inhibitors, sodium-glucose cotransporter type 2 inhibitors, diuretics. Treatment of a patient with DM and HF will be successful only if adequate and safe antidiabetic therapy is prescribed, on the one hand, and metabolically neutral pharmacological therapy, on the other.

Abstract 9495: Prognostic Value of Machine Learning on Clinical Parameters for Cardiac Prognosis in Patinets with Acute Congestive Heart Failure

Introduction: Congestive heart failure (CHF) in acute phase, many clinical fundamental parameters including vital sign, laboratory data, or initial treatment were investigated, and we can roughly estimate the prognosis with the parameters. However, machine learning method for prediction of the prognosis is still challenging. Hypothesis: Machine learning methods have higher performance for predicting cardiac prognosis in patients with CHF than conventional statistical model. Methods: We enrolled consecutive 300 patients with CHF (79.5±12.1 years, 158 Males). Patients with acute coronary syndrome, mechanical circulatory support cases, and cardio-pulmonary arrest cases were excluded. Objective variable was set as cardiac death in one year. First, multivariate stepwise logistic regression analysis with Akaike’s information criterion (AIC) was performed, and extracted parameters which had the most versatile predictive value. Propensity score (PS) was calculated with the extracted parameters, and the prediction model constructed by cut-off value of ROC curve analysis of PS. Next, machine learning (random forest method and deep learning) to build predictive model was performed with the predictors. Finally, accuracy of each predictive model was compared. Results: Thirty cases showed cardiac death in one year. Logistic regression with AIC extracted 8 predictors, and the cut off-value of propensity score with the 8 parameters was 0.110. The accuracy was 0.714 and area under ROC (AUROC) was 0.836. Conversely, random forest method demonstrated the accuracy as 0.927, AUROC 0.860. On deep learning, the accuracy was 0.937 and AUROC 0.901.The top 4 high feature importance of random forest were Cl/red blood cell count/pH/Anion Gap. However, accuracy of those predictors was lower than that of machine learning. Conclusions: Machine learning was a powerful tool to predict cardiac prognosis of CHF, comparing with conventional statistical model.

MMMELD-XI Score Is Associated With Short-Term Adverse Events in Patients With Heart Failure With Preserved Ejection Fraction.

Aim: Accumulating evidence suggests that MELD-XI score holds the ability to predict the prognosis of congestive heart failure. However, most of the evidence is based on the end-stage heart failure population; thus, we aim to explore the association between the MELD-XI score and the prognosis in heart failure with preserved ejection fraction (HFpEF).Methods: A total of 30,096 patients hospitalized for HFpEF in Fujian Provincial Hospital between January 1, 2014 and July 17, 2020 with available measures of creatinine and liver function were enrolled. The primary endpoint was 60-day in-hospital all-cause mortality. Secondary endpoints were 60-day in-hospital cardiovascular mortality and 30-day rehospitalization for heart failure.Results: A total of 222 patients died within 60 days after admission, among which 75 deaths were considered cardiogenic. And 73 patients were readmitted for heart failure within 30 days after discharge. Generally, patients with an elevated MELD-XI score tended to have more comorbidities, higher NYHA class, and higher inflammatory biomarkers levels. Meanwhile, the MELD-XI score was positively correlated with NT-pro BNP, left atrial diameter, E/e' and negatively correlated with LVEF. After adjusting for conventional risk factors, the MELD-XI score was independently associated with 60-day in-hospital all-cause mortality [hazard ratio(HR) = 1.052, 95% confidential interval (CI) 1.022–1.083, P = 0.001], 60-day in-hospital cardiovascular mortality (HR = 1.064, 95% CI 1.013–1.118, P = 0.014), and 30-day readmission for heart failure (HR = 1.061, 95% CI 1.015–1.108, P = 0.009). Furthermore, the MELD-XI score added an incremental discriminatory capacity to risk stratification models developed based on this cohort.Conclusion: The MELD-XI score was associated with short-term adverse events and provided additional discriminatory capacity to risk stratification models in patients hospitalized for HFpEF.

B type natriuretic peptide (BNP) as diagnostic and prognostic biomarker in children with congestive heart failure

Background: Pediatric acute heart failure is now being increasingly recognized as an important source of healthcare resource utilization. B-type natriuretic peptide (BNP) continues to be the dominant biomarker in pediatric heart failure. This study aimed to prove the role of BNP in diagnosis and prognosis of congestive heart failure in children. Method: This case control study was performed in Zagazig University Hospitals and include 60 infants and children who divided into 2 groups, group 1 consists of 30 children diagnosed by congestive heart failure and group 2 consists of 30 age and sex-matched apparently healthy children. Serum BNP level measured for both groups with assessment to the cardiac function, CBC, CRP and serum creatin level. Result: BNP and is significantly higher among CHF patients compared to controls. BNP is found to be higher in patients with sever heart failure compared to moderate and mild HF patients with significance correlation. BNP is found to be higher among congestive heart disease patients with sensitivity 93.3% and specificity 76%. BNP is a significant independent diagnostic parameter for CHF. BNP is found to be non-significant prognostic factors for children with CHF. Conclusion: BNP continues to be the dominant biomarker in pediatric heart failure. BNP is a significant diagnostic marker in diagnosis of heart failure, while it found to be non-significant prognostic factor in CHF.

LVMI: A detrimental paradigm shift of left ventricular geometry and function in accidently detected hypertensives

LVMI: A detrimental paradigm shift of left ventricular geometry and function in accidently detected hypertensives - IJCAP- Print ISSN No: - 2394-2118 Online ISSN No:- 2394-2126 Article DOI No:- 10.18231/2394-2126.2018.0114, Indian Journal of Clinical Anatomy and Physiology-Indian J Clin Anat Physiol

Congestive Heart Failure and Thyroid Dysfunction: The Role of the Low T3 Syndrome and Therapeutic Aspects.

Both the morbidity and mortality rates from congestive heart failure (CHF) remain elevated despite the medical and non-medical management of the disease, thus suggesting the existence of residual risk factors such as thyroid dysfunction. Particularly, the 15-30% of patients with CHF, especially those with severe ventricular dysfunction, display the so-called low T3 syndrome (LT3S), which seems to negatively affect the cardiovascular prognosis. Only a few clinical trials have been carried out to verify both the safety and the efficacy of thyroid replacement in the LT3S, aiming to ameliorate the prognosis of CHF, and most of the results were controversial. Since the aim of the present review was to briefly overview both the indication and contraindication of triiodothyronine replacement in CHF and LT3S, the authors searched PubMed using the medical subject headings (MeSH) related to the following terms: "congestive heart failure" and "low T3 syndrome" or "euthyroid sick syndrome" or "non-thyroidal sick syndrome". The research study only focused on the narrative and systematic reviews, randomized clinical trials and meta-analysis studies which were conducted before June 2019. Studies conducted in both animal models and humans provided controversial information about the effectiveness and safety of the T3 replacement for improving ventricular dysfunction, particularly in the long-term. Further clinical trials are needed to better explore the role of LT3S in patients with CHF and its consequent therapeutic strategy in this clinical setting.

Myeloperoxidase and related biomarkers are suggestive footprints of endothelial microvascular inflammation in HFpEF patients.

AimsIn heart failure (HF) with preserved ejection fraction (HFpEF), microvascular inflammation is proposed as an underlying mechanism. Myeloperoxidase (MPO) is associated with vascular dysfunction and prognosis in congestive HF.Methods and resultsMPO, MPO‐related biomarkers, and echocardiography were assessed in 86 patients, 4–8 weeks after presentation with acute HF (EF ≥ 45%), and in 46 healthy controls. Patients were followed up for median 579 days (Q1;Q3 276;1178) regarding the composite endpoint all‐cause mortality or HF hospitalization. Patients were 73 years old, 51% were female, EF was 64% (Q1;Q3 58;68), E/e′ was ratio 10.8 (8.3;14.0), and left atrial volume index (LAVI) was 43 mL/m2 (38;52). Controls were 60 (57;62) years old (vs. patients; P < 0.001), 24% were female (P = 0.005), and left ventricular EF was 63% (59;66; P = 0.790). MPO was increased in HFpEF compared with controls, 101 (81;132) vs. 86 (74;101 ng/mL, P = 0.015), as was uric acid 369 (314;439) vs. 289 (252;328 μmol/L, P < 0.001), calprotectin, asymmetric dimethyl arginine (ADMA), and symmetric dimethyl arginine (SDMA), while arginine was decreased. MPO correlated with uric acid (r = 0.26; P = 0.016). In patients with E/e′ > 14, uric acid and SDMA were elevated (421 vs. 344 μM, P = 0.012; 0.54 vs. 0.47 μM, P = 0.039, respectively), and MPO was 121 vs. 98 ng/mL (P = 0.090). The ratios of arginine/ADMA (112 vs. 162; P < 0.001) and ADMA/SDMA (1.36 vs. 1.17; P = 0.002) were decreased in HFpEF patients, suggesting reduced NO availability and increased enzymatic clearance of ADMA, respectively. Uric acid independently predicted the endpoint [hazard ratio (HR) 3.76 (95% CI 1.19–11.85; P = 0.024)] but not MPO [HR 1.48 (95% CI 0.70–3.14; P = 0.304)] or the other biomarkers.ConclusionsIn HFpEF, MPO‐dependent oxidative stress reflected by uric acid and calprotectin is increased, and SDMA is associated with diastolic dysfunction and uric acid with outcome. This suggests microvascular neutrophil involvement mirroring endothelial dysfunction, a central component of the HFpEF syndrome and a potential treatment target.

Ventricular Arterial Coupling and Left Ventricular Global Longitudinal Strain: Does Race Play a Role in Children?

Background: Among adults, the incidence and prognosis of congestive heart failure (CHF) is worse in African-Americans, compared to other races. Also, in adults, black race is associated with abnormal global longitudinal strain (GLS), a marker of subclinical left ventricle (LV) dysfunction. LV interaction with arterial afterload is considered to be a key component of optimal cardiovascular efficiency. Data on the impact of race on GLS and ventricular arterial coupling (VAC) in the pediatric population is scarce. We hypothesized that there are racial differences in VAC …

Iron in kidney and heart failure: from theory to practice.

There is evidence that serum iron levels, regardless of the presence of anemia, directly impact outcomes in congestive heart failure (CHF) including quality of life, hospitalization rate and overall survival. Despite modern medical treatments, the prognosis of CHF remains grim. Ironically, simple iron replenishment may serve as a powerful tool in the armamentarium. This review will start from fundamental concepts of iron in oxygen delivery and analyze evidence-based outcomes in CHF iron-directed therapeutic trials. Imaging rationale that dovetails with this pathophysiology will also be detailed in a clinician-directed fashion.

333 - Predicting Readmission Risk: A Promising Heart Failure Bedside Risk Stratification Tool

Introduction: Although many individual factors have been reported to worsen the prognosis of congestive heart failure (CHF) patients, it is challenging to build an accurate risk stratification tool for physicians and other health care providers to utilize at the point of care to identify patients at risk for readmissions. Limiting factors can include: correlations among reported prognostic factors; healthcare systems' lack of patients' social determinant and behavioral factor data; and difficulty embedding the risk stratification tools into healthcare providers' workflow. Hypothesis: We hypothesized that a model derived from a holistic conceptual framework of readmissions based on CHF's pathophysiology and prognosis would accurately stratify risk for readmissions among CHF patients. In addition, we hypothesized that a simple flowchart developed based on the risk model could suffice to facilitate bedside decisions when operationalizing a full predictive model into workflow was not feasible. Methods: Inpatient admissions with a primary discharge diagnosis of CHF from a large urban academic hospital between May 2013 and April 2016 were studied. A risk stratification model was derived and cross-validated from clinical and nonclinical factors to predict risk of 30-day unplanned all-cause readmission to the same facility. A flowchart was then developed based on the risk model. All data were extracted from electronic medical records and administrative data. Results: The 30-day readmission rate of the CHF study population was 15.23%. The model with 48 predictors demonstrated good discrimination (C statistic 0.77, 95% CI: 0.74 - 0.79) and calibration (Goodness-of-fit P = .8) for readmission. When using 0.15 (the prevalence rate) as the probability threshold for at-risk, the model resulted in a sensitivity of 0.74, specificity of 0.70, positive predictive value of 0.30, and negative predictive value of 0.94. Per the model, by reaching out to the patients with a predicted probability above the threshold (which was 38% of the patients discharged), we could capture 74% of the true readmissions. The flowchart containing only five factors demonstrated a reduced sensitivity, but similar specificity and predictive values as the model. Conclusions: Clinical and non-clinical factors derived from a holistic conceptual framework of readmissions demonstrated promising capability of accurately stratifying risk for readmissions among CHF patients. Risk stratification models may be simplified into a flowchart with acceptable reduction in performance to facilitate use at the point of care.

Combined Assessment of Relaxin and B-Type Natriuretic Peptide Improves Diagnostic Value in Patients With Congestive Heart Failure

BackgroundTo improve the poor prognosis of congestive heart failure (CHF), early and accurate diagnosis is necessary. Relaxin is an endogenous cardiovascular peptide, and its plasma level is usually increased in patients with CHF. In this pilot study, we aimed to determine the diagnostic value of relaxin and B-type natriuretic peptide (BNP) in patients with and without CHF. Materials and MethodsThe plasma level of relaxin was measured by enzyme-linked immunosorbent assay and plasma level of BNP by fluorescence immunoassay. The area under the receiver operating characteristic curve was used to assess the diagnostic value of relaxin and BNP. ResultsWe included 81 patients with decompenstated CHF and 36 controls. Plasma levels of relaxin and BNP were both higher in CHF patients than in controls. The correlation between plasma levels of relaxin and BNP and between relaxin or BNP and cardiac function was nonlinear. Relaxin had medium diagnostic value, and BNP had higher value for cardiac function and CHF. At a cutoff of 39.76pg/mL relaxin, sensitivity was 82.7%, specificity 55.6%, sum of the highest positive predictive value 80.5% and negative predictive value 58.8%. Although the diagnostic value was not better for relaxin than BNP, their combined assessment improved the sensitivity and specificity of diagnosis for CHF as compared with BNP alone. ConclusionsCombined assessment of relaxin and BNP may improve the diagnosis of decompensated CHF, which may have potential application in the clinic.

Interactions cardiorénales

Hypertension is common in patients with chronic renal disease particularly those with diabetes. It is sometimes resistant to the pharmacological treatment. The mineralocorticoid receptor antagonist spironolactone may be indicated here. The mineralocorticoid receptor antagonists have a Class 1, Level A indication for the treatment of heart failure with reduced ejection fraction. There is an associated risk of worsening renal function and of hyperkalemia which does not hinder their clinical benefit. However, an appropriate biological monitoring is warranted, along with potential dose adaptations. Cardiorenal syndrome significantly worses the prognosis of congestive heart failure. The use of ultrafiltration can be effective when conventional treatments failed. Its place in the front line needs to be evaluated.

Plasmatic NT-proBNP concentrations in patients with coexistent periodontal disease and congestive heart failure: pilot studies

The presented pilot study was conducted in order to evaluate dynamic fluctuations of blood inflammation markers among patients with congestive heart failure (CHF) and coexistent periodontitis (PD). The study hypothesis stated that elimination of chronic inflammation caused by PD has a significant impact on inflammation markers and, secondarily, also on the course and prognosis of CHF. N-terminal pro-B-type natriuretic peptide (NT-proBNP) and tumour necrosis factor alpha (TNF-α) markers were assessed due to their proven diagnostic significance. Blood samples were collected at the time of CHF patients' admission to the clinical ward (I examination) and then after 3-9 months (average six months) after periodontal treatment completion (II examination). With antibiotic cover, basic periodontal parameters (such as CAL, PD, PI, BOP) were evaluated, scaling and root-planning were performed, and orthopantomogram X-rays were conducted. Patients received instructions about domestic oral hygiene procedures. Measurements were repeated during a second examination of blood samples. Obtained results were compared and statistically analysed. The initial outcome of the study confirmed the hypothesis that maintaining good and complex oral hygiene has an essential impact on blood concentration of NT-proBNP and TNF-α markers. Exploration of possibilities considering medical help and treatment optimisation seems to be evident also according to improvement of prognosis, therapy effectiveness, and patient comfort. Foregoing conclusions about biomarkers are, according to authors' best knowledge, the first such results reported in medical literature.

A Dying Man's Wish Fulfilled.

A Dying Man's Wish Fulfilled.

ErbB4 Gene Polymorphism Is Associated With the Risk and Prognosis of Congestive Heart Failure in a Northern Han Chinese Population

BackgroundThere has been no research evaluating the association between human Neuregulin (NRG) 1/ErbB2/ErbB4 gene polymorphisms and heart failure risk. Methods and ResultsGenotyping of 13 single nucleotide polymorphisms (SNPs) in the NRG-1/ErbB2/ErbB4 genes was performed in 569 unrelated heart failure patients and 682 healthy controls from a Northern Han Chinese population with the use of iPlex SNP Genotyping analysis on a Sequenom Massarray System. In the ErbB4 gene, the variants rs10932374 and rs1595064 were associated with reduced risk of heart failure under allelic, recessive and additive genetic models, and the variants rs13003941 and rs1595065 were associated with increased risk of heart failure under allelic, dominant, and additive models. The G-G-C-C-T haplotype of rs10932374-rs13003941-rs1595064-rs1595065-rs3748960 in the ErbB4 gene increased the risk of heart failure (odd ratio 1.35, 95% confidence interval [CI] 1.06–1.70; P = .014). The T variant of rs13003941 was associated with larger left ventricle (dominant model, P = .014; additive model, P = .048), and increased risk of overall death (relative risk [RR] 1.48, 95% CI 1.01–2.18; P = .045) and cardiovascular death (RR 1.56, 95% CI 1.04–2.33; P = .03) after adjusting for age and sex. NRG-1/ErbB2 gene polymorphisms were not associated with heart failure risk or prognosis. ConclusionErbB4 gene polymorphisms were associated with the risk, severity, and prognosis of heart failure in a Northern Han Chinese population.