Congestive Heart Failure Status Research Articles

Translation and Cross-Cultural Adaptation, Reliability and Validation Study of the Persian Version of Kansas City Cardiomyopathy Questionnaire

The Kansas City Cardiomyopathy Questionnaire (KCCQ) has been developed to measure the health status of Congestive heart failure (CHF) patients. This study aimed to translate KCCQ into a Persian version and assess its validity and reliability. We used a forward-backward procedure to translate the questionnaire. In a cross-sectional study, 150 CHF patients and 50 healthy subjects over 30 years old were selected to assess the reliability and construct validity of the instrument. The face and content validity were used for the questionnaire's validity. The validity was examined on a population of patients with CHF using the Persian version of the Minnesota Living Heart Failure Questionnaire (MLHF) health survey. Calculation of the Intraclass correlation coefficient (ICC) and Cronbach's alpha was done to evaluate the questionnaire's reliability. Test-retest reliability was examined by re-administering the KCCQ after 2 weeks. Test-retest results demonstrated that the Persian version has excellent reliability (ICC for all domains was higher than 0.93, P≤0.000). Internal consistency was found by Cronbach's alpha to be 0.86 for the clinical summary and 0.87 for the overall summary, respectively. Also, the correlation between the components of KCCQ and MLHQ showed satisfactory construct validity. Good Pearson's Correlation Coefficient was seen between KCCQ and MLHF (r= -0.44, P≤0.000 for the clinical summary; r= -0.45, P≤0.000 for the overall summary). Analysing the data from 50 healthy persons and 150 patients were shown that the Persian version of KCCQ has acceptable discriminate validity for all domains except self-efficacy. The Persian version of the KCCQ had satisfactory reliability and validity for assessing health-related quality of life status for Iranian CHF patients.

Inpatient mortality outcomes of patients with hepatocellular carcinoma with congestive heart failure: A nationwide retrospective cohort study.

e16256 Background: Chronic conditions create challenges in improving outcomes and treatment strategies for cancer patients. In the general population, for example, congestive heart failure (CHF) has been associated with poor cardiovascular health and thus increased mortality. However, its prognostic implications in patients with hepatocellular carcinoma (HCC) are less clear despite the physiological connection of the cardiohepatic system. This study aims to elucidate the relationship between CHF and mortality among HCC patients, offering insights that could inform clinical management strategies and improve care. Methods: The 2017 – 2019 versions of the National Inpatient Sample (NIS) database from the Healthcare Cost and Utilization Project (HCUP) were used to acquire the sample population. ICD-10 codes were used to identify diagnoses and procedures. The main sample population consisted of all patients diagnosed with HCC. A multivariate regression model was used (adjusted for age, sex, race, median household income based on patient ZIP code, Charleston Comorbidity Index score, hospital region, hospital teaching status based on rural/urban setting) to calculate the adjusted odds ratio (aOR) for outcomes. First, the association between CHF and inpatient outcomes was examined. Then mortality was calculated for HCC patients receiving therapeutic interventions (chemoradiation, liver transplant, radiation, or immunotherapy) based on CHF status. Results: There were 29,396 patients with HCC. Of this amount, 3,810 patients (13%) had CHF diagnoses. For inpatient procedures, 1,120 patients (3.8%) underwent a liver transplant, 265 (0.9%) received chemotherapy, 2 (0.01%) received immunotherapy, and 5 (0.02%) received radiation therapy. The cohort of CHF patients was found to be older than non-CHF patients (70.2 ± 0.3 years and 64.3 ± 0.2 years, respectively, with p < 0.001). The multivariate regression analysis for the entire sample showed that the adjusted odds of mortality for HCC patients with CHF was 0.92 times that of not having CHF but not significant (95% CI 0.8 – 1.07, p = 0.3). The analysis was then applied to HCC patients receiving one of the four treatments during their hospitalization. Results showed that the CHF cohorts had increased odds of mortality if they received a liver transplant (aOR 20.3, 95% CI 2.5 – 165.7; p = 0.005) or chemotherapy (aOR 338.4, 95% CI 10.0 – 11428.9; p = 0.001). Conclusions: Having CHF is not a significant predictor of mortality in patients with HCC. However, when considering HCC patients undergoing liver transplantation, having comorbid CHF significantly carried about a 20-fold odds in mortality. In addition, HCC patients receiving chemotherapy had a 338-fold odds of death if they have CHF. Thus, careful consideration and planning must be taken into account to optimize patients’ cardiac status when considering treatment options.

The association between serum testosterone level and congestive heart failure in US male adults: data from National Health and Nutrition Examination Survey (NHANES) 2011-2016.

This study aimed to investigate the relationship between serum testosterone levels and the risk of congestive heart failure (CHF) in adult males. Previous research has suggested a potential link between serum testosterone and cardiovascular health, but the findings have been inconclusive. This study was cross-sectional, and the data were obtained from the 2011-2016 cycle of the National Health and Nutrition Examination Survey (NHANES), which included a sample of 6,841 male participants. Serum testosterone levels were measured using a standardized assay, and CHF status was assessed through self-reporting. Covariates such as age, ethnicity, lifestyle factors, and health conditions were considered in the analysis. Among the participants, 242 individuals had a documented history of CHF. We observed a linear correlation between serum testosterone levels and CHF occurrence, with higher serum testosterone levels associated with a decreased risk of CHF (Q4 vs. Q1, OR = 0.29, 95% CI: 0.19-0.47, P < 0.001). After adjusting for confounding variables, multivariate analysis revealed that high serum testosterone levels remained significantly associated with a lower risk of CHF (OR: 0.47, 95% CI: 0.27-0.80, P = 0.01). Subgroup analysis indicated a significant association between high serum testosterone levels and reduced CHF risk in individuals over 50 years old. Our findings suggest that the serum testosterone level was positively associated with CHF in adult males. This study highlights the potential role of serum testosterone in cardiovascular health, particularly in older individuals. Further research is needed to elucidate the underlying mechanisms and explore the clinical implications of these findings.

Mitral valve transcriptome analysis in thirty-four age-matched Cavalier King Charles Spaniels with or without congestive heart failure caused by myxomatous mitral valve disease.

We here report the results of a mitral valve transcriptome study designed to identify genes and molecular pathways involved in development of congestive heart failure (CHF) following myxomatous mitral valve disease (MMVD) in dogs. The study is focused on a cohort of elderly age-matched dogs (n = 34, age ~ 10years) from a single breed-Cavalier King Charles Spaniels (CKCS)-with a high incidence of MMVD. The cohort comprises 19 dogs (10♀, 9♂) without MMVD-associated CHF, and 15 dogs (6♀, 9♂) with CHF caused by MMVD; i.e., we compare gene expression in breed and age-matched groups of dogs, which only differ with respect to CHF status. We identify 56 genes, which are differentially expressed between the two groups. In this list of genes, we confirm an enrichment of genes related to the TNFβ-signaling pathway, extracellular matrix organization, vascular development, and endothelium damage, which also have been identified in previous studies. However, the genes with the greatest difference in expression between the two groups are CNTN3 and MYH1. Both genes encode proteins, which are predicted to have an effect on the contractile activity of myocardial cells, which in turn may have an effect on valvular performance and hemodynamics across the mitral valve. This may result in shear forces with impact on MMVD progression.

EXPLORATORY IN-CLINIC STUDY EVALUATING FEASIBILITY OF JVP HEIGHT ASSESSMENT BY EARLY PROTOTYPE OF MACHINE VISION ALGORITHM

EXPLORATORY IN-CLINIC STUDY EVALUATING FEASIBILITY OF JVP HEIGHT ASSESSMENT BY EARLY PROTOTYPE OF MACHINE VISION ALGORITHM

Late Gadolinium Enhancement by Cardiac Magnetic Resonance and Speckle Tracking Echocardiography in the Evaluation of Cardiac Complications in Chagas Cardiomyopathy: A Systematic Review

Background: Chagas cardiomyopathy (CC) increases cardiovascular mortality associated with congestive heart failure (CHF), ventricular arrhythmias (VA), and sudden cardiac death (SCD). Different imaging techniques have been tested to assess disease progression and cardiac risk in individuals with Chagas disease (ChD). In this systematic review, we evaluated the accuracy in detecting cardiac complications in CC patients using cardiac magnetic resonance (CMR) and speckle tracking echocardiography (STE). Methods: A search was done on PubMed, Cochrane, and Embase for studies in humans over 18 years of age with ChD. Demographic data, research methodology, imaging parameters, and cardiac outcomes were extracted, and study quality was assessed, resulting in a narrative description. Results: Twelve studies with 1124 patients were analyzed. One study discovered a contractility pattern by STE. Four studies assessed the identification of Early Cardiac Impairment (ECI) and VA risk, respectively, while three studies evaluated the risk of SCD. Global Longitudinal Strain (GLS) identified patients with ECI (–18.5 ± 3.4% non-fibrosis vs –14.0 ± 5.8% fibrosis, p = 0.006 and –18 ± 2% non-fibrosis vs –15 ± 2% fibrosis, p = 0.004). The amount of fibrosis &gt;11.78% or in two or more contiguous transmural segments were markers for VA risk. GLS and the amount of fibrosis were found to be predictors of SCD. Conclusions: STE may be considered a screening technique for identifying the subclinical status of CHF. CMR using Late Gadolinium Enhancement (LGE) is considered a relevant parameter for stratifying patients with ChD who are at risk of SCD. Fibrosis and GLS can be used as markers to categorize patients at risk for arrhythmias.

Reduced risk of arterial thromboembolism in cats with pleural effusion due to congestive heart failure.

The aim of the study was to determine whether cardiogenic pleural effusion in cats is associated with a lower risk of arterial thromboembolism (ATE) compared with cats with cardiac disease without evidence of pleural effusion. A cross-sectional study was conducted on owned cats with natural occurring cardiac diseases. Cats included were classified in three groups: those with cardiac disease but no evidence of congestive heart failure (CHF); those with evidence of cardiogenic pulmonary oedema; and those with evidence of cardiogenic pleural effusion. Prevalence of ATE was calculated and the variables analysed for an association with this outcome were the presence and type of CHF, sex and neuter status, age, breed, type of cardiac diseases and left atrial (LA) dimension. A multivariable logistic regression model was used to fit the association between ATE and these variables. A total of 366 cats with cardiac disease met the inclusion criteria: 179 were included in the group with cardiac disease but no evidence of CHF, 66 in the group with evidence of cardiogenic pulmonary oedema and 121 in the group with evidence of cardiogenic pleural effusion. Prevalence of ATE (58/366 [15.8%]) was significantly different among groups (with no evidence of CHF, 28/179 [15.6%]; with evidence of cardiogenic pulmonary oedema, 22/66 [33.3%]; with evidence of cardiogenic pleural effusion, 8/121 [6.6%]; P <0.001). Cats with ATE had a significantly higher LA to aortic root ratio (2.30 ± 0.46) than those without ATE (2.04 ± 0.46; P <0.001). Multivariable logistic regression analysis indicated that the group with evidence of cardiogenic pleural effusion was associated with a lower risk of developing ATE compared with groups with cardiac disease but no evidence of CHF and with evidence of cardiogenic pulmonary oedema (P = 0.005 and P <0.001, respectively). Presence of cardiogenic pleural effusion is associated with a lower risk of developing ATE, while LA enlargement is a risk factor for ATE.

Development of clinical prediction models for renal and cardiovascular outcomes and mortality in patients with type 2 diabetes and chronic kidney disease using time-varying predictors

AimsTo develop a set of prediction models for end-stage kidney disease (ESKD), cardiovascular outcomes, and mortality in patients with type 2 diabetes (T2D) and chronic kidney disease (CKD) using commonly measured clinical variables. MethodsWe studied 1432 participants with T2D and CKD enrolled in the Chronic Renal Insufficiency Cohort, followed for a median period of 7 years. We used Cox proportional-hazards models to model the six outcomes (ESKD, stroke, myocardial infarction (MI), congestive heart failure (CHF), death before ESKD, and all-cause mortality). We internally evaluated these models using concordance and calibration measures. ResultsThe newly developed six prediction models included 15 predictors: age at diabetes diagnosis, sex, blood pressure, body mass index, hemoglobin A1c, high density lipoprotein cholesterol, urine protein-to-creatinine ratio, estimated glomerular filtration rate, smoking status, and history of stroke, MI, CHF, ESKD, and amputation. The resulting models demonstrated good/strong discrimination (cross-validation C-index range: 0.70 to 0.90) and calibration. ConclusionsThis study provided an internally validated and useful tool for predicting individual adverse outcomes and mortality in patients with T2D and CKD. These models may inform optimal use of targeted health interventions.

Rates of respiratory syncytial virus (RSV)-associated hospitalization among adults with congestive heart failure-United States, 2015-2017.

BackgroundRespiratory syncytial virus (RSV) can cause severe disease in adults with cardiopulmonary conditions, such as congestive heart failure (CHF). We quantified the rate of RSV-associated hospitalization in adults by CHF status using population-based surveillance in the United States.MethodsPopulation-based surveillance for RSV (RSV-NET) was performed in 35 counties in seven sites during two respiratory seasons (2015–2017) from October 1–April 30. Adults (≥18 years) admitted to a hospital within the surveillance catchment area with laboratory-confirmed RSV identified by clinician-directed testing were included. Presence of underlying CHF was determined by medical chart abstraction. We calculated overall and age-stratified (<65 years and ≥65 years) RSV-associated hospitalization rates by CHF status. Estimates were adjusted for age and the under-detection of RSV. We also report rate differences (RD) and rate ratios (RR) by comparing the rates for those with and without CHF.Results2042 hospitalized RSV cases with CHF status recorded were identified. Most (60.2%, n = 1230) were ≥65 years, and 28.3% (n = 577) had CHF. The adjusted RSV hospitalization rate was 26.7 (95% CI: 22.2, 31.8) per 10,000 population in adults with CHF versus 3.3 (95% CI: 3.3, 3.3) per 10,000 in adults without CHF (RR: 8.1, 95% CI: 6.8, 9.7; RD: 23.4, 95% CI: 18.9, 28.5). Adults with CHF had higher rates of RSV-associated hospitalization in both age groups (<65 years and ≥65 years). Adults ≥65 years with CHF had the highest rate (40.5 per 10,000 population, 95% CI: 35.1, 46.6).ConclusionsAdults with CHF had 8 times the rate of RSV-associated hospitalization compared with adults without CHF. Identifying high-risk populations for RSV infection can inform future RSV vaccination policies and recommendations.

Connection between Heart Failure, Diabetes, and Overall Mortality in Individuals with Suicidal Ideation: Findings from a Nationally Representative Study

Heart Failure hospitalizations and readmissions continue to rise due to many factors, including increased prevalence of the disease, lack of guideline directed therapy, and lack of patient adherence. The precise contributory relationship of diabetes and congestive heart failure (CHF) is poorly understood.Adult respondents of the National Health and Nutrition Examination Survey NHANES survey aged 20 or older with a self-reported positive history of suicidal ideation between the years 2005-2010 were included in the analysis, with follow-up through 2015. Analysis was performed using complex samples Cox regression to determine the relationship of CHF on all-cause mortality and the influence, if any, of diabetes status.Percent mortality among individuals with CHF was 12.6% among males and 11.2% among females, with mean follow-up of 7.4 years. For all-cause mortality, the overall unadjusted hazard ratio (HR) for CHF to no CHF was 8.90 (95% confidence interval [CI], 3.84-20.65, p < 0.001). The adjusted HR was elevated, 23.91 (CI 2.94-194.32, p = 0.004), among individuals who had CHF and diabetes but closer to 1.0 (3.57 CI 0.56-19.95, p = 0.18) among individuals who had CHF and no diabetes, after adjusting for medical and demographic risk factors. No significant similar patterns were found among the general population.Analysis of the data suggests that adults with suicidal ideation and a combination of positive diabetes and CHF status experience 24 times higher mortality rates than those adults with CHF alone. Conclusions include the need to develop and administer diabetes education programs and health promotion that address CHF risk factors to improve diabetes prognosis while also recognizing early warning mental health signs.

UNIQUE CASE OF ISOPROPYL POISONING INDUCING THYROTOXICOSIS AND ATRIAL FIBRILLATION

SESSION TITLE: Medical Student/Resident Cardiovascular Disease Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October 18-21, 2020 INTRODUCTION: Atrial fibrillation is the most common sustained rhythm disorder observed in clinical practice leading to serious clinical consequences such as hemodynamic impairment and ischemic stroke. A few common risk factors are older age, heart failure and smoking. However, drugs and toxins may induce the onset or worsen pre-existing Atrial fibrillation. Our case discusses isopropyl alcohol use inducing renal failure and severe thyrotoxicosis which led to uncontrolled atrial tachycardia CASE PRESENTATION: 59-year-old male presented due to the sensation of his AICD delivering shocks. He presented with history of Systolic Congestive Heart Failure status post AICD placement, Atrial flutter status post ablation, Atrial Fibrillation on Xarelto, Chronic Respiratory Failure on home oxygen. He endorsed the AICD delivered shocks while attempting to climb stairs and a sensation of unsteadiness. On physical exam he became confused, JVD was present with bilateral lower extremity swelling with cellulitis. Vital signs were significant for hypotension 90/53 and tachycardia of 140. Labs revealed leukocytosis 17K, high anion gap metabolic acidosis, elevated BNP 1900k and severe hypocalcemia. He was admitted to ICU for emergent CVVHD and IV antibiotics for cellulitis. EKG revealed atrial fibrillation with rapid ventricular rate. Amiodarone continuous infusion was started but held due to propagating hypotension and Esmolol was attempted. AICD interrogation revealed no shocks being transmitted. The following day labs revealed TSH <0.005 and T4 of 1.67 After CVVHD, mentation improved, the patient admitted to buying methadone off the street and mixing it with rubbing alcohol as well as cough syrup to ingest. CVVHD was discontinued after two days due to marked improvement of renal failure. Although the patient remained in atrial tachycardia for 5 days after presentation eventually controlled with methimazole treatment and Amiodarone. The acute kidney failure and electrolyte abnormalities were likely due to isopropyl ingestion perpetuating severe thyrotoxicosis causing persistent atrial tachycardia which is a unique presentation DISCUSSION: Isopropyl alcohol is a solvent, antiseptic, and disinfectant also known as rubbing alcohol. Isopropyl alcohol metabolizes to acetone which is a central nervous system depressant. The side effects of poisoning are respiratory sedation, hypotension and may induce arrhythmia. CONCLUSIONS: There has not been a case that discusses the effects of this toxin causing thyroxicosis potentiating uncontrolled Atrial Fibrillation. Initially the electrolyte abnormalities and renal failure were suspected to be caused by sepsis from cellulitis or acute tubular necrosis. Toxin induced Atrial fibrillation may play a role in only a minority of the patients nevertheless the ability to recognize potential clinical offenders is significant for early diagnosis and treatment, leading to improved morbidity. Reference #1: Reddy, Taha, Kundumadam, Khanc "Atrial fibrillation and hyperthyroidism: A literature review” Indian Heart J. 2017 Jul-Aug Reference #2: Shetty Tumkur, Bhat, Chacko "An unusual cause of cardiac arrest in a hospitalized patient” J Pharmacol Pharmacother. 2013 Jan-Mar DISCLOSURES: No relevant relationships by Siddharth Bhesania, source=Web Response No relevant relationships by Adnan Raza, source=Web Response No relevant relationships by Jean Singh, source=Web Response

Influence of Baseline Cardiovascular Comorbidities on Mortality after Androgen Deprivation Therapy for Metastatic Prostate Cancer.

Few studies have assessed the benefits of androgen deprivation therapy (ADT) in men with metastatic prostate cancer (PC; mPC) at an old age or with major cardiovascular conditions. A retrospective cohort consisted of 3835 men with newly diagnosed mPC from the Taiwan Cancer Registry of 2008–2014. Among them, 2692 patients received only ADT in the first year after the cancer diagnosis, and 1143 patients were on watchful waiting. The inverse probability of treatment-weighted Cox model was used to estimate the effects of ADT on all-cause mortality and PC-specific mortality according to age, and the status of congestive heart failure (CHF), coronary arterial diseases (CADs), and stroke at the baseline. After a median follow-up of 2.65 years, 1650 men had died. ADT was associated with a 17–22% risk reduction in all-cause and PC-specific mortality in men without stroke, CAD, or CHF in the 65–79-year group. The survival benefit diminished in men with any of these preexisting conditions. In contrast, ADT was not found to be associated with any survival benefit in the ≥80-year group, even though they did not present with any major cardiovascular disease at the baseline. Patients who had CHF, CAD, or stroke at the baseline did not show a survival benefit following ADT in any of the age groups. Men who have preexisting major cardiovascular diseases or are ≥80 years do not demonstrate a survival benefit from ADT for mPC. The risk–benefit ratio should be considered when using ADT for mPC in older men especially those with major cardiovascular comorbidities.

2797. Rates of Respiratory Syncytial Virus (RSV) Infection among Hospitalized Adults by Congestive Heart Failure Status—United States, 2015–2017

BackgroundRespiratory syncytial virus (RSV) can cause severe disease in older adults and adults with cardiopulmonary conditions, such as congestive heart failure (CHF). RSV vaccines in development may target adults based on age or medical conditions. We assessed rates of RSV infection in hospitalized adults by CHF status using RSV surveillance conducted through the Centers for Disease Control and Prevention’s Emerging Infections Program, a population-based platform in the United StatesMethodsRSV surveillance was performed during two seasons (2015–2017) from October 1–April 30 at seven US sites covering an annual catchment population up to 13.7 million adults. Adults (≥ 18 years) admitted to a hospital from the catchment area and with laboratory-confirmed RSV infections identified by clinician-directed testing were included. Demographic data and any history of CHF were abstracted from medical charts. For adults ≥ 65 years, county-level CHF prevalence was obtained from 2015 Centers for Medicare and Medicaid Services (CMS) data. To estimate county-level CHF prevalence for adults < 65 years, we used 2015–2016 National Health and Nutrition Examination Survey and CMS data. We calculated crude incidence rates (and 95% exact Poisson confidence intervals) of RSV by CHF status and age group (< 65 years vs. ≥ 65 years) using RSV cases (numerator) and catchment area county-level population estimates from the US Census (denominator).ResultsDuring 2015–2017, a total of 2,211 hospitalized RSV cases were identified; 2,055 (92.9%) had CHF status documented. The majority were ≥ 65 years (n = 1236, 60.1%) and 26.8% (n = 550) had CHF. The crude rate of RSV was 62.7 (95% CI: 57.5–68.2) per 100,000 population in adults with CHF compared with 6.1 (95% CI: 5.7–6.4) per 100,000 population in adults without CHF (rate ratio: 10.3, 95% CI: 9.3–11.3). In both age groups, those with CHF had higher rates of RSV than those without CHF. Rates were highest in adults ≥ 65 years with CHF (73.4 per 100,000 population, 95% CI: 66.4–80.9).ConclusionUsing population-based surveillance, we found that adults with CHF had RSV hospitalization rates 10 times higher than those without CHF. Identifying high-risk populations for RSV infection are critical to inform clinical practice and future RSV vaccine policy.Disclosures All authors: No reported disclosures.

Prevalence of Alzheimer Disease in Hospitalized Patients with Congestive Heart Failure

Background: Alzheimer’s disease (AD) may be the most critical medical condition of the 21st century in part because it affects more than 5 million Americans, including one out of eight Americans aged 65 or older, and nearly half of those being over the age of 85. It is also recognized that cardiovascular disease (CVD) risks can catalyze the development of AD. AD and congestive heart failure (CHF) often occur together and thus increase the cost of care and health resources. We investigated the prevalence of AD in patients hospitalized with CHF. In addition, factors that affect the outcomes of this special population were determined. Methods: Data from the National Inpatient Samples (NIS) were extracted and analyzed using ICD 9 codes (CHF 428, PD 331) for the main diagnosis. For continuous variables, we calculated the mean and standard deviations and evaluated significant differences of these factors by Alzheimer disease status using the t-test. For categorical variables, we obtained the counts (proportions) and evaluated significant differences using the Chi-square and Fisher’s exact test Propensity score was utilized to match age, gender and race using logistic model for hospital death and generalized linear model for length of stay (LOS) and hospital charges. Results: The overall characteristics of matched participants with CHF and AD status showed that average age of inpatients was ~84 (SD=6.31). The prevalence of inpatients with both CHF and AD was significant (p $63,000). Finally, patient with CHF and AD stayed longer with higher mortality rates than those without AD, p< 0.0001. Age and race significantly affected all the outcomes, p< 0.0001 while gender showed significance for hospital death and charges (p< 0.0001). Hospital death was not affected by patient’s household income but its interesting to note that LOS was affected by patients with household income between $39,000 - $62,999 and hospital charge by patients with higher household incomes from $48.000 and above. Stroke was the only comorbidity that significantly (p

Cardioprotective role of peroxisome proliferator-activated receptor-γ agonist, rosiglitazone in a unique murine model of diabetic cardiopathy

AimsRosiglitazone (RSZ), a PPARγ agonist was potent efficacious insulin sensitizing blockbuster drug for treatment of Type 2 diabetes mellitus (T2DM) but the benefit of PPARγ activation in congestive heart failure (CHF) was controversial. The present work was planned to study the role of RSZ in diabetic cardiopathy. Main methodsZucker fa/fa rats, the genetic model of T2DM were subjected to constriction of suprarenal abdominal aorta so that they represent a combined model of diabetes and cardiopathy. The development cardiopathy was assessed biochemically (plasma BNP and aldosterone levels), using echocardiography and expression angiotensin II receptor type 1a gene in heart and Endothelin-1 gene in aorta. Rats were treated with RSZ and in combination with amiloride for four weeks and were assessed to evaluate the effect of RSZ or amiloride or its combination on antidiabetic activity, adverse or toxic effects and congestive heart failure status. Key findingsRSZ shows its anti-diabetic effect from 0.3mg/kg dose onwards and at 3mg/kg dose levels it caused beneficial effects (reduction of blood pressure) on cardiovascular system and at highest (30mg/kg) dose it starts showing adverse effects like body weight gain, edema, left ventricular hypertrophy. However, when highest dose of RSZ animals were treated with amiloride (ENaC inhibitor) at 2mg/kg the reversal of the adverse effects was evident, indicating the combination of RSZ and amiloride is beneficial in diabetic cardiopathy model. SignificanceRSZ and amiloride combination appeared promising treatment in diabetic patients with cardiopathy without any side effect.

Physical Activity and Cognitive Function among Older Adults with Congestive Heart Failure Patients

Objective: Research among the general population demonstrates that regular participation in physical activity is associated with enhanced cognitive function. Although less investigated among congestive heart failure patients, this is important to consider among congestive heart failure patients because this population exhibits less physical activity behavior, worse executive function, psychomotor speed and memory-related cognitive function. The purpose of this brief report was to examine the association between physical activity and cognitive function among congestive heart failure patients. Methods: Data from the 1999-2002 population-based National Health and Nutrition Examination Survey was used. Moderate-to-vigorous physical activity (MVPA) and congestive heart failure status were subjectively assessed, with cognitive function assessed via the Digit Symbol Substitution Test (DSST). Results: 133 participants (Agerange = 60-85; Agemean = 72.8; 51.3% male; 83.7% white) had congestive heart failure and complete data on the study variables. In a weighted multivariable linear regression accounting for the complex survey design employed in NHANES, congestive heart failure patients who engaged in any level of MVPA in the past month had a significantly higher DSST score (βadjusted = 5.40; 95% CI: 0.58-10.22; P=0.03). Conclusion: Physical activity was positively associated with cognitive function among congestive heart failure patients, which provides suggestive evidence that physical activity may help to preserve cognitive function among older adults with evidence of congestive heart failure.

Congestive heart failure patient monitoring using wearable Bio-impedance sensor technology.

A new technique to monitor the fluid status of congestive heart failure (CHF) patients in the hospital is proposed and verified in a clinical trial with 8 patients. A wearable Bio-impedance (BioZ) sensor allows a continuous localized measurement which can be complement clinical tools in the hospital. Thanks to the multi-parametric approach and correlation analysis with clinical reference, BioZ is successfully shown as a promising parameter for continuous and wearable CHF patient monitoring application.

Miralax Mix Up: A Case Report on Caustic Injury to the Esophagus

Introduction: Ingestion of caustic agents causes a variety of injuries to the esophagus making management difficult. We describe an interesting case of ingestion of an unknown caustic agent and briefly discuss the current recommendations on diagnosis and treatment. Case Report: A 68-year-old Caucasian male presented with a 2 day history of painful swallowing after drinking what he believed was Miralax with water. The patient denied any recent antibiotic or steroid use. The patient’s past medical and surgical history is significant for congestive heart failure status post defibrillator, type 2 diabetes mellitus, coronary artery disease status CABG, bipolar disorder, tobacco abuse and polysubstance abuse. On evaluation, the patient’s vital signs were within normal limits. Physical exam was remarkable for scattered white patches on the surface of the oropharynx, which revealed a denuded area when removed by scraping with a tongue blade. Labs were significant for an elevated white blood cell count of 17,500. Basic metabolic panel was within normal limits. Examination by a fiberoptic nasolaryngoscope revealed burns of the oropharynx and hypopharynx. Esophagogastroduodenoscopy (EGD) showed severe diffuse esophageal injury (Grade 2A/2B) likely related to an inadvertent caustic ingestion. Patient was treated with a proton pump inhibitor drip and broad spectrum antibiotics. After several days, the patient was able to tolerate a clear liquid diet. He continued to improve clinically and was discharged on a soft diet with crushed medications. A follow-up EGD was scheduled for 8 weeks. Discussion: Ingestion of caustic agents occurs most commonly by accident in the pediatric population and as a suicide attempt in adults. These agents include both acidic and alkali chemicals commonly found in household cleaning products, which cause tissue injury resulting in both systemic and focal injuries. Most serious and long-term complications occur in the esophagus and include esophageal ulcerations, edema, perforation, strictures, and an increased lifetime risk for carcinoma. Presenting symptoms can vary from no symptoms to life threatening symptoms depending on the extent of tissue damage. Endoscopy should ideally be performed within 24 hours of ingestion. A 6-point grading system based on endoscopy findings is often used to predict clinical outcomes and treatment plans. Treatment is mainly focused on supportive care depending on the extent of injury and often includes gastric acid suppression and broad spectrum antibiotics until the patient recovers and complications such as strictures and perforations are treated.

A comparison of all-cause mortality with pioglitazone and insulin in type 2 diabetes: an expanded analysis from a retrospective cohort study

Objectives:The objectives of this study were to assess and compare all-cause mortality rates between pioglitazone (PIO) and insulin (INS).Research design:The study population included 56,536 patients with type 2 diabetes aged ≥45 years who were first-time users of PIO or INS. Data from 1 May 2000 until 30 June 2010 from the i3 InVision Data Mart database were linked to death records of the US Social Security Administration obtained in March 2012, with approval from the Institutional Review Board and in full compliance with the Health Insurance Portability and Accountability Act of 1996.Main outcome measures:Kaplan–Meier curves were generated and hazard ratios (HRs) were estimated for the occurrence of deaths in the PIO and INS cohorts using Cox proportional hazards models adjusted with inverse probability weights derived from propensity scores.Results:After adjustment for >40 covariates through inverse probability weights derived from propensity scores, the PIO group showed a significantly lower risk of all-cause mortality (HR 0.33; 95% confidence interval, 0.31, 0.36). The risk of all-cause mortality was also significantly lower in the PIO cohort than the INS cohort among subgroups based on baseline variables such as sex, age (<55 years, ≥55 years), antidiabetic medication use (sulfonylureas or metformin), lipid-altering medication use, and congestive heart failure status. The study has some limitations. Use of a claims database means a potential bias toward a younger cohort. Disease-specific mortality was not identified because of no recorded cause of death. Reliable information regarding the differences in disease deterioration rate and some clinical and lab results were not available, which limits the statistical adjustment of baseline variables.Conclusion:PIO was associated with a lower risk of all-cause mortality than INS.

Association of CASQ2 polymorphisms with sudden cardiac arrest and heart failure in patients with coronary artery disease

Abnormal calcium handling plays a crucial role in arrhythmias, sudden cardiac arrest (SCA), and congestive heart failure (CHF). Calsequestrin 2 (CASQ2) mutations affect calcium release and initiate malignant ventricular arrhythmias (VAs) and SCA syndromes. Common single nucleotide polymorphisms (SNPs) in CASQ2 may be associated with SCA in patients with coronary artery disease (CAD). The purpose of this study was to examine the association of common CASQ2 SNPs with the risk of SCA in patients with CAD. CASQ2 SNPs (n = 14) were genotyped and analyzed in a case control study comparing 114 patients with CAD and SCA due to VA to 311 CAD controls without VA or SCA. Multivariate logistic regression adjusting for age and CHF status identified an association between rs7521023 with SCA (odds ratio [OR] 2.72, 95% confidence interval [CI] 1.44-5.13, P = .002). The substantial impact of CHF on SCA in the model (OR 26.6, 95% CI 13.40-52.70, P <.001) led us to further examine the relationship between CHF, SCA, and CASQ2 SNPs. We identified 2 CASQ2 variants (rs7521023: OR 0.4, 95% CI 0.25-0.76, P = .003; rs6684209: OR 19.8, 95% CI 3.63-108.2, P <.001) associated with CHF after adjusting for SCA, age, gender, and hypertension. We observed association between a CASQ2 polymorphism and SCA due to VA in patients with CAD adjusting for CHF and independent associations between CASQ2 SNPs and CHF adjusting for SCA. Further investigation in independent cohorts is needed to confirm these findings.