scholarly journals Anaemia as Predictor of All-Cause Mortality in Patients with Systolic Dysfunction

2015 ◽  
Vol 1 (3) ◽  
pp. 51-55
Author(s):  
Cristina Vassalle ◽  
Alessandro Vannucci ◽  
Francesca Mastorci ◽  
Debora Battaglia ◽  
Patrizia Landi ◽  
...  
Keyword(s):  
Systolic Dysfunction ◽  
All Cause Mortality

Very early detection of low dose anti-cancer therapy-related cardiotoxicity in lymphoma patients

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
Y.W Liu ◽  
H.Y Chang ◽  
C.H Lee ◽  
W.C Tsai ◽  
P.Y Liu ◽  
...  
Keyword(s):  
Heart Failure ◽  
Cancer Therapy ◽  
Cardiac Dysfunction ◽  
Systolic Dysfunction ◽  
Multivariable Analysis ◽  
Cardiopulmonary Exercise Test ◽  
Left Ventricular ◽  
Funding Source ◽  
Anti Cancer ◽  
All Cause Mortality

Abstract Background and purpose Left ventricular (LV) global peak systolic longitudinal strain (GLS) by speckle-tracking echocardiography is a sensitive modality for the detection of subclinical LV systolic dysfunction and a powerful prognostic predictor. However, the clinical implication of LV GLS in lymphoma patients receiving anti-cancer therapy remains unknown. Methods We prospectively enrolled 74 patients (57.9±17.0 years old, 57% male) with lymphoma who underwent echocardiography prior to chemotherapy, post 3rd and 6th cycle and 1 year after chemotherapy. Cancer therapy-related cardiac dysfunction (CTRCD) is defined as the reduction of absolute GLS value from baseline of ≥15%. All the eligible patients underwent a cardiopulmonary exercise test (CPET) upon completion of 3 cycles of anti-cancer therapy. The primary outcome was defined as a composite of all-cause mortality and heart failure events. Results Among 36 (49%) patients with CTRCD, LV GLS was significantly decreased after the 3rd cycle of chemotherapy (20.1±2.6% vs. 17.5±2.3%, p<0.001). In the multivariable analysis, male sex and anemia (hemoglobin <11 g/dL) were found to be independent risk factors of CTRCD. Objectively, patients with CTRCD had lower minute oxygen consumption/kg (VO2/kg) and lower VO2/kg value at anaerobic threshold in the CPET. The incidence of the primary composite outcome was higher in the CTRCD group than in the non-CTRCD group (hazard ratio 3.21; 95% CI, 1.04–9.97; p=0.03). Conclusion LV GLS is capable of detecting early cardiac dysfunction in lymphoma patients receiving anti-cancer therapy. Patients with CTRCD not only had a reduced exercise capacity but also a higher risk of all-cause mortality and heart failure events. Change of LVEF and GLS after cancer Tx Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): The Ministry of Science and Technology (MOST), Taiwan

scholarly journals Beta-blockers Associated with a Mortality Benefit in Patients with Systolic Dysfunction and Elevated Serum Bilirubin

2014 ◽  
Vol 8 (1) ◽  
pp. 76-82
Author(s):  
Christopher Labos ◽  
Vivian Nguyen ◽  
Nadia Giannetti ◽  
Thao Huynh
Keyword(s):  
Heart Failure ◽  
Beta Blocker ◽  
Beta Blockers ◽  
Systolic Dysfunction ◽  
Tertiary Care ◽  
Elevated Serum ◽  
Secondary Endpoint ◽  
Cardiac Transplant ◽  
All Cause Mortality ◽  
The Impact

Background:Hyperbilirubinemia is associated with increased mortality in heart failure (HF) patients. We evaluated the impact of evidence-based medical therapy, in particular beta-blocker on the survival of patients with HF and hyperbilirubinemia.Methods and Results:We reviewed the charts of all patients followed at our tertiary care heart failure clinic. Hyperbilirubinemia was defined as total bilirubin >30 µmol/L (1.5 times the upper limit of our laboratory value). The primary endpoint was all-cause mortality. The secondary endpoint was a composite of death, cardiac transplant or ventricular assistance device implantation (VAD). Of 1035 HF patients, 121 patients (11.7%) had hyperbilirubinemia. Median follow-up was 556 days. Hyperbilirubinemia was associated with an eight-fold increase in all-cause mortality, hazard ratio (HR): 8.78[95% Confidence Intervals (CI): 5.89-13.06]. Beta-blocker use was associated with approximately 60% reduction in all-cause mortality (HR: 0.38, 95% CI:0.15-0.94) and 70% reduction in the composite secondary endpoint (HR:0.31, 95% CI:0.13-0.71) in patients with hyperbilirubinemia.Conclusion:HF patients with hyperbilirubinemia have increased early mortality, need for cardiac transplantation or VAD. Beta-blocker use was associated with early survival benefit in these patients. Bilirubin levels should be monitored in patients with HF and early initiation of beta-blockers in patients with hyperbilirubinemia should be considered.

scholarly journals Impact of right ventricular volume and function assessed by cardiac magnetic resonance imaging on outcomes in patients undergoing MitraClip implantation

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
M Spieker ◽  
J Marpert ◽  
S Afzal ◽  
A Karathanos ◽  
D Scheiber ◽  
...  
Keyword(s):  
Heart Failure ◽  
Cardiac Magnetic Resonance ◽  
Mitral Valve ◽  
Right Ventricular ◽  
Systolic Dysfunction ◽  
Poor Clinical Outcome ◽  
All Cause Mortality ◽  
And Function ◽  
Cmr Imaging

Abstract Background Right ventricular (RV) dysfunction is a predictor of poor clinical outcome in patients with heart failure and valvular heart disease. However, in patients undergoing MitraClip implantation, only limited data exist regarding the prognostic role of RV function and dimensions on outcomes. Previous studies suggested that RV dysfunction may be associated with poor clinical outcome following MitraClip, while other studies demonstrated contractionary results. Purpose The purpose of this study was to assess whether cardiac magnetic resonance (CMR) imaging derived RV assessment can facilitate risk stratification among patients undergoing transcatheter mitral valve repair with the MitraClip. Methods Sixty-one patients (mean age 77±9 years; 72% functional MR; logistic EuroScore 24±15) with severe mitral regurgitation (MR) were included and underwent CMR imaging and right heart catheterization prior MitraClip procedure. We divided patients into groups according to the presence of RV systolic dysfunction defined by RV ejection fraction (RVEF) <45%. Similarly, patients were separated into groups according to the presence of RV dilatation. For the assessment of RV dilatation, the RV end-diastolic volume index (RVEDVi) assessed by CMR was matched to age and gender specific reference values for each patient. All-cause mortality was assessed during one-year follow-up. Results Patients with RV systolic dysfunction displayed increased left and right ventricular volumes as well as reduced LVEF (all p<0.05). Patients with RV dilatation showed increased left atrial area index (p=0.012) and had more advanced tricuspid regurgitation (p=0.028). Moreover, we observed a negative correlation between RVEDVi and PAPi (r=−0.231, p=0.087) and a positive correlation between RVEDVi and the ratio of right atrial (RA) pressure/ pulmonary artery wedge pressure (PAWP) (r=0.278, p=0.043). We found an inverse correlation between RVEF and systolic pulmonary artery pressure (r=−0.329, p=0.012) (Figure 3). During 12±1 month follow-up, 15 patients (25%) died. Kaplan-Meier survival analysis for 1-year mortality shows that patients with RV systolic dysfunction (p=0.026) and RV dilatation (p=0.005) had an increased 1-year all-cause mortality. Patients presenting with both, RV systolic dysfunction and RV dilatation, exhibited a very high 1-year mortality of 71% (p<0.001). Conclusion The assessment of RV volumes and function by CMR imaging yields important prognostic information that enable an estimation of heart failure severity and prognosis. In this regard, not only RV systolic dysfunction, but also RV dilatation was associated with increased 1-year mortality, while patients presenting with both exhibit additive high mortality risk. Therefore, current criteria for patient selection that are mainly based on mitral valve characteristics only, should also consider RV volumes and function as can be accurately assessed by CMR. Funding Acknowledgement Type of funding source: None

scholarly journals Characterisation of the patients with suspected heart failure: experience from the SHEAF registry

Open Heart ◽  
2021 ◽  
Vol 8 (1) ◽  
pp. e001448
Author(s):  
Pankaj Garg ◽  
Ahmed Dakshi ◽  
Hosamadin Assadi ◽  
Andrew J Swift ◽  
Umna Naveed ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Systolic Dysfunction ◽  
Diagnostic Algorithm ◽  
Preserved Ejection Fraction ◽  
Ventricular Systolic Dysfunction ◽  
Reduced Ejection Fraction ◽  
All Cause Mortality ◽  
Failure Experience

ObjectivesTo characterise and risk-stratify patients presenting to a heart failure (HF) clinic according to the National Institute for health and Care Excellence (NICE) algorithm.MethodsThis is an observational study of prospectively collected data in the Sheffield HEArt Failure registry of consecutive patients with suspected HF between April 2012 and January 2020. Outcome was defined as all-cause mortality.Results6144 patients were enrolled: 71% had HF and 29% had no HF. Patients with N-terminal pro-brain-type natriuretic peptide (NT-proBNP) >2000 pg/mL were more likely to have HF than those with NT-proBNP of 400–2000 pg/mL (92% vs 64%, respectively). Frequency of HF phenotypes include: HF with preserved ejection fraction (HFpEF) (33%), HF with reduced ejection fraction (HFrEF) (29%), HF due to valvular heart disease (4%), HF due to pulmonary hypertension (5%) and HF due to right ventricular systolic dysfunction (1%). There were 1485 (24%) deaths over a maximum follow-up of 6 years. The death rate was higher in HF versus no HF (11.49 vs 7.29 per 100 patient-years follow-up, p<0.0001). Patients with HF and an NT-proBNP >2000 pg/mL had lower survival than those with NT-proBNP 400–2000 pg/mL (3.8 years vs 5 years, p<0.0001). Propensity matched survival curves were comparable between HFpEF and HFrEF (p=0.88).ConclusionOur findings support the use by NICE’s HF diagnostic algorithm of tiered triage of patients with suspected HF based on their NT-proBNP levels. The two pathways yielded distinctive groups of patients with varied diagnoses and prognosis. HFpEF is the most frequent diagnosis, with its challenges of poor prognosis and paucity of therapeutic options.

scholarly journals Antialdosterone in Acute Myocardial Infarction patients: a Meta-Analysis and Systematic Review

2021 ◽  
Author(s):  
Qiao Chen ◽  
Zhuqing Li ◽  
Die Zhao ◽  
Jie Sun ◽  
Yiling Wang ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Ventricular Remodeling ◽  
Left Ventricular Systolic Dysfunction ◽  
Systolic Dysfunction ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Cochrane Library ◽  
Ventricular Ejection Fraction ◽  
All Cause Mortality

Abstract Purpose: A comprehensive evaluation of the benefits of mineralocorticoid receptor antagonists (MRA) in acute myocardial infarction (AMI) patients is lacking. We aimed to summarize the evidence on the efficacy and safety of MRA in post-AMI patients.Methods: Articles were identified through PubMed, Embase, Cochrane Library, Ovid (Medline1946-2021) and ClinicalTrials.gov databases from their inception to Dec 31, 2020. Results: MRA reduced the risk of all-cause mortality by 16% (relative ratio(RR) 0.84, 95% confidence interval(CI) (0.76,0.94), P=.002), new or worsening heart failure (HF) 14% (RR 0.86, 95%CI (0.78,0.96), P=.007), death from HF by 22% (RR 0.78, 95%CI (0.62,0.99), P=.04), and cardiovascular death by 16% (RR 0.84, 95%CI (0.74,0.94), P=.003) in post-AMI patients. Meanwhile, all-cause mortality was reduced by 38% (RR 0.62, 95%CI (0.42,0.90), P=.01), 30% (RR 0.70, 95%CI (0.49,1.00), P=.05), and 29% (RR 0.71, 95%CI (0.59,0.86), P=.0004) in ST-elevation myocardial infarction (STEMI) patients and those who initiated MRA treatment within 3 days and (3,7) days, respectively. Post-AMI patients without left ventricular systolic dysfunction (LVSD) treated with MRA improved left ventricular ejection fraction (mean difference[MD] 2.74, 95%CI (2.49,2.99), P<.00001) and reduced left ventricular end-systolic and end-diastolic volume indices (MD -6.23, 95%CI (-10.93,-1.52), P=.009; MD -3.13, 95%CI (-5.79,-0.47), P=.02). The corresponding RR were 1.73 (95%CI (1.44,2.08), P<.00001) for considered common side effects (hyperkalemia and gynecomastia).Conclusion: Our findings suggest that all-cause mortality is lower in STEMI patients and in patients initiating MRA within 7 days, and that post-AMI patients without LVSD have improved left ventricular remodeling and cardiac function.

scholarly journals Antialdosterone in Acute Myocardial Infarction patients: a Meta-Analysis and Systematic Review

2021 ◽  
Author(s):  
Qiao Chen ◽  
Die Zhao ◽  
Jie Sun ◽  
Chengzhi Lu
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Ventricular Remodeling ◽  
Left Ventricular Systolic Dysfunction ◽  
Systolic Dysfunction ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Cochrane Library ◽  
Ventricular Ejection Fraction ◽  
All Cause Mortality

Abstract We aimed to summarize the evidence on the efficacy and safety of mineralocorticoid receptor antagonists (MRA) in post acute myocardial infarction (AMI) patients. Articles were identified through PubMed, Embase, Cochrane Library, Ovid (Medline1946-2021) and ClinicalTrials.gov databases from their inception to December 31, 2020. MRA reduced the risk of all-cause mortality by 16% (relative ratio (RR) 0.84, 95% confidence interval (CI) (0.76, 0.94), P = 0.002). Meanwhile, all-cause mortality was reduced by 38% (RR 0.62, 95% CI (0.42, 0.90), P = 0.01), 30% (RR 0.70, 95% CI (0.49, 1.00), P = 0.05), and 29% (RR 0.71, 95% CI (0.59, 0.86), P = 0.0004) in ST-elevation myocardial infarction (STEMI) patients and those who initiated MRA treatment within 3 days and (3,7) days, respectively. Post-AMI patients without left ventricular systolic dysfunction (LVSD) treated with MRA improved left ventricular ejection fraction (mean difference [MD] 2.74, 95% CI (2.49, 2.99), P < 0.00001) and reduced left ventricular end-systolic and end-diastolic volume indices (MD -6.23, 95% CI (-10.93, -1.52), P = 0.009; MD -3.13, 95% CI (-5.79, -0.47), P = 0.02). The corresponding RR were 1.73 (95% CI (1.44, 2.08), P < 0.00001) for considered common side effects (hyperkalemia and gynecomastia). Our findings suggest that all-cause mortality is lower in STEMI patients and in patients initiating MRA within 7 days, and that post-AMI patients without LVSD have improved left ventricular remodeling and cardiac function.

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