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1.
Ayodele Odutayo Christopher X. Wong Rashida Williams Benjamin Hunn Connor A. Emdin 《Journal of cardiac failure》2017,23(1):56-62
Background
Atrial fibrillation (AF) is common among adults with congestive heart failure (CHF). We conducted a meta-analysis to summarize the risk of mortality and cardiovascular disease associated with AF in CHF and stratified our analyses by AF timing and pattern.Methods
We searched MEDLINE and EMBASE for observational studies examining the association of AF with cardiovascular disease and death. Eligible studies had a minimum of 50 participants with AF and 50 participants without AF, and a median follow-up of 6 months.Results
Thirty-three studies involving 114,204 adults (43,549 with AF) were included in this meta-analysis. AF was associated with an increased risk of mortality and this risk varied between incident and prevalent AF (relative risk 2.21, 95% confidence interval 1.96–2.49 vs relative risk 1.19, 95% confidence interval 1.03–1.38, respectively; P?<?.001 for interaction). The risk of mortality associated with incident AF was consistent in adults with CHF with reduced and preserved ejection fraction. The relative risk of mortality did not vary between paroxysmal and chronic AF. Finally, AF was associated with an increased risk of cardiovascular mortality and stroke.Limitation
Use of anticoagulation was infrequently reported in included studies.Conclusions
AF was associated with an increased risk of cardiovascular disease and death and, notably, the risk of mortality varied by AF timing. 相似文献2.
Systolic blood pressure and cardiovascular outcomes in heart failure with preserved ejection fraction: an analysis of the TOPCAT trial 
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下载免费PDF全文 Senthil Selvaraj Brian Claggett Sanjiv J. Shah Inder Anand Jean L. Rouleau Akshay S. Desai Eldrin F. Lewis Bertram Pitt Nancy K. Sweitzer Marc A. Pfeffer Scott D. Solomon 《European journal of heart failure》2018,20(3):483-490
Aims
Recent guidelines have advocated for stricter systolic blood pressure (SBP) control in heart failure with preserved ejection fraction (HFpEF), though data regarding the optimal SBP in HFpEF are sparse.Methods and results
We analysed participants from the Americas from the Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist (TOPCAT) study with available baseline and 8‐week visit SBP data (n = 1645). We related baseline SBP to several efficacy and safety outcomes. To determine whether blood pressure lowering was responsible for the potential beneficial effects of spironolactone observed in the Americas, we assessed the randomized treatment adjusting for baseline and change in 8‐week SBP. The average age was 71.7 ± 9.7 years, 50% were women, and 79% were White. Patients in the lowest baseline SBP quartile were less often female, more often White, had lower body mass index, lower baseline diastolic blood pressure and pulse pressure, and more often had atrial fibrillation. After multivariable adjustment, there was no relationship observed between baseline SBP quartiles and any outcome. Spironolactone reduced SBP by 4.4 ± 0.6 mmHg compared with placebo (and consistently across baseline SBP quartiles). There was minimal change in the treatment effect for all outcomes after adjusting for baseline SBP and 8‐week change in SBP.Conclusion
No relationship was observed between baseline SBP quartiles and outcomes in TOPCAT. The anti‐hypertensive effects of spironolactone did not account for the potential benefit in cardiovascular outcomes in the Americas.3.
Merrick Miles Bret D. Alvis Kyle Hocking Franz Baudenbacher Christy Guth Joann Lindenfeld Colleen Brophy Susan Eagle 《Journal of cardiac failure》2018,24(8):525-532
Background
To determine the feasibility of peripheral intravenous volume analysis (PIVA) of venous waveforms for assessing volume overload in patients admitted to the hospital with acute decompensated heart failure (ADHF).Methods
Venous waveforms were captured from a peripheral intravenous catheter in subjects admitted for ADHF and healthy age-matched controls. Admission PIVA signal, brain natriuretic peptide, and chest radiographic measurements were related to the net volume removed during diuresis.Results
ADHF patients had a significantly greater PIVA signal on admission compared with the control group (P?=?.0013, n?=?18). At discharge, ADHF patients had a PIVA signal similar to the control group. PIVA signal, not brain natriuretic peptide or chest radiographic measures, accurately predicted the amount of volume removed during diuresis (R2?=?0.781, n?=?14). PIVA signal at time of discharge greater than 0.20, demonstrated 83.3% 120-day readmission rate.Conclusions
This study demonstrates the feasibility of PIVA for assessment of volume overload in patients admitted to the hospital with ADHF. 相似文献4.
Nathalie Satta Sabrina Pagano Fabrizio Montecucco Baris Gencer 《The Journal of infection》2018,76(2):186-195
Objectives
To determine the existence of autoantibodies against apolipoprotein A-1 (anti-apoA-1 IgG) in HIV patients and explore their association with biological features of HIV infection and different inflammatory biomarkers. We also evaluated their impact on CD4+ lymphocytes survival.Methods
Anti-apoA-1 IgG plasma levels were assessed by ELISA in 237 HIV positive patients from a national prospective cohort with no current lipid-lowering therapy.Results
58% of patients were found positive for anti-apoA-1 IgG and were associated with lower CD4+ counts, but higher viremia and systemic inflammation. Logistic regression analyses indicated that high anti-apoA-1 IgG levels were associated with a 16-fold increased risk of displaying low CD4+ levels, independent of HIV RNA levels and treatment (adjusted Odds ratio [OR]:16.1, 95% Confidence Interval [95%CI]:1.80–143.6; p = 0.01), and a 6-fold increased risk of having a detectable viremia, independent of antiretroviral treatment (OR:5.47; 95% CI:1.63–18.36; p = 0.006). In vitro, anti-apoA-1 IgG induced dose and time-dependent CD4+ apoptosis that was increased by exposure to HIV RNA.Conclusions
In HIV patients, anti-apoA-1 IgG levels are associated with low CD4+ counts, high viremia and a pro-inflammatory systemic profile. Anti-apoA-1 IgG can promote CD4+ lymphocyte apoptosis via undefined pathways. 相似文献5.
Jiacong Luo Steven M. Brunelli Donna E. Jensen Alex Yang 《Clinical journal of the American Society of Nephrology》2016,11(1):90-100
Background and objectives
Patients with CKD are more likely than others to have abnormalities in serum potassium (K+). Aside from severe hyperkalemia, the clinical significance of K+ abnormalities is not known. We sought to examine the association of serum K+ with mortality and hospitalization rates within narrow eGFR strata to understand how the burden of hyperkalemia varies by CKD severity. Associations were examined between serum K+ and discontinuation of medications that block the renin-angiotensin-aldosterone system (RAAS), which are known to increase serum K+.Design, setting, participants, & measurements
A cohort of patients with CKD (eGFR<60 ml/min per 1.73 m2) with serum K+ data were studied (n=55,266) between January 1, 2009, and June 30, 2013 (study end). Serum K+, eGFR, and covariates were considered on a time-updated basis. Mortality, major adverse cardiovascular events (MACE), hospitalization, and discontinuation of RAAS blockers were considered per time at risk.Results
During the study, serum K+ levels of 5.5–5.9 and ≥6.0 mEq/L were most prevalent at lower eGFR: they were present, respectively, in 1.7% and 0.2% of patient-time for eGFR of 50–59 ml/min per 1.73 m2 versus 7.6% and 1.8% of patient-time for eGFR<30 ml/min per 1.73 m2. Serum K+ level <3.5 mEq/L was present in 1.2%–1.4% of patient-time across eGFR strata. The median follow-up time was 2.76 years. There was a U-shaped association between serum K+ and mortality; pooled adjusted incidence rate ratios were 3.05 (95% confidence interval, 2.53 to 3.68) and 3.31 (95% confidence interval, 2.52 to 4.34) for K+ levels <3.5 mEq/L and ≥6.0 mEq/L, respectively. Within eGFR strata, there were U-shaped associations of serum K+ with rates of MACE, hospitalization, and discontinuation of RAAS blockers.Conclusions
Both hyperkalemia and hypokalemia were independently associated with higher rates of death, MACE, hospitalization, and discontinuation of RAAS blockers in patients with CKD who were not undergoing dialysis. Future studies are needed to determine whether interventions targeted at maintaining normal serum K+ improve outcomes in this population. 相似文献6.
Nancy M. Albert James F. Bena Denise Buxbaum Linda Martensen Shannon L. Morrison Marilyn A. Prasun Kelly D. Stamp 《Heart & lung : the journal of critical care》2018,47(3):184-191
Background
Research findings on the value of nurse certification were based on subjective perceptions or biased by correlations of certification status and global clinical factors. In heart failure, the value of certification is unknown.Objectives
Examine the value of certification based nurses' decision-making.Methods
Cross-sectional study of nurses who completed heart failure clinical vignettes that reflected decision-making in clinical heart failure scenarios. Statistical tests included multivariable linear, logistic and proportional odds logistic regression models.Results
Of nurses (N = 605), 29.1% were heart failure certified, 35.0% were certified in another specialty/job role and 35.9% were not certified. In multivariable modeling, nurses certified in heart failure (versus not heart failure certified) had higher clinical vignette scores (p = 0.002), reflecting higher evidence-based decision making; nurses with another specialty/role certification (versus no certification) did not (p = 0.62).Conclusions
Heart failure certification, but not in other specialty/job roles was associated with decisions that reflected delivery of high-quality care. 相似文献7.
Kenneth C. Bilchick Eliany Mejia-Lopez Peter McCullough Khadijah Breathett Jamie L. Kennedy Jose Tallaj James Bergin Salpy Pamboukian Mohammad Abuannadi Sula Mazimba 《Journal of cardiac failure》2018,24(1):43-50
Background
The objective of this work was to determine the impact of improving right ventricular versus left ventricular stroke work indexes (RVSWI vs LVSWI) during therapy for acute decompensated heart failure (ADHF).Methods and Results
Cox proportional hazards regression and logistic regression were used to analyze key factors associated with outcomes in 175 patients (mean age 56.7?±?13.6 years, 29.1% female) with hemodynamic data from the Evaluation Study of Congestive Heart Failure and Pulmonary Artery Catheterization Effectiveness trial. In this cohort, 28.6% and 69.7%, respectively, experienced the outcomes of death, transplantation, or ventricular assist device implantatation (DVADTX) and DVADTX or HF rehospitalization (DVADTXHF) during 6 months of follow-up. Increasing RVSWI (ΔRVSWI) from baseline to discharge was associated with a decrease in DVADTXHF (hazard ratio [HR] 0.923, 95% confidence interval [CI] 0.871–0.979) per 0.1?mm?Hg?L?m?2 increase); however, increasing LVSWI (ΔLVSWI) had only a nonsignificant association with decreased DVADTXHF (P?=?.11) In a multivariable model, patients with ΔRVSWI ≤1.07?mm?Hg?L?m?2 and ΔLVSWI ≤4.57?mm?Hg?L?m?2 had a >2-fold risk of DVADTXHF (HR 2.05, 95% CI 1.23–3.41; P?=?.006).Conclusion
Compared with left ventricular stroke work, increasing right ventricular stroke work during treatment of ADHF was associated with better outcomes. The results promise to inform optimal hemodynamic targets for ADHF. 相似文献8.
Yasuyuki Shiraishi Shun Kohsaka Takayuki Abe Kazumasa Harada Tetsuro Miyazaki Takamichi Miyamoto Kiyoshi Iida Shuzou Tanimoto Mayuko Yagawa Makoto Takei Yuji Nagatomo Toru Hosoda Takeshi Yamamoto Ken Nagao Morimasa Takayama 《The American journal of medicine》2018,131(2):156-164.e2
Background
The onset of acute heart failure is known to be associated with increased physical activity and other specific behaviors that can trigger hemodynamic deterioration. This analysis aimed to describe the distribution of triggers in patients hospitalized for acute heart failure, and investigate their effects on in-hospital outcomes.Methods
Consecutive patients hospitalized for acute heart failure between 2010 and 2014 were registered in a multicenter data registration system (72 institutions within Tokyo, Japan). Baseline demographics and in-hospital mortality were extracted from 17,473 patients. Patients with a trigger were grouped based on their triggering event: those with onset during (a) physical activity; (b) sleeping; (c) eating or watching television; (d) bathing or excretion (use of restrooms); and (e) engaging in other activities. These patients were compared with patients without identifiable triggers. Multiple imputation was used for missing data.Results
Patients were predominantly men (57.1%), with a mean age of 76.0 ± 13.0 years; a triggering event was present in 49.1%. No significant difference in baseline characteristics was noted between groups except for younger age, higher blood pressure, and prevalence of signs of congestion in the trigger-positive group. In-hospital mortality rate was 7.9%. Presence of triggers was positively associated with a reduced risk of in-hospital mortality (adjusted odds ratio 0.79; 95% confidence interval, 0.70-0.90; P = .0003). In a delta-adjusted pattern mixture model, the effect of a triggering event on in-hospital mortality remained consistently significant.Conclusion
Triggering events for acute heart failure can provide additional information for risk prediction. Efforts to identify the triggers should be made to classify patients according to risk group. 相似文献9.
Nick Mattsson Olav Wendelboe Nielsen Linda Johnson Eva Prescott Peter Schnohr Gorm Boje Jensen Lars Køber Ahmad Sajadieh 《The American journal of medicine》2018,131(3):318.e9-318.e19
Background
Potassium supplementation reduces the risk of cardiovascular mortality and stroke in population studies; however, the prognostic impact of mild hypokalemia in the general population has not been thoroughly investigated. We aimed to investigate associations between mild hypokalemia and endpoints in the general population.Methods
Participants (aged 48-76 years) from the general population study “Copenhagen City Heart Study” (n = 5916) were studied. Participants were divided into groups according to baseline values of plasma potassium (potassium): hypokalemia (<3.7 mmol/L, n = 758), normokalemia (3.7-4.5 mmol/L, n = 4973), and high potassium (>4.5 mmol/L, n = 185). Hypokalemia was further divided as potassium <3.4 mmol/L and 3.4-3.6 mmol/L. The primary endpoints were all-cause mortality and nonfatal validated ischemic stroke. The secondary endpoint was acute myocardial infarction (AMI). We adjusted for conventional risk factors, diuretics, and atrial fibrillation at baseline.Results
Mean potassium in the hypokalemic group was 3.5 mmol/L (range, 2.6-3.6 mmol/L) and was associated (P < 0.05) with increased systolic blood pressure, higher CHA2DS2-VASc score, and increased use of diuretics as compared with normokalemia. Baseline atrial fibrillation was equally frequent across groups. Median follow-up-time was 11.9 years (Q1-Q3: 11.4-12.5 years). Hypokalemia was borderline associated with increased stroke risk in a multivariable Cox model (including adjustment for competing risk) as compared with normokalemia (hazard ratio [HR] 1.40; 95% confidence interval [CI], 1.00-1.98). The subgroup with potassium <3.4 mmol/L had higher stroke risk (HR 2.10; 95% CI, 1.19-3.73) and mortality risk (HR 1.32; 95% CI, 1.01-1.74) as compared with normokalemia. Hypokalemia was not associated with AMI, and no increased risk of mortality was seen with concomitant AMI and hypokalemia. No associations were seen with high potassium.Conclusion
In a general population mild hypokalemia is associated with increased stroke risk and, to a lesser degree, increased mortality risk. 相似文献10.
Federica Dellafiore Harleah G. Buck Gianluca Pucciarelli Claudio Barbaranelli Marco Paturzo Rosaria Alvaro Ercole Vellone 《Heart & lung : the journal of critical care》2018,47(6):553-561
Background
Higher patient-caregiver mutuality is associated with improved patient and caregiver outcomes, but no studies have tested the psychometric characteristics of the mutuality scale (MS) in heart failure (HF) patient and caregiver population.Objectives
To test the validity and reliability of the MS.Methods
A cross-sectional design. The MS validity and reliability were tested with confirmatory factor analysis (CFA) and hypothesis testing, and with Cronbach's alpha and model-based internal consistency index, respectively.Results
CFA supported the validity of the MS in the HF patient and caregiver versions. Hypothesis testing showed significant correlations between both versions of the MS and anxiety, depression, quality of life, and self-care. Also, MS caregiver version scores correlated significantly with caregiver preparedness. Cronbach's alphas and the model-based internal consistency index ranged between 0.72 and 0.94 in both versions.Conclusions
The Mutuality Scale showed supportive validity and reliability for HF patients and caregivers. 相似文献11.
Kelly D. Stamp Marilyn Prasun Christopher S. Lee Tiny Jaarsma Mariann R. Piano Nancy M. Albert 《Heart & lung : the journal of critical care》2018,47(2):169-175
Background
Heart Failure (HF) is a public health problem globally affecting approximately 6 million in the United States.Objectives
A tailored position statement was developed by the American Association of Heart Failure Nurses (AAHFN) and their Research Consortium to assist researchers, funding institutions and policymakers with improving HF clinical advancements and outcomes.Methods
A comprehensive review was conducted using multiple search terms in various combinations to describe gaps in HF nursing science. Based on gaps described in the literature, the AAHFN made recommendations for future areas of research in HF.Results
Nursing has made positive contributions through disease management interventions, however, quality, rigorous research is needed to improve the lives of patients and families while advancing nursing science.Conclusions
Advancing HF science is critical to managing and improving patient outcomes while promoting the nursing profession. Based on this review, the AAHFN is putting forth a call to action for research designs that promote validity, sustainability, and funding of future nursing research. 相似文献12.
Martin S. Maron Raymond H. Chan Navin K. Kapur Iris Z. Jaffe Adam P. McGraw Raj Kerur Barry J. Maron James E. Udelson 《The American journal of medicine》2018,131(7):837-841
Background
Myocardial fibrosis has proved to be an important marker and determinant in the pathogenesis of hypertrophic cardiomyopathy. In particular, scar formation, if substantial, can promote ventricular tachyarrhythmias or progressive heart failure in the absence of left ventricular outflow obstruction. Therefore, an intervention to mitigate myocardial fibrosis would be potentially advantageous to hypertrophic cardiomyopathy patients.Methods
Eligible hypertrophic cardiomyopathy patients were randomized 1:1 in a prospective double-blind fashion to spironolactone 50 mg or placebo to be taken over a 12-month period. The primary endpoint was the effect of mineralocorticoid receptor blockade on serum markers of collagen synthesis and degradation. A number of other functional and morphologic variables and biomarkers comprised secondary exploratory measures.Results
Fifty-three hypertrophic cardiomyopathypatients (41 ± 13 years old; 72% men) were randomized; demographic and clinical variable were well matched at baseline. Absolute change between baseline and 12 months did not differ between hypertrophic cardiomyopathy patients treated with spironolactone and those receiving placebo with respect to serum markers of collagen synthesis or degradation, fibrosis by late gadolinium enhancement on cardiac magnetic resonance imaging, or other clinical variables, including objective measure of functional capacity (peak VO2), New York Heart Association functional class, left ventricular wall thickness, mass and volume, and left atrial size, as well as assessment of diastolic function (P = .4-1.0).Conclusions
These findings do not support the use of spironolactone in hypertrophic cardiomyopathy to improve left ventricular remodeling by mitigating myocardial fibrosis or altering clinical course. 相似文献13.
Kevin Damman Serge Masson Donata Lucci Marco Gorini Renato Urso Aldo P. Maggioni Luigi Tavazzi Luigi Tarantini Gianni Tognoni Adriaan Voors Roberto Latini 《Journal of cardiac failure》2017,23(1):2-9
Background
Data on the natural change in renal function in patients with chronic heart failure (HF) are limited.Methods and Results
Estimated glomerular filtration rate (eGFR) was assessed over 36 months in 6934 patients included in the GISSI-HF study. Associations from baseline, changes in renal function, and occurrence of cardiovascular death or HF hospitalization were assessed. Mean age was 67 years, mainly men (78%), and mean eGFR was 68?mL???min?1???1.73?m?2. Change in eGFR in the 1st year was ?1.5?±?16?mL???min?1???1.73?m?2, and over 36 months it was ?3.7?±?18?mL???min?1???1.73?m?2. Over the latter period, only 25% deteriorated ≥1 Kidney Disease Outcomes Quality Initiatives (KDOQI) class of chronic kidney disease (CKD). Fifteen percent of patients had >15?mL???min?1???1.73?m?2 decrease in eGFR in the 1st 12 months. Lower eGFR was associated with outcome: hazard ratio (HR) 1.10, 95% confidence interval (CI) 1.08–1.10 (P?<?.001) per 10?mL???min?1???1.73?m?2 decrease, as well as every 10?mL???min?1???1.73?m?2 decrease over the 1st year (HR 1.10, 95% CI 1.04–1.17; P?<?.001). A deterioration in eGFR >15?mL???min?1???1.73?m?2 in the 1st year showed the highest risk of events (HR 1.22, 95% CI 1.10–1.36; P?<?.001).Conclusions
Mean decrease in renal function over time in patients with chronic HF was modest. Only 25% deteriorated ≥1 KDOQI class of CKD after 3 years. Any decrease in eGFR over time was associated with strongly increased event rates. 相似文献14.
Joanna M. Joly Ashraf El-Dabh James K. Kirklin Ramey Marshell Michelle G. Smith Deepak Acharya Indranee N. Rajapreyar José A. Tallaj Margaret Tresler Salpy V. Pamboukian 《Journal of cardiac failure》2018,24(8):487-493
Background
Gastrointestinal bleeding (GIB) remains a major morbid event during continuous flow left ventricular assist device (LVAD) support. This study investigated whether a common hemodynamic profile is associated with GIB in patients with LVADs.Methods and Results
A single institution analysis reviewed all patients who underwent right heart catheterization (RHC) following LVAD implant between January 1, 2006, and December 31, 2013, with follow-up through June 2015. Kaplan-Meier and multiphase hazard statistical methods were employed. Among 108 patients with 341 RHC, 55 hospitalizations for GIB occurred within 1 year of RHC. Freedom from GIB at 6 months was 92% in patients with pulse pressure?≥35?mmHg, compared with 76% with pulse pressure?<35?mmHg. By multivariable analysis, the significant predictors of GIB were: older age at implant, number of prior GIB, lower pulse pressure, lower mean arterial pressure, and higher right atrial pressure (all P?<?.05). The magnitude of effect is influenced by pulse pressure.Conclusions
Greater pulsatility and less venous congestion, along with other factors, are associated with a lower risk for GIB. It is reasonable to adjust therapeutic strategies to target this hemodynamic profile in patients with a propensity for GIB. 相似文献15.
Background
A previous randomized controlled trial evaluating the use of spironolactone in heart failure patients reported a low risk of hyperkalemia (2%) and renal insufficiency (0%). Because treatments for heart failure have changed since the benefits of spironolactone were reported, the prevalence of these complications may differ in current clinical practice. We therefore sought to determine the prevalence and clinical associations of hyperkalemia and renal insufficiency in heart failure patients treated with spironolactone.Methods
We performed a case control study of heart failure patients treated with spironolactone in our clinical practice. Cases were patients who developed hyperkalemia (K+ >5.0 mEq/L) or renal insufficiency (Cr ≥2.5 mg/dL), and they were compared to 2 randomly selected controls per case. Clinical characteristics, medications, and serum chemistries at baseline and follow-up time periods were compared.Results
Sixty-seven of 926 patients (7.2%) required discontinuation of spironolactone due to hyperkalemia (n = 33) or renal failure (n = 34). Patients who developed hyperkalemia were older and more likely to have diabetes, had higher baseline serum potassium levels and lower baseline potassium supplement doses, and were more likely to be treated with β-blockers than controls (n = 134). Patients who developed renal insufficiency had lower baseline body weight and higher baseline serum creatinine, required higher doses of loop diuretics, and were more likely to be treated with thiazide diuretics than controls.Conclusions
Spironolactone-induced hyperkalemia and renal insufficiency are more common in our clinical experience than reported previously. This difference is explained by patient comorbidities and more frequent use of β-blockers. 相似文献16.
Arnold Piek Wouter C. Meijers Nicolas F. Schroten Ron T. Gansevoort Rudolf A. de Boer Herman H.W. Silljé 《Journal of cardiac failure》2017,23(1):12-19
Background
The novel biomarker human epididymis protein 4 (HE4) shows prognostic value in acute heart failure (HF) patients. We measured HE4 levels in patients with chronic heart failure (CHF) and correlated them to HF severity, kidney function, and HF biomarkers, and determined its predictive value.Methods
Serum HE4 levels in patients (n?=?101) with stable CHF with reduced left ventricular ejection fraction (LVEF <45%) from the Vitamin D CHF (VitD-CHF) study (NCT01092130) were compared with those in age- and sex-matched healthy control subjects (n?=?58) from the Prevention of Renal and Vascular End-Stage Disease (PREVEND) study.Results
HE4 levels were higher in CHF compared with control subjects (69.2 pmol/L [interquartile range 55.6-93.8] vs 56.1 pmol/L [46.6-69.0]; P?<?.001) and were higher with increasing New York Heart Association functional class. Levels were associated with HF risk factors, including age, gender, diabetes, smoking and N-terminal prohormone of B-type natriuretic peptide (NT-proBNP). HE4 demonstrated strong associations with kidney function and HF fibrosis biomarkers. In a multivariable model, we identified creatinine, NT-proBNP, galectin-3, high-sensitive troponin T, and smoking as factors associated with HE4. Independently from these factors, HE4 levels predicted death and HF rehospitalization (5-year follow-up, hazard ratio 3.8; confidence interval 1.31–11.1; P?=?.014).Conclusions
HE4 levels are increased in CHF, correlate with HF severity and kidney function, and predict HF outcome. 相似文献17.
Yingying Chen Peng Liu Xia Chen Yanan Li Fengmei Zhang Yangang Wang 《The American journal of the medical sciences》2018,355(5):418-424
Background
There is a lack of research on the effect of low dose of angiotensin receptor blockers combined with spironolactone, and the effect of high dose of angiotensin receptor blockers alone on the urinary albumin excretion rate (UAER) in elderly patients with early type 2 diabetic nephropathy (DN).Methods
We conducted a prospective, randomized, open-label, parallel-controlled study that included 244 elderly patients with early DN and mild-to-moderate essential hypertension. Patients were randomly divided into 4 groups: low-dose irbesartan (group A), high-dose irbesartan (group B), low-dose irbesartan combined with spironolactone (group C) and high-dose irbesartan combined with spironolactone (group D). Changes in UAER, serum potassium and blood pressure were compared.Results
There were no statistical differences in the baseline characteristics among groups. Furthermore, no significant difference in blood pressure before and after treatment was found among different groups. After 72-week treatment, UAER in group D was lower compared to group A and B (P < 0.05). Meanwhile, compared with group B, UAER in group C decreased significantly (P < 0.05). Additionally, significantly higher serum potassium was found in group D compared to other groups (P < 0.05). Also, group D had the highest count of patients who withdrew from the study due to hyperkalemia compared to other groups (P < 0.05).Conclusions
Our results indicate high-dose irbesartan combined with spironolactone may be more efficient in reducing UAER in elderly patients with early DN, but this treatment could cause hyperkalemia. Low-dose irbesartan combined with spironolactone was shown to be safer and more effective in decreasing UAER compared to high-dose irbesartan. 相似文献18.
Sorel Goland Vladimir NaugolnyZila Korbut Izabella RozenAbraham Caspi Steven Malnick 《European Journal of Internal Medicine》2011,22(4):424-427
Objectives
The widespread use of spironolactone in patients with congestive heart failure (CHF) has resulted in side effects and complications. We analyzed a cohort of patients treated by a dedicated CHF team, in order to examine the tolerability and safety of spironolactone in clinical practice.Methods
We retrospectively evaluated data on 157 patients who were followed by the Heart Failure clinic of whom 100 patients on maximal treatment (all on β blockers, 99% on ACE inhibitors) received spironolactone. The complications following spironolactone use were defined as: hyperkalemia with serum K 5.2 mEq/l; creatinine 2.0 mg/dl; hyponatremia with serum Na 135 mEq/l, hypotension and side effects such as gynecomastia and abdominal pain.Results
At 1 year follow-up 6 patients developed hyperkalemia (range 5.3-5.9), 4 of them had K > 5.5 mEq/l. Two patients developed hyponatremia. Six patients stopped spironolactone for: 1-gynecomastia, 2-worsening renal failure and hyperkalemia, 2-hyperkalemia (5.9 mEq/l) and 1 for bradycardia. There was an increase in mean creatinine level at 1 year (1.12 ± 0.35 vs. 1.21 ± 0.38 mg/dl, p = 0.02), however, no significant changes were found in GFR (99.9 ± 33.5 vs. 65.7 ± 27.7 ml min− 1 1.73 m− 2, p = ns) and potassium (4.5 ± 0.4 vs. 4.6 ± 0.5 mEq/l, p = ns). We found improvement of GFR by > 10% in 19 patients and worsening by > 10% in 38 patients. No patient was hospitalized or required urgent treatment for spironolactone-related side effects.Conclusions
In patients with CHF on optimal therapy with ACE inhibitors and β blockers appropriate spironolactone use and close follow-up by a dedicated HF team can minimize the risk for adverse events and complications. 相似文献19.
20.
Naoki Sato Carolyn S.P. Lam John R. Teerlink Barry H. Greenberg Hiroyuki Tsutsui Byung-Hee Oh Jian Zhang Martin Lefkowitz Tsushung A. Hua Thomas Holbro Miriam Marshood Xing Li Wang Junbo Ge 《Journal of cardiac failure》2017,23(1):63-71