Hemoconcentration is a good prognostic predictor for clinical outcomes in acute heart failure: Data from the Korean Heart Failure (KorHF) Registry

Background

Hemoconcentration is a surrogate marker of effective decongestion and diuresis therapy. Recently, hemoconcentration has been associated with decreased mortality and rehospitalization in heart failure (HF) patients. However, the prognostic power of hemoconcentration in a large sample-sized HF cohort was limited until now.

Methods and results

We analyzed data from hospitalized patients with acute heart failure (AHF) that were enrolled in the Korean Heart Failure Registry(n = 2,357). The primary end point was a composite of all-cause mortality and HF rehospitalization during the follow-up period (median = 347, interquartile range = 78–744 days).Hemoconcentration, defined as an increased hemoglobin level between admission and discharge, was presented in 1,016 AHF patients (43.1%). In multivariable logistic regression, hemoglobin, total cholesterol, and serum glucose levels at admission, and ischemic HF, were significant determinants for hemoconcentration occurrence. The Kaplan–Meier curve showed that event-free survival was significantly higher in the hemoconcentration group compared to the non-hemoconcentration group (65.1% vs. 58.1%, log rank p < 0.001). In multiple Cox proportional hazard analysis, hemoconcentration was an independent predictor of the primary end point after adjusting for other HF risk factors (hazard ratio = 0.671, 95% confidence interval = 0.564–0.798, p < 0.001).

Conclusions

Hemoconcentration during hospitalization was a prognostic marker of fewer clinical events in the AHF cohort. Therefore, this novel surrogate marker will help in the risk stratification of AHF patients.     

Prognostic implications of arterial blood gases in acute decompensated heart failure

Background

The prognostic value of arterial blood gases (ABG) in patients with acute decompensated heart failure (ADHF) is not well-established. We therefore conducted the present study to determine the relationship between ABG on admission and long-term mortality in patients with ADHF.

Methods

We studied 588 patients consecutively admitted to our department with ADHF. ABG and classical prognostic variables were determined at patients' arrival to the emergency department. The independent association among the main variables of ABG (pO2, pCO2 and pH) and mortality was assessed with Cox regression analysis.

Results

At a median follow-up of 23 months, 221 deaths (37.6%) were registered. 308 (52.4%), 54 (9.2%) and 50 (8.5%) patients showed hypoxemia (pO2 < 60 mm Hg), hypercapnia (pCO2 > 50 mm Hg) and acidosis (pH < 7.35), respectively. Patients with hypoxemia, hypercapnia and acidosis did not show higher mortality rates (38% vs. 37.1%, 42.6% vs. 37.1%, and 48% vs. 36.6%, respectively; p-value = ns for all comparisons). In multivariate analysis, after adjusting for well-known prognostic covariates, pO2, pCO2 and pH did not show a significant association with mortality. Hazard ratios (HR) for these variables were: pO2, per increase in 10 mm Hg: 0.99 (95% CI: 0.90–1.09), p = 0.861; pCO2, per increase in 10 mm Hg: 1.12 (95% CI: 0.91–1.39), p = 0.262; pH per increase in 0.1: 1.01 (95% CI: 0.99–1.04), p = 0.309. When dichotomizing these variables according to established cut-points, the HR were: hypoxemia (pO2 < 60 mm Hg):1.07 (95% CI: 0.81–1.40), p = 0.637; hypercapnia (pCO2 > 50 mm Hg): 0.98 (95% CI: 0.62–1.57), p = 0.952; acidosis (pH < 7.35): 1.38 (95% CI: 0.87–2.19), p = 0.173.

Conclusion

In patients admitted with ADHF, admission arterial pO2, pCO2 and pH were not associated with all-cause long-term mortality.     

动脉血气及脉搏氧饱和度监测在内科胸腔镜术中的应用

目的　研究动脉血气及脉搏氧饱和度监测在开放式胸腔镜术中的应用价值。方法　前瞻性监测 15例接受开放式胸腔镜术患者术前、术中、术后的呼吸、血压、心率、ECG、动脉血气、肺功能指标 ,并分析术中脉搏氧饱度变化及其与动脉血气指标的相关性及与手术并发症的关系。结果　 15例患者术前、术中、术后呼吸、脉搏、心率、血压、血气指标 (p H值、Pa O2 、Sa O2 、Pa CO2 )皆无明显变化 ,无显著统计学差异 (P>0 .0 5 ) ;15例患者中有 10例术中出现一过性 ECG变化。出现 ECG变化者术中 30 min BE高于未发生者 ,差异均有显著统计学意义(P<0 .0 5 ) ;心脏并发症的发生与术中 VC<1.0 L、FEV1 <0 .5 L 高度相关 (P<0 .0 5 )。结论　内科胸腔镜术中心脏并发症的发生与患者术中肺功能减低有关 ,单独监测动脉血气分析及脉搏氧饱和度对于预防内科胸腔镜术中心脏并发症的价值有限 ,必需结合肺功能指标进行评估。     

The prognostic impact of hyperglycemia on clinical outcomes of acute heart failure: Insights from the heart function assessment registry trial in Saudi Arabia

Background

The prognostic impact of hyperglycemia (HG) in acute heart failure (AHF) is controversial. Our aim is to examine the impact of HG on short- and long-term survival in AHF patients.

Acute coronary syndromes and acute heart failure: a diagnostic dilemma and high‐risk combination. A statement from the Acute Heart Failure Committee of the Heart Failure Association of the European Society of Cardiology

Acute coronary syndrome is a precipitant of acute heart failure in a substantial proportion of cases, and the presence of both conditions is associated with a higher risk of short‐term mortality compared to acute coronary syndrome alone. The diagnosis of acute coronary syndrome in the setting of acute heart failure can be challenging. Patients may present with atypical or absent chest pain, electrocardiograms can be confounded by pre‐existing abnormalities, and cardiac biomarkers are frequently elevated in patients with chronic or acute heart failure, independently of acute coronary syndrome. It is important to distinguish transient or limited myocardial injury from primary myocardial infarction due to vascular events in patients presenting with acute heart failure. This paper outlines various clinical scenarios to help differentiate between these conditions and aims to provide clinicians with tools to aid in the recognition of acute coronary syndrome as a cause of acute heart failure. Interpretation of electrocardiogram and biomarker findings, and imaging techniques that may be helpful in the diagnostic work‐up are described. Guidelines recommend an immediate invasive strategy for patients with acute heart failure and acute coronary syndrome, regardless of electrocardiographic or biomarker findings. Pharmacological management of patients with acute coronary syndrome and acute heart failure should follow guidelines for each of these syndromes, with priority given to time‐sensitive therapies for both. Studies conducted specifically in patients with the combination of acute coronary syndrome and acute heart failure are needed to better define the management of these patients.     

无创正压通气在急性左心衰治疗中的应用

目的探讨无创正压通气（NIPPV）在治疗急性左心衰竭的应用价值。方法将62例急性左心衰竭患者随机分为两组：对照组30例用常规治疗;NIPPV组32例在给予常规治疗基础上加用NIPPV治疗,比较两组治疗前后动脉血气分析、呼吸频率、心率、血压等指标。结果 NIPPV组患者呼吸频率、心率下降,动脉血氧分压（PaO2）上升,动脉二氧化碳分压（PaCO2）下降,治疗总有效率为93.75%（30/32）,对血压无明显影响;对照组治疗总有效率为70.00%（21/30）,两组临床疗效比较差异有统计学意义（P〈0.05）。结论急性左心衰竭时,在常规治疗的基础上联合NIPPV治疗效果显著。     

Worsening renal function in patients hospitalised for acute heart failure: clinical implications and prognostic significance

BACKGROUND: Renal function is a powerful prognostic variable in patients with heart failure (HF). Hospitalisations for acute HF (AHF) may be associated with further worsening of renal function (WRF). METHODS AND RESULTS: We analysed the clinical significance of WRF in 318 consecutive patients admitted at our institute for AHF. WRF was defined as the occurrence, at any time during the hospitalisation, of both a > or =25% and a > or =0.3 mg/dL increase in serum creatinine (s-Cr) from admission (WRF-Abs-%). RESULTS: Patients were followed for 480+/-363 days. Fifty-three patients (17%) died and 132 (41%) were rehospitalised for HF. WRF-Abs-% occurred in 107 (34%) patients. At multivariable survival analysis, WRF-Abs-% was an independent predictor of death or HF rehospitalisation (adjusted HR, 1.47; 95%CI, 1.13-1.81; p=0.024). The independent predictors of WRF-Abs-%, evaluated using multivariable logistic regression, were history of chronic kidney disease (p=0.002), LV ejection fraction (p=0.012), furosemide daily dose (p=0.03) and NYHA class (p=0.05) on admission. CONCLUSION: WRF is a frequent finding in patients hospitalised for AHF and is associated with a poor prognosis. Severity of HF and daily furosemide dose are the most important predictors of the occurrence of WRF.