共查询到20条相似文献，搜索用时 15 毫秒
1.
Liza Grosman-Rimon Prabjit Ajrawat Jocelyn Lioe Laura C. Tumiati Vivek Rao Filio Billia Andrzej Chruscinski 《Journal of cardiac failure》2019,25(4):301-306
Background
Left ventricular assist devices (LVADs) can serve as a bridge to transplant or destination therapy for patients with advanced heart failure. Implantation of LVADs is known to be associated with increases in anti-HLA antibodies, but less is known about how autoantibody levels change with the use of these devices.Methods and Results
Autoantibody levels were quantified with the use of customized antigen microarrays in 22 patients both before and after LVAD. We observed an increase (1.5- to 2-fold) in 14 IgG autoantibodies in the serum of patients after LVAD, including autoantibodies against cardiac proteins (myosin, troponin I, tropomyosin), DNA, and structural proteins (collagen, laminin). There was also a small but significant rise in total serum IgG after LVAD. Increases in autoantibodies after LVAD were positively associated with increases in calculated panel-reactive antibody class II (P?=?.05) and negatively correlated with age (r?=??0.45; P < .05). Cytokines were evaluated to gain insights into the mechanism of antibody generation, and we observed a positive correlation between total IgG levels after LVAD and the level of monocyte chemoattractant protein 1 (r?=?0.60; P < .05).Conclusions
LVAD implantation is associated with increases in IgG autoantibodies, anti-HLA antibodies, and total IgG. Increases in IgG after LVAD implantation may relate to an inflammatory response triggered by these devices. 相似文献2.
Noelle V. Pavlovic Tania Randell Tim Madeira Steven Hsu Radoslav Zinoviev Martha Abshire 《Heart & lung : the journal of critical care》2019,48(2):90-104
Background
Left ventricular assist devices (LVADs) improve quality of life in end-stage heart failure but can cause serious complications such as infections with driveline infection causing significant morbidity and mortality.Objectives
The purpose of this systematic literature review is to synthesize the literature to determine variables associated with driveline infection and seek opportunities to improve nursing management of LVAD drivelines.Methods
A systematic literature review was performed. The evidence was synthesized using the Johns Hopkins Nursing Evidence-Based Practice tools and the Chain of Infection epidemiological framework.Results
Thirty-four studies focused on vulnerable host, portal of entry, and causative organism aspects of the Chain of Infection. Increased BMI, younger age, exposed driveline velour showed increased risk of infection and driveline dressing protocol change showed lower risk of infection.Conclusions
Although some risk factors for infection were identified, evidence is still limited. Nurses are uniquely positioned to improve driveline management, disrupting the chain of infection. 相似文献3.
Quan M. Bui Oscar O. Braun Michela Brambatti Yan K. Gernhofer Holly Hernandez Victor Pretorius Eric Adler 《Heart & lung : the journal of critical care》2019,48(2):85-89
Background
The Stanford integrated psychosocial assessment for transplantation (SIPAT) is a validated psychosocial evaluation tool in the transplant population.Objective
We evaluated SIPAT in predicting post-left ventricular assist device (LVAD) outcomes, including cumulative re-admissions, driveline infections, pump malfunction, pump thrombosis, gastrointestinal bleeding, major bleeding, stroke and right ventricular failure.Methods
This retrospective study included 50 LVAD patients at an academic institution in the United States who had a pre-implant SIPAT score during the years 2015-2017. Patients were split into two groups based on SIPAT score, separating a “excellent”/“good” from a “minimally acceptable”/“poor” candidate. Poisson regression, using SIPAT as both a categorical and continuous variable, was used to compare the incidence rates of the primary outcome of cumulative re-admissions and secondary outcomes of LVAD complications.Results
The patient cohort was predominantly male 93.5% vs 89.4% (p = 0.629) with a median age of 67.0 vs 58.0 years (p = 0.037), planned destination therapy 48.4% vs 68.4% (p = 0.242) and median LVAD follow-up time of 241 vs 379 days (p = 0.10) in the low- and high- SIPAT groups, respectively. SIPAT was not a significant predictor for cumulative re-admissions, but there was an association between higher SIPAT scores and major bleeding.Conclusion
In this single-center retrospective study, SIPAT did not predict cumulative re-admissions. Further study is required to validate SIPAT before clinical implementation. 相似文献4.
Ellie J. Coromilas Koji Takeda Masahiko Ando Marisa Cevasco Phillip Green Dimitri Karmpaliotis Ajay Kirtane Veli K. Topkara Melana Yuzefpolskaya Hiroo Takayama Yoshifumi Naka Daniel Burkhoff Paolo C. Colombo A. Reshad Garan 《Journal of cardiac failure》2019,25(2):105-113
Background
Early right ventricular (RV) failure after left ventricular assist device (LVAD) implantation increases morbidity and mortality. Percutaneous right ventricular assist device (pRVAD) support is an alternative to more invasive surgical RVAD (sRVAD).Methods and Results
We retrospectively reviewed patients receiving isolated pRVAD or sRVAD after durable LVAD at our center in the years 2007–2018. Hemodynamic parameters before and after implantation and survival outcomes were compared among groups. Nineteen patients received pRVAD and 21 sRVAD. Hemodynamic parameters improved immediately with the use of pRVAD; central venous pressure decreased (from 15.9 ± 2.4 to 12.3 ± 3.2 mm Hg; P<.001) and cardiac index increased (from 2.4 ± 0.5 to 3.5 ± 0.8 L·min?1·m?2; P<.001). These were sustained after device removal and were similar to those with the use of sRVAD. Patients with pRVAD required fewer blood transfusions and mechanically ventilated days than those with sRVAD. Among survivors, intensive care unit and hospital days were fewer with the use of pRVAD: 21 (16–27) versus 34 (27–46) ICU days (P?=?.01); 43.5 (30–66) versus 91 (62–111) hospital days (P?=?.03). There was no significant difference in 30-day mortality with the use of pRVAD compared with sRVAD (21.1% vs 42.9%; P?=?.14), but there was a trend toward a higher rate of discharge free from hemodialysis (73.7% vs 47.6%; P?=?.09).Conclusions
Novel pRVAD systems for RV failure provide hemodynamic benefits similar to sRVAD, are associated with less morbidity, and should be considered as an alternative to sRVAD. 相似文献5.
Zachary Boivin Mario F. Perez Nkiruka C. Atuegwu Antonio Anzueto Eric M. Mortensen 《The American journal of the medical sciences》2019,357(4):296-301
Background
Prior research has demonstrated high mortality rates in patients with cirrhosis who contract bacterial infections. The purpose of our study was to explore clinical outcomes such as 90-day mortality, rehospitalization, and intensive care unit (ICU) admission in older veterans with pneumonia and cirrhosis.Methods
We conducted a retrospective cohort study of hospitalized patients with community-acquired pneumonia at any Departments of Veterans Affairs (VA) hospital over a 10-year period. We included patients 65 years or older who consistently received VA care and who were diagnosed with community-acquired pneumonia. There were 103,997 patients who met the inclusion criteria, and 1,246 patients with cirrhosis. We used multilevel regression models to examine the association between cirrhosis and the outcomes of interest after controlling for potential confounders.Results
Cirrhosis was associated with significantly increased odds of 90-day mortality (odds ratio 1.79, 95% confidence interval, 1.57-2.04). There were also significantly increased odds of rehospitalization within 90-days (1.30, 1.16-1.47). No significant association was found with ICU admission (1.00, 0.83-1.19).Conclusions
We found an association between cirrhosis and 90-day mortality and rehospitalization in older patients with pneumonia. We suggest that physicians should carefully monitor patients with cirrhosis who develop pneumonia. 相似文献6.
Adelita Tinoco David W. Mortara Xiao Hu Cass Piper Sandoval Michele M. Pelter 《Heart & lung : the journal of critical care》2019,48(2):114-120
Background
Cheyne-Stokes respiration and periodic breathing (CSRPB) have not been studied sufficiently in the intensive care unit setting (ICU).Objectives
To determine whether CSRPB is associated with adverse outcomes in ICU patients.Methods
The ICU group was divided into quartiles by CSRPB (86 patients in quartile 1 had the least CSRPB and 85 patients in quartile 4 had the most CSRPB). Adverse outcomes (emergent intubation, cardiorespiratory arrest, inpatient mortality and the composite of all) were compared between patients with most CSRPB (quartile 4) and those with least CSRPB (quartile 1).Results
ICU patients in quartile 4 had a higher proportion of cardiorespiratory arrests (5% versus 0%, (p=.042), and more adverse events over all (19% versus 8%, p=.041) as compared to patients in quartile 1.Conclusions
CSRPB can be measured in the ICU and it's severity is associated with adverse outcomes in critically ill patients. 相似文献7.
Stefanos Despotopoulos Anastasios Roumeliotis Nicholas G. Kounis Grigorios Tsigkas George Hahalis Periklis Davlouros 《Heart & lung : the journal of critical care》2019,48(2):138-140
Background
Kounis syndrome is a systemic complication following an allergic reaction, presenting with coronary artery spasm or thrombosis and occasionally with stent thrombosis that can have fatal outcome.Objectives
Heparins can induce allergic reactions via tissue antigenicity, heparin induced thrombocytopenia and contact system-activating effects of contaminants but allergy bivalirudin has not been reported so far.Methods
Herein, we describe a patient with fatal acute coronary in-stent thrombosis following an allergic reaction soon after an intra-arterial heparin dose and intravenous administration of bivalirudin during angioplasty.Results
The patient received intense myocardial infarction protocol treatment including angioplasty and defibillation together with antiallergic therapy but despite all of these efforts and measures, he succumbed 2 h later.Conclusions
Significant suspicion should be raised that life saving drugs such as heparin and bivalirudin could join forces with concurrent medication acting as antigens and induce fulminant and fatal stent thrombosis as a manifestation of Kounis syndrome 相似文献8.
Antonia Scobie Sanch Kanagarajah Ross J. Harris Lisa Byrne Corinne Amar Kathie Grant Gauri Godbole 《The Journal of infection》2019,78(3):208-214
Listeriosis
is a foodborne illness that can result in septicaemia, Central Nervous System (CNS) disease, foetal loss and death in high risk patients.Objectives
To analyse the demographic trends, clinical features and treatment of non-perinatal listeriosis cases over a ten year period and identify mortality-associated risk factors.Methods
Reported laboratory-confirmed non-pregnancy associated cases of listeriosis between 2006 and 2015 in England were included and retrospectively analysed. Multivariate logistic regression analysis was performed to determine independent risk factors for mortality.Results
1357/1683 reported cases met the inclusion criteria. Overall all-cause mortality was 28.7%; however, mortality rates declined from 42.1% to 20.2%. Septicaemia was the most common presentation 69.5%, followed by CNS involvement 22.4%. CNS presentations were significantly associated with age?<?50 years, and septicaemia with older age. Age?>?80 years (OR 3.32 95% CI 1.92–5.74), solid-organ malignancy (OR 3.42 95% CI 2.29-5.11), cardiovascular disease (OR 3.30 95% CI 1.64–6.63), liver disease (OR 4.61 95% CI 2.47–8.61), immunosuppression (OR 2.12 95% CI 1.40-3.21) and septicaemia (OR 1.60 95% CI 1.17–2.20) were identified as independent mortality risk factors.Conclusions
High risk groups identified in this study should be the priority focus of future public health strategies aimed at reducing listeriosis incidence and mortality. 相似文献9.
Anna M. Nordenskjöld Bo Lagerqvist Tomasz Baron Tomas Jernberg Nermin Hadziosmanovic Harmony R. Reynolds Per Tornvall Bertil Lindahl 《The American journal of medicine》2019,132(3):335-346
Background
Myocardial infarction (MI) with nonobstructive coronary arteries (MINOCA) is common. There are limited data on the mechanisms and prognosis for reinfarction in MINOCA patients.Methods
In this observational study of MINOCA patients hospitalized in Sweden and registered in the SWEDEHEART registry between July 2003 and June 2013 and followed until December 2013, we identified 9092 unique patients with MINOCA of 199,163 MI admissions in total. The 570 (6.3%) MINOCA patients who were hospitalized due to a recurrent MI constituted the study group.Results
The mean age was 69.1 years and 59.1% were women. The median time to readmission was 17 months. A total of 340 patients underwent a new coronary angiography and 180 (53%) had no obstructive coronary artery disease (CAD) and 160 (47%) had obstructive CAD; 123 had 1-vessel, 26 had 2-vessel, 9 had 3-vessel disease, and 2 had left main together with 1-vessel disease. Male sex, diabetes, peripheral vascular disease, higher levels of creatinine, and ST elevation at presentation were more common in patients with MI with obstructive CAD than in patients with a recurrent MINOCA. Mortality during a median follow-up of 38 months was similar whether the reinfarction event was MINOCA or MI with obstructive CAD 13.9% vs 11.9% (P?=?.54).Conclusions
About half of patients with reinfarction after MINOCA who underwent coronary angiography had progression of coronary stenosis. Angiography should be strongly considered in patients with MI after MINOCA. Mortality associated with recurrent events was substantial, though there was no difference in mortality between those with or without significant CAD. 相似文献10.
Paul Welsh Olia Papacosta Sheena Ramsay Peter Whincup John McMurray Goya Wannamethee Naveed Sattar 《Journal of cardiac failure》2019,25(4):230-237
Objective
The aim of this work was to study the association of high-sensitivity troponin T (hsTnT) with incident heart failure (HF), and implications for its use in prediction models.Methods and Results
In the British Regional Heart Study, 3852 men aged 60–79years without baseline HF (3165 without baseline chronic heart disease) were followed for a median of 12.6years, during which 295 incident cases of HF occurred (7.7%). A 1-SD increase in log-transformed hsTnT was associated with a higher risk of incident HF after adjusting for classic risk factors (hazard ratio [HR] 1.58, 95% confidence interval [CI] 1.42–1.77) and after additional adjustment for N-terminal pro–B-type natriuretic peptide (NT-proBNP; HR 1.34, 95% CI 1.19–1.52). The strength of the association between hsTnT and incident HF did not differ by strata of other risk factors. An hsTnT concentration of <5ng/L had a sensitivity of 99.7% (95% CI 98.1%–99.9%) and a specificity of 3.4% (95% CI 2.8%–4.0%). A risk-prediction model including classic risk factors and NT-proBNP yielded a C-index of 0.791, but addition of hsTnT did not further improve prediction (P?=?.28).Conclusions
Elevated hsTnT is consistently associated with risk of HF in older men. HF occurred rarely over 12years when baseline hsTnT was below the limit of detection. hsTnT measurement, however, does not improve HF prediction in a model already containing NT-proBNP. 相似文献11.
Kohei Nozaki Kentaro Kamiya Yuya Matsue Nobuaki Hamazaki Ryota Matsuzawa Shinya Tanaka Emi Maekawa Takuya Kishi Atsuhiko Matsunaga Takashi Masuda Toru Izumi Junya Ako 《Journal of cardiac failure》2019,25(3):156-163
Background:
Autonomic function can be evaluated based on the pupillary light reflex (PLR). However, the relationship between PLR and prognosis in patients with heart failure (HF) remains unclear. This study was performed to examine whether PLR could be used as a prognostic indicator in patients with HF.Methods and Results:
A retrospective review was performed in 535 consecutive Japanese patients hospitalized for acute HF (mean age 66.1 ± 13.7 y). PLR was recorded at least 7 days after hospitalization for HF with the use of a pupilometer. Fifty-three patients died over a median follow-up period of 1.3 years (interquartile range 0.6–2.3 y). After adjustment for several preexisting prognostic factors, including Seattle Heart Failure Score (SHFS), PLR as assessed by recovery time (time to 63% redilation) was independently associated with all-cause mortality (hazard ratio 0.50, 95% confidence interval 0.35–0.73; P < .001). The addition of recovery time to SHFS resulted in a significant increase in the area under the curve on receiver-operating characteristic curve analysis (0.69 vs 0.77; P < .001).Conclusions:
PLR assessed by recovery time was an independent predictor of mortality and added prognostic information to the SHFS in patients with HF. Our results suggest that PLR may be useful as a new prognostic marker in HF patients. 相似文献12.
Babak Hooshmand Minna Rusanen Tiia Ngandu Jaana Leiviskä Shireen Sindi Christine A.F. von Arnim Peter Falkai Hilkka Soininen Jaakko Tuomilehto Miia Kivipelto 《The American journal of medicine》2019,132(3):367-373
Purpose
The aim of this study was to examine the association of serum glucose, insulin, and insulin resistance with cognitive functioning 7 years later in a longitudinal population-based study of Finnish older adults.Methods
Serum glucose and insulin were measured at baseline in 269 dementia-free individuals aged 65-79 years, from the Cardiovascular Risk Factors, Aging, and Dementia (CAIDE) study. Insulin resistance was estimated with the homeostasis model assessment (HOMA-IR). Participants were reexamined 7 years later, and global cognition, episodic memory, executive functioning, verbal expression, and psychomotor speed were assessed, both at baseline and at follow-up. Multiple linear regression was used to investigate the associations with cognitive performance at follow-up, after adjusting for several potential confounders, including common vascular risk factors.Results
In the multivariable-adjusted linear regression models, no associations of insulin resistance with cognitive functioning were observed. After excluding 19 incident dementia cases, higher baseline HOMA-IR values were related to worse performance in global cognition (β [standard error (SE)] -.050 [0.02]; P?=?.043) and psychomotor speed (β [SE] -.064 [.03]; P?=?[.043]) 7 years later. Raised serum insulin levels were associated with lower scores on global cognition (β [SE] -.054 [.03]; P?=?.045) and tended to relate to poorer performance in psychomotor speed (β [SE] -.061 [.03]; P?=?.070).Conclusions
Serum insulin and insulin resistance may be independent predictors of cognitive performance 7 years later in elderly individuals without dementia. Randomized controlled trials are needed to determine this issue. 相似文献13.
Gary P. Wormser Kitae Park Colby Madison Julia Rozenberg Donna McKenna Carol Scavarda Carol Karmen Rhea Dornbush Paul Visintainer 《The American journal of medicine》2019,132(4):519-524
Background
The Beck Depression Inventory (BDI-II) may be used to evaluate individuals for symptoms of depression.Methods
In a 1-year prospective study, 52 adult Lyme disease patients with erythema migrans and 104 matched control subjects were clinically assessed and completed the BDI-II at study entry and approximately 6 and 12 months later following antibiotic treatment.Results
The mean BDI-II score was significantly higher at the baseline visit among Lyme disease patients compared with controls (P?=?.002), but no significant differences between the groups were observed at either the 6- or 12-month study visits. Over the course of the study, the mean BDI-II scores decreased an average of approximately 0.22 points per month (P < .0005) for Lyme disease patients, whereas the mean scores changed very little for controls (mean change?=??0.02 per month, P?=?.50). The total number of somatic symptoms, of the 12 symptoms evaluated, strongly and directly correlated with the BDI-II scores at the baseline visit for the Lyme disease patients.Conclusions
The mean BDI-II scores of patients with early Lyme disease significantly exceeded that of matched controls at study entry, but by 6 months the values did not differ significantly. There was a good-to-excellent direct correlation between the BDI-II score and the total number of symptoms, suggesting that the BDI-II scores were reflecting somatic rather than affective depressive symptoms. When using the BDI-II as an assessment tool of patients with Lyme disease, infection-related somatic symptoms per se need to be considered in the interpretation of the results. 相似文献14.
Stephan Neidhardt Jens Garbade Fabian Emrich Kristin Klaeske Michael A. Borger Sven Lehmann Khalil Jawad Maja-Theresa Dieterlen 《Journal of cardiac failure》2019,25(3):204-212
Background
Oxidative stress due to reactive oxygen species (ROS) production is a key factor in the development of heart failure (HF). This study investigated the thioredoxin (Trx) system, which plays a major role in antioxidant defense, in patients suffering from ischemic (ICM) or dilated (DCM) cardiomyopathy.Methods and Results
Myocardial tissue from ICM (n?=?13) and DCM (n?=?13) patients, as well as septal tissue of patients with aortic stenosis but without diagnosed hypertrophic cardiomyopathy or subaortic stenosis (control; n?=?12), was analyzed for Trx1, Trx-interacting protein (TXNIP) and E3 ligase ITCH (E3 ubiquitin-protein ligase Itchy homolog) expression. Trx-reductase 1 (TXNRD1) amount and activity, cytosolic cytochrome C content, and apoptosis markers were quantified by means of enzyme-linked immunosorbent assay and multiplexing. Compared with control samples, ITCH and Trx1 expression, TXNRD1 amount and activity were reduced and TXNIP expression was increased in ICM (ITCH: P?=?.013; Trx1: P?=?.028; TXNRD1 amount: P?=?.035; TXNRD1 activity: P?=?.005; TXNIP: P?=?.014) but not in DCM samples. A higher level of the downstream apoptosis marker caspase-9 (ICM: 582 ± 262 MFI [P?=?.995]; DCM: 1251 ± 548 MFI [P?=?.002], control: 561 ± 214 MFI) was detected in DCM tissue. A higher expression of Bcl-2 was found in DCM (P?=?.011).Conclusion
The Trx system was impaired in ICM but not in DCM. ITCH appeared to be responsible for the down-regulation of the Trx system. ROS-induced mitochondrial instability appeared to play a role in DCM. 相似文献15.
Rushi V. Parikh Kiran Khush Vedant S. Pargaonkar Helen Luikart David Grimm Michelle Yu Kozo Okada Yasuhiro Honda Alan C. Yeung Hannah Valantine William F. Fearon 《Journal of cardiac failure》2019,25(2):97-104
Background
Endothelin-1 (ET-1) has been implicated in the development of post–heart transplantation (HT) cardiac allograft vasculopathy (CAV), but has not been well studied in humans.Methods and Results
In 90 HT patients, plasma ET-1 was measured within 8 weeks after HT (baseline) via a competitive enzyme-linked immunosorbent assay. Three-dimensional volumetric intravascular ultrasound of the left anterior descending artery was performed at baseline and at 1 year. Accelerated CAV (lumen volume loss) was defined with the 75th percentile as a cutoff. Patients were followed beyond the first year after HT for late death or retransplantation. A receiver operating characteristic (ROC) curve demonstrated that a baseline ET-1 concentration of 1.75 pg/mL provided the best accuracy for diagnosis of accelerated CAV at 1 year (area under the ROC curve 0.69, 95% confidence interval [CI] 0.57–0.82; P?=?.007). In multivariate logistic regression, a higher baseline ET-1 concentration was independently associated with accelerated CAV (odds ratio [OR] 2.13, 95% CI 1.15–3.94; P?=?.01); this relationship persisted when ET-1 was dichotomized at 1.75 pg/mL (OR 4.88, 95% CI 1.69–14.10; P?=?.003). Eighteen deaths occurred during a median follow-up period of 3.99 (interquartile range 2.51–9.95) years. Treated as a continuous variable, baseline ET-1 was not associated with late mortality in multivariate Cox regression (hazard ratio [HR] 1.22, 95% CI 0.72–2.05; P?=?.44). However, ET-1 >1.75 pg/mL conferred a significantly lower cumulative event-free survival on Kaplan-Meier analysis (P?=?.047) and was independently associated with late mortality (HR 2.94, 95% CI 1.12–7.72; P?=?.02).Conclusions
Elevated ET-1 early after HT is an independent predictor of accelerated CAV and late mortality, suggesting that ET-1 has durable prognostic value in the HT arena. 相似文献16.
Juan Jiang Chengping Hu Yuanyuan Li Pinhua Pan Xiaoli Su Pengbo Deng Junpu Wang Xiaoying Wu 《The American journal of the medical sciences》2019,357(4):289-295
Background
Severe pneumonia is responsible for great mortality and morbidity worldwide, and early-applied effective anti-infective therapy can improve the prognosis of patients. However, identification of infectious agents in severe pneumonia remains a major challenge so far. In this study, the potential utility of transmission electron microscopy (TEM) in detecting nonbacterial pathogens in patients with severe pneumonia was retrospectively evaluated.Materials and Methods
A total of 106 patients diagnosed with severe pneumonia at our hospital from September 2015 to December 2017 were included, and their baseline clinical characteristics were collected. Nonbacterial infectious agents detected by TEM in bronchoalveolar lavage fluid (BALF) and serological tests were summarized. The detection rates were further compared between TEM and serological tests.Results
BALF examination under the transmission electron microscope revealed 24 viruses, 16 mycoplasmas, 18 chlamydia, 2 fungi and 74 bacteria in 99 samples, among which 61 samples were mixed infections. The combined use of serological tests and TEM significantly improved the detection rate of nonbacterial infectious agents in patients with severe pneumonia.Conclusions
Our data support that implementation of TEM could improve the sensitivity for detecting viruses, atypical pathogens and mixed infections in BALF from patient of severe pneumonia. Therefore, TEM may be used as an auxiliary diagnostic method of other microbiological tests in severe pneumonia. 相似文献17.
Yu Sato Akiomi Yoshihisa Yusuke Kimishima Takatoyo Kiko Yuki Kanno Tetsuro Yokokawa Satoshi Abe Tomofumi Misaka Takamasa Sato Masayoshi Oikawa Atsushi Kobayashi Takayoshi Yamaki Hiroyuki Kunii Kazuhiko Nakazato Yasuchika Takeishi 《Journal of cardiac failure》2019,25(3):195-203
Background
We aimed to clarify the prognosis and pathophysiological parameters of low T3 syndrome in patients with heart failure (HF).Methods and Results
Hospitalized patients with HF and euthyroidism (n?=?911) were divided into 2 groups on the basis of free triiodothyronine (FT3) serum levels: the normal FT3 group (FT3 ≥2.3 pg/mL; n?=?590; 64.8%) and the low FT3 group (FT3 <2.3 pg/mL; n?=?321; 35.2%). We compared post-discharge cardiac and all-cause mortality by means of Kaplan-Meier analysis and Cox proportional hazard analysis, and the parameters of echocardiography and cardiopulmonary exercise testing by means of Student t test. In the follow-up period of median 991 (interquartile range 534-1659) days, there were 193 all-cause deaths, including 88 cardiac deaths. Cardiac and all-cause mortality were higher in the low FT3 group (log-rank P < .01). Low FT3 was a predictor of cardiac death (hazard ratio 1.926, 95% confidence interval [CI] 1.268–2.927; P?=?.002) and all-cause death (hazard ratio 2.304, 95% CI 1.736–3.058; P < .001). Although left ventricular ejection fraction was similar between the groups, the low FT3 group showed lower peak VO2 (13.6 ± 4.6 vs 16.6 ± 4.4 mL·kg?1·min,?one P < .001) and higher VE/VCO2 slope (36.5 ± 8.2 vs 33.0 ± 7.5; P?=?.001).Conclusion
Low T3 syndrome in patients with HF is associated with higher cardiac and all cause-mortality. 相似文献18.
Hassan Khan Stefan D. Anker James L. Januzzi Darren K. McGuire Naveed Sattar Hans Juergen Woerle Javed Butler 《Journal of cardiac failure》2019,25(2):78-86
Background
Epidemiology of patients with comorbid heart failure (HF) and diabetes mellitus (DM) without coronary heart disease (CHD) is not well described.Methods and Results
We assessed HF incidence and outcomes in 2896 participants of the Health ABC Study (age 74.0 ± 3.0 years, 48.4% men, 41.1% black, 34.6% with DM) in relation to prio DM and CHD status. During a median follow-up of 11.4 years, 484 participants (16.7%) developed incident HF; 214 (44.2%) had DM of whom 71 (33.1%) had no prio CHD. Incident HF rate was 2.5% per 100 person-years in those with and 1.5% in those without DM (hazard ratio [HR] 1.66, 95% CI 1.39–1.99). In those with DM, incident HF rate was 4.6% in those with and 1.3% in those without CHD (HR 3.75, 95% CI 2.81–4.99). During a median follow-up of 2.1 years after HF onset, 329 (68.0%) of the participants died. Amongst those with DM, annual mortality was 22.6% in those with versus 25.9% without CHD (HR 0.86, 95% CI 0.61–1.22). All-cause hospitalizations after incident HF in DM patients were 55.0 per 100 person-years in those with and 33.3 in those without CHD (rate ratio [RR] 1.64, 95% CI 1.24–2.16); HF hospitalizations were 42.7 and 30.7 per 100-person years (RR 1.39, 95% CI 1.03–1.86) in those with and without CHD. Reduced ejection fraction was seen in 49.6% of HF patients with DM and CHD and in 34.7% of those without CHD (P?=?.08); mortality but not hospitalization risk tended to be lower in those with reduced compared with preserved ejection fraction regardless of CHD status.Conclusions
A sizeable proportion of HF in patients with DM develops in the absence of prior CHD; these patients are at risk for mortality similar to those with CHD. These data underscore the importance of modulating risk beyond atherosclerosis in patients with comorbid HF and DM. 相似文献19.
Hajime Kataoka 《Journal of cardiac failure》2019,25(3):213-217
Background
Optimal vascular volume is required to avoid organ dysfunction during decongestive therapy for worsening heart failure (HF). This study investigated the relation between changes in serum substance(s) and the vascular volume after diuresis in HF patients.Methods and Results
Data from 47 patients with HF undergoing conventional diuretic therapy were analyzed. Blood tests included measurements of hemoglobin, hematocrit, and serum albumin/solutes. The relative changes in the plasma volume (%PV) from worsening HF to recovery were determined with the use of the Strauss formula. When divided into 2 groups based on the median %PV, the group with preserved volume (%PV ≥ ?10%, range ?10% to 21%; n?=?23) exhibited a smaller decrease in body weight (?2.50 ± 1.98 vs ?4.29 ± 2.60 kg; P?=?.012) and serum sodium (Na) (?1.57 ± 3.29 vs ?4.13 ± 4.96 mEq/L; P?=?.04) and chloride (Cl) (?2.0 ± 4.06 vs ?6.79 ± 5.21 mEq/L; P?=?.001) concentrations and a smaller increase in albumin (0.20 ± 0.28 vs 0.41 ± 0.24g/dL; P?=?.009) compared with the group with nonpreserved volume (%PV < ?11%, range ?33% to ?11%; n?=?24) after decongestive therapy. Changes in %PV were positively correlated with changes in body weight (r?=?0.406; P?=?.0047) and serum Na (r?=?0.433; P?=?.0024) and Cl (r?=?0.408; P?=?.0044) concentrations and negatively correlated with changes in albumin (r?=??0.492; P?=?.0004), blood urea nitrogen (r?=??0.306; P?=?.037), and creatinine (r?=??0.306; P?=?.036). Multivariate logistic regression analysis demonstrated an independent association between preserved %PV and an increased or preserved serum Cl concentration after decongestive therapy (odds ratio 8.71, 95% confidence interval 1.20–63.0; P?=?.032).Conclusions
Positive and independent association exists between change in the vascular volume and the serum Cl concentration under decongestive HF therapy. 相似文献20.
Daniel Modin Morten Sengeløv Peter Godsk Jørgensen Flemming Javier Olsen Niels Eske Bruun Thomas Fritz-Hansen Ditte Madsen Andersen Jan Skov Jensen Tor Biering-Sørensen 《Journal of cardiac failure》2019,25(2):87-96