Ischemia-modified albumin levels in patients with acute decompensated heart failure treated with dobutamine or levosimendan: IMA-HF study

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Snapshot evaluation of acute and chronic heart failure in real-life in Turkey: a follow-up data for mortality

Objective: Heart failure (HF) is a progressive clinical syndrome. SELFIE-TR is a registry illustrating the overall HF patient profile of Turkey. Herein, all-cause mortality (ACM) data during follow-up were provided. Methods: This is a prospective outcome analysis of SELFIE-TR. Patients were classified as acute HF (AHF) versus chronic HF (CHF) and HF with reduced ejection fraction (HFrEF), HF with mid-range ejection fraction, and HF with preserved ejection fraction and were followed up for ACM. Results: There were 1054 patients with a mean age of 63.3±13.3 years and with a median follow-up period of 16 (7–17) months. Survival data within 1 year were available in 1022 patients. Crude ACM was 19.9% for 1 year in the whole group. ACM within 1 year was 13.7% versus 32.6% in patients with CHF and AHF, respectively (p<0.001). Angiotensin-converting enzyme inhibitor/angiotensin receptor blocker, beta blocker, and mineralocorticoid receptor antagonist were present in 70.6%, 88.2%, and 50.7%, respectively. In the whole cohort, survival curves were graded according to guideline-directed medical therapy (GDMT) scores ?1 versus 2 versus 3 as 28% versus 20.2% versus 12.2%, respectively (p<0.001). Multivariate analysis of the whole cohort yielded age (p=0.009) and AHF (p=0.028) as independent predictors of mortality in 1 year. Conclusion: One-year mortality is high in Turkish patients with HF compared with contemporary cohorts with AHF and CHF. Of note, GDMT score is influential on 1-year mortality being the most striking one on chronic HFrEF. On the other hand, in the whole cohort, age and AHF were the only independent predictors of death in 1 yea

Current barriers and recommendations on the diagnosis of transthyretin amyloid cardiomyopathy: a Delphi study

ObjectivesThis study has been conducted to investigate the non-invasive diagnostic journey of patients with a transthyretin amyloid cardiomyopathy (aTTR-CM) in Turkey, identify the challenges and uncertainties encountered on the path to diagnosis from the perspectives of expert physicians, and develop recommendations that can be applied in such cases.MethodsThis study employed a three-round modified Delphi method and included 10 cardiologists and five nuclear medicine specialists. Two hematologists also shared their expert opinions on the survey results related to hematological tests during a final face-to-face discussion. A consensus was reached when 80% or more of the panel members marked the “agree/strongly agree” or “disagree/strongly disagree” option.ResultsThe panelists unanimously agreed that the aTTR-CM diagnosis could be established through scintigraphy (using either 99mTc-PYP, 99mTc-DPD, or 99mTc-HMPD) in a patient with suspected cardiac amyloidosis (CA) without a further investigation if AL amyloidosis is ruled out (by sFLC, SPIE and UPIE). In addition, scintigraphy imaging performed by SPECT or SPECT-CT should reveal a myocardial uptake of Grade ≥2 with a heart-to-contralateral (H/CL) ratio of ≥1.5. The cardiology panelists recommended using cardiovascular magnetic resonance (CMR) and a detailed echocardiographic scoring as a last resort before considering an endomyocardial biopsy in patients with suspected CA whose scintigraphy results were discordant/inconclusive or negative but still carried a high clinical suspicion of aTTR-CM.ConclusionThe diagnostic approach for aTTR-CM should be customized based on the availability of diagnostic tools/methods in each expert clinic to achieve a timely and definitive diagnosis

Post-discharge heart failure monitoring program in Turkey: Hit-PoinT

Objective: The aim of this study was to assess the efficacy and feasibility of an enhanced heart failure (HF) education with a 6-month telephone follow- up program in post-discharge ambulatory HF patients. Methods: The Hit-Point trial was a multicenter, randomized, controlled trial of enhanced HF education with a 6-month telephone follow-up program (EHFP) vs routine care (RC) in patients with HF and reduced ejection fraction. A total of 248 patients from 10 centers in various geographical areas were randomized: 125 to EHFP and 123 to RC. Education included information on adherence to treatment, symptom recognition, diet and fluid intake, weight monitoring, activity and exercise training. Patients were contacted by telephone after 1, 3, and 6 months. The primary study endpoint was cardiovascular death. Results: Although all-cause mortality didn't differ between the EHFP and RC groups (p=NS), the percentage of cardiovascular deaths in the EHFP group was significantly lower than in the RC group at the 6-month follow up (5.6% vs. 8.9%, p=0.04). The median number of emergency room visits was one and the median number of all cause hospitalizations and heart failure hospitalizations were zero. Twenty-tree percent of the EHFP group and 35% of the RC group had more than a median number of emergency room visits (p=0.05). There was no significant difference regarding the median number of all-cause or heart failure hospitalizations. At baseline, 60% of patients in EHFP and 61% in RC were in NYHA Class III or IV, while at the 6-month follow up only 12% in EHFP and 32% in RC were in NYHA Class III or IV (p=0.001). Conclusion: These results demonstrate the potential clinical benefits of an enhanced HF education and follow up program led by a cardiologist in reducing cardiovascular deaths and number of emergency room visits with an improvement in functional capacity at 6 months in post-discharge ambulatory HF patients.Türk Kardiyoloji Derneği Kalp Yetmezliği Çalışma Grub

The Relationship Between Natriuretic Peptide Levels and Long-Term Prognosis After Optimal Therapy with Including Inotropic Support in Acute Decompensated Heart Failure

Objective: Natriuretic peptide levels at initial presentation and especially discharge levels have been identified as powerful predictors for long term outcomes in patients with decompensated heart failure. However, changes in natriuretic peptides levels during therapy in predicting clinical outcomes remains to be established. The aim of this study was to evaluate whether changes in natriuretic peptide levels in response to heart failure therapy with inotropic support in patients hospitalized with acute decompensated heart failure may have a role in predicting long-term outcomes. Material and Method: The study population consisted of 44 patients hospitalized for the management of decompensated heart failure with NYHA class IV, left ventricular ejection fraction 0,05). Ölen olguların hastaneye kabulündeki NT-proBNP düzeyleri, yaşayan olgulara göre hem tüm grupta (sırasıyla 25.905±3.251 ve 11.684±2.022 pg/mL, p<0,01) hem de subgrup analizinde levosimendan (sırasıyla 23.723 ± 4.052 ve 12.601 ± 2601 pg/mL, p<0,05) ve dobutamin (sırasıyla 30268 ± 5476 ve 10.555 ± 3.269 pg/mL, p<0,01) gruplarında anlamlı yüksek bulundu. Optimal kalp yetersizliği tedavisine ilave inotropik destek sonrası 48.s NT-proBNP düzeyleri benzer şekilde ölen olgularda yaşayan olgulara göre hem tüm grupta (sırasıyla 19.602±3.473 ve 8.854±2.052 pg/mL, p<0,01) hem levosimendan (sırasıyla 16.902±4.041 ve 7.972±2.053 pg/mL, p<0,05) ve hem de dobutamin (sırasıyla 25.002 ± 6.474 ve 10.324±4.422 pg/mL, p<0,05) grubunda anlamlı yüksek bulundu. NT-proBNP düzeylerindeki azalma oranının yaşayan olgularda, ölen olgulara göre hem tüm grupta (sırasıyla - %34±5 ve - %13 ± 14) hem levosimendan grubunda (sırasıyla - %36±8 ve - %24±13) hem de dobutamin grubunda (sırasıyla - %32±8 ve + %9±32) daha fazla olduğu tespit edildi. Sonuç: Bulgularımız, akut dekompanse kalp yetersizliği nedeniyle hastaneye yatırılan olgular da, hastaneye kabul sırasındaki natriüretik peptid düzeyleri kadar, kalp yetersizliği tedavisine yanıt olarak natriüretik peptid düzeylerinde sağlanan azalma oranlarının da uzun dönem prognozun bir göstergesi olabileceğini desteklemektedir

Potential clinical application of LCZ696 in real life clinical practice baased on 2016/AHA/HFSA and ESC heart failure guidelines criteria:results from TREAT HF study

We explain a connection between the combinatorial Kashiwara-Vergne conjectureand the Kontsevich formula for quantization of Poisson manifold

Hyponatremia is associated with occurrence of atrial fibrillation in outpatients with heart failure and reduced ejection fraction

Objectives: Hyponatremia and atrial fibrillation (AF) have been established as strong predictors for worse clinical outcomes in patients with heart failure (HF). However, little is known about hyponatremia in relation to the occurrence of AF. This study aims to investigate the possible relationship between hyponatremia and AF in patients with chronic HF and reduced ejection fraction (HFrEF)

Resting heart rate and real-life treatment modalities in outpatients with left ventricular systolic dysfunction study: A multicenter, prospective, observational, and national registry

Objective: Heart rate (HR) reduction is associated with improved outcomes in heart failure (HF). This multicenter, prospective, observational, and national registry aimed to evaluate resting HR and the impacts of HR-related medications in real-life clinical practice in patients with HF