Hospitalization rate and outcomes in patients with left ventricular dysfunction receiving hemodialysis

Marwan A Albeshri,1 Mohammed S Alsallum,1 Sulafa Sindi,1 Mohammed Kadi,1 Abdullah Albishri,2 Hanadi Alhozali,3 Kamal Alghalayini3 1College of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia; 2College of Medicine, King Abdulaziz University-Rabigh Branch, Rabigh, Saudi Arabia; 3Department of Internal Medicine, King Abdulaziz University Hospital, Jeddah, Saudi Arabia Introduction: Left ventricular dysfunction (LVD) is characterized as left ventricular ejection fraction (EF) below half of the systolic capacity of the left ventricle. Patients on hemodialysis have higher risk of developing LVD than the general population. Our aim was to assess hospitalization rate and outcomes in hemodialysis patients with LVD.Patients and methods: All patients ≥18 years old, who started hemodialysis therapy at King Abdulaziz University Hospital between January 2011 and December 2011, were identified using medical records of hemodialysis unit. Patients were then divided into three groups, according to their EF results prior to the initiation of hemodialysis, as patients with EF <40%, EF between 40% and 49%, and EF ≥50%. Patients were then followed for 5 years by reviewing their hospital records to assess their outcomes, hospital admissions, and length of hospital stay.Results: Analysis included 333 patients. Patients with EF <40% were 40, 36 patients with EF 40%–49%, and 257 patients had an EF >50%. Patients with EF <50% were significantly older than patients with EF >50% (P=0.002). Diabetes mellitus and hypertension were more prevalent in patients with EF <40% and EF 40%–49% when compared with patients with EF >50% (P<0.001, P=0.002). The average length of stay between the three groups was significantly different (P=0.007). Intensive care unit admissions were significantly different when comparing the three groups (P=0.013) and was found to be an independent risk factor for mortality in our patients. Half of the patients with EF <40% and 44% of patients with EF of 40%–49% died compared with only 27% of patients with EF >50% (P=0.002). However, Kaplan–Meier analysis showed no significant difference in the survival time among the three groups (P=0.845).Conclusion: Mortality and morbidity increased in patients with LVD on hemodialysis compared with patients with normal EF. Keywords: LVD, hemodialysis, mortality, hospitalization&nbsp

Features and behavior of valvular abnormalities in adolescent and adult patients in mucopolysaccharidosis: an echocardiographic study

Mucopolysaccharidoses, a rare inherited disorder of lysosomal storage, account for less than 0.1% of all genetic diseases.  The penetrance is highly variable and clinically it varies from severe fetal-neonatal forms to attenuated diseases diagnosed in adult individuals. The majority of the patients have been reported to show cardiac abnormalities since pediatric age, however, there is a minority of patients with attenuated disease diagnosed in the adolescent and adult age. The haematopoietic stem cell transplantation and enzyme replacement therapy are the current therapies for these disorders. Thanks to these treatments, Mucopolysaccharidoses patients live longer than in the past. Even though enzyme replacement therapy has been demonstrated to reduce left ventricular mass in patients with cardiomyopathy, the efficacy on valve abnormalities has not been clearly demonstrate yet. Furthermore, thanks to the current therapy, to better understanding and to the advent on new technologies, an increasing number of adolescent and adult patients diagnosed with MPS are followed up in the adult echocardiographic laboratory. Indeed, a systematic descriptive study describing the echocardiographic features of valvular involvement and their evolution in adolescent and adult patients lacks of medical literature and this was the aim of our investigation. Our results showed that all the valves are affected, mainly the mitral valve with a higher prevalence compared to the pediatric age.  The echocardiographic features of MPS differs from other valvular disease of adolescent and adult age, and knowing them can avoid misdiagnosis. Our observations also suggest that the progression of cardiac involvement slows after the initiation of the therapy in our group of age. Further studies on larger population are required to confirm our results

Global variations in heart failure etiology, management, and outcomes

Importance: Most epidemiological studies of heart failure (HF) have been conducted in high-income countries with limited comparable data from middle- or low-income countries. Objective: To examine differences in HF etiology, treatment, and outcomes between groups of countries at different levels of economic development. Design, Setting, and Participants: Multinational HF registry of 23 341 participants in 40 high-income, upper–middle-income, lower–middle-income, and low-income countries, followed up for a median period of 2.0 years. Main Outcomes and Measures: HF cause, HF medication use, hospitalization, and death. Results: Mean (SD) age of participants was 63.1 (14.9) years, and 9119 (39.1%) were female. The most common cause of HF was ischemic heart disease (38.1%) followed by hypertension (20.2%). The proportion of participants with HF with reduced ejection fraction taking the combination of a β-blocker, renin-angiotensin system inhibitor, and mineralocorticoid receptor antagonist was highest in upper–middle-income (61.9%) and high-income countries (51.1%), and it was lowest in low-income (45.7%) and lower–middle-income countries (39.5%) (P < .001). The age- and sex- standardized mortality rate per 100 person-years was lowest in high-income countries (7.8 [95% CI, 7.5-8.2]), 9.3 (95% CI, 8.8-9.9) in upper–middle-income countries, 15.7 (95% CI, 15.0-16.4) in lower–middle-income countries, and it was highest in low-income countries (19.1 [95% CI, 17.6-20.7]). Hospitalization rates were more frequent than death rates in high-income countries (ratio = 3.8) and in upper–middle-income countries (ratio = 2.4), similar in lower–middle-income countries (ratio = 1.1), and less frequent in low-income countries (ratio = 0.6). The 30-day case-fatality rate after first hospital admission was lowest in high-income countries (6.7%), followed by upper–middle-income countries (9.7%), then lower–middle-income countries (21.1%), and highest in low-income countries (31.6%). The proportional risk of death within 30 days of a first hospital admission was 3- to 5-fold higher in lower–middle-income countries and low-income countries compared with high-income countries after adjusting for patient characteristics and use of long-term HF therapies. Conclusions and Relevance: This study of HF patients from 40 different countries and derived from 4 different economic levels demonstrated differences in HF etiologies, management, and outcomes. These data may be useful in planning approaches to improve HF prevention and treatment globally