Aktualne spojrzenie na parametry czerwonokrwinkowe w niewydolności serca

  Heart failure (HF) is a growing problem and curren­tly affects 1–2% of the population and its symptoms are the leading cause of hospitalization among pe­ople over 65 years of age. Clinical parameters (e.g. dyspnea, edema, weight change) and laboratory (e.g. natriuretic peptides) are used to assess the efficacy of treatment for heart failure, among which more attention is paid to the parameters of red blo­od cell. Hemoglobin and hematocrit are primarily the basis for the diagnosis of anemia, which often accompanies HF and worsens prognosis in this di­sease. It appears, however, that these parameters may also be useful in monitoring diuretic changes related to diuretics, allowing the identification of patients with diuretic therapy. Evaluation of hemo­concentration may be useful in optimizing diuretic dosage and interventions frequently observed in the treatment of exacerbation of HF of fluctuations in renal function. The aim of the study is to present current knowledge on the possibility of using red blood cell parameters in the assessment of patients with HF.  Niewydolność serca (HF) jest narastającym proble­mem i dotyczy obecnie 1–2% populacji, a jej objawy stanowią główną przyczynę hospitalizacji u osób po­wyżej 65. roku życia. W ocenie skuteczności leczenia HF są stosowane parametry kliniczne (np. duszność, obrzęki, zmiana masy ciała) oraz laboratoryjne (np. peptydy natriuretyczne), wśród których coraz więcej uwagi poświęca się parametrom czerwonokrwinko­wym. Wartości hemoglobiny i hematokrytu to przede wszystkich podstawa rozpoznanie niedokrwistości, która często towarzyszy HF i pogarsza rokowanie w tej chorobie. Okazuje się jednak, że parametry te mogą być również przydatne w monitorowaniu zmian wolemii związanej ze stosowaniem diuretyków, umoż­liwiając identyfikację chorych opornych na leczenie moczopędne. Ocena zjawiska hemokoncentracji może być przydatna w optymalizacji dawkowania diuretyków oraz interpretacji często obserwowanych w przebiegu leczenia zaostrzeń HF wahań stężenia parametrów nerkowych. Celem prezentowanej pra­cy jest przedstawienia aktualnego stanu wiedzy na temat możliwości wykorzystania parametrów czerwo­nokrwinkowych w ocenie chorych na HF

Clinical presentations and hemodynamic parameters in patients hospitalized due to acute heart failure stratified by the left-ventricular ejection fraction

Background: Currently, one of the most common causes of hospitalization, especially in the elderly,is heart failure (HF) exacerbation. In nearly 95% of patients, this is caused by fluid overload. Therehave been studies comparing the rates of comorbidities and biochemical disturbances in HF patients;however, their hemodynamic parameters have not yet been assessed. Thus, the aim of this studywas to compare the clinical presentations and hemodynamic parameters assessed via impedancecardiography (ICG) in patients hospitalized due to acute HF, stratified by the left-ventricular ejectionfraction (LVEF). Methods: This study enrolled 102 patients, aged > 18 years, hospitalized due to decompensated HF.Ninety-seven patients (74 men, 23 women) underwent echocardiographic examination. Biochemicaland hemodynamic parameters were assessed on the day of admission and, subsequently, everyother day during hospitalization. Based on echocardiographic findings and the ESC guidelines thestudy group was divided into the following subgroups: HFrEF (EF < 40%), HFpEF (EF > 50%), andHFmrEF (EF 40–49%). Results: The HFrEF group, which constituted 60.8% of patients (n = 58), was predominantly male (P =0.0005); and most had elevated N-terminal pro-brain natriuretic peptide levels (P = 0.0008). The HFpEF andHFmrEF subgroups, jointly (n = 38), were characterized by higher systolic blood pressure (P = 0.0001),and lower hemoglobin levels (P = 0.003). The hemodynamic assessment showed that HFrEF patientshad higher total fluid content (P = 0.005) and lower systolic time ratio (P = 0.0002). Conclusions: Despite similar clinical presentation, patients with HF exhibited different values of hemodynamicand biochemical parameters depending on their LVEF; this indicates non-homogeneity of pathomechanismsand causes of HF decompensation

Stężenie wysokoczułej troponiny T u chorych hospitalizowanych z powodu zaostrzenia niewydolności serca

Introduction: The most common cause of heart failure is a history of myocardial infarction, and coronary heart disease is one of the most frequent causes of heart failure, which in its natural history often leads to decompensation of the circulatory system. Particular diagnostic difficulties occur in patients with diabetes, where dyspnoea may be both a symptom of exacerbation of heart failure symptoms and an equivalent of angina pectoris. Thus, any clinically relevant marker identifying patients with heart failure is important in conducting effective differential diagnosis. The aim of the study was to evaluate the association of Tn concentration with other clinical and laboratory indicators in the group of patients hospitalized due to exacerbation of heart failure. Material and methods: This study enrolled patients of both sexes, aged >18 years, who were admitted to the Department of Cardiology and Internal Diseases due to decompensated heart failure. Clinical examinations were conducted with a particular emphasis on the history of symptoms, concomitant diseases, also biochemical parameters were determined, including hsTnT and NTproBNP. During the hospitalization, echocardiography was also performed. Results: In the study group the mean value of hsTnT concentration was 106.9 ng / l. In the laboratory assessment, patients with higher hsTnT values were characterized by worse renal function, more frequent occurrence of anemia and a significantly elevated NT-proBNP concentration. Patients with higher hsTnT values presented lower LVEF and had greater volum overload assessed by impedance cardiography. Conclusions: The occurrence of elevated values of high-sensitivity troponin T in patients with exacerbation of heart failure is associated with lower LVEF, worse renal function, anemia, elevated NT-proBNP level and greater congestion. The indicated circumstances should be taken into account during the clinical interpretation of the origin of elevated concentrations of markers of myocardial necrosis in this group of patients.Wstęp: Najczęstszą przyczyną niewydolności serca jest choroba niedokrwienna serca i jej konsekwencje, w tym zawał. W tej grupie duszność może być zarówno objawem zaostrzenia objawów niewydolności serca, jak i ekwiwalentem dolegliwości dławicowych. Zatem każdy miarodajny klinicznie marker identyfikujący pacjentów z niewydolnością serca ma znaczenie w diagnostyce różnicowej. Celem pracy była ocena powiązania stężenia troponiny hsTnT (high sensitive troponin T) z innymi wskaźnikami klinicznymi i laboratoryjnymi w grupie chorych hospitalizowanych z powodu zaostrzenia niewydolności serca. Materiał i metody: Przeanalizowano 102 chorych powyżej 18 roku życia, hospitalizowanych z powodu zaostrzenia objawów niewydolności serca. W badanej grupie zebrano szczegółowy wywiad dotyczący chorób współistniejących, dokonano oceny klinicznej oraz oznaczono parametry biochemiczne w tym hsTnT oraz NTproBNP (N-terminal pro-brain natriuretic peptide). W trakcie hospitalizacji wykonano także badanie echokardiograficzne. Wyniki: W badanej grupie średnia wartość stężenia hsTnT wyniosła 106,9 ng/l. Pacjenci z wyższymi wartościami hsTnT charakteryzowali się gorszą funkcją nerek, częstszym występowaniem niedokrwistości oraz znacznie podwyższonym stężeniem NT-proBNP. Pacjenci z wyższymi wartościami hsTnT prezentowali niższą frakcję wyrzutową lewej komory (LVEF, left ventricular ejection fraction) oraz charakteryzowali się większym zastojem ocenianym metodą kardiografii impedancyjnej. Wnioski: Występowanie podwyższonych wartości wysokoczułej troponiny T u pacjentów z zaostrzeniem niewydolności serca wykazuje związek z niższą LVEF, gorszą funkcją nerek, niedokrwistością, podwyższonym poziomem NT-proBNP oraz nasileniem przewodnienia w obrębie klatki piersiowej. Wskazane okoliczności należy brać pod uwagę podczas klinicznej interpretacji pochodzenia podwyższonych stężeń markerów martwicy mięśnia sercowego w przedmiotowej grupie chorych

What kind of heart rhythm is this?

Pacjent w wieku 81 lat ze złożoną wadą serca pod postacią ciężkiej stenozy zastawki aortalnej i niedomykalności zastawki mitralnej (kwalifikowany do przezskórnej implantacja zastawki aortalnej), z przewlekłą niewydolnością serca (II klasa wg New York Heart Association [NYHA]), z wywiadem napadowego migotania przedsionków, cukrzycą typu 2, nadciśnieniem tętniczym i tętniakiem aorty brzusznej został przyjęty do Kliniki Kardiologii i Chorób Wewnętrznych WIM z powodu zaostrzenia niewydolności serca (III/IV klasa wg NYHA). Wcześniej był 2-krotnie hospitalizowany — w elektrokardiogramie (EKG) opisywano tachykardię zatokową. W EKG z kolejnej hospitalizacji opisano częstoskurcz przedsionkowy z blokiem 2:1, z miarową czynnością komór 100/min. Opis przypadku obrazuje trudności w różnicowaniu częstoskurczu przedsionkowego i tachykardii zatokowej.A 81-year-old man with severe aortic stenosis (qualified for transcatheter aortic valve implantation), mitral insufficiency, chronic heart failure (New York Heart Association [NYHA] II), paroxysmal atrial fibrillation, diabetes mellitus type 2, hypertension, abdominal aortic aneurysm was admitted to the Clinic because of heart failure exacerbation (NYHA III/IV). In the past patient was hospitalized twice — rhythm in electrocardiogram (ECG) was described as sinus tachycardia. During next hospitalization on ECG there was atrial tachycardia with 2:1 block and regular ventricular rate 100/min. This case report demonstrates difficulty in distinguishing sinus tachycardia and atrial tachycardia

Wszczepiono CRT-P i co dalej…

One of the main reason of hospitalization are arrhythmias and conduction disorders, exceptionally rarely they may have a genetic basis. Muscular dystrophy Emery-Dreifuss is a genetic disease in which the image of muscular atrophy and abnormal heart rhythm and conduction disturbances, which often require immediate intervention. Characteristic of patients with muscular dystrophy Emery-Dreifuss is the presence of the absence of the electrical activity of the atrial (atrial standstill, atrial paralysis), which is caused by atrial muscle fibrosis, as well as the conduction system. The paper presents a patient with suspected Emery’ego-Dreifuss muscular dystrophy in which besides conduction disturbances requiring pacemaker implantation occurred as complex ventricular arrhythmias, which required the extension of the CRT-P to CRT-D.Jednym z głównych powodów hospitalizacji są zaburzenia rytmu i przewodzenia, których podłoże wyjątkowo rzadko bywa genetyczne. Dystrofia mięśniowa Emery’ego-Dreifussa jest chorobą uwarunkowaną genetycznie, w obraz której wpisują się zaniki mięśniowe oraz zaburzenia rytmu serca i zaburzenia przewodzenia, które często wymagają natychmiastowej interwencji. Charakterystyczny dla pacjentów z tą dystrofią jest brak czynności elektrycznej przedsionków (atrial standstill, atrial paralysis) spowodowany włóknieniem mięśniówki przedsionków, a także układu bodźco-przewodzącego. W pracy przedstawiono chorego z podejrzeniem dystrofii Emery’ego-Dreifussa, u którego poza zaburzeniami przewodzenia wymagającymi wszczepienia układu stymulującego serce wystąpiły także złożone komorowe zaburzenia rytmu, co wymagało rozszerzenia układu CRT-P do CRT-D

Resting heart rate at hospital admission and its relation to hospital outcome in patients with heart failure

Background: Resting heart rate (HR) has been proven to influence long-term prognosis in patients with chronic heart failure (HF). The aim of this study was to assess the relationship between resting HR at hospital admission and hospital outcome in patients with HF. Methods: The study included Polish patients admitted to hospital due to HF who agreed to participate in Heart Failure Pilot Survey of the European Society of Cardiology. Results: The final analysis included 598 patients. Median HR at hospital admission was 80 bpm. In univariate analyses, higher HR at admission was associated with more frequent use of inotropic support (p = 0.0462) and diuretics (p = 0.0426), worse clinical (New York Heart Association — NYHA) status at discharge (p = 0.0483), longer hospital stay (p = 0.0303) and higher in-hospital mortality (p = 0.003). Compared to patients who survived, patients who died during hospitalization (n = 21; 3.5%) were older, more often had a history of stroke or tran­sient ischemic attack and were characterized by higher NYHA class, higher HR at admission, lower systolic and diastolic blood pressure at admission, lower ejection fraction, lower glomeru­lar filtration rate, and lower natrium and hemoglobin concentrations at hospital admission. In multivariate analysis, higher HR at admission (OR 1.594 [per 10 bpm]; 95% CI 1.061–2.395; p = 0.0248) and lower natrium concentration at admission (OR 0.767 [per 1 mmol/L]; 95% CI 0.618–0.952; p = 0.0162) were the only independent predictors of in-hospital mortality. Conclusions: In patients with HF, higher resting HR at hospital admission is associated with increased in-hospital mortality.

The effect of hemodynamically-guided hypotensive therapy in one-year observation: Randomized, prospective and controlled trial (FINEPATH study)

Background: The use of impedance cardiography (ICG) revealed to provide beneficial blood pressure (BP) lowering effect. However, the follow-up in previous trials was short and brachial BP was the only evaluated hemodynamic variable. Thus, we aimed to estimate the influence of ICG-guided therapy on brachial and central BP, impedance-derived hemodynamic profile and echocardiographic features after 12 months in a randomized, prospective and controlled trial (NCT01996085). Methods: One hundred and forty-four hypertensives were randomly assigned to groups of empiric (GE) and ICG-guided therapy (HD). Office BP, ambulatory BP monitoring, central BP and echocardiography (left ventricular hypertrophy and diastolic function assessment) were performed before and after 12 months of treatment. Results: Blood pressure reduction was higher in HD (office BP: 21.8/14.1 vs. 19.9/11.8 mm Hg; mean 24-h BP: 19.0/10.9 vs. 14.4/9.2 mm Hg). However, the only statistically significant differences were: percentage of patients achieving BP reduction of minimum 20 mm Hg for of­fice diastolic BP (27.3% vs. 12.1%; p = 0.034) and mean 24-h systolic BP (49.1% vs. 27.3%; p = 0.013). More pronounced improvement in the left ventricular diastolic dysfunction (delta E/A 0.34 vs. 0.12, p = 0.017) was the only other beneficial hemodynamic effect. Conclusions: Beneficial BP lowering effect of hemodynamically-guided pharmacotherapy, observed previously in short-term observation, persists over time. Hemodynamic effects of such a treatment approach, especially those of prognostic value (central BP, myocardial hypertrophy), should be evaluated in further studies including patients with resistant hypertension, heart failure, diabetes mellitus and chronic kidney disease

Diagnosis, clinical course, and 1-year outcome in patients hospitalized for heart failure with preserved ejection fraction (from the Polish Cohort of the European Society of Cardiology Heart Failure Long-Term Registry)

[Abstract] Compared with heart failure (HF) with reduced ejection fraction (HF-REF), the diagnosis of HF with preserved EF (HF-PEF) is more challenging. The aim of the study was to assess the prevalence of HF-PEF among patients hospitalized for HF, to evaluate the pertinence of HF-PEF diagnosis and to compare HF-PEF and HF-REF patients with respect to outcomes. The analysis included 661 Polish patients hospitalized for HF, selected from the European Society of Cardiology (ESC)-HF Long-Term Registry. Patients with an EF of ≥50% were included in the HF-PEF group and patients with an EF of <50% - in the HF-REF group. The primary end point was all-cause death at 1 year. The secondary end point was a composite of all-cause death and rehospitalization for HF at 1 year. HF-PEF was present in 187 patients (28%). Of those 187 patients, mitral inflow pattern was echocardiographically assessed in 116 patients (62%) and classified as restrictive/pseudonormal in 37 patients (20%). Compared with HF-REF subjects, patients with HF-PEF were older, more often female, and had a higher prevalence of hypertension, atrial fibrillation and sleep apnea. Despite lower B-type natriuretic peptide concentrations and lower prevalence of moderate-to-severe mitral regurgitation in patients with HF-PEF, congestive symptoms at admission were as severe as in patients with HF-REF. There were no significant differences in in-hospital mortality between the HF groups. One-year mortality was high in both groups (17% in HF-PEF vs 21% in HF-REF, p = 0.22). There was a trend toward a lower frequency of the secondary end point in the HF-PEF group (32% vs 40%, p = 0.07). In conclusion, in clinical practice, even easily obtainable echocardiographic indexes of diastolic dysfunction are relatively rarely acquired. One-year survival rate of patients with HF-PEF is not significantly better than that of patients with HF-REF

Heart failure patients with a previous coronary revascularisation: results from the ESC-HF registry

Background: Coronary revascularization is common in heart failure (HF). Aims: Clinical characteristic and assessment of in-hospital and long-term outcomes in patients hospitalized for HF with or without a previous percutaneous coronary intervention (PCI) or a coronary artery bypass grafting (CABG). Methods: The primary endpoint (PE) (all-cause death) and the secondary endpoint (SE) (all-cause death or hospitalization for HF-worsening) were assessed at one-year in 649 inpatients of the ESC-HF Pilot Survey. Additionally, occurrence of death during index hospitalization was evaluated. Results: PCI/CABG-patients (32.7%) were more frequently male, smokers, had myocardial infarction, hypertension (HT), peripheral artery disease and diabetes. The non-PCI/CABG-patients more often had a cardiogenic shock and died in-hospital. The PE occurred in 33 of the 212 PCI/CABG-patients (15.6%) and in 56 of the 437 non-PCI/CABG-patients (12.8%; P=0.3). The SE occurred in 82 of the 170 PCI/CABG-patients (48.2%) and in 122 of the 346 non-PCI/CABG-patients (35.3%; P=0.01). Independent predictors of the PE in the PCI/CABG-patients were: lower left ventricular ejection fraction, use of antiplatelets; in the non-PCI/CABG-patients were: age, ACS at admission. Independent predictors of the SE in the PCI/CABG-patients were: diabetes, NYHA (New York Heart Association) class at admission, HT; in the non-PCI/CABG-patients were: NYHA class, haemoglobin at admission. Serum sodium concentration at admission was a predictor of the PE and the SE in both groups. Heart rate at discharge was a predictor of the PE and the SE in the non-PCI/CABG patients. Conclusions: The revascularized HF patients had a similar mortality and higher risk of death or hospitalizations at 12 months compared with the non-PCI/CABG-patients. The revascularized patients had more comorbidities, while the non-PCI/CABG-patients had a higher incidence of cardiogenic shock and in-hospital mortality.Background: Coronary revascularisation is common in heart failure (HF). Aim: Clinical characteristic and assessment of in-hospital and long-term outcomes in patients hospitalised for HF with or without a previous percutaneous coronary intervention (PCI) or a coronary artery bypass grafting (CABG). Methods: The primary endpoint (PE) (all-cause death) and the secondary endpoint (SE) (all-cause death or hospitalisation for HF-worsening) were assessed at one year in 649 inpatients of the ESC-HF Pilot Survey. Additionally, occurrence of death during index hospitalisation was evaluated. Results: PCI/CABG-patients (32.7%) were more frequently male, smokers, and had myocardial infarction, hypertension, pe¬ripheral artery disease, and diabetes. The non-PCI/CABG-patients more often had cardiogenic shock and died in-hospital. The PE occurred in 33 of the 212 PCI/CABG-patients (15.6%) and in 56 of the 437 non-PCI/CABG-patients (12.8%; p = 0.3). The SE occurred in 82 of the 170 PCI/CABG-patients (48.2%) and in 122 of the 346 non-PCI/CABG-patients (35.3%; p = 0.01). Independent predictors of the PE in the PCI/CABG-patients were: lower left ventricular ejection fraction and use of anti¬platelets; in the non-PCI/CABG-patients were: age and acute coronary syndrome at admission. Independent predictors of SE in the PCI/CABG-patients were: diabetes, New York Heart Association (NYHA) class at admission, and hypertension; in the non-PCI/CABG-patients they were: NYHA class and haemoglobin at admission. Serum sodium concentration at admission was a predictor of PE and SE in both groups. Heart rate at discharge was a predictor of PE and SE in the non-PCI/CABG patients. Conclusions: The revascularised HF patients had a similar mortality and higher risk of death or hospitalisation at 12 months compared with the non-PCI/CABG-patients. The revascularised patients had more comorbidities, while the non-PCI/CABG-patients had a higher incidence of cardiogenic shock and in-hospital mortality