Congestive heart failure (Greenwich, Conn.)最新文献

{"title":"Predictors of Left Ventricular Function Deterioration in Patients With Left Bundle Branch Block and Ejection Fraction >50%","authors":"George O. Angheloiu MD,&nbsp;Melissa Saul MS,&nbsp;Kathy Edelman BS, RDCS,&nbsp;Hemal Shah MD,&nbsp;Ure L. Mezu MD,&nbsp;Samir Saba MD","doi":"10.1111/chf.12028","DOIUrl":"10.1111/chf.12028","url":null,"abstract":"<div>\u0000 <p>Resynchronization therapy has become standard of care in patients with left bundle branch block (LBBB), congestive heart failure (CHF), and low ejection fraction (EF). In order to characterize the left ventricular (LV) function evolution in patients with LBBB and baseline preserved LVEF, records of all patients who visited an academic echocardiography laboratory during a period of 4 years were retrospectively investigated. Patients were included if they had a baseline EF &gt;50%, LBBB on surface electrocardiography, and at least one follow-up echocardiogram no earlier than 3 months after the baseline study. The endpoint was the occurrence of EF deterioration to values ≤40%. Clinical variables associated with this outcome were identified. Forty-nine patients satisfied the entry criteria. Over a mean 13±8.5 months of follow-up (range 3 to 36), 8 patients (16%) experienced EF deterioration ≤40%. History of CHF prior to baseline echocardiogram and LV mass &gt;300 g were associated with this phenomenon (<i>P</i>=.004 and <i>P</i>=.015, respectively), with a negative predictive value of 100% and 92%, respectively. Our data profiles a risk-stratification methodology in patients with LBBB and baseline EF &gt;50% and possibly a triage strategy toward resynchronization therapy in this population.</p>\u0000 </div>","PeriodicalId":83668,"journal":{"name":"Congestive heart failure (Greenwich, Conn.)","volume":"19 4","pages":"E1-E4"},"PeriodicalIF":0.0,"publicationDate":"2013-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1111/chf.12028","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31450890","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Can Vitamin D Supplementation Improve the Severity of Congestive Heart Failure?","authors":"Ahmad Amin MD,&nbsp;Shima Minaee MD,&nbsp;Mitra Chitsazan MD,&nbsp;Nassim Naderi MD,&nbsp;Sepideh Taghavi MD,&nbsp;Maryam Ardeshiri MD","doi":"10.1111/chf.12026","DOIUrl":"10.1111/chf.12026","url":null,"abstract":"<div>\u0000 <p>The aim of the present study was to investigate whether vitamin D supplementation could improve biochemical findings and functional capacity of patients with heart failure (HF). One hundred patients with New York Heart Association (NYHA) class I through III HF were included in this prospective study and their 25-hydroxyvitamin D levels were evaluated. Only 6% of the participants had a sufficient serum concentration of 25(OH) D &gt;30 nmol/L. Patients with insufficient or deficient serum levels of 25(OH) D (&lt;30 ng/mL and &lt;20 ng/mL, respectively) received oral vitamin D₃ (cholecalciferol) for a total period of 4 months. Vitamin D supplementation increased mean serum concentration of 25(OH) D from 12.63±7.60 nmol/L to 54.49±18.01 nmol/L (<i>P</i>&lt;.001). After vitamin D supplementation, the serum level of pro-brain natriuretic peptide markedly decreased (<i>P</i>&lt;.001). Cholecalciferol significantly decreased high-sensitivity C-reactive protein level (<i>P</i>&lt;.001). Restoration of serum 25(OH) D level was also associated with substantial improvement in NYHA class (<i>P</i>&lt;.001) and 6-minute walk distance (<i>P</i>&lt;.001).</p>\u0000 </div>","PeriodicalId":83668,"journal":{"name":"Congestive heart failure (Greenwich, Conn.)","volume":"19 4","pages":"E22-E28"},"PeriodicalIF":0.0,"publicationDate":"2013-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1111/chf.12026","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31325650","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cerebral Perfusion is Associated With White Matter Hyperintensities in Older Adults With Heart Failure","authors":"Michael L. Alosco BA,&nbsp;Adam M. Brickman PhD,&nbsp;Mary Beth Spitznagel PhD,&nbsp;Sarah L. Garcia BA,&nbsp;Atul Narkhede MS,&nbsp;Erica Y Griffith BS,&nbsp;Naftali Raz PhD,&nbsp;Ronald Cohen PhD,&nbsp;Lawrence H. Sweet PhD,&nbsp;Lisa H. Colbert PhD,&nbsp;Richard Josephson MS, MD,&nbsp;Joel Hughes PhD,&nbsp;Jim Rosneck MS,&nbsp;John Gunstad PhD","doi":"10.1111/chf.12025","DOIUrl":"10.1111/chf.12025","url":null,"abstract":"<p>Cognitive impairment is common in heart failure (HF) and believed to be the result of cerebral hypoperfusion and subsequent brain changes including white matter hyperintensities (WMHs). The current study examined the association between cerebral blood flow and WMHs in patients with HF and the relationship between WMHs and cognitive impairment. Sixty-nine patients with HF completed the Mini-Mental State Examination (MMSE) and underwent echocardiography, transcranial Doppler sonography for cerebral blood flow velocity of the middle cerebral artery, and brain magnetic resonance imaging. Multivariable hierarchical regression analyses controlling for medical and demographic characteristics as well as intracranial volume showed reduced cerebral blood flow velocity of the middle cerebral artery was associated with greater WMHs (β=−0.34, <i>P</i>=.02). Follow-up regression analyses adjusting for the same medical and demographic factors in addition to cerebral perfusion also revealed marginal significance between increased WMHs and poorer performance on the MMSE (β=−0.26, <i>P</i>=.05). This study suggests that reduced cerebral perfusion is associated with greater WMHs in older adults with HF. These findings support the widely proposed mechanism of cognitive impairment in HF patients and prospective studies are needed to confirm these results.</p>","PeriodicalId":83668,"journal":{"name":"Congestive heart failure (Greenwich, Conn.)","volume":"19 4","pages":"E29-E34"},"PeriodicalIF":0.0,"publicationDate":"2013-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1111/chf.12025","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31327387","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Epoetin Alfa on Left Ventricular Structure, Function, and Pressure Volume Relations as Assessed by Cardiac Magnetic Resonance: The Heart Failure Preserved Ejection Fraction (HFPEF) Anemia Trial","authors":"Philip Green MD,&nbsp;Benson A. Babu MD,&nbsp;Sergio Teruya MD,&nbsp;Stephen Helmke RCDS, MPH,&nbsp;Martin Prince MD,&nbsp;Mathew S. Maurer MD","doi":"10.1111/chf.12027","DOIUrl":"10.1111/chf.12027","url":null,"abstract":"<p>Anemia, a common comorbidity in older adults with heart failure and a preserved ejection fraction (HFPEF), is associated with worse outcomes. The authors quantified the effect of anemia treatment on left ventricular (LV) structure and function as measured by cardiac magnetic resonance (CMR) imaging. A prospective, randomized single-blind clinical trial (NCT NCT00286182) comparing the safety and efficacy of epoetin alfa vs placebo for 24 weeks in which a subgroup (n=22) had cardiac magnetic resonance imaging (MRI) at baseline and after 3 and 6 months to evaluate changes in cardiac structure and function. Pressure volume (PV) indices were derived from MRI measures of ventricular volume coupled with sphygmomanometer-measured pressure and Doppler estimates of filling pressure. The end-systolic and end-diastolic PV relations and the area between them as a function of end-diastolic pressure, the isovolumic PV area (PVAiso), were calculated. Patients (75±10 years, 64% women) with HFPEF (EF=63%±15%) with an average hemoglobin of 10.3±1.1 gm/dL were treated with epoetin alfa using a dose-adjusted algorithm that increased hemoglobin compared with placebo (<i>P</i>&lt;.0001). As compared with baseline, there were no significant changes in end-diastolic (−7±8 mL vs −3±8 mL, <i>P</i>=.81) or end-systolic (−0.4±2 mL vs −0.7±5 mL, <i>P</i>=.96) volumes at 6-month follow-up between epoetin alfa compared with placebo. LV function as measured based on EF (−1.5%±1.6% vs −2.6%±3.3%, <i>P</i>=.91) and pressure volume indices (PVAiso-EDP at 30 mm Hg, −5071±4308 vs −1662±4140, <i>P</i>=.58) did not differ between epoetin alfa and placebo. Administration of epoetin alfa to older adult patients with HFPEF resulted in a significant increase in hemoglobin, without evident change in LV structure, function, or pressure volume relationships as measured quantitatively using CMR imaging.</p>","PeriodicalId":83668,"journal":{"name":"Congestive heart failure (Greenwich, Conn.)","volume":"19 4","pages":"172-179"},"PeriodicalIF":0.0,"publicationDate":"2013-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1111/chf.12027","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31326986","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association Between Weight Loss and Improvement of Ventricular Systolic Function in Advanced Heart Failure","authors":"Maya Guglin MD, PhD,&nbsp;Sameer Verma MD,&nbsp;Ren Chen MD, MPH","doi":"10.1111/chf.12024","DOIUrl":"10.1111/chf.12024","url":null,"abstract":"<div>\u0000 <p>In heart failure (HF), longitudinal changes in ventricular ejection fraction are poorly studied. The authors' objective was to document the dynamic changes in systolic function of both ventricles during acute HF and after a 3-month follow-up period, and to identify factors associated with ventricular improvement. A limited access dataset from the Evaluation Study of Congestive Heart Failure and Pulmonary Artery Catheterization Effectiveness (ESCAPE) trial provided by The National Heart, Lung, and Blood Institute was analyzed. In patients admitted to the hospital with acute HF, both ventricles were evaluated by echocardiography on admission, at discharge, and at 3 months. From baseline to 3 months, left ventricular ejection fraction (LVEF) increased in 43.4% of patients, decreased in 23.9%, and remained unchanged in 32.7%. Similarly, right ventricular systolic function improved in 40.9%, deteriorated in 25.0%, and remained stable in 34.1%. Weight loss during index admission and cardiac index/cardiac output increase were the only factors associated with LVEF improvement from baseline to month 3. There was no difference between ischemic and nonischemic etiology. In acute HF, ischemic or nonischemic, systolic function of the ventricles improved during 3 months in about 40% of patients and remained unchanged or deteriorated in the rest. Weight loss and increase in cardiac index/output during hospitalization was associated with improvement in LVEF.</p>\u0000 </div>","PeriodicalId":83668,"journal":{"name":"Congestive heart failure (Greenwich, Conn.)","volume":"19 4","pages":"186-191"},"PeriodicalIF":0.0,"publicationDate":"2013-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1111/chf.12024","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31235994","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Left Ventricular Remodeling: One Small Step for the Extracellular Matrix Will Translate to a Giant Leap for the Myocardium","authors":"Andriy Yabluchanskiy PhD,&nbsp;Robert J. Chilton DO, FACC,&nbsp;Merry L. Lindsey PhD","doi":"10.1111/chf.12023","DOIUrl":"10.1111/chf.12023","url":null,"abstract":"<p>Myocardial infarction (MI) is initiated by an acute disruption of blood supply to the heart. Prolonged ischemia in the region downstream of the occlusion culminates with tissue necrosis. Inflammation follows the induction of necrosis and orchestrates the wound healing response. Key components of wound healing are the recruitment and engagement of leukocytes and the reorganization of the extracellular matrix (ECM). As a result of the poor regenerative capacity of the heart, cardiomyocyte loss is compensated by the generation of a collagen-based ECM scar.</p><p>The early post-MI scar is mainly composed of collagen III, but as the collagen scar maturates, the ratio of collagen types changes toward a predominance of collagen I. Long-term outcomes post-MI depend on the quality of scar formed, in terms of quantity, quality, and extent of cross-linking. The irreversible changes in the biomechanics and geometry of the left ventricle are collectively known as left ventricular (LV) remodeling, and adverse LV remodeling stimulates the progression to congestive heart failure.</p><p>The most promising treatments for patients with MI involve pre-MI detection to avert ischemia, early diagnosis to limit myocyte loss during ischemia, or targeting mechanisms that occur during resolution of the inflammatory and fibrotic responses to prevent the progression to heart failure (Figure). As such, understanding how the ECM influences remodeling will identify novel targets for clinical intervention.</p><p>The adult mammalian heart is characterized by a myocardium that is highly organized with an overlapping layered structure, and the ECM scaffold surrounds and supports the cells of the myocardium. ECM is mainly composed of fibrillar collagen that provides structural strength through its 3-dimensional structure that interdigitates between cardiac muscle fibers. As such, the ECM plays a pivotal role in the transmission of contractile forces. Collagen I accounts for approximately 70% to 85% of total cardiac collagen in the left ventricle and provides tensile strength, whereas collagen III accounts for about 10% of total cardiac collagen. The thin collagen III fibers maintain the elasticity of the ECM network.<span>1</span> In addition to collagen and other glycoproteins, glycosaminoglycans, basement membrane components, and proteoglycans are components of the ECM.<span>2</span> Besides providing an environment for cells, ECM also serves as a reservoir for growth factors and proteases. Under normal conditions, ECM homeostasis is maintained by signaling interactions between cardiac cells and matrix proteins through cell surface receptors, eg, integrins.</p><p>Prolonged ischemia that turns into irreversible ischemia ultimately leads to cell death, and this event requires ECM network reorganization. Key players in the degradation of ECM are the matrix metalloproteinases (MMPs). Neutrophils are a rich source of MMPs, and neutrophil infiltration occurs as early as 15 minutes af","PeriodicalId":83668,"journal":{"name":"Congestive heart failure (Greenwich, Conn.)","volume":"19 4","pages":"E5-E8"},"PeriodicalIF":0.0,"publicationDate":"2013-01-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1111/chf.12023","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31187587","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Novel Approach to Monitoring Pulmonary Congestion in Heart Failure: Initial Animal and Clinical Experiences Using Remote Dielectric Sensing Technology","authors":"Offer Amir MD,&nbsp;Dan Rappaport PhD,&nbsp;Barak Zafrir MD,&nbsp;William T. Abraham MD","doi":"10.1111/chf.12021","DOIUrl":"10.1111/chf.12021","url":null,"abstract":"<p>Despite current therapies and disease management approaches, rates of heart failure (HF) rehospitalization remain high. New tools are needed to assess preclinical (asymptomatic) pulmonary congestion to enable outpatient management. Hence, a novel monitoring system based on noninvasive remote dielectric sensing (ReDS) technology was developed. Validation of the ReDS technology was conducted in preclinical and clinical studies. In a porcine HF model, acute fluid overload followed by administration of diuretics were performed. Changes in ReDS values were correlated to serial computed tomographic (CT) assessments of lung fluid concentrations. In hospitalized decompensated HF patients, changes in ReDS values were correlated to net fluid balance changes. A nearly linear pattern between the changes in ReDS and CT fluid concentration values was observed in 6 discrete experiments (Intraclass correlation=0.95). Results from 24 patients demonstrated a reduction in ReDS values of 17.53%±11% throughout hospitalization, consistent with a reduction in pulmonary congestion. This finding strongly correlated with changes in net fluid balance (Pearson correlation=0.86; 95% confidence interval, 0.68–0.94; <i>R</i>²=0.74). These findings suggest that ReDS technology accurately quantifies lung fluid concentration and has potential for monitoring HF patients through hospitalization and possibly at home.</p>","PeriodicalId":83668,"journal":{"name":"Congestive heart failure (Greenwich, Conn.)","volume":"19 3","pages":"149-155"},"PeriodicalIF":0.0,"publicationDate":"2013-01-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1111/chf.12021","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31188377","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Diuretic Protocol Increases Volume Removal and Reduces Readmissions Among Hospitalized Patients With Acute Decompensated Heart Failure","authors":"Jeffrey H. Barsuk MD, MS,&nbsp;Robert A. Gordon MD, PharmD,&nbsp;Elaine R. Cohen MEd,&nbsp;William G. Cotts MD,&nbsp;David Malkenson BS,&nbsp;Clyde W. Yancy MD, MSc,&nbsp;Mark V. Williams MD","doi":"10.1111/chf.12020","DOIUrl":"10.1111/chf.12020","url":null,"abstract":"<div>\u0000 <p>Despite the widespread use of loop diuretics to treat acute decompensated heart failure (ADHF), robust data supporting their role and optimal dosing strategies are scarce. This analysis aimed to compare clinical outcomes of patients admitted with ADHF who received a diuretic dosing protocol with those who received the usual diuretic therapy. We performed an observational medical records review to compare the use of a nurse-driven diuretic dosing protocol with usual diuretic dosing for patients admitted with ADHF during a 1-year period. Using a propensity scoring model, comparisons were made between groups for total weight loss, length of stay (LOS), 30-day readmissions, in-hospital mortality, 30-day mortality, and acute kidney failure. Sixty-eight of the 596 patients admitted with ADHF during the study period received the diuretic protocol. Protocol use was associated with an additional 2.63-kg weight loss (<i>P</i>=.003) but a trend toward increased LOS compared with patients receiving usual care (<i>P</i>=.097). However, patients receiving the protocol had a significantly lower risk of 30-day readmission (odds ratio, 0.46, 95% confidence interval, 0.22–0.95). Protocol use was not associated with significant differences in kidney failure, inpatient mortality, or 30-day mortality. A diuretic dosing protocol for patients admitted with ADHF improves weight loss and may lower 30-day readmissions, at the cost of potentially increasing LOS.</p>\u0000 </div>","PeriodicalId":83668,"journal":{"name":"Congestive heart failure (Greenwich, Conn.)","volume":"19 2","pages":"53-60"},"PeriodicalIF":0.0,"publicationDate":"2013-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1111/chf.12020","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31176929","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Aldosterone Antagonists: Evidence-Based Yet Underutilized Effective Heart Failure Therapy","authors":"Carl J. Lavie MD,&nbsp;James J. DiNicolantonio PharmD,&nbsp;James H. O'Keefe MD,&nbsp;Hector O. Ventura MD","doi":"10.1111/chf.12022","DOIUrl":"10.1111/chf.12022","url":null,"abstract":"<p>Standard therapy for heart failure (HF) consists of β-adrenergic–blocking agents or β-blockers and either an angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB). In symptomatic patients, especially with left ventricular (LV) systolic dysfunction, digitalis is used to improve exercise tolerance and quality of life and reduce hospitalizations, with no beneficial or detrimental effects on survival. For HF with reduced or preserved ejection fraction, diuretics are frequently used to prevent and treat volume overload.</p><p>A therapy that is too often forgotten, however, is the aldosterone antagonists (AAs), despite impressive data for their clinical benefit.<span>1</span> Clearly, the activation of mineralocorticoid receptors by both aldosterone and cortisol have deleterious effects on cardiovascular (CV) diseases.<span>2</span> Activation of these receptors plays an important role in the pathophysiology of HF, with mineralocorticoid receptors being overexpressed in the failing heart. AAs promote cardiac fibrosis and have beneficial effects on extracellular matrix turnover as assessed by measured levels of collagen biomarkers, as well as beneficial effects on several other mechanisms involved in the pathogenesis and prognosis of HF.<span>1-6</span></p><p>Since the placebo-controlled Randomized Aldactone Evaluation Study (RALES)<span>7</span> was published about 15 years ago, adding the AA spironolactone to other recommended therapies has been sporadically used in patients with systolic HF and moderate to severe symptoms. Since spironolactone was the only AA available for decades, and because of its low cost, it has been the AA of choice, although we believe that this agent was always underutilized. However, because of the substantial off-target effects on testosterone as well as progesterone receptors, spironolactone frequently causes sexual side effects, particularly gynecomastia, which can be especially troublesome to men, but also reduces libido and, occasionally, uterine bleeding, which may limit patient compliance.<span>1</span></p><p>Eplerenone is the other available AA and is much more specific than spironolactone as an AA. Although initially this agent was expensive, it has now become generic, so along with its more favorable side effect profile, it is an attractive alternative to spironolactone for patients with LV dysfunction, HF, and hypertension (HTN). In the Eplerenone Post-Acute Myocardial Infarction Heart Failure Efficacy and Survival Study (EPHESUS),<span>8</span> this AA when added to other recommended therapies, reduced the rate of death from any cause and hospitalization for CV reasons among patients with acute myocardial infarction (MI) complicated by LV systolic dysfunction and HF, with the results particularly impressive in the subgroup of patients with diabetes mellitus (DM).<span>9</span> In the Eplerenone in Mild Patient Hospitalization and Survivals Study in Heart Failure (EMPHASIS-HF),<spa","PeriodicalId":83668,"journal":{"name":"Congestive heart failure (Greenwich, Conn.)","volume":"19 3","pages":"105-106"},"PeriodicalIF":0.0,"publicationDate":"2013-01-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1111/chf.12022","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31173283","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lack of Concordance in Defining Worsening Renal Function by Rise in Creatinine vs Rise in Cystatin C","authors":"Matthias Dupont MD,&nbsp;Kevin Shrestha AB,&nbsp;Dhssraj Singh MD,&nbsp;Michael Finucan BS,&nbsp;W. H. Wilson Tang MD","doi":"10.1111/chf.12015","DOIUrl":"10.1111/chf.12015","url":null,"abstract":"<p>Worsening renal function (WRF) during treatment of acute decompensated heart failure (ADHF) is generally associated with adverse outcomes. An increase ≥0.3 mg/dL in creatinine level is widely used as the definition of WRF. The authors sought to determine the level of agreement between WRF based on changes in creatinine and changes in cystatin C (CysC) by analyzing data from 121 ADHF patients with available admission and day 3 creatinine and CysC levels. Admission creatinine and CysC levels were 1.39 (0.98–2.11) mg/dL and 1.95 (1.42–2.69) mg/L, respectively, and correlated well (<i>r</i>=0.81). On average, creatinine (−0.04±0.40 mg/dL) and CysC (0.001±0.34 mg/L) changed minimally from admission to day 3. Although the correlation between both markers on day 3 was still good (<i>r</i>=0.79), the correlation between changes therein was only modest (<i>r</i>=0.43). From the 14 and 15 patients who had WRF based on a ≥0.3 mg/dL increase in creatinine and ≥0.3 mg/L increase in CysC, respectively, only four (about 30%) met both definitions. These observations, together with recent insights in the inconsistencies of creatinine-defined concept of worsening renal function and outcomes, raises the need to research more reliable measures of renal function during treatment of ADHF.</p>","PeriodicalId":83668,"journal":{"name":"Congestive heart failure (Greenwich, Conn.)","volume":"19 4","pages":"E17-E21"},"PeriodicalIF":0.0,"publicationDate":"2013-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1111/chf.12015","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40216904","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}