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

{"title":"Biomarkers in Acute Heart Failure: From Risk Markers to Therapeutic Targets","authors":"Andreas P. Kalogeropoulos MD, PhD,&nbsp;Vasiliki V. Georgiopoulou MD,&nbsp;Javed Butler MD, MPH","doi":"10.1111/chf.12019","DOIUrl":"10.1111/chf.12019","url":null,"abstract":"<p>Scientific and technological progress has led to the discovery of an unprecedented large number of circulating molecules (“biomarkers”) in the past decade. However, the role of these biomarkers in clinical practice is variable and, in many cases, uncertain. Specifically in heart failure (HF), biomarkers have been used to (1) identify pathophysiologic perturbations that either precede HF or result as a downstream consequence of HF and altered physiology of target organs; (2) aid in the diagnosis, differential diagnosis, and classification of HF; (3) guide therapy and management; and (4) refine risk stratification.<span>1</span> However, although newer markers are now approved by the Food and Drug Administration (eg, galactin-3), there are currently no other uses for biomarkers in HF endorsed by national or international guidelines, with the exception of certain applications for B-type natriuretic peptide (BNP) or its precursor fragment N-terminal pro-BNP (NT-proBNP).<span>2</span> A large number of molecules have been shown to correlate with or refine prognosis in acute and chronic HF. However, in the absence of a common framework for development of biomarkers in HF and the disconnect between projected risks, underlying biology, and therapeutic decisions, these associations between the various biomarkers and prognosis have had minimal impact on clinical practice.<span>1</span> This discrepancy between discovery and clinical adoption of biomarkers in HF is also true for biomarkers of renal dysfunction, both in acute and chronic HF settings.</p><p>Renal dysfunction is common in patients with HF, with a prevalence ranging from 20% to 57% in chronic HF and 30% to 67% in patients with acute HF.<span>3</span> Although the prognostic impact of worsening renal function during an acute HF episode is still a matter of debate, and likely represents a manifestation with variable underlying etiology with differing impact on prognosis, there is little controversy that chronic renal dysfunction is associated with worse long-term outcomes and increased health care resources utilization among patients hospitalized with acute HF.<span>4</span> The association of renal dysfunction with worse outcomes in acute HF has been consistently demonstrated both with routine clinical (eg, serum urea nitrogen [BUN], creatinine, estimated glomerular filtration rate [eGFR]) and novel (eg, neutrophil gelatinase-associated lipocalin, cystatin C) biomarkers.<span>3</span> However, it is currently unclear which renal biomarker (or biomarkers) adds the most useful information from a clinical perspective for patients with acute HF and how to use these for clinical decisions.</p><p>In this issue of the <i>Journal</i>, Kim and colleagues report that serum levels of both cystatin C and uric acid conferred superior prognostic information compared with other renal function biomarkers (BUN, creatinine, and eGFR) in a cohort of 587 patients admitted with acute HF.<span>5</span> The authors","PeriodicalId":83668,"journal":{"name":"Congestive heart failure (Greenwich, Conn.)","volume":"19 2","pages":"51-52"},"PeriodicalIF":0.0,"publicationDate":"2012-12-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1111/chf.12019","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40202492","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":"Self-Management Intervention to Improve Self-Care and Quality of Life in Heart Failure Patients","authors":"Heng-Hsin Tung PhD, FNP, RN,&nbsp;Chun-Yu Lin ACNP, RN,&nbsp;Kuei-Ying Chen MSN, RN,&nbsp;Chien-Jung Chang MD,&nbsp;Yu-Ping Lin PhD, RN,&nbsp;Cheng-Hui Chou PhD, RN","doi":"10.1111/chf.12014","DOIUrl":"10.1111/chf.12014","url":null,"abstract":"<div>\u0000 <p>Self-management intervention is a good method to improve self-care ability, as such, to promote quality of life. However, the research focused on self-management intervention in heart failure patients in Taiwan is very limited. Therefore, the purposes of this study were to test the effectiveness of self-management intervention in patients with heart failure in Taiwan and examine the relationship between self-care ability and quality of life. A quasi-experimental design was used in this study with convenience sampling. Of the 82 subjects participating in this study, 40 of them chose to join the experimental (self-management intervention plus usual care) and 42 of them chose to join control (usual care) group. Three questionnaires were used to collect the data, which were the demographic questionnaire, the self-care questionnaire (Self-Care of HF Index V 6), and the quality of life questionnaire (Minnesota Living with Heart Failure Questionnaire). To examine the effectiveness of the intervention, self-care ability and quality of life were measured, using a pretest, 1- and 2-month follow-up assessment. Generalized estimation equations (GEE) were used to compare changes over time among groups for outcomes to ensure the effectiveness of the intervention. This study confirmed the effectiveness of the self-management intervention. The clinical provider should increase the awareness of the importance of self-management skills and self-care ability especially for heart failure patients. The designated disease-specific self-management patient book and individualize intervention should be dispensing and implementing.</p>\u0000 </div>","PeriodicalId":83668,"journal":{"name":"Congestive heart failure (Greenwich, Conn.)","volume":"19 4","pages":"E9-E16"},"PeriodicalIF":0.0,"publicationDate":"2012-12-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1111/chf.12014","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40202476","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":"What Is Causing Extremely Elevated Amino Terminal Brain Natriuretic Peptide in Cancer Patients?","authors":"Jesal Popat MD,&nbsp;Abel Rivero MD,&nbsp;Pravin Pratap MD,&nbsp;Maya Guglin MD, PhD","doi":"10.1111/chf.12018","DOIUrl":"10.1111/chf.12018","url":null,"abstract":"<div>\u0000 <p>High levels of B-type natriuretic peptide in cancer patients are poorly studied. Previously published data suggest that they are not related to fluid overload and are encountered mostly in solid cancers. The authors investigated the distribution of amino terminal pro-brain natriuretic peptide (NT-proBNP) between hematologic and solid organ malignancies and the relationship of NT-proBNP with volume status in oncologic patients. A total of 145 consecutive patients with at least one occurrence of NT-proBNP exceeding the upper normal range 10-fold were identified. The authors retrospectively reviewed their records including clinical, laboratory, and radiological data and echocardiograms. More than 70% of patients had hematologic malignancies. Patients with NT-proBNP &gt;50,000 pg/mL had only hematologic malignancies, primarily multiple myeloma. There was no association between M-spike proteins and NT-proBNP. About 80% of patients had signs of fluid overload. The magnitude of NT-proBNP elevation was similar between those with and without heart failure or volume overload, as well as with solid cancers vs hematologic malignancies. Contrary to prior reports, it was found that very high NT-proBNP in cancer patients is usually encountered in the context of fluid overload and most often in hematologic malignancies.</p>\u0000 </div>","PeriodicalId":83668,"journal":{"name":"Congestive heart failure (Greenwich, Conn.)","volume":"19 3","pages":"143-148"},"PeriodicalIF":0.0,"publicationDate":"2012-12-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1111/chf.12018","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40201318","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":"Remote Care Costs for Congestive Heart Failure: A Systematic Review and Meta-Analysis of Randomized Controlled Trials in the United States Comparing Remote Versus More Intensive Care Settings","authors":"Jeffrey Voigt MBA, MPH,&nbsp;Michael Mosier PhD","doi":"10.1111/chf.12017","DOIUrl":"10.1111/chf.12017","url":null,"abstract":"<div>\u0000 <p>It has been assumed that less intense levels of care for managing heart failure result in a lowering of the overall costs for this care in the United States. The objective of this review was to determine whether this assumption is correct. A systematic review was performed using Medline, technology assessment Web sites, and relevant cardiovascular and heart failure journals from the year 2000 to the present. US randomized controlled trials where costs were evaluated as one of the endpoints were included. Data were collected using Cochrane Review characteristics of included studies and risk of bias assessment forms. Cost data from each trial were converted to a uniform cost definition and year. Meta-analysis was performed where appropriate. Ten trials were identified evaluating costs at various time points (3, 6, and 12 months). Meta-analysis of trials demonstrated no difference in costs for care, no matter the patient condition or settings. In high-quality trials examining costs, there may be a shifting in costs from more expensive care settings to less expensive care settings without savings to the healthcare system. Larger and longer-term trials should be undertaken to understand this issue.</p>\u0000 </div>","PeriodicalId":83668,"journal":{"name":"Congestive heart failure (Greenwich, Conn.)","volume":"19 4","pages":"192-199"},"PeriodicalIF":0.0,"publicationDate":"2012-12-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1111/chf.12017","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40203574","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":"Characterization and Prediction of Natriuretic Peptide “Nonresponse” During Heart Failure Management: Results From the ProBNP Outpatient Tailored Chronic Heart Failure (PROTECT) and the NT-proBNP–Assisted Treatment to Lessen Serial Cardiac Readmissions and Death (BATTLESCARRED) Study","authors":"Hanna K. Gaggin MD, MPH,&nbsp;Quynh A. Truong MD, MPH,&nbsp;Shafiq U. Rehman MD,&nbsp;Asim A. Mohammed MD,&nbsp;Anju Bhardwaj MD,&nbsp;Kimberly A. Parks DO,&nbsp;Dorothy A. Sullivan ANP,&nbsp;Annabel Chen-Tournoux MD,&nbsp;Stephanie A. Moore MD,&nbsp;A. Mark Richards MD, PhD,&nbsp;Richard W. Troughton MD, PhD,&nbsp;John G. Lainchbury MD,&nbsp;Rory B. Weiner MD,&nbsp;Aaron L. Baggish MD,&nbsp;Marc J. Semigran MD,&nbsp;James L. Januzzi Jr MD","doi":"10.1111/chf.12016","DOIUrl":"10.1111/chf.12016","url":null,"abstract":"<div>\u0000 <p>Many proven heart failure (HF) therapies decrease N-terminal pro B-type natriuretic peptide (NT-proBNP) values over time, yet some patients have an NT-proBNP &gt;1000 pg/mL following treatment, which is associated with poor outcomes. A total of 151 patients with left ventricular systolic dysfunction were treated with aggressive HF therapy in the ProBNP Outpatient Tailored Chronic Heart Failure (PROTECT) study. Clinical characteristics and NT-proBNP were measured at each visit during 10 months. In this post hoc analysis, biomarker nonresponse was defined as an NT-proBNP &gt;1000 pg/mL and its relationship with echocardiographic and clinical characteristics and outcomes were explored. A risk model predictive of nonresponse was derived and externally validated. A rising NT-proBNP over time was associated with increased cardiovascular event rates while a decreasing NT-proBNP was associated with better clinical outcomes (58.2% vs 27.6%, <i>P</i>=.001). A higher percentage of time in biomarker response was associated with lower event rates (<i>P</i>&lt;.001). Importantly, responders showed improved left ventricular remodeling parameters (all <i>P</i>&lt;.001), while nonresponders did not. A risk model for predicting nonresponse had a C statistic of 0.82 (<i>P</i>&lt;.001) and predicted outcomes well. Using data from the NT-proBNP–Assisted Treatment to Lessen Serial Cardiac Readmissions and Death (BATTLESCARRED) cohort, the risk score was validated for its ability to predict nonresponse (C statistic 0.73, <i>P</i>&lt;.001). Serial changes in NT-proBNP inform risk for adverse outcome and are associated with prognostically meaningful metrics. Prediction of future NT-proBNP nonresponse to HF therapy is possible.</p>\u0000 </div>","PeriodicalId":83668,"journal":{"name":"Congestive heart failure (Greenwich, Conn.)","volume":"19 3","pages":"135-142"},"PeriodicalIF":0.0,"publicationDate":"2012-12-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1111/chf.12016","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40201309","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":"Prognostic Implications of Relative Hypochromia in Ambulatory Patients With Chronic Systolic Heart Failure","authors":"Cesar Simbaqueba MD,&nbsp;Kevin Shrestha AB,&nbsp;Maria Patarroyo MD,&nbsp;Richard W. Troughton MBBS,&nbsp;Allen G. Borowski RDCS,&nbsp;Allan L. Klein MD,&nbsp;W. H. Wilson Tang MD","doi":"10.1111/chf.12010","DOIUrl":"10.1111/chf.12010","url":null,"abstract":"<p>Iron insufficiency has been associated with heart failure, but the impact of a reduction of hemoglobin content in the erythrocytes as estimated by mean corpuscular hemoglobin concentration (MCHC) to myocardial structure, performance, and long-term clinical outcomes has not been well-established. The authors examined hematologic data and long-term outcomes of 197 ambulatory patients with chronic systolic and symptomatic heart failure who underwent comprehensive echocardiographic evaluation. The authors observed that relative hypochromia (defined as low MCHC) was associated with higher natriuretic peptide levels (NT-proBNP, r =−0.40, P&lt;.0001) and lower estimated glomerular filtration rate (eGFR; r = 0.45, P &lt;. 0001) and correlated modestly with indices of left and right ventricular diastolic dysfunction (all P&lt;.05), but were not related to left ventricular ejection fraction (LVEF, r=0.17, P=.079). After 5 years of follow-up, lower MCHC levels were associated with higher risk of death, transplant, or heart failure hospitalization after adjusting for age, LVEF, eGFR, and New York Heart Association class (hazard ratio, 1.34; 95% confidence interval, 1.04–1.72; P=.025), particularly in those with above-median hemoglobin (&gt;13.8 g/dL; hazard ratio, 2.02; 95% confidence interval, 1.44–2.81, P&lt;.0001). Taken together, the observations imply that physicians should take notice of the presence of relative hypochromia particularly in the absence of anemia in the setting of chronic systolic heart failure.</p>","PeriodicalId":83668,"journal":{"name":"Congestive heart failure (Greenwich, Conn.)","volume":"19 4","pages":"180-185"},"PeriodicalIF":0.0,"publicationDate":"2012-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1111/chf.12010","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40203234","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":"When Conventional Heart Failure Therapy is Not Enough: Angiotensin Receptor Blocker, Direct Renin Inhibitor, or Aldosterone Antagonist?","authors":"Sripal Bangalore MD, MHA,&nbsp;Sunil Kumar MD,&nbsp;Franz H. Messerli MD","doi":"10.1111/chf.12011","DOIUrl":"10.1111/chf.12011","url":null,"abstract":"<p>In patients on conventional heart failure therapy including angiotensin-converting enzyme (ACE) inhibitors, the addition of angiotensin receptor blockers (ARBs), direct renin inhibitors (DRIs), or aldosterone antagonists are therapeutic options to further reduce the risk of cardiovascular events. However, whether one is preferable over the other is not known. PubMed, EMBASE, and Cochrane Central Register of Controlled Trials databases were searched for randomized clinical trials (RCTs), until March 2011, of trials testing either an ARB, DRI, or an aldosterone antagonist in patients with heart failure who were on conventional heart failure therapy with follow-up of at least 3 months. Efficacy (death, cardiovascular death, nonfatal myocardial infarction, heart failure hospitalization and composite of cardiovascular death or heart failure hospitalization) and safety (hyperkalemia, hypotension, renal failure) outcomes were compared. The authors identified 16 RCTs involving 31,429 participants that satisfied the inclusion criteria. When compared with placebo (reference rate ratio [RR] of 1), aldosterone antagonists reduced the rate of death (RR, 0.79; 95% credibility interval [CrI], 0.66–0.98), cardiovascular death (RR, 0.78; 95% CrI, 0.65–0.93), heart failure hospitalization (RR, 0.74; 95% CrI, 0.55–0.94), and the composite of cardiovascular death or heart failure hospitalization (RR, 0.73; 95% CrI, 0.55–0.90) with no difference for other efficacy outcomes. However, ARBs and DRIs did not result in any significant reduction in the rate of any of the efficacy outcomes when compared with placebo. When compared with placebo (RR=1), ARBs increased the rate of hyperkalemia (138% increase), renal failure (126% increase), and hypotension (63% increase). Similarly, aldosterone antagonists resulted in a 110% increase in hyperkalemia and DRIs with a 98% increase in hypotension. In patients with heart failure and reduced systolic function on conventional heart failure medications, the risk benefit ratio favors the addition of aldosterone antagonists over ARBs or DRIs.</p>","PeriodicalId":83668,"journal":{"name":"Congestive heart failure (Greenwich, Conn.)","volume":"19 3","pages":"107-115"},"PeriodicalIF":0.0,"publicationDate":"2012-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1111/chf.12011","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31124590","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":"Is Chronic Sildenafil Therapy Safe and Clinically Beneficial in Patients With Systolic Heart Failure?","authors":"Ahmad Amin MD,&nbsp;Ebrahim Mahmoudi MD,&nbsp;Hossein Navid MD,&nbsp;Mitra Chitsazan MD","doi":"10.1111/chf.12008","DOIUrl":"10.1111/chf.12008","url":null,"abstract":"<p>Sildenafil is a selective phosphodiesterase-5 inhibitor and causes vasodilatation, particularly in pulmonary circulation. Since left heart failure may be associated with pulmonary hypertension “out of proportion to left heart disease,” sildenafil may have beneficial effect in such patients. The present investigation was designed as a 12-week, single-center, randomized, double-blind, placebo-controlled study evaluating the effects of sildenafil on mean blood pressure (primary endpoint) in patients with left systolic heart failure. Secondary endpoints included exercise capacity assessed by 6-minute walk test. A total of 106 patients were randomized 1:1 to sildenafil (n=53) or placebo (n=53). Patients received sildenafil 25 mg twice a day or matching placebo for the first 2 weeks and 50 mg 3 times a week for the remainder of the trial. The placebo-corrected effect on mean blood pressure was 1.16 mm Hg (95% confidence interval, −1.6 to 5.1, <i>P</i> &gt;.05), demonstrating that sildenafil did not decrease mean blood pressure. Compared with placebo, sildenafil increased the 6-minute walk test by a nonsignificant treatment effect of 14 m (<i>P</i>=.67). Adverse effects occurred in a comparable proportion of patients taking sildenafil and placebo, and none of the patients needed to discontinue therapy. Sildenafil is well tolerated in left heart failure patients and does not decrease blood pressure. It can be safely added to standard heart failure therapy.</p>","PeriodicalId":83668,"journal":{"name":"Congestive heart failure (Greenwich, Conn.)","volume":"19 2","pages":"99-103"},"PeriodicalIF":0.0,"publicationDate":"2012-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1111/chf.12008","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31123260","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 Ejection Fraction and Left Ventricular End-Diastolic Volume in Patients With Diastolic Dysfunction","authors":"Ion S. Jovin MD,&nbsp;Keita Ebisu MS,&nbsp;Yi-Hwa Liu PhD,&nbsp;Laurie A. Finta RN,&nbsp;Adriana D. Oprea MD,&nbsp;Cynthia A. Brandt MD,&nbsp;James Dziura PhD,&nbsp;Frans J. Wackers MD, PhD","doi":"10.1111/chf.12013","DOIUrl":"10.1111/chf.12013","url":null,"abstract":"<div>\u0000 <p>Diastolic dysfunction can be diagnosed on equilibrium radionuclide angiocardiography (ERNA) by a low peak filling rate (PFR) in the setting of a normal left ventricular ejection fraction (LVEF). The authors evaluated the relationship between diastolic dysfunction, LVEF, and end-diastolic volume (EDV). A total of 408 predominantly asymptomatic patients with an LVEF ≥50% by ERNA were studied. LVEF of patients with a low PFR was compared with the LVEF of patients with a normal PFR. Correlation analyses to evaluate the association between PFR and EDV were also performed. The LVEF of patients with a low PFR was lower than the LVEF of patients with normal PFR (59±7 vs 63%±7%; <i>P</i>&lt;.01). There was no correlation between EDV and PFR (<i>r</i>=−0.04; <i>P</i>=.32). The results did not change when the EDV indices were used. In patients who had repeat scans, there was no correlation between the change in EDV and the change in PFR (<i>r</i>=0.16; <i>P</i>=.2). In asymptomatic patients undergoing ERNA who have normal systolic function, a low PFR can be associated with a lower LVEF, but it is not associated with changes in EDV. This suggests that diastolic dysfunction is associated with mild systolic dysfunction.</p>\u0000 </div>","PeriodicalId":83668,"journal":{"name":"Congestive heart failure (Greenwich, Conn.)","volume":"19 3","pages":"130-134"},"PeriodicalIF":0.0,"publicationDate":"2012-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1111/chf.12013","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31124660","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":"Potentials of Cystatin C and Uric Acid for Predicting Prognosis of Heart Failure","authors":"Hyungseop Kim MD,&nbsp;Hyuck-Jun Yoon MD,&nbsp;Hyoung-Seob Park MD,&nbsp;Yun-Kyeong Cho MD,&nbsp;Chang-Wook Nam MD,&nbsp;Seung-Ho Hur MD,&nbsp;Yoon-Nyun Kim MD,&nbsp;Kwon-Bae Kim MD","doi":"10.1111/chf.12012","DOIUrl":"10.1111/chf.12012","url":null,"abstract":"<p>Few studies have explored the clinical potentials of combined Cystatin C (Cys) and uric acid (UA) in heart failure (HF). The authors evaluated Cys and UA as predictors of clinical outcomes compared with conventional renal biomarkers. This prospective cohort study included 587 HF patients presenting with dyspnea. At admission, Cys, UA, and other renal measures including serum urea nitrogen (BUN), creatinine (Cr), and glomerular filtration rate (GFR) were obtained. The primary endpoint was the composite of cardiac death and rehospitalization for worsening HF. During a 25-month median follow-up period, 68 patients experienced clinical outcomes: 9 cardiac deaths and 59 HFs. They showed higher BUN and Cr values and lower GFR. Within these parameters, Cys and UA had the most favorable area under the curves, and patients with Cys ≥0.8 mg/L and UA ≥6.6 mg/dL showed more frequent events. The net reclassification improvement analysis showed the combination of Cys and UA had a greater incremental effect for cardiac prognosis. On multivariate Cox hazard analysis, Cys and UA were independent predictive markers for clinical outcomes. In HF patients presenting with dyspnea, Cys and UA appear to be more useful predictors of clinical events than other renal measures.</p>","PeriodicalId":83668,"journal":{"name":"Congestive heart failure (Greenwich, Conn.)","volume":"19 3","pages":"123-129"},"PeriodicalIF":0.0,"publicationDate":"2012-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1111/chf.12012","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31124908","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}