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

{"title":"Diflunisal for ATTR Cardiac Amyloidosis","authors":"Adam Castaño MD,&nbsp;Stephen Helmke RDCS, MPH,&nbsp;Julissa Alvarez MD,&nbsp;Susan Delisle NP,&nbsp;Mathew S. Maurer MD","doi":"10.1111/j.1751-7133.2012.00303.x","DOIUrl":"10.1111/j.1751-7133.2012.00303.x","url":null,"abstract":"<p>©2012 Wiley Periodicals Inc.</p><p>Transthyretin (TTR) cardiac amyloidosis is an important, often under-recognized and potentially modifiable cause of heart failure with a preserved ejection fraction. The only proven treatment is liver or combined heart/liver transplantation, which, although effective, is not suitable for the vast majority of older adults with this condition. Diflunisal, a nonsteroidal anti-inflammatory drug, can stabilize the TTR tetramer in vitro and may prevent misfolding monomers and dimers from forming amyloid deposits in the heart. It is one of two small molecules assessed in animal safety studies and human clinical trials of TTR polyneuropathy. The authors conducted a single-arm, open-label investigation with a mean follow-up of 0.9±0.3 years to determine the safety and efficacy of diflunisal administration in a cohort of 13 patients with confirmed wild-type or mutant TTR cardiac amyloidosis. Diflunisal was well tolerated from a hematologic standpoint, although a 6% decline in estimated glomerular filtration rate was noted. Therapy was discontinued in one patient who rapidly developed volume overload. There was no significant mean change in cardiac structure (left ventricular mass: −53 g/m² change, <i>P</i>=.36), function (ejection fraction: –2% change, <i>P</i>=.61), or biomarkers (Troponin I: +0.03 ng/mL, <i>P</i>=.08; BNP: +93 pg/mL change, <i>P</i>=.52) during the course of therapy. These data suggest that at low dosages and with careful monitoring, diflunisal can be safely administered to compensated patients with cardiac TTR amyloidosis. Further study in a randomized placebo-controlled trial is warranted.</p>","PeriodicalId":83668,"journal":{"name":"Congestive heart failure (Greenwich, Conn.)","volume":"18 6","pages":"315-319"},"PeriodicalIF":0.0,"publicationDate":"2012-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1111/j.1751-7133.2012.00303.x","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30728257","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":"Serum Heat Shock Protein 60 in Acute Heart Failure: A New Biomarker?","authors":"Clara Bonanad MD,&nbsp;Julio Núñez MD,&nbsp;Juan Sanchis MD,&nbsp;Vicente Bodi MD,&nbsp;Fabian Chaustre PhD,&nbsp;Marifina Chillet MD,&nbsp;Gema Miñana MD,&nbsp;Maria José Forteza PhD,&nbsp;Patricia Palau MD,&nbsp;Eduardo Núñez MD, MPH,&nbsp;David Navarro MD,&nbsp;Angel Llàcer MD,&nbsp;Francisco J. Chorro MD","doi":"10.1111/j.1751-7133.2012.00299.x","DOIUrl":"10.1111/j.1751-7133.2012.00299.x","url":null,"abstract":"<p>©2012 Wiley Periodicals, Inc.</p><p>Heat shock protein 60 (HSP60) is a mitochondrial protein constitutively expressed in the majority of cells, and its expression is up-regulated by a variety of stressors. In heart failure, HSP60 is released from cardiomyocytes. The authors speculate that increased serum HSP60 (sHSP60) may be related to the severity of heart failure. This investigation sought to assess the association between sHSP60 and the composite end point of death/readmission in patients with acute heart failure (AHF). A total of 132 consecutive patients were admitted for AHF. The independent association between sHSP60 and the end point was assessed with Cox regression. During a median follow-up of 7 months (interquartile range, 3–14), 35 (26.5%) deaths, 40 (30.3%) readmissions, and 65 (49.2%) deaths/readmission were identified. Patients who exhibited the outcome showed higher median sHSP60 values (6.15 ng/mL [8.49] vs 4.71 ng/mL [7.55] P=.010). A monotonic increase in the incidence of the composite end point was observed when moving from lower to higher tertile (4.74, 4.76, and 6.98 per 10 patients-years of follow-up, P for trend &lt;.001). After adjusting for established risk factors, only patients in the upper tertile showed an increased risk of death/readmission (hazard ratio, 2.63; 95% confidence interval, 1.29–5.37; P=.008). In patients with AHF, high sHSP60 was related to a higher risk for subsequent death/readmission for AHF.</p>","PeriodicalId":83668,"journal":{"name":"Congestive heart failure (Greenwich, Conn.)","volume":"19 1","pages":"6-10"},"PeriodicalIF":0.0,"publicationDate":"2012-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1111/j.1751-7133.2012.00299.x","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30695338","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":"Quality Improvement in Heart Failure: A Randomized Educational Intervention to Change Provider Behavior","authors":"Ileana L. Piña MD, MPH,&nbsp;David Bruckman MS,&nbsp;Craig Lance MD,&nbsp;Jeanne Hitch (CL)MDDB,&nbsp;Julie Gee ANP,&nbsp;Kimberley Schaub PhD,&nbsp;Michelle Davidson MEd,&nbsp;Scott Ober MD, MBA,&nbsp;David Aron MD, MS","doi":"10.1111/j.1751-7133.2012.00300.x","DOIUrl":"10.1111/j.1751-7133.2012.00300.x","url":null,"abstract":"<p>©2012 Wiley Periodicals, Inc.</p><p>Whether provider education changes practice for HF has not been reported. (NHeFT)™ uses didactic and experiential training of primary care providers (PCP) to optimize treatment of HF. We randomized PCP’s in the Cleveland VA clinics to training (T) vs control (C). Endpoints: Primary – the number of patients with EF &lt; 40% treated with ACEI/ARB and Beta Blocker, +/− diuretic post T vs pre T; Secondary – the number of patients with increase in ACEI/ARB or a decrease in diuretic post T vs. pre T. Of 641 patients, 216 (85 C,131 T) had EF &lt; 40%; 188 (85%) did not meet the primary endpoint at baseline. After T, a similar proportion (64.2% C, 74.4%,T) met the endpoint at end of study (<i>P</i> = 0.14). The odds of a patient meeting the primary endpoint by care of a T provider, was not significantly higher than C (OR 1.496, 95% CI (0.751, 2.982)). Patients seen by T were more likely to have the diuretic dose decreased vs patients under C, without increases in ACEI or ARB (<i>P </i>&lt; 0.03). Thus, a didactic program of HF plus a preceptorship changed practice modestly. Studies should address provider readiness of change and self efficacy to adhere to evidenced-based care.</p>","PeriodicalId":83668,"journal":{"name":"Congestive heart failure (Greenwich, Conn.)","volume":"18 5","pages":"245-253"},"PeriodicalIF":0.0,"publicationDate":"2012-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1111/j.1751-7133.2012.00300.x","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30694300","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":"Post-Infarct Biomaterials, Left Ventricular Remodeling, and Heart Failure: Is Good Good Enough?","authors":"Fouad A. Zouein BS,&nbsp;Carlos Zgheib MS,&nbsp;Kenneth W. Liechty MD,&nbsp;George W. Booz PhD","doi":"10.1111/j.1751-7133.2012.00298.x","DOIUrl":"10.1111/j.1751-7133.2012.00298.x","url":null,"abstract":"<p>Almost 3 decades ago, myocardial infarction (MI) was associated with very high morbidity and mortality rates. If a patient survived an acute infarct, their prognosis was very poor and highly dependent on post-injury complications.¹ Acute complications such as rupture of the myocardium, contractile dysfunction, valvular disease, and heart block or long-term complications such as heart failure and arrhythmias severely limited survival. Marked improvements were not seen until the mid-1980s with the development of interventional and pharmacologic therapies and the focus on early coronary reperfusion.¹ With clot-busting agents, coronary artery bypass grafting (CABG), percutaneous coronary intervention, and long-term treatment with angiotensin-converting enzyme inhibitors and β-blockers, survival has increased to &gt;80% for the 30-day period post-MI; although, outcome is highly dependent on patient risk level and hospital performance.^2,3</p><p>Of course, not all patients exert the same level of response or have the same infarct size. In addition, high-risk patients are more prone to infarct expansion and border zone extension due, in part, to increased mechanical wall stress placed on the injured myocardium, which inevitably progresses into heart failure.^4,5 The border zone is characterized by a hypocontractile myocardium that is nonetheless perfused. With time, adverse cellular and tissue remodeling events contribute, along with mechanical forces, to infarct expansion and border zone extension. This progressive maladaptive response is associated with increased myocyte apoptosis/necrosis and slippage, extracellular matrix disturbances marked by fibrosis and changes in collagen makeup, and a complex wound healing process.^6,7 In time, the heart loses most of its function and pumping capacity due to chamber dilation and thinning of the ventricular wall.⁸ Despite extensive research and discovery of a large number of biomarkers that represent possible therapeutic targets, how the heart reaches this irreversible stage is still unclear.</p><p>Intense research has been focused recently on late stages of heart failure, and novel strategies such as regenerative stem cell therapy and tissue engineering have emerged.^9–11 Some modest improvements in cardiac function have been documented in clinical trials of stem cell treatment¹²; however, reversing adverse remodeling and regenerating a fully functional and integrated myocardium is still a dream. Alternative strategies aimed at preventing adverse remodeling may represent a much more attainable goal. With that in mind, some groups have focused efforts on devising ways of preventing the initial injury, especially in patients with high-risk factors, while others have focused on preventing adverse remodeling after the injury has occurred (Figure 1).</p><p>In this review, we focus on therapeutic strategies that prevent adverse re","PeriodicalId":83668,"journal":{"name":"Congestive heart failure (Greenwich, Conn.)","volume":"18 5","pages":"284-290"},"PeriodicalIF":0.0,"publicationDate":"2012-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1111/j.1751-7133.2012.00298.x","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30632959","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":"Clinical Picture and Social Characteristics of Super-Elderly Patients With Heart Failure in Japan","authors":"Yu Kawai MD,&nbsp;Nobutaka Inoue MD, PhD,&nbsp;Kazuo Onishi MD, PhD","doi":"10.1111/j.1751-7133.2012.00297.x","DOIUrl":"10.1111/j.1751-7133.2012.00297.x","url":null,"abstract":"<p>©2012 Wiley Periodicals Inc.</p><p>The number of super-elderly patients older than 80 years with chronic heart failure (HF) is dramatically increased in Japan; however, therapeutic strategies for patients 80 years or older remains to be established. The present investigation was undertaken to clarify the clinical picture and socioeconomic characteristics of super-elderly HF patients. A total of 380 consecutive patients with acute HF or acutely worsening chronic HF were divided into three groups according to age: patients younger than 60 years, those 60 to 80 years, and those 80 years or older (super-elderly group). HF patients in the super-elderly group initially presented with more atypical symptoms at admission compared with those in the younger age group. The prevalence of HF with preserved ejection fraction was more pronounced compared with the patients in the younger age group. Furthermore, the social background was quite different for the 3 groups in several respects: recurrent hospitalization, the prevalence of dementia, and the number of patients living alone all increased with age. The lack of social support in patients with HF is a problem that needs to be resolved in the “super-graying” societies such as Japan.</p>","PeriodicalId":83668,"journal":{"name":"Congestive heart failure (Greenwich, Conn.)","volume":"18 6","pages":"327-332"},"PeriodicalIF":0.0,"publicationDate":"2012-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1111/j.1751-7133.2012.00297.x","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40185163","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 Value of Capnography During Rest and Exercise in Patients With Heart Failure","authors":"Ross Arena PhD, PT,&nbsp;Marco Guazzi MD, PhD,&nbsp;Jonathan Myers PhD,&nbsp;Paul Chase MD,&nbsp;Daniel Bensimhon MD,&nbsp;Lawrence P. Cahalin PhD, PT,&nbsp;Mary Ann Peberdy MD,&nbsp;Euan Ashley MD,&nbsp;Erin West MS,&nbsp;Daniel E. Forman MD","doi":"10.1111/j.1751-7133.2012.00296.x","DOIUrl":"10.1111/j.1751-7133.2012.00296.x","url":null,"abstract":"<p>©2012 Wiley Periodicals Inc.</p><p>New variables obtained from cardiopulmonary exercise testing (CPX) have received attention in recent years, in particular the partial pressure of end-tidal carbon dioxide (P_ETCO₂). The purpose of this study was to therefore comprehensively assess the ability of resting and exercise P_ETCO₂ to predict major cardiac events in a heart failure (HF) cohort referred for CPX. A total of 963 patients with systolic HF undergoing symptom-limited CPX were included in the analysis. Resting and exercise P_ETCO₂ along with other CPX variables were determined, and patients were followed for major adverse events. With regard to resting measures, multivariate analysis revealed that left ventricular ejection fraction was the most robust prognostic marker (<i>P</i>&lt;.001) while resting P_ETCO₂ added significant predictive value and was retained in the regression (<i>P</i>&lt;.001). When exercise data were considered, the multivariate analysis revealed that the P_ETCO₂ apex during exercise added predictive value and was retained (<i>P</i>&lt;.05). In what is the largest evaluation of P_ETCO₂ in the assessment of systolic HF patients to date, the authors substantiate prior (smaller) studies showing prognostic utility of P_ETCO₂, both as a resting measure (an important potential screening tool) and during exercise. These data add to the rationale to incorporate P_ETCO₂ as a routine monitoring component in HF management.</p>","PeriodicalId":83668,"journal":{"name":"Congestive heart failure (Greenwich, Conn.)","volume":"18 6","pages":"302-307"},"PeriodicalIF":0.0,"publicationDate":"2012-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1111/j.1751-7133.2012.00296.x","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40185553","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":"Exercise Training Improves Heart Rate Variability in Older Patients With Heart Failure: A Randomized, Controlled, Single-Blinded Trial","authors":"Khalil Murad MD,&nbsp;Peter H. Brubaker PhD,&nbsp;David M. Fitzgerald MD,&nbsp;Timothy M. Morgan PhD,&nbsp;David C. Goff Jr MD, PhD,&nbsp;Elsayed Z. Soliman MD, MSc, MS,&nbsp;Joel D. Eggebeen MS,&nbsp;Dalane W. Kitzman MD","doi":"10.1111/j.1751-7133.2011.00282.x","DOIUrl":"10.1111/j.1751-7133.2011.00282.x","url":null,"abstract":"<p><i>Congest Heart Fail</i>. ****;**:**–**. ©2012 Wiley Periodicals, Inc.</p><p>Reduced heart rate variability (HRV) in older patients with heart failure (HF) is common and indicates poor prognosis. Exercise training (ET) has been shown to improve HRV in younger patients with HF. However, the effect of ET on HRV in older patients with HF is not known. Sixty-six participants (36% men), aged 69±5 years, with HF and both preserved ejection fraction (HFPEF) and reduced ejection fraction (HFREF), were randomly assigned to 16 weeks of supervised ET (ET group) vs attention-control (AC group). Two HRV parameters (the standard deviation of all normal RR intervals [SDNN] and the root mean square of successive differences in normal RR intervals [RMSSD]) were measured at baseline and after completion of the study. When compared with the AC group, the ET group had a significantly greater increase in both SDNN (15.46±5.02 ms in ET vs 2.37±2.13 ms in AC, P=.016) and RMSSD (17.53±7.83 ms in ET vs 1.69±2.63 ms in AC, P=.003). This increase was seen in both sexes and HF categories. ET improved HRV in older patients with both HFREF and HFPEF.</p>","PeriodicalId":83668,"journal":{"name":"Congestive heart failure (Greenwich, Conn.)","volume":"18 4","pages":"192-197"},"PeriodicalIF":0.0,"publicationDate":"2012-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1111/j.1751-7133.2011.00282.x","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40185145","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":"Exercise Training in Heart Failure With Preserved Systolic Function: A Randomized Controlled Trial of the Effects on Cardiac Function and Functional Capacity","authors":"Neil A. Smart PhD,&nbsp;Brian Haluska PhD,&nbsp;Leanne Jeffriess BSc,&nbsp;Dominic Leung PhD","doi":"10.1111/j.1751-7133.2012.00295.x","DOIUrl":"10.1111/j.1751-7133.2012.00295.x","url":null,"abstract":"<p>©2012 Wiley Periodicals Inc.</p><p>Exercise training improves functional capacity in patients with exercise limitation attributed to systolic dysfunction (SD), but exercise training effects in patients with diastolic dysfunction is unclear. The authors determined the functional capacity, quality of life, and echocardiography responses of heart failure with preserved ejection fraction (HFpEF) patients to 16 weeks exercise training. Thirty patients with HFpEF were randomized to an exercise training or non-exercising control group. The patients had a baseline mean age of 64±8 years, left ventricular ejection fraction 57%±10%, and peak oxygen consumption (peak VO₂) of 13.3±3.8 mL O₂/kg/min. Minnesota Living With Heart Failure and Hare-Davis scores and echocardiographic measures (ejection fraction, systolic and diastolic tissue velocity and filling pressure [<i>E</i>/<i>E</i>′]) were performed at baseline and after 16 weeks of exercise training. The exercise training and non-exercising control groups showed similar baseline VO₂ (12.2±3.6 mL/kg/min vs 14.1±4.1 mL/kg/min), ejection fraction (58%±13% vs 57%±8%), and systolic and diastolic function. After exercise training the increment in peak VO₂ in the exercise training group was (24.6%, <i>P</i>=.02), and the non-exercising control group (5.1%, <i>P</i>=.19). <i>V</i>_E/VCO₂ slope was reduced by 12.7% in the exercise training group (<i>P</i>=.02) but was unchanged in the non-exercising control group (<i>P</i>=.03). No significant changes in diastolic or systolic function were noted in either group. Quality-of-life and depression scores were unchanged with exercise training. Changes in peak VO₂ and <i>V</i>_E/VCO₂ slope were unrelated to measures of diastolic and systolic function. In patients with exercise limitation attributed to HFpEF, the improvement in peak VO₂ with exercise training was not clearly related to changes in cardiac function. Congest Heart Fail.</p>","PeriodicalId":83668,"journal":{"name":"Congestive heart failure (Greenwich, Conn.)","volume":"18 6","pages":"295-301"},"PeriodicalIF":0.0,"publicationDate":"2012-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1111/j.1751-7133.2012.00295.x","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40185916","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 Assist Device as Bridge to Recovery for Anthracycline-Induced Terminal Heart Failure","authors":"Jon M. Appel MD, PHD,&nbsp;Kåre Sander MD, DMSci,&nbsp;Peter B. Hansen MD,&nbsp;Jacob E. Møller MD, PHD, DmSci,&nbsp;Anders Krarup-Hansen MD, PHD,&nbsp;Finn Gustafsson MD, PHD, DMSci","doi":"10.1111/j.1751-7133.2012.00291.x","DOIUrl":"10.1111/j.1751-7133.2012.00291.x","url":null,"abstract":"<p>©2012 Wiley Periodicals, Inc.</p><p>Anthracycline treatments are hampered by dose-related cardiotoxicity, frequently leading to heart failure (HF) with a very poor prognosis. The authors report a case of a 19-year-old man developing HF after anthracycline treatment for Ewing sarcoma. Despite medical treatment, his condition deteriorated to terminal HF, leading to implantation of a mechanical left ventricular assist device (LVAD). His heart function recovered, allowing explantation of the device 14 months after implantation. Heart transplantation is often contraindicated in the first years after treatment for cancers, and LVAD as “bridge to recovery” may be warranted in similar patients.</p>","PeriodicalId":83668,"journal":{"name":"Congestive heart failure (Greenwich, Conn.)","volume":"18 5","pages":"291-294"},"PeriodicalIF":0.0,"publicationDate":"2012-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1111/j.1751-7133.2012.00291.x","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40171616","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":"Independent and Incremental Value of Severely Enlarged Left Atrium in Risk Stratification of Very Elderly Patients With Chronic Systolic Heart Failure","authors":"Gani Bajraktari MD, PhD,&nbsp;Paolo Fontanive MD,&nbsp;Spiro Qirko MD, PhD,&nbsp;Shpend Elezi MD, PhD,&nbsp;Anca Simioniuc MD, PhD,&nbsp;Alda Huqi MD,&nbsp;Venera Berisha MD,&nbsp;Frank L. Dini MD","doi":"10.1111/j.1751-7133.2011.00280.x","DOIUrl":"10.1111/j.1751-7133.2011.00280.x","url":null,"abstract":"<p>Congest Heart Fail. ****;**:**–**. ©2012 Wiley Periodicals, Inc.</p><p>The authors sought to assess the impact on survival of demographic, clinical, and echo-Doppler parameters in patients with chronic heart failure due to left ventricular systolic dysfunction divided according to age groups. This study included 734 patients (age 69±11 years) who were classified into tertiles of age: I (22–66 years), II (67–76 years), and III (77–94 years). Severely enlarged left atrial size was defined as ≥52 mm in men and ≥47 mm in women. Multivariable analysis identified male sex (<i>P</i>=.018) and severely enlarged left atrium (<i>P</i>=.024) as significant correlates of all-cause mortality in the very elderly cohort, while restrictive filling pattern (RFP) (<i>P</i>=.004) and New York Heart Association class III or IV (<i>P</i>=.005) among patients of the first tertile and RFP (<i>P</i>=.028) among patients in the second tertile were independently associated with mortality after 30±21 months of follow-up. At the interactive stepwise model in the very elderly population, a severely enlarged left atrium, added to the model after clinical parameters and ejection fraction, moved the chi-square value from 20.7 to 25.8 (<i>P</i>=.048). RFP emerged as the single best predictor of all-cause mortality in the younger and intermediate ranges, whereas severely enlarged left atrium was the best predictor in the very elderly.</p>","PeriodicalId":83668,"journal":{"name":"Congestive heart failure (Greenwich, Conn.)","volume":"18 4","pages":"222-228"},"PeriodicalIF":0.0,"publicationDate":"2012-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1111/j.1751-7133.2011.00280.x","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40169721","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}