1,720,999 research outputs found
Constrictive pericarditis in Erdheim-Chester disease: an integrated echocardiographic and magnetic resonance approach
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Loop Diuretics Strategies in Acute Heart Failure: From Clinical Trials to Practical Application
No full textAlthough loop diuretics are the most commonly used drugs for the treatment of acute heart failure (AHF), their short and long-term effects are relatively unknown. The use of loop diuretics is essential in the management of HF, particularly during episodes of acute decompensation, therefore more than 90% of patients admitted with HF receive this drug. The administration of intravenous loop diuretics to patients with heart failure and congestion typically results in the improvement of dyspnea, pulmonary congestion and in the reduction of Left Ventricular (LV) filling pressures. However, little is known about its appropriate dose, timing and modality administration in patients with AHF: several side effects may result from the administration of high diuretics dose, including worsening kidney function, diuretic resistance and sympathetic overdrive. Furthermore, there is no specific strategy that shows a clear benefit in HF outcome in relation to continuous versus intermittent administration modalities. Current data based on small and heterogeneous studies did not demonstrate a clear risk benefit ratio and larger prospective trials need to be completed in order to be able to provide definitive recommendations in the future. Since every patient represents a single entity and may have different responses to the same treatment, the best clinical approach should take into account physical examination, neuro-hormonal overdrive and kidney functional status. Due to these reasons, treatment with loop diuretics should be specifically customized for each patient, until multicenter blinded trials will provide satisfactory answers regarding optimal dosing, modality administration and precise targets
Different diuretic dose and response in acute decompensated heart failure: Clinical characteristics and prognostic significance
No full textBackground The question regarding the correct balance between optimal loop diuretic dose administration and best modality is under debate as well as the exact relation existing between congestion and renal dysfunction. We sought to evaluate the effects of different diuretic modalities (low [LD] versus high dose [HD]) and dose administration on decongestion, Worsening renal function (WRF) and outcome. Methods We retrospectively analyzed data of DIUR-HF study matching for LD vs HD (cut off 125 mg/day), and diuretic efficiency (DE) (weight loss/40 mg daily of furosemide). We also evaluated WRF rate (creatinine increase during hospitalization ≥ 0.3 mg/dl or estimated glomerular filtration rate (eGFR) reduction ≥ 25%) together with decongestion. Results HD patients (n.55) were older, more frequently affected by diabetes and chronic kidney disease (CKD) and demonstrated higher rate of inhospital WRF (65% vs 29% p = 0.001) and 180-days adverse events (70% vs 23% p < 0.001) respect to LD patients (n.41). Patients with low DE showed a higher 180 days adverse events rate than higher DE patients (p = 0.02). Univariate and multivariable analysis suggests a significant relationship between adverse events and low DE (patients with DE under median value) (U-HR = 2.59 [1.44–4.64]; p = 0.001. M-HR = 3.16 [1.55–6.46]; p = 0.002); continuous administration (HR = 3.12 [1.65–5.91]; p < 0.001) and WRF (HR = 5.30 [2.79–10.09]; p < 0.001) were also related with adverse events. Conclusions HD and poor DE are two conditions associated with adverse outcome. Both situations are the consequence of previous detrimental clinical status and they appear strictly related to WRF occurrence
The prognostic combined role of B-type natriuretic peptide, blood urea nitrogen and congestion signs persistence in patients with acute heart failure
No full textAIMS: B-type natriuretic peptide (BNP) decrease during hospitalization has been related to reduced risk of readmission and death in patients with acute heart failure (AHF). Conversely, the exact role of blood urea nitrogen (BUN) is still debated. Currently, no data have been published regarding the relation between these two biomarkers and the relation between them and clinical signs of congestion. METHODS: We consecutively studied 107 patients with diagnosis of AHF and systolic dysfunction. All patients were observed during a 6-month follow-up period. BUN and BNP were measured according to the decrease of BNP levels at discharge of greater than 30% with respect to basal values; the persistence of congestion signs at discharge and BUN increase at discharge to more than 20% with respect to baseline. RESULTS: In all patients mean BNP was 1014?±?767?pg/ml; in patients with severe systolic dysfunction BNP was higher (1382?±?1025 vs. 848?±?549; P?=?0.002). Mean BUN in all patients was 93?±?42?mg/dl; BUN was higher in patients affected by chronic kidney disease compared with patients with preserved renal function (114?±?45 vs. 68?±?21?mg/dl; P?<?0.001). Cox regression analysis demonstrated that BNP decrease of at least 30% together with congestion signs resolution was related to outcome improvement (univariate hazard ratio: 0.45 [0.19–0.97], P?=?0.05; multivariate hazard ratio: 0.44 [0.20–0.98], P?=?0.05). BUN increase of greater than 20% at discharge was associated with poor outcome independent of persistence of congestion signs (univariate hazard ratio: 2.72 [1.03–7.28], P?=?0.04; multivariate hazard ratio: 3.00 [1.12–8.06], P?=?0.03). Changes (Δ) of both BNP (univariate hazard ratio: 1.30 [1.04–1.61], P?=?0.01) and BUN (univariate hazard ratio: 5.24 [1.72–15.95], P?=?0.003) were associated with mortality, independently of congestion. CONCLUSIONS: In patients with AHF, BNP reduction of greater than 30% during hospitalization is associated with outcome improvement only if it occurs together with congestion resolution. Conversely, BUN increase of more than 20% was associated with poor outcome, independently of the persistence of congestion signs
The assessment, interpretation and implementation of lung ultrasound examinations in Heart Failure: Current evidence and gaps in knowledge
No full textLung ultrasound (LUS) is a simple, fast and non-invasive tool for pulmonary congestion assessment with higher accuracy for the detection of acute heart failure (HF) compared to clinical examination and chest radiography. The integrated assessment with other ultrasound and echocardiographic parameters can lead to a better systemic and pulmonary congestion characterization. Additionally, the combination of echocardiographic and pulmonary features can identify patients at higher risk for adverse outcomes, potentially facilitating both acute and chronic HF management and prognostic stratification. However, the optimal utilization of LUS needs to be better defined both in terms of imaging method and B-line thresholds which may differ based on the clinical scenario and, potentially, the HF phenotype. Despite the extensive potential role of LUS in a wide range of HF scenarios, clinicians may be unaware of the correct technique and exam interpretation. Specifically, the interpretation of LUS findings is influenced by several factors, such as imaging protocol, type of ultrasound transducer, patient positioning, and presence of concomitant pulmonary diseases. The aim of this review is to provide a practical overview of LUS in patients with known or suspected HF with the goal of providing a practical guide for clinicians and nurses in various clinical settings
Combined BNP and Echocardiographic assessment in interstitial lung disease for pulmonary hypertension detection
Full text linkNon-invasive assessment of acute heart failure by Stevenson classification: Does echocardiographic examination recognize different phenotypes?
No full textBACKGROUND: Acute heart failure (AHF) presentation is universally classified in relation to the presence or absence of congestion and the peripheral perfusion condition according to the Stevenson diagram. We sought to evaluate a relationship existing between clinical assessment and echocardiographic evaluation in patients with AHF. MATERIALS AND METHODS: This is a retrospective blinded multicenter analysis assessing both clinical and echocardiographic analyses during the early hospital admission for AHF. Patients were categorized into four groups according to the Stevenson presentation: group A (warm and dry), group B (cold and dry), group C (warm and wet), and group D (cold and wet). Echocardiographic evaluation was executed within 12 h from the first clinical evaluation. The following parameters were measured: left ventricular (LV) volumes, LV ejection fraction (LVEF); pattern Doppler by E/e1 ratio, pulmonary artery systolic pressure (PASP), tricuspid annular plane systolic excursion (TAPSE), and inferior cave vein diameter (ICV). RESULTS: We studied 208 patients, 10 in group A, 16 in group B, 153 in group C, and 29 in group D. Median age of our sample was 81 [69–86] years and the patients enrolled were mainly men (66.8%). Patients in groups C and A showed significant higher levels of systolic arterial pressures with respect to groups B and D (respectively, 130 [115–145] mmHg vs. 122 [119–130] mmHg vs. 92 [90–100] mmHg vs. 95 [90–100] mmHg, p 14 did not differ among groups. Follow-up analysis showed an increased mortality rate in D group (HR 8.2 p < 0.04). CONCLUSION: The early Stevenson classification remains a simple and universally recognized approach for the detection of congestion and perfusion status. The combined clinical and echocardiographic assessment may be useful to better define the patients’ profile
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