Home About us Contact
|
Home About us Contact | ||
|
|
||
Heart Failure Hospitalization (heart + failure_hospitalization)
Selected AbstractsPredictors of Long-Term Risk for Heart Failure Hospitalization after Acute Myocardial InfarctionANNALS OF NONINVASIVE ELECTROCARDIOLOGY, Issue 3 2010Juha S. Perkiömäki M.D. Background: Data on the value of baseline brain natriuretic peptide (BNP) and autonomic markers in predicting heart failure (HF) hospitalization after an acute myocardial infarction (AMI) are limited. Methods: A consecutive series of patients with AMI without a previous history of HF (n = 569) were followed up for 8 years. At baseline, the patients had a blood sample for determination of BNP, a 24-hour Holter recording for evaluating heart rate variability (HRV) and heart rate turbulence (HRT), and an assessment of baroreflex sensitivity (BRS) using phenylephrine test. Results: During the follow-up, 79 (14%) patients were hospitalized due to HF. Increased baseline BNP, decreased HRV, HRT, and BRS had a significant association with HF hospitalization in univariate comparisons (P < 0.001 for all). After adjusting with all the relevant clinical parameters, BNP, HRV, and HRT still significantly predicted HF hospitalization (P < 0.001 for BNP and for the short-term scaling exponent ,1, P < 0.01 for turbulence slope). In the receiver operator characteristics curve analysis, the area under the curve for BNP was 0.77, for the short-term scaling exponent ,1 0.69, for turbulence slope 0.71, and for BNP/standard deviation of all N-N intervals ratio 0.80. Conclusion: Baseline increased BNP and impaired autonomic function after AMI yield significant information on the long-term risk for HF hospitalization. Ann Noninvasive Electrocardiol 2010;15(3):250,258 [source] Fragmented QRS in Prediction of Cardiac Deaths and Heart Failure Hospitalizations after Myocardial InfarctionANNALS OF NONINVASIVE ELECTROCARDIOLOGY, Issue 2 2010Petri Korhonen M.D. Background: Increased QRS fragmentation in visual inspection of 12-lead ECG has shown association with cardiac events in postmyocardial infarction (MI) patients. We investigated user-independent computerized intra-QRS fragmentation analysis in prediction of cardiac deaths and heart failure (HF) hospitalizations after MI. Methods: Patients (n = 158) with recent MI and reduced left ventricular ejection fraction (LVEF) were studied. A 120-lead body surface potential mapping was performed at hospital discharge. Intra-QRS fragmentation was computed as the number of extrema (fragmentation index FI) in QRS. QRS duration (QRSd) was computed for comparison. Results: During a mean follow-up of 50 months 15 patients suffered cardiac death and 23 were hospitalized for HF. Using the mean + 1 SD as cut-point both parameters were univariate predictors of both end-points. In multivariate analysis including age, gender, LVEF, previous MI, bundle branch block, atrial fibrillation, and diabetes FI was an independent predictor for cardiac deaths (HR 8.7, CI 3.0,25.6) and HF hospitalizations (HR 3.8, CI 1.6,9.3) whereas QRSd only predicted HF hospitalizations (HR 4.6, CI 2.0,10.7). In comparison to QRSd, FI showed better positive (PPA) and equal negative (NPA) predictive accuracy for both end-points, and PPA was further improved when combined to LVEF < 40%. Limiting fragmentation analysis to 12-lead ECG or a randomly selected 8-lead set instead of all 120 leads resulted in an almost similar prediction. Conclusions: Increased QRS fragmentation in post-MI patients predicts cardiac deaths and HF progression. A computer-based fragmentation analysis is a stronger predictor than QRSd. Ann Noninvasive Electrocardiol 2010;15(2):130,137 [source] Implantable Cardioverter Defibrillators: Do Women Fare Worse Than Men?JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 9 2009Gender Comparison in the INTRINSIC RV Trial Introduction: Due to limited enrollment of women in previous trials, there is a paucity of data comparing outcome and arrhythmic events in men versus women with implantable cardioverter defibrillators (ICDs). Methods and Results: We analyzed outcome of patients in the INTRINSIC RV (Inhibition of Unnecessary RV Pacing with AV Search Hysteresis in ICDs) trial based on gender. Women comprised 19% (293/1530) of the INTRINSIC RV population. Compared with men, women were less likely to have coronary disease, ischemic cardiomyopathy, and hyperlipidemia, and were more likely to have congestive heart failure and diabetes. Women were less likely to receive beta blockers and ACE inhibitors, and more likely to receive diuretics. Over 10.8 ± 3.5 months of follow-up, unadjusted mortality was higher in women than men (6.8% vs 4.1%, P = 0.04). Heart failure hospitalizations occurred in 7.9% of women versus 5.7% of men (P = 0.13). After adjustment for baseline differences and drug therapy, there was no significant difference in mortality between men and women. Adverse events were observed more often in women. There were no gender differences in the percentage of patients receiving appropriate or inappropriate ICD shocks. Conclusions: In INTRINSIC RV, women receiving ICDs differed from men regarding baseline characteristics and drug therapy. After adjusting for baseline differences and medical therapy, there were no differences in heart failure hospitalization, survival, or ICD shock therapy during follow-up. Apparent undertreatment of heart failure and greater frequency of adverse advents in women receiving ICDs warrant further investigation. [source] Effect of Left Ventricular Lead Concordance to the Delayed Contraction Segment on Echocardiographic and Clinical Outcomes after Cardiac Resynchronization TherapyJOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 5 2009JEFFREY W.H. FUNG M.D. Introduction: The optimal left ventricular (LV) pacing site for cardiac resynchronization therapy (CRT) is unclear. The current study aims to explore the clinical significance of LV lead concordance to delayed contraction segment in CRT. Methods and Results: Concordant LV lead position was defined as the lead tip located by fluoroscopy at or immediately adjacent to the LV segment with latest contraction determined by tissue Doppler imaging. Echocardiographic and clinical outcomes among 101 consecutive patients with or without concordant LV lead positions were compared. There was no significant difference in changes in LV volumes and clinical parameters between patients with concordant (n = 46) or nonconcordant (n = 55) LV lead positions at 3 and 6 months. In multivariate analysis, the baseline asynchrony index (,= 1.092, 95% CI: 1.050,1.114; P < 0.001), but not LV lead concordance, was the only independent predictor of LV reverse remodeling. By Cox regression analysis, ischemic etiology, and LV reverse remodeling, but not LV lead concordance, were independent predictors of mortality (,= 2.475, 95% CI: 1.183,5.178; P = 0.016, and ,= 0.272, 95% CI: 0.130,0.567; P < 0.001, respectively), cardiovascular hospitalization (,= 1.551, 95% CI: 1.032,2.333; P = 0.035, and ,= 0.460, 95% CI: 0.298,0.708; P < 0.001, respectively), and heart failure hospitalization (,= 0.486, 95% CI: 0.320,0.738; P = 0.001 for LV reverse remodeling). Conclusion: LV lead concordance to the delayed contraction segment may not be a major determining factor for favorable echocardiographic and clinical outcomes after CRT. [source] Optimal Left Ventricular Lead Position Predicts Reverse Remodeling and Survival After Cardiac Resynchronization TherapyCONGESTIVE HEART FAILURE, Issue 2 2009David Tepper MD Background., A nonoptimal LV pacing lead position may be a potential cause for nonresponse to CRT. Methods., The site of latest mechanical activation was determined by speckle tracking radial strain analysis and related to the LV lead position on chest x-ray in 244 CRT candidates. Echocardiographic evaluation was performed after 6 months. Long-term follow-up included all-cause mortality and hospitalizations for heart failure. Results., Significant LV reverse remodeling (reduction in LV end-systolic volume from 189±83 mL to 134±71 mL, P<.001) was noted in the group of patients with a concordant LV lead position (n=153, 63%), whereas patients with a discordant lead position showed no significant improvements. In addition, during long-term follow-up (32±16 months), less events (combined for heart failure hospitalizations and death) were reported in patients with a concordant LV lead position. Moreover, a concordant LV lead position appeared to be an independent predictor of hospitalization-free survival after long-term CRT (hazard ratio: 0.22, P=.004). Conclusions., Pacing at the site of latest mechanical activation, as determined by speckle tracking radial strain analysis, resulted in superior echocardiographic response after 6 months of CRT and better prognosis during long-term follow-up. [source] | ||||||||||