The acute decompensated heart failure (ADHF) is not as well characterized as the chronic phase, particularly in Latin American countries. Thus, the aim of this overview was to describe the clinical ...profile, treatment, and inhospital course of ADHF during the last decade in Argentina.
Results obtained from 5 Argentinean prospective and multicenter registries, involving 2974 patients admitted for ADHF, were assessed. These registries were performed and published between 1992 and 2004.
The mean age was 65 to 70 years, and nearly 40% were female. Coronary artery disease was the main etiology in nearly 30% of the patients. Between 1992 and 2004, the use of angiotensin-converting enzyme inhibitors increased from 29.9% to 53.4% before admission and from 48.5% to 69.3% before discharge; the use of β-blockers rose from 4.2% to 33.2% at admission and from 2.5% to 42.4% at predischarge (all
P < .0001). Inhospital mortality rates in the first to the fifth registries were 12.1%, 4.6%, 10.5%, 8.9%, and 4.7% (
P trend = .006). However, there were 98 (7.7%) deaths among 1272 patients before 2002, compared with 129 (7.6%) among 1702 since 2002 (
P = .9).
The clinical profile of this largest sample of ADHF reported from a Latin American country is different from that observed in clinical trials and comparable to registries worldwide. Although an improvement in the use of recommended drugs was observed in the last decade, the average mortality has not changed. These findings might have implications in the design of multinational clinical trials.
In the STEP-HFpEF trial, semaglutide improved symptoms, physical limitations and exercise function and reduced body weight in patients with obesity phenotype of heart failure and preserved ejection ...fraction (HFpEF). This prespecified analysis examined the effects of semaglutide on dual primary endpoints (change in Kansas City Cardiomyopathy Questionnaire-Clinical Summary Score (KCCQ-CSS) and body weight) and confirmatory secondary endpoints (change in 6-minute walk distance (6MWD), hierarchical composite (death, HF events, change in KCCQ-CSS and 6MWD) and change in C-reactive protein (CRP)) across obesity classes I-III (body mass index (BMI) 30.0-34.9 kg m
, 35.0-39.9 kg m
and ≥40 kg m
) and according to body weight reduction with semaglutide after 52 weeks. Semaglutide consistently improved all outcomes across obesity categories (P value for treatment effects × BMI interactions = not significant for all). In semaglutide-treated patients, improvements in KCCQ-CSS, 6MWD and CRP were greater with larger body weight reduction (for example, 6.4-point (95% confidence interval (CI): 4.1, 8.8) and 14.4-m (95% CI: 5.5, 23.3) improvements in KCCQ-CSS and 6MWD for each 10% body weight reduction). In participants with obesity phenotype of HFpEF, semaglutide improved symptoms, physical limitations and exercise function and reduced inflammation and body weight across obesity categories. In semaglutide-treated patients, the magnitude of benefit was directly related to the extent of weight loss. Collectively, these data support semaglutide-mediated weight loss as a key treatment strategy in patients with obesity phenotype of HFpEF. ClinicalTrials.gov identifier: NCT04788511 .
Markers of myocardial necrosis and natriuretic peptides are risk predictors in decompensated heart failure (DHF). We prospectively studied the optimal timing of combined cardiac troponin T (cTnT) and ...N-terminal pro-brain natriuretic peptide (NT-proBNP) measurements for long-term risk stratification.
cTnT and NT-proBNP were measured upon admission, and before discharge in 76 patients hospitalized for DHF (mean age 62.3 +/- 15 years; 71% men).
During a mean follow-up of 252 +/- 120 days, 39.5% of patients died or were re-hospitalized for DHF. From receiver-operator-characteristic (ROC) curves, the selected cut-off values for cTnT and NT-proBNP were 0.026 ng/ml and 3,700 pg/ml on admission, and 0.030 ng/ml and 3,200 pg/ml, respectively, at discharge. Depending upon measurements above vs below cut-off, the population was distributed on admission and before discharge for three groups: both negative (24% and 30% of patients); one positive (43% and 42%); and both positive (33% and 28%). For the admission groups, the 1-year DHF-free re-hospitalization survival rates were 85%, 60% and 34%, respectively (p = 0.0047). One-year survival rates for DHF-free re-hospitalization were 63%, 71% and 26% (p = 0.0029), respectively, for the discharge groups. In the Cox proportional hazards model, systolic blood pressure (hazard ratio HR: 0.98; 95% confidence interval CI: 0.96 to 0.99), heart rate (HR: 0.97; 95% CI: 0.94 to 0.98), one positive biomarker on admission (HR: 10.5; 95% CI: 1.3 to 83.7) and two positive biomarkers on admission (HR: 13.9; 95% CI: 1.8 to 98.5) were independent predictors of long-term outcomes. However, NT-proBNP on admission was the most important predictor of long-term prognosis (HR: 5.1; 95% CI: 2.3 to 12.2).
The combined measurements of cTnT and NT-proBNP on hospital admission were more reliable than their measurements before discharge in the long-term risk stratification of DHF. A single positive measurement on admission predicted a poor long-term outcome.
The management of Pulmonary Arterial Hypertension (PAH) includes pharmacological and surgical strategies to control symptoms and increase survival. Current management guidelines provide ...recommendations about these strategies; however, their availability may be limited in different regions of the world.
To evaluate the current availability and access to the pharmacological strategies for the management of PAH in Latin America and the Caribbean (LA&C).
The Council on Heart Failure and Pulmonary Hypertension (CIFACAH) of the Inter-American Society of Cardiology (SIAC) conducted a survey to evaluate the availability and access (cost paid by patient) of pharmacological, interventional and surgical options for PAH in February 2023. Delegates from 21 LA&C countries that are part of the SIAC received and completed the survey.
Regarding pharmacological treatment for PAH, 100% of the countries have access to at least one nitric oxide pathway medication (sildenafil), 81% of the countries have access to at least one endothelin pathway medication and 81% of the countries have access to at least one prostanoid pathway medication (Table #1).The survey classified access to pharmacological therapies as the percentage of the cost / value of medication that must be paid by the patient, as follows: 0%: No additional payment; <50%: pay for lest that 50% of the cost; 50-99%: Pay for most of the medication; 100%: Pay for all.Access to at least one medication at 0% cost (no additional payment) for nitric oxide pathway therapy, endothelin pathway therapy and prostacyclin pathway therapy is available in 67%, 67% and 76% of the countries, respectively. By the other side, access to at least one medication paying full cost (100%) for nitric oxide pathway therapy, endothelin pathway therapy and prostacyclin pathway therapy is available in 76%, 67% and 59% of the countries, respectively.
The availability of pharmacological treatment for PAH is high and varies between pharmacological groups and different countries in LA&C. However, availability is different from accessibility, as the latter depends on many factors, including cost. Access to these medications at no cost or at full cost is available in almost two-thirds of LA&C countries, although most countries have health care systems that cover a percentage of the medication cost.
The management of heart failure (HF) includes pharmacological strategies to control symptoms and increase survival rates. Current management guidelines provide recommendations about these strategies; ...however, their availability and access may be limited in different regions of the world, including Latin America and the Caribbean (LA&C).
Evaluate the availability and accessibility to optimal medical therapy (OMT) for HF patients in LA&C, including beta blocker (BB), angiotensin converting enzyme inhibitor (ACEI) / angiotensin receptor antagonist (ARB) / angiotensin receptor-neprilysin inhibitor (ARNI), mineralocorticoid receptor antagonist (MRA) and sodium-glucose cotransporter-2 inhibitors (SGLT2i)
The Council on Heart Failure and Pulmonary Hypertension (CIFACAH) of the Inter-American Society of Cardiology (SAIC) conducted a survey to evaluate the availability and access (cost paid by patient) of pharmacological, interventional and surgical options for HF in February 2023. Delegates from 21 LA&C countries that are part of the SIAC received and completed the survey.
Regarding OMT, 100% of the countries have at least one BB, one ACEI, one ARB and one MRA available for HF treatment and ARNI and SGLT2i are available in 90% of countries (Table 1).The survey classified access to OMT as the percentage of the cost / value of medication that must be paid by the patient to access the specific therapy, as follows: 0%: No additional payment; <50%: pay for lest that 50% of the cost; 50-99%: Pay for most of the cost; 100%: Pay for all the cost.At least one BB of the OMT is available at 0% (No additional payment) in 76% of the countries, one ACEI / ARB / ARNI in 71%, one MRA in 71% and one SGLT2i in 42% of the countries (Table 2). By the other side, most of the available options for OMT are available in more than 86% of countries when patients can afford the hole cost (100%) of the medications.
In most LA&C countries, OMT is available with at least one medication from each pharmacological group. Most of the countries have health care systems that cover a percentage of the medication cost. Based on that, few countries have access to OMT at no cost, but in most of the countries there is a possibility to access to at least one medication of the OMT paying 100% of the value of the medications.
The coronavirus disease (COVID-19) has been associated with myocardial injury or cardiac involvement. Current evidence indicates that elevated cardiac biomarkers are associated with worse outcomes.
...Evaluate and compare which cardiac biomarker have the greatest clinical relevance in patients with COVID-19.
CARDIOCOVID 19-20 is an observational, ambispective, multicenter registry that included hospitalized patients with confirmed COVID-19 in 44 hospitals in 14 Latin American and Caribbean countries. We included patients who had troponin, natriuretic peptide, and D-dimer tests performed during hospitalization and divided them into 4 groups, those who had one, two or three abnormal or positive biomarkers, and those who had all negative.
476 patients had troponin, D-dimer, and natriuretic peptide tests performed during hospitalization and were classified as follows: 139 patients had 1 abnormal test (1AT), 190 had 2 abnormal tests (2AT), 118 had 3 abnormal tests (3AT) and 29 with all 3 tests normal (0AT). Median age was 64 years, and older patients were those that presented 3AT (69 years, p<0.001). In all groups, male was the predominant gender (Table 1A). Decompensated heart failure occurred in 35.6% of patients with 3AT, 18.4% of patients with 2AT, and 5.0% of patients with 1AT, while no patient with 0AT presented this complication (p<0.001). Invasive mechanical ventilation was required in more than 50% and ICU admission was required in more than 70% in those who presented at least one AT. Regarding mortality, the greater the number of elevated biomarkers, the greater the mortality, being 50.0%, 31.1%, and 18.0% in patients with 3AT, 2AT, and 1AT groups, respectively (p<0.001). We analyzed the group with 2AT and found that the overall mortality was 31.0% (59). Mortality of those who had positive troponin and natriuretic peptide was 43.2%, positive troponin and D-dimer was 44.0%, and positive natriuretic peptide and D-dimer was 24.0%. Of the 59 patients who died, 29 patients had positive natriuretic peptide and D-dimer (49.2%) and 19 patients the combination troponin and natriuretic peptide (32.2%). This means that patients who had positive troponin and natriuretic peptide, and positive troponin and D-dimer were 1.4 and 1.5 times more likely to die compared to those who had positive natriuretic peptide and D-dimer, respectively (Table 1B, 1C).
In COVID-19 patients, the higher the number of positive biomarkers (troponin, natriuretic peptide and / or D-dimer), the higher the prevalence of cardiovascular complications during hospitalization, and the higher the cardiovascular mortality.
Chagas disease, originally a South American endemic health problem, is expanding worldwide because of people migration. Its main impact is on the cardiovascular system, producing myocardial damage ...that frequently results in heart failure. Pathogenic pathways are mainly related to inmunoinflamatory reactions in the myocardium and, less frequently, in the gastrointestinal tract. The heart usually shows fibrosis, producing dilatation and damage of the electrogenic cardiac system. These changes result in cardiomyopathy with heart failure and frequent cardiac arrhythmias and heart blocks. Diagnosis of the disease must include a lab test to detect the parasite or its immune reactions and the usual techniques to evaluate cardiac function. Therapeutic management of Chagas heart failure does not differ significantly from the most common treatment for dilated cardiomyopathy, with special focus on arrhythmias and several degrees of heart block. Heart transplantation is reserved for end-stage cases. Major international scientific organisations are delivering recommendations for prevention and early diagnosis. This article provides an analysis of epidemiology, prevention, treatment and the relationship between Chagas disease and heart failure.
Obesity and type 2 diabetes are prevalent in patients with heart failure with preserved ejection fraction and are characterized by a high symptom burden. No approved therapies specifically target ...obesity-related heart failure with preserved ejection fraction in persons with type 2 diabetes.
We randomly assigned patients who had heart failure with preserved ejection fraction, a body-mass index (the weight in kilograms divided by the square of the height in meters) of 30 or more, and type 2 diabetes to receive once-weekly semaglutide (2.4 mg) or placebo for 52 weeks. The primary end points were the change from baseline in the Kansas City Cardiomyopathy Questionnaire clinical summary score (KCCQ-CSS; scores range from 0 to 100, with higher scores indicating fewer symptoms and physical limitations) and the change in body weight. Confirmatory secondary end points included the change in 6-minute walk distance; a hierarchical composite end point that included death, heart failure events, and differences in the change in the KCCQ-CSS and 6-minute walk distance; and the change in the C-reactive protein (CRP) level.
A total of 616 participants underwent randomization. The mean change in the KCCQ-CSS was 13.7 points with semaglutide and 6.4 points with placebo (estimated difference, 7.3 points; 95% confidence interval CI, 4.1 to 10.4; P<0.001), and the mean percentage change in body weight was -9.8% with semaglutide and -3.4% with placebo (estimated difference, -6.4 percentage points; 95% CI, -7.6 to -5.2; P<0.001). The results for the confirmatory secondary end points favored semaglutide over placebo (estimated between-group difference in change in 6-minute walk distance, 14.3 m 95% CI, 3.7 to 24.9; P = 0.008; win ratio for hierarchical composite end point, 1.58 95% CI, 1.29 to 1.94; P<0.001; and estimated treatment ratio for change in CRP level, 0.67 95% CI, 0.55 to 0.80; P<0.001). Serious adverse events were reported in 55 participants (17.7%) in the semaglutide group and 88 (28.8%) in the placebo group.
Among patients with obesity-related heart failure with preserved ejection fraction and type 2 diabetes, semaglutide led to larger reductions in heart failure-related symptoms and physical limitations and greater weight loss than placebo at 1 year. (Funded by Novo Nordisk; STEP-HFpEF DM ClinicalTrials.gov number, NCT04916470.).
Semaglutide and NT-proBNP in Obesity-Related HFpEF Petrie, Mark C.; Borlaug, Barry A.; Butler, Javed ...
Journal of the American College of Cardiology,
07/2024, Letnik:
84, Številka:
1
Journal Article
Recenzirano
Odprti dostop
The glucagon-like peptide-1 receptor agonist, semaglutide, improved health status and reduced body weight in patients with obesity-related heart failure (HF) with preserved ejection fraction (HFpEF) ...in the STEP-HFpEF (Semaglutide Treatment Effect in People with Obesity and HFpEF) program. Whether benefits were due to mechanical unloading or effects on HF pathobiology is uncertain.
This study sought to determine if semaglutide 2.4 mg reduced N-terminal pro–B-type natriuretic peptide (NT-proBNP) in patients with obesity-related HFpEF and compare treatment responses by baseline NT-proBNP.
This was a prespecified secondary analysis of pooled data from 2 double-blind, placebo-controlled, randomized trials (STEP-HFpEF Research Study to Investigate How Well Semaglutide Works in People Living With Heart Failure and Obesity and STEP-HFpEF DM Research Study to Look at How Well Semaglutide Works in People Living With Heart Failure, Obesity and Type 2 Diabetes) testing effects of semaglutide in patients with obesity-related HFpEF. The main outcomes were change in NT-proBNP at 52 weeks and change in the dual primary endpoints of Kansas City Cardiomyopathy Questionnaire Clinical Summary Score and body weight by baseline NT-proBNP.
In total, 1,145 patients were randomized. Semaglutide compared with placebo reduced NT-proBNP at 52 weeks (estimated treatment ratio: 0.82; 95% CI: 0.74-0.91; P = 0.0002). Improvements in health status were more pronounced in those with higher vs lower baseline NT-proBNP (estimated difference: tertile 1: 4.5 points, 95% CI: 0.8–8.2; tertile 2: 6.2 points, 95% CI: 2.4-10.0; tertile 3: 11.9 points, 95% CI: 8.1-15.7; P interaction = 0.02; baseline NT-proBNP as a continuous variable: P interaction = 0.004). Reductions in body weight were consistent across baseline NT-proBNP levels (P interaction = 0.21).
In patients with obesity-related HFpEF, semaglutide reduced NT-proBNP. Participants with higher baseline NT-proBNP had a similar degree of weight loss but experienced larger reductions in HF-related symptoms and physical limitations with semaglutide than those with lower NT-proBNP.
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Predictors of eclampsia in patients with preeclampsia Pizzorno, José Aníbal; Rivero, Mabel Itatí; Perna, Eduardo Roque ...
Journal of Cardiology & Current Research,
6/2024, Letnik:
17, Številka:
3
Journal Article
Odprti dostop
Objectives: To evaluate prevalence and predictors of eclampsia in patients with preeclampsia. Material and Methods: database of 11,026 consecutive births attended between Nov-98 and Jun-04, 323 ...patients admitted with a diagnosis of preeclampsia (blood pressure >=140-90 in 2 doses plus proteinuria) were included in this retrospective analysis. Eclampsia was diagnosed in the presence of associated seizures. Multiple logistic regression analysis was performed to identify independent markers of eclampsia. Results: The diagnosis of eclampsia was established in 32 (10%) patients. Patients with and without eclampsia differed in the following characteristics: primiparous (14.7 vs 6.4%, p=0.014), chronic anemia (14.6 vs 7.2%, p=0.031), adolescence (≤ 16 years) (40 vs 8.4%, p =0.002), smoking (29.2 vs 8.4%, p=0.005), multiple pregnancy (47.1 vs 8%, p<0.0001) and obesity (2.1 vs 11.8%, p=0.026). In the multivariate analysis, the independent predictors were the followings: multiple pregnancy (OR=13.6, 95%CI=4.4-41.8, p<0.0001), smoking (OR=4.9, 95%CI=1.6-15.1, p=0.006) and adolescence (OR =17.9, 95%CI=4.7-67.7, p<0.0001). In patients with none, one or two, and three variables, eclampsia occurred in 0% (0 of 265 cases), 44.7% (24 of 47), and 100% (11 of 11), respectively (p<0.0001). Conclusions: One in 10 patients with preeclampsia developed eclampsia during hospitalization. Three simple and widely available variables (adolescent mothers, smokers, and twin pregnancy) were useful to identify low- and high-risk population.
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