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Objective: To compare the safety and efficacy of valsartan/sacubitril (angiotensin receptor neprilysin inhibitor [ARNI]) against enalapril (angiotensin-converting enzyme inhibitor [ACEI]) in patients with acute heart failure at 6-month follow-up. Methods: In this prospective, single centre, and observational study conducted between September 2017 and February 2020 in India, patients with acute decompensated heart failure with reduced ejection fraction (<40%) were included. Patients were divided in two groups: valsartan/sacubitril (ARNI) group and enalapril (ACEI). Patients were followed up for at least 6 months after administration of first dose and were evaluated for safety, efficacy, and tolerability of target drug. Student's independent t-test was employed for comparing continuous variables. Chi-square test or Fisher's exact test, whichever appropriate, was applied for comparing categorical variables. Results: A total of 200 patients were included in the present study, 100 each in ARNI and ACEI group. The mean age of the population was 61.2 ± 8.4 years and 62.6 ± 8.6 years in ARNI group and ACEI group, respectively. The mean maximum tolerated dose by population in ARNI group was 203.6 mg and 8.9 mg in ACEI group. Readmission for heart failure were seen significantly higher in ACEI group than ARNI group (p value ¼ 0.001). Parameters like ejection fraction, left ventricular end diastolic and systolic dimensions, 6 min walk test and Kansas City Cardiomyopathy Questionnaires (KCCQ) showed p values < 0.05 between the groups. Conclusion: The ARNI study group showed better safety and efficacy outcomes at the end of 6 months follow-up compared to ACEI group
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Objective:To explore the effect of individual rehabilitation intervention on the clinical outcome of patients with acute decompensated heart failure.Methods:A total of 152 elderly patients with acute decompensated heart failure in a tertiary hospital from January 2017 to December 2018 were selected and randomly assigned to the test group and the control group. The test group developed individualized interim rehabilitation interventions based on the evaluation results of balance, mobility, muscle strength and endurance of patients. The control group only performed routine rehabilitation related health care and discharge follow up, the short physical performance battery and the rate of all-cause readmission 6 months after discharge were compared between the two groups.Results:Finally, 144 patients finished the reseach, 72 patients in each group. After 3 months of intervention, the total scores of balance test, 4-meter timed walking, time to complete 5 chair rise and SPPB in the test group were 3.05±1.01, 3.74±0.58, 2.75±0.76, 9.44±2.16, while those in the control group were 2.82±0.86, 3.30±1.02, 2.24±0.74, 8.33±2.46. There was significant difference between the two groups ( t value was from -5.287 to -2.001, P<0.01) . Six months after discharge, the all-cause readmission rate was 12.5% (9/72) in the test group and 23.6% (17/72) in the control group, the difference was statistically significant ( t value was -0.348, P<0.05). Conclusions:The individual rehabilitation exercise based on the results of physical function evaluation can effectively improve the patients' body function and quality of life. Besides this, it can reduce the rate of all-cause readmission 6 months after discharge, which can provide reference for the transitional rehabilitation training of the elderly patients with acute decompensated heart failure.
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INTRODUCTION@#Data on the long-term outcomes of Asian patients admitted for acute decompensated heart failure is scarce. The objectives of this study were to determine short-term, intermediate-term and long-term survival among patients admitted for acute decompensated heart failure in Thailand, and to identify factors independently associated with increased mortality.@*METHODS@#Patients who were admitted with a primary diagnosis of heart failure were enrolled in the Thai Acute Decompensated Heart Failure Registry (ADHERE) from 18 hospitals located across Thailand during 2006. Medical record data was collected according to ADHERE protocol. Mortality data was collected from death certificates on file at the Thailand Bureau of Registration Administration.@*RESULTS@#A total of 1,451 patients were included. The mean age of the patients was 63.7 ± 14.4 years, and 49.7% were male. One-year, five-year and ten-year mortality rates in Thai patients admitted for acute decompensated heart failure were 28.0%, 58.2% and 73.3%, respectively. Independent predictors of increased mortality were identified. There were more cardiovascular-related deaths than non-cardiovascular-related deaths (54.6% vs. 45.4%, respectively).@*CONCLUSIONS@#The ten-year mortality rate in Thai patients admitted for acute decompensated heart failure was 73.3%. Many factors were found to be independently associated with increased mortality, including left ventricular ejection fraction.
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OBJECTIVE：To observe the clinical effect and safety of recombinant human brain natriuretic peptide （rhBNP） combined with levosimendan in the treatment of acute decompensated heart failure （ADHF）complicated with renal insufficiency. METHODS：A total of 156 patients with ADHF complicated with renal insufficiency admitted to the Dept. of Cardiology in the Affiliated Hospital of Southwest Medical University during Jan.-Dec. 2019 were randomly divided into rhBNP group ，levosimendan group and combination group ，with 52 patients in each group. All patients received rountine treatment. On this basis ，rhBNP group was given rhBNP for injection [after 1.5 μg/kg intravenous pulse injection，intravenous dripping for 24 h with 0.007 5 μg（/ kg· min）]；leosimendan group was given Leosimendan injection 12.5 mg [intravenous dripping for 1 h with 6-12 μg（/ kg·min），then intravenous dripping for 23 h with 0.1 μg（/ kg·min）]. Combination group received drug combination according to the administration method of single drug group. Three groups received treatment for consecutive 7 d. Cardiac function indexes [heart rate （HR），left ventricular ejection fraction （LVEF），left ventricular end-diastolic diameter （LVEDD）]，mean arterial pressure （MAP），pulmonary capillary pressure （PCWP），renal function indexes [estimated glomerular filtration rate （eGFR），serum creatinine （Scr）]，serum levels of cystatin C （Cys-c）and amino-terminal brain natriuretic peptide precursor （NT-proBNP）were observed in 3 groups before and after treatment. Clinical efficacy and the occurrence of ADR were recorded. RESULTS ：Three cases withdrew from the study in rhBNP group and 1 case in levosimendan group ；152 cases completed the study. Before treatment ，there was no statistical significance in cardiac function indexes ，MAP，PCMP，renal function indexes or serum levels of Cys-C and NT-proBNP among 3 groups（P＞0.05）. After treatment ，the HP ，MAP，PCWP and serum level of NT-proBNP in 3 group as well as serum level of Cys-C in combination group were decreased significantly （P＜0.05）；the LVEF in 3 group as well as the eGFR and Scr level in levosimendan group and combination group were significantly increased （P＜0.05），compared with before treatment ；above indexes of combination group were significantly better than those of rhBNP group and levosimendan group （P＜0.05）. Total effective rate of combination group was 94.23％ ，which was significantly higher than those of rhBNP group （77.55％）and levosimendan group （76.47％）（P＜0.05）. There was no significant difference in the incidence of ADR among 3 groups（P＞ 0.05）. CONCLUSIONS ：rhBNP combined with levosimendan in the treatment of ADHF complicated with renal insufficiency can significantly increase the clinical efficacy ，and improve cardiac and renal function but don ’t increase the incidence of ADR.
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BACKGROUND: There have been few studies to evaluate the prognostic implications of guideline-directed therapy according to the temporal course of heart failure. This study assessed the relationship between adherence to guideline-directed therapy at discharge and 60-day clinical outcomes in de novo acute heart failure (AHF) and acute decompensated chronic heart failure (ADCHF) separately. METHODS: Among 5,625 AHF patients who were recruited from a multicenter cohort registry of Korean Acute Heart Failure, 2,769 patients with reduced ejection fraction were analyzed. Guideline-directed therapies were defined as the use of angiotensin-converting enzyme inhibitor (ACEI) or angiotensin receptor II blocker (ARB), β-blocker, and mineralocorticoid receptor antagonist. RESULTS: In de novo AHF, ACEI or ARB reduced re-hospitalization (hazard ratio [HR], 0.57; 95% confidence interval [CI], 0.34–0.95), mortality (HR, 0.41; 95% CI, 0.24–0.69) and composite endpoint (HR, 0.52; 95% CI, 0.36–0.77) rates. Beta-blockers reduced re-hospitalization (HR, 0.62; 95% CI, 0.41–0.95) and composite endpoint (HR, 0.65; 95% CI, 0.47–0.90) rates. In ADCHF, adherence to ACEI or ARB was associated with only mortality and β-blockers with composite endpoint. CONCLUSION: The prognostic implications of adherence to guideline-directed therapy at discharge were more pronounced in de novo heart failure. We recommend that guideline-directed therapy be started as early as possible in the course of heart failure with reduced ejection fraction.
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Humanos , Angiotensinas , Estudios de Cohortes , Insuficiencia Cardíaca , Corazón , Mortalidad , Receptores de MineralocorticoidesRESUMEN
Objective To study the effects of Tongxinluo capsule and Shen Mai injection in treatment of patients with acute myocardial infarction and its effects on level of left ventricular ejection fraction (LVEF),high sensitive C-reactive protein (hs-CRP),natriuretic peptide (BNP) and QT in acute decompensated heart failure ( QTcd) .Methods 82 patients with acute decompensated heart failure were selected in our hospital from May 2014 to April 2015, those patiens were divided into observation group and control group according to the method of lottery, 41 cases each group.The control group was treated with basic treatment and Huangxin injection, and the obsevation group was treated with Tongxinluo capsule on the basis of the control group.The changes of blood pressure, heart rate, LVEF, hs-CRP, BNP and QTcd were compared between the two groups before and after treatment. Results After treatment, the total effective rate of the observation group was significantly higher than the control group [92.68% (38/41) vs 60.97%(25/41)](P<0.05).The heart rate of the observation group was significantly lower than the control group (P<0.05), but the blood pressure level of the two groups had no significant difference.The levels of BNP, hs-CRP and QTcd in the observation group were significantly higher than the control group [(45.98 ±4.57)% vs(39.07 ±3.12)%](P<0.05) L, BNP, hs-CRP and QTcd were significantly lower than the control group [(2432.12 ± 114.32)ng/L,(17.32 ±1.87) mg/L, (34.76 ±3.02) ms vs (3565.87 ±174.76) ng/L, (14.08 ±1.23) mg/L,(38.45 ±3.86)].Adverse reactions were not observed in the observation group and the control group.Conclusion Tongxinluo capsule combined with Shen Mai injection can effectively increase the left ventricular ejection fraction and reduce hs-CRP, BNP and QTcd in patients with acute decompensated heart failure.The clinical curative effect is good and the safety is high.
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Objective To explore the clinical characteristics and causes of death in patients with acute heart failure at aged 75 and over.Methods The prospective study collected 175 patients with acute heart failure from January 2012 to December 2014.They were divided into ≥75 years old group and＜75 years old group and the general clinical data were recorded.Follow-up was performed mainly by telephone with supplemented hospitalization follow-up and outpatient follow-up.Survival rates were assessed by Kaplan-Meier method.The survival rate difference between the two groups was compared using the log-rank test.Multivariate Cox proportional hazards regression analysis was used to determine the independent risk factors for death.Results The proportions of ischemic heart disease,hypertension and old myocardial infarction were higher in the elderly group than in the young group with a higher proportion of male,diabetes and body mass index in ＜75 years old group.Elderly group had a higher level of left ventricular ejection fraction(LVEF)and a lower level of total cholesterol,triglycerides and low density lipoprotein cholesterol(LDL-C).Kaplan-Meier curves showed that allcause mortality(x2 =4.005,P =0.045) and non-cardiovascular mortality(x2 =4.418,P =0.041) were significantly higher in the elderly group than in the younger group,whereas cardiovascular mortality had no significant difference between the two groups (x2 =0.754,P =0.385).In patients with noncardiovascular mortality,12 cases (63.2％)died of pulmonary infection in elderly group,3 cases(25.0％) died of lung infection in younger group,and the difference was statistically significant between the 2 groups (x2 =4.288,P =0.038).Multivariate Cox proportional hazards regression analysis showed that age≥75 years was an independent predictor for both non-cardiovascular mortality [HR(95％CI):2.71(1.50-6.55),Wald x2 =2.266,P=0.038]and all-cause mortality[HR(95 ％CI):1.75(1.28-3.13),Wald x2 =2.914,P=0.026]in patients with acute heart failure.Conclusions Age ≥75 years is an independent risk factor for all dead patients with acute heart failure and noncardiovascular death,but it is not the independent risk factors for cardiovascular death,which is of great significance to establish a more rational treatment strategy for senile heart failure.
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Objective To investigate the effect of rh-BNP combined with sodium nitroprusside in acute decompensated heart failure patients with loss of blood flow dynamics, the effects on heart function and circulating factor levels.MethodsSelect Wenzhou Institute of Physiology from February 2014 to January 2016 admitted during the period of 120 cases of acute decompensated heart failure patients, according to random number table method to all of the patients were randomly divided into two groups, control group and test group with the control group patients were given conventional treatment of heart failure treatment, while the experimental group patients give tome sodium nitrate joint treatment with recombinant human brain natriuretic peptide, compare two groups of patients 12 h level of circulating factors, cardiac function and hemodynamics.ResultsTwo groups of patients after the hemodynamics after 24 h treatment was significantly lower than that after the treatment of 12h(P<0.05), the control group of patients after treatment of 12h and 24h after pulmonary capillary wedge pressure and right atrial pressure and central venous pressure index were significantly higher than those in the test group (P<0.05) for the treatment of 24h.After the control group of patients with left ventricular GSRa, GSRe, GSRs, ROTR, ROT, GCS, GLS levels were significantly lower than those in the test group (P<0.05).After treatment of 12h patients in the control group were hsCRP, ST2, IL-6 and blood The levels of cTn I and NT-proBNP were significantly higher than those in the experimental group (P<0.05).ConclusionRh-BNP combined with sodium nitroprusside in patients with acute decompensated heart failure treatment can effectively optimize the circulation of patients with factor level and heart function and hemodynamics, it is worth to be popularized in clinical use.
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Objective To investigate the clinical efficacy of levosimendan injection in the treatment of patients with acute decompensated heart failure.Methods70 patients with acute decompensated heart failure patients were selected from January 2016 to January 2017 in huzhou first people's hospital.35 cases of patients in control group were treated with levosimendan injection, and the other 35 cases of patients in experimental group was treated with dobutamine.BNP, 24 hourly urine volume, LVEF and SV were detected and the systemic clinical conditions were assessed both before and after the treatment.ResultsAfter treatment, all indexes of two groups were better than before(P<0.05).The extent of improvement of systemic symptoms and relevant indicators such as BNP, 24 hourly urine, LVEF and SV in experimental group was larger than that in control group (P<0.05).Adverse reaction rate of experimental group was 16.7%, and adverse reaction rate of control group was 43.8%, the differences were statistically significant (P<0.05).ConclusionLevosimendan injection can relieve symptoms of patients with acute decompensated heart failure,and it has less adverse reactions.
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Objective To investigate the effects of recombinant human brain natriuretic peptide and sodium nitroprusside in the treatment of acute decompensated heart failure.Methods 82 patients with acute decompensated heart failure were randomly divided into observation group and control group,41 cases in each group.The control group was given sodium nitroprusside intravenous infusion therapy on the basis of routine treatment.The observation group was given recombinant human brain natriuretic peptide infusion treatment on the basis of control group treatment.The clinical efficacy was compared between the two groups.Results The total effective rate of the observation group was 95.12％,which was significantly higher than 75.61％ of the control group (x2 =5.33,P ＜ 0.05).After treatment,the left ventricular diastolic end diameter in the observation group [(67.38 ± 6.82) mm] was significantly lower than before treatment and control group after treatment (t =4.12,3.23,all P ＜ 0.05).After treatment,the left ventricular shot ejection fraction in the observation group [(48.91 ± 7.42)％] was significantly higher than before treatment and control group after treatment (t =3.92,3.77,all P ＜ 0.05).The incidence rate of adverse reactions in the observation group was 9.76％,which of the control group was 7.32％.,the difference was not statistically significant (P ＞ 0.05).Conclusion Recombinant human brain natriuretic peptide combined with sodium nitroprusside could significantly improve the clinical curative effect of acute decompensated heart failure,improve heart function of patients,and inhibit myocardial remodeling.It had good security.
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OBJECTIVE:To observe the clinical efficacy of recombinant human brain natriuretic peptide (rhBNP) combined with levosimendan in acute decompensated heart failure(ADHF). METHODS:In retrospective study,120 cases diagnosed as AD-HF were divided into observation group and control group according to treatment plan,with 60 cases in each group. The patients of control group received rhBNP on the basis of conventional treatment,intravenously pulsed with dose of 0.15 μg/kg firstly,then maintained dose of 0.007 5 μg/kg viacontinuous intravenous pumping for 24-72 h;On the basis of control group,treatment group received levosimendan with loading-dose of 12 μg/(kg·min)for 10 min,maintenance dose of 0.1 μg/(kg·min)via intravenous pump,for 24 h,adjusted according to clinical manifestations of patients. The vital signs,hemodynamic and UCG indexes,the rate of dyspnea recovery,plasma level of BNP,urine and the occurrence of ADR were recorded in 2 groups. RESULTS:The vital sign and hemodynamic indexes of control group had no significant change 1 h after treatment;the levels of HR,RR,SBP,MPAP and MPCWP in 2 groups after treatment were significantly lower than before,while the levels of SaO2 and CO were significantly higher than before,with statistical significance (P0.05). 48 h after treatment,LVEF of 2 groups were increased while plasma levels of BNP were decreased,compared to before treatment;the improvement of observation group was more significant than control group,with statistical significance(P0.05). CONCLU-SIONS:rhBNP combined with levosimendan could effectively improve vital sign,hemodynamic indexes,UCG indexes and dys-pnea,and decrease the plasma level of BNP with good safety.
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OBJECTIVE:To observe therapeutic efficacy and safety of recombinant human brain natriuretic peptide (rhBNP) in the treatment of acute decompensated heart failure (ADHF). METHODS:129 ADHF patients admitted in our hospital during Jul. 2013-Jul. 2015 were randomly divided into observation group(69 cases)and control group(60 cases). Control group was giv-en routine treatment. Observation group was additionally given rhBNP 1.5 μg/(kg·d)vein shock(d1),and then rhBNP 1 mg+5%Glucose injection 100 ml by 0.007 5 μg/(kg·min),ivgtt(d2-4). Treatment courses of 2 groups lasted for 7 d. Therapeutic efficacy and heart function indexes [left ventricular ejection fraction(LVEF),left ventricular end-diastolic diameter(LVDd)] were observed in 2 groups as well as NT-proBNP level,medication fluid intake and urine volume 24 h after medication. The occurrence of ADR was observed. RESULTS:3 cases dropped out and 66 cases were included finally in doservation group. Total effective rate of AD-HF therapy in observation group (96.97%) was significantly higher than in control group (86.67%),with statistical significance (P0.05). Af-ter treatment,LVEF of 2 groups were increased significantly while LVDd were decreased significantly;LVEF of observation group [(42.3±3.6)%] was significantly higher than in control group[(37.9±3.3)%],while LVDd of observation group [(55.5± 3.6)%] was significantly lower than in control group[(61.3 ± 3.4)%]. NT-proBNP levels of 2 groups were decreased significant-ly,and the observation group [(1 389.5±29.6)pg/ml] was significantly lower than the control group [(2 778.0±26.8)pg/ml]. 24 h after medication,urine volume of 2 groups were significantly higher than medication fluid intake,and urine volume of observation group [(1 781.4 ± 89.7)ml] was significantly higher than that of control group [(1 372.6 ± 78.3)ml],with statistical significance (P0.05). CONCLUSIONS:rhBNP is significantly effective for ADHF,promotes heart function recovery and reduces renal function injury with good safety.
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Objective:To evaluate the security of recombinant human brain natriuretic peptide (rhBNP)in the treatment of acute decompensated heart failure (ADHF ), and to provide the basis for its application.Methods:Both foreign language databases including PubMed,The Cochrane Library (Issue 1,2015),EMBase and Chinese databases involving CNKI,VIP and Wanfang Data were searched.Two reviewers independently extracted the data,and assessed the quality;then the Meta-analysis was performed by using RevMan 5.1 software and Stata 12.0 software.Results:A total of 35 randomized controlled trials (RCTs)involving 12 143 patients were included. The results of Meta-analysis showed that compared with control group the 1-month mortality (RR=1.01,95%CI:0.85-1.21,P =0.88),3-month mortality (RR=0.89,95%CI:0.63-1.27,P =0.53)and 6-month mortality (RR = 0.97, 95% CI: 0.87 - 1.08,P = 0.59 )in rhBNP group had no statistical differences;no statistical difference was found in the incidence of side effects (RR=1.01,95%CI:0.71-1.43,P =0.97).The incidence of hypotension in rhBNP group was significantly higher than that in control group (RR= 1.42,95%CI:0.99 -2.03,P =0.06).Conclusion:Compared with dobutamine,vasodilator drugs and placebo,rhBNP doesn’t change the mortality and incidence of adverse reactions of the patients with ADHF,but increases the risk of hypotension.Clinical application of rhBNP should be reasonable and its effectiveness should be exerted sufficiently,meanwhile,as much as possible to avoid hypotension,etc.
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Objective To investigate the clinical characteristics and the associated risk factors for short-term prognosis in elderly patients with acute decompensated heart failure, in order to provide the evidence for improving clinical survival.Methods Clinical data of 200 elderly patients with acute decompensated heart failure in our hospital from June 2010 to December 2014 were retrospectively analyzed.The associated risk factors for prognosis were analyzed by using multivariate logistic regression analysis.All patients were followed up for six months, and cardiovascular events during the same follow-up period were recorded.All patients were divided into non-event group (n=158, no readmission during the follow-up period) and event group (n=42, readmission or death during follow-up).Results All the 200 elderly patients with acute decompensated heart failure had completed the 6 months follow-up, 23 (11.5％) patients died from cardiovascular events, and 19 (9.5％) patients had readmission due to heart failure.New York Heart Association (NYHA) classification, age, heart rate, systolic blood pressure, left ventricular ejection fraction (LVEF), left ventricular end-systolic diameter (LVESD), and left ventricular end-diastolic dimension (LVEDD) had significant differences between the two groups (x2=5.791, t=2.514, 2.552, 2.500, 2.582, 3.870, 2.275, all P＜0.05).Levels of NT-terminal pro-brain natriuretic peptide (NT-proBNP), high sensitivity C reactive protein (hs-CRP), red cell distribution width (RDW), creatinine, and uric acid were higher in the event group than in the non-event group (t=54.948, 9.932, 2.815, 8.888, 2.368, all P＜0.05).The hemoglobin level was lower in the event group than in the non-event group (t-2.455, P＜0.05).Multivariate unconditional logistic regression analysis showed that NYHA classification, LVEF, and NT-proBNP were the independent risk factors for the prognosis of acute decompensated heart failure in elderly patients (x2 =10.438, 61.943, 6.976, all P＜0.05).The mortality rate was 11.5％ within the six months follow-up.The area under the receiver operating characteristic (ROC) curve for NT-proBNP to predict short-term mortality was 0.860 (SE=0.034,P=0.000, 95％ CI: 0.794-0.926).The mortality within 6 months was lower in NT-proBNP ≤205 ng/L group than in NT proBNP＞ 205 ng / L group (x2=5.385, P=0.020).Conclusions NYHA classification, LVEF, and NT proBNP are the risk factors for the prognosis of acutely decompensated heart failure in the elderly.The elderly patients with acute decompensated heart failure have a poor prognosis.
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FUNDAMENTO: Identificação e impacto clínico da fração de ejeção preservada em desfechos intra-hospitalares em pacientes com insuficiência cardíaca (IC) descompensada permanecem pouco conhecidos. OBJETIVO: Descrever preditores clínicos e desfechos intra-hospitalares de pacientes com IC descompensada e fração de ejeção de ventrículo esquerdo (FEVE) preservada, e desenvolver um escore preditivo baseado em dados clínicos obtidos no momento da admissão. MÉTODOS: Internações consecutivas devido a IC descompensada (n=721) em um hospital terciário foram acompanhadas até a alta ou óbito. Mais de 80 variáveis clínicas foram avaliadas para identificar os preditores da FEVE preservada no momento da admissão. RESULTADOS: Identificou-se FEVE preservada (>50 por cento) em 224 (31 por cento) internações. Os preditores clínicos de FEVE preservada foram: idade >70 anos (p= 0,04); sexo feminino (p<0,001); etiologia não-isquêmica (p<0,001); fibrilação ou flutter atrial (p=0,001); anemia (p=0,001); pressão de pulso >45 mmHg (p<0,001); e ausência de anormalidades de condução intraventricular verificadas no eletrocardiograma (p<0,001). Um escore clínico baseado nessas variáveis foi capaz de predizer com acurácia a presença de FEVE preservada no momento da admissão hospitalar (área sob a curva ROC de 0,76). Nenhuma diferença significativa foi observada na taxa de mortalidade intra-hospitalar ou de complicações clínicas de acordo com os quintis de FEVE. CONCLUSÃO: A FEVE preservada é uma condição prevalente e mórbida entre pacientes hospitalizados por IC. Dados clínicos simples obtidos no momento da internação podem ser utilizados para predizer FEVE preservada.
BACKGROUND: Identification and clinical impact of preserved left ventricular ejection fraction (LVEF) on in-hospital outcomes in patients with acute decompensated heart failure (HF) remain poorly defined. OBJECTIVE: To describe clinical predictors and in-hospital outcomes of acute decompensated HF patients and preserved LVEF, and to develop a clinically-based predictive rule based on data acquired on admission. METHODS: Consecutive admissions for HF (n=721) at a tertiary care hospital were followed up to discharge or death. More than 80 clinical variables were evaluated to identify predictors of preserved LVEF upon admission. RESULTS: Preserved LVEF (>50 percent) was identified in 224 (31 percent) hospitalizations. Clinical predictors of preserved LVEF were age > 70 years old (p=0.04), female gender (p<0.001), non-ischemic etiology (p<0.001), atrial fibrillation or flutter (p=0.001), anemia (p=0.001), pulse pressure > 45 mmHg (p<0.01) and absence of EKG conduction abnormalities (p<0.001). A clinical score based on these variables was accurate to predict preserved LVEF upon hospital admission (area under ROC curve of 0.76). No significant differences were observed on in-hospital mortality or clinical complications according to quintiles of LVEF. CONCLUSION: Preserved LVEF is a prevalent and morbid condition among hospitalized HF patients. Simple clinical data obtained on admission might be useful for predicting preserved LVEF.