[Decompensated heart failure with reduced ejection fraction: overcoming barriers to improve prognosis in the "vulnerable" period after discharge].

Frequency of hospitalizations for decompensated heart failure (HF) and associated costs are steadily increasing worldwide. An episode of HF is a risk marker, reflects a change in the course of disease, a high probability of adverse events, and requirement for using all options to improve the prognosis. This article discusses barriers and ways to overcome them in managing HF patients with low ejection fraction. An evidence-based, disease-modifying therapy exists for this HF phenotype. Administration of the therapy along with additional, novel drugs that improve outcomes, and organization of medical care are essential during the "vulnerable period" after discharge from the hospital.

[Pulmonary congestion by lung ultrasound in decompensated heart failure: associations, in-hospital changes, prognostic value].

BACKGROUND: Recently lung ultrasound (LUS) based on B-lines measurement has been proposed as an effective tool for assessment of pulmonary congestion (PC) in patients with decompensated heart failure (DHF). OBJECTIVE: to assess the incidence, in-hospital changes and prognostic significance of PC assessed by LUS in DHF patients. MATERIALS AND METHODS: Routine clinical assessment and eight-zone LUS were performed in 162 patients with DHF (men 66%, mean age 68±12 years, hypertension 97%, history of myocardial infarction 44%, atrial fibrillation 60%, ejection fraction [EF] 40±14%, EF<40% 46%, baseline NT-proBNP 4 246 [1741; 6 837] pg/ml). Sum of B-lines ≤5 was considered as normal, 6-15, 16-30 and >30 - as mild, moderate and severe PC, respectively. RESULTS: Using LUS on admission PC was diagnosed in all patients (moderate and severe in 31.5 and 67.3%, respectively). At discharge normal LUS profile was observed in 48.2% of patients. In 33.3, 14.8 and 3.7% of patients PC was mild, moderate, and severe, respectively. According to multivariable Cox regression analysis including age, sex, EF, NYHA functional class, and jugular venous distension sum of B-lines >5 at discharge was associated with higher probability of 12-month all-cause death (hazard ratio [HR] 2.86, 95% confidence interval [CI] 1.15-7.13, p=0.024), sum of B-lines >15 - with higher probability of HF readmission (HR 2.83, 95%CI 1.41-5.67, p=0.003). CONCLUSION: During hospital stay the incidence of PC as assessed by LUS decreased from 100 to 52% of patients. Sum of B-lines >5 at discharge was independently associated with higher risk of 12-month all-cause death, >15 - with higher risk of 12-month HF readmission.

[Prognostic value of liver stiffness in decompensated heart failure: results of prospective observational transient elastography-based study].

OBJECTIVE: There is growing evidence that liver stiffness (LS) in decompensated heart failure (DHF) is related to congestion, however data about its impact on outcomes are limited. The aim of the study was to evaluate associations and long-term prognostic significance of LS measured by transient elastography (TE) in DHF. METHODS: Single-center prospective observational study of 194 patients hospitalized with DHF, of whom 71 % were male, 68 ± 11 years (mean ± SD), had a left ventricular ejection fraction of 39±14%. LS by TE (FibroScan 502, Echosens, France) was measured on admission (n=176) and/or discharge (n=165). Outcomes of interest were all-cause death or heart transplantation, heart failure (HF) rehospitalisation, heart valve repair surgery. Outcome analysis was performed with Kaplan-Meier survival curves compared by log-rank test and with Cox proportional hazards regression. RESULTS: Median LS on admission and discharge were 11.1 (interquartile range 6.3;22.9) and 8.2 (5.8;14.0) kPa, respectively. Higher LS was associated with more clinical congestion on admission and discharge. Patients with LS on admission ≥11.1 kPa and at discharge ≥8.2 kPa were characterised by more pronounced clinical and echocardiographic signs of right-sided HF. Total of 5 (2.6%) patients died in hospital. Further, 31 (17.3%) deaths, 1 (0.6%) heart transplantation, 3 (1.7%) valve repair surgeries and 54 (30.2%) HF rehospitalizations occurred during follow-up (median 183 days). LS ≥ median was associated with higher probability of HF rehospitalizations and composite end point (all-cause death, heart transplantation, HF rehospitalisation and valve replacement therapy) both on admission (logrank p=0.004 and p=0.006) and at discharge (log-rank p=0.001 and p=0.004). Multivariable Cox regression analysis revealed that on a continuous scale LS increase per 1 kPa on admission was related to higher risk of HF hospitalization (hazard ratio [HR] 1.024, 95% confidential interval [CI] 1.002-1.046, p=0.03). LS at discharge was independently associated with increased all-cause mortality (HR per 1 kPa increase 1.098, 95% CI 1.025-1.176, p=0.008), higher risk of HF hospitalization (HR 1.075, 95% CI 1.035-1.117, p.

[Cardio-hepatic Syndrome in Heart Failure: Prevalence, Pathogenesis and Prognostic Significance].

In a framework of the concept of organ interactions great attention has been paid during recent years to interaction of the heart and liver. The term cardio-hepatic syndrome (CHS) designates the combination of clinical-laboratory signs of liver dysfunction and acute or chronic cardiac pathology. In this article, we present mechanisms and characteristics of CHS in acute and chronic heart failure (HF), data of large clinical studies and registries on prevalence, associations, and prognostic significance of cardiogenic disturbances of liver function in patients with HF.