Two-year prognosis of patients hospitalized for decompensated heart failure in a district general hospital.

BACKGROUND: Patients hospitalized for heart failure (HF) exacerbation tend to have a poor prognosis. Most previous studies were performed in large clinical centers and detailed analyses of patients with HF hospitalized in district general hospitals are lacking. AIMS: The aim of this study was to assess the outcomes of patients admitted with HF exacerbation to a district general hospital. METHODS: We retrospectively enrolled patients hospitalized for HF exacerbation in the years 2010 to 2011 (191 patients) and 2016 to 2017 (203 patients). The primary and secondary endpoints were all­cause mortality and rehospitalization due to HF exacerbation, respectively, within a 2­year follow­up. RESULTS: Compared with patients hospitalized from 2010 to 2011, those hospitalized from 2016 to 2017 had more favorable clinical parameters and more appropriate pharmacological treatment; however, the rate of implantable cardioverter­defibrillator and resynchronization device use remained low. The overall mortality decreased from 44% between 2010 and 2011 to 33% between 2016 and 2017 (P = 0.03), but the number of rehospitalizations increased from 26% to 41%, respectively (P <0.001). Male sex, low systolic blood pressure, symptoms of right HF, and renal dysfunction were independent risk factors for the primary endpoint. Symptoms of right HF, renal dysfunction, left ventricular ejection fraction below 24%, and low systolic blood pressure independently predicted the secondary endpoint. CONCLUSIONS: The prognosis of patients hospitalized for decompensated HF in a regional district hospital was poor. Despite some improvement in pharmacological treatment, which probably led to reduced all­­cause mortality, there was a low rate of implantable electronic device use and a high rate of rehospitalizations due to HF exacerbation, which needs further elucidation.

Usefulness of transesophageal echocardiography before cardioversion in atrial arrhythmias.

BACKGROUND: Although many thromboembolism risk factors are well defined, formation of thrombus or dense spontaneous contrast (sludge) in the left atrium remains enigmatic and confounding. Exclusion of the thrombus is extremely important with respect to planned reversal of sinus rhythm. Data regarding the routine transesophagal echocardiography (TEE) before cardioversion are inconclusive. The authors focused on analyzing the usefulness of TEE before cardioversion by assessment of factors influencing the risk of thrombus and/or dense spontaneous echo contrast with the intention of extending indications for TEE in the group with a high risk of thrombus or to forgo TEE in the low risk group. METHODS: Two hundred sixty-nine consecutive patients with persistent (> 48 h) atrial fibrillation or atrial flutter, in whom a direct current cardioversion was planned, were undergoing TEE for the detection of the left atrial thrombus or dense spontaneous echo contrast. Additional clinical and echocardiographic data were collected. The relationship between both thrombus and dense spontaneous echo contrast and covariates was analyzed with the use of binary logistic regression. RESULTS: Left atrium (LA) appendage (LAA) thrombus and/or sludge were detected in 79 (29%) patients. Signs of dementia in mini-mental state examination (hazard ratio [HR]: 1.16; p = 0.005), low velocities in LAA (HR: 3.38; p = 0.032); presence of spontaneous echo contrast in LA (HR: 3.38; p = 0,003) consecutive episode of AF (HR: 2.27; p = 0,046); longer duration of atrial fibrillation (HR: 1.009; p = 0.022); were significant predictors of thrombus and/or dense spontaneous echo contrast. None of the patients with a CHA2DS2VASc score ≤ 1 had thrombus or sludge in the LAA. Among patients with a CHA2DS2VASc score > 1, the prevalence of thrombus or sludge in LAA was independent of the CHA2DS2VASc score value. CONCLUSIONS: Amongst many factors, including an established as risk for thromboembolism only a few of them increased the risk for the presence of thrombus in LAA: low velocities in LAA, presence of spontaneous echo contrast, longer duration of arrhythmia, consecutive (not first) arrhythmia episode and signs of dementia from a mini-mental state examination questionnaire. It was believed that there could be a need for an extension of indications of TEE in vast majority of the patients with atrial arrhythmias, due most often to an unpredictable occurrence of thrombus and potentially disastrous thromboembolism. The only exception could have been the group of the patients with a CHA2DS2VASc score ≤ 1.

Analysis of reported cases of left main coronary artery injury during catheter ablation: In search of a pattern.

INTRODUCTION: Left main coronary artery (LMCA) injury is a rare but potentially fatal complication of catheter ablation. Due to LMCA large perfusion area, its occlusion is usually a dramatic event. METHODS AND RESULTS: Reports of LMCA injury complicating catheter ablations from 1987 to 2018 were searched in electronic databases. Twenty-two cases of serious LMCA damage have been identified. Additionally, four reports of direct mechanical trauma involving major LMCA branches induced by inadvertent catheter insertion have been studied. Typically 86% LMCA injury presented as an acute/subacute complication of retrograde ablation in left ventricle/left ventricular outflow tract or aortic cusps. In at least 86% of patients with an in-hospital presentation, the LMCA trauma manifested dramatically as a life-threatening arrhythmia, cardiogenic shock, or severe hypotension requiring vasopressors. In-hospital mortality rate was 32%. Direct stenting has been found to be the most successful strategy. CONCLUSION: LMCA injury, even if initially asymptomatic with normal angiographic appearance, may cause delayed flow deterioration, requiring prolonged monitoring and extended follow-up. Special caution should be given to the prevention whereas survival depends on prompt detection and treatment.

Predictors of poor outcome in patients with pulmonary arterial hypertension: A single center study.

OBJECTIVES: Pulmonary arterial hypertension (PAH) is a rare disorder with unfavorable prognosis despite implementation of specific PAH-oriented therapy. The aim of the study was to define predictors of poor prognosis in patients from one center treated according to the Polish National Health Fund program. PATIENTS AND METHODS: Forty-seven consecutive patients (30 women; aged 39±17 years) with PAH diagnosis were enrolled to the study. Clinical assessment, laboratory measurements, electrocardiogram, echocardiography, 6-minute walk test, 24-hour Holter monitoring, cardiopulmonary exercise test and microvolt T-wave alternans test were performed during routine visits. Eight patients died during 2.6±1.7 years follow-up. RESULTS: Parametrs which differentiated patients who died were brain natriuretic peptide (BNP) concentration ≥330 pg/mL (sensitivity 88%, specificity 92%, area under the ROC curve [AUC] 0.92); bilirubin concentration ≥1.2 mg/dL (sensitivity 88%, specificity 81%, AUC 0.85); right atrial area ≥21 cm2 (sensitivity 86%, specificity 69%, AUC 0.84), right ventricular (RV) dimension in the apical 4-chamber view ≥47 mm (sensitivity 86%, specificity 86%, AUC 0.85) and RV to left ventricular diastolic diameter ratio ≥1.5 (sensitivity 83%, specificity 84%; AUC 0.85). In multivariate analysis, independent predictors of mortality were higher BNP (p = 0.04) and bilirubin level (p = 0.03), higher right atrial area (p = 0.02) and lower tricuspid annular plane systolic excursion (p = 0.03). CONCLUSIONS: In PAH patients treated with specific PAH-oriented therapy right atrial enlargement, impaired right ventricular systolic function, as well as increased BNP and bilirubin concentration was associated with an increased mortality risk.

Practical Application of Biogenic Amine Profiles for the Diagnosis of Patients with Ischemic Stroke.

BACKGROUND: Ischemic stroke (IS) is still one of the major issues in medicine. Still, early diagnosis and misdiagnosis remain the main barriers for proper patient treatment and follow-up. Exploring new potential diagnostic biomarkers for IS is relevant to decrease patient morbidity and the occurrence of poststroke diseases. Biomedical analysis could bring new light to the background of IS and-in such a way-propose new bioanalytical tools for the early diagnosis, prognostication, and monitoring of IS. MATERIALS AND METHODS: This research aimed to present a discussion on the employment of biogenic amines (BAs), as well as their precursory amino acids and main metabolites, as a new panel of biomarkers for IS. Preliminary patient data were presented and the patients were described with respect to their clinical history and examination records, as well as scientific data gained from the liquid extraction-capillary electrophoresis determination of BAs in the patients' urine samples. RESULTS: The results showed the potential of BA screening using the developed sample preparation and analysis methods in urine during IS, and this will be further studied on a more numerous group of patients with IS to reveal the usefulness of BAs as a new panel of biomarkers for early IS diagnosis and prognostication. CONCLUSIONS: To our best knowledge, this methodology for the first time has been used for the simultaneous analysis of multiple small molecular biomarkers. In addition, the factors that might influence the determination of BAs in real samples were pointed out.

Prognostic factors in pulmonary arterial hypertension: Literature review.

Pulmonary arterial hypertension is a disease that has a bad influence on the patient's prognosis. Recently, the possibility of therapy has dramatically changed. Nowadays, the treatment of this disease is concerned mainly with the pathophysiological target. In clinical practice, it is important to start therapy at the appropriate time, when the patient is qualified because of an unsatisfactory examination result or improve therapy when the patient is getting worse. The understanding of prognosis factors in pulmonary arterial hypertension is necessary, because it is used to determine the length of patients' life expectancy. In September of 2015, new guidelines of ESC concerning the diagnosis and treatment of pulmonary hypertension have been presented. In our article we centered on the prognosis factor in pulmonary arterial hypertension. This document is a continuation of ESC guidelines. Many of the most contemporary articles are here summarized.