Advanced Heart Failure

ABCHF

Case Report

Management of Patients with Advanced Heart Failure According to Hemodynamic Parameters

Carlos Aurélio dos Santos Aragão et al. Daniella Motta da Costa Dan Mônica Samuel Ávila

Introduction

Heart failure (HF) is characterized by progressive functional or structural worsening of the myocardium. Despite significant therapeutic advances that have improved survival and quality of life, HF still has high morbidity and mortality rates. Patients with HF may progress with refractory disease, whose gold standard treatment is heart transplantation (HT).^,

The assessment of pulmonary hemodynamics is indicated for HT candidates. The presence of fixed pulmonary hypertension (PH) is a contraindication for HT because it promotes right ventricular (RV) dysfunction in the graft, reducing post-HT survival. In addition, the assessment of hemodynamic parameters helps in bedside therapeutic management, including in the setting of PH, favoring HT indication.^, We report a successful case of optimal bedside therapy guided by invasive hemodynamic parameters.

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ABCHF

Research Letter

When to Suspect Advanced Heart Failure in Heart Failure with Preserved Ejection Fraction?

Miguel Morita Fernandes-Silva et al. Fabiana G. Marcondes-Braga

Author Contributions

Writing of the manuscript and Critical revision of the manuscript for intellectual content: Fernandes-Silva MM, Marcondes-Braga FG.

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ABC

Research Letter

Emerging Topics in Heart Failure: Contemporaneous Management of Advanced Heart Failure

Fabiana G. Marcondes-Braga et al. Jefferson L. Vieira João David de Souza Neto Gustavo Calado … Silvia Moreira Ayub-Ferreira Fernando Bacal Nadine Clausell

Definition

Advanced heart failure (HF) is a condition characterized by persistent severe HF symptoms, frequent episodes of decompensation, and progressive cardiac dysfunction despite optimal evidence-based treatment. These patients may be candidates for advanced therapies, such as heart transplantation (HT), mechanical circulatory support (MCS), and/or palliative care. It should be pointed out that some comorbidities, including pulmonary disease and liver and kidney dysfunction, are now included as possible major determinants of poor prognosis and should be considered during patient evaluation for advanced HF therapies.

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ABC

Artigo Original

Serum NT-proBNP levels are a prognostic predictor in patients with advanced heart failure

Antonio Carlos Pereira-Barretto et al. Mucio Tavares de Oliveira Junior Célia Cassaro Strunz Carlos Henrique Del Carlo … Airton Roberto Scipioni José Antonio Franchini Ramires

OBJECTIVE: To verify if the determination of NT-proBNP values would help predict the prognosis in advanced heart failure (HF) patients. METHODS: One hundred and five subjects with average age of 52.4 years were evaluated, 66.6% of them males. Thirty-three (32.0%) subjects were outpatients and 70 (67.9%) were inpatients (functional class III/IV) admitted to the hospital for cardiac compensation. All patients had left ventricular systolic dysfunction and a mean ejection fraction of 0.29. The NT-proBNP levels were measured in all patients and they were followed-up over a period from 2 to 90 days (average 77 days). A ROC curve was drawn to determine the best cut-off point, as well as the corresponding Kaplan-Meyer survival curves. RESULTS: During the follow-up period, 22 patients died. The average NT-proBNP value of the patients who remained alive was 6,443.67±6,071.62 pg/ml, whereas that of those who died was 14,609.66±12,165.15 pg/ml (p=0.001). The ROC curve identified a cut-off point at 6,000 pg/ml with 77.3% sensitivity (area under the curve: 0.74). The survival curve for values below and above 6,000 pg/ml was significantly different (p=0.002): patients with values below 6,000 pg/ml had a 90.2% 90-day survival, and those patients with values above, a 66% survival. CONCLUSION: Patients with advanced HF, especially those admitted to the hospital for cardiac compensation, had much higher NT-proBNP values, with a two-fold increase among those who died during the follow-up period. Values above 6,000 pg/ml identify the patients most likely to die within 90 days after hospital discharge.

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Artigo Original

Major clinical characteristics of patients surviving 24 months or more after hospitalization due to decompensated heart failure

Mucio Tavares de Oliveira Jr et al. Manoel Fernandes Canesin Robson Tadeu Munhoz Carlos Henrique Del Carlo … Airton Scipioni José Antonio Franchini Ramires Antonio Carlos Pereira Barretto

OBJECTIVE: To study the major clinical characteristics of patients with heart failure who survived more than 24 months after hospitalization for compensation. METHODS: The study comprised 126 patients with heart failure in functional class III or IV, with a mean age of 51.7 years. Most patients were men (73%), had a mean ejection fraction (EF) of 0.36 and left ventricular diastolic diameter (DD) of 7.13 cm. The major clinical and laboratory characteristics were assessed, and, on follow-up, 25 (19.8%) patients, who survived more than 24 months after hospital discharge, were identified. Data of survivors (G1) were compared with those of patients who died (G2) before 24 months. RESULTS: In G1, the following levels were greater: serum sodium (138.3±3.4 vs 134.5±5.8 mEq/L; P=0.001); blood pressure levels (120.0 vs 96.7 mm Hg; P=0.003); and LVEF levels (0.40±0.08 vs 0.34±0.09; P=0.004); and the following levels were lower: urea (59.8 vs 76.3 mg/dL; P=0.007); prothrombin time (12.9 vs 14.8 seconds; P=0.001); LVDD (6.78±0.55 vs 7.22±0.91; P=0.003); and LA diameter (4.77 vs 4.99cm; P=0.0003). More survivors were found among patients with idiopathic cardiomyopathy and arterial hypertension than among patients with Chagas’ disease and coronary artery disease. In multivariate analysis, the following variables remained as independent predictors of mortality: LVDD > 7.8 cm (HR 1.95); Na 14 seconds (HR 1.69). CONCLUSION: The study allowed predicting which patients with heart failure will have a good survival after hospital discharge and those with a greater chance of a long survival after discharge.

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Management of Patients with Advanced Heart Failure According to Hemodynamic Parameters

Introduction

When to Suspect Advanced Heart Failure in Heart Failure with Preserved Ejection Fraction?

Author Contributions

Emerging Topics in Heart Failure: Contemporaneous Management of Advanced Heart Failure

Definition

Serum NT-proBNP levels are a prognostic predictor in patients with advanced heart failure

Major clinical characteristics of patients surviving 24 months or more after hospitalization due to decompensated heart failure

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