What's new?Recently, the definition of heart failure (HF) phenotypes has been introduced.However, little is known about the survival of patients with HF in the Polish population, in terms of HF phenotypes.To ensure accurate diagnosis and classification of HF phenotypes, our electronic database was thoroughly verified, thereby avoiding misdiagnosis and exclusion of patients after heart transplantation or incorrect classification.Our study provides important insights into the prognosis of patients with HF, classified into three distinct phenotypes, and highlights differences in their characteristics based on survival status.Additionally, we identified predictors of survival for each HF phenotype.To our knowledge, this is the first publication to report on survival and predictors of prognosis for patients with different HF phenotypes among hospitalized HF patients in referral center in Poland.
The course and treatment of COVID-19 in heart transplant recipients -boosted nirmatrelvir, another drug approved and now available for the early treatment of mild to moderate COVID-19.Due to the ritonavir component of the combination, a strong cytochrome P450 (CYP) 3A4 inhibitor and a P-glycoprotein inhibitor, many significant drug-drug interactions could be expected.In general, it is recommended to temporarily withhold certain immunosuppressants (e.g., tacrolimus, everolimus, sirolimus) and reduce the dose of others (e.g.cyclosporine) during ritonavir-boosted nirmatrelvir administration [5].Any change in immunosuppressive regimen should be individualised and discussed with a transplant physician.
Background/Objectives: The pathophysiological background of the processes activated by physical activity in patients with heart failure (HF) is not fully understood. Proteomic studies can help to preliminarily identify new protein markers for unknown or poorly defined physiological processes. We aimed to analyse the changes in the plasma proteomic profile of HF patients after a cardiopulmonary exercise test (CPET) to define pathways involved in the response to exercise. Methods: The study prospectively enrolled 20 male patients with advanced HF (aged 53.3 ± 8.3 years). Blood samples were taken from the patients before and immediately after the CPET to obtain plasma proteomic profiles. Two-sample t-tests (paired or non-paired) were performed with and without false discovery rate (FDR) correction for multiple testing. Enrichment analysis was performed to associate biological processes and pathways with the study results. Results: A total of 968 plasma proteins were identified, of which 722 underwent further statistical analysis. Of these, 236 proteins showed differential expression when comparing all plasma samples collected before and after CPT (p < 0.05), and for 86 of these the difference remained statistically significant after FDR correction. Proteins whose expression changed after exercise are mostly involved in immune response and inflammatory processes, coagulation, cell adhesion, regulation of cellular response to stimulus and regulation of programmed cell death. There were no differences in resting proteomics according to HF etiology (ischemic vs. non-ischemic). Conclusions: Changes in the proteomic profile revealed a complexity of exercise-induced processes in patients with HF, suggesting that few major physiological pathways are involved. Further studies focusing on specific pathways are needed.
Abstract Funding Acknowledgements Type of funding sources: Public hospital(s). Main funding source(s): The study was supported by an intramural research grant from the National Institute of Cardiology. Background Heart failure (HF) is a significant cause of morbidity and mortality in both women and men. The discrepancies in the underlying mechanisms and etiology of HF in both sexes suggest that factors related to the prognosis of HF and the risk of death may also be different in men and women. Objective The aim of the study was to identify factors related with survival in men and women with HF. Methods Patients from a hospital database coded as hospitalizations for HF between 01/2014 and 05/2019 were included in the analysis. In all patients, the diagnosis of HF was verified. Information on HF, comorbidities, and death was obtained from available medical records. Kaplan-Meier survival curves were generated to analyze time-to-event data and to compare survival in both men and women. Multivariable Cox proportional hazard analysis was used to evaluate the risk of death and related factors. Results 1824 (70.1%) men and 777 (29.9%) women were included. Women were older than men (68.3 vs. 62.4 years; p<0.001). The median follow-up time (2.43 vs. 2.42 years; p=0.550), and the proportion of all deaths during follow-up were similar in men and women (37.8 vs. 34.5%; p=0.112). The Kaplan-Meier survival curves by sex were alike (p=0.2732) and are presented in Figure 1. The results of the multivariable Cox proportional hazards analysis are presented in Table 1. In both men and women respectively, after adjustment for other covariates, a significant association with an increased risk of death was documented for: catecholamines (HR=2.27 and HR=2.92), significant tricuspid regurgitation (HR=1.46 and HR=1.66), renal failure (HR=1.59 and HR=1.68), liver failure (HR=1.90 and HR=2.44), anemia (HR=1.51 and HR=1.46) and emergency admission (HR=1.21 and HR=1.77). The optimal dose of ACEI was associated with a decreased risk of death in both sexes (HR=0.75 in men and HR=0.60 in women). In men, we also found that other factors, such as diuretics (HR=2.29), chronic HF (HR=1.87), ischemic etiology (HR=1.40), atherosclerosis (HR=1.37), stroke (HR = 1.28), cardioverter defibrillator implantation (HR=1.27), ventricular arrythmias (HR=1.24), and age (HR=1.02) were related with a higher risk of death. Furthermore, only in women a higher risk of death was associated with dementia (HR=2.26), hypertension (HR=1.81), amiodarone (HR=1.68), aortic stenosis (HR=1.52), and myocardial infarction (HR=1.46), while a lower risk was found for an increasing number of comorbidities (HR=0.86). Conclusions Overall survival in men and women with HF was similar, as well as the strength and direction of the relationship with the risk of death in common risk factors. However, some of the predictors of death differed between men and women, which should draw our attention to potential differences in gender-related parameters affecting survival in HF.
Carotid artery disease is thought to be a risk factor for neurological complications after cardiac surgery. Routine ultrasonographic screening is still not performed in every patient scheduled for coronary artery bypass grafting (CABG).To assess factors which may facilitate the selection for elective carotid artery ultrasound examination in patients undergoing CABG.682 patients (mean age 63.2 +/- 8.7, range: 37-85 years) scheduled for CABG underwent preoperative duplex ultrasound examination of the carotid arteries. The following factors were collected and analysed: age, sex, LVEF, history of cerebrovascular accidents (stroke and/or TIA), myocardial infarction, and presence of hypertension, diabetes, unstable angina, chronic obstructive pulmonary disease, chronic kidney disease, left main stenosis > or = 50%, lower-extremity peripheral arterial disease, and obesity (BMI > 30 kg/m(2)). Logistic regression analysis was used to determine the risk factors for carotid artery stenosis.Internal or common carotid artery stenosis > or = 50% was detected in 123 (18%) patients. Bilateral stenosis occurred in 35 (5.1%) patients, of whom 29 (4.5%) presented at least a monolateral vessel diameter reduction of > or= 70%. History of cerebrovascular accidents, presence of lower-extremity peripheral arterial disease, and unstable angina were independent risk factors for at least monolateral vessel diameter reduction > or = 50%. Although older age was also an independent predictor (Exp(B) = 1.035, p < 0.05), the ROC curve analysis did not reveal an age threshold above which the probability of detecting carotid disease increases significantly with satisfying sensitivity and specificity. The predictors of bilateral stenosis (at least one of them > or = 70%) were a history of stroke, presence of left main disease, and lower-extremity peripheral arterial disease.Carotid disease is common in patients scheduled for CABG. Preoperative carotid artery ultrasound examination should be performed, regardless of age, in all patients with more advanced symptomatic atherosclerosis, such as a history of cerebrovascular accidents, presence of lower-extremity peripheral arterial disease, left main disease, or unstable angina.
Objective: Mitral valve repair improves symptoms and reduces myocardial remodeling, however in patients with significantly impaired left ventricle systolic function its impact on long term prognosis remains controversial. The aim of the study was to determine the predictors of long term survival in patients with concomitant systolic heart failure and mitral insufficiency undergoing mitral valve repair. Patients and methods: We included 39 patients (aged 63±12 years, 12 women) with LVEF≤40% (mean 32.3±5.7%, ranged: 15-40%) undergoing mitral valve repair. Patients scheduled for concomitant aortic valve surgery, surgical ventricle restoration or operation due to infective endocarditis were excluded from the analysis. Most patients (n=31, 79%) were significantly symptomatic (NYHA class III or IV), although only one required inotropic support as well as IABP before surgery. In 26 cases (67%) mitral insufficiency had an ischemic etiology. Predicted 30-days mortality as estimated by EuroSCORE II or STS risk models was 3.25 and 4.85% (median), respectively. All patients underwent mitral valve repair (restrictive annuloplasty was done in all cases and an additional intervention on mitral valve, e.g. chordal transfer, posterior leaflet quadrangular resection in 6 cases). Moreover, 18 patients underwent coronary artery bypass grafting, 9 - tricuspidal valve repair and 3 - surgical ablation of atrial arrhythmia. 34 demographic, clinical and echocardiographic parameters were analyzed to identify the independent risk factors for late mortality. Results: During median 3.3 years (IQR: 2-5 years) of follow up 13 patients died. There was one intrahospital death (30-days mortality was 2.5%). The 2- and 5- years cumulative survival was 77 and 66%. Multivariate Cox analysis revealed that the independent predictors for death was COPD (HR 7.95, 95% CI 6.66-9.25) and the need of intense postoperative inotropic support (at least two inotropes for at least 48 hours; HR 7.76, 95% CI 6.52-9.0). Surprisingly, according to the univariate analysis, none of the parameters analyzed (including i.e. left ventricle diameter, renal function, concomitant surgical procedure) except for the mentioned above and the length of stay at the ICU (which in fact is strongly correlated with the postoperative heart failure) differed between survivors and non-survivors. Conclusions: Severe postoperative heart failure that could represent poor reserve of impaired left ventricle predicted worse long term prognosis after mitral valve repair. COPD increased late mortality independently of pulmonary hypertension.
