Objective:arterial hypertension is a major pandemic in the modern world and is a common cause of heart failure. Identification of pulmonary and venous congestion is relevant in patients with arterial hypertension(AH) and decompensated heart failure (DHF)Design and method:to assess the severity and dynamics of venous congestion (VC) by VExUS (including the study of the inferior vena cava (IVC), porto-hepatic and renal blood flow), and pulmonary congestion (PC) by LUS (with B-lines assessment according to 8-zone method) in patients with AH and DHF at admission to hospital and at discharge. The PC was defined as the sum of B-lines of more than 5 (6–15, 16–30 and> 30 - light, moderate and severe pulmonary congestion, respectively). Standard examinations and assessment of VC and LUS were performed in 52 patients with AH and DHF in the first 48 hours after admission and at discharge (men 48%, age 70 ± 11 years (M ± SD), atrial fibrillation 60%, diabetes 40%, chronic anemia 27%, left ventricle ejection fraction (LVEF) 50 [40; 57] %, EF < 40% - 29%, NTproBNP 1421 [754; 2024] pg/ml (Me; IQR)). To assess the severity of clinical symptoms and signs of congestion, the composite congestion score (CCS) was assessed: 0 - no congestion; 1–2-moderate; > = 3 severe congestion.Results:at admission, 27% of patients had moderate congestion according to CCS scale, 65% had severe congestion. In 31%, 13% and 17% of patients, mild, moderate and severe VC was revealed, respectively. Mild, moderate and severe PC was detected in 21%, 27% and 48% of patients, respectively. Congestion was present in 50% of patients at discharge according to CCS scale (moderate-42%, severe-8%). VC persisted in 38% of patients:mild in 20%, moderate–in 12%, severe–in 6% of cases. At discharge, PC was still present in 44% of patients. 15% of patients had mild PC, 20%-moderate and 9%-severe. VC and PC significantly correlated with NT-proBNP (r = 0.3,p = 0.03 and r = 0.41,p = 0.003,respectively) and with each other (r = 0.35,p = 0.01)Conclusions:Correlations between venous congestion assessed by VEXUS protocol and PC by LUS with NtproBNP in patients with AH and DHF were revealed
Aim. To assess the frequency, dynamics, and prognostic value of renal venous congestion using Doppler ultrasound in patients with decompensated heart failure (DHF).Materials and methods. A prospective, single-center study included 124 patients with DHF (mean age 70 ± 12 years, 51.6% were males), left ventricular ejection fraction (LVEF) 44 [34; 55] %, N-terminal pro B-type natriuretic peptide (NT-proBNP) 1,609 [591; 2,700] pg / ml. All patients underwent a standard physical examination and laboratory and instrumental tests, including the assessment of the NT-proBNP level. Renal venous blood flow was assessed using pulsed-wave Doppler ultrasound. The presence of continuous renal blood flow was considered as the absence of venous congestion, while intermittent blood flow (two-phase and single-phase flow) indicated venous congestion. Rehospitalization for DHF and reaching a composite endpoint (rehospitalization for DHF and cardiovascular mortality) within 12 months after discharge were selected as endpoints.Results. At admission, continuous renal venous blood flow was observed in 34 (27.4%) patients, intermittent renal venous blood flow was found in 90 (72.6%) patients: two-phase flow in 62 (50%) and single-phase flow in 28 (22.6%) patients with DHF. At discharge, 66 (53.2%) patients had intermittent renal venous blood flow: two-phase flow in 50 (40.3%) and single-phase flow in 16 (12.9%) patients. Correlations of renal venous congestion with the levels of NT-proBNP, serum iron, uric acid, creatinine, LVEF, systolic pressure in the pulmonary artery (SPPA), and the development of acute kidney injury (AKI) were revealed. Persistent renal venous congestion at discharge was significantly associated with a higher probability of rehospitalization for DHF (hazard ratio (HR) 1.93 95% confidence interval (CI) (1.017–3.67); p = 0.044) and a composite endpoint (HR 2.66, 95% CI (1.43–4.96); p = 0.002).Conclusion. In patients with DHF, it is necessary to evaluate renal venous blood flow using pulsed-wave Doppler ultrasound to stratify patients with development of cardiovascular complications within 12 months.
Funding Acknowledgements Type of funding sources: None. Introduction Hyperuricemia is a risk factor for cardiovascular disease. Aim to determine the prognostic value of asymptomatic hyperuricemia for stratifying the risk of complications in patients with Acute Decompensation of Heart Failure (ADHF) for predicting Heart Failure (HF) readmission and all-cause mortality Material and methods The study population consisted of 111 ADHF patients (78 men) aged 68 ± 11 years old. Asymptomatic hyperuricemia was defined as a serum UA (uric acid) level > 420 µmol/L (7 mg/dL) in men and >360 µmol/L (6 mg/dL) in women. Study duration was 5 years, the primary end points were HF readmissions and all-cause mortality and combined outcome (HF readmissions + all - cause mortality). Secondary endpoints were uric acid levels, signs of cardiovascular disease and severity of heart failure. ROC curve analysis for predicting primary end points identified the following cut-off of UA: >451 μmol/ L (7,58 mg/dL) (Sensitivity: 70%, Specificity: 56%) Results Asymptomatic hyperuricemia (HU) was observed in 66, 3% men and 33,7% women ADHF patients. The mean UA level in HU group was 486,1 ± 145 µmol/l (8,17 ± 2,43 mg/dl). Asymptomatic HU group compared with group with normal UA characterized by highest number of patients with HFrEF phenotype [53,8% vs. 27,2%, p<0,05], lowest incidence of the HFpEF phenotype [26,9% vs. 51,5%, p > 0,05], highest number of patients with dilatation of the right atrium [84,6% vs. 63,6%, p = 0,007], greater dilatation of the right ventricle [3,4 ± 0,64 cm vs 3,1 ± 0,51 cm, p = 0,011], inferior vena cava [2,34 ± 0,39 mm vs 2,1 ± 0,33 mm, p = 0,017] and higher pulmonary pressure [56 mmHg (45 - 68) vs 40 mmHg (34 - 65), p = 0,012] respectively. Cox and Kaplan Meier's analysis showed that uric acid values > 451 µmol/L (7,58 mg/dL) were associated with a higher likelihood of HF readmissions [HR 2,19, 95% CI (1,12–4,23), p=0,02] Log Rank: 0,011 and combined outcome (HF readmissions + all-cause mortality) [HR 1,77, 95% CI (1,00-3,11), p = 0,04] in patients with ADHF. Conclusion Hyperuricemia can be used as prognostic marker of heart failure readmission and all-cause mortality in patients with ADHF.
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