Acute Heart Failure Syndromes in Patients With Coronary Artery Disease

Abstract

Acute heart failure syndromes (AHFS) have emerged as a leading public health problem worldwide, accounting for a substantial number of hospitalizations and a high utilization of resources. Although in-hospital mortality rates are relatively low, patients with AHFS have very high early after-discharge mortality and rehospitalization rates. The majority of patients admitted with AHFS have coronary artery disease (CAD), which independently has an adverse impact on prognosis. The initial in-hospital and after-discharge management of AHFS may be dependent on clinical presentation: AHFS in patients with underlying CAD or acute coronary syndromes (ACS) complicated by heart failure. In addition, the extent and severity of CAD and the presence of ischemia and/or stunned/hibernating myocardium should be assessed for optimal management. Although the overall management of AHFS with CAD may be similar to that in patients with ACS complicated by heart failure, for which specific guidelines exist, management of the former is less well defined. Prospective studies of the assessment and treatment of CAD in patients with AHFS are urgently needed.

Episodes of Acute Heart Failure Syndrome Are Associated With Increased Levels of Troponin and Extracellular Matrix Markers

“…A common cause of cardiac myocyte death is ischemia due to CAD. 12 However, troponin levels in our study were similar in patients with nonischemic and ischemic HF, suggesting that other factors might be responsible. Of note, episodes of AHFS are associated with nonischemic processes that are known to cause myocyte death including mechanical strain, oxidative stress, and neurohormonal activation.…”

Relation of Ankle Brachial Index to Left Ventricular Ejection Fraction in Diabetic Patients

“…Although CAD is often accompanied by LV systolic dysfunction [5], data relating ABI values to LV structural and functional abnormalities are sparse. Recently, low ABI values have been found to be associated with LV hypertrophy [6,7] a well-known risk factor for LV dysfunction and heart failure [8].…”

Prognostic Factors in Patients Hospitalized for Heart Failure

“…Ischemic etiology of HF predicts increased post-discharge mortality and rehospitalization [27][28][29]. Estimates of the increased risk of rehospitalization in ischemic HF range from 1.25 to 2 times greater than of non-ischemic HF in the 2 to 6 months post-discharge [7, 20••, 27].…”

“…According to EHFS II, in over 70 % of cases, the etiology of HFH for cardiogenic shock is ischemia. Independent of acute coronary syndromes, coronary artery disease can precipitate comorbidities that can worsen the degree of HF [29]. For instance, ventricular arrhythmias often present in the setting Curr Heart Fail Rep of ischemia can amplify the hemodynamic consequences of HF [15].…”