Pub Date : 2009-07-01DOI: 10.1111/J.1751-7133.2009.00098.X
S. Harris, D. Tepper, Randy J. Ip
Abstract. Background. In heart failure (HF), renal dysfunction is associated with an adverse prognosis. Impaired renal perfusion from left ventricular dysfunction is thought to be a principal underlying mechanism. Less is known about the influence of venous congestion, including the potential contribution of tricuspid regurgitation (TR). Methods and Results. Echocardiograms and a simultaneous (±1 day) blood sample from 196 HF patients were analyzed. Patients with at least moderate TR (n=78) had larger right-sided cardiac cavities, higher right ventricular systolic pressure, lower estimated glomerular filtration rate (eGFR), higher serum urea nitrogen (SUN) level, and SUN/creatinine ratio than patients with less than moderate TR (n=118). In multivariate linear regression analysis, TR severity (P=.003), older age (P<.001), and loop diuretic use (P=.008) were independently associated with lower eGFR, and use of inhibitors of the renin-angiotensin-aldosterone system was associated with higher eGFR (P=.001). TR severity (P<.001) and older age (P<.001) were independently associated with higher SUN value. TR severity (P=.004) and smaller left ventricular end-diastolic diameter (P=.048) were independent predictors of a higher SUN/creatinine ratio (P=.004). Conclusions. Although a causal relationship cannot be proven, we suggest that significant TR contributes to renal dysfunction in HF patients, probably by elevation of central and renal venous pressure.—Maeder MT, Holst DP, Kaye DM. Tricuspid regurgitation contributes to renal dysfunction in patients with heart failure. J Card Fail. 2008;14:824–830.
{"title":"Tricuspid Regurgitation Contributes to Renal Dysfunction in Patients With Heart Failure","authors":"S. Harris, D. Tepper, Randy J. Ip","doi":"10.1111/J.1751-7133.2009.00098.X","DOIUrl":"https://doi.org/10.1111/J.1751-7133.2009.00098.X","url":null,"abstract":"Abstract. Background. In heart failure (HF), renal dysfunction is associated with an adverse prognosis. Impaired renal perfusion from left ventricular dysfunction is thought to be a principal underlying mechanism. Less is known about the influence of venous congestion, including the potential contribution of tricuspid regurgitation (TR). \u0000 \u0000 \u0000 \u0000Methods and Results. Echocardiograms and a simultaneous (±1 day) blood sample from 196 HF patients were analyzed. Patients with at least moderate TR (n=78) had larger right-sided cardiac cavities, higher right ventricular systolic pressure, lower estimated glomerular filtration rate (eGFR), higher serum urea nitrogen (SUN) level, and SUN/creatinine ratio than patients with less than moderate TR (n=118). In multivariate linear regression analysis, TR severity (P=.003), older age (P<.001), and loop diuretic use (P=.008) were independently associated with lower eGFR, and use of inhibitors of the renin-angiotensin-aldosterone system was associated with higher eGFR (P=.001). TR severity (P<.001) and older age (P<.001) were independently associated with higher SUN value. TR severity (P=.004) and smaller left ventricular end-diastolic diameter (P=.048) were independent predictors of a higher SUN/creatinine ratio (P=.004). \u0000 \u0000 \u0000 \u0000Conclusions. Although a causal relationship cannot be proven, we suggest that significant TR contributes to renal dysfunction in HF patients, probably by elevation of central and renal venous pressure.—Maeder MT, Holst DP, Kaye DM. Tricuspid regurgitation contributes to renal dysfunction in patients with heart failure. J Card Fail. 2008;14:824–830.","PeriodicalId":10536,"journal":{"name":"Congestive heart failure","volume":"161 1","pages":"207-207"},"PeriodicalIF":0.0,"publicationDate":"2009-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83854152","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2009-05-01DOI: 10.1111/J.1751-7133.2009.00091_1.X
S. Harris, D. Tepper, Randy J. Ip
Abstract. Objectives. The purpose of this study was to examine the long-term incidence of heart failure (HF) in elderly patients with myocardial infarction (MI). Background. In-hospital HF is common after MI and is associated with poor short-term prognosis. Limited data exist concerning the long-term incidence or prognosis of HF after MI, particularly in the era of coronary revascularization. Methods. A population-based cohort of 7733 patients 65 years and older hospitalized for a first MI (International Classification of Diseases, 9th Revision Clinical Modification code 410.x) and without a prior history of HF was established between 1994 and 2000 in Alberta, Canada, and followed up for 5 years. Results. During the index MI hospitalization, 2831 (37%) MI patients were diagnosed with new HF and 1024 (13%) died. Among hospital survivors who did not have HF during their index hospitalization (n=4291), an additional 3040 patients (71%) developed HF by 5 years, 64% of which occurred in the first year. In total, 5871 (76%) elderly patients who survived their first MI developed HF over 5 years. Among those who survived the index hospitalization, the 5-year mortality rate was 39.1% for those with HF during the index MI hospitalization compared with 26.7% among those without HF (P<.0001) during the index MI hospitalization. Over the study period, the 5-year mortality rate after MI decreased by 28%, whereas the 5-year rate of HF increased by 25%. Conclusions. In this large cohort of elderly patients without a history of HF, HF developed in three-quarters in the 5 years after their first MI; this proportion increased over time as peri-MI mortality rates declined. New-onset HF significantly increases the mortality risk among these patients.—Ezekowitz JA, Kaul P, Bakal JA, et al. Declining in-hospital mortality and increasing heart failure incidence in elderly patients with first myocardial infarction.J Am Coll Cardiol. 2009;53(1):21–23.
摘要目标。本研究的目的是研究老年心肌梗死(MI)患者心力衰竭(HF)的长期发病率。背景。院内心衰在心肌梗死后很常见，且与较差的短期预后相关。关于心肌梗死后HF的长期发病率或预后的数据有限，特别是在冠状动脉血运重建术时期。方法。1994年至2000年间，在加拿大阿尔伯塔省建立了7733例65岁及65岁以上因首次MI(国际疾病分类，第9版临床修改代码410.x)住院且无HF病史的患者为基础的人群队列，随访5年。结果。在指数心肌梗死住院期间，2831例(37%)心肌梗死患者被诊断为新发心衰，1024例(13%)死亡。在住院期间未发生HF的住院幸存者中(n=4291)，另外3040例(71%)患者在5年内发生HF，其中64%发生在第一年。总共有5871例(76%)首次心肌梗死存活的老年患者在5年内发展为心衰。在指数住院期间存活的患者中，心衰患者的5年死亡率为39.1%，非心衰患者的5年死亡率为26.7% (P< 0.0001)。在研究期间，心肌梗死后的5年死亡率下降了28%，而心衰的5年死亡率上升了25%。结论。在这个没有HF病史的老年患者大队列中，四分之三的患者在首次心肌梗死后的5年内发生HF;随着时间的推移，这一比例随着心肌梗死期死亡率的下降而增加。新发心衰显著增加了这些患者的死亡风险。-Ezekowitz JA, Kaul P, Bakal JA，等。老年首次心肌梗死患者住院死亡率下降和心力衰竭发生率增高中华心血管病杂志，2009;33(1):21-23。
{"title":"Declining In‐Hospital Mortality and Increasing Heart Failure Incidence in Elderly Patients With First Myocardial Infarction","authors":"S. Harris, D. Tepper, Randy J. Ip","doi":"10.1111/J.1751-7133.2009.00091_1.X","DOIUrl":"https://doi.org/10.1111/J.1751-7133.2009.00091_1.X","url":null,"abstract":"Abstract. Objectives. The purpose of this study was to examine the long-term incidence of heart failure (HF) in elderly patients with myocardial infarction (MI). \u0000 \u0000 \u0000 \u0000 Background. In-hospital HF is common after MI and is associated with poor short-term prognosis. Limited data exist concerning the long-term incidence or prognosis of HF after MI, particularly in the era of coronary revascularization. \u0000 \u0000 \u0000 \u0000 Methods. A population-based cohort of 7733 patients 65 years and older hospitalized for a first MI (International Classification of Diseases, 9th Revision Clinical Modification code 410.x) and without a prior history of HF was established between 1994 and 2000 in Alberta, Canada, and followed up for 5 years. \u0000 \u0000 \u0000 \u0000 Results. During the index MI hospitalization, 2831 (37%) MI patients were diagnosed with new HF and 1024 (13%) died. Among hospital survivors who did not have HF during their index hospitalization (n=4291), an additional 3040 patients (71%) developed HF by 5 years, 64% of which occurred in the first year. In total, 5871 (76%) elderly patients who survived their first MI developed HF over 5 years. Among those who survived the index hospitalization, the 5-year mortality rate was 39.1% for those with HF during the index MI hospitalization compared with 26.7% among those without HF (P<.0001) during the index MI hospitalization. Over the study period, the 5-year mortality rate after MI decreased by 28%, whereas the 5-year rate of HF increased by 25%. \u0000 \u0000 \u0000 \u0000 Conclusions. In this large cohort of elderly patients without a history of HF, HF developed in three-quarters in the 5 years after their first MI; this proportion increased over time as peri-MI mortality rates declined. New-onset HF significantly increases the mortality risk among these patients.—Ezekowitz JA, Kaul P, Bakal JA, et al. Declining in-hospital mortality and increasing heart failure incidence in elderly patients with first myocardial infarction.J Am Coll Cardiol. 2009;53(1):21–23.","PeriodicalId":10536,"journal":{"name":"Congestive heart failure","volume":"25 1","pages":"154-154"},"PeriodicalIF":0.0,"publicationDate":"2009-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85648219","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2009-03-01DOI: 10.1111/J.1751-7133.2009.00059.X
D. Tepper, S. Harris, Randy J. Ip
Abstract. Objectives. The aim of the current study was to evaluate echocardiographic parameters after 6 months of cardiac resynchronization therapy (CRT) as well as long-term outcome in patients with the left ventricular (LV) lead positioned at the site of latest activation (concordant LV lead position) as compared with that seen in patients with a discordant LV lead position. Background. A nonoptimal LV pacing lead position may be a potential cause for nonresponse to CRT. Methods. The site of latest mechanical activation was determined by speckle tracking radial strain analysis and related to the LV lead position on chest x-ray in 244 CRT candidates. Echocardiographic evaluation was performed after 6 months. Long-term follow-up included all-cause mortality and hospitalizations for heart failure. Results. Significant LV reverse remodeling (reduction in LV end-systolic volume from 189±83 mL to 134±71 mL, P<.001) was noted in the group of patients with a concordant LV lead position (n=153, 63%), whereas patients with a discordant lead position showed no significant improvements. In addition, during long-term follow-up (32±16 months), less events (combined for heart failure hospitalizations and death) were reported in patients with a concordant LV lead position. Moreover, a concordant LV lead position appeared to be an independent predictor of hospitalization-free survival after long-term CRT (hazard ratio: 0.22, P=.004). Conclusions. Pacing at the site of latest mechanical activation, as determined by speckle tracking radial strain analysis, resulted in superior echocardiographic response after 6 months of CRT and better prognosis during long-term follow-up.
{"title":"Optimal Left Ventricular Lead Position Predicts Reverse Remodeling and Survival After Cardiac Resynchronization Therapy","authors":"D. Tepper, S. Harris, Randy J. Ip","doi":"10.1111/J.1751-7133.2009.00059.X","DOIUrl":"https://doi.org/10.1111/J.1751-7133.2009.00059.X","url":null,"abstract":"Abstract. Objectives. The aim of the current study was to evaluate echocardiographic parameters after 6 months of cardiac resynchronization therapy (CRT) as well as long-term outcome in patients with the left ventricular (LV) lead positioned at the site of latest activation (concordant LV lead position) as compared with that seen in patients with a discordant LV lead position. \u0000 \u0000 \u0000 \u0000Background. A nonoptimal LV pacing lead position may be a potential cause for nonresponse to CRT. \u0000 \u0000 \u0000 \u0000Methods. The site of latest mechanical activation was determined by speckle tracking radial strain analysis and related to the LV lead position on chest x-ray in 244 CRT candidates. Echocardiographic evaluation was performed after 6 months. Long-term follow-up included all-cause mortality and hospitalizations for heart failure. \u0000 \u0000 \u0000 \u0000Results. Significant LV reverse remodeling (reduction in LV end-systolic volume from 189±83 mL to 134±71 mL, P<.001) was noted in the group of patients with a concordant LV lead position (n=153, 63%), whereas patients with a discordant lead position showed no significant improvements. In addition, during long-term follow-up (32±16 months), less events (combined for heart failure hospitalizations and death) were reported in patients with a concordant LV lead position. Moreover, a concordant LV lead position appeared to be an independent predictor of hospitalization-free survival after long-term CRT (hazard ratio: 0.22, P=.004). \u0000 \u0000 \u0000 \u0000Conclusions. Pacing at the site of latest mechanical activation, as determined by speckle tracking radial strain analysis, resulted in superior echocardiographic response after 6 months of CRT and better prognosis during long-term follow-up.","PeriodicalId":10536,"journal":{"name":"Congestive heart failure","volume":"43 1","pages":"99-99"},"PeriodicalIF":0.0,"publicationDate":"2009-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84617867","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2008-01-01DOI: 10.1111/J.1751-7133.2008.07773.X
D. Tepper, S. Harris, Randy J. Ip
{"title":"Characterization and Prognostic Value of Persistent Hyponatremia in Patients With Severe Heart Failure in the ESCAPE Trial","authors":"D. Tepper, S. Harris, Randy J. Ip","doi":"10.1111/J.1751-7133.2008.07773.X","DOIUrl":"https://doi.org/10.1111/J.1751-7133.2008.07773.X","url":null,"abstract":"","PeriodicalId":10536,"journal":{"name":"Congestive heart failure","volume":"85 1","pages":"46-46"},"PeriodicalIF":0.0,"publicationDate":"2008-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87721242","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2006-11-01DOI: 10.1111/J.1527-5299.2006.04942.X
I. S. Virk, D. Tepper
{"title":"Diurnal Blood Pressure Pattern and Risk of Congestive Heart Failure","authors":"I. S. Virk, D. Tepper","doi":"10.1111/J.1527-5299.2006.04942.X","DOIUrl":"https://doi.org/10.1111/J.1527-5299.2006.04942.X","url":null,"abstract":"","PeriodicalId":10536,"journal":{"name":"Congestive heart failure","volume":"53 1","pages":"350-351"},"PeriodicalIF":0.0,"publicationDate":"2006-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90582645","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2006-05-01DOI: 10.1111/J.1527-5299.2005.04939.X
I. S. Virk, John Ip, D. Tepper
{"title":"Changing Incidence and Survival for Heart Failure","authors":"I. S. Virk, John Ip, D. Tepper","doi":"10.1111/J.1527-5299.2005.04939.X","DOIUrl":"https://doi.org/10.1111/J.1527-5299.2005.04939.X","url":null,"abstract":"","PeriodicalId":10536,"journal":{"name":"Congestive heart failure","volume":"1 1","pages":"176-178"},"PeriodicalIF":0.0,"publicationDate":"2006-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89812332","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2006-01-01DOI: 10.1111/j.1527-5299.2006.05772.x-i1
S. Toggweiler, M. Zuber, P. Erne
{"title":"Optimization of atrioventricular and interventricular delay with acoustic cardiography in biventricular pacing.","authors":"S. Toggweiler, M. Zuber, P. Erne","doi":"10.1111/j.1527-5299.2006.05772.x-i1","DOIUrl":"https://doi.org/10.1111/j.1527-5299.2006.05772.x-i1","url":null,"abstract":"","PeriodicalId":10536,"journal":{"name":"Congestive heart failure","volume":"36 20","pages":"37-40"},"PeriodicalIF":0.0,"publicationDate":"2006-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91401876","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2006-01-01DOI: 10.1111/J.1527-5299.2006.04937.X
I. S. Virk, John Ip, Rubinder S. Ruby, D. Tepper
{"title":"Is the Prophylactic Implantable Cardioverter‐Defibrillator Cost‐Effective?","authors":"I. S. Virk, John Ip, Rubinder S. Ruby, D. Tepper","doi":"10.1111/J.1527-5299.2006.04937.X","DOIUrl":"https://doi.org/10.1111/J.1527-5299.2006.04937.X","url":null,"abstract":"","PeriodicalId":10536,"journal":{"name":"Congestive heart failure","volume":"9 1","pages":"51-53"},"PeriodicalIF":0.0,"publicationDate":"2006-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75443997","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2005-11-01DOI: 10.1111/J.1527-5299.2005.04186.X
I. S. Virk, John Ip, D. Tepper
{"title":"Should ? Blockers Be First in Chronic Heart Failure?. Revised ACC/AHA Heart Failure Management Guidelines Reflect Current Clinical Practice","authors":"I. S. Virk, John Ip, D. Tepper","doi":"10.1111/J.1527-5299.2005.04186.X","DOIUrl":"https://doi.org/10.1111/J.1527-5299.2005.04186.X","url":null,"abstract":"","PeriodicalId":10536,"journal":{"name":"Congestive heart failure","volume":"11 1","pages":"336-338"},"PeriodicalIF":0.0,"publicationDate":"2005-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87346006","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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