Aim: To assess the prevalence and prognostic value of AKI in patients with acute decompensation of chronic heart failure (ADCHF) with a reduced ejection fraction (HFrEF) and with preserved ejection fraction (HFpEF) or acute coronary syndrome (ACS), to identify predictors of AKI.
Materials And Methods: In a prospective study included 863 patients, of which 141 with ADCHF, 446 - non-ST-elevation acute coronary syndromes (NSTE-ACS) and 276 - ST-segment elevation myocardial infarction (STEMI). AKI was diagnosed according to KDIGO recommendations. The end point was defined as death from cardiovascular causes.
Result: During the follow-up from 1 to 37 months (median follow-up was 18 months) for patients with ADCHF in 24,8 % an endpoint was reported. For patients with ACS, the observation time ranged from 1 day to 14 months (median follow-up was 12 months), in 4,3 % - NSTE-ACS, 10,9 % - STEMI the end point was recorded. AKI developed in 14,8 % of patients with ADCHF HFpEF and 11,2 % ADCHF HFrEF, in 23,1 % - STEMI and 21,4 % - NSTE-ACS. AKI increases the risk of death from cardiovascular causes in patients with ADCHF HFrEF (OR 95 % 98,750 (11,158-873,976), р<0,001) and STEMI (OR 95 % 5,395 (2,451-11,878), p<0,001), but did not increase the risk of an endpoint occurrence in patients with ADCHF HFpEF (OR 95 % 1,875 (0,221-15,930), р=0,565) and NSTE-ACS (OR 95 % 1,199 (0,421-3,412), р=0,734). The multivariate analysis revealed risk factors for the development of AKI in patients with ADCHF HFrEF: high albuminuria (AU) from 30 mg / l (OR 95 % 5,763 (1,338-24,819), р=0,019), GFR<45 ml / min initially at admission to hospital (OR 95 % 76,593 (1,193-36,446), p=0,031), age>75 years (OR 15,933 (1,020-248,856), р=0,048). In patients with STEMI: age>75 years (OR 95 % 3,248 (1,476-7,146), p=0,003), female gender (OR 95 % 2,321 (1,190-4,526), p=0,013), acute heart failure (AHF) Killip IV (OR 95 % 10,334 (1,777-60,110), p=0,009). Risk factors for the development of AKI in patients with NSTE-ACS: age>75 years (OR 95 % 1,761 (1,051-2,949), р=0,032), PCI on RCA (OR 95 % 2,565 (1,193-5,517), р=0,016).
Conclusion: In patients with ADCHF HFrEF and STEMI development AKI is associated with a poor prognosis, but does not affect the prognosis of patients with ADCHF HFpEF and NSTE-ACS. AKI in patients with ADCHF HFrEF can be predicted using predictors: GFR<45 ml / min, AU more than 30 mg / l and age>75 years. In patients with STEMI, the predictors of AKI were age>75 years, female gender, AHF Killip IV, and in patients with NSTE-ACS age>75 years, PCI on RCA.
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- The study aimed to investigate how different patterns of blood flow in the kidneys, assessed through Doppler ultrasound, can indicate the severity of venous congestion and predict kidney function impairment in patients suffering from acute decompensated chronic heart failure (ADCHF).
- Conducted on 75 ICU patients, the study analyzed the blood flow patterns (normal, biphasic, monophasic) and measured sodium concentration in urine after diuretic treatment to monitor kidney injury and other complications.
- Results revealed that patients with a monophasic blood flow pattern had a significantly higher incidence of acute kidney injury (100%) and were more likely to experience in-hospital death and diuretic resistance compared to those with normal or biphasic patterns
A new nomogram to predict in-hospital mortality in patients with acute decompensated chronic heart failure and diabetes after 48 Hours of Intensive Care Unit.
BMC Cardiovasc Disord
April 2024
Department of Cardiology, Shanghai Tongji Hospital, Tongji University School of Medicine, No. 389, Xincun Rd, Putuo District, Shanghai, 200065, China.
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J Clin Med
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Department of Cardiology and Internal Diseases, Military Institute of Medicine-National Research Institute, 04-141 Warsaw, Poland.
Background: Heart failure (HF) is associated with high mortality, morbidity, and frequent hospitalizations due to acute HF (AHF) and requires immediate diagnosis and individualized therapy. Some differences between acutely decompensated chronic heart failure (ADCHF) and de novo HF (dnHF) patients in terms of clinical profile, comorbidities, and outcomes have been previously identified, but the hemodynamics related to both of these clinical states are still not well recognized.
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View Article and Find Full Text PDFElectrocardiographic and other Noninvasive Hemodynamic Markers in Decompensated CHF Patients.
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Acutely decompensated chronic heart failure (adCHF) is among the most important causes of in-hospital mortality. R-wave peak time (RT) or delayed intrinsicoid deflection was proposed as a risk marker of sudden cardiac death and heart failure decompensation. Authors want to verify if QR interval or RT, obtained from 12-lead standard ECG and during 5-min ECG recordings (II lead), could be useful to identify adCHF.
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