Krista Siirilä-Waris

Prognostic role of pro- and anti-inflammatory cytokines and their polymorphisms in acute decompensated heart failure

Cytokines play an important role in chronic heart failure (HF), but little is known about their involvement in acute decompensated heart failure (ADHF).

The use of more than one inotrope in acute heart failure is associated with increased mortality: A multi-centre observational study

Background: Although weakly supported by scientific evidence, according to guidelines the use of inotropes in acute heart failure is indicated in the presence of hypoperfusion refractory to fluid resuscitation. Aims: We examined the characteristics of the inotrope-treated patients, as well as, their in-hospital mortality. The frequency and dosing of inotropic infusions in patients admitted with acute heart failure was assessed in detail. Methods: We included 620 consecutive patients with acute heart failure who were admitted to hospital during three months during spring 2004 in an observational multi-centre study. Results: Of the patients 84 (14%) were treated with inotropes. Dopamine was used in 46 (7%), dobutamine 22 (4%), epinephrine 5 (1%), norepinephrine in 33 (5%), and levosimendan in 44 (7%) cases. The in-hospital mortality was 21% in the inotrope-treated group, and 5% in the control group. The mortality was 7% if only one inotrope was used. The mortality increased in proportion to the number of inotropes used. Lower blood pressure at admission, low ejection fraction, elevated C-reactive protein and cardiac markers correlated with the inotrope administration. Conclusion: Inotrope administration is a marker of increased mortality in patients with acute heart failure. Still, the use of a single inotrope during hospital stay seems rather safe.

Quantifying Cardiac Hemodynamic Stress and Cardiomyocyte Damage in Ischemic and Nonischemic Acute Heart Failure

Background— The early and noninvasive differentiation of ischemic and nonischemic acute heart failure (AHF) in the emergency department (ED) is an unmet clinical need. Methods and Results— We quantified cardiac hemodynamic stress using B-type natriuretic peptide (BNP) and cardiomyocyte damage using 2 different cardiac troponin assays in 718 consecutive patients presenting to the ED with AHF (derivation cohort). The diagnosis of ischemic AHF was adjudicated using all information, including coronary angiography. Findings were validated in a second independent multicenter cohort (326 AHF patients). Among the 718 patients, 400 (56%) were adjudicated to have ischemic AHF. BNP levels were significantly higher in ischemic compared with nonischemic AHF (1097 [604–1525] pg/mL versus 800 [427–1317] pg/mL; P<0.001). Cardiac troponin T (cTnT) and sensitive cardiac troponin I (s-cTnI) were also significantly higher in ischemic compared with nonischemic AHF patients (0.040 [0.010–0.306] &mgr;g/L versus 0.018 [0.010–0.060] &mgr;g/L [P<0.001]; 0.024 [0.008–0.106] &mgr;g/L versus 0.016 [0.004–0.044 ] &mgr;g/L [P=0.002]). The diagnostic accuracy of BNP, cTnT, and s-cTnI for the diagnosis of ischemic AHF, as quantified by the area under the receiver-operating characteristic curve, was low (0.58 [95% CI, 0.54–0.63], 0.61 [95% CI, 0.57–0.66], and 0.59 [95% CI,0.54–0.65], respectively). These findings were confirmed in the validation cohort. Conclusions— At presentation to the ED, patients with ischemic AHF exhibit more extensive hemodynamic cardiac stress and cardiomyocyte damage than patients with nonischemic AHF. However, the overlap is substantial, resulting in poor diagnostic accuracy.

Ventricular conduction abnormalities as predictors of long-term survival in acute de novo and decompensated chronic heart failure

Data on the prognostic role of left and right bundle branch blocks (LBBB and RBBB), and nonspecific intraventricular conduction delay (IVCD; QRSu2009≥u2009110u2009ms, no BBB) in acute heart failure (AHF) are controversial. Our aim was to investigate electrocardiographic predictors of long‐term survival in patients with de novo AHF and acutely decompensated chronic heart failure (ADCHF).

Prognostic role of NT-proXNP, a novel virtual analyte, in acute heart failure

function, whereas free fatty acids (FFA) may compromise contractile function. It is unknown whether short-term modulation of myocardial substrate supply affects risk markers of HF severity. Methods: We studied 8 patients with ischemic heart disease and chronic HF and 8 healthy controls. Each patient was subjected to a 3-h infusion of 1) saline (SAL), 2) insulin–glucose (INS) (high insulin, low FFA), and 3) somatostatin–heparin (HEP) (low insulin, high FFA). Measurements were made at baseline and during the last 15 min of each study period. Results: Hemodynamics remained unaltered. NT-proBNP, OPG and ADI were increased in patients compared to controls [NT-proBNP (pg/ml): 169±46 (patients) vs. 8±2 (controls), pb0.01]; [OPG (ng/ml): 1.8±0.3 (patients) vs. 1.2±0.1 (controls), pb0.05]; [ADI (mg/L): 13.7±2.1 (patients) vs. 10.0±1.4 (controls), p=0.07]. Expressed as percentage change from fasting baseline values, INS caused a significant decrease in NT-proBNP [(%): 98±5 (SAL); 90±3 (INS); 103±4 (HEP), pb0.05] and a near significant decrease in ADI [(%): 97±1 (SAL); 94±1 (INS); 97±1 (HEP), p=0.096]. OPG tended to be decreased during INS [(%): 119± 12 (SAL); 97±5 (INS); 111±11 (HEP), p=0.25]. Conclusions: In HF patients short-term metabolic modulation with insulin has a favourable effect on risk markers in spite of unaltered hemodynamics. Metabolic status must be considered when interpreting NT-proBNP, OPG, and ADI levels.