Ondřej Ludka

Neurohumoral Activity, Heart Failure and Prognosis in Patients with End-Stage Renal Disease Treated by Hemodialysis

Background: Chronic renal failure treated by regular hemodialysis is frequently accompanied by chronic heart failure; the mortality of both is high. Aim: To evaluate the role of markers of neurohumoral activation for the prognosis of patients treated with regular dialysis. Patients: 99 patients with end-stage renal disease were followed up for 3 years. Methods: Clinical evaluation, echocardiography, biochemistry including NT-proBNP and big endothelin (Big-ET). Results: The incidence of heart failure was 97% and the 3-year mortality was 50%. The sensitivity of NT-proBNP and Big-ET level for the prediction of death was 0.712 and 0.824, respectively, and specificity 0.642 and 0.695, respectively. The cut-off points were NT-proBNP ≧2,000 pg/ml and Big-ET ≧1.55 pmol/l. Neither NT-proBNP nor Big-ET could be incorporated in the multivariate model for overall survival, which means that although both parameters significantly influenced overall survival as single risk factors, they were not effective in competition with the other significant predictors. Conclusion: Overall survival seems to be influenced namely by age, hemoglobin, left atrium diameter or pulmonary congestion class on chest X-ray, while probability of early risk was associated with Big-ET, history of diabetes mellitus, C-reactive protein, uric acid and hemoglobin. The only intersection of the models is hemoglobin as a thoroughly significant predictor.

Usefulness of exercise tissue doppler echocardiography for prognostic stratification of congestive heart failure patients with left ventricular systolic dysfunction.

AIM Determination of the importance of exercise tissue Doppler echocardiography in prognostic stratification of congestive heart failure patients with systolic dysfunction. METHODS 106 patients with congestive heart failure and LVEF ≤ 45% on optimal pharmacotherapy were included in the study. Results of resting and post-exercise echocardiography, cardiopulmonary exercise test and serum BNP levels were available for all patients. Two patient groups were constituted, based on the prognostic classification. Group I contained 21 patients with poor prognosis (defined by predicted value of pVO2 < 76% together with both VE/VCO2 slope > 32.7 and BNP > 210 pg/mL) and group II with 85 patients who did not meet the criteria. RESULTS The patient groups significantly differed in indexed volume of left atrium, mitral regurgitation severity, rest and post-exercise systolic velocity of mitral annulus and in rest and post-exercise E/Em. Multivariate analysis identified E/Em as the only independent predictor of prognosis. E/Em at rest (post-exercise) ≥ 16.6 (≥ 18.7) defined poor prognosis with sensitivity of 71% (86%) and specificity of 71% (71%). CONCLUSION Our study suggests usefulness of exercise tissue Doppler echocardiography for prognostic stratification of patients with congestive heart failure with possible superiority to resting parameters.

Prognostic Impact of Copeptin and Mid-Regional Pro-Adrenomedullin in Chronic Heart Failure with Regard to Comorbidities

The aim of the study is to evaluate the impact of new humoral substances: copeptin and mid- regional proadrenomedullin (MR-proADM) on one-year survival of patients with stable systolic chronic heart failure (CHF) and to compare them with AHEAD score assessing the comorbidities. The FAR NHL (FARmacology and NeuroHumoraL activation) registry is a database of patients with stable CHF (ejection fraction (EF) <50%) treated in specialized HF departments. AHEAD score is a simple bed-side mortality predictive model based on age and comorbidities. Primary endpoint after 1-year follow-up was: death or hospitalization for decompensation of HF or heart transplantation or LVAD implantation. To whole FAR NHL registry, a total amount of 1088 patients were included, in 552 of them the levels of copeptin and MR-proADM were available. Mean age was 65+12 years, mean EF was 31+9%. Patients without primary endpoint were assigned as group A (469 pts), those with the primary endpoint group B (83 pts). There were statistically significant differences between the groups in the levels of copeptin: group A median 15.9 pmol/l (3.4-50.9) vs group B 23.7 pmol/l(5.0-89.44) (p<0.001), MR-proADM: group A median 0.63 nmol/l(0.32-1.34) vs group B 0.74 nmol/l (0.4-1.94) (p<0.001). Relationship of AHEAD score to primary endpoint in the first year of follow-up was not significant, but within 24th month it reached statistical significance: p= 0.017. Patients with higher AHEAD score (more comorbidities) reached more often the primary end-point. The cutt-off value ≥ 23.7 for copeptin had 50.6% sensitivity and 73.3%. The cut –off value for MR-proADM ≥ 0.58 had higher sensitivity 79.5% and lower specificity 42.0%. For both humoral substances there was statistical significant difference for discrimination of patients with primary endpoint in lower AHEAD score groups. However, in the highest AHEAD score the level of these substances lost their predictive value.

Atrial fibrillation as prognostic factor of myocardial infarction and/or acute heart failure

Atrial fibrillation (AF) is a supraventricular tachyarrhythmia characterized by uncoordinated atrial activation with consequence deterioration of atrial mechanical function. It has an incidence of approximately 6 million people in European Union as a result of the aging population and affects about 1 percent of patients younger than 60 years and about 8 percent of patients older than 80 years [2, 10]. AF is also the most common supraventricular arrhythmia in patients with acute myocardial infarction (MI) and/or acute heart failure (AHF), complicating its course with an incidence between 6–21% in hospitalized patients with MI although recent advances in pharmacological treatment of myocardial infarction has probably changed the impact of this arrhythmia and vice versa. These two diseases (AF + MI) are a growing health concern all over the world and when one considers the occurrence of these two diseases simultaneously, the relevance of AF in the course of MI and vice versa cannot be overemphasized in cardiovascular health care and more importantly its treatment and prevention. This article therefore aims to correlate data from controlled studies to summarize the incidence of AF in MI and vice versa and the impact of pharmacotherapy. Data from our registry Brno (3502 patients with MI and/or AHF) show that AF is not a predictor of short-term mortality in patients with myocardial infarction and/or heart failure, but is a strong predictor of long-term mortality.

P6-04 Neurohumoral activation and chronic heart failure incidence in patients in chronic hemodialysis programme two-year follow up

Neurohumoral activation and chronic heart failure incidence in patients in chronic hemodialysis programme, two - year follow up

Big endothelin in chronic heart failure: marker of disease severity or genetic determination?

Big endothelin in chronic heart failure-marker of disease severity or genetic determination?