Y.J. Kim

Characteristics, Outcomes and Predictors of Long-Term Mortality for Patients Hospitalized for Acute Heart Failure: A Report From the Korean Heart Failure Registry

Background and Objectives Acute heart failure (AHF) is associated with a poor prognosis and it requires repeated hospitalizations. However, there are few studies on the characteristics, treatment and prognostic factors of AHF. The aims of this study were to describe the clinical characteristics, management and outcomes of the patients hospitalized for AHF in Korea. Subjects and Methods We analyzed the clinical data of 3,200 hospitalization episodes that were recorded between June 2004 and April 2009 from the Korean Heart Failure (KorHF) Registry database. The mean age was 67.6±14.3 years and 50% of the patients were female. Results Twenty-nine point six percent (29.6%) of the patients had a history of previous HF and 52.3% of the patients had ischemic heart disease. Left ventricular ejection fraction (LVEF) was reported for 89% of the patients. The mean LVEF was 38.5±15.7% and 26.1% of the patients had preserved systolic function (LVEF ≥50%), which was more prevalent in the females (34.0% vs. 18.4%, respectively, p<0.001). At discharge, 58.6% of the patients received beta-blockers (BB), 53.7% received either angiotensin converting enzyme-inhibitors or angiotensin receptor blockers (ACEi/ARB), and 58.4% received both BB and ACEi/ARB. The 1-, 2-, 3- and 4-year mortality rates were 15%, 21%, 26% and 30%, respectively. Multivariate analysis revealed that advanced age {hazard ratio: 1.023 (95% confidence interval: 1.004-1.042); p=0.020}, a previous history of heart failure {1.735 (1.150-2.618); p=0.009}, anemia {1.973 (1.271-3.063); p=0.002}, hyponatremia {1.861 (1.184-2.926); p=0.007}, a high level of serum N-terminal pro-B-type natriuretic peptide (NT-proBNP) {3.152 (1.450-6.849); p=0.004} and the use of BB at discharge {0.599 (0.360-0.997); p=0.490} were significantly associated with total death. Conclusion We present here the characteristics and prognosis of an unselected population of AHF patients in Korea. The long-term mortality rate was comparable to that reported in other countries. The independent clinical risk factors included age, a previous history of heart failure, anemia, hyponatremia, a high NT-proBNP level and taking BB at discharge.

Images in cardiovascular medicine. Chronic cardiac transplant rejection: evaluation with magnetic resonance imaging.

A 35-year-old man was admitted with pitting edema on both lower legs, dyspnea on exertion, and orthopnea for 2 months before presentation. He had undergone cardiac transplantation for idiopathic dilated cardiomyopathy 12 years previously and had a history of mild acute rejection during the immediate postoperative period. The rejection was well controlled and transplant function was restored. However, 9 years after transplantation, coronary angiography revealed total occlusion of the left anterior descending coronary artery, and echocardiography demonstrated …A 35-year-old man was admitted with pitting edema on both lower legs, dyspnea on exertion, and orthopnea for 2 months before presentation. He had undergone cardiac transplantation for idiopathic dilated cardiomyopathy 12 years previously and had a history of mild acute rejection during the immediate postoperative period. The rejection was well controlled and transplant function was restored. However, 9 years after transplantation, coronary angiography revealed total occlusion of the left anterior descending coronary artery, and echocardiography demonstrated akinesia of the interventricular septum at the apical level, which was clinically diagnosed as transplant vasculopathy. The left atrium was then progressively dilated, and the global left ventricular systolic function was shown to be normal on regular echocardiography at 6-month intervals. Echocardiography on admission revealed significant diastolic dysfunction (E/E 20) with abnormal septal motion and increased volume of both atria. The patient underwent cardiac magnetic resonance imaging on admission. Fourchamber cine images showed prominent biatrial enlargement with normal-sized ventricles (Figure 1). T2-weighted black blood short-axis imaging demonstrated abnormal signal intensity in the right side of the interventricular septum (Figure 2A). The abnormal high-signal area was not due to slow flow artifact with reference to the cine image taken at the same anatomic position (Figure 2B). On delayed-enhancement magnetic resonance imaging, hyperenhancement was noted not only in the abnormal T2 signal area but also in the subendocardial portion of all left ventricular segments (Figure 2C). The pattern of delayed enhancement was not explained by a particular vascular territory, so we suggested extensive fibrosis. Endomyocardial biopsy was performed from the right side of the interventricular septum. Histological specimen demonstrated myocyte hypertrophy, interstitial fibrosis, and replacement fibrosis, suggestive of chronic transplant rejection (Figure 3).