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  • 1
    Online Resource
    Online Resource
    Elevated ST 2 levels are associated with antibody‐mediated rejection in heart transplant recipients
    Wiley ; 2018
    In:  Clinical Transplantation Vol. 32, No. 9 ( 2018-09)
    Details
    In: Clinical Transplantation, Wiley, Vol. 32, No. 9 ( 2018-09)
    Abstract: Soluble ST 2 ( sST 2) is a novel biomarker of inflammation and fibrosis. Elevated sST 2 levels (≥35 ng/mL) are associated with worse outcomes in patients with heart failure ( HF ). There are sparse data regarding the significance of sST 2 levels after heart transplantation ( HT x). The study aims were to evaluate trends in soluble ST 2 levels after the resolution of HF status with HT x and association between post‐ HT x sST 2 levels and outcomes. Plasma sST 2 levels were measured at baseline (median [ IQR ] of 118 days pre‐ HT x) and 12 months post‐ HT x in 62 subjects who were stratified into two groups by post‐ HT x sST 2 levels 〈 or ≥35 ng/mL: “Group 1” or “Group 2,” respectively. Plasma sST 2 levels were elevated in 58% of patients pre‐ HT x and in 50% of patients post‐ HT x. There was no association between elevated sST 2 levels before and after HT x, and no significant differences in baseline characteristics between Group 1 and Group 2 patients. Group 2 as compared to Group 1 HT x recipients had significantly higher incidence of antibody‐mediated rejection ( AMR ) for the entire post‐transplant follow‐up period (32% vs 4%, P  = 0.006). There was no association between post‐ HT x sST 2 level status and other post‐ HT x outcomes including survival. In conclusion, elevated plasma sST 2 levels after HT x are associated with increased risk for AMR.
    Type of Medium: Online Resource
    ISSN: 0902-0063 , 1399-0012
    URL: Issue
    URL: Article
    DOI: 10.1111/ctr.2018.32.issue-9
    DOI: 10.1111/ctr.13349
    Language: English
    Publisher: Wiley
    Publication Date: 2018
    detail.hit.zdb_id: 2739458-X
    detail.hit.zdb_id: 2004801-4
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  • 2
    Online Resource
    Online Resource
    HFA of the ESC Position paper on the management of LVAD supported patients for the non LVAD specialist healthcare provider Part 1: Introduction and at the non‐hospital settings in the community
    Wiley ; 2021
    In:  ESC Heart Failure Vol. 8, No. 6 ( 2021-12), p. 4394-4408
    Details
    In: ESC Heart Failure, Wiley, Vol. 8, No. 6 ( 2021-12), p. 4394-4408
    Abstract: The accepted use of left ventricular assist device (LVAD) technology as a good alternative for the treatment of patients with advanced heart failure together with the improved survival of the LVAD‐supported patients on the device and the scarcity of donor hearts has significantly increased the population of LVAD‐supported patients. The expected and non‐expected device‐related and patient–device interaction complications impose a significant burden on the medical system exceeding the capacity of the LVAD implanting centres. The ageing of the LVAD‐supported patients, mainly those supported with the ‘destination therapy’ indication, increases the risk for those patients to experience comorbidities common in the older population. The probability of an LVAD‐supported patient presenting with medical emergency to a local emergency department, internal, or surgical ward of a non‐LVAD implanting centre is increasing. The purpose of this trilogy is to supply the immediate tools needed by the non‐LVAD specialized physician: ambulance clinicians, emergency ward physicians, general cardiologists, internists, anaesthesiologists, and surgeons, to comply with the medical needs of this fast‐growing population of LVAD‐supported patients. The different issues discussed will follow the patient's pathway from the ambulance to the emergency department and from the emergency department to the internal or surgical wards and eventually to the discharge home from the hospital back to the general practitioner. In this first part of the trilogy on the management of LVAD‐supported patients for the non‐LVAD specialist healthcare provider, after the introduction on the assist devices technology in general, definitions and structured approach to the assessment of the LVAD‐supported patient in the ambulance and emergency department is presented including cardiopulmonary resuscitation for LVAD‐supported patients.
    Type of Medium: Online Resource
    ISSN: 2055-5822 , 2055-5822
    URL: Issue
    URL: Article
    DOI: 10.1002/ehf2.v8.6
    DOI: 10.1002/ehf2.13588
    Language: English
    Publisher: Wiley
    Publication Date: 2021
    detail.hit.zdb_id: 2814355-3
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  • 3
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    Online Resource
    The burden of heart failure in cardiac intensive care unit: a prospective 7 years analysis
    Wiley ; 2023
    In:  ESC Heart Failure Vol. 10, No. 3 ( 2023-06), p. 1615-1622
    Details
    In: ESC Heart Failure, Wiley, Vol. 10, No. 3 ( 2023-06), p. 1615-1622
    Abstract: The profiles of patients at cardiac intensive care units (CICU) have evolved towards a patient population with an increasing number of co‐morbid medical conditions and acute heart failure (HF). The current study was designed to illustrate the burden of HF patients admitted to CICU, and evaluate patient characteristics, in‐hospital course and outcomes of CICU patients with HF compared with patients with acute coronary syndrome (ACS). Methods and results A prospective study including all consecutive patients admitted to the CICU at a tertiary medical centre between 2014 and 2020. The main outcome was a direct comparison between HF and ACS patients in processes of care, resource use, and outcomes during CICU hospitalization. A secondary analysis compared ischaemic versus non‐ischaemic HF aetiology. Adjusted analysis evaluated parameters associated with prolonged hospitalization. The cohort included 7674 patients with a total annual CICU admissions of 1028–1145 patients. HF diagnosis patients represented 13–18% of the annual CICU admissions and were significantly older with higher incidence of multiple co‐morbidities compared with patients with ACS. HF patients also required more intensive therapies and demonstrated higher incidence of acute complications as compared with ACS patients. Length of stay at the CICU was significantly longer among HF patients compared with patients with ACS (either STEMI or NSTEMI) (6.2 ± 4.3 vs. 4.1 ± 2.5 vs. 3.5 ± 2.1, respectively, P   〈  0.001). HF patients represented a disproportionately higher amount of total CICU patient days during the study period, as the total length of hospitalization of HF patients was 44–56% out of the total cumulative days in CICU of patients with ACS every year. In hospital mortality rates were also significantly higher among patients with HF compared with STEMI or NSTEMI (4.2% vs. 3.1% vs. 0.7%, respectively, P   〈  0.001). Despite several differences in baseline characteristics between patients with ischaemic versus non‐ischaemic HF, which can be attributed mainly to disease aetiology, hospitalization length and outcomes were similar among the groups regardless of HF aetiology. In multivariable analysis for the risk of prolonged hospitalization in the CICU adjusted to potential significant co‐morbidities associated with poor outcomes, HF was found to be an independent and significant parameter associated with the risk of prolonged hospitalization with an OR of 3.5 (95% CI 2.9–4.1, P   〈  0.001). Conclusions Patients with HF in CICU have higher severity of illness with a prolonged and complicated hospital course, all of which can substantially increase the burden on clinical resources.
    Type of Medium: Online Resource
    ISSN: 2055-5822 , 2055-5822
    URL: Issue
    URL: Article
    DOI: 10.1002/ehf2.v10.3
    DOI: 10.1002/ehf2.14320
    Language: English
    Publisher: Wiley
    Publication Date: 2023
    detail.hit.zdb_id: 2814355-3
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  • 4
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    Online Resource
    Characterization of heart failure patients with reverse left ventricular remodelling post‐angiotensin receptor blockers/neprilysin inhibitors therapy
    Wiley ; 2022
    In:  ESC Heart Failure Vol. 9, No. 3 ( 2022-06), p. 1682-1688
    Details
    In: ESC Heart Failure, Wiley, Vol. 9, No. 3 ( 2022-06), p. 1682-1688
    Abstract: To assess the effect of angiotensin receptor blockers/neprilysin inhibitors (ARNI) on left ventricular (LV) ejection fraction (LVEF) and LV dimensions in a real‐life cohort of heart failure and reduced ejection fraction (HFrEF) patients, while analysing patient characteristics that may predict reverse LV remodelling. Methods and results The ARNI‐treated HFrEF patients followed at a single tertiary medical centre HF‐outpatient clinic were included in the study. Clinical and echocardiographic parameters were evaluated prior to ARNI initiation, and while on ARNI therapy, assessing patient characteristics associated with reverse LV remodelling. The cohort included 91 patients (mean age 60.5 years, 90% male) and 47 (52%) patients exhibited ARNI responsiveness, defined as an increase in LVEF during therapy. Overall, LVEF increased by 19% post‐ARNI (23.8 to 28.4%, P   〈  0.001). Subgroup analysis revealed several parameters associated with significant LVEF improvement, including baseline LVEF 〈 30%, non‐ischaemic HF aetiology, lack of cardiac resynchronization therapy (CRT), better initial functional class and ARNI initiation within 3 years from HF diagnosis ( P  ≤ 0.001 for all). Significant reduction in LV dimensions was noted in patients with lower initial LVEF, non‐ischaemic HF and no CRT. Further combined subgrouping of the study population demonstrated that patients with both LVEF 〈 30% and a non‐ischaemic HF gained most benefit from ARNI with an average of 51% improvement in LVEF (19.9 to 30%, P   〈  0.001). Conclusions The ARNI treatment response is not uniform among HFrEF patient subgroups. More pronounce reverse LV remodelling is associated with early ARNI treatment initiation in the course of HFrEF, and in those with LVEF 〈 30%, non‐ischaemic HF and no CRT.
    Type of Medium: Online Resource
    ISSN: 2055-5822 , 2055-5822
    URL: Issue
    URL: Article
    DOI: 10.1002/ehf2.v9.3
    DOI: 10.1002/ehf2.13801
    Language: English
    Publisher: Wiley
    Publication Date: 2022
    detail.hit.zdb_id: 2814355-3
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  • 5
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    Online Resource
    Navigating between Scylla and Charybdis: challenges and strategies for implementing guideline‐directed medical therapy in heart failure with reduced ejection fraction
    Wiley ; 2021
    In:  European Journal of Heart Failure Vol. 23, No. 12 ( 2021-12), p. 1999-2007
    Details
    In: European Journal of Heart Failure, Wiley, Vol. 23, No. 12 ( 2021-12), p. 1999-2007
    Abstract: Guideline‐directed medical therapy (GDMT) has the potential to reduce the risks of mortality and hospitalisation in patients with heart failure (HF) with reduced ejection fraction (HFrEF). However, real‐world data indicate that many patients with HFrEF do not receive optimised GDMT, which involves several different medications, many of which require up‐titration to target doses. There are many challenges to implementing GDMT, the most important being patient‐related factors (comorbidities, advanced age, frailty, cognitive impairment, poor adherence, low socioeconomic status), treatment‐related factors (intolerance, side‐effects) and healthcare‐related factors that influence availability and accessibility of HF care. Accordingly, international disparities in resources for HF management and limited public reimbursement of GDMT, coupled with clinical inertia for treatment intensification combine to hinder efforts to provide GDMT. In this review paper, authors aim to provide solutions based on available evidence, practical experience, and expert consensus on how to utilise evolving strategies, novel medications, and patient profiling to allow the more comprehensive uptake of GDMT. Authors discuss professional education, motivation, and training, as well as patient empowerment for self‐care as important tools to overcome clinical inertia and boost GDMT implementation. We provide evidence on how multidisciplinary care and institutional accreditation can be successfully used to increase prescription rates and adherence to GDMT. We consider the role of modern technologies in advancing professional and patient education and facilitating patient–provider communication. Finally, authors emphasise the role of novel drugs (especially sodium–glucose co‐transporter 2 inhibitors), and a tailored approach to drug management as evolving strategies for the more successful implementation of GDMT.
    Type of Medium: Online Resource
    ISSN: 1388-9842 , 1879-0844
    URL: Issue
    URL: Article
    DOI: 10.1002/ejhf.v23.12
    DOI: 10.1002/ejhf.2378
    Language: English
    Publisher: Wiley
    Publication Date: 2021
    detail.hit.zdb_id: 1500332-2
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  • 6
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    Online Resource
    The safety of sodium glucose transporter 2 inhibitors and trends in clinical and hemodynamic parameters in patients with left ventricular assist devices
    Wiley ; 2024
    In:  Artificial Organs
    Details
    In: Artificial Organs, Wiley
    Abstract: The safety and impact of sodium glucose transporter 2 inhibitors (SGLT2‐I) in patients with left ventricular assist devices (LVAD) are unknown. Methods A retrospective analysis of all consecutive patients who underwent LVAD Heart Mate 3 (HM3) implantation at a single medical center and received SGLT2‐I therapy following surgery was conducted. LVAD parameters, medical therapy, laboratory tests, echocardiography, and right heart catheterization (RHC) study results were recorded and compared before and after initiation of SGLT2‐I. Results SGLT2‐I medications were initiated in 29 (21%) of 138 patients following HM3 implantation (23 (79%) received Empagliflozin and 6 (21%) Dapagliflozin). The mean age at the time of LVAD implantation was 62 ± 6.7 years, 25 (86%) were male, and 23 (79%) had diabetes mellitus. The median time from HM3 implantation to SGLT2‐I initiation was 108 days, IQR (26–477). Following SGLT2‐I therapy, the daily dose of furosemide decreased from 47 to 23.5 mg/day (mean difference = 23.5 mg/d, 95% CI 8.2–38.7, p = 0.004) and significant weight reduction was observed (mean difference 2.5 kg, 95% CI 0.7–4.3, p = 0.008). Moreover, a significant 5.6 mm Hg reduction in systolic pulmonary artery pressure (sPAP) was measured during RHC (95% CI 0.23–11, p = 0.042) in a subgroup of 11 (38%) patients. LVAD parameters were similar before and after SGLT2‐I initiation ( p 〉 0.2 for all). No adverse events were recorded during median follow‐up of 354 days, IQR (206–786). Conclusion SGLT2‐I treatment is safe in LVAD patients and might contribute to reduction in patients sPAP.
    Type of Medium: Online Resource
    ISSN: 0160-564X , 1525-1594
    URL: Article
    DOI: 10.1111/aor.14733
    Language: English
    Publisher: Wiley
    Publication Date: 2024
    detail.hit.zdb_id: 2003825-2
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