BACKGROUNDPrevious data are controversial about the association of renal artery stenosis (RAS) with clinical outcome in patients with heart failure. Definition of RAS in previous studies might not be appropriate. By definition of RAS with renal duplex sonography, we investigated the association of RAS with clinical outcome in patients with heart failure.

METHODSIn this retrospective study, we identified 164 patients with heart failure (New York Heart Association classification ≥II; left ventricular ejection fraction <50%) who had received renal duplex sonography during hospital stay. RAS was defined as renal-aortic ratio ≥3.5 or a peak systolic velocity ≥200 cm/s (or both), or occlusion of the renal artery. Categorical data of patients were compared using the Chi-square test or Fisher's exact test. Cox proportional hazards regression modeling technique was used to investigate the prognostic significance of possible predictors.

RESULTSFinally, 143 patients were enrolled. Median follow-up time was 32 months (1-53 months). Twenty-two patients were diagnosed as RAS by renal duplex sonography, including 13 unilateral RAS (3 left RAS, 10 right RAS) and 9 bilateral RAS. There were more all-cause mortality and cardiovascular death in patients with RAS than patients without RAS. By multivariate analysis, RAS was a significant predictor for all-cause death and cardiovascular death (hazard ratio [HR] = 4.155, 95% confidence interval [CI]: 1.546-11.164, P = 0.005; and HR = 3.483, 95% CI: 1.200-10.104, P = 0.022, respectively). As for composite endpoint events, including death, nonfatal myocardial infarction, ischemic stroke or intracranial hemorrhage, rehospitalization for cardiac failure, and renal replacement therapy, only angiotensin-converting enzyme inhibitor or angiotensin-receptor blocker was significant predictor. RAS was not a significant predictor for composite endpoint events.

CONCLUSIONSOur data suggested that RAS is associated with a poorer clinical outcome in patients with heart failure.

Aged ; Atherosclerosis ; diagnosis ; etiology ; mortality ; Chi-Square Distribution ; Heart Failure ; complications ; mortality ; Humans ; Middle Aged ; Renal Artery Obstruction ; diagnosis ; etiology ; mortality ; Retrospective Studies ; Stroke Volume ; physiology

Heart failure (HF) complicating acute myocardial infarction (AMI) is common and is associated with poor clinical outcome. Limited data exist regarding the incidence and in-hospital mortality of AMI with HF (AMI-HF). We retrospectively analyzed 1,427 consecutive patients with AMI in the five major university hospitals in Korea at two time points, 1998 (n = 608) and 2008 (n = 819). Two hundred twenty eight patients (37.5%) in 1998 and 324 patients (39.5%) in 2008 of AMI patients complicated with HF (P = 0.429). AMI-HF patients in 2008 were older, had more hypertension, previous AMI, and lower systolic blood pressure than those in 1998. Regarding treatments, AMI-HF patients in 2008 received more revascularization procedures, more evidence based medical treatment and adjuvant therapy, such as mechanical ventilators, intra-aortic balloon pulsation compared to those in 1998. However, overall in-hospital mortality rates (6.4% vs 11.1%, P = 0.071) of AMI-HF patients were unchanged and still high even after propensity score matching analysis, irrespective of types of AMI and revascularization methods. In conclusion, more evidence-based medical and advanced procedural managements were applied for patients with AMI-HF in 2008 than in 1998. However the incidence and in-hospital mortality of AMI-HF patients were not significantly changed between the two time points.
Acute Disease ; Age Factors ; Aged ; Blood Pressure ; Demography ; Female ; Heart Failure/complications/*diagnosis/mortality ; Hospital Mortality/*trends ; Humans ; Hypertension/complications ; Male ; Middle Aged ; Myocardial Infarction/complications/*diagnosis/mortality ; Odds Ratio ; Republic of Korea ; Retrospective Studies

BACKGROUND: Mesenteric infarction is a significant cause of death in elderly patients, and is being reported with increasing frequency. The diagnosis seldom is made prior to the onset of gangrene, despite an increased awareness of the lethality of mesenteric ischemia. The outcome for patients with mesenteric ischemia depends on the age of the patient, the extent and the severity of the ischemia and the effectiveness of the collateral blood supply. METHODS: We retrospectively reviewed the cases of 23 patient with mesenteric infarction who had been treated at the Department of Surgery, Hallym University, Chunchon Sacred Heart Hospital, between September 1988 and August 1977. RESULTS: The mean age was 52.3 years and the ratio of males to females was 1:1.6. The most frequent underlying diseases were hypertension, congestive heart failure, atrial fibrillation, and myocardial infarction. The radiologic study of a simple plain abdomen revealed a paralytic ileus in 87% of the cases; a partial vascular occlusion was shown under angiogram. The mean time lapse from onset of symptom to operation was 38.3 hours. Eight (34.8%) patients died when renal failure, ARDS or peritonitis developed. CONCLUSIONS: The cause of the persistently high mortality in patients with mesenteric in farction and to define a more effective form of management based on our results and recent clinical or laboratory findings. This study was concluded that early detection of the mesenteric infarction was reduced postoperative complications.
Abdomen ; Aged ; Atrial Fibrillation ; Cause of Death ; Diagnosis ; Female ; Gangrene ; Gangwon-do ; Heart ; Heart Failure ; Humans ; Hypertension ; Infarction* ; Intestinal Pseudo-Obstruction ; Ischemia ; Male ; Mortality ; Myocardial Infarction ; Peritonitis ; Postoperative Complications ; Renal Insufficiency ; Retrospective Studies

BACKGROUND/AIMS: Brain natriuretic peptide (BNP) levels are known to be elevated in patients with chronic kidney disease (CKD) and normal heart function. Therefore, the present study was performed to examine the effectiveness of BNP level in diagnosing heart failure in patients with CKD and to determine its effects on survival rate and prognosis. METHODS: A total of 182 patients with CKD who visited the hospital due to dyspnea of NYHA class II were included in the study. BNP levels were measured and echocardiography was performed to divide the subjects into groups with and without heart failure. Their BNP levels, clinical courses, and survival rates were analyzed retrospectively. RESULTS: When BNP level was > or =858.5 pg/mL in CKD patients, heart failure could be diagnosed with sensitivity and specificity of 77% and 72%, respectively. Survival rate of the group with BNP levels of > or =858.8 pg/mL was significantly lower than that of the group with BNP level below this threshold (p=0.012) and multivariate analysis showed that BNP level, age, and sex affected survival rate in the group with BNP level > or =858.8 pg/mL. CONCLUSIONS: BNP levels of patients with CKD showed a positive correlation with creatinine levels, and the critical point of BNP level for diagnosis of heart failure was 858.5 pg/mL. As the survival rate in patients with BNP level above the critical point was significantly low, this level was a useful indicator for predicting their prognosis. Care should be taken in interpreting BNP level because patients with stage 5 CKD may show a high concentration of BNP without heart failure.
Aged ; Cohort Studies ; Female ; Heart Failure/blood/complications/*diagnosis ; Humans ; Kidney Diseases/*blood/complications/mortality ; Male ; Middle Aged ; Natriuretic Peptide, Brain/*blood ; Predictive Value of Tests ; Retrospective Studies ; Survival Rate

Peripartum cardiomyopathy (PPCM) is a rare but serious form of cardiac failure affecting women in the last months of pregnancy or early puerperium. Clinical presentation of PPCM is similar to that of systolic heart failure from any cause, and it can sometimes be complicated by a high incidence of thromboembolism. Prior to the availability of echocardiography, diagnosis was based only on clinical findings. Recently, inclusion of echocardiography has made diagnosis of PPCM easier and more accurate. Its etiopathogenesis is still poorly understood, but recent evidence supports inflammation, viral infection and autoimmunity as the leading causative hypotheses. Prompt recognition with institution of intensive treatment by a multidisciplinary team is a prerequisite for improved outcome. Conventional treatment consists of diuretics, beta blockers, vasodilators, and sometimes digoxin and anticoagulants, usually in combination. In resistant cases, newer therapeutic modalities such as immunomodulation, immunoglobulin and immunosuppression may be considered. Cardiac transplantation may be necessary in patients not responding to conventional and newer therapeutic strategies. The role of the anesthesiologist is important in perioperative and intensive care management. Prognosis is highly related to reversal of ventricular dysfunction. Compared to historically higher mortality rates, recent reports describe better outcome, probably because of advances in medical care. Based on current information, future pregnancy is usually not recommended in patients who fail to recover heart function. This article aims to provide a comprehensive updated review of PPCM covering etiopathogeneses, clinical presentation and diagnosis, as well as pharmacological, perioperative and intensive care management and prognosis, while stressing areas that require further research.
Anesthesia, Obstetrical/adverse effects ; Echocardiography, Doppler ; Female ; Heart Failure/*diagnosis/etiology/therapy ; Humans ; Incidence ; Mortality ; Pregnancy ; Pregnancy Complications, Cardiovascular/*diagnosis/etiology/therapy ; Prognosis ; Recurrence ; Risk Factors ; Ventricular Dysfunction, Left/ultrasonography

Thyroid storm (thyrotoxicosis) is rarely encountered during pregnancy or the puerperium, even in untreated women and characterized by hypertension, hyperthermia, and multiple systems involvement. Much more common is heart failure, apparently caused by the long-term myocardial effects of thyroid hormone and intensified by other pregnancy complications that include severe preeclampsia, infection, anemia, or combinations of these. Prompt diagnosis and treatment of thyroid storm are essential in reducing morbidity and mortality of a patient from this disorder. We experienced a case of triiodothyroxine induced thyroid storm (T3 thyrotoxicosis) developed after Cesarean section. This case highlights both physicians should be aware of the symptoms and risk factors and reversing of heart failure successfully by reducing cardiac workload is important through immediate medical treatment - adequate hydration, thermoregulation, and control of hypertension, infection and anemia et al.
Anemia ; Body Temperature Regulation ; Cesarean Section* ; Diagnosis ; Female ; Fever ; Graves Disease ; Heart Failure ; Humans ; Hypertension ; Mortality ; Postpartum Period ; Pre-Eclampsia ; Pregnancy ; Pregnancy Complications ; Risk Factors ; Thyroid Crisis ; Thyroid Gland ; Thyrotoxicosis*

BACKGROUND/AIMS: This meta-analysis compared the effects of amlodipine besylate, a charged dihydropyridine-type calcium channel blocker (CCB), with other non-CCB antihypertensive therapies regarding the cardiovascular outcome. METHODS: Data from seven long-term outcome trials comparing the cardiovascular outcomes of an amlodipine-based regimen with other active regimens were pooled and analyzed. RESULTS: The risk of myocardial infarction was significantly decreased with an amlodipine-based regimen compared with a non-CCB-based regimen (odds ratio [OR], 0.91; 95% confidence interval [CI], 0.84 to 0.99; p = 0.03). The risk of stroke was also significantly decreased (OR, 0.84; 95% CI, 0.79 to 0.90; p < 0.00001). The risk of heart failure increased slightly with marginal significance for an amlodipine-based regimen compared with a non-CCB-based regimen (OR, 1.14; 95% CI, 0.98 to 1.31; p = 0.08). However, when compared overall with beta-blockers and diuretics, amlodipine showed a comparable risk. Amlodipine-based regimens demonstrated a 10% risk reduction in overall cardiovascular events (OR, 0.90; 95% CI, 0.82 to 0.99; p = 0.02) and total mortality (OR, 0.95; 95% CI, 0.91 to 0.99; p = 0.01). CONCLUSIONS: Amlodipine reduced the risk of total cardiovascular events as well as all-cause mortality compared with non-CCB-based regimens, indicating its benefit for high-risk cardiac patients.
Amlodipine/*therapeutic use ; Antihypertensive Agents/*therapeutic use ; Blood Pressure/*drug effects ; Calcium Channel Blockers/*therapeutic use ; Chi-Square Distribution ; Clinical Trials as Topic ; Heart Failure/etiology/mortality/*prevention & control ; Humans ; Hypertension/complications/diagnosis/*drug therapy/mortality/physiopathology ; Myocardial Infarction/etiology/mortality/*prevention & control ; Odds Ratio ; Risk Factors ; Stroke/etiology/mortality/*prevention & control ; Treatment Outcome