Hearts

Background: Serum albumin is a well-known marker of nutritional and inflammatory status and has been associated with adverse outcomes in heart failure (HF). However, its predictive value for length of hospital-stay and short-term mortality in elderly HF patients remains underexplored. Objectives: To investigate the association between serum albumin levels at hospital admission and length of stay, as well as post-admission mortality, in a cohort of elderly patients hospitalized for HF. Methods: We conducted a retrospective analysis of 56 consecutive patients aged ≥65 years admitted for HF. Comorbidities were assessed using the Cumulative Illness Rating Scale for Geriatrics (CIRS-G), and inflammatory status was measured via C-reactive protein (CRP). Negative binomial regression with robust confidence intervals was employed to evaluate the relationship between serum albumin and length of hospital-stay, adjusting for age, comorbidity burden, and CRP. Cox proportional hazards models were used to assess mortality at 6 months and 1 year, adjusting for age, comorbidity, CRP, and HF subtype, with Kaplan–Meier curves illustrating unadjusted survival differences according to albumin levels and HF subtype. Results: Mean age was 78.6 ± 7.5 years, with 69.6% female patients. Mean serum albumin at admission was 3.58 ± 0.60 g/dL, and mean length of stay was 14.8 ± 10.1 days. Each 1 g/dL increase in albumin was associated with a 32% reduction in length of stay (adjusted IRR = 0.68; 95% CI: 0.54–0.85; p = 0.01), independently by age, inflammatory status and comorbidity. Serum albumin was independently associated with reduced risk of death at 6 months (HR 0.30; 95% CI: 0.11–0.82; p = 0.019) and 1 year (HR = 0.41; 95% CI: 0.17–0.96; p = 0.041). Conclusions: Serum albumin at hospital admission independently predicts length of stay and short-term mortality in elderly patients with HF. Albumin measurement, simple, cheap and universally available biomarker, is helpful for early risk stratification and may guide clinical management in this vulnerable population.

Background: In cardiology, vasoregulation is one of the most important targets of pharmacotherapy. SOMNOtouch™-NIBP (SOMNOmedics AG, Randersacker, Germany) is a cuffless device designed for continuous, non-invasive blood pressure measurements, and it appears to be ready for use in infants and children with congenital heart disease. For infants, minor methodological modifications are required due to their small body size. Methods: Using this device, we demonstrate fluctuations in diastolic blood pressure in three patients: an infant with hypoplastic left heart syndrome after Norwood stage 1 and 2 operations; an infant with Tetralogy of Fallot with heart failure due to pulmonary overcirculation after an aorto-pulmonary shunt implantation; and a 13-year-old girl with chronic cyanosis due to a congenitally corrected transposition of the great arteries (ccTGA) with a ventricular septal defect and pulmonary stenosis. The measurement procedures are completely non-invasive and feasible in an outpatient setting. Results: The results demonstrate strong correlations between blood pressure and oxygen saturation levels as well as heart rate variability. We discuss our results in relation to current concepts of hypoxic pulmonary/systemic vasoconstriction and hypoxemia-related pathways. Conclusions: The cuffless device for continuous, non-invasive blood pressure measurement seems to be useful for infants with and without congenital heart defects who receive pharmacotherapies that modulate vasoregulation. These patients should also be non-invasively monitored for safety reasons and for a better understanding of their pathophysiology.

Heart transplantation is the gold standard in patients with end stage heart failure, offering vastly improved survival, mortality and quality of life. However, hypertension occurring after cardiac transplantation is a serious issue, with the incidence ranging from 50 to 80% of patients. The pathophysiology of the hypertension encompasses a more varied and unique set of causes than those identified in non-organ transplant patients, particularly related to the use of calcineurin inhibitors (CNIs) especially cyclosporine. An in-depth understanding of hypertension after heart transplantation remains a critical issue that necessitates further clarification, due to its deleterious long-term consequence such as impaired graft survival, cardiac allograft vasculopathy (CAV), and overall survival. This article provides a comprehensive review of the prevalence, risk factors, etiology, complications, and management of hypertension after heart transplantation.