Editorial

3 pages, 216 KiB

Open AccessEditorial

Personalized Therapy and Clinical Outcome for Heart Failure

by Alvaro Aceña, Javier de Juan Bagudá and Luis M. Rincón

J. Clin. Med. 2022, 11(16), 4851; https://doi.org/10.3390/jcm11164851 - 18 Aug 2022

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Heart failure (HF) is a complex clinical syndrome that results from the structural and/or functional impairment of systolic function or ventricular filling, which in turn causes elevated intracardiac pressure and/or inadequate cardiac output at rest and/or during exercise [...] Full article

(This article belongs to the Special Issue Personalized Therapy and Clinical Outcome for Heart Failure)

Research

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10 pages, 736 KiB

Open AccessFeature PaperArticle

The Effects of a Therapeutic Strategy Guided by Lung Ultrasound on 6-Month Outcomes in Patients with Heart Failure: Results from the EPICC Randomized Controlled Trial

by Juan Torres-Macho, Jose Manuel Cerqueiro-González, Jose Carlos Arévalo-Lorido, Pau Llácer-Iborra, Jose María Cepeda-Rodrigo, Pilar Cubo-Romano, Jose Manuel Casas-Rojo, Raúl Ruiz-Ortega, Luis Manzano-Espinosa, Noel Lorenzo-Villalba and Manuel Méndez-Bailón

J. Clin. Med. 2022, 11(16), 4930; https://doi.org/10.3390/jcm11164930 - 22 Aug 2022

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Abstract

Background: Pulmonary congestion (PC) is associated with an increased risk of hospitalization and death in patients with heart failure (HF). Lung ultrasound is highly sensitive for detecting PC. The aim of this study is to evaluate whether lung ultrasound-guided therapy improves 6-month outcomes [...] Read more.

Background: Pulmonary congestion (PC) is associated with an increased risk of hospitalization and death in patients with heart failure (HF). Lung ultrasound is highly sensitive for detecting PC. The aim of this study is to evaluate whether lung ultrasound-guided therapy improves 6-month outcomes in patients with HF. Methods: A randomized, multicenter, single-blind clinical trial in patients discharged after hospitalization for decompensated HF. Participants were assigned 1:1 to receive treatment guided according to the presence of lung ultrasound signs of congestion (semi-quantitative evaluation of B lines and the presence of pleural effusion) versus standard of care (SOC). The primary endpoint was the combination of cardiovascular death, readmission, or emergency department or day hospital visit due to worsening HF at 6 months. In September 2020, after an interim analysis, patient recruitment was stopped. Results: A total of 79 patients were randomized (mean age 81.2 +/− 9 years) and 41 patients (51.8%) showed a left ventricular ejection fraction >50%. The primary endpoint occurred in 11 patients (29.7%) in the SOC group and in 11 patients (26.1%) in the LUS group (log-rank = 0.83). Regarding nonserious adverse events, no significant differences were found. Conclusions: LUS-guided diuretic therapy after hospital discharge due to ADHF did not show any benefit in survival or a need for intravenous diuretics compared with SOC. Full article

(This article belongs to the Special Issue Personalized Therapy and Clinical Outcome for Heart Failure)

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13 pages, 1170 KiB

Open AccessArticle

Levosimendan Administration May Provide More Benefit for Survival in Patients with Non-Ischemic Cardiomyopathy Experiencing Acute Decompensated Heart Failure

by Wei-Chieh Lee, Po-Jui Wu, Hsiu-Yu Fang, Yen-Nan Fang, Huang-Chung Chen, Meng-Shen Tong, Pei-Hsun Sung, Chieh-Ho Lee and Wen-Jung Chung

J. Clin. Med. 2022, 11(14), 3997; https://doi.org/10.3390/jcm11143997 - 10 Jul 2022

Cited by 4 | Viewed by 1433

Abstract

Background: Acute decompensated heart failure (ADHF) is a life-threatening condition with a high mortality rate. Levosimendan is an effective inotropic agent used to maintain cardiac output and a long-lasting effect. However, only few studies have compared the clinical outcomes, after levosimendan therapy, among [...] Read more.

Background: Acute decompensated heart failure (ADHF) is a life-threatening condition with a high mortality rate. Levosimendan is an effective inotropic agent used to maintain cardiac output and a long-lasting effect. However, only few studies have compared the clinical outcomes, after levosimendan therapy, among etiologies of ADHF. Methods: Between July 2014 and December 2019, 184 patients received levosimendan therapy for ADHF at our hospital. A total of 143 patients had ischemic cardiomyopathy (ICM), and 41 patients had non-ICM (NICM). Data on comorbidities, echocardiographic findings, laboratory findings, use of mechanical devices, consumption of other inotropic or vasopressor agents, frequency of HF hospitalization, cardiovascular (CV) mortality, and all-cause mortality were compared between the ICM and NICM groups. Results: Patients with ICM were older with higher prevalence of diabetes mellitus when compared to patients with NICM. Patients with NICM had a poorer left ventricular ejection fraction (LVEF) and higher left ventricular end-systolic volume when compared to patients with ICM. At the 30 day follow-up period, a lower CV mortality (ICM vs. NICM: 20.9% vs. 5.1%; log-rank p = 0.033) and lower all-cause mortality (ICM vs. NICM: 28.7% vs. 9.8%; log-rank p = 0.018) was observed in the NICM patients. A significantly lower all-cause mortality was noted at 180 day (ICM vs. NICM: 39.2% vs. 22.0%; log-rank p = 0.043) and 1 year (ICM vs. NICM: 41.3% vs. 24.4%; log-rank p = 0.046) follow up in the NICM subgroup. NICM (hazard ratio (HR): 0.303, 95% confidence interval (CI): 0.108–0.845; p = 0.023) and ECMO use (HR: 2.550, 95% CI: 1.385–4.693; p = 0.003) were significant predictors of 30 day all-cause mortality. Conclusions: In our study on levosimendan use for ADHF patients, better clinical outcomes were noted in the NICM population when compared to the ICM population. In the patients with cardiogenic shock or ventilator use, significantly lower incidence of 30 day mortality presented in the NICM population when compared with the ICM population. Full article

(This article belongs to the Special Issue Personalized Therapy and Clinical Outcome for Heart Failure)

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