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Short-term treatments for acute cardiac care: inotropes and inodilators.

ABSTRACT: Acute heart failure (AHF) continues to be a substantial cause of illness and death, with in-hospital and 3-month mortality rates of 5% and 10%, respectively, and 6-month re-admission rates in excess of 50% in a range of clinical trials and registry studies; the European Society of Cardiology (ESC) Heart Failure Long-Term Registry recorded a 1-year death or rehospitalization rate of 36%. As regards the short-term treatment of AHF patients, evidence was collected in the ESC Heart Failure Long-Term Registry that intravenous (i.v.) treatments are administered heterogeneously in the critical phase, with limited reference to guideline recommendations. Moreover, recent decades have been characterized by a prolonged lack of successful innovation in this field, with a plethora of clinical trials generating neutral or inconclusive findings on long-term mortality effects from a multiplicity of short-term interventions in AHF. One of the few exceptions has been the calcium sensitizer and inodilator levosimendan, introduced 20 years ago for the treatment of acutely decompensated chronic heart failure. In the present review, we will focus on the utility of this agent in the wider context of i.v. inotropic and inodilating therapies for AHF and related pathologies.

SUBMITTER: Guarracino F

PROVIDER: S-EPMC7225903 | biostudies-literature | 2020 May

REPOSITORIES: biostudies-literature

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Short-term treatments for acute cardiac care: inotropes and inodilators.

Guarracino Fabio F Zima Endre E Pollesello Piero P Masip Josep J

European heart journal supplements : journal of the European Society of Cardiology 20200515 Suppl D

Acute heart failure (AHF) continues to be a substantial cause of illness and death, with in-hospital and 3-month mortality rates of 5% and 10%, respectively, and 6-month re-admission rates in excess of 50% in a range of clinical trials and registry studies; the European Society of Cardiology (ESC) Heart Failure Long-Term Registry recorded a 1-year death or rehospitalization rate of 36%. As regards the short-term treatment of AHF patients, evidence was collected in the ESC Heart Failure Long-Term ...[more]

PMID: 32431568

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Project description:Background: It has been shown that a new Tissue Doppler index, E/ (E’×S’), is able to predict a high level of left ventricular (LV) end-diastolic pressure (E = early diastolic transmitral velocity, E’ = early diastolic mitral annular velocity and S’ = systolic mitral annular velocity). The purpose of our study was to investigate whether E/ (E’×S’) could be a predictor of cardiac death in patients hospitalized with acute decompensated heart failure (ADHF). Methods: We determined E/ (E’×S’) in 131 consecutive patients hospitalized with ADHF, in sinus rhythm, after appropriate medical treatment. The average of the velocities from the septal and lateral mitral annular sites was used. Patients with inadequate echocardiographic images, congenital heart disease, paced rhythm, significant primary valvular heart disease, acute coronary syndrome, coronary revascularization during follow-up, severe pulmonary disease, malignant neoplasia, renal failure, were excluded. Only 105 patients formed our study group. The primary study end-point was definite as cardiac death. Results: In our study group, the mean LV ejection fraction was 38 ± 14%. During the follow-up period (36.5 ± 12.7 months) cardiac death occurred in 17 patients (16.1%). Mean E/ (E’×S’) was 3.81 ± 0.79 in these patients, while it was 1.58 ± 0.86 in the rest (p < 0.001). The optimal E/ (E’×S’) cut-off to predict future cardiac death was 2.9 (81% sensitivity, 87% specificity). Cardiac death was significantly higher in the group of patients with E/ (E’×S’) > 2.9 than in the rest with E/ (E’×S’) ?2.9 [13 (50%) vs. 4 (5.1%), p < 0.001]. On multivariate Cox analysis including the variables that predicted cardiac death on univariate analysis [N-terminal pro-brain natriuretic peptide levels, severe mitral regurgitation, LV ejection fraction, left atrial volume index, E/A (A = peak late diastolic transmitral flow), S’, E’, E/E’ ratio, E/ (E’×S’) >2.9, LV ejection fraction ?40% combined with E/E’ >15, and restrictive pattern], the E/ (E’×S’) index >2.9 was the only independent predictor of cardiac death (HR = 7.3; 95%CI = 1.4-26.3; p = 0.002). Conclusions: In patients with ADHF, E/ (E’×S’) >2.9 is an important independent long-term prognostic index of cardiac death.

Project description:BACKGROUND: Periostin was proved to play an important role in extra-cellular matrix remodeling after acute myocardial infarction (AMI). Myocardial periostin was markedly up-regulated after AMI and participated in the maladaptive process of cardiac remodeling. However, few researches focused on the circulating periostin and its significance. This study aims to investigate the association of serum periostin level with cardiac function and short-term prognosis in AMI patients. METHODOLOGY/PRINCIPAL FINDINGS: We totally recruited 50 patients diagnosed as ST-elevation myocardial infarction. Blood samples were taken within 12 hours after the onset of AMI before emergency coronary revascularization procedures. Serum periostin was measured using enzyme-linked immunosorbent assay. All patients received echocardiography examination within one week after hospitalization. Correlations of serum periostin with echocardiography parameters, Killip class and myocardium injury biomarkers (CK-MB/troponin T) were investigated. AMI patients were divided into two groups by serum periostin level (higher/lower periostin group) and followed up for six months. Primary endpoints included cardiovascular mortality, nonfatal stroke/transient ischemic attack, chest pain occurrence and re-hospitalization. Secondary endpoint referred to composite cardiovascular events including all the primary endpoints. RESULT: Serum periostin was in negative association with left ventricular ejection fraction (LVEF) (r = -0.472, *p<0.01) and left atrium diameter (LAD) (r = -0.328, *p<0.05). Positive correlation was found between serum periostin level and Killip class (r = 0.395, *p<0.01). There was no association between serum periostin and CK-MB or troponin T (p>0.05). After six months follow up, patients in higher periostin group showed increased composite cardiovascular events (*p<0.05). Patients showed no significant difference in primary endpoints between the two groups. CONCLUSIONS/SIGNIFICANCE: Serum periostin was in negative correlation with LVEF and LAD, in positive association with Killip class and higher serum periostin level may be predictive for worse short-term disease prognosis indicated as more composite cardiovascular events six months post AMI.

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Project description:ObjectivesTo 1) analyze the short-term biochemical improvements and clinical outcomes following treatment of children with post-severe acute respiratory syndrome coronavirus-2 inflammatory syndrome (multisystem inflammatory syndrome in children/pediatric inflammatory multisystem syndrome temporally associated with severe acute respiratory syndrome coronavirus-2) admitted to U.K. PICUs and 2) collate current treatment guidance from U.K. PICUs.DesignMulticenter observational study.SettingTwenty-one U.K. PICUs.PatientsChildren (< 18 yr) admitted to U.K. PICUs between April 1, 2020, and May 10, 2020, fulfilling the U.K. case definition of pediatric inflammatory multisystem syndrome temporally associated with severe acute respiratory syndrome coronavirus-2.InterventionsNone.Measurements and main resultsRoutinely collected, deidentified data were analyzed. Propensity score and linear mixed effects models were used to analyze the effect of steroids, IV immunoglobulin, and biologic agents on changes in C-reactive protein, platelet counts, and lymphocyte counts over the course of PICU stay. Treatment recommendations from U.K. clinical guidelines were analyzed. Over the 6-week study period, 59 of 78 children (76%) received IV immunoglobulin, 57 of 78 (73%) steroids, and 18 of 78 (24%) a biologic agent. We found no evidence of a difference in response in clinical markers of inflammation between patients with multisystem inflammatory syndrome in children/pediatric inflammatory multisystem syndrome temporally associated with severe acute respiratory syndrome coronavirus-2 who were treated with IV immunoglobulin, steroids, or biologics, compared with those who were not. By the end of the study period, most patients had received immunomodulation. The 12 patients who did not receive any immunomodulators had similar decrease in inflammatory markers as those treated. Of the 14 guidelines analyzed, the use of IV immunoglobulin, steroids, and biologics was universally recommended.ConclusionsWe were unable to identify any short-term benefit from any of the treatments, or treatment combinations, administered. Despite a lack of evidence, treatment guidelines for multisystem inflammatory syndrome in children/pediatric inflammatory multisystem syndrome temporally associated with severe acute respiratory syndrome coronavirus-2 have become very similar in advising step-wise treatments. Retaining clinical equipoise regarding treatment will allow clinicians to enroll children in robust clinical trials to determine the optimal treatment for this novel important condition.

Dataset Information

Short-term treatments for acute cardiac care: inotropes and inodilators.

Publications

Short-term treatments for acute cardiac care: inotropes and inodilators.

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