These observations in a contemporary advanced ADHF cohort suggest that serum chloride levels at admission are independently and inversely associated with mortality. The prognostic value of serum sodium in ADHF was diminished compared with chloride.

prognosis. Systematic description of metabolite patterns in large numbers of HF patients has not been described. Methods: We analyzed plasma samples from 400 patients with chronic HF. All participants met Framingham criteria for HF and had a previous echocardiogram. Data on demographics, comorbid conditions, functional status (6 minute walk distance [6MWD]), and quality of life (Kansas City Cardiomyopathy Questionnaire [KCCQ]) were collected. A blood sample was obtained and aliquoted plasma stored at -70 OC. Eighty-six amino acids (AA), organic acids (OA) and acylcarnitines (AC) were quantified using targeted metabolomic profiling. Analytes with coefficient of variation!0.05 were considered non-variable and not analyzed further. Data was log transformed to maintain a symmetric distribution. Metabolite levels were tested for association with gender, race, HF type (HFrEF vs HFpEF), diabetes status, NYHA class, and 6MWD using linear regression. Multiple comparisons were accounted for by False Discovery Rate (FDR), with FDR!0.05 being considered significant. Results: The cohort was 50% African American, 50% female, 67% HFrEF, and had an average age of 70. There were significant differences in metabolite abundance by each characteristic examined, including race and gender. A strong pattern emerged for citric acid cycle intermediates and HF phenotype; one or more of these intermediates showed significant association with HF type, NYHA class, and 6MWD. Also of note was an increased abundance of short branched-chain AC among diabetics, which was not accompanied by the expected increase in corresponding branched-chain AA. Each of these associations persisted after adjustment for renal function. Conclusion: There are significant differences in plasma metabolomic profiles among HF patients. Metabolites vary by demographics and diabetes status, and citric acid cycle intermediates may be associated with disease severity/prognosis. Analysis in larger data sets is warranted.Introduction: Acute decompensated heart failure (ADHF) can be complicated by electrolyte abnormalities. While there is an abundance of knowledge regarding the clinical significance of serum sodium levels, to our knowledge, there are limited data regarding the prognostic significance of serum chloride levels in ADHF. Hypothesis: We hypothesize that lower serum chloride levels will be associated with long-term mortality after admission for ADHF. Methods: We reviewed 1,318 consecutive patients with established chronic heart failure, with implantable cardioverter defibrillators, admitted for ADHF to the Cleveland Clinic between 7/2008 and 12/2013 and also validated our findings in an independent ADHF cohort from the University of Pennslvania (N5876). All patients were followed for all-cause mortality. Cox-proportional hazards models were adjusted for admission sodium, blood urea nitrogen, length of stay, age, ischemic cardiomyopathy, beta-blocker use, renin-angiotensin system inhibitor use, and mineralocorticoid antagonist use. Results: In our cohort (median age...

Background : The aim of the study was to assess, characterize, and describe the prevalence and predicting factors of patient-reported severe coronavirus disease 2019 (COVID-19) infection and post-acute sequelae of COVID-19 (PASC). Methods : We prospectively surveyed patients who received care in our outpatient clinic for COVID-19 from March 13, 2020, through August 17, 2020, and then retrospectively reviewed their electronic health records. We collected data for age, sex, and persistence of symptoms and compared data for hospitalized and nonhospitalized patients. Continuous and categorical variables were summarized, including time from COVID-19 onset, time to resuming normal activities, and length of time away from work. Results : Of those receiving the survey, 437 adult patients with different degrees of severity of COVID-19 illness responded: 77% were between 3 and 6 months from the onset of infection. In total, 34.9% had persistent symptoms, and 11.5% were hospitalized. The most common symptom was fatigue (75.9%), followed by poor sleep quality (60.3%), anosmia (56.8%), dysgeusia (55%), and dyspnea (54.6%). Predicting factors for PASC were female sex and a negative psychological impact of the disease. Age, hospitalization, persistent symptoms, psychological impact (eg, anxiety and depression), and time missed from work were significantly associated with perception of having severe COVID-19 illness. Hospitalization was not significantly associated with PASC. Conclusions : Over one-third of patients in our study had PASC. Persistent symptoms correlated with severity of disease and were significantly more common for women, for patients who had psychological symptoms (depression and/or anxiety), and for patients reporting inability to resume normal activities.

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Calf muscle pump (CMP) promotes venous return from the lower extremity and contributes to preload and cardiac output. Impaired CMP function may reflect a measure of frailty or cumulative disease burden or may impede cardiac function. The study objective was to test the hypothesis that impaired CMP negatively impacts survival. Consecutive adult patients who underwent venous strain gauge plethysmography at the Mayo Clinic Gonda Vascular Laboratory (January 1, 1998 – December 31, 2011) were assessed for overall survival. Patients with venous incompetence, venous obstruction or unilateral calf pump dysfunction were excluded. Risk of mortality was assessed with Cox proportional hazard ratios and after adjusting for Charlson Comorbidity Index variables. Over the study period, 2728 patients were included in the analysis. Compared to patients with normal CMP, those with impaired CMP were older ( p < 0.001), predominantly female ( p = 0.01) and had higher mean Charlson scores ( p < 0.001). Patients with impaired CMP had a higher mortality rate at 5 (8.9% vs 2.4%), 10 (17.5% vs 5.9%), and 15 years (22.8% vs 8.3%) compared to those with normal CMP ( p < 0.001 for each comparison). Of patients with heart failure, those with impaired CMP had worse survival at each 5-year increment compared to those with normal CMP ( p < 0.05 at each increment). In conclusion, impaired CMP appears to be an independent predictor of poor outcomes after adjusting for variables within the Charlson Comorbidity Index. The association between impaired CMP, heart failure, and mortality may represent a negative impact on circulatory function or a surrogate measure of frailty.