Pathophysiology and Therapeutic Approaches to Acute Decompensated Heart Failure

Njoroge, Joyce N.; Teerlink, John R.

doi:10.1161/circresaha.121.318186

“…Despite similar clinical presentations, acute decompensated heart failure (ADHF) is a highly heterogeneous syndrome with incompletely understood pathophysiology [ 1 , 2 ]. In contrast to increasing therapeutic options of chronic heart failure (CHF), no new drug for ADHF has been approved in decades [ 2 , 3 ].…”

Section: Introductionmentioning

confidence: 99%

“…Despite similar clinical presentations, acute decompensated heart failure (ADHF) is a highly heterogeneous syndrome with incompletely understood pathophysiology [ 1 , 2 ]. In contrast to increasing therapeutic options of chronic heart failure (CHF), no new drug for ADHF has been approved in decades [ 2 , 3 ]. Considering higher rates of morbidity and mortality in ADHF patients than in those with recently diagnosed HF, it is critical to identify high-risk groups before discharge to improve their prognosis [ 4 , 5 ].…”

Section: Introductionmentioning

confidence: 99%

“…Previous studies have showed some clinical biomarkers, such as elevated BNP, hyponatremia, anemia, and worsening renal function, are associated with poor outcomes in ADHF [ 6 – 9 ]. However, there are few well-validated biomarkers and effective clinical tools in patients with ADHF [ 2 ]. Therefore, appropriate risk stratification of ADHF and further individualization of care needs to be further explored [ 2 , 10 ].…”

Section: Introductionmentioning

confidence: 99%

“…However, there are few well-validated biomarkers and effective clinical tools in patients with ADHF [ 2 ]. Therefore, appropriate risk stratification of ADHF and further individualization of care needs to be further explored [ 2 , 10 ].…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Prognostic value of triglyceride glucose (TyG) index in patients with acute decompensated heart failure

Huang

¹

,

Wang

²

,

Chen

³

et al. 2022

Cardiovasc Diabetol

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Background The triglyceride glucose (TyG) index has been proposed as a reliable marker of insulin resistance (IR) and an independent predictor of cardiovascular disease risk. However, its prognostic value in patients with acute decompensated heart failure (ADHF) remains unclear. Methods A total of 932 hospitalized patients with ADHF from January 1st, 2018 to February 1st, 2021 were included in this retrospective study. The TyG index was calculated as ln [fasting triglyceride level (mg/dL) × fasting plasma glucose level (mg/dL)/2]. Patients were divided into tertiles according to TyG index values. The primary endpoints were all-cause death, cardiovascular (CV) death and major adverse cardiac and cerebral events (MACCEs) during follow-up. We used multivariate adjusted Cox proportional hazard models and restricted cubic spline analysis to investigate the associations of the TyG index with primary endpoints. Results During a median follow-up time of 478 days, all-cause death, CV death and MACCEs occurred in 140 (15.0%), 103 (11.1%) and 443 (47.9%) cases, respectively. In multivariate Cox proportional hazard models, the risk of incident primary endpoints was associated with the highest TyG tertile. After adjustment for confounding factors, hazard ratios (HRs) for the highest tertile (TyG index ≥ 9.32) versus the lowest tertile (TyG index < 8.83) were 2.09 (95% confidence interval [CI], 1.23–3.55; p = 0.006) for all-cause death, 2.31 (95% CI, 1.26–4.24; p = 0.007) for CV death and 1.83 (95% CI, 1.18–3.01; p = 0.006) for MACCEs. Restricted cubic spline analysis also showed that the cumulative risk of primary endpoints increased as TyG index increased. When the TyG index was used as a continuous variable, the hazard ratios of the three primary endpoints rapidly increased within the higher range of the TyG index (all cause death, TyG > 9.08; CV death, TyG > 9.46; MACCEs, TyG > 9.87). Conclusions The elevated TyG index was independently associated with poor prognosis, and thus would be useful in the risk stratification in patients with ADHF.

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“…Moreover, it seems reasonable that a potential pharmaceutical should first act longer than in a hospital (ideally for weeks/months following one or a few easy administrations during the acute phase). Secondly, it is essential to target mechanisms involved in a complex AHF pathophysiology other than hemodynamics [ 14 ].…”

Section: Introductionmentioning

confidence: 99%

Iron deficiency as an emerging therapeutic target in patients stabilized after an episode of acute heart failure

Tkaczyszyn

¹

,

Skrzypczak

²

,

Michałowicz

³

et al. 2021

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Renal function during hospitalization and outcome in Chinese patients with acute decompensated heart failure: A retrospective study and literature review

Lee

¹

,

Huang

²

,

Yang

³

et al. 2022

Clinical Cardiology

2

0

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Background The heart and kidneys had demonstrated a bidirectional interaction that dysfunction of the heart or kidneys can induce dysfunction in the other organ. Hypothesis Renal function and its decline during hospitalization may have impact on cardiovascular outcomes in patients with acute decompensated heart failure (ADHF). Methods A total of 119 consecutive Chinese patients admitted for ADHF were prospectively enrolled. The course of renal function was presented with estimated glomerular filtration rate (eGFR), calculated by the four‐variable equation proposed by the Modification of Diet in Renal Disease (MDRD) Study. Worsening renal function (WRF) was defined as eGFR decline between admission (eGFR admission ) and predischarge (eGFR predischarge ). Clinical outcomes were defined as 4P‐major adverse cardiovascular events (4P‐MACE), including the composition of cardiovascular death, nonfatal myocardial infarction, nonfatal stroke, and nonfatal HF hospitalization. Results During an average 2.6 ± 3.2 years follow‐up, 66 patients (55%) experienced 4P‐MACE. Patients with impaired eGFR predischarge (<60 ml/min/1.73 m 2 ) had more 4P‐MACE than those with preserved eGFR predischarge (64.7% vs. 43.1%, p = .019). The Kaplan–Meier survival curves showed significantly higher incidence of 4P‐MACE in patients with impaired eGFR predischarge than those with preserved eGFR predischarge ( p = .002). Cox regression analysis revealed that impaired eGFR predischarge was significantly correlated with the development of 4P‐MACE (hazard ratio, 2.003; 95% confidence interval, 1.072–3.744; p = .029). In contrast, outcomes would be similar with regard to eGFR on admission and eGFR decline during hospitalization. Conclusions Impaired renal function before discharge, but not impaired renal function on admission or WRF, is a significant risk factor for poor outcomes in patients with ADHF.

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Pathophysiology and Therapeutic Approaches to Acute Decompensated Heart Failure

Cited by 108 publications

References 197 publications

Prognostic value of triglyceride glucose (TyG) index in patients with acute decompensated heart failure

Prognostic value of triglyceride glucose (TyG) index in patients with acute decompensated heart failure

Iron deficiency as an emerging therapeutic target in patients stabilized after an episode of acute heart failure

Renal function during hospitalization and outcome in Chinese patients with acute decompensated heart failure: A retrospective study and literature review

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