Phenotyping congestion in patients with acutely decompensated heart failure with preserved and reduced ejection fraction: The Decongestion duRing therapY for acute decOmpensated heart failure in HFpEF vs HFrEF- DRY-OFF study

Cogliati, Chiara; Ceriani, Elisa; Gambassi, Giovanni; Matteis, Giuseppe De; Perlini, Stefano; Perrone, Tiziano; Muiesan, María Lorenza; Salvetti, Massimo; Leidi, Federica; Ferrara, Francesco; Sabbà, Carlo; Suppressa, Patrizia; Montano, Nicola; Fiorelli, Elisa Maria; Tripepi, Giovanni; Gori, Mauro; Pitino, Annalisa; Pietrangelo, Antonello

doi:10.1016/j.ejim.2021.11.010

Cited by 18 publications

(23 citation statements)

References 36 publications

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“…The results of the study of Cogliati et al [ 1 ] echoed the results of another study reported by Spanish investigators just a few months earlier [ 3 ]. That study, as well, looked at heart failure patients, but only the subset with preserved ejection fraction upon discharge from the hospital, specifically regarding their discharge medications.…”

Section: Introductionsupporting

confidence: 59%

“…These two factors, taken together, may predispose this area of the brainstem to ischemia, even in the absence of what is typically thought of as ‘occlusive cerebrovascular disease’. Although subsequently cited dozens of times, the concepts outlined by De Caro et al in [ 4 ] have probably been under-utilized in clinical practice, as is possibly demonstrated by the two recent papers [ 1 , 3 ], neither of which mentioned the possible role of the brainstem. The concepts [ 4 ] additionally provided reasonable answers [ 5 ] to questions previously unresolved regarding arrhythmia-induced sudden unexpected deaths related to small ischemic brain lesions in the medulla, the home of the solitary tract nucleus.…”

Section: Discussionmentioning

confidence: 99%

“…Recently, a multi-center group of Italian investigators [ 1 ] evaluated patients with pulmonary and intravascular congestion at admission, as well as repeatedly during hospitalization, for acute decompensated heart failure. Patients with a reduced ejection fraction ( n = 142) were compared to those with a preserved ejection fraction ( n = 172) using lung ultrasound and inferior vena cava ultrasound.…”

Section: Introductionmentioning

confidence: 99%

“…Primary outcomes included death or re-admission to the hospital for heart failure at 90 days. Cogliati et al [ 1 ] concluded that there was no significant difference in the primary outcome between the two groups. They further suggested that “other factors beyond ejection fraction could play a role in congestion/decongestion patterns”.…”

Section: Introductionmentioning

confidence: 99%

“…The results from both of these studies [ 1 , 3 ] may seem to defy logic. It may seem counter-intuitive to some that heart failure patients with a poor ejection fraction [ 1 ] have the same 90-day mortalities as those with preserved ejection fraction or that heart failure patients using medications known to improve hemodynamics and cardio-dynamics [ 3 ] do not experience a benefit in 90-day mortality following hospital discharge.…”

Section: Introductionmentioning

confidence: 99%

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Acute Heart Failure, 90-Day Mortality, and Gravitational Ischemia in the Brain

Jaster

Ottaviani

2022

Diagnostics

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During the 90 days following hospitalization for acute heart failure, the ejection fraction and type of discharge medications have been shown in clinical trials to have little effect on mortality. We examined the recent literature addressing brain-related etiologies of sudden death following heart failure. Two mechanisms of sudden unexpected death have been suggested to possibly result from four significant influences on pathophysiology in the brain. The two causes of sudden death are (1) severe cardiac arrhythmia and (2) neurogenic pulmonary edema. They are both mediated through the brainstem autonomic nuclei generally and executed specifically through the dorsal motor nucleus of the vagus nerve. The four significant influences on pathophysiology, all contributing to ischemia in the brainstem autonomic nuclei, are: (1) Hyper-stimulation of neurons in the solitary tract nucleus, increasing their metabolic requirements; (2) Inadequate blood flow at a vascular watershed terminus, perfusing the autonomic nuclei; (3) Additionally decreased blood flow, globally throughout the brain, following vasoconstriction related to relative hyperventilation and decreased pCO2 levels; (4) Gravitational ischemia in the brainstem caused by the weight of the cerebral hemispheres sitting above the brainstem. Changes in head tilt release gravitational ischemia in the brain. There is no specific head position relative to gravity that is considered favorable or unfavorable for an extended period of time, longer than 24 h. Even a small degree of head elevation, used in managing pulmonary congestion, may increase gravitational ischemia in the posterior fossa and brainstem. In this paper, we suggest a new and important research avenue for intervening in cardiac arrhythmias and preventing their occurrence through the non-invasive use of head-tilting and other head repositioning maneuvers. This could potentially help many geriatric patients with heart failure, who have decreased mobility in bed, and who tend to stay in one position longer, thereby increasing gravitational ischemia in the brain.

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Section: Introductionsupporting

confidence: 59%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Acute Heart Failure, 90-Day Mortality, and Gravitational Ischemia in the Brain

Jaster

Ottaviani

2022

Diagnostics

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PRecision Event Monitoring for PatienTs with Heart Failure using HeartLogic (PREEMPT‐HF) study design and enrolment

Boehmer,

Sauer,

Gardner

et al. 2023

ESC Heart Failure

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AimsThe HeartLogic multisensor index has been found to be a sensitive predictor of worsening heart failure (HF). However, there is limited data on this index's association and its constituent sensors with HF readmissions.Methods and resultsThe PREEMPT‐HF study is a global, multicentre, prospective, observational, single‐arm, post‐market study. HF patients with an implantable defibrillator device or cardiac resynchronization therapy with defibrillator with HeartLogic capabilities were eligible if sensor data collection was turned on and the HeartLogic feature was not enabled. Thus, the HeartLogic Index/alert and heart sounds sensor trends were unavailable via the LATITUDE remote monitoring system to clinicians (blinded). Evaluation of subject medical records at 6 months and a final in‐clinic visit at 12 months was required for collection of all‐cause hospitalizations and HF outpatient visits. The purpose of this study is exploratory, no formal hypothesis tests are planned, and no adjustment for multiple testing will be performed. A total of 2183 patients were enrolled at 103 sites between June 2018 and June 2020. A significant proportion of the patients were implanted with implantable defibrillator devices (39%) versus cardiac resynchronization therapy with defibrillator (61%); were female (27%); over 65 (61%); New York Heart Association class I (13%), II (53%), and III (33%); ejection fraction < 25% (21%); ischaemic (50%); and with a history of renal dysfunction (23%).ConclusionsThe PREEMPT study will provide clinical data and blinded sensor trends for the characterization of sensor changes with HF readmission, tachyarrhythmias, and event subgroups. These data may help to refine the clinical use of HeartLogic and to improve patient outcomes.

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