Coexistent chronic heart failure and iron deficiency is frequently encountered in clinical practice and affects prognosis. We investigated factors associated with serum growth differentiation factor (GDF)-15, iron deficiency and lower hemoglobin levels in patients with heart failure and healthy elderly individuals. Blood tests were performed on 90 patients with heart failure (aged 75.0 ± 10.7 years) and 73 healthy elderly individuals (aged 76.3 ± 6.4 years). Serum GDF-15, tumor necrosis factor (TNF) α, N-terminal pro-brain natriuretic peptide (NT-proBNP), and hepcidin concentrations were measured using enzyme-linked immunosorbent assay. Left atrial volume index (LAVI) was measured by echocardiography. Hemoglobin (Hb) in healthy elderly individuals correlated with serum iron and hepcidin. In contrast, Hb in patients with heart failure correlated with serum iron and GDF-15. Serum GDF-15 concentration in healthy elderly subjects correlated with estimated glomerular filtration rate, serum iron, and hepcidin. In contrast, in patients with heart failure, it correlated with NT-proBNP and TNFα. In patients with heart failure, serum iron correlated with LAVI. Lower hemoglobin levels in patients with heart failure might be associated with elevated serum GDF-15 due to higher serum NT-proBNP and inflammation, as well as iron deficiency. In contrast, lower hemoglobin levels in healthy elderly individuals might involve lower serum iron and hepcidin levels. Lower serum iron concentration was suggested to be involved in left atrial remodeling in patients with heart failure.
Among patients with cardiogenic shock receiving Impella-based mechanical circulatory support, pulmonary vascular load and right ventricular dysfunction may affect left ventricular preload and device flow. Prospective data on the acute hemodynamic effects of inhaled nitric oxide (iNO) in this setting are limited. We evaluated short-term hemodynamic changes after iNO initiation in patients receiving Impella or Impella combined with veno-arterial extracorporeal membrane oxygenation (ECPELLA) support. We conducted a prospective single-center pilot study of adult patients receiving Impella or ECPELLA support who were treated with iNO. iNO was initiated at 20 ppm after initial circulatory resuscitation once pulmonary artery pulse pressure could be reliably assessed. Hemodynamic variables were recorded immediately before iNO initiation (T0) and 30 min (T1) and 24 h (T2) after initiation. The primary endpoint was the change in mean pulmonary artery pressure (mPAP) from T0 to T1. We enrolled 11 patients, and 10 were analyzed. mPAP decreased from 19.0 (14.8–20.3) mmHg at T0 to 16.5 (12.8–19.3) mmHg at T1 (P = 0.004). The T0–T2 difference was not significant. Lactate levels decreased, but this temporal change could not be attributed directly to iNO without a control group. Methemoglobin levels increased slightly at T2 without clinical methemoglobinemia. iNO was temporally associated with an early reduction in mPAP in patients receiving Impella-based support, without clear improvement in systemic hemodynamic indices. These hypothesis-generating findings require confirmation in larger controlled studies.
Chronic kidney disease (CKD) is a well-established risk factor in acute myocardial infarction (AMI); however, the clinical relevance of admission estimated glomerular filtration rate (eGFR)-based categories remains unclear. We analyzed 10,870 patients from a prospective multicenter AMI registry in Japan. Patients were stratified into stages 1 (≥ 90), 2 (60–89), 3a (45–59), 3b (30–44), 4 (15–29), and 5 (< 15 mL/min/1.73 m2) based on the admission eGFR. The primary endpoint was 30-day major adverse cardiovascular events (MACE), defined as cardiovascular death, non-fatal myocardial infarction, or non-fatal stroke. Bleeding was defined as BARC type 3 or 5. More advanced admission eGFR stages were associated with a higher risk of adverse events. After multivariable adjustment, stages 4 and 5 were associated with a significantly higher risk of MACE compared with the reference group of stages 1 and 2 (stage 4: HR 2.12, 95
We aimed to investigate association of three DanGer Shock trial criteria [systolic blood pressure [SBP] < 100 mmHg, lactate ≥ 2.5 mmol/L, and left ventricular ejection fraction (LVEF) < 45
