المؤلفون: Cao, Yulei, Zhang, Robert S., Chen, Jessica H., Acker, Andrew M., Chellappa, Deepa K., Heyward, Quetrell D., Janssen, Matthew, McCauley, Brian D., Levine, Lisa D., Musunuru, Kiran

المصدر: Journal of Cardiac Failure; 2022 Supplement, Vol. 28 Issue 5, pS129-S129, 1p

مستخلص: Molar pregnancies are associated with increased maternal complications, notably hyperemesis gravidarum, pre-eclampsia, or development of gestational trophoblastic neoplasia, but rarely cardiomyopathy. We present a case of a partial molar pregnancy complicated by new-onset heart failure. A 38-year-old female G9P7017 patient at 17 weeks gestation with an unremarkable past medical history presented to the emergency department with worsening dyspnea, orthopnea, peripheral edema, and a 20-pound weight gain. Initial vital signs were notable for sinus tachycardia with a heart rate of 120 beats/min and a blood pressure of 131/94 mmHg. Her BNP was >35,000 pg/mL, with an initial troponin of 0.08 ng/mL peaking at 0.092 ng/mL. TSH was 0.07 uIU/mL, and free T4 was 0.95 ng/dL. ECG showed no acute ischemic changes. Transthoracic echocardiography (TTE) showed a dilated cardiomyopathy with global hypokinesis and a newly reduced left ventricular ejection fraction (LVEF) of 21%. Right heart catheterization showed CVP 9, PCWP 29, and CI 2.33. Pelvic ultrasonography demonstrated omphalocele, intracranial abnormalities, and placentomegaly with beta-hCG >1,000,000 mIU/mL, consistent with a partial molar pregnancy. Multidisciplinary teams from maternal fetal medicine, general cardiology, and heart failure collaborated to provide care for this patient. The mechanism by which her molar pregnancy led to her cardiomyopathy is unclear, but it was believed that continuation of the pregnancy could lead to worsening or persistent heart failure. She underwent successful dilation and evacuation and products of conception confirmed a partial mole with karyotype of 69 XXX. She was ultimately discharged on neurohormonal blockade. TTE three months post discharge demonstrated an improved LVEF of 40%. Her beta-hCG level downtrended appropriately to 9 mIU/mL at the most recent follow-up. Partial molar pregnancy can be a rare but important cause of heart failure during pregnancy. Removal of the molar pregnancy and initiating neurohormonal blockade can lead to myocardial recovery. The mechanism by which molar pregnancy leads to cardiomyopathy is unclear, warranting additional research. [ABSTRACT FROM AUTHOR]

: Copyright of Journal of Cardiac Failure is the property of W B Saunders and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

المؤلفون: BRISCO, MEREDITH A., MCCAULEY, BRIAN D., CHEN, JENNIFER, PARIKH, CHIRAG R., TESTANI, JEFFREY M.

المصدر: Journal of Cardiac Failure; Nov2013, Vol. 19 Issue 11, p739-745, 7p

مستخلص: Background: Differentiation of HF-induced renal dysfunction (RD) from irreversible intrinsic kidney disease is challenging, likely related to the multifactorial pathophysiology underlying HF-induced RD. In contrast, HF-induced liver dysfunction results in characteristic laboratory abnormalities. Given that similar pathophysiologic factors are thought to underlie both conditions, and that the liver and kidneys share a common circulatory environment, patients with laboratory evidence of HF-induced liver dysfunction may also have a high incidence of potentially reversible HF-induced RD. Methods and Results: Hospitalized patients with a discharge diagnosis of HF were reviewed (n = 823). Improvement in renal function (IRF) was denned as a 20% improvement in estimated glomerular filtration rate (eGFR). An elevated international normalized ratio (INR; odds ratio [OR] 2.8; P < .001), bilirubin (BIL; OR 2.2; P < .001), aspartate aminotransferase (AST; OR 1.8; P = .004), and alanine aminotransferase (ALT; OR 2.1; P = .001) were all significantly associated with IRF. Among patients with baseline RD (eGFR ≤45 mL min^-1 1.73 m^-2), associations between liver dysfunction and IRF were particularly strong (INR: OR 5.7 [P < .001]; BIL: OR 5.1 [P < .001]; AST: OR 2.9 [P = .005]; ALT: OR 4.8 [P < .001]). Conclusions: Biochemical evidence of mild liver dysfunction is associated with reversible RD in decompensated HF patients. In the absence of methodology to directly identify HF-induced RD, signs of HF-induced dysfunction of other organs may serve as an accessible method by which HF-induced RD is recognized. [ABSTRACT FROM AUTHOR]

: Copyright of Journal of Cardiac Failure is the property of W B Saunders and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

المؤلفون: Testani, Jeffrey M., McCauley, Brian D., Chen, Jennifer, Coca, Steven G., Cappola, Thomas P., Kimmel, Stephen E.

المصدر: Journal of Cardiac Failure; Dec2011, Vol. 17 Issue 12, p993-1000, 8p

مستخلص: Abstract: Background: In the setting of acute decompensated heart failure, worsening renal function (WRF) and improved renal function (IRF) have been associated with similar hemodynamic derangements and poor prognosis. Our aim was to further characterize IRF and its associated mortality risk. Methods and Results: Consecutive patients with a discharge diagnosis of congestive heart failure at the Hospital of the University of Pennsylvania were reviewed. IRF was defined as a ≥20% improvement and WRF as a ≥20% deterioration in glomerular filtration rate. Overall, 903 patients met the eligibility criteria, with 31.4% experiencing IRF. Baseline venous congestion/right-side cardiac dysfunction was more common (P ≤ .04) and volume of diuresis (P = .003) was greater in patients with IRF. IRF was associated with a greater incidence of preadmission (odds ratio [OR] 4.2, 95% confidence interval [CI] 2.6–6.7; P < .0001) and postdischarge (OR 1.8, 95% CI 1.2–2.7; P = .006) WRF. IRF was associated with increased mortality (adjusted hazard ratio 1.3, 95% CI, 1.1–1.7; P = .011), a finding largely restricted to patients with postdischarge recurrence of renal dysfunction (P interaction = .038). Conclusions: IRF is associated with significantly worsened survival and may represent the resolution of venous congestion–induced preadmission WRF. Unlike WRF, the renal dysfunction in IRF patients occurs independently from the confounding effects of acute decongestion and may provide incremental information for the study of cardiorenal interactions. [Copyright &y& Elsevier]

: Copyright of Journal of Cardiac Failure is the property of W B Saunders and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

المؤلفون: Testani, Jeffrey M., Cappola, Thomas P., McCauley, Brian D., Chen, Jennifer, Shen, James, Shannon, Richard P., Kimmel, Stephen E.

المصدر: American Heart Journal; May2011, Vol. 161 Issue 5, p944-949, 6p

مستخلص: Background: Worsening renal function (WRF) commonly complicates the treatment of acute decompensated heart failure. Despite considerable investigation in this area, it remains unclear to what degree WRF is a reflection of treatment- versus patient-related factors. We hypothesized that if WRF is significantly influenced by factors intrinsic to the patient, then WRF during an index hospitalization should predict WRF during subsequent hospitalization. Methods: Consecutive admissions to the Hospital of the University of Pennsylvania with a discharge diagnosis of congestive heart failure were reviewed. Patients with >1 hospitalization were retained for analysis. Results: In total, 181 hospitalization pairs met the inclusion criteria. Baseline patient characteristics demonstrated significant correlation between hospitalizations (P ≤ .002 for all) but minimal association with WRF. In contrast, variables related to the aggressiveness of diuresis were weakly correlated between hospitalizations but significantly associated with WRF (P ≤ .024 for all). Consistent with the primary hypothesis, WRF during the index hospitalization was strongly associated with WRF during subsequent hospitalization (odds ratio [OR] 2.7, P = .003). This association was minimally altered after controlling for traditional baseline characteristics (OR 2.5, P = .006) and in-hospital treatment–related parameters (OR 2.8, P = .005). Conclusions: A prior history of WRF is strongly associated with subsequent episodes of WRF, independent of in-hospital treatment received. These results suggest that baseline factors intrinsic to the patient''s cardiorenal pathophysiology have substantial influence on the subsequent development of WRF. [Copyright &y& Elsevier]

: Copyright of American Heart Journal is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

المؤلفون: Testani, Jeffrey M., McCauley, Brian D., Chen, Jennifer, Coca, Steven G., Cappola, Thomas P., Kimmel, Stephen E.

المصدر: Journal of Cardiac Failure; Aug2011 Supplement, Vol. 17 Issue 8, pS98-S98, 1p

المؤلفون: Testani, Jeffrey M., Chen, Jennifer, McCauley, Brian D., Kimmel, Stephen E., Shannon, Richard P.

المصدر: Journal of Cardiac Failure; Aug2010 Supplement, Vol. 16 Issue 8, pS104-S104, 1p

المؤلفون: Testani, Jeffrey M., McCauley, Brian D., Chen, Jennifer, Kimmel, Stephen E., Shannon, Richard P.

المصدر: Journal of Cardiac Failure; Aug2010 Supplement, Vol. 16 Issue 8, pS88-S88, 1p