Journal of Yeungnam Medical Science

Original article

Prognostic impact of chromogranin A in patients with acute heart failure: Hong Nyun Kim, Dong Heon Yang, Bo Eun Park, Yoon Jung Park, Hyeon Jeong Kim, Se Yong Jang, Myung Hwan Bae, Jang Hoon Lee, Hun Sik Park, Yongkeun Cho, Shung Chull Chae; Yeungnam Univ J Med. 2021;38(4):337-343. Published online July 8, 2021; DOI: https://doi.org/10.12701/yujm.2020.00843

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Background
Chromogranin A (CgA) levels have been reported to predict mortality in patients with heart failure. However, information on the prognostic value and clinical availability of CgA is limited. We compared the prognostic value of CgA to that of previously proven natriuretic peptide biomarkers in patients with acute heart failure.
Methods
We retrospectively evaluated 272 patients (mean age, 68.5±15.6 years; 62.9% male) who underwent CgA test in the acute stage of heart failure hospitalization between June 2017 and June 2018. The median follow-up period was 348 days. Prognosis was assessed using the composite events of 1-year death and heart failure hospitalization.
Results
In-hospital mortality rate during index admission was 7.0% (n=19). During the 1-year follow-up, a composite event rate was observed in 12.1% (n=33) of the patients. The areas under the receiver-operating characteristic curves for predicting 1-year adverse events were 0.737 and 0.697 for N-terminal pro-B-type natriuretic peptide (NT-proBNP) and CgA, respectively. During follow-up, patients with high CgA levels (>158 pmol/L) had worse outcomes than those with low CgA levels (≤158 pmol/L) (85.2% vs. 58.6%, p<0.001). When stratifying the patients into four subgroups based on CgA and NT-proBNP levels, patients with high NT-proBNP and high CgA had the worst outcome. CgA had an incremental prognostic value when added to the combination of NT-proBNP and clinically relevant risk factors.
Conclusion
The prognostic power of CgA was comparable to that of NT-proBNP in patients with acute heart failure. The combination of CgA and NT-proBNP can improve prognosis prediction in these patients.

Citations

Citations to this article as recorded by

The Role of Congestion Biomarkers in Heart Failure with Reduced Ejection Fraction
Michele Correale, Francesco Fioretti, Lucia Tricarico, Francesca Croella, Natale Daniele Brunetti, Riccardo M. Inciardi, Anna Vittoria Mattioli, Savina Nodari
Journal of Clinical Medicine.2023; 12(11): 3834. CrossRef
Novel Biomarkers of Renal Dysfunction and Congestion in Heart Failure
Agata Zdanowicz, Szymon Urban, Barbara Ponikowska, Gracjan Iwanek, Robert Zymliński, Piotr Ponikowski, Jan Biegus
Journal of Personalized Medicine.2022; 12(6): 898. CrossRef

Case reports

Safety and effectiveness of early cardiac rehabilitation in a stroke patient with heart failure and atrial fibrillation: a case report: Sang Cheol Lee, Eun Jae Ko, Ju Yeon Lee, Ae Lee Hong; Yeungnam Univ J Med. 2021;38(4):361-365. Published online March 22, 2021; DOI: https://doi.org/10.12701/yujm.2020.00885

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Abstract PDF: Stroke patients have reduced aerobic capacity. Therefore, intensive structured exercise programs are needed. We report the case of a patient with stroke and cardiac disease who underwent early inpatient cardiac rehabilitation (CR). A 38-year-old male patient with atrial fibrillation, heart failure, and cerebral infarction underwent a symptom-limited exercise tolerance test (ETT) without any problems on day 45 after admission. He completed a 2-week inpatient program and an 8-week home-based CR program. Follow-up ETT showed increased exercise capacity. The present case might be the first to report a safely performed CR program in a patient with stroke and cardiac comorbidity in Korea. Systematic guidance is needed for post-stroke patients to receive safe and effective CR for the secondary prevention of stroke and cardiovascular risk.

Fatal progressive right heart failure in a pancreatic cancer patient: Jeong Tae Byoun, Jae Young Cho; Yeungnam Univ J Med. 2020;37(2):122-127. Published online September 19, 2019; DOI: https://doi.org/10.12701/yujm.2019.00332

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Abstract PDF

Pulmonary tumor thrombotic microangiopathy (PTTM) is a rare but fatal complication of cancer and causes pulmonary hypertension and acute/subacute right heart failure. PTTM is most commonly associated with gastric cancer and more rarely associated with pancreatic cancer. We report a case of progressive right heart failure associated with clinically diagnosed pancreatic cancer, suggesting PTTM.

Citations

Citations to this article as recorded by

A rare, life-threatening debut of pancreatic adenocarcinoma: Pulmonary tumor thrombotic microangiopathy
Pablo Jiménez-Labaig, Soledad Fernández Solé, Susana Gómez Varela, Jorge García Calvo, Sergio Carrera Revilla, Alberto Muñoz Llarena
Current Problems in Cancer: Case Reports.2023; 10: 100238. CrossRef
Evidence of sex differences in cancer‐related cardiac complications in mouse models of pancreatic and liver cancer
Anna Gams, Alejandro Nevarez, Stephanie Perkail, Aileen Venegas, Sharon A. George, Tatiana Efimova, Igor R. Efimov
Physiological Reports.2023;[Epub] CrossRef
Prospective of Pancreatic Cancer Diagnosis Using Cardiac Sensing
Mansunderbir Singh, Priyanka Anvekar, Bhavana Baraskar, Namratha Pallipamu, Srikanth Gadam, Akhila Sai Sree Cherukuri, Devanshi N. Damani, Kanchan Kulkarni, Shivaram P. Arunachalam
Journal of Imaging.2023; 9(8): 149. CrossRef
Fatal pulmonary tumour thrombotic microangiopathy in patient with ovarian adenocarcinoma: review and a case report
Gintare Neverauskaite-Piliponiene, Kristijonas Cesas, Darius Pranys, Skaidrius Miliauskas, Lina Padervinskiene, Jolanta Laukaitiene, Giedre Baksyte, Gintare Sakalyte, Egle Ereminiene
BMC Cardiovascular Disorders.2022;[Epub] CrossRef

Case Reports

Acute decompensated heart failure and acute kidney injury due to bilateral renal artery stenosis.: Ho Jin Jung, Won Suk Choi, Hyun Jae Kang, Byung Chun Jung, Bong Ryeol Lee, Jong Joo Lee, Jun Young Lee; Yeungnam Univ J Med. 2015;32(2):146-151. Published online December 31, 2015; DOI: https://doi.org/10.12701/yujm.2015.32.2.146

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Abstract PDF: Atherosclerotic renal artery stenosis (RAS) may result in hypertension, azotemia, and acute pulmonary edema. We report on a renal angioplasty with stent placement for bilateral RAS in a patient with acute decompensated heart failure and acute kidney injury. A 67-year-old female patient was admitted to our hospital with acute shortness of breath and generalized edema. Echocardiography showed left ventricular wall motion abnormality and the follow up electrocardiography showed T wave inversion in the precordial leads. We performed a coronary angiography to differentiate ischemic heart disease from non-cardiac origin for the cause of the heart failure. The coronary angiography showed no significant luminal narrowing, but bilateral RAS was confirmed on the renal artery angiography, therefore, we performed renal artery revascularization. After the procedure, the pulmonary edema was improved and the serum creatinine was decreased. Two weeks later, an echocardiography showed improvement of the left ventricular systolic function.

Successful emergency transcatheter aortic valve implantation.: Jung Hee Lee, Ah Young Ji, Young Ju Kim, Changho Song, Moo Nyun Jin, Sun Wook Kim, Myeong Ki Hong, Geu Ru Hong; Yeungnam Univ J Med. 2014;31(2):144-147. Published online December 31, 2014; DOI: https://doi.org/10.12701/yujm.2014.31.2.144

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Abstract PDF: Despite the necessity of surgical aortic valve replacement, many patients with symptomatic severe aortic stenosis (AS) cannot undergo surgery because of their severe comorbidities. In these high-risk patients, percutaneous transcatheter aortic valve implantation (TAVI) can be safely accomplished. However, no study has shown that TAVI can be performed for patients with severe AS accompanied by acute decompensated heart failure. In this case report, 1 patient presented a case of severe pulmonary hypertension with decompensated heart failure after diagnosis with severe AS, and was successfully treated via emergency TAVI. Without any invasive treatment, acute decompensated heart failure with severe pulmonary hypertension is common in patients with severe AS, and it can increase mortality rates. In conclusion, TAVI can be considered one of the treatment options for severe as presented as acute decompensated heart failure patients with pulmonary hypertension.

Cardiovascular beriberi: rare cause of reversible pulmonary hypertension.: Joon Hyuk Song, Sang Soo Cheon, Myung Hwan Bae, Jang Hoon Lee, Dong Heon Yang, Hun Sik Park, Yongkeun Cho, Shung Chull Chae; Yeungnam Univ J Med. 2014;31(1):38-42. Published online June 30, 2014; DOI: https://doi.org/10.12701/yujm.2014.31.1.38

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Abstract PDF

Cardiovascular beriberi is caused by thiamine deficiency and usually presents as high cardiac output failure associated with predominantly right-sided heart failure and rapid recovery after treatment with thiamine. Because of its rarity in developed countries, the diagnosis can often be delayed and missed. We recently experienced a case of cardiovascular beriberi with pulmonary hypertension which successfully treated with thiamine infusion. A 50-year-old man with chronic heavy alcoholics was refered to our department for dyspnea with mental change. Echocardiography showed marked right ventricular (RV) dilatation and flattening of the interventricular septum with a D-shaped deformation of the left ventricle. Moderate tricuspid valve regurgitation was found and estimated RV systolic pressure was 52 mm Hg. Because of his confused mentality and history of chronic alcohol intake, neurological disorder due to thiamine deficiency was suspected and intravenous thiamine was administered and he continuously received a daily dose of 100 mg of thiamine. Follow up echocardiography showed marked reduction of RV dilatation and improvement of a D-shaped deformation of the left ventricle. He finally diagnosed as cardiovascular beriberi on the basis of dramatic response to intravenous thiamine. Thiamine deficiency can cause reversible pulmonary hypertension, and can still be encountered in the clinical setting. Thus high index of suspicion is critically needed for diagnosis.

Citations

Citations to this article as recorded by

Beriberi: A Reversible Cause of Acute Severe Pulmonary Hypertension
Mei L Tan, Christopher G Willis
Cureus.2022;[Epub] CrossRef
Mechanical ventilation-associated pneumothorax presenting with paroxysmal supraventricular tachycardia in patients with acute respiratory failure
Jeong Ho Eom, Myung Goo Lee, Chang Youl Lee, Kyong Min Kwak, Won Jae Shin, Jung Wook Lee, Seong Hoon Kim, Sang Hyeon Choi, So Young Park
Yeungnam University Journal of Medicine.2015; 32(2): 106. CrossRef

Anesthetic Induction in a Sitting Position for a Patient with Congestive Heart Failure.: Seung Dong Kim, Gul Jung, Dae Lim Jee; Yeungnam Univ J Med. 2008;25(2):150-153. Published online December 31, 2008; DOI: https://doi.org/10.12701/yujm.2008.25.2.150

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Abstract PDF: A 67-year-old woman with severe congestive heart failure (New York Heart Association, NYHA class IV) was set to receive general anesthesia for cardiac surgery. For several months, she had been in a constant sitting position from which the slightest change evoked dyspnea. A patient in such a condition is rarely considered a candidate for general anesthesia, because such patients are never eligible for any type of surgery other than that used to fix the heart problem itself. We report this case to explain how anesthesia was induced with the patient sitting in a crouching position and discuss other methods of induction that can probably be used in similar situations.

Review

Cardiac Resynchronization Therapy.: Hyong Jun Kim, Dong Gu Shin; Yeungnam Univ J Med. 2005;22(2):131-140. Published online December 31, 2005; DOI: https://doi.org/10.12701/yujm.2005.22.2.131

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Abstract PDF: Heart failure is a clinical syndrome comprised of a number of symptoms and signs associated with congestion and/or hypoperfusion. Specific pharmacologic therapies have been developed to slow disease progression from early to more advanced stages. Once symptoms have developed, aggressive multimodality interventions are instituted to alleviate symptoms and improve clinical status and quality of life; especially in those patients that present symptoms. Recently, an evolving adjunctive therapeutic modality, that involves using implanted electrical devices: cardiac resynchronization with or without implantable cardioverter defibrillators (ICD). has been used for management. Cardiac resynchronization therapy (CRT) is a proven treatment for selected patients with heart failure-induced conduction disturbances and ventricular dyssynchrony. When used in combination with stable, optimal medical therapy, CRT is designed to reduce symptoms and improve cardiac function by restoring the mechanical sequence of ventricular activation and contraction. This review summarizes the rationale, procedure, clinical trials, and clinical indications for CRT.

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