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Objective: To compare Middle East Arabs and Indian subcontinent acute heart failure (AHF) patients., Methods: AHF patients admitted from February 14, 2012 to November 14, 2012 in 47 hospitals among 7 Middle East countries., Results: The Middle Eastern Arab group (4157) was older (60 vs. 54 years), with high prevalence of coronary artery disease (48% vs. 37%), valvular heart disease (14% vs. 7%), atrial fibrillation (12% vs. 7%), and khat chewing (21% vs. 1%). Indian subcontinent patients (382) were more likely to be smokers (36% vs. 21%), alcohol consumers (11% vs. 2%), diabetic (56% vs. 49%) with high prevalence of AHF with reduced ejection fraction (76% vs. 65%), and with acute coronary syndrome (46% vs. 26%). In-hospital mortality was 6.5% with no difference, but 3-month and 12-month mortalities were significantly high among Middle East Arabs, (13.7% vs. 7.6%) and (22.8% vs. 17.1%), respectively., Conclusions: AHF patients from this region are a decade younger than Western patients with high prevalence of ischemic heart disease, diabetes mellitus, and AHF with reduced ejection fraction. There is an urgent need to control risk factors among both groups, as well as the need for setting up heart failure clinics for better postdischarge management., (Copyright © 2015 Cardiological Society of India. Published by Elsevier B.V. All rights reserved.)

Background: Heart failure (HF) is a prevalent condition in our society, frequently accompanied by various interacting comorbidities. Among these, brain-related comorbidities such as stroke and transient ischemic attack (TIA) play a crucial role in exacerbating the severity of HF. The relationship between cerebrovascular accidents (CVAs) and HF across different left ventricular ejection fraction (LVEF) levels is not well understood. Objectives: This study aims to assess the impact of CVA including stroke and TIA on mortality and morbidity in patients with acute heart failure (AHF) stratified by LVEF. Methods: We conducted an analysis of consecutive patients admitted to 47 hospitals in seven Middle Eastern countries (Saudi Arabia, Oman, Yemen, Kuwait, United Arab Emirates, Qatar, and Bahrain) with AHF from February to November 2012 with AHF who were enrolled in a multinational registry of patients with HF. The study population consisted of patients with CVA and AHF, categorized into three groups based on EF: HF patients with preserved EF (HFpEF) (250%), HF patients with reduced EF (HFrEF) (<40%), and HF patients with mid-range EF (HFmrEF) (40%-49%). Univariate and multivariate statistical techniques were employed for the analysis. Results: Our study involved 370 patients, averaging 66.4 ± 13.2 years. In-hospital mortality for CVA and AHF patients was 8.4% (n = 31). Patients in different ranges of LVEF experienced comparable rates of hospitalization and mortality at both the 3-month and 12-month intervals. Left atrial enlargement (odd ratio [OR]: 3.27, 95% confidence interval [CI]: 1.33-9.32, P = 0.015) and noninvasive ventilation (OR: 6.17, 95% CI: 2.71-14.07, P < 0.001) were associated with a higher mortality rate while discharging on digoxin (OR: 0.14, 95% CI: 0.02-0.52, P = 0.011) was linked to lower mortality. The sole distinction among HF groups was observed in 12-month survival, with HFpEF patients having a superior survival rate of 91.7% compared to HFIEF patients at 77.5% and HFmrEF at 77.8% during this perio Conclusions: This study found significant differences in all-cause mortality at 12 months. Further research is warranted to better understand the mechanisms underlying these associations. [ABSTRACT FROM AUTHOR]

Background: Clinical characteristics and outcomes in patients with type 2 diabetes mellitus (T2DM) and acute heart failure (AHF) patients with idiopathic cardiomyopathy are not well known. Objective: The objective of our study is to determine all-cause mortality in patients with idiopathic cardiomyopathy presenting with AHF. Methods: We analyzed the data from 509 consecutive patients with idiopathic cardiomyopathy presenting with AHF to 47 hospitals in seven Middle Eastern countries (Saudi Arabia, Oman, Yemen, Kuwait, United Arab Emirates, Qatar, and Bahrain) between February and November 2012. All patients were stratified according to T2DM. The analyses were performed using the univariate and multivariate statistical techniques. Results: The mean age of the cohort was 52.0 ± 14.8 years. Of the 509 patients, 123 (24.2%) had T2DM and had a higher incidence of major stroke than the nondiabetic group (11.4% vs. 2.8%; P = 0.001). Diabetic patients were also more likely to be associated with hypertension than those without diabetes mellitus (78.9% vs. 21.8%; P < 0.001). Multivariate logistic regression demonstrated that those with cardiogenic shock (adjusted odds ratio [aOR], 59.3; 95% confidence interval [CI]: 20.1-207; P = 0.001) and noninvasive ventilation (NIV) (aOR: 4.19; 95% CI: 1.33-13.1; P = 0.013) were associated with higher odds of all-cause in-hospital mortality. However, age (aOR: 1.00; 95% CI: 0.96-1.03; P = 0.792), T2DM status (aOR: 0.43; 95% CI: 0.10-1.51; P = 0.207), and atrial fibrillation (aOR: 3.95; 95% CI: 0.82-17.2; P = 0.07) were not associated with higher odds of all-cause inhospital mortality. Conclusions: In AHF patients with idiopathic cardiomyopathy, T2DM was not associated with higher odds of all-cause inhospital mortality. Patients on NIV and cardiogenic shock were demonstrated as the independent predictors of increased inhospital mortality. [ABSTRACT FROM AUTHOR]

Background: Patients undergoing TAVR constitute a high-risk population given their comorbidities and out-of-hospital mortality rates remain high despite significant improvements in the overall procedural outcomes. Objectives: The objective of this study was to determine the early and late mortality rates following transfemoral transcatheter aortic valve replacement (TAVR) and identify the risk factors for poor outcomes. Methods: This study population examined patients extracted from 43 publicly funded hospitals in Hong Kong between 2010 and 2019. The study constitutes retrospective analysis of mortality outcomes for severe aortic stenosis patients undergoing TAVR. The primary end points include out-of-hospital 30-day, 1-year, 1-2-year, and 2-5-year mortality rates. Results: A total of 448 patients underwent TAVR and were included into the study. The rates of mortality following TAVR were 1.7%, 3.3%, 1.3%, and 0.22% at 30 days, 1, 1-2, and 2-5 years, respectively. Age and chronic renal failure (CRF) were concluded to be associated with postprocedural mortality. Further analysis of the baseline echocardiographic parameters revealed a higher prevalence of right atrial enlargement (RAE) and tricuspid and pulmonary regurgitation in the deceased subgroup. Conclusion: We report the 30-day, 1-, 1-2-, and 2-5-year all-cause mortality for TAVR of 1.7%, 3.3%, 1.3%, and 0.22% at 30 days. Factors associated with a higher prevalence of mortality include age, CRF, RAE, and tricuspid and pulmonary regurgitation. [ABSTRACT FROM AUTHOR]

Background: Systemic congestion is the leading pathophysiological mechanism of decompensated heart failure (HF), and hospitalization and poor prognosis. Unfortunately, patients are discharged with residual congestion, possibly due to the lack of a clear strategy for its assessment. The existing criteria for discharge of patients from the hospital are more often based on a subjective assessment and poorly correlate with the state of hemodynamic stabilization, and the search for methods for detecting congestion remains relevant. Objective: The objective is to determine the prognostic value of an integrated assessment of congestion based on novel diagnostic methods in patients hospitalized with acute decompensated chronic HF (ADCHF). Methods: Single-center prospective study in 171 patients hospitalized with ADCHF. All patients underwent physical examination, paraclinical (laboratory and instrumental) investigations-N-terminal pro-brain natriuretic peptide (NT-proBNP) level, lung ultrasound, transient elastography (TE), bioimpedance vector analysis (BIVA) on admission and discharge. Clinical congestion was assessed in accordance with the HF Association consensus document. Clinical outcomes were assessed by structured telephone survey 1, 3, 6, 12 months after discharge. Combined rates of all-cause mortality and re-admissions were used as the study endpoint. Results: Patients hospitalized with ADCHF had the following congestion status at discharge as assessed by individual methods (TE, lung ultrasound, BIVA and NT-proBNP): The incidence of clinical residual Congestion I ranged 33%-39%, the incidence of subclinical congestion was 12%-24%, and patients with euvolemia accounted for 19%-32%. According to the integral assessment of hydration status, the incidences of clinical residual Congestion I, subclinical congestion, and euvolemia were 57%, 31% and 12%, respectively. The study has demonstrated a significant worsening of all congestion parameters with increasing number of methods (1-4) that had detected congestion. Patients with congestion detected at discharge by 2, 3, or 4 methods were at a significantly higher risk of all-cause mortality or readmission. TE + NT-proBNP had a higher prognostic value in regard to the risk of endpoint event, while the combination of all four methods was the most predictive. Conclusions: Patients hospitalized with ADCHF should undergo an integral assessment of residual and subclinical congestion at discharge. The introduction of integral congestion assessment into the routine practice will help identify patients with less favorable prognosis in terms of the risk of death and re-admission, as well as to enhance pharmacologic therapy and follow-up. [ABSTRACT FROM AUTHOR]

Background: Clinical outcomes after transcatheter aortic valve implantation (TAVI) patients have not been reported in the Gulf region. Objectives: To define the baseline electrocardiographic (ECG), echocardiographic, and computed tomographic findings of patients undergoing TAVI and analyze the predictors of developing new-onset persistent left bundle branch block (LBBB). Methods: Patients with severe aortic stenosis who underwent TAVI between 2013 and 2021 at the Sabah Al-Ahmed Cardiac Centre in Al-Amiri Hospital in the state of Kuwait were included in this study. Baseline characteristics, electrocardiography (ECG), echocardiography, and preprocedural computed tomography data were extracted. The primary outcome was new-onset LBBB. Results: A total of 61 patients were included (65.6% females; mean age: 73.5 ± 9 years; baseline ejection fraction: 55.5% ± 9.7%). Of these, 18 developed new-onset LBBB. Those who developed LBBB tended to have lower ejection fraction (52.5 ± 9.6 vs. 56.8% ± 9.5%; P = 0.116). Those who developed LBBB were more likely to develop 1st degree atrioventricular block post-TAVI (P = 0.001). Conclusion: The incidence of new-onset LBBB post-TAVI was 29.5%. The new-onset LBBB group was more likely to develop conduction abnormalities requiring permanent pacemaker implantation. [ABSTRACT FROM AUTHOR]

Shock index (SI) has a prognostic role in coronary heart disease; however, data on acute heart failure (AHF) are lacking. We evaluated the predictive values of SI in patients with AHF. Data were retrospectively analyzed from the Gulf Acute Heart Failure Registry. Patients were categorized into low SI versus high SI based on the receiver operating characteristic curves. Primary outcomes included cardiogenic shock (CS) and mortality. Among 4818 patients with AHF, 1143 had an SI ≥0.9. Compared with SI <0.9, patients with high SI were more likely males, younger, and having advanced New York Heart Association class, fewer cardiovascular risk factors and less prehospital β-blockers and angiotensin-converting enzyme inhibitor use. Shock index had significant negative correlations with age, pulse pressure, mean arterial pressure, and left ventricle ejection fraction and had positive correlation with hospital length of stay. Shock index ≥0.9 was significantly associated with higher composite end points, in-hospital, and 3-month mortality. Shock index ≥0.9 had 96% negative predictive value (NPV) and 3.5 relative risk for mortality. Multivariate regression analysis showed that SI was independent predictor of mortality and CS. With a high NPV, SI is a simple reliable bedside tool for risk stratification of patients with AHF. However, this conclusion needs further support. [ABSTRACT FROM AUTHOR]

Objectives: Initial reports indicate a high incidence of abnormal aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels in patients with COVID-19 and possible association with acute kidney injury (AKI). We aimed to investigate clinical features of elevated transaminases on admission, its association with AKI, and outcomes in patients with COVID-19. Methods: A retrospective analysis of the registered data of hospitalized patients with laboratory-confirmed COVID-19 and assessment of the AST and ALT was performed. Multinomial logistic regression was used to determine factors associated with community-acquired AKI (CA-AKI) and hospital-acquired AKI (HA-AKI). Results: The subjects comprised 828 patients (mean age = 65.0±16.0 years; 51.4% male). Hypertension was present in 70.3% of patients, diabetes mellitus in 26.0%, and chronic kidney disease in 8.5%. In-hospital mortality was 21.0%. At admission, only 41.5% of patients had hypertransaminasemia. Patients with elevated transaminases at admission were younger, had higher levels of inflammatory markers and D-dimer, and poorer outcomes. The AKI incidence in the study population was 27.1%. Patients with hypertransaminasemia were more likely to develop AKI (33.5% vs. 23.3%, p = 0.003). Patients with predominantly elevated AST (compared to elevated ALT) were more likely to have adverse outcomes. Multinomial logistic regression found that hypertension, chronic kidney disease, elevated AST, and hematuria were associated with CA-AKI. Meanwhile, age > 65 years, hypertension, malignancy, elevated AST, and hematuria were predictors of HA-AKI. Conclusions: Elevated transaminases on admission were associated with AKI and poor outcomes. Patients with elevated AST were more likely to have adverse outcomes. Elevated AST on admission was associated with CA-AKI and was a predictor of HA-AKI. [ABSTRACT FROM AUTHOR]