Veno-venous extra-corporeal membrane oxygenation in a COVID-19 patient with cold-agglutinin haemolytic anaemia: A case report.

Overview: The use of extra-corporeal membrane oxygenation (ECMO) therapy to treat severe COVID-19 patients with acute respiratory failure is increasing worldwide. We reported herein the use of veno-venous ECMO in a patient with cold agglutinin haemolytic anaemia (CAHA) who suffered from severe COVID-19 infection.

Description: A 64-year-old man presented to the emergency department (ED) with incremental complaints of dyspnoea and cough since one week.

Hyponatraemia in heart failure: time for new solutions?

Hyponatraemia is very common in heart failure (HF), especially in decompensated patients. It is associated with increased mortality and morbidity and considered a marker of advanced disease. Recognition of hyponatraemia and its causes may help guide treatment strategy.

Measures of Loop Diuretic Efficiency and Prognosis in Chronic Kidney Disease.

Background: The evolution and prognostic impact of loop diuretic efficiency according to chronic kidney disease (CKD) severity is unclear.

Methods: This retrospective cohort study includes 783 CKD patients on oral loop diuretic therapy with a 24-h urine collection available. Acute kidney injury and history of renal replacement therapy were exclusion criteria.

Impact of oral anticoagulation in patients with atrial fibrillation at very low thromboembolic risk.

Objective: To investigate reasons for and impact of oral anticoagulation (OAC) in patients with atrial fibrillation (AF) at very low thromboembolic risk.

Methods: Individuals with CHADS-VASc score 0 (men) or 1 (women) from the Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF) were studied. Baseline characteristics according to OAC use were evaluated by logistic regression analysis.

Utility of Urine Biomarkers and Electrolytes for the Management of Heart Failure.

Purpose Of Review: To provide insight into the role of urine biomarkers and electrolytes for the management of heart failure.

Recent Findings: The age-dependent decrease in glomerular filtration rate due to loss of functional nephrons occurs at a faster pace in heart failure, potentially exacerbated by episodes of acute kidney injury. Urine biomarkers have not convincingly demonstrated to improve detection of irreversible renal damage and predict long-term renal trajectories, compared with serial creatinine measurements.

Urinary Sodium Profiling in Chronic Heart Failure to Detect Development of Acute Decompensated Heart Failure.

Objectives: This study sought to determine the relationship between urinary sodium (U) concentration and the pathophysiologic interaction with the development of acute heart failure (AHF) hospitalization.

Background: No data are available on the longitudinal dynamics of U concentration in patients with chronic heart failure (HF), including its temporal relationship with AHF hospitalization.

Methods: Stable, chronic HF patients with either reduced or preserved ejection fraction were prospectively included to undergo prospective collection of morning spot U samples for 30 consecutive weeks.

Hyponatremia in Acute Heart Failure in Relation to Hematocrit Levels: Clinical Relevance and Prognostic Implication.

Background: Hyponatremia is the most common electrolyte abnormality found in hospitalized patients with acute heart failure (AHF) and is related to poor prognosis. This study sought to evaluate: (1) the different prognostic impact of dilutional versus depletional hyponatremia, evaluating short- and long-term outcome; (2) the relationship between both types of hyponatremia and intravenous furosemide dose, renal function changes, and persistent congestion at discharge.

Methods: This retrospective single-center study included 233 consecutive patients with a primary diagnosis of AHF.

Renal sodium avidity in heart failure: from pathophysiology to treatment strategies.

Increased neurohumoral stimulation resulting in excessive sodium avidity and extracellular volume overload are hallmark features of decompensated heart failure. Especially in case of concomitant renal dysfunction, the kidneys often fail to elicit effective natriuresis. While assessment of renal function is generally performed by measuring serum creatinine-a surrogate for glomerular filtration-, this only represents part of the nephron's function.

Optimizing CRT - Do We Need More Leads and Delivery Methods.

Cardiac resynchronization therapy (CRT) is an established therapeutic option in symptomatic heart failure with reduced ejection fraction and evidence of left ventricular (LV) conduction delay (QRS width ≥120 ms), especially when typical left bundle branch block is present. The rationale behind CRT is restoration of aberrant LV electrical activation. As there is considerable heterogeneity of the LV electrical activation pattern among CRT candidates, an individualized approach with targeting of the LV lead in the region of latest electrical activation while avoiding scar tissue may enhance CRT response.

Management of the cardiorenal syndrome in decompensated heart failure.

Background: The management of the cardiorenal syndrome (CRS) in decompensated heart failure (HF) is challenging, with high-quality evidence lacking.

Summary: The pathophysiology of CRS in decompensated HF is complex, with glomerular filtration rate (GFR) and urine output representing different aspects of kidney function. GFR depends on structural factors (number of functional nephrons and integrity of the glomerular membrane) versus hemodynamic alterations (volume status, renal perfusion, arterial blood pressure, central venous pressure or intra-abdominal pressure) and neurohumoral activation.

Prognostic value of glomerular filtration changes versus natriuretic response in decompensated heart failure with reduced ejection.

Background: Glomerular filtration rate (GFR) and natriuretic response to diuretics represent important treatment targets in acute decompensated heart failure (ADHF).

Methods And Results: Consecutive ADHF patients (n = 50) with ejection fraction ≤ 45% and clinical signs of volume overload received protocol-driven decongestive therapy. Serum creatinine (Cr), cystatin C (CysC), and β-trace protein (βTP) were measured on admission and three subsequent days of treatment.

Asymptomatic episodes of device-registered atrial tachyarrhythmia are not associated with worse cardiac resynchronization therapy response.

Aims: To assess the influence of device-registered episodes of atrial tachyarrhythmia (AT) on the response to cardiac resynchronization therapy (CRT).

Methods And Results: Consecutive CRT patients without history of atrial fibrillation (AF; n = 118) were followed prospectively. AT was defined as a device-registered episode of atrial rate >190 b.

New insights into combinational drug therapy to manage congestion in heart failure.

Congestion is the most important contributor to morbidity and mortality in heart failure. In patients without congestion, maintaining a neutral sodium balance is imperative to prevent evolving volume overload. Adequate use of neurohumoral blockers, in combination with dietary sodium restriction, is essential and may preclude the need for maintenance diuretic therapy.

Time from emerging heart failure symptoms to cardiac resynchronisation therapy: impact on clinical response.

Objective: To investigate whether time from onset of heart failure signs and/or symptoms (ie, progression to stage C/D heart failure) until implantation affects reverse remodelling and clinical outcome after cardiac resynchronisation therapy (CRT).

Design: Cohort study of consecutive CRT patients, implanted between 1 October 2008 and 30 April 2011.

Setting: Single tertiary care centre (Ziekenhuis Oost-Limburg, Genk, Belgium).