Adriana Acosta

Bio: Adriana Acosta is an academic researcher from Cardiovascular Institute of the South. The author has contributed to research in topics: Heart failure & Ejection fraction. The author has an hindex of 5, co-authored 11 publications receiving 74 citations.

Relation of left ventricular ejection fraction and functional capacity with metabolism and inflammation in chronic heart failure with reduced ejection fraction (from the MIMICA Study).

Abstract: Catabolism and inflammation play a role in the physiopathology of heart failure with reduced ejection fraction and are more pronounced in the advanced stages of the disease. Our aim was to demonstrate that in patients with stable heart failure with reduced ejection fraction adequately treated, a direct relation exists between functional impairment, as evaluated by left ventricular ejection fraction (LVEF) and the 6-minute walking distance (6MWD), and catabolic and inflammatory markers. In 151 outpatients with heart failure and a LVEF of ≤40% (median age 64 years, LVEF 29%, and 6MWD 290 m) we measured the laboratory and body composition parameters that indicate directly or indirectly inflammatory activation, anabolic-catabolic balance, and nutritional status. We performed an analysis stratified by quartiles of LVEF and 6MWD and linear regression analysis to explore our hypothesis. In the linear regression analysis, after adjusting for age, gender, and etiology, LVEF was not related to the metabolic, inflammatory, or nutritional parameters. The 6MWD was directly related to albumin (p = 0.002) and log transformation of dehydroepiandrosterone (p = 0.013) and inversely to adiponectin (p = 0.001) and the log-transformation of high-sensitivity C-reactive protein (p = 0.037). In conclusion, in a population with stable heart failure with reduced ejection fraction, the 6MWD was related to the degree of inflammatory activity and catabolism, but LVEF was not. Even a slightly diminished functional capacity implies underlying inflammation and catabolic activation.

High-sensitivity troponin is associated with high risk clinical profile and outcome in acute heart failure

Abstract: Background: The aim of the study was to evaluate the value of high-sensitivity cardiac troponin (hs-cTn) for identifying high-risk patients. Methods and results: One hundred and eighty-seven patients admitted with acute heart failure (HF) (without myocardial infarction) were consecutively included; hs-cTn was measured at admission; the relation between elevated hs-cTn and the clinical outcome during hospitalization and at 90 days was analyzed; 93% (n = 174) had hs-cTn above the maximal normal value (14 ng/L); median hs-cTn was 42 ng/L (IQR 24–81). Patients with ejection fraction (EF) ≤ 45% had higher hs-cTn values (p = 0.0004). Patients with low cardiac output syndrome (LCOS) or shock had higher troponin levels compared with those with less severe clinical presentations (p = 0.004). Patients who required inotropic presented higher troponin values (p = 0.002), troponin values were also higher in those requiring complex therapies (intra-aortic balloon pump, mechanical ventilation or hemodialysis, p = 0.002). At 90-day follow-up, 28 (15.5%) patients died and 27 rehospitalizations occurred (55 events). The risk of events was greater in patients with hs-cTn > 42 ng/L (0.021), low blood pressure at admission (p = 0.002), LCOS or shock (p < 0.0001), EF ≤ 45% (p = 0.005) and inotropic use (p < 0.0001). In multivariate analysis, only inotropic agents requirements was associated independently with a high risk of death or rehospitalizations at 90 days (p = 0.007). Conclusions: Elevation of hs-cTn is a finding almost constant in patients with decompensated HF. In subjects with higher troponin levels ventricular dysfunction is frequent. The use of hs-cTn for risk stratification at admission helps to identify populations with poor outcome during hospitalization and increased risk of death or rehospitalizations during follow-up who will require rapid implementation of aggressive treatment.

Low plasma triiodothyronine levels in heart failure are associated with a reduced anabolic state and membrane damage

Abstract: Fil: Brenta, Gabriela. Gobierno de la Ciudad de Buenos Aires. Hospital Cesar Milstein; Argentina

Atrial Fibrillation in Heart Failure Patients with Preserved or Reduced Ejection Fraction. Prognostic significance of Rhythm control strategy with Catheter Ablation.

Abstract: Introduction Atrial fibrillation (AF) and heart failure (HF) often coexist with an increase in morbidity and mortality. AF catheter ablation (CA) has proved to be a safe and efficient option for HF patients, but long-term evolution and prognosis remain uncertain. The aim is to assess the efficacy and safety of CA in HF patients with AF, and analyze HF long-term evolution. Methods We prospectively analyzed consecutive patients with AF and congestive HF or left ventricular ejection fraction (EF) less than 45%, who underwent CA of AF between 2011 and 2016. We excluded patients who did not complete one year of follow-up. Results Seventy-nine patients were included. Mean age was 62.1 years, 72.4% were men, 67.2% had hypertension and 8.6% were diabetics. Mean EF was 49%, left atrial area was 26.5 cm2 and mean CHA2DS2-VASc score was 2. 70.6% were on NYHA FC II-III.The recurrence rate of AF was 60%, and after a second CA the rate decreased to 27.8%. Only persistent AF prior to the procedure was identified as independent predictor of recurrence. There was a significant NYHA FC improvement in the sinus rhythm (SR) group vs those with recurrence (63.6% vs 36.4%; p=0.047). None of the patients in SR were hospitalized, whereas six with recurrence were hospitalized due to HF (0% vs. 18.2%; p = 0.07). The rate of complications was 9.1%. Conclusions Catheter ablation of atrial fibrillation in heart failure presents an adequate success rate, improving symptoms and reducing rehospitalizations due to heart failure.

Predictores ecocardiográficos de capacidad de ejercicio en pacientes con insuficiencia cardiaca sistólica. Valor de la insuficiencia mitral

Abstract: Resumen Introduccion y objetivos Pacientes con insuficiencia cardiaca y similar disfuncion sistolica del ventriculo izquierdo tienen diferente capacidad de ejercicio. El objetivo de este estudio es detectar predictores ecocardiograficos de capacidad de ejercicio en pacientes con insuficiencia cardiaca y disfuncion sistolica. Metodos Se incluyo a 150 pacientes con insuficiencia cardiaca en clase II (70%) o III (30%) con fraccion de eyeccion ventricular izquierda Resultados Se detecto insuficiencia mitral en 112 pacientes (75%), que fue significativa en 40 (27%). El grupo 1 evidencio mas insuficiencia mitral significativa (el 35 frente al 18%), area auricular izquierda (27 ± 1 frente a 24 ± 1 cm2), amplitud de E mitral (88 ± 5 frente a 72 ± 3 cm/s) y presion sistolica pulmonar (37 ± 1 frente a 32 ± 1 mmHg; todos p Conclusiones En pacientes con insuficiencia cardiaca en clase II-III y disfuncion sistolica ventricular izquierda, los principales predictores ecocardiograficos de capacidad de ejercicio se relacionan con la presencia de insuficiencia mitral significativa.

Heart failure is associated with depletion of core intestinal microbiota.

Abstract: Aims In spite of current medical treatment approaches, mortality of chronic heart failure (HF) remains high and novel treatment modalities are thus urgently needed. A recent theory proposes a possible impact of the intestinal microbiome on the incidence and clinical course of heart failure. This study sought to systematically investigate, if there are specific changes of the intestinal microbiome in heart failure patients. Methods and results The intestinal microbiome of 20 patients with heart failure with reduced ejection fraction due to ischemic or dilated cardiomyopathy was investigated by applying high-throughput sequencing of the bacterial 16S rRNA gene. Microbial profiles were compared to those of matched controls in which heart failure was ruled out by clinical assessment and NT-proBNP serum levels (n = 20). According to the Shannon diversity index (which measures the intra-individual alpha-diversity) based on the distribution of operational taxonomic units (OTUs), HF cases showed a nominally significantly lower diversity index compared to controls (Pnom. = 0.01), and testing for genera abundance showed a tendency towards a decreased alpha diversity of HF patients. Beta-diversity measures (inter-individual diversity) revealed a highly significant separation of HF cases and controls, (e.g. Pweighted UniFracv = 0.004). Assessing the individual abundance of core measurable microbiota (CMM), a significant decrease of Coriobacteriaceae, Erysipelotrichaceae and Ruminococcaceae was observed on the family level. In line with that, Blautia, Collinsella, uncl. Erysipelotrichaceae and uncl. Ruminococcaceae showed a significant decrease in HF cases compared to controls on the genus level. Conclusions Heart failure patients showed a significantly decreased diversity of the intestinal microbiome as well as a downregulation of key intestinal bacterial groups. Our data point to an altered intestinal microbiome as a potential player in the pathogenesis and progression of heart failure.