Research Article
Open Access

Better Clinical Outcome For Rehospitalization Heart Failure Patients With Reduced Left Ventricular Function in Mode of Sudden Cardiac Death

Hassah Batool Iftikhar*, Jiang Hong

Department of Cardiology, Renmin Hospital of Wuhan University, 430060, Wuhan, Hubei
Province, PR China

*Corresponding Author: Hassah Batool Iftikhar, Department of Cardiology, Renmin Hospital of Wuhan University, 430060, Wuhan, Hubei Province, PR China, E-mail: hassabatool@yahoo.com
 
Received: 25 April 2018; Accepted: 27 April 2018; Published: 30 April 2018


Abstract:

Aim: The determined stage of ischemia and unknown HF in critical CVD events well-defined the higher incidence of SCD risk factors in the long-term modes of responsiveness with reduced LVEF if the idiopathic fibrillation lacking is not treated with counseling of LV remodeling in the association of rehospitalization survival rates.

Methods and results: The acute study in the time-dependent logistic evaluation of randomized decompensate HF characteristic reduce the all-cause mortality within each consecutive 180 days. Among 3000 patients of combined study on Kaplan-Meier event rates of 6.1 SCD alive [95% Confidence Interval 4.8- 8.5] and 3.2 SCD death [95% Confidence Interval 2.5 – 4.4] account 20% of SCD with hazard ratio 4.8 (2.6- 8.7). In the multivariable model of rate and rhythm control of 6-12 months per year highly affected the NYHA class II-IV 70- 78% with the P value <0.001 on wider QRS complex adjustments in overall (n= 2,427) responding to LVESV and LVEDV median to the follow-up of 85% females predicted improvement by LV reverse remodeling.

Conclusion: The identified relative risk in the comparison of controlling and preventions make the proportion of VT/VF death cause noted every 30 days denying the significance of obvious beneficial proof when implantation alternatively select LV remodeling in standard parameters.


Keywords:

Heart failure; Ventricular fibrillation; SCD; medical therapy; ICD; Cardiac resynchronization therapy

1. Introduction
Sudden death in 100,000 population every year claims the mode of disastrous progression of unrecognized cardiac arrest carrying the entities of increased pathophysiological symptomatic events in the predominance of heart failure and ischemic cardiomyopathies. The modulation of multifactorial pathogenesis in the concerns of coronary artery spasm risk factors highlights the contribution of ejection fraction, atrial fibrillation, ventricular fibrillation, myocardial infarction and coronary heart disease mortality rate, the cause of origin in detecting the natural history and ECG interpretation [1]. Several cohort studies presume the disrupted arrhythmogenesis morphology by the adjacent confounding data of premature ventricular beats in provoking the therapeutic justifications of differential diagnosis based protocols at early repolarization (ER), ion channels vulnerability, hormonal perception, hypertrophy dilations or metabolic causes.

Moreover, the optimal mandatory therapy in the improvements of necessitating appropriate prophylactic emphasizes the cardiac screening of implantable cardiac device and secondary prevention [2, 3] in the resuscitation of daily diagnostic practice. The guidelines in the possible prognosis of sophisticated technology in left ventricular dysfunction incidence overlap the long-term effectiveness by the follow-up of safest tool in survival rates to analyze the comprehensive abnormalities to measure QTc interval at 12 lead ECG by the selection of angiography flow chart for the casual studies of the functional acquisition of ventricular dysplasia and artery stenosis reoccurrences.

The objective of this study is to assess the clinical experience based on the documentation of linked family history abnormalities, biomarker yields, radiography examination, routine testing and the aborted VF conceals [4] the critical controversies of predictable outcomes by reversal left ventricular remodeling in terms of revascularization to discordance the validation of benefitting responsive survivors

 2. Methods of study patients
The study design in the randomized study of clinical effectiveness at the decompensation of Acute Heart Failure cases enrolled the participants of 3000 patients rehospitalized on worsening conditions with EF> 35%, <35%, NYHA functional class I ? IV, from 2015 ? 2017 preserved the setting of quantified LVH by conventional viewing the end-diastolic volumes.

  1. Carry the limitations of drugs study composite to mortality rate.
  2. Follow-up of arrhythmic events (torsade de pointes, VF, Burgada syndrome) within 6-12 months monitoring
  3. Substrating the evidence of echocardiography in the eligibility of regional or general hypokinesis with the additional tests of NT- proBNP/ CT scan/ medication and the consideration of cardioverter defibrillator.
  4. The post hoc analysis of CHD differentiates ischemia by a successful enhanced device therapy of pacing in the identification of 98% clinical results.

2.1 End points
The independent sustainable premature ventricular beats define the unexplained SCD in the witnesses of favorable stable conditions of patients

  1. The instantaneous pre-existing pumping failure obviously makes etiology of co-morbidity progression.
  2. The deterioration signs and symptoms in acute heart failure nonresponders herald the predictor of quality of life abruptly requiring the rate and rhythm control within first 24 hours of admission [5,6].
  3. The classification of CVD events alike per year follow-up measures the clinical status of resuscitation therapy in the observations of life-threatening arrhythmia dysfunction episodes.
  4. The composite clinical score (CCS) in the improvement of each NYHA classes ? 25% end points preplanned the awareness of re-hospitalization treatment defining the statistical medical records sub clinically by the baseline criteria in the prolongation of blinded cardiac arrest time period at multivariable all-cause mortality.

2.2 Statistics
In the expressed standard ± deviation (SD) count the comparative parameters of dilated cardiomyopathy analysis between EF percentage distributed the transformed statistic of death ratio and re-hospitalized analysis. The impetrating multiple variables choose the assessment of survival curves in all the (n-value) responders in remodeling the impact on cardiac events. The incidence of SCD logarithm the index ratio of 0.5 equal to the proportions of <0.1 censor the evaluation of graph risk factors in the exploratory hazard proportion adjustments [7]. HR 13.5 (9.7-17.1)
The known stratifies results stepwise correlate the curve of cause based on side effects in the elimination of probability score [8] in adding the inclusion of linear co-ordinate assumption within study duration years, as measured by Kaplan-Meier. The examined caliber of each variable categorical the distribution of survival rate at the intra-observation of cardiac echocardiography of randomized calculated average value of significance in the measure of differences by using SPSS statistic version 21 (NY, USA)

3. Results
During the population-based follow-up of 2 years, longitudinal study divided into 2 groups

  1. Rehospitalized survival rate of >1 year.
  2. The HF hospitalized all-cause mortality.

A total of 3000 patients with often comorbidity of NYHA II-IV alive 70% and SCD 72% as shown in Table .1 the incidence of EF>30% decrease the HR 0.96 (0.94 ? 1.00). Moreover, the overall mortality rate 1.65 (1.60 ? 1.69) with P<0.0001experience the equal gender effect of idiopathic ventricular fibrillation in the demonstration of 1-year hospitalization composite to the history of co-existing conditions between (55-75%) predominant risk value.

a). Baseline variables prediction for SCD:
The countless demographic data in Table 2 outline the selection of High-Quality Life and Low-Quality Life survey independent to P<0.0001. The distinguishable of previous data i.e. SBP, DBP, BMI, and NT-proBNP reveal the calculation of (35-49%) from ECG variables according to each ?QTc interval respectively. The recognized outcome of n-value approaches the preventive strategy in the established impressive diagnostic screening to translucent the precipitating cardiac factors.

Variable

 

  Overall
  n value

   SCD (alive)
     n value

SCD (death cause) n value

(Mortality)
Hazard Ratio

  P value

Age and gender

76 (69 - 89)

 74 ( 62 – 79)

38 (69 – 89)

1.65 (1.60 – 1.69)

<0.0001

BMI, kg/m2

32 (28 – 37)

 26 (22 – 30)

21 (24 – 33)

1.33 (1.13 – 1.56)

<0.001

HR, bpm (median)

88 (74 – 96)

 83 (69 – 95)

70 (65 – 100)

1.38 (1.28 – 1.49)

<0.001

HF hospitalized per year 6-12 months

 
60%

 

 6.1(4.8 – 8.5)

 

3.2(2.5 – 4.4)

 

4.8 (2.6 – 8.7)

 

 <0.003

Dilated cardiomyopathy

 

72%

 

10%

 

58%

 

2.48 (1.28 – 4.78)

 

 0.46

LVEF%

30%

29%

36%

0.96 (0.94 – 1.00)

 <0.05

History of MI

58%

61%

44%

1.41 (1.09 – 1.84)

 0.01

Hypertension

69%

76%

53%

0.95 (0.65 – 1.39)

 0.72

NYHA class II-IV

77%

70%

72%

8.45 (3.59 – 20.04)

 

 <0.001

GFR (ml/min)

78 ± 19

72 ± 19

75 ± 19

1.34 (1.29 – 1.38)

 <0.001

Stroke

8.3 (5.2 -13.2)

2.0 (1.7 – 2.5)

40 (38.1 – 43.5)

2.9 (2.3 – 3.5 )

 <0.01

Valvular heart disease

75 (67 – 85)

62 (71 – 86)

54 (72 – 85)

1.23 (1.07 – 1.42)

 <0.001

Paroxysmal or persistant  AF

 

4.5%

 

2.9%

 

9.4%

 

3.26 (2.17 – 4.91)

 

 <0.0001

2nd ? 3rd Heart block

2.6

2.58 (1.4 – 4.4)

1.09 (0.6 – 1.88)

1.31 (1.06 – 1.62)

 0.50

Hyperlipidemia

72%

11%

59%

1.02 (0.79 – 1.34)

 0.85

CHD

72%

65%

32%

2.04 (1.67 – 2.49)

 <0.05

DM

61%

52%

24%

1.57 (1.46 – 1.57)

 0.8

Table 1: Baseline variables in comparison of alive and SCD in the PRESERVE trial

Variables

  Patients  in Quality of Life
             (n value)

Patients  not in Quality of Life
             (n value)

        P value

BMI

         0.98 (0.92 – 0.97)

            0.96 (0.95 – 0.98)

          0.05

HR

         1.06 (1.02 – 1.04)

           0.92 (0.97 – 1.03 )

          0.50

SBP (mmHg)

                116 ± 21

                  118 ± 18

          0.51

DBP (mmHg)

                71 ± 8

                     74 ± 9

           0.1

Creatinine

          2.53 (1.81 – 3.53)

             3.01 (1.82 – 3.54)

         <0.0001

CKD

          0.39 (0.17 – 1.74)

             0.23 (4.90 – 7.94) 

         <0.0001

EF = 35%

      18.6 ± 8.0 (13.3 – 23.8)

      40.5 ± 1.2 (39.1 – 41.9)

         <0.0001

Haemoglobin

                       <11

                    12 – 13

           0.50

Albumin

                       36%

                      72 %

           0.004

Sodium

           32% improvement

               49% restriction

           0.035

Potassium

           3.5 – 5.3mmom/L

                     4.3 – 5.6 

           0.05

NT- proBNP

                53 (42 – 73)

                   74 (59 – 87)

        <0.05

Platelet

                62.09 ± 22.09

                  51.11 ± 19.81

           0.005

Jugular venous distension

             1.32 (1.09 – 1.63)

             1.35 (1.07 – 1.75) 

         <0.05

NYHA I - II

            1.21 (1.05 – 1.43)

               16.5(9.0 – 27.0)

        <0.01

NYHA III - IV

            20.0 (12.0 – 31.0)

            23.0 (15.0 – 37.0)

           0.02

X-ray congestion

              31% (18 – 52%)

              72% (63 – 88%)

           0.4

ECG variables
LBBB

 

                       49%

 

                        35%

 

           0.001

LVH on ECG

                   <19mm

                      >30mm

           0.001

AF on ECG

          76.33 ± 14.91 units

                 82.07 ± 12.38 

           0.01

PR interval, ms

          142 ± 3 (133 – 148)

             140 ± 2 (136 – 152)

           0.7

QRS interval, ms

          106 ± 25 (82 – 135)

          109 ± 26 (93 – 125)

           0.8

QTc interval

          478 ± 32 (443 – 514)

          479 ± 31 (458 – 499)

           0.9

LVEF

          9.9 ± 5.6 (3.7 – 16.1)

      25.8 ± 6.7 (22.5 – 31.2 )

           0.004

Table 2: Clinical assessments of patients in QoL study

b). Event rates:
At the Kaplan-Meier of 6 months event rate favor (75-85%) ischemic disease with n=2,427 on controlling the rate amount initially with antihypertensive and anti-arrhythmia drugs as discussed in Table 3. The relative risk of atherosclerotic presence after the recovery discharge can be reduced (70-80%) satisfactory results in the combination of amiodarone dosing with the highest efficacy on patients health. In contrast, prior to VT/VF specifically make the reliable diagnostic of ICD in the suspection of prognostic complications.

                    Variables

 

             Rhythm Control %

                 Rate Control %

                    ACEI / ARB

 6%

 18%

                      – blocker

37%

71%

        Calcium channel blockers

29%

53%

                       Digoxin

14%

40%

                   Amiodarone

73%

82%

               Thiazide diuretics

>80%

20 ? 30%

                   Loop diuretics 

<80%

40 ? 45%

               Potassium sparing

30 ? 70%

10%

                      Sotalol

30%

20%

                      Aspirin

41%

38%

              Anti-thrombolytics

45%

20%

                   Anti-diabetics

23%

20%

            Lipid-lowering agents

46%

43%

         Anti-arrhythmic agents

45%

47%

                Spironolactone

30%

39%

                  Anti-platelet

Reduced Relative Risk  10%

Reduced Relative Risk  13%

                Anti-coagulant

Reduced Relative Risk 16%

Reduced Relative Risk  18%

             Vitamin K agonist

>70%

77%

                        NSAIDS

Elevated Relative Risk  45-75%

Elevated Relative Risk  30%

                  Dobutamine

51%

64%

               Norepinephrine

8%

12%

                 Bromocriptine

7.2%

33%

          Treatment
ICD

82%

71%

 Cardiac resynchronization     therapy

86%

32%

Table 3: Characteristics of the patients according to the assigned treatment

The sensitive analysis in the absolute of preserved EF improved LVEDV=52% as shown in Table .4 with the least enhancement of CRT scoring criteria underlying the conditions of cardiomyopathies suppression. The modifiable treatment according to sex highly remained effective in females of 85% as compared in males of 37%. The notability of stable condition positively with echocardiography visualize extends of LVESV 37.1% responsiveness and 10.9% nonresponsiveness.

    All
    (n)

             Favorable
          (Responders )

           Non-Favorable
          (Responders )

Aetiology

     75% ischemic disease

    61% non ischemic disease

Co-morbidity per year

                n = 2,427

                 n = 1,020

Optimal medication
Before therapy

>40 Consecutive
Days (42%)

          <40 Consecutive
Days (29%)

Optimal medication
After therapy

>50%  target dose
6 months (94%)

         1 - 50%  target dose
6 months (56%)

ECG variables
Predictors

 >6 CRT score (98%)

         <6 CRT score (40 - 80%)

Echocardiography
LVESV, mL
LVEDV, mL
EF Improvement

                        88%
37.1%
52%
69%

                      81%
10.9%
40.1%
28.3%

NYHA class II ? III
NYHA class IV

                        79%
48%

                    14.5%
53%

Device therapy
Gender
CRT-D defibrillator
CRT-P pacing

 

                  85% Females
47%
98%

 

                  37% Males
29%
50.1%

Table 4: Baseline characteristic grouped according to the diagnostic treatment response

c). Survival and clinical responses:
The minimum duration with the backups of myocardial infarction and shock arrhythmia to ICD borderline the analysis of n=1,020 to least 40 consecutive days of nonresponding medication therapy in the emergence of targeting endpoints. The asymptomatic correlated pump failure as shown in Figure.1 bind the use of resynchronization with 86% successfully elicit the reverse remodeling therapy with cohort proportional outcomes of 98% survivors on CRT-pacing treatment.

image

Figure 1: Estimation of SCD in AHF according to echocardiographic responses.

4. Discussion
The true assumption of the quarter percentage of HF in total death remains vigilance in delaying the electrical activity of LV end-diastolic recovery of evolutionary ventricular contractions [9]. The displaying risk factor of systemic arterial hypertension is a global proceeding disability in LV relaxation classifying the magnitude of HF refractory forms. The averting pathway of CHF in the dominance of LVD strictly ponder the Framingham Heart Study enormously scaffolds the rheumatic heart disease association strengthening the elliptically shaped modeling. The triggering hemodynamic circulation optimizes the compensatory adaptation of cellular tissue study that distorts the chamber for reperfusion in the presence of aneurysm process [10]. Therefore, the prevalence of thrombus-embolism engages a biological inhibitory action in co-morbidities directing the use of anticoagulation in fixed myocardial injury mass formation [11-13].

According to recent ASCEND-HF and VARIANT studies on wider QRS complex strongly predict 30-70% HF in sustainable NSTEMI ratio of combined ischemic cardiomyopathies in common risk. And also the registry from ARISTOTLE varying ROCKET-AF and ENGAGE-AF evaluated the hazard ratio of cluster formations in the contemporary random trials differentiating the prosthetic repair reminding the long- term asymptomatic activations. The amplifying unequivocal mechanism affects the atria fibrillation intersection in a moderate appearance of arterial disorders involvements relates the aggressiveness of low EF against mediated pump failure. As demonstrated in Figure 2 the novel finding of pivotal responder’s recipient the episodes of the premature beat in the protective support of Insync ICD Italian study [14] in ascertains of necessary odd preventions. The consistent NYHA risk factor surprisingly remarks a change with an interaction of Quality of Life partially [15] in the conduction of biventricular pacing method of repolarization [16]. The hypothesis in the attachment of (REVERSE) study govern the grades of intuitive nonsurvivors [17] to measure the chronic AF within 3-6months of diagnostic review. Moreover, the result in the diagnosis of two dimensional Trans echocardiography effectively influenced the surrogate markers of HF in the importance of stand by death cause.

image

Figure 2: Event rates of 24 months for SCD, VT/VF and all-cause mortality in the resuscitated pacing therapy

Furthermore, studies of RALES, MERIT, and CIBIS strike the reduction of 25-30% CHF mortality by introducing the evidence of beta blockers [18, 19] as an inotropic agent to maintain the SBP in the regulations of metabolism and also the playing role of vasopressin in increasing myocardial oxygen in the profounded continuous infusion. On the other hand, the impairments of right ventricular functioning in the adoption of LAD healing hormonal network involve the debated secondary actions of vasodilations and vasoconstrictions with the dual bradykinin in complex HF. In addition the prognostic rejections of apoptosis and fibrosis in the alteration of stimulating genesis favor the oxidative stress in the proliferative endothelial balances [20] by treating ACEIs initially and antifibrinolytics as an importance of better adjunctive with bromocriptine and heparin in the beginning of procoagulant activity despite the implantation. The overviewed percutaneous in stabilized strategy integrated by experts ensure the challenged confirmation of physicians by including the advantageous choices of LV maintenance dependability to assess the restrictions of coagulation site basically at veno-arterial Impella as mentioned in the publications of SOLVED and SAVES database.

4.1 Clinical implications
The characteristic of VT/VF in a closer element of SCD reduced the events by restoring the medication of ACE or ARB (28) ? blocker (29) and receptor antagonists (30) to overlook the further HF exacerbations at rehospitalized assumed coagulation patients. But the likelihood of survival improvement stays extensive if the use of VT ablation remains a standard goal beyond 90 days treatment of drugs it shall remain fundamental to some limit within 30-60 days that can uncertainly cause 18-20% mortality if not triage the abnormal findings concomitantly.

4.2 Limitations
The prospective considerations in the direction of tachycardia briefly fulfill the strict ECG monitoring to determine the early and late phase of interruptions at the unanticipated high-risk study groups. The precisely understood phenomenon in the regulations of analysis epidemiologically based on community trials tackle the similarities and accentuate the situations differently if required. In the exclusion of I-PRESERVE trials declare the unexpected syncope with low-risk sudden death mainly reveals the peripartum cardiomyopathy in females at first trimester of pregnancy as newly diagnosed in women’s health centers. The unpredictable preferences in 2-way methods of sensitive measurements focus on ECG readings particularly QRS duration in order to follow the C-reactive protein and troponin reactivity classifying the other clinical factors i.e. COPD, PE, CKD, stroke and cerebrovascular disease. Therefore, in order to equivalent account of severity adjudicating the medical attention generate the solution of ICDs in arrhythmic risk factors to guideline the quantified valvular heart disease at functional corrections of aortic stenosis, aortic regurgitation, mitral tricuspid and pulmonary valve regurgitation susceptible to higher death ratio. The overall examined variability chiefly begin with diabetes as a leading cause exclusively dyslipidemia for the judgments of investigated heart-related cumulative incidences in the competing optimistic limitations. And often the cross-valid co-efficient at interquartile ranges substantially include the sample trials of intervention bothering the crude observation ranking in the final calculation of annual individual medical records for interconnecting a stronger technique of remodeling in the possible measures of largely the higher lives intimate relationships.

5. Conclusion
In the contemporary readmitted patients exposure to the unlike ventricular dysfunctions definitive to LBBB or RBBB in an association of SCD experience differential diagnosis along with the VF history prolonging the instability to transverse the use of ICD at arrhythmic events. The several retrospective studies in the post-partum of 6-12 months delay the lowering of LV partially at the termination of adjusted analyses in the increasing population of VHD to exhibit the comprising results of NT-proBNP, HFREF, and ECG interpretations. Alternatively, the system of pacing in recent representative trials have a good option of healing solution permanently in new ways of LV remodeling at the quantitative degrees of regurgitation complications in the affliction of AHF supporting the lesions of patients competent effectiveness with evidence.

Conflicts of Interest Statement
The author declared that they have no competing interest.

Acknowledgement
The Author would like to thank Dr. Hassam Ali for the great help in revising the manuscript for important intellectual content.

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About This Article

Cite this article as:

Hassah Batool Iftikhar, Jiang Hong

.

Better Clinical Outcome For Rehospitalization Heart Failure Patients With Reduced Left Ventricular Function in Mode of Sudden Cardiac Death

. Cardiology and Cardiovascular Medicine 2 (2018): 53 - 64.

DOI

10.26502/fccm.92920036

Publisher Name

Fortune Journals

Online ISSN

ISSN: 2572-9292

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