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Letnes JM, Wisløff U, Dalen H. Heart Failure With Preserved Ejection Fraction: Exercise Deficiency or Ventricular Maladaptation to Metabolic Demands? JACC Cardiovasc Imaging 2023; 16:1233-1235. [PMID: 37673477 DOI: 10.1016/j.jcmg.2023.05.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Revised: 05/16/2023] [Accepted: 05/23/2023] [Indexed: 09/08/2023]
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Sarma S, MacNamara JP, Hieda M, Howden EJ, Lawley JS, Livingston S, Samels M, Levine BD. SERCA2a Agonist Effects on Cardiac Performance During Exercise in Heart Failure With Preserved Ejection Fraction. JACC. HEART FAILURE 2023:S2213-1779(23)00090-2. [PMID: 37086245 DOI: 10.1016/j.jchf.2023.02.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 01/31/2023] [Accepted: 02/08/2023] [Indexed: 04/23/2023]
Abstract
BACKGROUND Impaired ventricular relaxation influences left ventricular pressures during exercise in heart failure with preserved ejection fraction (HFpEF). Sarco/endoplasmic reticulum calcium-adenosine triphosphatase (SERCA2a) facilitates myocardial relaxation by increasing calcium reuptake and is impaired in HFpEF. OBJECTIVES This study sought to investigate the effects of istaroxime, a SERCA2 agonist, on lusitropic and hemodynamic function during exercise in patients with HFpEF and control subjects. METHODS Eleven control subjects (7 male, 4 female) and 15 patients with HFpEF (8 male, 7 female) performed upright cycle exercise with right-sided heart catheterization. Participants received istaroxime (0.5 mg/kg/min) or saline placebo (single-blind, crossover design). Cardiac output, pulmonary capillary wedge pressure (PCWP), and diastolic function were measured at rest and during submaximal exercise. In an exploratory analysis (Hedges' g), 7 patients with HFpEF received higher-dose istaroxime (1.0 mg/kg/min). End-systolic elastance (Ees) was calculated by dividing systolic blood pressure (SBP) × 0.9 by end-systolic volume (ESV; on 3-dimensional echocardiography). RESULTS Patients with HFpEF had higher PCWP (25 ± 10 mm Hg vs 12 ± 5 mm Hg; P < 0.001) and lower tissue Doppler velocities during exercise. Istaroxime (0.5 mg/kg/min) had no effect on resting or exercise measures in patients with HFpEF or control subjects. Control subjects had a larger increase in Ees (Δ 1.55 ± 0.99 mm Hg/mL vs D 0.86 ± 1.31 mm Hg/mL; P = 0.03), driven by lower ESV. Comparing placebo and istaroxime 1.0 mg /kg/min during exercise, PCWP during the 1.0 mg /kg/min istaroxime dose was slightly lower (Δ 2.2 mm Hg; Hedges' g = 0.30). There were no effects on diastolic function, but there were increases in SBP and s', suggesting a mild inotropic effect. CONCLUSIONS Low-dose istaroxime had no effect on cardiac filling pressure or parameters of relaxation in patients with HFpEF during exercise. Higher doses of istaroxime may have been more effective in reducing exercise PCWP in patients with HFpEF. (Hemodynamic Response to Exercise in HFpEF Patients After Upregulation of SERCA2a; NCT02772068).
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Affiliation(s)
- Satyam Sarma
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas, USA; Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - James P MacNamara
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas, USA; Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Michinari Hieda
- Department of Medicine and Biosystemic Science, School of Medicine, Kyushu University, Fukuoka, Japan; Department of Hematology, Oncology, and Cardiovascular Medicine, School of Medicine, Kyushu University, Fukuoka, Japan
| | - Erin J Howden
- Baker Heart and Diabetes Institute, Melbourne, Australia
| | - Justin S Lawley
- Department Sport Science, University of Innsbruck, Innsbruck, Austria
| | - Sheryl Livingston
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas, USA
| | - Mitchel Samels
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas, USA
| | - Benjamin D Levine
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas, USA; Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
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3
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Hagendorff A, Helfen A, Brandt R, Altiok E, Breithardt O, Haghi D, Knierim J, Lavall D, Merke N, Sinning C, Stöbe S, Tschöpe C, Knebel F, Ewen S. Expert proposal to characterize cardiac diseases with normal or preserved left ventricular ejection fraction and symptoms of heart failure by comprehensive echocardiography. Clin Res Cardiol 2023; 112:1-38. [PMID: 35660948 PMCID: PMC9849322 DOI: 10.1007/s00392-022-02041-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 05/10/2022] [Indexed: 01/22/2023]
Abstract
Currently, the term "heart failure with preserved left ventricular ejection fraction (HFpEF)" is based on echocardiographic parameters and clinical symptoms combined with elevated or normal levels of natriuretic peptides. Thus, "HFpEF" as a diagnosis subsumes multiple pathophysiological entities making a uniform management plan for "HFpEF" impossible. Therefore, a more specific characterization of the underlying cardiac pathologies in patients with preserved ejection fraction and symptoms of heart failure is mandatory. The present proposal seeks to offer practical support by a standardized echocardiographic workflow to characterize specific diagnostic entities associated with "HFpEF". It focuses on morphological and functional cardiac phenotypes characterized by echocardiography in patients with normal or preserved left ventricular ejection fraction (LVEF). The proposal discusses methodological issues to clarify why and when echocardiography is helpful to improve the diagnosis. Thus, the proposal addresses a systematic echocardiographic approach using a feasible algorithm with weighting criteria for interpretation of echocardiographic parameters related to patients with preserved ejection fraction and symptoms of heart failure. The authors consciously do not use the diagnosis "HFpEF" to avoid misunderstandings. Central illustration: Scheme illustrating the characteristic echocardiographic phenotypes and their combinations in patients with "HFpEF" symptoms with respect to the respective cardiac pathology and pathophysiology as well as the underlying typical disease.
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Affiliation(s)
- A. Hagendorff
- Department of Cardiology, University of Leipzig, Liebigstraße 20, 04103 Leipzig, Germany
| | - A. Helfen
- Department of Cardiology, Kath. St. Paulus Gesellschaft, St-Marien-Hospital Lünen, Altstadtstrasse 23, 44534 Lünen, Germany
| | - R. Brandt
- Department of Cardiology, Kerckhoff Heart Center, Benekestr. 2-8, 61231 Bad Nauheim, Germany
| | - E. Altiok
- Department of Cardiology, University of Aachen, Pauwelsstrasse 30, 52074 Aachen, Germany
| | - O. Breithardt
- Klinik für Innere Medizin-Kardiologie and Rhythmologie, Agaplesion Diakonie Kliniken Kassel, Herkulesstrasse 34, 34119 Kassel, Germany
| | - D. Haghi
- Kardiologische Praxisklinik Ludwigshafen-Akademische Lehrpraxis der Universität Mannheim-Ludwig-Guttmann, Strasse 11, 67071 Ludwigshafen, Germany
| | - J. Knierim
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Augustenburger Platz 1, 13353 Berlin, Germany ,Paulinenkrankenhaus Berlin, Klinik Für Innere Medizin Und Kardiologie, Dickensweg 25-39, 14055 Berlin, Germany
| | - D. Lavall
- Department of Cardiology, University of Leipzig, Liebigstrasse 20, 04103 Leipzig, Germany
| | - N. Merke
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - C. Sinning
- Department of Cardiology, University Heart and Vascular Center Hamburg, German Centre of Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Martinistrasse 52, 20251 Hamburg, Germany
| | - S. Stöbe
- Department of Cardiology, University of Leipzig, Liebigstrasse 20, 04103 Leipzig, Germany
| | - C. Tschöpe
- Berlin Institute of Health at Charité (BIH), Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany ,BIH Center for Regenerative Therapies (BCRT), Augustenburger Platz 1, 13353 Berlin, Germany ,German Centre for Cardiovascular Research DZHK, Partner Site Berlin, Augustenburger Platz 1, 13353 Berlin, Germany ,Department of Cardiology, Charité University Medicine Berlin, Campus Virchow Klinikum, Augustenburger Platz 1, 13353 Berlin, Germany
| | - F. Knebel
- Klinik Für Innere Medizin II, Kardiologie, Sana Klinikum Lichtenberg, Fanningerstrasse 32, 10365 Berlin, Germany ,Department of Cardiology, University of Berlin, Campus Charité Mitte, Charitéplatz 1, 10117 Berlin, Germany
| | - S. Ewen
- Zentrale Notaufnahme and Klinik Für Innere Medizin III, Kardiologie, Angiologie Und Internistische Intensivmedizin, Universitätsklinikum Des Saarlandes, Kirrberger Strasse, 66421 Homburg, Germany
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4
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Vriz O, Palatini P, Rudski L, Frumento P, Kasprzak JD, Ferrara F, Cocchia R, Gargani L, Wierzbowska-Drabik K, Capone V, Ranieri B, Salzano A, Stanziola AA, Marra AM, Annunziata R, Chianese S, Rega S, Saltalamacchia T, Maramaldi R, Sepe C, Limongelli G, Cademartiri F, D’Andrea A, D’Alto M, Izzo R, Ferrara N, Mauro C, Cittadini A, Ekkehard G, Guazzi M, Bossone E. Right Heart Pulmonary Circulation Unit Response to Exercise in Patients with Controlled Systemic Arterial Hypertension: Insights from the RIGHT Heart International NETwork (RIGHT-NET). J Clin Med 2022; 11:451. [PMID: 35054145 PMCID: PMC8778233 DOI: 10.3390/jcm11020451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Revised: 01/09/2022] [Accepted: 01/10/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Systemic arterial hypertension (HTN) is the main risk factor for the development of heart failure with preserved ejection fraction (HFpEF). The aim of the study was was to assess the trends in PASP, E/E' and TAPSE during exercise Doppler echocardiography (EDE) in hypertensive (HTN) patients vs. healthy subjects stratified by age. METHODS EDE was performed in 155 hypertensive patients and in 145 healthy subjects (mean age 62 ± 12.0 vs. 54 ± 14.9 years respectively, p < 0.0001). EDE was undertaken on a semi-recumbent cycle ergometer with load increasing by 25 watts every 2 min. Left ventricular (LV) and right ventricular (RV) dimensions, function and hemodynamics were evaluated. RESULTS Echo-Doppler parameters of LV and RV function were lower, both at rest and at peak exercise in hypertensives, while pulmonary hemodynamics were higher as compared to healthy subjects. The entire cohort was then divided into tertiles of age: at rest, no significant differences were recorded for each age group between hypertensives and normotensives except for E/E' that was higher in hypertensives. At peak exercise, hypertensives had higher pulmonary artery systolic pressure (PASP) and E/E' but lower tricuspid annular plane systolic excursion (TAPSE) as age increased, compared to normotensives. Differences in E/E' and TAPSE between the 2 groups at peak exercise were explained by the interaction between HTN and age even after adjustment for baseline values (p < 0.001 for E/E', p = 0.011 for TAPSE). At peak exercise, the oldest group of hypertensive patients had a mean E/E' of 13.0, suggesting a significant increase in LV diastolic pressure combined with increased PASP. CONCLUSION Age and HTN have a synergic negative effect on E/E' and TAPSE at peak exercise in hypertensive subjects.
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Affiliation(s)
- Olga Vriz
- Cardiac Centre, King Faisal Specialist Hospital and Research Center, Riyadh 11564, Saudi Arabia;
- School of Medicine, Alfaisal University, Riyadh 11533, Saudi Arabia
| | - Paolo Palatini
- Department of Medicine, University of Padova, 35122 Padova, Italy;
| | - Lawrence Rudski
- Azrieli Heart Center and Center for Pulmonary Vascular Diseases, Jewish General Hospital, McGill University, Montreal, QC H3A 0G4, Canada;
| | - Paolo Frumento
- Department of Political Sciences, University of Pisa, 56126 Pisa, Italy;
| | - Jarosław D. Kasprzak
- Department of Cardiology, Bieganski Hospital, Medical University, 91-347 Lodz, Poland; (J.D.K.); (K.W.-D.)
| | - Francesco Ferrara
- Heart Department, University Hospital of Salerno, 84131 Salerno, Italy;
| | - Rosangela Cocchia
- Division of Cardiology, A Cardarelli Hospital, 80131 Naples, Italy; (R.C.); (V.C.); (R.A.); (S.C.); (C.S.)
| | - Luna Gargani
- Institute of Clinical Physiology, National Research Council, 56124 Pisa, Italy; (L.G.); (C.M.)
| | - Karina Wierzbowska-Drabik
- Department of Cardiology, Bieganski Hospital, Medical University, 91-347 Lodz, Poland; (J.D.K.); (K.W.-D.)
| | - Valentina Capone
- Division of Cardiology, A Cardarelli Hospital, 80131 Naples, Italy; (R.C.); (V.C.); (R.A.); (S.C.); (C.S.)
| | - Brigida Ranieri
- IRCCS Synlab SDN, 80143 Naples, Italy; (B.R.); (A.S.); (F.C.)
| | - Andrea Salzano
- IRCCS Synlab SDN, 80143 Naples, Italy; (B.R.); (A.S.); (F.C.)
| | - Anna Agnese Stanziola
- Department of Respiratory Diseases, Monaldi Hospital, University “Federico II”, 80131 Naples, Italy;
| | - Alberto Maria Marra
- Department of Translational Medical Sciences, “Federico II” University of Naples, 80138 Naples, Italy; (A.M.M.); (S.R.); (T.S.); (R.M.); (N.F.); (A.C.)
| | - Roberto Annunziata
- Division of Cardiology, A Cardarelli Hospital, 80131 Naples, Italy; (R.C.); (V.C.); (R.A.); (S.C.); (C.S.)
| | - Salvatore Chianese
- Division of Cardiology, A Cardarelli Hospital, 80131 Naples, Italy; (R.C.); (V.C.); (R.A.); (S.C.); (C.S.)
| | - Salvatore Rega
- Department of Translational Medical Sciences, “Federico II” University of Naples, 80138 Naples, Italy; (A.M.M.); (S.R.); (T.S.); (R.M.); (N.F.); (A.C.)
| | - Teresa Saltalamacchia
- Department of Translational Medical Sciences, “Federico II” University of Naples, 80138 Naples, Italy; (A.M.M.); (S.R.); (T.S.); (R.M.); (N.F.); (A.C.)
| | - Renato Maramaldi
- Department of Translational Medical Sciences, “Federico II” University of Naples, 80138 Naples, Italy; (A.M.M.); (S.R.); (T.S.); (R.M.); (N.F.); (A.C.)
| | - Chiara Sepe
- Division of Cardiology, A Cardarelli Hospital, 80131 Naples, Italy; (R.C.); (V.C.); (R.A.); (S.C.); (C.S.)
| | - Giuseppe Limongelli
- Division of Cardiology, Monaldi Hospital, Second University of Naples, 81100 Naples, Italy; (G.L.); (M.D.)
| | | | - Antonello D’Andrea
- Department of Cardiology and Intensive Coronary Unit, “Umberto I” Hospital, 84014 Nocera Inferiore, Italy;
| | - Michele D’Alto
- Division of Cardiology, Monaldi Hospital, Second University of Naples, 81100 Naples, Italy; (G.L.); (M.D.)
| | - Raffaele Izzo
- Department of Advanced Biomedical Sciences, “Federico II” University of Naples, 80131 Naples, Italy;
| | - Nicola Ferrara
- Department of Translational Medical Sciences, “Federico II” University of Naples, 80138 Naples, Italy; (A.M.M.); (S.R.); (T.S.); (R.M.); (N.F.); (A.C.)
| | - Ciro Mauro
- Institute of Clinical Physiology, National Research Council, 56124 Pisa, Italy; (L.G.); (C.M.)
| | - Antonio Cittadini
- Department of Translational Medical Sciences, “Federico II” University of Naples, 80138 Naples, Italy; (A.M.M.); (S.R.); (T.S.); (R.M.); (N.F.); (A.C.)
| | - Grünig Ekkehard
- Centre for Pulmonary Hypertension, Thoraxklinik at Heidelberg University Hospital, Translational Lung Research Center Heidelberg (TLRC), German Center for Lung Research (DZL), 69120 Heidelberg, Germany;
| | - Marco Guazzi
- Heart Failure Unit, Cardiopulmonary Laboratory, University Cardiology Department, IRCCS Policlinico San Donato University Hospital, 20097 Milan, Italy;
| | - Eduardo Bossone
- Division of Cardiology, A Cardarelli Hospital, 80131 Naples, Italy; (R.C.); (V.C.); (R.A.); (S.C.); (C.S.)
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5
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Bombardini T, Zagatina A, Ciampi Q, Arbucci R, Merlo PM, Haber DML, Morrone D, D’Andrea A, Djordjevic-Dikic A, Beleslin B, Tesic M, Boskovic N, Giga V, de Castro e Silva Pretto JL, Daros CB, Amor M, Mosto H, Salamè M, Monte I, Citro R, Simova I, Samardjieva M, Wierzbowska-Drabik K, Kasprzak JD, Gaibazzi N, Cortigiani L, Scali MC, Pepi M, Antonini-Canterin F, Torres MAR, Nes MD, Ostojic M, Carpeggiani C, Kovačević-Preradović T, Lowenstein J, Arruda-Olson AM, Pellikka PA, Picano E. Hemodynamic Heterogeneity of Reduced Cardiac Reserve Unmasked by Volumetric Exercise Echocardiography. J Clin Med 2021; 10:jcm10132906. [PMID: 34209955 PMCID: PMC8267648 DOI: 10.3390/jcm10132906] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 06/23/2021] [Accepted: 06/23/2021] [Indexed: 12/04/2022] Open
Abstract
Background: Two-dimensional volumetric exercise stress echocardiography (ESE) provides an integrated view of left ventricular (LV) preload reserve through end-diastolic volume (EDV) and LV contractile reserve (LVCR) through end-systolic volume (ESV) changes. Purpose: To assess the dependence of cardiac reserve upon LVCR, EDV, and heart rate (HR) during ESE. Methods: We prospectively performed semi-supine bicycle or treadmill ESE in 1344 patients (age 59.8 ± 11.4 years; ejection fraction = 63 ± 8%) referred for known or suspected coronary artery disease. All patients had negative ESE by wall motion criteria. EDV and ESV were measured by biplane Simpson rule with 2-dimensional echocardiography. Cardiac index reserve was identified by peak-rest value. LVCR was the stress-rest ratio of force (systolic blood pressure by cuff sphygmomanometer/ESV, abnormal values ≤2.0). Preload reserve was defined by an increase in EDV. Cardiac index was calculated as stroke volume index * HR (by EKG). HR reserve (stress/rest ratio) <1.85 identified chronotropic incompetence. Results: Of the 1344 patients, 448 were in the lowest tertile of cardiac index reserve with stress. Of them, 303 (67.6%) achieved HR reserve <1.85; 252 (56.3%) had an abnormal LVCR and 341 (76.1%) a reduction of preload reserve, with 446 patients (99.6%) showing ≥1 abnormality. At binary logistic regression analysis, reduced preload reserve (odds ratio [OR]: 5.610; 95% confidence intervals [CI]: 4.025 to 7.821), chronotropic incompetence (OR: 3.923, 95% CI: 2.915 to 5.279), and abnormal LVCR (OR: 1.579; 95% CI: 1.105 to 2.259) were independently associated with lowest tertile of cardiac index reserve at peak stress. Conclusions: Heart rate assessment and volumetric echocardiography during ESE identify the heterogeneity of hemodynamic phenotypes of impaired chronotropic, preload or LVCR underlying a reduced cardiac reserve.
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Affiliation(s)
- Tonino Bombardini
- Clinical Center of The Republic of Srpska, Faculty of Medicine, University of Banja-Luka, 78000 Banja-Luka, Bosnia and Herzegovina; (T.B.); (M.O.); (T.K.-P.)
| | - Angela Zagatina
- Cardiology Department, Saint Petersburg University Clinic, Saint Petersburg University, 199034 St Petersburg, Russia;
| | - Quirino Ciampi
- Cardiology Division, Fatebenefratelli Hospital, 82100 Benevento, Italy
- Correspondence:
| | - Rosina Arbucci
- Cardiodiagnosticos, Investigaciones Medicas, C1082 ACB Buenos Aires, Argentina; (R.A.); (P.M.M.); (D.M.L.H.); (J.L.)
| | - Pablo Martin Merlo
- Cardiodiagnosticos, Investigaciones Medicas, C1082 ACB Buenos Aires, Argentina; (R.A.); (P.M.M.); (D.M.L.H.); (J.L.)
| | - Diego M. Lowenstein Haber
- Cardiodiagnosticos, Investigaciones Medicas, C1082 ACB Buenos Aires, Argentina; (R.A.); (P.M.M.); (D.M.L.H.); (J.L.)
| | - Doralisa Morrone
- Cardiothoracic Department, University of Pisa, 56100 Pisa, Italy;
| | - Antonello D’Andrea
- Department of Cardiology-Umberto I° Hospital Nocera Inferiore (Salerno)-L. Vanvitelli University of Campania, 84014 Nocera Inferiore, Italy;
| | - Ana Djordjevic-Dikic
- Cardiology Clinic, Clinical Center of Serbia, Medical School, University of Belgrade, 11000 Belgrade, Serbia; (A.D.-D.); (B.B.); (M.T.); (N.B.); (V.G.)
| | - Branko Beleslin
- Cardiology Clinic, Clinical Center of Serbia, Medical School, University of Belgrade, 11000 Belgrade, Serbia; (A.D.-D.); (B.B.); (M.T.); (N.B.); (V.G.)
| | - Milorad Tesic
- Cardiology Clinic, Clinical Center of Serbia, Medical School, University of Belgrade, 11000 Belgrade, Serbia; (A.D.-D.); (B.B.); (M.T.); (N.B.); (V.G.)
| | - Nikola Boskovic
- Cardiology Clinic, Clinical Center of Serbia, Medical School, University of Belgrade, 11000 Belgrade, Serbia; (A.D.-D.); (B.B.); (M.T.); (N.B.); (V.G.)
| | - Vojislav Giga
- Cardiology Clinic, Clinical Center of Serbia, Medical School, University of Belgrade, 11000 Belgrade, Serbia; (A.D.-D.); (B.B.); (M.T.); (N.B.); (V.G.)
| | | | | | - Miguel Amor
- Cardiology Department, Ramos Mejia Hospital, C1221 ADC Buenos Aires, Argentina; (M.A.); (H.M.); (M.S.)
| | - Hugo Mosto
- Cardiology Department, Ramos Mejia Hospital, C1221 ADC Buenos Aires, Argentina; (M.A.); (H.M.); (M.S.)
| | - Michael Salamè
- Cardiology Department, Ramos Mejia Hospital, C1221 ADC Buenos Aires, Argentina; (M.A.); (H.M.); (M.S.)
| | - Ines Monte
- Cardio-Thorax-Vascular Department, Echocardiography Lab, Policlinico Vittorio Emanuele, Catania University, 95124 Catania, Italy;
| | - Rodolfo Citro
- Cardio-Thoracic-Vascular-Department, University Hospital “San Giovanni di Dio e Ruggi d’Aragona”, 84125 Salerno, Italy;
| | - Iana Simova
- Heart and Brain Center of Excellence, University Hospital, 5800 Sofia, Bulgaria; (I.S.); (M.S.)
| | - Martina Samardjieva
- Heart and Brain Center of Excellence, University Hospital, 5800 Sofia, Bulgaria; (I.S.); (M.S.)
| | - Karina Wierzbowska-Drabik
- Department of Cardiology, Bieganski Hospital, Medical University, 93-487 Lodz, Poland; (K.W.-D.); (J.D.K.)
| | - Jaroslaw D. Kasprzak
- Department of Cardiology, Bieganski Hospital, Medical University, 93-487 Lodz, Poland; (K.W.-D.); (J.D.K.)
| | - Nicola Gaibazzi
- Cardiology Department, Parma University Hospital, 43100 Parma, Italy;
| | | | | | - Mauro Pepi
- Centro Cardiologico Monzino, IRCCS, 20138 Milano, Italy;
| | - Francesco Antonini-Canterin
- Highly Specialized Rehabilitation Hospital Motta di Livenza, Cardiac Prevention and Rehabilitation Unit, 31045 Treviso, Italy;
| | - Marco A. R. Torres
- Department of Cardiology, Federal University of Rio Grande do Sul, 90040-060 Porto Alegre, Brazil;
| | - Michele De Nes
- Biomedicine Department, CNR, Institute of Clinical Physiology, 56124 Pisa, Italy; (M.D.N.); (C.C.); (E.P.)
| | - Miodrag Ostojic
- Clinical Center of The Republic of Srpska, Faculty of Medicine, University of Banja-Luka, 78000 Banja-Luka, Bosnia and Herzegovina; (T.B.); (M.O.); (T.K.-P.)
| | - Clara Carpeggiani
- Biomedicine Department, CNR, Institute of Clinical Physiology, 56124 Pisa, Italy; (M.D.N.); (C.C.); (E.P.)
| | - Tamara Kovačević-Preradović
- Clinical Center of The Republic of Srpska, Faculty of Medicine, University of Banja-Luka, 78000 Banja-Luka, Bosnia and Herzegovina; (T.B.); (M.O.); (T.K.-P.)
| | - Jorge Lowenstein
- Cardiodiagnosticos, Investigaciones Medicas, C1082 ACB Buenos Aires, Argentina; (R.A.); (P.M.M.); (D.M.L.H.); (J.L.)
| | - Adelaide M. Arruda-Olson
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN 55901, USA; (A.M.A.-O.); (P.A.P.)
| | - Patricia A. Pellikka
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN 55901, USA; (A.M.A.-O.); (P.A.P.)
| | - Eugenio Picano
- Biomedicine Department, CNR, Institute of Clinical Physiology, 56124 Pisa, Italy; (M.D.N.); (C.C.); (E.P.)
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6
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Pieske B, Tschöpe C, de Boer RA, Fraser AG, Anker SD, Donal E, Edelmann F, Fu M, Guazzi M, Lam CSP, Lancellotti P, Melenovsky V, Morris DA, Nagel E, Pieske-Kraigher E, Ponikowski P, Solomon SD, Vasan RS, Rutten FH, Voors AA, Ruschitzka F, Paulus WJ, Seferovic P, Filippatos G. How to diagnose heart failure with preserved ejection fraction: the HFA-PEFF diagnostic algorithm: a consensus recommendation from the Heart Failure Association (HFA) of the European Society of Cardiology (ESC). Eur Heart J 2020; 40:3297-3317. [PMID: 31504452 DOI: 10.1093/eurheartj/ehz641] [Citation(s) in RCA: 828] [Impact Index Per Article: 207.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 10/30/2018] [Accepted: 08/26/2019] [Indexed: 02/07/2023] Open
Abstract
Making a firm diagnosis of chronic heart failure with preserved ejection fraction (HFpEF) remains a challenge. We recommend a new stepwise diagnostic process, the 'HFA-PEFF diagnostic algorithm'. Step 1 (P=Pre-test assessment) is typically performed in the ambulatory setting and includes assessment for HF symptoms and signs, typical clinical demographics (obesity, hypertension, diabetes mellitus, elderly, atrial fibrillation), and diagnostic laboratory tests, electrocardiogram, and echocardiography. In the absence of overt non-cardiac causes of breathlessness, HFpEF can be suspected if there is a normal left ventricular ejection fraction, no significant heart valve disease or cardiac ischaemia, and at least one typical risk factor. Elevated natriuretic peptides support, but normal levels do not exclude a diagnosis of HFpEF. The second step (E: Echocardiography and Natriuretic Peptide Score) requires comprehensive echocardiography and is typically performed by a cardiologist. Measures include mitral annular early diastolic velocity (e'), left ventricular (LV) filling pressure estimated using E/e', left atrial volume index, LV mass index, LV relative wall thickness, tricuspid regurgitation velocity, LV global longitudinal systolic strain, and serum natriuretic peptide levels. Major (2 points) and Minor (1 point) criteria were defined from these measures. A score ≥5 points implies definite HFpEF; ≤1 point makes HFpEF unlikely. An intermediate score (2-4 points) implies diagnostic uncertainty, in which case Step 3 (F1: Functional testing) is recommended with echocardiographic or invasive haemodynamic exercise stress tests. Step 4 (F2: Final aetiology) is recommended to establish a possible specific cause of HFpEF or alternative explanations. Further research is needed for a better classification of HFpEF.
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Affiliation(s)
- Burkert Pieske
- Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin, Campus Virchow Klinikum.,German Center for Cardiovascular Research (DZHK), Berlin, Partner Site, Germany.,Department of Internal Medicine and Cardiology, German Heart Institute, Berlin, Germany.,Berlin Institute of Health (BIH), Germany
| | - Carsten Tschöpe
- Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin, Campus Virchow Klinikum.,German Center for Cardiovascular Research (DZHK), Berlin, Partner Site, Germany.,Berlin Institute of Health (BIH) Center for Regenerative Therapies (BCRT), Charite, Berlin, Germany
| | - Rudolf A de Boer
- University Medical Centre Groningen, University of Groningen, Department of Cardiology, Groningen, the Netherlands
| | | | - Stefan D Anker
- Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin, Campus Virchow Klinikum.,German Center for Cardiovascular Research (DZHK), Berlin, Partner Site, Germany.,Berlin Institute of Health (BIH) Center for Regenerative Therapies (BCRT), Charite, Berlin, Germany.,Department of Cardiology and Pneumology, University Medicine Göttingen (UMG), Germany
| | - Erwan Donal
- Cardiology and CIC, IT1414, CHU de Rennes LTSI, Université Rennes-1, INSERM 1099, Rennes, France
| | - Frank Edelmann
- Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin, Campus Virchow Klinikum.,German Center for Cardiovascular Research (DZHK), Berlin, Partner Site, Germany
| | - Michael Fu
- Section of Cardiology, Department of Medicine, Sahlgrenska University Hosptal/Ostra, Göteborg, Sweden
| | - Marco Guazzi
- Department of Biomedical Sciences for Health, University of Milan, IRCCS, Milan, Italy.,Department of Cardiology, IRCCS Policlinico, San Donato Milanese, Milan, Italy
| | - Carolyn S P Lam
- National Heart Centre, Singapore & Duke-National University of Singapore.,University Medical Centre Groningen, The Netherlands
| | - Patrizio Lancellotti
- Department of Cardiology, Heart Valve Clinic, University of Liège Hospital, GIGA Cardiovascular Sciences, CHU Sart Tilman, Liège, Belgium
| | - Vojtech Melenovsky
- Institute for Clinical and Experimental Medicine - IKEM, Prague, Czech Republic
| | - Daniel A Morris
- Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin, Campus Virchow Klinikum
| | - Eike Nagel
- Institute for Experimental and Translational Cardiovascular Imaging, University Hospital Frankfurt.,German Centre for Cardiovascular Research (DZHK), Partner Site Frankfurt, Germany
| | - Elisabeth Pieske-Kraigher
- Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin, Campus Virchow Klinikum
| | | | - Scott D Solomon
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Ramachandran S Vasan
- Section of Preventive Medicine and Epidemiology and Cardiovascular Medicine, Department of Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Frans H Rutten
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Adriaan A Voors
- University Medical Centre Groningen, University of Groningen, Department of Cardiology, Groningen, the Netherlands
| | - Frank Ruschitzka
- University Heart Centre, University Hospital Zurich, Switzerland
| | - Walter J Paulus
- Department of Physiology and Amsterdam Cardiovascular Sciences, Amsterdam University Medical Center, The Netherlands
| | - Petar Seferovic
- University of Belgrade School of Medicine, Belgrade University Medical Center, Serbia
| | - Gerasimos Filippatos
- Department of Cardiology, National and Kapodistrian University of Athens Medical School; University Hospital "Attikon", Athens, Greece.,University of Cyprus, School of Medicine, Nicosia, Cyprus
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7
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Friebel J, Weithauser A, Witkowski M, Rauch BH, Savvatis K, Dörner A, Tabaraie T, Kasner M, Moos V, Bösel D, Gotthardt M, Radke MH, Wegner M, Bobbert P, Lassner D, Tschöpe C, Schutheiss HP, Felix SB, Landmesser U, Rauch U. Protease-activated receptor 2 deficiency mediates cardiac fibrosis and diastolic dysfunction. Eur Heart J 2020; 40:3318-3332. [PMID: 31004144 DOI: 10.1093/eurheartj/ehz117] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Revised: 11/11/2018] [Accepted: 04/05/2019] [Indexed: 02/06/2023] Open
Abstract
AIMS Heart failure with preserved ejection fraction (HFpEF) and pathological cardiac aging share a complex pathophysiology, including extracellular matrix remodelling (EMR). Protease-activated receptor 2 (PAR2) deficiency is associated with EMR. The roles of PAR1 and PAR2 have not been studied in HFpEF, age-dependent cardiac fibrosis, or diastolic dysfunction (DD). METHODS AND RESULTS Evaluation of endomyocardial biopsies from patients with HFpEF (n = 14) revealed that a reduced cardiac PAR2 expression was associated with aggravated DD and increased myocardial fibrosis (r = -0.7336, P = 0.0028). In line, 1-year-old PAR2-knockout (PAR2ko) mice suffered from DD with preserved systolic function, associated with an increased age-dependent α-smooth muscle actin expression, collagen deposition (1.7-fold increase, P = 0.0003), lysyl oxidase activity, collagen cross-linking (2.2-fold increase, P = 0.0008), endothelial activation, and inflammation. In the absence of PAR2, the receptor-regulating protein caveolin-1 was down-regulated, contributing to an augmented profibrotic PAR1 and transforming growth factor beta (TGF-β)-dependent signalling. This enhanced TGF-β/PAR1 signalling caused N-proteinase (ADAMTS3) and C-proteinase (BMP1)-related increased collagen I production from cardiac fibroblasts (CFs). PAR2 overexpression in PAR2ko CFs reversed these effects. The treatment with the PAR1 antagonist, vorapaxar, reduced cardiac fibrosis by 44% (P = 0.03) and reduced inflammation in a metabolic disease model (apolipoprotein E-ko mice). Patients with HFpEF with upstream PAR inhibition via FXa inhibitors (n = 40) also exhibited reduced circulating markers of fibrosis and DD compared with patients treated with vitamin K antagonists (n = 20). CONCLUSIONS Protease-activated receptor 2 is an important regulator of profibrotic PAR1 and TGF-β signalling in the heart. Modulation of the FXa/FIIa-PAR1/PAR2/TGF-β-axis might be a promising therapeutic approach to reduce HFpEF.
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Affiliation(s)
- Julian Friebel
- Department of Cardiology, Charité Center 11, Charité-University Medicine Berlin, Hindenburgdamm 30, Berlin, Germany
| | - Alice Weithauser
- Department of Cardiology, Charité Center 11, Charité-University Medicine Berlin, Hindenburgdamm 30, Berlin, Germany
| | - Marco Witkowski
- Department of Cardiology, Charité Center 11, Charité-University Medicine Berlin, Hindenburgdamm 30, Berlin, Germany
| | - Bernhard H Rauch
- Institute of Pharmacology, Center of Drug Absorption and Transport, University Medicine Greifswald, Felix-Hausdorff-Str. 3, Greifswald, Germany.,German Centre for Cardiovascular Research (DZHK), Partner Site Greifswald, Ferdinand-Sauerbruch-Str., Greifswald, Germany
| | - Konstantinos Savvatis
- Inherited Cardiovascular Diseases Unit, Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London, UK.,William Harvey Research Institute, Queen Mary University London, Charterhouse Square, London, UK
| | - Andrea Dörner
- Department of Cardiology, Charité Center 11, Charité-University Medicine Berlin, Hindenburgdamm 30, Berlin, Germany
| | - Termeh Tabaraie
- Department of Cardiology, Charité Center 11, Charité-University Medicine Berlin, Hindenburgdamm 30, Berlin, Germany
| | - Mario Kasner
- Department of Cardiology, Charité Center 11, Charité-University Medicine Berlin, Hindenburgdamm 30, Berlin, Germany
| | - Verena Moos
- Medical Department I, Gastroenterology, Infectious Diseases and Rheumatology, Charité-University Medicine Berlin, Hindenburgdamm 30, Berlin, Germany
| | - Diana Bösel
- Medical Department I, Gastroenterology, Infectious Diseases and Rheumatology, Charité-University Medicine Berlin, Hindenburgdamm 30, Berlin, Germany
| | - Michael Gotthardt
- Neuromuscular and Cardiovascular Cell Biology, Max Delbrück Center for Molecular Medicine, Berlin, Robert-Rössle-Str. 10, Berlin, Germany.,German Centre for Cardiovascular Research (DZHK), Partner Site Berlin, Oudenarder Straße 16, Berlin, Germany
| | - Michael H Radke
- Neuromuscular and Cardiovascular Cell Biology, Max Delbrück Center for Molecular Medicine, Berlin, Robert-Rössle-Str. 10, Berlin, Germany.,German Centre for Cardiovascular Research (DZHK), Partner Site Berlin, Oudenarder Straße 16, Berlin, Germany
| | - Max Wegner
- Department of Cardiology, Charité Center 11, Charité-University Medicine Berlin, Hindenburgdamm 30, Berlin, Germany
| | - Peter Bobbert
- Department of Internal Medicine and Angiology, Hubertus Hospital, Berlin, Spanische Allee 10-14, Berlin, Germany
| | - Dirk Lassner
- Institute for Cardiac Diagnostics and Therapy (IKDT), Moltkestr. 31, Berlin, Germany
| | - Carsten Tschöpe
- Department of Cardiology, Charité Center 11, Charité-University Medicine Berlin, Hindenburgdamm 30, Berlin, Germany
| | | | - Stephan B Felix
- German Centre for Cardiovascular Research (DZHK), Partner Site Greifswald, Ferdinand-Sauerbruch-Str., Greifswald, Germany.,Department of Internal Medicine B, Cardiology, University Medicine Greifswald, Ferdinand-Sauerbruch-Str., Greifswald, Germany
| | - Ulf Landmesser
- Department of Cardiology, Charité Center 11, Charité-University Medicine Berlin, Hindenburgdamm 30, Berlin, Germany.,German Centre for Cardiovascular Research (DZHK), Partner Site Berlin, Oudenarder Straße 16, Berlin, Germany
| | - Ursula Rauch
- Department of Cardiology, Charité Center 11, Charité-University Medicine Berlin, Hindenburgdamm 30, Berlin, Germany.,German Centre for Cardiovascular Research (DZHK), Partner Site Berlin, Oudenarder Straße 16, Berlin, Germany
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8
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Heizer J, Carbone S, Billingsley HE, VAN Tassell BW, Arena R, Abbate A, Canada JM. Left ventricular concentric remodeling and impaired cardiorespiratory fitness in patients with heart failure and preserved ejection fraction. Minerva Cardiol Angiol 2020; 69:438-445. [PMID: 32996304 DOI: 10.23736/s2724-5683.20.05295-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Left ventricular (LV) concentric remodeling refers to a process by which increased LV relative wall thickness alters myocardial geometry, resulting in reduced LV end-diastolic volume (LVEDV) and stroke volume (SV). While the degree of concentric remodeling is a negative prognostic factor in heart failure with preserved ejection fraction (HFpEF), it is not known how it contributes to cardiorespiratory fitness (CRF). METHODS We performed a retrospective analysis of patients with HFpEF who underwent treadmill single-photon emission computed tomography myocardial perfusion imaging (SPECT-MPI) and cardiopulmonary exercise testing (CPX). From exercise SPECT-MPI, we recorded postexercise LVEDVi, LVESVi, SVi, LVEF, the presence and extent of perfusion defects, and perfusion reversibility. Peak oxygen consumption (VO<inf>2</inf>), the oxygen uptake efficiency slope (OUES), oxygen (O<inf>2</inf>) pulse, ventilatory efficiency (V<inf>E</inf>/VCO<inf>2</inf> slope), ventilatory anaerobic threshold, respiratory exchange ratio, exercise time, and maximum heart rate were obtained from CPX. Data are expressed as mean (±standard deviation). Univariate and multivariate linear regression was performed. RESULTS We identified 23 subjects who had completed both an exercise SPECT-MPI and a CPX. Patients were more commonly women (83%), black (65%), middle age (50 [±7.3] years), and obese (Body Mass Index [BMI] 39.7 [±6.0] kg/m2). Greater LVEDVi and LVESVi correlated positively with peak VO<inf>2</inf> (R=+0.648, P=0.001; R=+0.601, P=0.002), O<inf>2</inf> pulse (R=+0.686, P<0.001; R=+0.625, P=0.001) and OUES (R=+0.882, P<0.001; R=+0.779, P<0.001). The LVEF correlated inversely with peak VO<inf>2</inf> and OUES (R=-0.450, P=0.031; R=-0.485, P=0.035). Perfusion defect area, grade of severity, and presence of reversibility were not associated with CRF variables. CONCLUSIONS Postexercise reduced LV volumes correlate with measures of impaired CRF in patients with HFpEF, thus supporting a pathophysiologic role of concentric remodeling in impaired CRF in HFpEF.
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Affiliation(s)
- Justin Heizer
- VCU Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, USA
| | - Salvatore Carbone
- VCU Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, USA.,Department of Kinesiology and Health Sciences, College of Humanities and Sciences, Virginia Commonwealth University, Richmond, VA, USA
| | - Hayley E Billingsley
- VCU Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, USA.,Department of Kinesiology and Health Sciences, College of Humanities and Sciences, Virginia Commonwealth University, Richmond, VA, USA
| | - Benjamin W VAN Tassell
- Department of Pharmacotherapy and Outcome Sciences, Virginia Commonwealth University, Richmond, VA, USA
| | - Ross Arena
- Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, USA
| | - Antonio Abbate
- VCU Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, USA
| | - Justin M Canada
- VCU Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, USA -
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9
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Dzhioeva O, Belyavskiy E. Diagnosis and Management of Patients with Heart Failure with Preserved Ejection Fraction (HFpEF): Current Perspectives and Recommendations. Ther Clin Risk Manag 2020; 16:769-785. [PMID: 32904123 PMCID: PMC7450524 DOI: 10.2147/tcrm.s207117] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 07/20/2020] [Indexed: 12/13/2022] Open
Abstract
Heart failure with preserved ejection fraction (HFpEF) is a major global public health problem. Diagnosis of HFpEF is still challenging and built based on the comprehensive echocardiographic analysis. Currently, there are no universally accepted therapies that alter the clinical course of HFpEF. This review attempts to summarize the current advances in the diagnosis of HFpEF and provide future directions of the patients´ management with this very widespread, heterogeneous clinical syndrome.
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Affiliation(s)
- Olga Dzhioeva
- Department of Fundamental and Applied Aspects of Obesity, National Medical Research Center for Preventive Medicine of the Ministry of Health of the Russian Federation, Moscow, Russia
| | - Evgeny Belyavskiy
- Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
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10
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Pieske B, Tschöpe C, de Boer RA, Fraser AG, Anker SD, Donal E, Edelmann F, Fu M, Guazzi M, Lam CSP, Lancellotti P, Melenovsky V, Morris DA, Nagel E, Pieske-Kraigher E, Ponikowski P, Solomon SD, Vasan RS, Rutten FH, Voors AA, Ruschitzka F, Paulus WJ, Seferovic P, Filippatos G. How to diagnose heart failure with preserved ejection fraction: the HFA-PEFF diagnostic algorithm: a consensus recommendation from the Heart Failure Association (HFA) of the European Society of Cardiology (ESC). Eur J Heart Fail 2020; 22:391-412. [PMID: 32133741 DOI: 10.1002/ejhf.1741] [Citation(s) in RCA: 180] [Impact Index Per Article: 45.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 10/30/2018] [Accepted: 08/26/2019] [Indexed: 12/11/2022] Open
Abstract
Making a firm diagnosis of chronic heart failure with preserved ejection fraction (HFpEF) remains a challenge. We recommend a new stepwise diagnostic process, the 'HFA-PEFF diagnostic algorithm'. Step 1 (P=Pre-test assessment) is typically performed in the ambulatory setting and includes assessment for heart failure symptoms and signs, typical clinical demographics (obesity, hypertension, diabetes mellitus, elderly, atrial fibrillation), and diagnostic laboratory tests, electrocardiogram, and echocardiography. In the absence of overt non-cardiac causes of breathlessness, HFpEF can be suspected if there is a normal left ventricular (LV) ejection fraction, no significant heart valve disease or cardiac ischaemia, and at least one typical risk factor. Elevated natriuretic peptides support, but normal levels do not exclude a diagnosis of HFpEF. The second step (E: Echocardiography and Natriuretic Peptide Score) requires comprehensive echocardiography and is typically performed by a cardiologist. Measures include mitral annular early diastolic velocity (e'), LV filling pressure estimated using E/e', left atrial volume index, LV mass index, LV relative wall thickness, tricuspid regurgitation velocity, LV global longitudinal systolic strain, and serum natriuretic peptide levels. Major (2 points) and Minor (1 point) criteria were defined from these measures. A score ≥5 points implies definite HFpEF; ≤1 point makes HFpEF unlikely. An intermediate score (2-4 points) implies diagnostic uncertainty, in which case Step 3 (F1 : Functional testing) is recommended with echocardiographic or invasive haemodynamic exercise stress tests. Step 4 (F2 : Final aetiology) is recommended to establish a possible specific cause of HFpEF or alternative explanations. Further research is needed for a better classification of HFpEF.
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Affiliation(s)
- Burkert Pieske
- Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin, Campus Virchow Klinikum.,German Center for Cardiovascular Research (DZHK), Berlin, Partner Site, Germany.,Department of Internal Medicine and Cardiology, German Heart Institute, Berlin, Germany.,Berlin Institute of Health (BIH), Germany
| | - Carsten Tschöpe
- Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin, Campus Virchow Klinikum.,German Center for Cardiovascular Research (DZHK), Berlin, Partner Site, Germany.,Berlin Institute of Health (BIH) Center for Regenerative Therapies (BCRT), Charite, Berlin, Germany
| | - Rudolf A de Boer
- University Medical Centre Groningen, University of Groningen, Department of Cardiology, Groningen, the Netherlands
| | | | - Stefan D Anker
- Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin, Campus Virchow Klinikum.,German Center for Cardiovascular Research (DZHK), Berlin, Partner Site, Germany.,Berlin Institute of Health (BIH) Center for Regenerative Therapies (BCRT), Charite, Berlin, Germany.,Department of Cardiology and Pneumology, University Medicine Göttingen (UMG), Germany
| | - Erwan Donal
- Cardiology and CIC, IT1414, CHU de Rennes LTSI, Université Rennes-1, INSERM 1099, Rennes, France
| | - Frank Edelmann
- Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin, Campus Virchow Klinikum.,German Center for Cardiovascular Research (DZHK), Berlin, Partner Site, Germany
| | - Michael Fu
- Section of Cardiology, Department of Medicine, Sahlgrenska University Hosptal/Ostra, Göteborg, Sweden
| | - Marco Guazzi
- Department of Biomedical Sciences for Health, University of Milan, IRCCS, Milan, Italy.,Department of Cardiology, IRCCS Policlinico, San Donato Milanese, Milan, Italy
| | - Carolyn S P Lam
- National Heart Centre, Singapore & Duke-National University of Singapore.,University Medical Centre Groningen, The Netherlands
| | - Patrizio Lancellotti
- Department of Cardiology, Heart Valve Clinic, University of Liège Hospital, GIGA Cardiovascular Sciences, CHU Sart Tilman, Liège, Belgium
| | - Vojtech Melenovsky
- Institute for Clinical and Experimental Medicine - IKEM, Prague, Czech Republic
| | - Daniel A Morris
- Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin, Campus Virchow Klinikum
| | - Eike Nagel
- Institute for Experimental and Translational Cardiovascular Imaging, University Hospital Frankfurt.,German Centre for Cardiovascular Research (DZHK), Partner Site Frankfurt, Germany
| | - Elisabeth Pieske-Kraigher
- Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin, Campus Virchow Klinikum
| | | | - Scott D Solomon
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Ramachandran S Vasan
- Section of Preventive Medicine and Epidemiology and Cardiovascular Medicine, Department of Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Frans H Rutten
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Adriaan A Voors
- University Medical Centre Groningen, University of Groningen, Department of Cardiology, Groningen, the Netherlands
| | - Frank Ruschitzka
- University Heart Centre, University Hospital Zurich, Switzerland
| | - Walter J Paulus
- Department of Physiology and Amsterdam Cardiovascular Sciences, Amsterdam University Medical Center, The Netherlands
| | - Petar Seferovic
- University of Belgrade School of Medicine, Belgrade University Medical Center, Serbia
| | - Gerasimos Filippatos
- Department of Cardiology, National and Kapodistrian University of Athens Medical School; University Hospital "Attikon", Athens, Greece.,University of Cyprus, School of Medicine, Nicosia, Cyprus
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11
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Pandey A, Khera R, Park B, Haykowsky M, Borlaug BA, Lewis GD, Kitzman DW, Butler J, Berry JD. Relative Impairments in Hemodynamic Exercise Reserve Parameters in Heart Failure With Preserved Ejection Fraction: A Study-Level Pooled Analysis. JACC-HEART FAILURE 2019; 6:117-126. [PMID: 29413366 DOI: 10.1016/j.jchf.2017.10.014] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2017] [Revised: 10/21/2017] [Accepted: 10/23/2017] [Indexed: 12/23/2022]
Abstract
OBJECTIVES The aim of this study was to compare the relative impairment in different exercise hemodynamic reserve parameters in patients with heart failure with preserved ejection fraction (HFpEF) and control patients using a study-level meta-analysis. BACKGROUND A cardinal manifestation of chronic HFpEF is severely decreased exercise capacity. Developing effective therapies for exercise intolerance in HFpEF requires optimal understanding of the factors underlying exercise intolerance. METHODS Data were included from 17 unique cohorts that measured peak oxygen uptake and hemodynamic or echocardiographic parameters during exercise in patients with HFpEF and control subjects in this meta-analysis. Standardized mean differences (SMDs) in the exercise reserve (exercise - resting) measures of hemodynamic or echocardiographic parameters between the HFpEF and control groups were pooled in a random-effects meta-analysis. RESULTS The pooled analysis included 910 patients with HFpEF and 476 control subjects. In pooled analysis, patients with HFpEF had significantly lower peak oxygen uptake (SMD: -2.13; 95% confidence interval [CI]: -2.68 to -1.57). Among hemodynamic exercise reserve parameters, the largest impairment was observed in chronotropic response reserve (change in heart rate from rest to peak exercise; SMD: -1.87; 95% CI: -2.44 to -1.29), followed by exaggerated increase in pulmonary capillary wedge pressure with exercise (SMD: 1.78; 95% CI: 1.46 to 2.09). Significant abnormalities were also observed in the arteriovenous oxygen difference reserve and stroke volume reserve between the HFpEF and control groups. CONCLUSIONS The most consistent and severe hemodynamic reserve abnormalities observed in patients with HFpEF were impairment in chronotropic reserve and exaggerated increase in pulmonary capillary wedge pressure with exercise. These may be important targets for therapeutic strategies to improve exercise tolerance in patients with HFpEF.
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Affiliation(s)
- Ambarish Pandey
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwest Medical Center, Dallas, Texas
| | - Rohan Khera
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwest Medical Center, Dallas, Texas
| | - Bryan Park
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwest Medical Center, Dallas, Texas
| | - Mark Haykowsky
- College of Nursing and Health Innovation, University of Texas at Arlington, Arlington, Texas
| | - Barry A Borlaug
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - Gregory D Lewis
- Division of Cardiology, Department of Internal Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Dalane W Kitzman
- Department of Internal Medicine, Sections on Cardiovascular Medicine and Geriatrics, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Javed Butler
- Division of Cardiology, Department of Internal Medicine, Stony Brook University School of Medicine, New York, New York
| | - Jarett D Berry
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwest Medical Center, Dallas, Texas.
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12
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Arques S. [Why not integrate the spectral tissue Doppler E/(e'xs') in the multiparametric assessment of cardiovascular diseases by transthoracic Doppler echocardiography?]. Ann Cardiol Angeiol (Paris) 2019; 68:358-362. [PMID: 31466722 DOI: 10.1016/j.ancard.2019.07.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2019] [Accepted: 07/22/2019] [Indexed: 06/10/2023]
Abstract
Assessment of left ventricular diastolic function by transthoracic Doppler echocardiography is based on a multiparametric approach which includes the spectral tissue Doppler-derived E/e'. Recently, a new Doppler index, E/(e'xs'), which combines E/e' with a spectral tissue Doppler-derived marker of systolic function, s', has been proposed in noninvasive assessment of left ventricular myocardial dysfunction. Current literature provides evidence that E/(e'xs') has good correlation with NT proBNP levels and invasive left ventricular end-diastolic pressure, both used as markers of left ventricular myocardial dysfunction, irrespective of left ventricular ejection fraction and wall motion abnormalities. More specifically, E/(e'xs') has good diagnostic accuracy in patients with intermediate values for E/e' (8 to 15). Average E/(e'xs')>1.6 is reported to predict invasive left ventricular end-diastolic pressure>15mmHg with a sensitivity of 86% and a specificity of 85%. Current literature provides evidence that E/(e'xs') could offer better prognostic information than E/e' in patients with systolic heart failure and heart failure with normal ejection fraction, as well as in patients with asymptomatic heart disease. A few clinical studies also suggest that E/(e'xs') could predict recurrence of atrial fibrillation after cardioversion and left ventricular remodeling after acute myocardial infarction. Further experimental and clinical investigation is critically needed to determine the role of this under-recognized tissue Doppler index in noninvasive assessment of cardiovascular diseases, in particular heart failure with normal ejection fraction.
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Affiliation(s)
- S Arques
- Unité fonctionnelle de cardiologie, centre hospitalier Edmond-Garcin, avenue des Soeurs-Gastine, 13400 Aubagne, France.
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13
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Nordanstig J, Bech-Hanssen O, Skoog P, Jivegård L. Echocardiographic assessment at rest and during stress in patients with intermittent claudication. SCAND CARDIOVASC J 2019; 53:153-161. [DOI: 10.1080/14017431.2019.1616813] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Joakim Nordanstig
- Departments of Vascular Surgery, Sahlgrenska University Hospital, Goteborg, Sweden
- Institute of Medicine at The Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Odd Bech-Hanssen
- Institute of Medicine at The Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
- Clinical Physiology, Sahlgrenska University Hospital, Goteborg, Sweden
| | - Per Skoog
- Departments of Vascular Surgery, Sahlgrenska University Hospital, Goteborg, Sweden
- Institute of Medicine at The Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Lennart Jivegård
- Departments of Vascular Surgery, Sahlgrenska University Hospital, Goteborg, Sweden
- Institute of Medicine at The Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
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14
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Tokmachev RE, Mukhortova MS, Budnevsky AV, Tokmachev EV, Ovsyannikov ES. Comorbidity of chronic heart failure and chronic obstructive pulmonary disease: features of pathogenesis, clinic and diagnostics. КАРДИОВАСКУЛЯРНАЯ ТЕРАПИЯ И ПРОФИЛАКТИКА 2018. [DOI: 10.15829/1728-8800-2018-6-62-68] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
This article discusses the epidemiology of chronic heart failure (CHF) and chronic obstructive pulmonary disease (COPD). CHF and COPD are characterized by high prevalence and high mortality, especially when they are combined. The article analyzes the general mechanisms of formation of these diseases: the relationship of COPD with cardiovascular diseases is explained by common risk factors, including smoking, physical inactivity, improper feeding and genetic predisposition. The leading role in the pathogenesis of pathologies is played by the activation and maintenance of systemic inflammation. Article presents the features of the clinical picture and the direction of the diagnostics in case of suspected combined pathology, the possibilities of modern laboratory and instrumental research methods. Diagnostics of comorbidity of CHF and COPD may be difficult, given the above common risk factors, some common pathogenesis mechanisms and similar clinical symptoms. However the caution regarding the comorbidity of the studied conditions, as well as a thorough clinical examination and the appointment of the necessary additional research methods, can reduce the number of diagnostic mistakes and improve the prognosis in such patients.
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Granegger M, Dave H, Knirsch W, Thamsen B, Schweiger M, Hübler M. A Valveless Pulsatile Pump for the Treatment of Heart Failure with Preserved Ejection Fraction: A Simulation Study. Cardiovasc Eng Technol 2018; 10:69-79. [PMID: 30536212 DOI: 10.1007/s13239-018-00398-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Accepted: 12/03/2018] [Indexed: 12/13/2022]
Abstract
PURPOSE Effective treatment of patients with terminal heart failure and preserved ejection fraction (HFpEF) is an unmet medical need. The aim of this study was to investigate a novel valveless pulsatile pump as a therapeutic option for the HFpEF population through comprehensive in silico investigations. METHODS The pump was simulated in a numerical model of the cardiovascular system of four HFpEF phenotypes and compared to a typical case of heart failure with reduced ejection fraction (HFrEF). The proposed pump, which was modeled as being directly connected to the left ventricle, features a single valveless inlet and outlet cannula and is driven in co-pulsation with the left ventricle. We collected hemodynamics for two different pump volumes (30 and 60 mL). RESULTS In all HFpEF conditions, the 30 mL pump improved the cardiac output by approximately 1 L/min, increased the mean arterial pressure by > 11% and lowered the mean left atrial pressure by > 30%. With the larger (60 mL) stroke volume, these hemodynamic improvements were more pronounced. In the HFrEF condition however, these effects were three times less in magnitude. CONCLUSIONS In this simulation study, the valveless pulsatile device improves hemodynamics in HFpEF patients by increasing the total stroke volume. The hemodynamic benefits are achieved with a small device volume comparable to implantable rotary blood pumps.
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Affiliation(s)
- Marcus Granegger
- Pediatric Cardiovascular Surgery, Department of Surgery, Pediatric Heart Center, University Children's Hospital Zurich, Zurich, Switzerland. .,Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland.
| | - Hitendu Dave
- Pediatric Cardiovascular Surgery, Department of Surgery, Pediatric Heart Center, University Children's Hospital Zurich, Zurich, Switzerland.,Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland
| | - Walter Knirsch
- Pediatric Cardiology, Department of Surgery, Pediatric Heart Center, University Children's Hospital Zurich, Zurich, Switzerland.,Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland
| | - Bente Thamsen
- Pediatric Cardiovascular Surgery, Department of Surgery, Pediatric Heart Center, University Children's Hospital Zurich, Zurich, Switzerland.,Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland
| | - Martin Schweiger
- Pediatric Cardiovascular Surgery, Department of Surgery, Pediatric Heart Center, University Children's Hospital Zurich, Zurich, Switzerland.,Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland
| | - Michael Hübler
- Pediatric Cardiovascular Surgery, Department of Surgery, Pediatric Heart Center, University Children's Hospital Zurich, Zurich, Switzerland.,Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland
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16
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Belyavskiy E, Morris DA, Url-Michitsch M, Verheyen N, Meinitzer A, Radhakrishnan AK, Kropf M, Frydas A, Ovchinnikov AG, Schmidt A, Tadic M, Genger M, Lindhorst R, Bobenko A, Tschöpe C, Edelmann F, Pieske-Kraigher E, Pieske B. Diastolic stress test echocardiography in patients with suspected heart failure with preserved ejection fraction: a pilot study. ESC Heart Fail 2018; 6:146-153. [PMID: 30451399 PMCID: PMC6352885 DOI: 10.1002/ehf2.12375] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 09/07/2018] [Accepted: 10/10/2018] [Indexed: 12/28/2022] Open
Abstract
AIMS The purpose of this pilot study was to assess the potential usefulness of diastolic stress test (DST) echocardiography in patients with suspected heart failure with preserved ejection fraction (HFpEF). METHODS AND RESULTS Patients with suspected HFpEF (left ventricular ejection fraction ≥ 50%, exertional dyspnoea, septal E/e' at rest 9-14, and N-terminal pro-B-type natriuretic peptide (NT-proBNP) at rest < 220 pg/mL; n = 13) and a control group constituted from asymptomatic patients with arterial hypertension (n = 19) and healthy subjects (n = 18) were included. All patients were analysed by two-dimensional and Doppler echocardiography at rest and during exercise (DST) and underwent cardiopulmonary exercise testing and NT-proBNP analysis during exercise. HFpEF during exercise was defined as exertional dyspnoea and peak VO2 ≤ 20.0 mL/min/kg. In patients with suspected HFpEF at rest, 84.6% of these patients developed HFpEF during exercise, whereas in the group of asymptomatic patients with hypertension and healthy subjects, the rate of developed HFpEF during exercise was 0%. Regarding the diagnostic performance of DST to detect HFpEF during exercise, an E/e' ratio >15 during exercise was the most accurate parameter to detect HFpEF (accuracy 86%), albeit a low sensitivity (45.5%). Nonetheless, combining E/e' with tricuspid regurgitation (TR) velocity > 2.8 m/s during exercise provided a significant increase in the sensitivity to detect patients with HFpEF during exercise (sensitivity 72.7%, specificity 79.5%, and accuracy 78%). Consistent with these findings, an increase of E/e' was significantly linked to worse peak VO2 , and the combination of an increase of both E/e' and TR velocity was associated with elevated NT-proBNP values during exercise. CONCLUSIONS The findings of this pilot study suggest that DST using E/e' ratio and TR velocity could be of potential usefulness to diagnose HFpEF during exercise in patients with suspected HFpEF at rest.
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Affiliation(s)
- Evgeny Belyavskiy
- Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin, Campus Virchow Klinikum, Berlin, Germany.,German Center for Cardiovascular Research (DZHK), partner site Berlin, Berlin, Germany
| | - Daniel A Morris
- Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin, Campus Virchow Klinikum, Berlin, Germany
| | | | - Nicolas Verheyen
- Department of Cardiology, Medical University Graz, Graz, Austria
| | - Andreas Meinitzer
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria
| | - Aravind-Kumar Radhakrishnan
- Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin, Campus Virchow Klinikum, Berlin, Germany
| | - Martin Kropf
- Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin, Campus Virchow Klinikum, Berlin, Germany.,AIT Austrian Institute of Technology, Graz, Austria
| | - Athanasios Frydas
- Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin, Campus Virchow Klinikum, Berlin, Germany.,Berlin Institute of Health (BIH), Berlin, Germany
| | - Artem G Ovchinnikov
- Out-Patient Department, Institute of Clinical Cardiology of A.L.Myasnikov, National Medical Research Center of Cardiology of Ministry of Healthcare of the Russian Federation, Moscow, Russia
| | - Albrecht Schmidt
- Department of Cardiology, Medical University Graz, Graz, Austria
| | - Marijana Tadic
- Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin, Campus Virchow Klinikum, Berlin, Germany
| | - Martin Genger
- Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin, Campus Virchow Klinikum, Berlin, Germany.,Department of Cardiology and Intensive Care Medicine, LKH Graz Süd-West, Graz, Austria
| | - Ruhdja Lindhorst
- Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin, Campus Virchow Klinikum, Berlin, Germany
| | - Anna Bobenko
- Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin, Campus Virchow Klinikum, Berlin, Germany.,German Center for Cardiovascular Research (DZHK), partner site Berlin, Berlin, Germany.,Berlin Institute of Health (BIH), Berlin, Germany
| | - Carsten Tschöpe
- Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin, Campus Virchow Klinikum, Berlin, Germany.,German Center for Cardiovascular Research (DZHK), partner site Berlin, Berlin, Germany.,Charité, Berlin Center for Regenerative Therapies (BCRT), Campus Virchow Klinikum (CVK), Berlin, Germany
| | - Frank Edelmann
- Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin, Campus Virchow Klinikum, Berlin, Germany.,German Center for Cardiovascular Research (DZHK), partner site Berlin, Berlin, Germany.,Berlin Institute of Health (BIH), Berlin, Germany
| | - Elisabeth Pieske-Kraigher
- Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin, Campus Virchow Klinikum, Berlin, Germany
| | - Burkert Pieske
- Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin, Campus Virchow Klinikum, Berlin, Germany.,German Center for Cardiovascular Research (DZHK), partner site Berlin, Berlin, Germany.,Berlin Institute of Health (BIH), Berlin, Germany.,Department of Internal Medicine and Cardiology German Heart Center Berlin, Berlin, Germany
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17
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Circular RNAs as Novel Biomarkers for Cardiovascular Diseases. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2018; 1087:159-170. [DOI: 10.1007/978-981-13-1426-1_13] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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18
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Hohendanner F, Messroghli D, Bode D, Blaschke F, Parwani A, Boldt L, Heinzel FR. Atrial remodelling in heart failure: recent developments and relevance for heart failure with preserved ejection fraction. ESC Heart Fail 2018; 5:211-221. [PMID: 29457877 PMCID: PMC5880666 DOI: 10.1002/ehf2.12260] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Accepted: 12/11/2017] [Indexed: 12/11/2022] Open
Affiliation(s)
- Felix Hohendanner
- Department of CardiologyCharité University MedicineCampus Virchow‐Klinikum, Augustenburger Platz 113353BerlinGermany
- German Center for Cardiovascular Research (DZHK), Partner SiteBerlinGermany
| | - Daniel Messroghli
- Department of CardiologyCharité University MedicineCampus Virchow‐Klinikum, Augustenburger Platz 113353BerlinGermany
- German Center for Cardiovascular Research (DZHK), Partner SiteBerlinGermany
- Department of Internal Medicine—CardiologyDeutsches Herzzentrum BerlinBerlinGermany
| | - David Bode
- Department of CardiologyCharité University MedicineCampus Virchow‐Klinikum, Augustenburger Platz 113353BerlinGermany
- German Center for Cardiovascular Research (DZHK), Partner SiteBerlinGermany
| | - Florian Blaschke
- Department of CardiologyCharité University MedicineCampus Virchow‐Klinikum, Augustenburger Platz 113353BerlinGermany
- German Center for Cardiovascular Research (DZHK), Partner SiteBerlinGermany
| | - Abdul Parwani
- Department of CardiologyCharité University MedicineCampus Virchow‐Klinikum, Augustenburger Platz 113353BerlinGermany
- German Center for Cardiovascular Research (DZHK), Partner SiteBerlinGermany
| | - Leif‐Hendrik Boldt
- Department of CardiologyCharité University MedicineCampus Virchow‐Klinikum, Augustenburger Platz 113353BerlinGermany
- German Center for Cardiovascular Research (DZHK), Partner SiteBerlinGermany
| | - Frank R. Heinzel
- Department of CardiologyCharité University MedicineCampus Virchow‐Klinikum, Augustenburger Platz 113353BerlinGermany
- German Center for Cardiovascular Research (DZHK), Partner SiteBerlinGermany
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19
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Tschöpe C, Birner C, Böhm M, Bruder O, Frantz S, Luchner A, Maier L, Störk S, Kherad B, Laufs U. Heart failure with preserved ejection fraction: current management and future strategies : Expert opinion on the behalf of the Nucleus of the "Heart Failure Working Group" of the German Society of Cardiology (DKG). Clin Res Cardiol 2017; 107:1-19. [PMID: 29018938 DOI: 10.1007/s00392-017-1170-6] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Accepted: 10/02/2017] [Indexed: 12/21/2022]
Abstract
About 50% of all patients suffering from heart failure (HF) exhibit a reduced ejection fraction (EF ≤ 40%), termed HFrEF. The others may be classified into HF with midrange EF (HFmrEF 40-50%) or preserved ejection fraction (HFpEF, EF ≥ 50%). Presentation and pathophysiology of HFpEF is heterogeneous and its management remains a challenge since evidence of therapeutic benefits on outcome is scarce. Up to now, there are no therapies improving survival in patients with HFpEF. Thus, the treatment targets symptom relief, quality of life and reduction of cardiac decompensations by controlling fluid retention and managing risk factors and comorbidities. As such, renin-angiotensin-aldosterone inhibitors, diuretics, calcium channel blockers (CBB) and beta-blockers, diet and exercise recommendations are still important in HFpEF, although these interventions are not proven to reduce mortality in large randomized controlled trials. Recently, numerous new treatment targets have been identified, which are further investigated in studies using, e.g. soluble guanylate cyclase stimulators, inorganic nitrates, the angiotensin receptor neprilysin inhibitor LCZ 696, and SGLT2 inhibitors. In addition, several devices such as the CardioMEMS, interatrial septal devices (IASD), cardiac contractility modulation (CCM), renal denervation, and baroreflex activation therapy (BAT) were investigated in different forms of HFpEF populations and some of them have the potency to offer new hopes for patients suffering from HFpEF. On the basic research field side, lot of new disease-modifying strategies are under development including anti-inflammatory drugs, mitochondrial-targeted antioxidants, new anti-fibrotic and microRNA-guided interventions are under investigation and showed already promising results. This review addresses available data of current best clinical practice and management approaches based on expert experiences and summarizes novel approaches towards HFpEF.
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Affiliation(s)
- Carsten Tschöpe
- Department of Cardiology, Universitätsmedizin Berlin, Charite, Campus Rudolf Virchow Clinic (CVK), Augustenburger Platz 1, 13353, Berlin, Germany. .,Berliner Zentrum für Regenerative Therapien (BCRT), Charite, Campus Virchow Clinic (CVK), Berlin, Germany. .,Deutsches Zentrum für Herz Kreislaufforschung (DZHK), Standort Berlin/Charité, Berlin, Germany.
| | - Christoph Birner
- Germany Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
| | - Michael Böhm
- Innere Medizin III-Kardiologie, Angiologie und internistische Intensivmedizin, Universitätsklinikum des Saarlandes und Medizinische Fakultät der Universität des Saarlandes, Homburg, Germany
| | - Oliver Bruder
- Department of Cardiology and Angiology, Elisabeth Hospital, Essen, Germany
| | - Stefan Frantz
- Department of Internal Medicine III, University Halle, Halle, Germany
| | - Andreas Luchner
- Department of Internal Medicine I, Clinic St. Marien, Amberg, Germany
| | - Lars Maier
- Germany Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
| | - Stefan Störk
- Deutsches Zentrum für Herzinsuffizienz, Universitätsklinikum und Universität Würzburg, Würzburg, Germany
| | - Behrouz Kherad
- Department of Cardiology, Universitätsmedizin Berlin, Charite, Campus Rudolf Virchow Clinic (CVK), Augustenburger Platz 1, 13353, Berlin, Germany.,Privatpraxis Dr. Kherad, Berlin, Germany
| | - Ulrich Laufs
- Klinik und Poliklinik für Kardiologie im Department für Innere Medizin, Neurologie und Dermatologie, Universitätsklinikum Leipzig, Leipzig, Germany
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20
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Prat V, Rozec B, Gauthier C, Lauzier B. Human heart failure with preserved ejection versus feline cardiomyopathy: what can we learn from both veterinary and human medicine? Heart Fail Rev 2017; 22:783-794. [DOI: 10.1007/s10741-017-9645-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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21
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Diastolic Function Changes during Stress Echocardiography in Hypertensive Patients. RAZAVI INTERNATIONAL JOURNAL OF MEDICINE 2017. [DOI: 10.5812/rijm.42876] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
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22
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Pérez del Villar C, Savvatis K, López B, Kasner M, Martinez-Legazpi P, Yotti R, González A, Díez J, Fernández-Avilés F, Tschöpe C, Bermejo J. Impact of acute hypertension transients on diastolic function in patients with heart failure with preserved ejection fraction. Cardiovasc Res 2017; 113:906-914. [DOI: 10.1093/cvr/cvx047] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Accepted: 03/08/2017] [Indexed: 12/12/2022] Open
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23
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24
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Saitoh M, Ishida J, Doehner W, von Haehling S, Anker MS, Coats AJS, Anker SD, Springer J. Sarcopenia, cachexia, and muscle performance in heart failure: Review update 2016. Int J Cardiol 2017; 238:5-11. [PMID: 28427849 DOI: 10.1016/j.ijcard.2017.03.155] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 03/31/2017] [Accepted: 03/31/2017] [Indexed: 02/06/2023]
Abstract
Cachexia in the context of heart failure (HF) has been termed cardiac cachexia, and represents a progressive involuntary weight loss. Cachexia is mainly the result of an imbalance in the homeostasis of muscle protein synthesis and degradation due to a lower activity of protein synthesis pathways and an over-activation of protein degradation. In addition, muscle wasting leads to of impaired functional capacity, even after adjusting for clinical relevant variables in patients with HF. However, there is no sufficient therapeutic strategy in muscle wasting in HF patients and very few studies in animal models. Exercise training represents a promising intervention that can prevent or even reverse the process of muscle wasting, and worsening the muscle function and performance in HF with muscle wasting and cachexia. The pathological mechanisms and effective therapeutic approach of cardiac cachexia remain uncertain, because of the difficulty to establish animal cardiac cachexia models, thus novel animal models are warranted. Furthermore, the use of improved animal models will lead to a better understanding of the pathways that modulate muscle wasting and therapeutics of muscle wasting of cardiac cachexia.
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Affiliation(s)
- Masakazu Saitoh
- Institute of Innovative Clinical Trials, Department of Cardiology and Pneumology, University Medical Center Göttingen, Göttingen, Germany
| | - Junichi Ishida
- Institute of Innovative Clinical Trials, Department of Cardiology and Pneumology, University Medical Center Göttingen, Göttingen, Germany
| | - Wolfram Doehner
- Charité - Campus Virchow (CVK), Center for Stroke Research, Berlin, Germany
| | - Stephan von Haehling
- Institute of Innovative Clinical Trials, Department of Cardiology and Pneumology, University Medical Center Göttingen, Göttingen, Germany
| | - Markus S Anker
- Charité - Campus Benjamin Franklin (CBF), Department of Cardiology, Berlin, Germany Charité - Campus Virchow (CVK), Center for Stroke Research, Berlin, Germany
| | | | - Stefan D Anker
- Institute of Innovative Clinical Trials, Department of Cardiology and Pneumology, University Medical Center Göttingen, Göttingen, Germany
| | - Jochen Springer
- Institute of Innovative Clinical Trials, Department of Cardiology and Pneumology, University Medical Center Göttingen, Göttingen, Germany.
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Sarwar CMS, Butler J, Anker SD. The Syndrome of Heart Failure With Preserved Systolic Function. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2017; 70:232-233. [PMID: 27894772 DOI: 10.1016/j.rec.2016.10.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Accepted: 10/05/2016] [Indexed: 06/06/2023]
Affiliation(s)
- Chaudhry M S Sarwar
- Cardiology Division, Stony Brook University, Stony Brook, New York, United States
| | - Javed Butler
- Cardiology Division, Stony Brook University, Stony Brook, New York, United States
| | - Stefan D Anker
- Innovative Clinical Trials, Department of Cardiology and Pneumology, University Medical Center (UMG), Göttingen, Germany.
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26
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von Haehling S, Papp Z, Anker SD. ESC Heart Failure: a new journal aims to broaden heart failure views. Eur J Heart Fail 2016; 18:1415-1419. [PMID: 27910285 DOI: 10.1002/ejhf.692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Accepted: 10/12/2016] [Indexed: 11/06/2022] Open
Affiliation(s)
- Stephan von Haehling
- Department of Cardiology and Pneumology, Innovative Clinical Trials, University Medical Center Göttingen, Göttingen, Germany
| | - Zoltan Papp
- Division of Clinical Physiology, Institute of Cardiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Stefan D Anker
- Department of Cardiology and Pneumology, Innovative Clinical Trials, University Medical Center Göttingen, Göttingen, Germany
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27
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Tschöpe C, Post H. Latent ischaemia as a trigger for a circulus vitiosus of inflammation, fibrosis, and stiffness in HFPEF. Eur J Heart Fail 2016; 17:1210-2. [PMID: 26647213 DOI: 10.1002/ejhf.439] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Affiliation(s)
- Carsten Tschöpe
- Department of Cardiology, Charité-Universitätsmedizin Berlin, Campus Virchow Klinikum, Berlin, Germany.,Berlin-Brandenburg Center for Regenerative Therapies, Charité-Universitätsmedizin Berlin, Campus Virchow Klinikum, Berlin, Germany.,German Centre for Cardiovascular Research (DZHK), Charite, Berlin, Germany
| | - Heiner Post
- Department of Cardiology, Charité-Universitätsmedizin Berlin, Campus Virchow Klinikum, Berlin, Germany
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28
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Kasner M, Sinning D, Lober J, Post H, Fraser AG, Pieske B, Burkhoff D, Tschöpe C. Heterogeneous responses of systolic and diastolic left ventricular function to exercise in patients with heart failure and preserved ejection fraction. ESC Heart Fail 2015; 2:121-132. [PMID: 27708854 PMCID: PMC5042029 DOI: 10.1002/ehf2.12049] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2015] [Revised: 06/10/2015] [Accepted: 06/17/2015] [Indexed: 01/08/2023] Open
Abstract
Aims This study aimed to evaluate ventricular diastolic properties using three‐dimensional echocardiography and tissue Doppler imaging at rest and during exercise in heart failure with preserved ejection fraction (HFpEF) patients with borderline evidence of diastolic dysfunction at rest. Methods and results Results obtained from 52 HFpEF patients (left ventricular ejection fraction ≥ 50%) identified on the basis of heart failure symptoms and E/E′ values between 8 and 15 were compared with those obtained in 26 control patients with no evidence of cardiovascular disease. Mitral flow patterns, tissue Doppler imaging, and volume analysis obtained by three‐dimensional echocardiography were performed at rest and during bicycle exercise. Diastolic compliance was indexed by the E/E′ ratio and left ventricular end‐diastolic volume [(E/E′)/EDV]. There were no significant differences in end‐diastolic volume (EDV), stroke volume (SV), or ejection fraction at rest between groups. In 27 of the 52 patients, E/E′ increased during exercise (11.2 ± 3.7 to 16.8 ± 10.5), driven by a failure to augment early diastole (E′). This correlated with a fall in SV and was associated with an increase in the diastolic index (E/E′)/EDV as a measure for LV stiffness (0.122 ± 0.038 to 0.217 ± 0.14/mL), indicating that impaired diastolic reserve (designated PEF‐IDR) contributed to exercise intolerance. Of the 52 patients, 25 showed no changes in E/E′ during exercise associated with a significant rise in SV and cardiac output, still inappropriate compared with controls. Despite disturbed early diastole (E′), a blunted increase in estimated systolic LV elastance indicated that impaired systolic reserve and chronotropic incompetence rather than primarily diastolic disturbances contributed to exercise intolerance in this group (designated PEF). Conclusion Three‐dimensional stress echocardiography may allow non‐invasive analysis of changes in cardiac output that can differentiate HFpEF patients with an inappropriate increase or a fall in SV during exercise. Impaired systolic or diastolic reserve can contribute to these haemodynamic abnormalities, which may arise from different underlying pathophysiologic mechanisms.
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Affiliation(s)
- Mario Kasner
- Department of Cardiology Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin Hindenburgdamm 30 Berlin Germany
| | - David Sinning
- Department of Cardiology Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin Hindenburgdamm 30 Berlin Germany
| | - Jil Lober
- Department of Cardiology Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin Hindenburgdamm 30 Berlin Germany
| | - Heiner Post
- Department of Cardiology Charité-Universitätsmedizin Berlin, Campus Virchow Berlin Germany
| | - Alan G Fraser
- Wales Heart Research Institute, Cardiff University Cardiff UK
| | - Burkert Pieske
- Department of CardiologyCharité-Universitätsmedizin Berlin, Campus VirchowBerlinGermany; Germany Centre for Cardiovascular Research (DZHK)BerlinGermany
| | | | - Carsten Tschöpe
- Department of CardiologyCharité-Universitätsmedizin Berlin, Campus VirchowBerlinGermany; Germany Centre for Cardiovascular Research (DZHK)BerlinGermany; Berlin-Brandenburg Center for Regenerative TherapiesCharité-Universitätsmedizin Berlin, Campus VirchowBerlinGermany
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