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Miyata K, Igarashi T, Tamura S, Iizuka T, Otani T, Usuda S. Rasch analysis of the Short Physical Performance Battery in older inpatients with heart failure. Disabil Rehabil 2024; 46:401-406. [PMID: 36597920 DOI: 10.1080/09638288.2022.2162610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 12/21/2022] [Indexed: 01/05/2023]
Abstract
PURPOSE The physical function of older patients with heart failure (HF) is likely to decline, and the Short Physical Performance Battery (SPPB) is widely used for its evaluation. No study has analyzed the SPPB by using Rasch model in these patients. The aim of this study was to examine the structural validity and item response of the SPPB in older inpatients with HF. MATERIALS AND METHODS In this multicenter cross-sectional study, we investigated 106 older inpatients with HF. We evaluated the SPPB's rating scale structure, unidimensionality, and measurement accuracy (0 = poor performance to 4 = normal performance). RESULTS The SPPB rating scale fulfilled the category functioning criteria. All items fit the underlying scale construct. The SPPB demonstrated adequate reliability (person reliability = 0.81) and separated persons into four strata: those with very low, low, moderate, and high physical performance. Item-difficulty measures were -0.59 to 0.96 logits, and regarding the person ability-item difficulty matching for the SPPB, the item was somewhat easy (the mean of person ability = 0.89 logits; mean of item difficulty = 0.00). CONCLUSION The SPPB has strong measurement properties and is an appropriate scale for quantitatively evaluating physical function in older patients with HF.
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Affiliation(s)
- Kazuhiro Miyata
- Department of Physical Therapy, Ibaraki Prefectural University of Health Science, Ibaraki, Japan
| | - Tatsuya Igarashi
- Department of Rehabilitation, Numata Neurosurgery & Heart Disease Hospital, Gunma, Japan
- Department of Rehabilitation Sciences, Gunma University Graduate School of Health Sciences, Gunma, Japan
| | - Shuntaro Tamura
- Department of Rehabilitation, Fujioka General Hospital, Gunma, Japan
| | - Takamitsu Iizuka
- Home-visit Nursing Station COCO-LO Maebashi, COCO-LO Co., Ltd., Gunma, Japan
| | - Tomohiro Otani
- Department of Physical Therapy, Ota College of Medical Technology, Gunma, Japan
| | - Shigeru Usuda
- Department of Rehabilitation Sciences, Gunma University Graduate School of Health Sciences, Gunma, Japan
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Umemura I, Eguchi S, Morita Y, Mitani H, Iekushi K, Kato T. Relationship Between Left Ventricular Ejection Fraction and Treatment Characteristics in Hospitalized Patients With Heart Failure - A Japanese Database Analysis. Circ Rep 2023; 5:392-402. [PMID: 37818283 PMCID: PMC10561998 DOI: 10.1253/circrep.cr-23-0066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Accepted: 08/09/2023] [Indexed: 10/12/2023] Open
Abstract
Background: Triple combination therapy with a renin-angiotensin system modulator, a β-blocker, and a mineralocorticoid receptor antagonist is currently recommended for patients with heart failure (HF) with reduced ejection fraction. However, there is limited evidence on the extent to which triple combination therapy is currently prescribed to patients at the time of discharge from hospital in Japan. Methods and Results: Japanese patients hospitalized for HF (n=3,582) were evaluated in subgroups defined by left ventricular ejection fraction (LVEF) using anonymized claims and electronic health record data. At discharge, triple combination therapy prescription rates were low (40.4%, 30.0%, 20.8%, 14.0%, and 12.5% for patients with LVEF <30%, 30-<40%, 40-<50%, 50-<60%, and ≥60%, respectively). Advanced age, lower levels of B-type natriuretic peptide, and renal impairment were all significantly associated with lower rates of triple combination therapy use in the overall population. There were no significant differences in rehospitalization rates between LVEF subgroups; however, triple combination therapy use was associated with a significantly reduced risk of rehospitalization for HF in patients with LVEF <30%, 30-<40%, and 40-<50%. Conclusions: The use of triple combination therapy was significantly associated with a lower risk of rehospitalization for HF within 1 year of discharge in patients with LVEF <30%, 30-<40%, and 40-<50%. However, patients were undertreated with triple combination therapy.
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Affiliation(s)
- Ichiro Umemura
- Medical Affairs Division, Novartis Pharma K.K. Tokyo Japan
| | | | - Yohei Morita
- Medical Affairs Division, Novartis Pharma K.K. Tokyo Japan
| | | | - Kazuma Iekushi
- Medical Affairs Division, Novartis Pharma K.K. Tokyo Japan
| | - Takao Kato
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine Kyoto Japan
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Ohte N, Kikuchi S, Iwahashi N, Kinugasa Y, Dohi K, Takase H, Masai K, Inoue K, Okumura T, Hachiya K, Kitada S, Seo Y. Unfavourable outcomes in patients with heart failure with higher preserved left ventricular ejection fraction. Eur Heart J Cardiovasc Imaging 2023; 24:293-300. [PMID: 36464890 DOI: 10.1093/ehjci/jeac240] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 11/11/2022] [Indexed: 12/12/2022] Open
Abstract
AIMS Newly introduced drugs for heart failure (HF) have been reported to improve the prognosis of HF with preserved ejection fraction (HFpEF) in the lower range of left ventricular ejection fraction (LVEF). We hypothesized that a higher LVEF is related to an unfavourable prognosis in patients with HFpEF. METHODS AND RESULTS We tested this hypothesis by analysing the data from a prospective multicentre cohort study in 255 patients admitted to the hospital due to decompensated HF (LVEF > 40% at discharge). The primary endpoint of this study was a composite outcome of all-cause death and readmission due to HF, and the secondary endpoint was readmission due to HF. LVEF and the mitral E/e' ratio were measured using echocardiography. In multicovariate parametric survival time analysis, LVEF [hazard ratio (HR) = 1.046 per 1% increase, P = 0.001], concurrent atrial fibrillation (AF) (HR = 3.203, P < 0.001), and E/e' (HR = 1.083 per 1.0 increase, P < 0.001) were significantly correlated with the primary endpoint. In addition to these covariates, angiotensin-converting enzyme inhibitor (ACEI)/angiotensin receptor blocker (ARB) use was significantly correlated with the secondary endpoint (HR = 0.451, P = 0.008). Diagnostic performance plot analysis demonstrated that the discrimination threshold value for LVEF that could identify patients prone to reaching the primary endpoint was ≥57.2%. The prevalence of AF or E/e' ratio did not differ significantly between patients with LVEF ≥ 58% and with 40% < LVEF < 58%. CONCLUSION A higher LVEF is independently related to poor prognosis in patients with HFpEF, in addition to concurrent AF and an elevated E/e' ratio. ACEI/ARB use, in contrast, was associated with improved prognosis, especially with regard to readmission due to HF. CLINICAL TRIAL REGISTRATION https://www.umin.ac.jp/ctr/index.htm. UNIQUE IDENTIFIER UMIN000017725.
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Affiliation(s)
- Nobuyuki Ohte
- Department of Cardiology, Graduate School of Medical Sciences, Nagoya City University, Nagoya 467-8601, Japan
| | - Shohei Kikuchi
- Department of Cardiology, Graduate School of Medical Sciences, Nagoya City University, Nagoya 467-8601, Japan
| | - Noriaki Iwahashi
- Cardiovascular Center, Yokohama City University Medical Center, Yokohama, Japan
| | - Yoshiharu Kinugasa
- Department of Cardiovascular Medicine and Endocrinology and Metabolism, Faculty of Medicine, Tottori University, Yonago, Japan
| | - Kaoru Dohi
- Department of Cardiology and Nephrology, Graduate School of Medicine, Mie University, Tsu, Japan
| | - Hiroyuki Takase
- Department of Internal Medicine, Enshu Hospital, Hamamatsu, Japan
| | - Kumiko Masai
- Department of Cardiovascular and Renal Medicine, Hyogo College of Medicine, Nishinomiya, Japan
| | - Katsuji Inoue
- Department of Cardiology, Pulmonology, Hypertension & Nephrology, Graduate School of Medicine, Ehime University, Toon, Japan
| | - Takahiro Okumura
- Department of Cardiology, Graduate School of Medicine, Nagoya University, Nagoya, Japan
| | - Kenta Hachiya
- Department of Cardiology, Nagoya City University East Medical Center, Nagoya, Japan
| | - Shuichi Kitada
- Department of Cardiology, Graduate School of Medical Sciences, Nagoya City University, Nagoya 467-8601, Japan
| | - Yoshihiro Seo
- Department of Cardiology, Graduate School of Medical Sciences, Nagoya City University, Nagoya 467-8601, Japan
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Reclassification of Heart Failure with Preserved Ejection Fraction Following Cardiac Sympathetic Nervous System Activation: A New Cutoff Value of 58. Tomography 2022; 8:1595-1607. [PMID: 35736880 PMCID: PMC9229723 DOI: 10.3390/tomography8030132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 06/14/2022] [Accepted: 06/16/2022] [Indexed: 11/17/2022] Open
Abstract
Heart failure (HF) with preserved left ventricular ejection fraction (LVEF) is a heterogeneous syndrome. An LVEF of 50% is widely used to categorize patients with HF; however, this is controversial. Previously, we have reported that patients with an LVEF of ≥ 58% have good prognoses. Further, cardiac sympathetic nervous system (SNS) activation is a feature of HF. In this retrospective, observational study, the cardiac SNS activity of HF patients (n = 63, age: 78.4 ± 9.6 years; male 49.2%) with LVEF ≥ 58% (n = 15) and LVEF < 58% (n = 48) were compared using 123I-metaiodobenzylguanidine scintigraphy. During the follow-up period (median, 3.0 years), 18 all-cause deaths occurred. The delayed heart/mediastinum (H/M) ratio was significantly higher in the LVEF ≥ 58% group than in the LVEF < 58% group (2.1 ± 0.3 vs. 1.7 ± 0.4, p = 0.004), and all-cause mortality was significantly lower in patients in the former than those in the latter group (log-rank, p = 0.04). However, when these patients were divided into LVEF ≥ 50% (n = 22) and LVEF < 50% (n = 41) groups, no significant differences were found in the delayed H/M ratio, and the all-cause mortality did not differ between the groups (log-rank, p = 0.09). In conclusion, an LVEF of 58% is suitable for reclassifying patients with HF according to cardiac SNS activity.
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Tsuboi K, Nagaki A, Shibutani T, Kawakami Y, Onoguchi M. The setting of heartbeat acceptance windows on gated myocardial perfusion single-photon emission computed tomography using CZT camera: effect of left ventricular functional parameters in patients with arrhythmia. Nucl Med Commun 2021; 42:1005-1010. [PMID: 33852532 DOI: 10.1097/mnm.0000000000001417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Consistently variable with several peaks in heart rate histogram (e.g. bigeminy and trigeminy) is one of the arrhythmia types. We investigated the effects of gating error by consistently variable patients on left ventricular (LV) functional with cadmium zinc telluride (CZT) camera. The purpose of this study is to evaluate LV functional parameters by setting different heartbeat acceptance windows on gated myocardial perfusion single-photon emission computed tomography (SPECT) (MPS) in consistently variable patients, using echocardiography (echo) as a reference. MATERIALS AND METHODS Sixteen consistently variable patients underwent the gated MPS using a D-SPECT. The MPS images were obtained by setting two different types of heartbeat acceptance windows. The heartbeat acceptance windows were set to include only one peak and two peaks of the maximum count peaks, respectively. RESULTS Mean end-diastolic volume, end-systolic volume and left ventricular ejection fraction (LVEF) were 112.7 mL, 62.2 mL and 51.3% for one peak, 114.5 mL, 66.1 mL and 47.1% for two peak, and 113.0 mL, 54.2 mL and 54.1% for echo, respectively. The mean differences between two peaks and echo in LVEF were larger than those of between one peak and echo. CONCLUSION Our study suggests that setting the heartbeat acceptance window of one peak was suitable for accurate measurement of LV function in consistently variable patients.
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Affiliation(s)
- Kunihito Tsuboi
- Department of Central Radiology, Gifu Prefectural Gero Hot Spring Hospital, Gero
- Department of Radiological Technology, Kurashiki Central Hospital, Kurashiki
| | - Akio Nagaki
- Department of Radiological Technology, Kurashiki Central Hospital, Kurashiki
- Department of Quantum Medical Technology, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa, Japan
| | - Takayuki Shibutani
- Department of Quantum Medical Technology, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa, Japan
| | - Yuji Kawakami
- Department of Radiological Technology, Kurashiki Central Hospital, Kurashiki
| | - Masahisa Onoguchi
- Department of Quantum Medical Technology, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa, Japan
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Muto K, Wakami K, Yamamoto J, Banno T, Kikuchi S, Goto T, Fukuta H, Seo Y, Ohte N. Correlation Between Longitudinal Strain in the Apical Segments of the Left Ventricle at End-Systole Obtained by 2-Dimensional Speckle-Tracking Echocardiography and Left Ventricular Relaxation. Circ J 2021; 85:1575-1583. [PMID: 33840657 DOI: 10.1253/circj.cj-20-1162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND It is well acknowledged that left ventricular (LV) contractile performance affects LV relaxation via LV elastic recoil. Accordingly, we aimed to investigate whether global longitudinal strain (GLS), particularly longitudinal strain at LV apical segments at end-systole (ALS), obtained by 2-dimensional speckle-tracking echocardiography could be used to assess LV relaxation. METHODS AND RESULTS We enrolled 121 patients with suspected or definite coronary artery disease in whom echocardiography and diagnostic cardiac catheterization were performed on the same day. We obtained conventional echo-Doppler parameters and GLS, as well as ALS prior to catheterization. LV functional parameters were obtained from the LV pressure recorded using a catheter-tipped micromanometer. In all patients, GLS and ALS were significantly correlated with the time constant τ of LV pressure decay during isovolumetric relaxation (r=0.63 [P<0.001] and r=0.66 [P<0.001], respectively). Receiver operating characteristic curve analysis for identifying impaired LV relaxation (τ ≥48 ms) revealed that ALS greater than -22.3% was an optimal cut-off value, with 81.7% sensitivity and 82.4% specificity. Even in patients with preserved LV ejection fraction, the same ALS cut-off value enabled the identification of impaired LV relaxation with 70% sensitivity and 87.5% specificity. CONCLUSIONS The findings indicate that contractile dysfunction at LV apical segments slows LV relaxation via loss of LV elastic recoil, even in patients with preserved LVEF.
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Affiliation(s)
- Keisuke Muto
- Department of Cardiology, Nagoya City University Graduate School of Medical Sciences
| | - Kazuaki Wakami
- Department of Cardiology, Nagoya City University Graduate School of Medical Sciences
| | - Junki Yamamoto
- Department of Cardiology, Nagoya City University Graduate School of Medical Sciences
| | - Tomoyuki Banno
- Department of Cardiology, Nagoya City University Graduate School of Medical Sciences
| | - Shohei Kikuchi
- Department of Cardiology, Nagoya City University Graduate School of Medical Sciences
| | - Toshihiko Goto
- Department of Cardiology, Nagoya City University Graduate School of Medical Sciences
| | - Hidekatsu Fukuta
- Department of Cardiology, Nagoya City University Graduate School of Medical Sciences
| | - Yoshihiro Seo
- Department of Cardiology, Nagoya City University Graduate School of Medical Sciences
| | - Nobuyuki Ohte
- Department of Cardiology, Nagoya City University Graduate School of Medical Sciences
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Kumar VRS, Choudhary SK, Radhakrishnan PK, Bharath RS, Chandrasekaran N, Sankar V, Sukumaran A, Oommen C. Lopsided Blood-Thinning Drug Increases the Risk of Internal Flow Choking Leading to Shock Wave Generation Causing Asymptomatic Cardiovascular Disease. GLOBAL CHALLENGES (HOBOKEN, NJ) 2021; 5:2000076. [PMID: 33728053 PMCID: PMC7933821 DOI: 10.1002/gch2.202000076] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 11/13/2020] [Indexed: 05/04/2023]
Abstract
The discovery of Sanal flow choking in the cardiovascular-system calls for multidisciplinary and global action to develop innovative treatments and to develop new drugs to negate the risk of asymptomatic-cardiovascular-diseases. Herein, it is shown that when blood-pressure-ratio (BPR) reaches the lower-critical-hemorrhage-index (LCHI) internal-flow-choking and shock wave generation can occur in the cardiovascular-system, with sudden expansion/divergence/vasospasm or bifurcation regions, without prejudice to the percutaneous-coronary-intervention (PCI). Analytical findings reveal that the relatively high and the low blood-viscosity are cardiovascular-risk factors. In vitro studies have shown that nitrogen, oxygen, and carbon dioxide gases are dominant in fresh blood samples of humans/guinea pigs at a temperature range of 98.6-104 F. An in silico study demonstrated the Sanal flow choking phenomenon leading to shock-wave generation and pressure-overshoot in the cardiovascular-system. It has been established that disproportionate blood-thinning treatment increases the risk of the internal-flow-choking due to the enhanced boundary-layer-blockage-factor, resulting from an increase in flow-turbulence level in the cardiovascular-system, caused by an increase in Reynolds number as a consequence of low blood-viscosity. The cardiovascular-risk can be diminished by concurrently lessening the viscosity of biofluid/blood and flow-turbulence by raising the thermal-tolerance-level in terms of blood-heat-capacity-ratio (BHCR) and/or by decreasing the systolic-to-diastolic blood-pressure-ratio.
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Affiliation(s)
- Valsalayam Raghavapanicker Sanal Kumar
- Vikram Sarabhai Space Centre (SC CA No.6301/2013)Indian Space Research OrganisationThiruvananthapuramKerala695022India
- National Centre for Combustion Research and DevelopmentIndian Institute of ScienceBangaloreKarnataka560012India
- Department of Aeronautical EngineeringKumaraguru College of TechnologyCoimbatoreTamil Nadu641049India
| | - Shiv Kumar Choudhary
- Department of Cardiothoracic and Vascular SurgeryAll India Institute of Medical SciencesNew Delhi110029India
| | | | | | - Nichith Chandrasekaran
- National Centre for Combustion Research and DevelopmentIndian Institute of ScienceBangaloreKarnataka560012India
- Department of Aeronautical EngineeringKumaraguru College of TechnologyCoimbatoreTamil Nadu641049India
| | - Vigneshwaran Sankar
- Department of Aeronautical EngineeringKumaraguru College of TechnologyCoimbatoreTamil Nadu641049India
- Department of Aerospace EngineeringIndian Institute of TechnologyKanpurUttar Pradesh208016India
| | - Ajith Sukumaran
- Department of Aeronautical EngineeringKumaraguru College of TechnologyCoimbatoreTamil Nadu641049India
| | - Charlie Oommen
- National Centre for Combustion Research and DevelopmentIndian Institute of ScienceBangaloreKarnataka560012India
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Yamamoto S, Yamaga T, Nishie K, Sakai Y, ishida T, Oka K, Ikegami S, Horiuchi H. Impact of physical performance on prognosis among patients with heart failure: Systematic review and meta-analysis. J Cardiol 2020; 76:139-146. [DOI: 10.1016/j.jjcc.2020.02.022] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Revised: 02/12/2020] [Accepted: 02/25/2020] [Indexed: 11/25/2022]
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Left Ventricular End-Systolic Volume Is a Reliable Predictor of New-Onset Heart Failure with Preserved Left Ventricular Ejection Fraction. Cardiol Res Pract 2020; 2020:3106012. [PMID: 32670635 PMCID: PMC7341373 DOI: 10.1155/2020/3106012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 05/07/2020] [Accepted: 06/04/2020] [Indexed: 01/15/2023] Open
Abstract
Background Left ventricular (LV) ejection fraction (EF) and LV volumes were reported to have prognostic efficacy in cardiac diseases. In particular, the end-systolic volume index (LVESVI) has been featured as the most reliable prognostic indicator. However, such efficacy in patients with LVEF ≥ 50% has not been elucidated. Methods We screened the patients who received cardiac catheterization to evaluate coronary artery disease concomitantly with both left ventriculography and LV pressure recording using a catheter-tipped micromanometer and finally enrolled 355 patients with LVEF ≥ 50% and no history of heart failure (HF) after exclusion of the patients with severe coronary artery stenosis requiring early revascularization. Cardiovascular death or hospitalization for HF was defined as adverse events. The prognostic value of LVESVI was investigated using a Cox proportional hazards model. Results A univariable analysis demonstrated that age, log BNP level, tau, peak − dP/dt, LVEF, LV end-diastolic volume index (LVEDVI), and LVESVI were associated with adverse events. A correlation analysis revealed that LVESVI was significantly associated with log BNP level (r = 0.356, p < 0.001), +dP/dt (r = −0.324, p < 0.001), −dP/dt (r = 0.391, p < 0.001), and tau (r = 0.337, p < 0.001). Multivariable analysis with a stepwise procedure using the variables with statistical significance in the univariable analysis revealed that aging, an increase in BNP level, and enlargement of LVESVI were significant prognostic indicators (age: HR: 1.071, 95% CI: 1.009–1.137, p=0.024; log BNP : HR : 1.533, 95% CI: 1.090–2.156, p=0.014; LVESVI : HR : 1.051, 95% CI: 1.011–1.093, p=0.013, respectively). According to the receiver-operating characteristic curve analysis for adverse events, log BNP level of 3.23 pg/ml (BNP level: 25.3 pg/ml) and an LVESVI of 24.1 ml/m2 were optimal cutoff values (BNP : AUC : 0.753, p < 0.001, LVESVI : AUC : 0.729, p < 0.001, respectively). Conclusion In patients with LVEF ≥ 50%, an increased LVESVI is related to the adverse events. LV contractile performance even in the range of preserved LVEF should be considered as a role of a prognostic indicator.
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Kitada S, Kawada Y, Osaga S, Kato M, Kikuchi S, Wakami K, Seo Y, Ohte N. Left ventricular contractile performance and heart failure in patients with left ventricular ejection fraction more than 40. Heart Vessels 2020; 35:1689-1698. [PMID: 32504319 PMCID: PMC7595999 DOI: 10.1007/s00380-020-01641-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Accepted: 05/29/2020] [Indexed: 01/06/2023]
Abstract
Heart failure (HF) with mid-range left ventricular ejection fraction (LVEF) (HFmrEF) is considered a new category of HF and LVEF < 50%, which is the upper threshold of LVEF for HFmrEF, is thought to represent a mild decrease in LV contractile performance. We aimed to consider an LVEF threshold value to be taken as a surrogate for impairment of LV contractile performance, resulting in new-onset HF. We enrolled 398 patients with LVEF ≥ 40% that underwent cardiac catheterization. Using the LV pressure recording with a catheter-tipped micromanometer, we calculated the inertia force of late systolic aortic flow (IFLSAF), which was sensitive to the slight impairment in LV contractile performance. We evaluated the utility of the IFLSAF for predicting future cardiovascular death or hospitalization for HF. We performed a receiver operating characteristic (ROC) curve analysis to determine the best LVEF threshold value for distinguishing whether the LV maintained the IFLSAF. A multivariate Cox proportional-hazards model revealed that the loss of IFLSAF was significantly associated with the future adverse events (HR: 7.798, 95%CI 2.174–27.969, p = 0.002). According to the ROC curve analysis, an LVEF ≥ 58% indicated that the LV could maintain the IFLSAF. We concluded that the loss of IFLSAF, which could reflect even slight impairment in LV contractile performance, was a reliable indicator for new-onset HF in patients with LVEF ≥ 40%. LVEF ≥ 58% could be taken as a surrogate for the IFLSAF maintenance; this threshold could be useful for risk stratification of new-onset HF in patients with preserved LVEF.
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Affiliation(s)
- Shuichi Kitada
- Department of Cardiology, Nagoya City University, 1 Kawasumi, Mizuho-cho, Mizuho-Ku, Nagoya, Japan.
| | - Yu Kawada
- Department of Cardiology, Nagoya City University, 1 Kawasumi, Mizuho-cho, Mizuho-Ku, Nagoya, Japan
| | - Satoshi Osaga
- Department of Medical Innovation, Nagoya City University, Nagoya, Japan
| | - Marina Kato
- Department of Cardiology, Nagoya City University, 1 Kawasumi, Mizuho-cho, Mizuho-Ku, Nagoya, Japan
| | - Shohei Kikuchi
- Department of Cardiology, Nagoya City University, 1 Kawasumi, Mizuho-cho, Mizuho-Ku, Nagoya, Japan
| | - Kazuaki Wakami
- Department of Cardiology, Nagoya City University, 1 Kawasumi, Mizuho-cho, Mizuho-Ku, Nagoya, Japan
| | - Yoshihiro Seo
- Department of Cardiology, Nagoya City University, 1 Kawasumi, Mizuho-cho, Mizuho-Ku, Nagoya, Japan
| | - Nobuyuki Ohte
- Department of Cardiology, Nagoya City University, 1 Kawasumi, Mizuho-cho, Mizuho-Ku, Nagoya, Japan
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11
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Role of Inflammatory Cell Subtypes in Heart Failure. J Immunol Res 2019; 2019:2164017. [PMID: 31565659 PMCID: PMC6745095 DOI: 10.1155/2019/2164017] [Citation(s) in RCA: 66] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 07/25/2019] [Indexed: 02/07/2023] Open
Abstract
Inflammation is a well-known feature of heart failure. Studies have shown that while some inflammation is required for repair during injury and is protective, prolonged inflammation leads to myocardial remodeling and apoptosis of cardiac myocytes. Various types of immune cells are implicated in myocardial inflammation and include neutrophils, macrophages, eosinophils, mast cells, natural killer cells, T cells, and B cells. Recent clinical trials have targeted inflammatory cascades as therapy for heart failure with limited success. A better understanding of the temporal course of the infiltration of the different immune cells and their contribution to the inflammatory process may improve the success for therapy. This brief review outlines the major cell types involved in heart failure, and some of their actions are summarized in the supplementary figure.
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12
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Dimiati H, Wahab AS, Juffrie M, Julia M, Gani BA. Study of NT-proBNP and Hs-Troponin I biomarkers for early detection of children's heart function of proteinenergy malnutrition. Pediatr Rep 2019; 11:7997. [PMID: 31214302 PMCID: PMC6549000 DOI: 10.4081/pr.2019.7997] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 04/11/2019] [Indexed: 11/23/2022] Open
Abstract
The Protein Energy Malnutrition (PEM) is the condition of a lack of carbohydrate and protein stores in the body that trigger chronic failure nutrient intake and body maintenance function caused to impact the heart functions. The NT-pro-BNP and Hs- Troponin I proteins were found as the indicator of cardiac dysfunction. The sixty subjects of PEM, analyzed by standard of Indonesia Healt Ministry as well as nutritional status. The blood electrolytes examined by laboratory assay and the levels of Hs-Troponin 1 and NT-Pro-BNP were analyzed by Immune-Chromatography method. Assessing of the ventricular mass with the seeing the peak of the diastolic flow rate of left ventricular that estimated by the curve of the receiver operating characteristic and the area under the curve (P<0.05). The result has shown that the PEM decreased in the left ventricular mass for impaired heart function and systolic disorder. The Hs- Troponin I (90.9%) has better sensitivity than NT-pro-BNP (85.5%) if the merger of those markers possesses the lowest sensitivity (81.8%). These proteins have good biomarkers in heart function, mainly in cases where PEM is present.
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Affiliation(s)
- Herlina Dimiati
- Cardiology Division, Pediatric Health Department, Faculty of Medicine, Universitas Syiah Kuala-RSUZA Hospital, Banda Aceh
| | - Abdus Samik Wahab
- Pediatric Health Department, Faculty of Medicine, Gadjah Mada University, Yogyakarta
| | - Mohammad Juffrie
- Pediatric Health Department, Faculty of Medicine, Gadjah Mada University, Yogyakarta
| | - Madarina Julia
- Pediatric Health Department, Faculty of Medicine, Gadjah Mada University, Yogyakarta
| | - Basri A Gani
- Oral Biology Department, Faculty of Dentistry, Universitas Syiah Kuala, Darussalam Banda Aceh, Indonesia
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13
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Kitada S, Kikuchi S, Tsujino T, Masuyama T, Ohte N. The prognostic value of brain natriuretic peptide in patients with heart failure and left ventricular ejection fraction higher than 60%: a sub-analysis of the J-MELODIC study. ESC Heart Fail 2017; 5:36-45. [PMID: 28941144 PMCID: PMC5793961 DOI: 10.1002/ehf2.12206] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Revised: 07/23/2017] [Accepted: 07/26/2017] [Indexed: 12/02/2022] Open
Abstract
Aims Cardiac function varies in the population of patients with heart failure (HF) with preserved left ventricular ejection fraction (LVEF; HFpEF). This study investigated the heterogeneity of clinical features associated with HF and the prognostic value of BNP levels in patients with HFpEF. Methods and results The study enrolled 288 patients with stable HF and serum creatinine <1.5 mg/dL who were part of the original J‐MELODIC study cohort. They were categorized as having HF with reduced LVEF (HFrEF; EF ≤ 40%, n = 83) or as having HFpEF (EF > 40%, n = 205). Patients with HFpEF were further categorized as having relatively low LVEF (HFrlEF; EF 40–60%, n = 107) or as having relatively high LVEF (HFrhEF; EF ≥ 60%, n = 98). We defined cardiovascular death and hospitalization for HF as adverse events and evaluated the prognostic value of the BNP levels in each group. There was no significant difference in event‐free survival between HFpEF and HFrEF patients or between HFrhEF and HFrlEF patients. A multivariate Cox proportional hazards model revealed that the BNP level was an independent predictor of adverse events in HFrEF patients (hazard ratio: 4.088, 95% confidence interval: 1.178–14.179, P = 0.027) and in HFrlEF patients (hazard ratio: 14.888, 95% confidence interval: 4.969–44.608, P < 0.001) but not in HFrhEF patients (P = 0.767). Conclusions The BNP level has prognostic value in HFrlEF but not in HFrhEF. This indicates that HFrhEF and HFrlEF are distinct entities that may require different approaches for the management of HF.
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Affiliation(s)
- Shuichi Kitada
- Department of Cardio-Renal Medicine and Hypertension, Nagoya City University, Nagoya, Japan
| | - Shohei Kikuchi
- Department of Cardio-Renal Medicine and Hypertension, Nagoya City University, Nagoya, Japan
| | - Takeshi Tsujino
- Department of Pharmacy, School of Pharmacy, Hyogo University of Health Sciences, Kobe, Japan
| | - Tohru Masuyama
- Cardiovascular Division, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan
| | - Nobuyuki Ohte
- Department of Cardio-Renal Medicine and Hypertension, Nagoya City University, Nagoya, Japan
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14
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Okuyama R, Ishii J, Takahashi H, Kawai H, Muramatsu T, Harada M, Yamada A, Motoyama S, Matsui S, Naruse H, Sarai M, Hasegawa M, Watanabe E, Suzuki A, Hayashi M, Izawa H, Yuzawa Y, Ozaki Y. Combination of high-sensitivity troponin I and N-terminal pro-B-type natriuretic peptide predicts future hospital admission for heart failure in high-risk hypertensive patients with preserved left ventricular ejection fraction. Heart Vessels 2017; 32:880-892. [PMID: 28154958 DOI: 10.1007/s00380-017-0948-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Accepted: 01/13/2017] [Indexed: 01/20/2023]
Abstract
Additional risk stratification may provide more aggressive and focalized preventive treatment to high-risk hypertensive patients according to the Japanese hypertension guidelines. We prospectively investigated the predictive value of high-sensitivity troponin I (hsTnI), both independently and in combination with N-terminal pro-B-type natriuretic peptide (NT-proBNP), for incident heart failure (HF) in high-risk hypertensive patients with preserved left ventricular ejection fraction (LVEF). Baseline hsTnI and NT-proBNP levels and echocardiography data were obtained for 493 Japanese hypertensive outpatients (mean age, 68.5 years) with LVEF ≥ 50%, no symptomatic HF, and at least one of the following comorbidities: stage 3-4 chronic kidney disease, diabetes mellitus, and stable coronary artery disease. During a mean follow-up period of 86.1 months, 44 HF admissions occurred, including 31 for HF with preserved ejection fraction (HFpEF) and 13 for HF with reduced ejection fraction (HFrEF; LVEF <50%). Both hsTnI (p < 0.01) and NT-proBNP (p < 0.005) levels were significant independent predictors of HF admission. Furthermore, when the patients were stratified into 4 groups according to increased hsTnI (≥highest tertile value of 10.6 pg/ml) and/or increased NT-proBNP (≥highest tertile value of 239.7 pg/ml), the adjusted relative risks for patients with increased levels of both biomarkers versus neither biomarker were 13.5 for HF admission (p < 0.0001), 9.45 for HFpEF (p = 0.0009), and 23.2 for HFrEF (p = 0.003). Finally, the combined use of hsTnI and NT-proBNP enhanced the C-index (p < 0.05), net reclassification improvement (p = 0.0001), and integrated discrimination improvement (p < 0.05) to a greater extent than that of any single biomarker. The combination of hsTnI and NT-proBNP, which are individually independently predictive of HF admission, could improve predictions of incident HF in high-risk hypertensive patients but could not predict future HF phenotypes.
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Affiliation(s)
- Ryunosuke Okuyama
- Department of Cardiology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Junnichi Ishii
- Department of Joint Research Laboratory of Clinical Medicine, Fujita Health University School of Medicine, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, 470-1192, Japan.
| | - Hiroshi Takahashi
- Division of Statistics, Fujita Health University School of Medicine, Toyoake, Japan
| | - Hideki Kawai
- Department of Cardiology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Takashi Muramatsu
- Department of Cardiology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Masahide Harada
- Department of Cardiology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Akira Yamada
- Department of Cardiology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Sadako Motoyama
- Department of Cardiology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Shigeru Matsui
- Department of Cardiology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Hiroyuki Naruse
- Department of Joint Research Laboratory of Clinical Medicine, Fujita Health University School of Medicine, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, 470-1192, Japan
| | - Masayoshi Sarai
- Department of Cardiology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Midori Hasegawa
- Department of Nephrology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Eiichi Watanabe
- Department of Cardiology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Atsushi Suzuki
- Department of Endocrinology and Metabolism, Fujita Health University School of Medicine, Toyoake, Japan
| | - Mutsuharu Hayashi
- Department of Cardiology, Banbuntane Houtokukai Hospital, Nagoya, Japan
| | - Hideo Izawa
- Department of Cardiology, Banbuntane Houtokukai Hospital, Nagoya, Japan
| | - Yukio Yuzawa
- Department of Nephrology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Yukio Ozaki
- Department of Cardiology, Fujita Health University School of Medicine, Toyoake, Japan
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15
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Prognostic impact of disseminated intravascular coagulation score in acute heart failure patients referred to a cardiac intensive care unit: a retrospective cohort study. Heart Vessels 2017; 32:872-879. [DOI: 10.1007/s00380-017-0946-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Accepted: 01/06/2017] [Indexed: 10/20/2022]
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16
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Prognostic value of ankle brachial index for future incident heart failure in patients without previous heart failure: data from the impressive predictive value of ankle brachial index for clinical long term outcome in patients with cardiovascular disease examined by ABI study. Heart Vessels 2016; 32:295-302. [PMID: 27412398 DOI: 10.1007/s00380-016-0873-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Accepted: 07/01/2016] [Indexed: 01/06/2023]
Abstract
The ankle brachial index (ABI) is regarded as a predictor of future cardiovascular events. However, the relationship between ABI and incident heart failure (HF) in patients without previous HF is poorly understood. This study aimed to assess the prognostic value of ABI for incident HF in patients without previous HF. The IMPACT-ABI study was a retrospective, single-center, cohort study that enrolled and measured ABI in 3131 patients hospitalized for cardiovascular disease between January 2005 and December 2012. From this cohort, 307 patients were excluded because of previous HF and high (>1.4) ABI. The remaining 2824 patients were stratified into three groups: low ABI (≤0.9), borderline ABI (0.91-0.99), and normal ABI (1.0-1.4). The primary endpoint was hospitalization for HF. Over a mean 4.8-year follow-up, 105 cases of HF occurred. The cumulative incidence of HF was significantly higher in patients with low and borderline ABIs than in those with normal ABI (19.3 vs. 21.0 vs. 10.4 %, log rank P <0.001). In multivariate Cox proportional hazard analysis, low ABI and borderline ABI were independent predictors of incident HF [hazard ratio (HR) 3.00; 95 % confidence interval (CI) 1.70-5.28; P < 0.001 and HR 2.68; 95 % CI 1.35-5.34; P = 0.005, respectively]. In conclusion, low and borderline ABI were strong predictors for future incident HF in patients without previous HF.
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17
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Berezin AE. Prognostication in Different Heart Failure Phenotypes: The Role of Circulating Biomarkers. J Circ Biomark 2016; 5:6. [PMID: 28936254 PMCID: PMC5548324 DOI: 10.5772/62797] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Accepted: 03/02/2016] [Indexed: 12/11/2022] Open
Abstract
Heart failure (HF) is multifactorial syndrome with high cardiovascular (CV) morbidity and mortality rates associated with an increasing prevalence worldwide. Measuring plasma levels of circulating biomarkers, i.e., natriuretic peptides, cardiac-specific troponins, metabolomic intermediates, Galectin-3, ST2, cardiotrophin-1, soluble endoglin and growth differentiation factor 15, may assist in the prognostication of HF development. However, the role of biomarker models in the prediction of an early stage of HF with a preserved ejection fraction (HFpEF) and HF with a reduced ejection fraction (HFrEF) is not still understood. This review explores the knowledge regarding the utility of cardiac biomarkers, aiming to reclassify patients with different phenotypes of HF. The review reports that several biomarkers reflected on subsequently alter collagen turnover, cardiac fibrosis and inflammation, which might have diagnostic and predictive value in HFpEF and HFrEF. The best candidates for determining the early stage of HF development were sST2, Galectin-3, CT-1 and GDF-15. However, increased plasma concentrations of these biomarkers were not specific to a distinct disease group of HFpEF and HFrEF. Finally, more investigations are required to determine the role of novel biomarkers in the prediction of HF and the determination of the early stages of HFpEF and HFrEF development.
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Yamamoto S, Yamaga T, Sakai Y, Ishida T, Nakasone S, Ohira M, Ota E, Mori R. Association between physical performance and cardiovascular events in patients with coronary artery disease: protocol for a meta-analysis. Syst Rev 2016; 5:32. [PMID: 26892852 PMCID: PMC4758159 DOI: 10.1186/s13643-016-0206-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2015] [Accepted: 02/08/2016] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Physical performance such as muscle strength or walking speed of patients with coronary artery disease (CAD) is lower than that of people who do not have CAD and is related to mortality and re-admission rates. Recent studies have shown that skeletal muscle strength, such as grip strength, was closely associated with cardiac events. Physical performance testing is quick, safe, and inexpensive and provides a reliable assessment tool for routine clinical practice. The aim of this meta-analysis is to clarify the association between physical performance testing and the risk of cardiovascular events and mortality. METHODS/DESIGN This meta-analysis will include male and female participants of any age in community settings who have a history of the following conditions or procedures: myocardial infarction, or coronary revascularization (coronary artery bypass grafting, percutaneous transluminal coronary angioplasty, or coronary artery stent), angina pectoris, heart failure, heart transplant, or coronary artery disease defined by angiography. We will search EMBASE and MEDLINE, PubMed, and the Cochrane Library with no limitations on date, language, document type, or publication status. Identified studies will be prospective and retrospective cohort studies. Physical performance will be defined as upper extremity strength, lower extremity strength, walking speed, or other performance scale. Six review authors will independently extract study characteristics from included studies. Participants will be divided into subgroups according to age (middle-aged <65 years and elderly ≥ 65 years), diagnosis (coronary artery disease and heart failure) and follow-up time (up to 12 months and over 12 months). We will pool hazard ratios of Cox proportional hazard models after logarithmic transformation and perform the meta-analysis by using inverse-variance method. DISCUSSION To our knowledge, this meta-analysis will be the first report to assess the association between physical performance and cardiovascular events in CAD patients. We hope that these findings may help to estimate the prognosis for CAD patients in clinical practice. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42015020886.
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Affiliation(s)
- Shuhei Yamamoto
- Department of Rehabilitation, Shinshu University Hospital, 3-1-1 Asahi, Matsumoto-shi, Nagano, 390-8621, Japan. .,Department of Health Policy, National Center for Child Health and Development, Tokyo, Japan.
| | - Takayoshi Yamaga
- Department of Rehabilitation, Shinshu University Hospital, 3-1-1 Asahi, Matsumoto-shi, Nagano, 390-8621, Japan.
| | - Yasunari Sakai
- Department of Rehabilitation, Shinshu University Hospital, 3-1-1 Asahi, Matsumoto-shi, Nagano, 390-8621, Japan.
| | - Takaaki Ishida
- Department of Rehabilitation, Shinshu University Hospital, 3-1-1 Asahi, Matsumoto-shi, Nagano, 390-8621, Japan.
| | - Saki Nakasone
- Department of Rehabilitation, Shinshu University Hospital, 3-1-1 Asahi, Matsumoto-shi, Nagano, 390-8621, Japan.
| | - Masayoshi Ohira
- Department of Physical Therapy, School of Health Sciences, Shinshu University, Nagano, Japan.
| | - Erika Ota
- Department of Health Policy, National Center for Child Health and Development, Tokyo, Japan.
| | - Rintaro Mori
- Department of Health Policy, National Center for Child Health and Development, Tokyo, Japan.
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