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Naddaf N, Dianati Maleki N, Goldschmidt ME, Kalogeropoulos AP. Point of Care Ultrasound (POCUS) in the Management of Heart Failure: A Narrative Review. J Pers Med 2024; 14:766. [PMID: 39064020 PMCID: PMC11277924 DOI: 10.3390/jpm14070766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2024] [Revised: 07/08/2024] [Accepted: 07/10/2024] [Indexed: 07/28/2024] Open
Abstract
Assessing for volume overload is a key component of both short and long-term management of heart failure patients. Physical examination findings are neither sensitive nor specific for detecting congestion, and subclinical congestion may not be evident at the time of examination. Point of care ultrasound (POCUS) is an efficient and non-invasive way to assess heart failure patients for volume overload. The aim of our narrative review is to summarize how each of the following ultrasound modalities can be used to assess for congestion in the heart failure population: 2D and Doppler echocardiography, lung ultrasound, inferior vena cava ultrasound, internal jugular vein ultrasound, and venous excess grading. While each of these modalities has their limitations, their use in the acute and outpatient space offers the potential to reduce heart failure readmissions and mortality.
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Affiliation(s)
| | | | | | - Andreas P. Kalogeropoulos
- Division of Cardiology, Department of Medicine, Stony Brook Renaissance School of Medicine, Stony Brook, NY 11794, USA; (N.N.); (N.D.M.); (M.E.G.)
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Carresi C, Cardamone A, Coppoletta AR, Caminiti R, Macrì R, Lorenzo F, Scarano F, Mollace R, Guarnieri L, Ruga S, Nucera S, Musolino V, Gliozzi M, Palma E, Muscoli C, Volterrani M, Mollace V. The protective effect of Bergamot Polyphenolic Fraction on reno-cardiac damage induced by DOCA-salt and unilateral renal artery ligation in rats. Biomed Pharmacother 2024; 171:116082. [PMID: 38242036 DOI: 10.1016/j.biopha.2023.116082] [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: 09/21/2023] [Revised: 11/28/2023] [Accepted: 12/26/2023] [Indexed: 01/21/2024] Open
Abstract
To date, the complex pathological interactions between renal and cardiovascular systems represent a real global epidemic in both developed and developing countries. In this context, renovascular hypertension (RVH) remains among the most prevalent, but also potentially reversible, risk factor for numerous reno-cardiac diseases in humans and pets. Here, we investigated the anti-inflammatory and reno-cardiac protective effects of a polyphenol-rich fraction of bergamot (BPF) in an experimental model of hypertension induced by unilateral renal artery ligation. Adult male Wistar rats underwent unilateral renal artery ligation and treatment with deoxycorticosterone acetate (DOCA) (20 mg/kg, s.c.), twice a week for a period of 4 weeks, and 1% sodium chloride (NaCl) water (n = 10). A subgroup of hypertensive rats received BPF (100 mg/kg/day for 28 consecutive days, n = 10) by gavage. Another group of animals was treated with a sub-cutaneous injection of vehicle (that served as control, n = 8). Unilateral renal artery ligation followed by treatment with DOCA and 1% NaCl water resulted in a significant increase in mean arterial blood pressure (MAP; p< 0.05. vs CTRL) which strongly increased the resistive index (RI; p<0.05 vs CTRL) of contralateral renal artery flow and kidney volume after 4 weeks (p<0.001 vs CTRL). Renal dysfunction also led to a dysfunction of cardiac tissue strain associated with overt dyssynchrony in cardiac wall motion when compared to CTRL group, as shown by the increased time-to-peak (T2P; p<0.05) and the decreased whole peak capacity (Pk; p<0.01) in displacement and strain rate (p<0.05, respectively) in longitudinal motion. Consequently, the hearts of RAL DOCA-Salt rats showed a larger time delay between the fastest and the lowest region (Maximum Opposite Wall Delay-MOWD) when compared to CTRL group (p<0.05 in displacement and p <0.01 in strain rate). Furthermore, a significant increase in the levels of the circulating pro-inflammatory cytokines and chemokines (p< 0.05 for IL-12(40), p< 0.01 for GM-CSF, KC, IL-13, and TNF- α) and in the NGAL expression of the ligated kidney (p< 0.001) was observed compared to CTRL group. Interestingly, this pathological condition is prevented by BPF treatment. In particular, BPF treatment prevents the increase of blood pressure in RAL DOCA-Salt rats (p< 0.05) and exerts a protective effect on the volume of the contralateral kidney (p <0.01). Moreover, BPF ameliorates cardiac tissue strain dysfunction by increasing Pk in displacement (p <0.01) and reducing the T2P in strain rate motion (p<0.05). These latter effects significantly improve MOWD (p <0.05) preventing the overt dyssynchrony in cardiac wall motion. Finally, the reno-cardiac protective effect of BPF was associated with a significant reduction in serum level of some pro-inflammatory cytokines and chemokines (p<0.05 for KC and IL-12(40), p<0.01 for GM-CSF, IL-13, and TNF- α) restoring physiological levels of renal neutrophil gelatinase-associated lipocalin (NGAL, p<0.05) protein of the tethered kidney. In conclusion, the present results show, for the first time, that BPF promotes an efficient renovascular protection preventing the progression of inflammation and reno-cardiac damage. Overall, these data point to a potential clinical and veterinary role of dietary supplementation with the polyphenol-rich fraction of citrus bergamot in counteracting hypertension-induced reno-cardiac syndrome.
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Affiliation(s)
- Cristina Carresi
- Veterinary Pharmacology Laboratory, Institute of Research for Food Safety and Health IRC-FSH, Department of Health Sciences, University Magna Graecia of Catanzaro, 88100 Catanzaro, Italy.
| | - Antonio Cardamone
- Pharmacology Laboratory, Institute of Research for Food Safety and Health IRC-FSH, Department of Health Sciences, University Magna Græcia of Catanzaro, 88100 Catanzaro, Italy
| | - Anna Rita Coppoletta
- Pharmacology Laboratory, Institute of Research for Food Safety and Health IRC-FSH, Department of Health Sciences, University Magna Græcia of Catanzaro, 88100 Catanzaro, Italy
| | - Rosamaria Caminiti
- Pharmacology Laboratory, Institute of Research for Food Safety and Health IRC-FSH, Department of Health Sciences, University Magna Græcia of Catanzaro, 88100 Catanzaro, Italy
| | - Roberta Macrì
- Pharmacology Laboratory, Institute of Research for Food Safety and Health IRC-FSH, Department of Health Sciences, University Magna Græcia of Catanzaro, 88100 Catanzaro, Italy
| | - Francesca Lorenzo
- Pharmacology Laboratory, Institute of Research for Food Safety and Health IRC-FSH, Department of Health Sciences, University Magna Græcia of Catanzaro, 88100 Catanzaro, Italy
| | - Federica Scarano
- Pharmacology Laboratory, Institute of Research for Food Safety and Health IRC-FSH, Department of Health Sciences, University Magna Græcia of Catanzaro, 88100 Catanzaro, Italy
| | - Rocco Mollace
- Pharmacology Laboratory, Institute of Research for Food Safety and Health IRC-FSH, Department of Health Sciences, University Magna Græcia of Catanzaro, 88100 Catanzaro, Italy; Department of Systems Medicine, University of Rome Tor Vergata, Italy
| | - Lorenza Guarnieri
- Pharmacology Laboratory, Institute of Research for Food Safety and Health IRC-FSH, Department of Health Sciences, University Magna Græcia of Catanzaro, 88100 Catanzaro, Italy
| | - Stefano Ruga
- Pharmacology Laboratory, Institute of Research for Food Safety and Health IRC-FSH, Department of Health Sciences, University Magna Græcia of Catanzaro, 88100 Catanzaro, Italy
| | - Saverio Nucera
- Pharmacology Laboratory, Institute of Research for Food Safety and Health IRC-FSH, Department of Health Sciences, University Magna Græcia of Catanzaro, 88100 Catanzaro, Italy
| | - Vincenzo Musolino
- Laboratory of Pharmaceutical Biology, Department of Health Sciences, Institute of Research for Food Safety & Health IRC-FSH, University "Magna Græcia" of Catanzaro, 88100 Catanzaro, Italy
| | - Micaela Gliozzi
- Pharmacology Laboratory, Institute of Research for Food Safety and Health IRC-FSH, Department of Health Sciences, University Magna Græcia of Catanzaro, 88100 Catanzaro, Italy
| | - Ernesto Palma
- Pharmacology Laboratory, Institute of Research for Food Safety and Health IRC-FSH, Department of Health Sciences, University Magna Græcia of Catanzaro, 88100 Catanzaro, Italy
| | - Carolina Muscoli
- Pharmacology Laboratory, Institute of Research for Food Safety and Health IRC-FSH, Department of Health Sciences, University Magna Græcia of Catanzaro, 88100 Catanzaro, Italy
| | | | - Vincenzo Mollace
- Pharmacology Laboratory, Institute of Research for Food Safety and Health IRC-FSH, Department of Health Sciences, University Magna Græcia of Catanzaro, 88100 Catanzaro, Italy
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El-Dosouky II, Seddik EH, Wageeh S. The Use of Global Longitudinal Strain to Detect Subclinical Reduction in Left Ventricular Pump Function. Crit Pathw Cardiol 2023; 22:149-152. [PMID: 37782622 DOI: 10.1097/hpc.0000000000000335] [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: 10/04/2023]
Abstract
BACKGROUND Left ventricular (LV) ejection fraction (LVEF) is not a sensitive marker of LV systolic function in a subset of patients with preserved EF. The relation between LV pump function and global longitudinal strain (GLS) has not been elucidated well in patients with objectively preserved EF and no apparent heart failure (HF). We aimed to detect whether LV GLS can discover impaired LV pump function [presented as low stroke volume index (SVI) and low cardiac output (COP)] in patients with objectively preserved EF and no apparent clinical HF and its practice utility. METHODS In total, 100 participants with LVEF of ≥50% were studied for demographic and echocardiographic data, including LVEF, stroke volume, SVI, COP, LV longitudinal strain assessments, apical 4-, 3-, and 2-chamber views averaged for GLS, and were classified into 2 groups: group 1: normal GLS (more negative than -18%) and group 2: low GLS (less negative than -18%). RESULTS Reduced LV GLS was associated with lower SVI (35.6 ± 13.6 vs. 43.8 ± 12.7 mL/m 2 ; P = 0.01), lesser COP (5.4 ± 1.9 vs. 6.5 ± 2.1 l/min; P = 0.02), GLS had strong positive correlations with SVI ( r = 0.75; P < 0.001), and COP ( r = 0.66; P < 0.001). LV GLS at a cutoff value less negative than -15% is a strong predictor of SVI ≤35 mL/m 2 (76% sensitivity and 79% specificity) and at a cutoff value less negative than -13.5% it is a strong predictor of COP ≤4 L/min (76% sensitivity and 73% specificity). LV GLS was the best independent predictor of low SVI (<35 mL/m 2 ) and low COP (<4 L/min). CONCLUSION Impaired LV strain is associated with lower LV pump function, presented as lower COP and lower SVI in patients with preserved EF even in the absence of clinical HF. It is of great importance to incorporate GLS in the routine evaluation of LV function hand-by-hand with the noninvasive assessment of LV stroke volume and COP that can replace GLS on evaluation of LV pump function in old machines with no GLS modalities, for early pick-up of patients with impaired LV pump function before apparent HF.
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Affiliation(s)
- Ibtesam I El-Dosouky
- From the Cardiology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
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Samuel TJ, Oneglia AP, Cipher DJ, Ezekowitz JA, Dyck JRB, Anderson T, Howlett JG, Paterson DI, Thompson RB, Nelson MD. Integration of longitudinal and circumferential strain predicts volumetric change across the cardiac cycle and differentiates patients along the heart failure continuum. J Cardiovasc Magn Reson 2023; 25:55. [PMID: 37779191 PMCID: PMC10544545 DOI: 10.1186/s12968-023-00969-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 09/21/2023] [Indexed: 10/03/2023] Open
Abstract
BACKGROUND Left ventricular (LV) circumferential and longitudinal strain provide important insight into LV mechanics and function, each contributing to volumetric changes throughout the cardiac cycle. We sought to explore this strain-volume relationship in more detail, by mathematically integrating circumferential and longitudinal strain and strain rate to predict LV volume and volumetric rates of change. METHODS Cardiac magnetic resonance (CMR) imaging from 229 participants from the Alberta HEART Study (46 healthy controls, 77 individuals at risk for developing heart failure [HF], 70 patients with diagnosed HF with preserved ejection fraction [HFpEF], and 36 patients with diagnosed HF with reduced ejection fraction [HFrEF]) were evaluated. LV volume was assessed by the method of disks and strain/strain rate were assessed by CMR feature tracking. RESULTS Integrating endocardial circumferential and longitudinal strain provided a close approximation of LV ejection fraction (EFStrain), when compared to gold-standard volumetric assessment (EFVolume: r = 0.94, P < 0.0001). Likewise, integrating circumferential and longitudinal strain rate provided a close approximation of peak ejection and peak filling rates (PERStrain and PFRStrain, respectively) compared to their gold-standard volume-time equivalents (PERVolume, r = 0.73, P < 0.0001 and PFRVolume, r = 0.78, P < 0.0001, respectively). Moreover, each integrated strain measure differentiated patients across the HF continuum (all P < 0.01), with the HFrEF group having worse EFStrain, PERStrain, and PFRStrain compared to all other groups, and HFpEF having less favorable EFStrain and PFRStrain compared to both at-risk and control groups. CONCLUSIONS The data herein establish the theoretical framework for integrating discrete strain components into volumetric measurements across the cardiac cycle, and highlight the potential benefit of this approach for differentiating patients along the heart failure continuum.
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Affiliation(s)
- T Jake Samuel
- College of Nursing and Health Innovation, University of Texas at Arlington, Arlington, TX, USA
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Andrew P Oneglia
- College of Nursing and Health Innovation, University of Texas at Arlington, Arlington, TX, USA
| | - Daisha J Cipher
- College of Nursing and Health Innovation, University of Texas at Arlington, Arlington, TX, USA
| | - Justin A Ezekowitz
- Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, AB, Canada
- Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Jason R B Dyck
- Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, AB, Canada
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Todd Anderson
- Libin Cardiovascular Institute of Alberta, Calgary, AB, Canada
- Department of Cardiac Sciences, University of Calgary, Calgary, AB, Canada
| | | | - D Ian Paterson
- University of Ottawa Heart Institute, University of Ottawa, Ottawa, ON, Canada
| | - Richard B Thompson
- Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, AB, Canada
- Department of Biomedical Engineering, University of Alberta, Edmonton, AB, Canada
| | - Michael D Nelson
- College of Nursing and Health Innovation, University of Texas at Arlington, Arlington, TX, USA.
- Applied Physiology and Advanced Imaging Laboratory, Department of Kinesiology, University of Texas at Arlington, 676 W. Nedderman Dr., Arlington, TX, 76019, USA.
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Sciatti E, Coccia MG, Magnano R, Aakash G, Limonta R, Diep B, Balestrieri G, D'Isa S, Abramov D, Parwani P, D'Elia E. Heart Failure Preserved Ejection Fraction in Women: Insights Learned from Imaging. Heart Fail Clin 2023; 19:461-473. [PMID: 37714587 DOI: 10.1016/j.hfc.2023.06.001] [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: 09/17/2023]
Abstract
While the prevalence of heart failure, in general, is similar in men and women, women experience a higher rate of HFpEF compared to HFrEF. Cardiovascular risk factors, parity, estrogen levels, cardiac physiology, and altered response to the immune system may be at the root of this difference. Studies have found that in response to increasing age and hypertension, women experience more concentric left ventricle remodeling, more ventricular and arterial stiffness, and less ventricular dilation compared to men, which predisposes women to developing more diastolic dysfunction. A multi-modality imaging approach is recommended to identify patients with HFpEF. Particularly, appreciation of sex-based differences as described in this review is important in optimizing the evaluation and care of women with HFpEF.
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Affiliation(s)
- Edoardo Sciatti
- Cardiology Unit, Hospital Papa Giovanni XXIII, Bergamo, Italy
| | | | | | - Gupta Aakash
- Division of Cardiology, Department of Medicine, Loma Linda University Health, Loma Linda, CA, USA
| | - Raul Limonta
- School of Medicine and Surgery, Milano Bicocca University, Milano, Italy
| | - Brian Diep
- Division of Cardiology, Department of Medicine, Loma Linda University Health, Loma Linda, CA, USA
| | | | - Salvatore D'Isa
- Cardiology Unit, Hospital Papa Giovanni XXIII, Bergamo, Italy
| | - Dmitry Abramov
- Division of Cardiology, Department of Medicine, Loma Linda University Health, Loma Linda, CA, USA
| | - Purvi Parwani
- Division of Cardiology, Department of Medicine, Loma Linda University Health, Loma Linda, CA, USA
| | - Emilia D'Elia
- Cardiology Unit, Hospital Papa Giovanni XXIII, Bergamo, Italy.
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Iaconelli A, Cuthbert J, Kazmi S, Maffia P, Clark AL, Cleland JGF, Pellicori P. Inferior vena cava diameter is associated with prognosis in patients with chronic heart failure independent of tricuspid regurgitation velocity. Clin Res Cardiol 2023; 112:1077-1086. [PMID: 36894788 PMCID: PMC10359207 DOI: 10.1007/s00392-023-02178-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 02/22/2023] [Indexed: 03/11/2023]
Abstract
AIMS A high, Doppler-derived, tricuspid regurgitation velocity (TRV) indicates pulmonary hypertension, which may contribute to right ventricular dysfunction and worsening tricuspid regurgitation leading to systemic venous congestion, reflected by an increase in inferior vena cava (IVC) diameter. We hypothesized that venous congestion rather than pulmonary hypertension would be more strongly associated with prognosis. METHODS AND RESULTS 895 patients with chronic heart failure (CHF) (median (25th and 75th centile) age 75 (67-81) years, 69% men, LVEF 44 (34-55)% and NT-proBNP 1133 (423-2465) pg/ml) were enrolled. Compared to patients with normal IVC (< 21 mm) and TRV (≤ 2.8 m/s; n = 504, 56%), those with high TRV but normal IVC (n = 85, 9%) were older, more likely to be women and to have LVEF ≥ 50%, whilst those with dilated IVC but normal TRV (n = 142, 16%) had more signs of congestion and higher NT-proBNP. Patients (n = 164, 19%) with both dilated IVC and high TRV had the most signs of congestion and the highest NT-proBNP. During follow-up of 860 (435-1121) days, 239 patients died. Compared to those with both normal IVC and TRV (reference), patients with high TRV but normal IVC did not have a significantly increased mortality (HR: 1.41; CI: 0.87-2.29; P = 0.16). Risk was higher for patients with a dilated IVC but normal TRV (HR: 2.51; CI: 1.80-3.51; P < 0.001) or both a dilated IVC and elevated TRV (HR: 3.27; CI: 2.40-4.46; P < 0.001). CONCLUSION Amongst ambulatory patients with CHF, a dilated IVC is more closely associated with an adverse prognosis than an elevated TRV.
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Affiliation(s)
- Antonio Iaconelli
- School of Cardiovascular & Metabolic Health, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Joe Cuthbert
- Department of Cardiorespiratory Medicine, Centre for Clinical Sciences, Hull York Medical School, University of Hull, Kingston-Upon-Hull, East Riding of Yorkshire, HU6 7RX, UK
- Department of Cardiology, Castle Hill Hospital, Hull University Teaching Hospitals Trust, Castle Road, Cottingham, Kingston-Upon-Hull, East Riding of Yorkshire, HU6 5JQ, UK
| | - Syed Kazmi
- Department of Cardiorespiratory Medicine, Centre for Clinical Sciences, Hull York Medical School, University of Hull, Kingston-Upon-Hull, East Riding of Yorkshire, HU6 7RX, UK
| | - Pasquale Maffia
- School of Cardiovascular & Metabolic Health, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
- School of Infection & Immunity, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
- Department of Pharmacy, School of Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Andrew L Clark
- Department of Cardiology, Castle Hill Hospital, Hull University Teaching Hospitals Trust, Castle Road, Cottingham, Kingston-Upon-Hull, East Riding of Yorkshire, HU6 5JQ, UK
| | - John G F Cleland
- School of Cardiovascular & Metabolic Health, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Pierpaolo Pellicori
- School of Cardiovascular & Metabolic Health, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK.
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Graham FJ, Iaconelli A, Sonecki P, Campbell RT, Hunter D, Cleland JGF, Pellicori P. Defining Heart Failure Based on Imaging the Heart and Beyond. Card Fail Rev 2023; 9:e10. [PMID: 37427007 PMCID: PMC10326661 DOI: 10.15420/cfr.2022.29] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 02/19/2023] [Indexed: 07/11/2023] Open
Abstract
Water and salt retention, in other words congestion, are fundamental to the pathophysiology of heart failure and are important therapeutic targets. Echocardiography is the key tool with which to assess cardiac structure and function in the initial diagnostic workup of patients with suspected heart failure and is essential for guiding treatment and stratifying risk. Ultrasound can also be used to identify and quantify congestion in the great veins, kidneys and lungs. More advanced imaging methods might further clarify the aetiology of heart failure and its consequences for the heart and periphery, thereby improving the efficiency and quality of care tailored with greater precision to individual patient need.
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Affiliation(s)
- Fraser J Graham
- School of Cardiovascular and Metabolic Health, University of GlasgowGlasgow, UK
| | - Antonio Iaconelli
- School of Cardiovascular and Metabolic Health, University of GlasgowGlasgow, UK
| | | | - Ross T Campbell
- School of Cardiovascular and Metabolic Health, University of GlasgowGlasgow, UK
| | - David Hunter
- School of Cardiovascular and Metabolic Health, University of GlasgowGlasgow, UK
| | - John GF Cleland
- School of Cardiovascular and Metabolic Health, University of GlasgowGlasgow, UK
| | - Pierpaolo Pellicori
- School of Cardiovascular and Metabolic Health, University of GlasgowGlasgow, UK
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Peters AE, Clare RM, Chiswell K, Felker GM, Kelsey A, Mentz R, DeVore AD. Echocardiographic Features Beyond Ejection Fraction and Associated Outcomes in Patients With Heart Failure With Mildly Reduced or Preserved Ejection Fraction. Circ Heart Fail 2023; 16:e010252. [PMID: 37192287 PMCID: PMC10195029 DOI: 10.1161/circheartfailure.122.010252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 03/30/2023] [Indexed: 05/18/2023]
Abstract
BACKGROUND Heart failure (HF) guidelines recommend assessment of left ventricular ejection fraction (LVEF) to classify patients and guide therapy implementation. However, LVEF alone may be insufficient to adequately characterize patients with HF, especially those with mildly reduced or preserved LVEF. Recommendations on additional testing are lacking, and there are limited data on use of echocardiographic features beyond LVEF in patients with heart failure with mildly reduced or preserved LVEF. METHODS In patients with HF with mildly reduced or preserved LVEF identified in a large US health care system, the association of the following metrics with mortality was evaluated: LV global longitudinal strain (LV GLS>-16), left atrial volume index (>28 mL/m2), left ventricular hypertrophy (LVH), and E/e´>13 and e´<9. A multivariable model for mortality was constructed including age, sex, and key comorbidities followed by stepwise selection of echocardiographic features. Characteristics and outcomes of subgroups with normal versus abnormal LV GLS and LVEF were evaluated. RESULTS Among 2337 patients with complete echocardiographic data assessed between 2017 and 2020, the following features were associated with all-cause mortality on univariate analysis over 3 years of follow-up: E/e´+e´, LV GLS, left atrial volume index (all P<0.01). In the multivariable model (C-index=0.65), only abnormal LV GLS was independently associated with all-cause mortality (HR, 1.35 [95% CI, 1.11-1.63]; P=0.002). Among patients with LVEF>55%, 498/1255 (40%) demonstrated abnormal LV GLS. Regardless of specific LVEF, patients with abnormal LV GLS demonstrated a higher burden of multiple comorbidities and higher event rates compared with patients with normal LV GLS. CONCLUSIONS In a large, real-world HF with mildly reduced or preserved LVEF population, echocardiographic features, led by LV GLS, were associated with adverse outcomes irrespective of LVEF. A large proportion of patients demonstrate adverse myocardial function by LV GLS despite preserved LVEF and may represent a key cohort of interest for HF medical therapies and future clinical studies.
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Affiliation(s)
- Anthony E. Peters
- Division of Cardiology, Duke University School of Medicine, Durham, North Carolina
- Duke Clinical Research Institute, Durham, North Carolina
| | | | - Karen Chiswell
- Duke Clinical Research Institute, Durham, North Carolina
| | - G. Michael Felker
- Division of Cardiology, Duke University School of Medicine, Durham, North Carolina
- Duke Clinical Research Institute, Durham, North Carolina
| | - Anita Kelsey
- Division of Cardiology, Duke University School of Medicine, Durham, North Carolina
| | - Robert Mentz
- Division of Cardiology, Duke University School of Medicine, Durham, North Carolina
- Duke Clinical Research Institute, Durham, North Carolina
| | - Adam D. DeVore
- Division of Cardiology, Duke University School of Medicine, Durham, North Carolina
- Duke Clinical Research Institute, Durham, North Carolina
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Pugliese NR, Pellicori P, Filidei F, De Biase N, Maffia P, Guzik TJ, Masi S, Taddei S, Cleland JGF. Inflammatory pathways in heart failure with preserved left ventricular ejection fraction: implications for future interventions. Cardiovasc Res 2023; 118:3536-3555. [PMID: 36004819 PMCID: PMC9897694 DOI: 10.1093/cvr/cvac133] [Citation(s) in RCA: 35] [Impact Index Per Article: 35.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 07/26/2022] [Accepted: 08/10/2022] [Indexed: 02/07/2023] Open
Abstract
Many patients with symptoms and signs of heart failure have a left ventricular ejection fraction ≥50%, termed heart failure with preserved ejection fraction (HFpEF). HFpEF is a heterogeneous syndrome mainly affecting older people who have many other cardiac and non-cardiac conditions that often cast doubt on the origin of symptoms, such as breathlessness, or signs, such as peripheral oedema, rendering them neither sensitive nor specific to the diagnosis of HFpEF. Currently, management of HFpEF is mainly directed at controlling symptoms and treating comorbid conditions such as hypertension, atrial fibrillation, anaemia, and coronary artery disease. HFpEF is also characterized by a persistent increase in inflammatory biomarkers. Inflammation may be a key driver of the development and progression of HFpEF and many of its associated comorbidities. Detailed characterization of specific inflammatory pathways may provide insights into the pathophysiology of HFpEF and guide its future management. There is growing interest in novel therapies specifically designed to target deregulated inflammation in many therapeutic areas, including cardiovascular disease. However, large-scale clinical trials investigating the effectiveness of anti-inflammatory treatments in HFpEF are still lacking. In this manuscript, we review the role of inflammation in HFpEF and the possible implications for future trials.
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Affiliation(s)
| | - Pierpaolo Pellicori
- Robertson Institute of Biostatistics and Clinical Trials Unit, University of Glasgow, Glasgow G12 8QQ, UK
| | - Francesco Filidei
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa 56126, Italy
| | - Nicolò De Biase
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa 56126, Italy
| | - Pasquale Maffia
- Centre for Immunobiology, Institute of Infection, Immunity and Inflammation, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow G12 8TA, UK
- Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow G12 8QQ, UK
- Department of Pharmacy, School of Medicine and Surgery, University of Naples Federico II, Naples 80138, Italy
| | - Tomasz J Guzik
- Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow G12 8QQ, UK
- Department of Internal and Agricultural Medicine, Jagiellonian University, Collegium Medicum, Krakow 31-008, Poland
| | - Stefano Masi
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa 56126, Italy
| | - Stefano Taddei
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa 56126, Italy
| | - John G F Cleland
- Robertson Institute of Biostatistics and Clinical Trials Unit, University of Glasgow, Glasgow G12 8QQ, UK
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10
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Das KM, Baskaki UMA, Pulinchani A, Ali HM, Almanssori TM, Gorkom KV, Das A, Dewedar H, Sharma S. Significance of Cardiac Magnetic Resonance Feature Tracking of the Right Ventricle in Predicting Subclinical Dysfunction in Patients with Thalassemia Major. Diagnostics (Basel) 2022; 12:diagnostics12081920. [PMID: 36010270 PMCID: PMC9406855 DOI: 10.3390/diagnostics12081920] [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: 06/29/2022] [Revised: 08/01/2022] [Accepted: 08/02/2022] [Indexed: 01/19/2023] Open
Abstract
In patients with thalassemia major (TM), cardiac magnetic resonance feature-tracking (CMR-FT) has been shown to be an effective method for diagnosing subclinical left ventricular (LV) dysfunction. This study aimed to determine whether CMR-FT could detect abnormal RV dysfunction in patients with a normal right ventricular ejection fraction (RVEF). We performed a retrospective analysis of TM patients admitted to Dubai’s Rashid Hospital between July 2019 and March 2021. The inclusion criteria were TM patients with SSFP cine with T2* (T2*-weighted imaging), while exclusion criteria included any other cardiovascular disease. When there was no myocardial iron overload (MIO) (T2* ≥ 20 ms) and when there was significant MIO (T2* < 20 ms), the CMR-FT was used to correlate with EF. Among the 89 participants, there were 46 men (51.7%) and 43 women (48.3%), with a mean age of 26.14 ± 7.4 years (range from 10 to 48 years). Forty-six patients (51.69%) did not have MIO, while 43 individuals did (48.31%). Thirty-nine patients (32.6%) were diagnosed with severe MIO, while seventeen (19.1%) were diagnosed with mild to moderate MIO. A significant correlation existed between RVEF and T2* values (r = 0.274, p = 0.014) and between left ventricular ejection fraction (LVEF) and T2* values (r = 0.256, p = 0.022). Using a multiple logistic regression model with predictors such as right ventricular longitudinal strain (RVGLS), LV ejection fraction (LV EF), and hemoglobin, abnormal myocardial iron overload can be predicted. This model demonstrates an AUC of 78.3%, a sensitivity of 72%, and a specificity of 76%. In the group with preserved RVEF > 53%, the left ventricular radial strain (LVGRS) (p = 0.001), right ventricular radial strain (RVGRS) (p = 0.000), and right ventricular basal circumferential strain (RVGCS-basal) (p = 0.000) CMR-FT strain values are significantly lower than those of the control group (p > 0.05). There was no significant correlation between the LVGLS and T2*. RVGLS was ranked among the most accurate predictors of abnormal myocardial iron overload. The LVGRS, RVGRS, and RVGCS-basal CMR-FT strain values were the best predictors of subclinical RV dysfunction in the group with preserved RVEF. The most accurate way to diagnose MIO is still T2*, but FT-strain can help us figure out how MIO affects the myocardium from a pathophysiological point of view.
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Affiliation(s)
- Karuna M. Das
- College of Medicine & Health Sciences, United Arab Emirates University, Al Ain P.O. Box 17666, United Arab Emirates
- Correspondence:
| | | | - Anisha Pulinchani
- Department of Data Science, PSPH, Manipal Academy of Higher Education, Manipal 576104, India
| | | | - Taleb M. Almanssori
- College of Medicine & Health Sciences, United Arab Emirates University, Al Ain P.O. Box 17666, United Arab Emirates
| | - Klaus Van Gorkom
- College of Medicine & Health Sciences, United Arab Emirates University, Al Ain P.O. Box 17666, United Arab Emirates
| | - Amrita Das
- Brighton College, Al Ain P.O. Box 17666, United Arab Emirates
| | - Hany Dewedar
- Thalassemia Center, Dubai P.O. Box 9115, United Arab Emirates
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11
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Albani S, Mesin L, Roatta S, De Luca A, Giannoni A, Stolfo D, Biava L, Bonino C, Contu L, Pelloni E, Attena E, Russo V, Antonini-Canterin F, Pugliese NR, Gallone G, De Ferrari GM, Sinagra G, Scacciatella P. Inferior Vena Cava Edge Tracking Echocardiography: A Promising Tool with Applications in Multiple Clinical Settings. Diagnostics (Basel) 2022; 12:diagnostics12020427. [PMID: 35204518 PMCID: PMC8871248 DOI: 10.3390/diagnostics12020427] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 01/29/2022] [Indexed: 01/25/2023] Open
Abstract
Ultrasound (US)-based measurements of the inferior vena cava (IVC) diameter are widely used to estimate right atrial pressure (RAP) in a variety of clinical settings. However, the correlation with invasively measured RAP along with the reproducibility of US-based IVC measurements is modest at best. In the present manuscript, we discuss the limitations of the current technique to estimate RAP through IVC US assessment and present a new promising tool developed by our research group, the automated IVC edge-to-edge tracking system, which has the potential to improve RAP assessment by transforming the current categorical classification (low, normal, high RAP) in a continuous and precise RAP estimation technique. Finally, we critically evaluate all the clinical settings in which this new tool could improve current practice.
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Affiliation(s)
- Stefano Albani
- Division of Cardiology, Umberto Parini Regional Hospital, 11100 Aosta, Italy; (L.B.); (C.B.); (L.C.); (E.P.); (P.S.)
- Cardio-Thoraco-Vascular Department, Division of Cardiology and Postgraduate School in Cardiovascular Sciences, University of Trieste, 34127 Trieste, Italy; (A.D.L.); (D.S.); (G.S.)
- Correspondence: ; Tel.: +39-3285999910
| | - Luca Mesin
- Mathematical Biology & Physiology, Department of Electronics and Telecommunications, Politecnico di Torino, 10129 Torino, Italy;
| | - Silvestro Roatta
- Integrative Physiology Lab, Department of Neuroscience, University of Turin, 10125 Turin, Italy;
| | - Antonio De Luca
- Cardio-Thoraco-Vascular Department, Division of Cardiology and Postgraduate School in Cardiovascular Sciences, University of Trieste, 34127 Trieste, Italy; (A.D.L.); (D.S.); (G.S.)
| | - Alberto Giannoni
- Scuola Superiore Sant’Anna, 56127 Pisa, Italy;
- Fondazione Toscana G. Monasterio, 56124 Pisa, Italy
| | - Davide Stolfo
- Cardio-Thoraco-Vascular Department, Division of Cardiology and Postgraduate School in Cardiovascular Sciences, University of Trieste, 34127 Trieste, Italy; (A.D.L.); (D.S.); (G.S.)
| | - Lorenza Biava
- Division of Cardiology, Umberto Parini Regional Hospital, 11100 Aosta, Italy; (L.B.); (C.B.); (L.C.); (E.P.); (P.S.)
| | - Caterina Bonino
- Division of Cardiology, Umberto Parini Regional Hospital, 11100 Aosta, Italy; (L.B.); (C.B.); (L.C.); (E.P.); (P.S.)
| | - Laura Contu
- Division of Cardiology, Umberto Parini Regional Hospital, 11100 Aosta, Italy; (L.B.); (C.B.); (L.C.); (E.P.); (P.S.)
| | - Elisa Pelloni
- Division of Cardiology, Umberto Parini Regional Hospital, 11100 Aosta, Italy; (L.B.); (C.B.); (L.C.); (E.P.); (P.S.)
| | - Emilio Attena
- Department of Translational Medical Sciences, University of Campania Luigi Vanvitelli-Monaldi Hospital—A.O.R.N. Dei Colli, 80131 Naples, Italy; (E.A.); (V.R.)
| | - Vincenzo Russo
- Department of Translational Medical Sciences, University of Campania Luigi Vanvitelli-Monaldi Hospital—A.O.R.N. Dei Colli, 80131 Naples, Italy; (E.A.); (V.R.)
| | | | | | - Guglielmo Gallone
- Division of Cardiology, Città della Salute e della Scienza, University of Turin, 10124 Turin, Italy; (G.G.); (G.M.D.F.)
| | - Gaetano Maria De Ferrari
- Division of Cardiology, Città della Salute e della Scienza, University of Turin, 10124 Turin, Italy; (G.G.); (G.M.D.F.)
| | - Gianfranco Sinagra
- Cardio-Thoraco-Vascular Department, Division of Cardiology and Postgraduate School in Cardiovascular Sciences, University of Trieste, 34127 Trieste, Italy; (A.D.L.); (D.S.); (G.S.)
| | - Paolo Scacciatella
- Division of Cardiology, Umberto Parini Regional Hospital, 11100 Aosta, Italy; (L.B.); (C.B.); (L.C.); (E.P.); (P.S.)
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12
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Rojas LZ, Gómez-Ochoa SA, Echeverría LE, Bautista-Niño PK, Hunziker L, Eisenga MF, Muka T. Circulating DHEA-S levels and major cardiovascular outcomes in chronic Chagas cardiomyopathy: A prospective cohort study. Int J Cardiol 2021; 349:90-95. [PMID: 34838827 DOI: 10.1016/j.ijcard.2021.11.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 11/18/2021] [Accepted: 11/22/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To analyze the association of circulating dehydroepiandrosterone sulfate (DHEA-S) levels with cardiovascular outcomes in patients with chronic Chagas cardiomyopathy (CCM) diagnosis. BACKGROUND DHEA-S is among the main endogenous steroid hormones. Some studies have suggested a relevant role of this hormone in infections and the setting of CCM. Nevertheless, no study has evaluated the prognostic role of DHEA-S in CCM patients. METHODS Prospective cohort study. Patients with CCM and reduced ejection fraction were included. We explored the association of DHEA-S levels with NT-proBNP levels and echocardiographic variables using linear regression models. Next, by using Cox Proportional Hazard models, we examined whether levels of DHEA-S could predict a composite outcome (CO) including all-cause mortality, cardiac transplantation, and implantation of a left ventricular assist device (LVAD). RESULTS Seventy-four patients were included (59% males, median age: 64 years). After adjustment for confounding factors, high DHEA-S levels were associated with better LVEF, lower left atrium volume, end-systolic volume of the left ventricle and lower NT-proBNP levels. 43% of patients experienced the CO during a median follow-up of 40 months. Increased levels of DHEA-S were associated with a lower risk of developing the CO (HR 0.43; 95%CI 0.21-0.86). Finally, adding DHEA-S to the multivariate model did not improve the prediction of the CO, but substituting NT-proBNP in the model with DHEA-S showed similar performance. CONCLUSIONS In patients with CCM, higher DHEA-S levels were associated with lower mortality, heart transplantation, and LVAD implantation. Further larger studies are required to confirm our results and assess causality.
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Affiliation(s)
- Lyda Z Rojas
- Research Group and Development of Nursing Knowledge (GIDCEN-FCV), Research Center, Cardiovascular Foundation of Colombia, Floridablanca, Santander, Colombia
| | | | - Luis E Echeverría
- Heart Failure and Heart Transplant Clinic, Fundación Cardiovascular de Colombia, Floridablanca, Colombia
| | | | - Lukas Hunziker
- Department of Cardiology, Bern University Hospital, Bern, Switzerland
| | - Michele F Eisenga
- Department of Internal Medicine, Division of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Taulant Muka
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland.
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13
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Bekfani T, Hamadanchi A, Ijuin S, Bekhite M, Nisser J, Derlien S, Westphal J, Bogoviku J, Morris DA, Fudim M, Braun-Dullaeus RC, Möbius-Winkler S, Schulze PC. Relation of left atrial function with exercise capacity and muscle endurance in patients with heart failure. ESC Heart Fail 2021; 8:4528-4538. [PMID: 34726343 PMCID: PMC8712812 DOI: 10.1002/ehf2.13656] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Revised: 09/13/2021] [Accepted: 09/27/2021] [Indexed: 11/18/2022] Open
Abstract
Aims Both left atrial strain (LAS) and skeletal muscle endurance demonstrate a linear relationship to peak VO2. Less is known about the relationship between central (cardiac) and peripheral (muscle endurance) limitations of exercise capacity in patients with heart failure (HF). We investigated this relationship using novel cardiac markers such as LAS and left atrial emptying fraction (LAEF). Methods and results We analysed echocardiographic measurements, cardiopulmonary exercise testing (CPET), and isokinetic muscle function in 55 subjects with HF and controls [17 heart failure with preserved ejection fraction (HFpEF), 18 heart failure with reduced ejection fraction (HFrEF), and 20 healthy controls]. Patients with reduced LAEF showed reduced peak VO2: 14.3 ± 3.5 vs. 18.5 ± 3.5 mL/min/kg, P = 0.003, and reduced muscle endurance (RME): 64.3 ± 23.9 vs. 88.5 ± 32.3 Nm/kg, P = 0.028. Patients with reduced LAS showed similar results. Neither left ventricular global longitudinal strain (LVGLS) nor left atrial volume index (LAVI) was associated with RME. The area under the curve of LAS and LAEF in patients with HF in association with RME were (0.76 vs. 0.80) with 95% confidence interval (CI) (0.59–0.96, P = 0.012 vs. 0.63–0.98, P = 0.006, respectively). In a multiple linear regression, LAEF and working load measured during CPET (watt) were independent factors for RME after adjusting for age, LVGLS, and 6 min walk test (6MWT) [LAEF (B: 0.09, 95% CI: 1.01; 1.18, P = 0.024), working load (B: 0.05, 95% CI: 1.01; 1.08, P = 0.006)]. Peak torque of the left leg was associated with E/LAS (E: early diastolic) in patients with HFpEF (r = −0.6, P = 0.020). Endurance of the left leg was associated with LAEF (r = 0.79, P = 0.001) in patients with HFrEF. Conclusions LAS/LAEF are potential cardiac markers in demonstrating the link between cardiac and peripheral limitations of exercise capacity. Thus, integrating LAS/LAEF in the evaluation of exercise intolerance in patients with HF could be useful.
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Affiliation(s)
- Tarek Bekfani
- Department of Internal Medicine I, Division of Cardiology, Angiology and Intensive Medical Care, University Hospital Magdeburg, Otto von Guericke-University, Magdeburg, Germany.,Department of Internal Medicine I, Division of Cardiology, Angiology, Pneumology and Intensive Medical Care, University Hospital Jena, Friedrich-Schiller-University, Jena, Germany
| | - Ali Hamadanchi
- Department of Internal Medicine I, Division of Cardiology, Angiology, Pneumology and Intensive Medical Care, University Hospital Jena, Friedrich-Schiller-University, Jena, Germany
| | - Shun Ijuin
- Department of Internal Medicine I, Division of Cardiology, Angiology, Pneumology and Intensive Medical Care, University Hospital Jena, Friedrich-Schiller-University, Jena, Germany
| | - Mohamed Bekhite
- Department of Internal Medicine I, Division of Cardiology, Angiology, Pneumology and Intensive Medical Care, University Hospital Jena, Friedrich-Schiller-University, Jena, Germany
| | - Jenny Nisser
- Institute of Physiotherapy, University Hospital Jena, Friedrich-Schiller-University, Jena, Germany
| | - Steffen Derlien
- Institute of Physiotherapy, University Hospital Jena, Friedrich-Schiller-University, Jena, Germany
| | - Julian Westphal
- Department of Internal Medicine I, Division of Cardiology, Angiology, Pneumology and Intensive Medical Care, University Hospital Jena, Friedrich-Schiller-University, Jena, Germany
| | - Jurgen Bogoviku
- Department of Internal Medicine I, Division of Cardiology, Angiology, Pneumology and Intensive Medical Care, University Hospital Jena, Friedrich-Schiller-University, Jena, Germany
| | - Daniel A Morris
- Department of Internal Medicine, Division of Cardiology, Virchow Klinikum, Charité Medical School, Berlin, Germany
| | - Marat Fudim
- Department of Medicine, Division of Cardiology, Duke University Medical Center, Durham, NC, USA.,Duke Clinical Research Institute, Durham, NC, USA
| | - Rüdiger C Braun-Dullaeus
- Department of Internal Medicine I, Division of Cardiology, Angiology and Intensive Medical Care, University Hospital Magdeburg, Otto von Guericke-University, Magdeburg, Germany
| | - Sven Möbius-Winkler
- Department of Internal Medicine I, Division of Cardiology, Angiology, Pneumology and Intensive Medical Care, University Hospital Jena, Friedrich-Schiller-University, Jena, Germany
| | - P Christian Schulze
- Department of Internal Medicine I, Division of Cardiology, Angiology, Pneumology and Intensive Medical Care, University Hospital Jena, Friedrich-Schiller-University, Jena, Germany
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14
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Pellicori P, Cleland JGF. Structural heart disease, cardiac dysfunction and heart failure: the ambiguity of a definition. Eur J Prev Cardiol 2021; 28:921-923. [PMID: 32718235 DOI: 10.1177/2047487320937135] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- Pierpaolo Pellicori
- Robertson Centre of Biostatistics and Clinical Trials Unit, University of Glasgow, UK
| | - John G F Cleland
- Robertson Centre of Biostatistics and Clinical Trials Unit, University of Glasgow, UK
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15
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Lin L, Zhou X, Dekkers IA, Lamb HJ. Cardiorenal Syndrome: Emerging Role of Medical Imaging for Clinical Diagnosis and Management. J Pers Med 2021; 11:734. [PMID: 34442378 PMCID: PMC8400880 DOI: 10.3390/jpm11080734] [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: 06/27/2021] [Revised: 07/24/2021] [Accepted: 07/24/2021] [Indexed: 12/16/2022] Open
Abstract
Cardiorenal syndrome (CRS) concerns the interconnection between heart and kidneys in which the dysfunction of one organ leads to abnormalities of the other. The main clinical challenges associated with cardiorenal syndrome are the lack of tools for early diagnosis, prognosis, and evaluation of therapeutic effects. Ultrasound, computed tomography, nuclear medicine, and magnetic resonance imaging are increasingly used for clinical management of cardiovascular and renal diseases. In the last decade, rapid development of imaging techniques provides a number of promising biomarkers for functional evaluation and tissue characterization. This review summarizes the applicability as well as the future technological potential of each imaging modality in the assessment of CRS. Furthermore, opportunities for a comprehensive imaging approach for the evaluation of CRS are defined.
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Affiliation(s)
- Ling Lin
- Cardiovascular Imaging Group (CVIG), Department of Radiology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; (L.L.); (I.A.D.); (H.J.L.)
| | - Xuhui Zhou
- Department of Radiology, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen 510833, China
| | - Ilona A. Dekkers
- Cardiovascular Imaging Group (CVIG), Department of Radiology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; (L.L.); (I.A.D.); (H.J.L.)
| | - Hildo J. Lamb
- Cardiovascular Imaging Group (CVIG), Department of Radiology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; (L.L.); (I.A.D.); (H.J.L.)
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16
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Çöllüoğlu T, Önalan O, Çakan F. The diagnostic value of 2D-speckle tracking echocardiography for identifying subclinical ventricular dysfunction in subjects with early repolarization pattern. Echocardiography 2021; 38:1141-1148. [PMID: 34114242 DOI: 10.1111/echo.15128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 05/07/2021] [Accepted: 05/20/2021] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Early repolarization pattern (ERP) can exist a silent substrate for arrhytmic events in accordance with the previous studies which have shown there has been evidence of morphological changes in left ventricle (LV) in ERP subjects. Despite structural changes in ERP subjects, it has not exactly known whether a change in LV functional parameters occur in ERP. The aim of our study was to investigate LV functional parameters in ERP athletes evaluated by 2D- speckle tracking echocardiography (2D-STE). METHOD In this study, athletes with ERP (n = 50) and athletes without ERP (n = 50) were recruited between April 2018 and September 2018. For each case, 2D- TTE and 2D- STE evaluation were performed by the same cardiologist. RESULTS Left ventricle mean global longitudinal strain (GLS) (P < .001) and GLS at all apical chamber views (P < .001), longitudinal peak systolic strain rate (SRS) at A3C (P: .011), early diastolic strain rate (SRE) at A3C (P < .001) and late diastolic strain rate (SRA) at A3C (P: .034) in the ERP athletes were significantly lower than those in the athletes without ERP. LV basal segment circumferential SRS (P: .002) and SRE (P: .006) were significantly lower in ERP athletes compared to athletes without ERP. LV mechanical dispersion was significantly higher in ERP athletes compared to athletes without ERP (P < .001). CONCLUSION Our study suggests ERP can be more associated with impaired LV longitudinal function than circumferential function. In addition, both LV inferolateral region and basal segment can be more affected functionally in ERP athletes.
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Affiliation(s)
- Tuğçe Çöllüoğlu
- Cardiology Department, KBU Educational and Research Hospital, Karabük, Turkey
| | - Orhan Önalan
- Cardiology Department, KBU Educational and Research Hospital, Karabük, Turkey
| | - Fahri Çakan
- Cardiology Department, KBU Educational and Research Hospital, Karabük, Turkey
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17
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Cincin A, Ozben B, Tukenmez Tigen E, Sunbul M, Sayar N, Gurel E, Tigen K, Korten V. Ventricular and atrial functions assessed by speckle-tracking echocardiography in patients with human immunodeficiency virus. JOURNAL OF CLINICAL ULTRASOUND : JCU 2021; 49:341-350. [PMID: 32954546 DOI: 10.1002/jcu.22921] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 07/29/2020] [Accepted: 09/01/2020] [Indexed: 06/11/2023]
Abstract
PURPOSE Antiretroviral therapy (ART) has dramatically changed the clinical manifestation of human immunodeficiency virus (HIV) associated cardiomyopathy from severe left ventricular (LV) systolic dysfunction to a pattern of subclinical cardiac dysfunction. The aim of this study was to evaluate by speckle tracking echocardiography (STE) LV, right ventricular (RV), and biatrial functions in HIV-infected patients under different ART combinations. METHODS We consecutively included 128 HIV-infected patients (mean age 44.2 ± 10.1 years, 110 males) and 100 controls (mean age 42.1 ± 9.4 years, 83 males). Ventricular and atrial functions were assessed by both conventional and STE. RESULTS Although there was not any significant difference in conventional echocardiographic variables, HIV-infected patients had significantly lower LV global longitudinal strain (GLS), RV GLS, left atrial (LA) reservoir and conduit strain, and right atrial conduit strain. HIV patients receiving integrase strand transfer inhibitors and protease inhibitors (PI) had significantly lower LV GLS and LA conduit strain, while patients receiving non-nucleoside reverse transcriptase inhibitors and PI had significantly lower RV GLS than controls. CD4 count at the time of echocardiography was strongly correlated with LV GLS (r = .619, P < .001) and RV GLS (r = .606, P < .001). CONCLUSION Biventricular and atrial functions are subclinically impaired in HIV-infected patients. ART regimen may also affect myocardial functions.
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Affiliation(s)
- Altug Cincin
- Marmara University School of Medicine Department of Cardiology, Istanbul, Turkey
| | - Beste Ozben
- Marmara University School of Medicine Department of Cardiology, Istanbul, Turkey
| | - Elif Tukenmez Tigen
- Marmara University School of Medicine Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
| | - Murat Sunbul
- Marmara University School of Medicine Department of Cardiology, Istanbul, Turkey
| | - Nurten Sayar
- Marmara University School of Medicine Department of Cardiology, Istanbul, Turkey
| | - Emre Gurel
- Marmara University School of Medicine Department of Cardiology, Istanbul, Turkey
| | - Kursat Tigen
- Marmara University School of Medicine Department of Cardiology, Istanbul, Turkey
| | - Volkan Korten
- Marmara University School of Medicine Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
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18
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Hidayet Ş, Yağmur J, Bayramoğlu A, Cansel M, Ermiş N, Taşolar H, Karaca Y, Yiğit Y, Şener S, Ulutaş Z, Pekdemir H. Fragmented QRS complexes are associated with subclinical left ventricular dysfunction in patients with Behcet's disease: Four-dimensional speckle tracking echocardiography. JOURNAL OF CLINICAL ULTRASOUND : JCU 2021; 49:227-233. [PMID: 32812267 DOI: 10.1002/jcu.22899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 06/18/2020] [Accepted: 06/30/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Behcet's disease (BD) is a chronic systemic inflammatory disease in which early detection of cardiac involvement is essential. The aim of this study was to assess the left ventricular (LV) functions in BD patients using four-dimensional (4D) speckle tracking echocardiography (STE) and to test the correlation between LV dysfunction and the presence of QRS fragmentation. METHODS This cross-sectional study included 64 Behcet's patients and 48 healthy volunteers. The BD group was divided into two subgroups depending on the presence (fQRS+) or absence (fQRS-) of fragmented QRS (fQRS). In both groups, left ventricular global area strain (LV-GAS), global radial strain (GRS), global longitudinal strain (GLS), and global circumferential strain (GCS) were obtained with 4D echocardiography. RESULTS GAS, GRS, GLS, and GCS values were significantly different in Behcet's patients and in healthy volunteers. GLS and GAS values were lower in the fQRS+ than in the fQRS- group (-15.8 ± 1.8 and -17.9 ± 1.6, P = .001 vs -25.0 ± 3.1 and -29.2 ± 4.2, P < .001, respectively). The duration of disease was longer in fQRS+ than in fQRS- patients (120.8 ± 67.4 vs 71.0 ± 40.5, P < .001). Multiple linear regression analysis showed that fQRS and disease duration were independent predictors of LV-GAS. CONCLUSIONS Four-dimensional STE may be helpful for the prediction of early cardiac dysfunction in patients with BD. The presence of fQRS may be an indicator of subclinical LV dysfunction.
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Affiliation(s)
- Şıho Hidayet
- Department of Cardiology, Inonu University Faculty of Medicine, Malatya, Turkey
| | - Jülide Yağmur
- Department of Cardiology, Inonu University Faculty of Medicine, Malatya, Turkey
| | - Adil Bayramoğlu
- Department of Cardiology, Inonu University Faculty of Medicine, Malatya, Turkey
| | - Mehmet Cansel
- Department of Cardiology, Inonu University Faculty of Medicine, Malatya, Turkey
| | - Necip Ermiş
- Department of Cardiology, Inonu University Faculty of Medicine, Malatya, Turkey
| | - Hakan Taşolar
- Department of Cardiology, Inonu University Faculty of Medicine, Malatya, Turkey
| | - Yücel Karaca
- Department of Cardiology, Inonu University Faculty of Medicine, Malatya, Turkey
| | - Yakup Yiğit
- Department of Cardiology, Inonu University Faculty of Medicine, Malatya, Turkey
| | - Serpil Şener
- Department of Dermatology, Inonu University Faculty of Medicine, Malatya, Turkey
| | - Zeynep Ulutaş
- Department of Cardiology, Fethi Sekin Training and Research Hospital, Elazığ, Turkey
| | - Hasan Pekdemir
- Department of Cardiology, Inonu University Faculty of Medicine, Malatya, Turkey
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Pellicori P, Platz E, Dauw J, Ter Maaten JM, Martens P, Pivetta E, Cleland JGF, McMurray JJV, Mullens W, Solomon SD, Zannad F, Gargani L, Girerd N. Ultrasound imaging of congestion in heart failure: examinations beyond the heart. Eur J Heart Fail 2020; 23:703-712. [PMID: 33118672 DOI: 10.1002/ejhf.2032] [Citation(s) in RCA: 89] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 10/12/2020] [Accepted: 10/22/2020] [Indexed: 12/15/2022] Open
Abstract
Congestion, related to pressure and/or fluid overload, plays a central role in the pathophysiology, presentation and prognosis of heart failure and is an important therapeutic target. While symptoms and physical signs of fluid overload are required to make a clinical diagnosis of heart failure, they lack both sensitivity and specificity, which might lead to diagnostic delay and uncertainty. Over the last decades, new ultrasound methods for the detection of elevated intracardiac pressures and/or fluid overload have been developed that are more sensitive and specific, thereby enabling earlier and more accurate diagnosis and facilitating treatment strategies. Accordingly, we considered that a state-of-the-art review of ultrasound methods for the detection and quantification of congestion was timely, including imaging of the heart, lungs (B-lines), kidneys (intrarenal venous flow), and venous system (inferior vena cava and internal jugular vein diameter).
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Affiliation(s)
- Pierpaolo Pellicori
- Robertson Institute of Biostatistics and Clinical Trials Unit, University of Glasgow, Glasgow, UK
| | - Elke Platz
- Cardiovascular Division, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Jeroen Dauw
- Department of Cardiology, Ziekenhuis Oost-Limburg (ZOL), Genk, Belgium.,Doctoral School for Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium
| | - Jozine M Ter Maaten
- Department of Cardiology, Ziekenhuis Oost-Limburg (ZOL), Genk, Belgium.,Department of Cardiology, University Medical Center Groningen, Groningen, The Netherlands
| | - Pieter Martens
- Department of Cardiology, Ziekenhuis Oost-Limburg (ZOL), Genk, Belgium.,Doctoral School for Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium
| | - Emanuele Pivetta
- Division of Emergency Medicine and High Dependency Unit, AOU Città della Salute e della Scienza di Torino, Cancer Epidemiology Unit and CPO Piemonte, Department of Medical Sciences, University of Turin, Turin, Italy
| | - John G F Cleland
- Robertson Institute of Biostatistics and Clinical Trials Unit, University of Glasgow, Glasgow, UK
| | - John J V McMurray
- BHF Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Wilfried Mullens
- Department of Cardiology, Ziekenhuis Oost-Limburg (ZOL), Genk, Belgium.,Biomedical Research Institute, Faculty of Medicine and Life Sciences, LCRC, Hasselt University, Diepenbeek, Belgium
| | - Scott D Solomon
- Cardiovascular Division, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Faiez Zannad
- Université de Lorraine, INSERM, Centre d'Investigations Cliniques Plurithématique, INSERM 1433, CHRU de Nancy, Institut Lorrain du Coeur et des Vaisseaux, Nancy, France.,INI-CRCT (Cardiovascular and Renal Clinical Trialists) F-CRIN Network, Nancy, France
| | - Luna Gargani
- Institute of Clinical Physiology, National Research Council, Pisa, Italy
| | - Nicolas Girerd
- Université de Lorraine, INSERM, Centre d'Investigations Cliniques Plurithématique, INSERM 1433, CHRU de Nancy, Institut Lorrain du Coeur et des Vaisseaux, Nancy, France.,INI-CRCT (Cardiovascular and Renal Clinical Trialists) F-CRIN Network, Nancy, France
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20
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Usefulness and clinical relevance of left ventricular global longitudinal systolic strain in patients with heart failure with preserved ejection fraction. Heart Fail Rev 2020; 25:67-73. [PMID: 31489515 DOI: 10.1007/s10741-019-09853-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
In recent years, several studies have shown the usefulness and clinical relevance of left ventricular global longitudinal systolic strain (GLS) in different cardiovascular diseases. In line with this, the role of GLS in patients with heart failure with preserved ejection fraction (HFpEF) has achieved great importance in this predominant form of heart failure in the last years. In this regard, GLS has shown to be not only a sensitive parameter to detect subtle myocardial abnormalities but also a parameter of clinical and prognostic relevance in patients with HFpEF. In this review, we analyze the current evidence concerning the clinical relevance of GLS in patients with HFpEF and we discuss the potential usefulness of GLS in this complex and heterogeneous condition for which so far no effective therapy exists.
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21
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Kalra R, Gupta K, Sheets R, Aryal S, Ebrahimi A, Rajapreyar I, Cribbs MG, Booker OJ, Prabhu SD, Bajaj NS. Cardiac Function and Sudden Cardiac Death in Heart Failure With Preserved Ejection Fraction (from the TOPCAT Trial). Am J Cardiol 2020; 129:46-52. [PMID: 32563496 DOI: 10.1016/j.amjcard.2020.04.038] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Revised: 04/23/2020] [Accepted: 04/27/2020] [Indexed: 01/30/2023]
Abstract
Patients with heart failure with preserved ejection fraction (HFpEF) have a significantly elevated risk of sudden cardiac death (SCD). However, few imaging data have been correlated to this risk. We evaluated the value of multiple echocardiographic markers of left ventricular (LV) function to predict SCD in HFpEF patients. The Treatment of Heart Failure with Preserved Ejection Fraction with Aldosterone Trial (TOPCAT)-Americas cohort was used to evaluate the echocardiographic predictors of SCD and/or aborted cardiac arrest (SCD/ACA). A retrospective cohort design was used. Cox proportional hazards and Poisson regression models were used to determine the associations between the risk of SCD/ACA and echocardiographic parameters: diastolic dysfunction grade, left ventricle ejection fraction, and LV global longitudinal strain (GLS) during follow-up. Impaired left ventricle ejection fraction and GLS were associated with SCD/ACA in univariate models (p = 0.007 and 0.002, respectively), but not diastolic function grade. After multivariate adjustment, only GLS remained a significant predictor of the incidence rate of SCD/ACA (p = 0.006). There was a 58% increase in the hazard of incident SCD/ACA for every 1 unit increase in GLS (1.58, 95%CI: 1.12 to 2.22, p = 0.009). These findings remained robust in the competing risk analyses. In conclusion, amongst the multiple echocardiographic parameters of LV function, GLS may help prognosticate the risk of SCD/ACA in HFpEF patients.
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Affiliation(s)
- Rajat Kalra
- Cardiovascular Division, University of Minnesota, Minneapolis, Minnesota
| | - Kartik Gupta
- Division of Cardiovascular Disease and Comprehensive Cardiovascular Center, University of Alabama at Birmingham, Alabama
| | - Ryan Sheets
- Department of Medicine, University of Alabama at Birmingham, Alabama
| | - Sudeep Aryal
- Division of Cardiovascular Disease and Comprehensive Cardiovascular Center, University of Alabama at Birmingham, Alabama
| | - Ali Ebrahimi
- Northside Hospital/Tampa Bay Heart Institute, St. Petersburg, Florida
| | - Indranee Rajapreyar
- Division of Cardiovascular Disease and Comprehensive Cardiovascular Center, University of Alabama at Birmingham, Alabama
| | - Marc G Cribbs
- Division of Cardiovascular Disease and Comprehensive Cardiovascular Center, University of Alabama at Birmingham, Alabama; Division of Pediatric Cardiology, University of Alabama at Birmingham, Alabama
| | - Oscar Julian Booker
- Division of Cardiovascular Disease and Comprehensive Cardiovascular Center, University of Alabama at Birmingham, Alabama
| | - Sumanth D Prabhu
- Division of Cardiovascular Disease and Comprehensive Cardiovascular Center, University of Alabama at Birmingham, Alabama
| | - Navkaranbir S Bajaj
- Division of Cardiovascular Disease and Comprehensive Cardiovascular Center, University of Alabama at Birmingham, Alabama; Division of Molecular Imaging and Therapeutics, University of Alabama at Birmingham, Alabama.
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22
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Kammerlander AA, Donà C, Nitsche C, Koschutnik M, Schönbauer R, Duca F, Zotter-Tufaro C, Binder C, Aschauer S, Beitzke D, Loewe C, Hengstenberg C, Bonderman D, Mascherbauer J. Feature Tracking of Global Longitudinal Strain by Using Cardiovascular MRI Improves Risk Stratification in Heart Failure with Preserved Ejection Fraction. Radiology 2020; 296:290-298. [PMID: 32484413 DOI: 10.1148/radiol.2020200195] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Background In heart failure with preserved ejection fraction (HFpEF), echocardiographic studies suggest that global longitudinal strain (GLS) has an impact on survival. Feature-tracking cardiovascular MRI also allows for strain analysis; however, to the knowledge of the authors, little is known about its prognostic value and whether it reflects severity of diffuse fibrosis, as assessed by cardiovascular MRI T1 mapping. Purpose To investigate the association between myocardial strain at cardiovascular MRI with extracellular volume by T1 mapping and outcome in participants with HFpEF. Materials and Methods In this secondary analysis of a prospective study (NCT03405987), consecutive participants with HFpEF underwent cardiovascular MRI between July 2012 and March 2018, including T1 mapping and three-dimensional strain analysis. Extracellular volume and strain results were assessed to determine if there was a correlation between these two factors. Cox regression was performed to determine the prognostic relevance of MRI-derived myocardial strain for a combined end point (events) of heart failure hospitalizations and cardiovascular death. Results In total, 206 consecutive participants with HFpEF (mean age, 71 years ± 8 [standard deviation]; 69% women) were included. Median myocardial global longitudinal strain (GLS) at MRI was -8.5% and showed low correlation with extracellular volume (r = 0.28; P = .003). A total of 109 events (53%) were recorded during a follow-up of 38 months ± 29. Participants with a GLS above the median had higher event rates (log-rank test, P < .001). By multivariable Cox regression analysis, GLS remained independently associated with outcome (hazard ratio, 1.06 per 1% strain increase; 95% confidence interval: 1.01, 1.11; P = .03) when corrected for risk factors including age, diabetes, renal function, N-terminal pro-b-type natriuretic peptide serum concentration, and right ventricular size and function. Conclusion In participants with heart failure with preserved ejection fraction, global longitudinal strain at cardiovascular MRI was correlated with extracellular volume by T1 mapping and was associated with cardiovascular events. © RSNA, 2020 Online supplemental material is available for this article.
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Affiliation(s)
- Andreas A Kammerlander
- From the Division of Cardiology (A.A.K., C.D., C.N., M.K., R.S., F.D., C.Z.T., C.B., S.A., C.H., D. Bonderman, J.M.) and Division of Cardiovascular and Interventional Radiology (D. Beitzke, C.L.), Medical University of Vienna, Währinger Gürtel 18-20, Vienna 1090, Austria; and Cardiovascular Imaging Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, Mass (A.A.K.)
| | - Carolina Donà
- From the Division of Cardiology (A.A.K., C.D., C.N., M.K., R.S., F.D., C.Z.T., C.B., S.A., C.H., D. Bonderman, J.M.) and Division of Cardiovascular and Interventional Radiology (D. Beitzke, C.L.), Medical University of Vienna, Währinger Gürtel 18-20, Vienna 1090, Austria; and Cardiovascular Imaging Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, Mass (A.A.K.)
| | - Christian Nitsche
- From the Division of Cardiology (A.A.K., C.D., C.N., M.K., R.S., F.D., C.Z.T., C.B., S.A., C.H., D. Bonderman, J.M.) and Division of Cardiovascular and Interventional Radiology (D. Beitzke, C.L.), Medical University of Vienna, Währinger Gürtel 18-20, Vienna 1090, Austria; and Cardiovascular Imaging Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, Mass (A.A.K.)
| | - Matthias Koschutnik
- From the Division of Cardiology (A.A.K., C.D., C.N., M.K., R.S., F.D., C.Z.T., C.B., S.A., C.H., D. Bonderman, J.M.) and Division of Cardiovascular and Interventional Radiology (D. Beitzke, C.L.), Medical University of Vienna, Währinger Gürtel 18-20, Vienna 1090, Austria; and Cardiovascular Imaging Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, Mass (A.A.K.)
| | - Robert Schönbauer
- From the Division of Cardiology (A.A.K., C.D., C.N., M.K., R.S., F.D., C.Z.T., C.B., S.A., C.H., D. Bonderman, J.M.) and Division of Cardiovascular and Interventional Radiology (D. Beitzke, C.L.), Medical University of Vienna, Währinger Gürtel 18-20, Vienna 1090, Austria; and Cardiovascular Imaging Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, Mass (A.A.K.)
| | - Franz Duca
- From the Division of Cardiology (A.A.K., C.D., C.N., M.K., R.S., F.D., C.Z.T., C.B., S.A., C.H., D. Bonderman, J.M.) and Division of Cardiovascular and Interventional Radiology (D. Beitzke, C.L.), Medical University of Vienna, Währinger Gürtel 18-20, Vienna 1090, Austria; and Cardiovascular Imaging Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, Mass (A.A.K.)
| | - Caroline Zotter-Tufaro
- From the Division of Cardiology (A.A.K., C.D., C.N., M.K., R.S., F.D., C.Z.T., C.B., S.A., C.H., D. Bonderman, J.M.) and Division of Cardiovascular and Interventional Radiology (D. Beitzke, C.L.), Medical University of Vienna, Währinger Gürtel 18-20, Vienna 1090, Austria; and Cardiovascular Imaging Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, Mass (A.A.K.)
| | - Christina Binder
- From the Division of Cardiology (A.A.K., C.D., C.N., M.K., R.S., F.D., C.Z.T., C.B., S.A., C.H., D. Bonderman, J.M.) and Division of Cardiovascular and Interventional Radiology (D. Beitzke, C.L.), Medical University of Vienna, Währinger Gürtel 18-20, Vienna 1090, Austria; and Cardiovascular Imaging Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, Mass (A.A.K.)
| | - Stefan Aschauer
- From the Division of Cardiology (A.A.K., C.D., C.N., M.K., R.S., F.D., C.Z.T., C.B., S.A., C.H., D. Bonderman, J.M.) and Division of Cardiovascular and Interventional Radiology (D. Beitzke, C.L.), Medical University of Vienna, Währinger Gürtel 18-20, Vienna 1090, Austria; and Cardiovascular Imaging Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, Mass (A.A.K.)
| | - Dietrich Beitzke
- From the Division of Cardiology (A.A.K., C.D., C.N., M.K., R.S., F.D., C.Z.T., C.B., S.A., C.H., D. Bonderman, J.M.) and Division of Cardiovascular and Interventional Radiology (D. Beitzke, C.L.), Medical University of Vienna, Währinger Gürtel 18-20, Vienna 1090, Austria; and Cardiovascular Imaging Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, Mass (A.A.K.)
| | - Christian Loewe
- From the Division of Cardiology (A.A.K., C.D., C.N., M.K., R.S., F.D., C.Z.T., C.B., S.A., C.H., D. Bonderman, J.M.) and Division of Cardiovascular and Interventional Radiology (D. Beitzke, C.L.), Medical University of Vienna, Währinger Gürtel 18-20, Vienna 1090, Austria; and Cardiovascular Imaging Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, Mass (A.A.K.)
| | - Christian Hengstenberg
- From the Division of Cardiology (A.A.K., C.D., C.N., M.K., R.S., F.D., C.Z.T., C.B., S.A., C.H., D. Bonderman, J.M.) and Division of Cardiovascular and Interventional Radiology (D. Beitzke, C.L.), Medical University of Vienna, Währinger Gürtel 18-20, Vienna 1090, Austria; and Cardiovascular Imaging Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, Mass (A.A.K.)
| | - Diana Bonderman
- From the Division of Cardiology (A.A.K., C.D., C.N., M.K., R.S., F.D., C.Z.T., C.B., S.A., C.H., D. Bonderman, J.M.) and Division of Cardiovascular and Interventional Radiology (D. Beitzke, C.L.), Medical University of Vienna, Währinger Gürtel 18-20, Vienna 1090, Austria; and Cardiovascular Imaging Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, Mass (A.A.K.)
| | - Julia Mascherbauer
- From the Division of Cardiology (A.A.K., C.D., C.N., M.K., R.S., F.D., C.Z.T., C.B., S.A., C.H., D. Bonderman, J.M.) and Division of Cardiovascular and Interventional Radiology (D. Beitzke, C.L.), Medical University of Vienna, Währinger Gürtel 18-20, Vienna 1090, Austria; and Cardiovascular Imaging Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, Mass (A.A.K.)
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23
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Kobayashi Y, Tremblay-Gravel M, Boralkar KA, Li X, Nishi T, Amsallem M, Moneghetti KJ, Bouajila S, Selej M, Ozen MO, Demirci U, Ashley E, Wheeler M, Knowlton KU, Kouznetsova T, Haddad F. Approaching Higher Dimension Imaging Data Using Cluster-Based Hierarchical Modeling in Patients with Heart Failure Preserved Ejection Fraction. Sci Rep 2019; 9:10431. [PMID: 31320698 PMCID: PMC6639369 DOI: 10.1038/s41598-019-46873-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Accepted: 07/04/2019] [Indexed: 02/05/2023] Open
Abstract
Heart failure with preserved ejection fraction (HFpEF) is a major cause of morbidity and mortality, accounting for the majority of heart failure (HF) hospitalization. To identify the most complementary predictors of mortality among clinical, laboratory and echocardiographic data, we used cluster based hierarchical modeling. Using Stanford Translational Research Database, we identified patients hospitalized with HFpEF between 2005 and 2016 in whom echocardiogram and NT-proBNP were both available at the time of admission. Comprehensive echocardiographic assessment including left ventricular longitudinal strain (LVLS), right ventricular function and right ventricular systolic pressure (RVSP) was performed. The outcome was defined as all-cause mortality. Among patients identified, 186 patients with complete echocardiographic assessment were included in the analysis. The cohort included 58% female, with a mean age of 78.7 ± 13.5 years, LVLS of −13.3 ± 2.5%, an estimated RVSP of 38 ± 13 mmHg. Unsupervised cluster analyses identified six clusters including ventricular systolic-function cluster, diastolic-hemodynamic cluster, end-organ function cluster, vital-sign cluster, complete blood count and sodium clusters. Using a stepwise hierarchical selection from each cluster, we identified NT-proBNP (standard hazard ratio [95%CI] = 1.56 [1.17–2.08]) and RVSP (1.37 [1.09–1.78]) as independent correlates of outcome. When adding these parameters to the well validated Get with the Guideline Heart Failure risk score, the Chi-square was significantly improved (p = 0.01). In conclusion, NT-proBNP and RVSP were independently predictive in HFpEF among clinical, imaging, and biomarker parameters. Cluster-based hierarchical modeling may help identify the complementally predictive parameters in small cohorts with higher dimensional clinical data.
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Affiliation(s)
- Yukari Kobayashi
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, United States. .,Stanford Cardiovascular Institute, Stanford, CA, United States.
| | - Maxime Tremblay-Gravel
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, United States.,Stanford Cardiovascular Institute, Stanford, CA, United States
| | - Kalyani A Boralkar
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, United States.,Stanford Cardiovascular Institute, Stanford, CA, United States
| | - Xiao Li
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, United States
| | - Tomoko Nishi
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, United States.,Stanford Cardiovascular Institute, Stanford, CA, United States
| | - Myriam Amsallem
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, United States.,Stanford Cardiovascular Institute, Stanford, CA, United States
| | - Kegan J Moneghetti
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, United States.,Stanford Cardiovascular Institute, Stanford, CA, United States
| | - Sara Bouajila
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, United States.,Stanford Cardiovascular Institute, Stanford, CA, United States
| | - Mona Selej
- Medical Director, Franchise, Medical Affairs Strategy, Actelion Pharmaceuticals US, Inc South, San Francisco, California, United States
| | - Mehmet O Ozen
- Stanford Cardiovascular Institute, Stanford, CA, United States.,Bio-Acoustic -MEMS in Medicine (BAMM) Laboratories, Canary Center at Stanford for Cancer Early Detection, Department of Radiology, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Utkan Demirci
- Stanford Cardiovascular Institute, Stanford, CA, United States.,Bio-Acoustic -MEMS in Medicine (BAMM) Laboratories, Canary Center at Stanford for Cancer Early Detection, Department of Radiology, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Euan Ashley
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, United States.,Stanford Cardiovascular Institute, Stanford, CA, United States
| | - Matthew Wheeler
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, United States.,Stanford Cardiovascular Institute, Stanford, CA, United States
| | - Kirk U Knowlton
- Intermountain Medical Center Intermountain Heart Institute, Salt Lake City, UT, United States
| | - Tatiana Kouznetsova
- Research Unit Hypertension and Cardiovascular Epidemiology, Department of Cardiovascular Sciences, Leuven, Belgium
| | - Francois Haddad
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, United States.,Stanford Cardiovascular Institute, Stanford, CA, United States
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24
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Fang S, Zhang Z, Wang Y, Jiang F, Yang K, He F, Zhang C. Predictive value of left ventricular myocardial strain by four-dimensional speckle tracking echocardiography combined with red cell distribution width in heart failure with preserved ejection fraction. Echocardiography 2019; 36:1074-1083. [PMID: 31162738 DOI: 10.1111/echo.14373] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Accepted: 05/07/2019] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVES The diagnostic difficulty of heart failure with preserved ejection fraction (HFpEF) is differentiating it in patients with similar symptoms and signs. This study aimed to assess the potential predictive value of left ventricular global longitudinal strain (GLS), global radial strain (GRS), global circumferential strain (GCS), and global area strain (GAS) measured by four-dimensional speckle tracking echocardiography (4DSTE) combined with red cell distribution width (RDW) in patients with HFpEF. METHODS One hundred and sixty-nine patients with symptoms or signs indicative of chronic heart failure and a left ventricular ejection fraction (LVEF) ≥ 50% and fifty controls with normal LVEF were recruited in this study. Standard echocardiography and 4DSTE examinations were performed. Laboratory examinations including RDW were performed on the same day as the echocardiographic study. RESULTS GLS, GCS, GRS, and GAS in the patient cohort were significantly lower, and RDW was significantly higher than those in the control cohort (P < 0.01), and the strain parameters in definite HFpEF patients were also dramatically lower than the rest patients (P < 0.01). The associations of age, gender, NYHA classification, hypertension history, left ventricular end-diastolic volume index, interventricular septal thickness, and diastolic dysfunction with HFpEF were significantly improved by adding 4DSTE parameters (P < 0.01) and further improved by adding RDW (P < 0.01). CONCLUSIONS In suspected HFpEF patients, who have symptoms or signs of heart failure, even without other conventional evidence of this diagnosis, GLS, GRS, and GCS have potential independent predictive value, while RDW has independent incremental predictive value for HFpEF.
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Affiliation(s)
- Sihua Fang
- Department of Ultrasound, the First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Zhihua Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, China
| | - Ying Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, China
| | - Fan Jiang
- Department of Ultrasound, the Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Kai Yang
- Department of Clinical Laboratory, the Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Fei He
- Department of Cardiovascular Medicine, the Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Chaoxue Zhang
- Department of Ultrasound, the First Affiliated Hospital of Anhui Medical University, Hefei, China
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25
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Right ventricular dysfunction in arterial hypertension: still terra incognita? J Hum Hypertens 2019; 33:491-498. [PMID: 31076653 DOI: 10.1038/s41371-019-0206-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 03/24/2019] [Accepted: 04/01/2019] [Indexed: 11/08/2022]
Abstract
The effects of systemic hypertension on left ventricular function have been well described, as has been the response of the resulting alterations to antihypertensive treatment. However, hypertension effects on the right ventricle (RV) have not been sufficiently investigated; only in recent years, with the development of new imaging modalities, has its importance become widely recognized. Indeed, evidence from clinical trials suggestive of RV functional and structural impairment early in the course of arterial hypertension continues to accumulate. Newer imaging techniques, especially speckle-tracking-derived myocardial deformation imaging, have provided new insights into the effect of systemic hypertension on this previously neglected cardiac chamber. Two- and three-dimensional echocardiography, along with cardiac magnetic resonance imaging, forms the cornerstone of RV structural and functional assessment. This article provides an overview of the effect of longstanding hypertension on RV structure and function, the respective underlying mechanisms, and the potential therapeutic implications. It summarizes the available options for RV structural and functional assessment, and evaluates the existing evidence with respect to RV alterations in hypertensive disease, aiming to assess the current limits of scientific knowledge about a heart chamber that has only recently become the focus of greater interest.
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26
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Pellicori P, Shah P, Cuthbert J, Urbinati A, Zhang J, Kallvikbacka-Bennett A, Clark AL, Cleland JGF. Prevalence, pattern and clinical relevance of ultrasound indices of congestion in outpatients with heart failure. Eur J Heart Fail 2019; 21:904-916. [PMID: 30666769 DOI: 10.1002/ejhf.1383] [Citation(s) in RCA: 92] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 07/13/2018] [Accepted: 11/11/2018] [Indexed: 12/28/2022] Open
Abstract
AIMS Even if treatment controls symptoms, patients with heart failure may still be congested. We aimed at assessing the prevalence and clinical relevance of congestion in outpatients with chronic heart failure. METHODS AND RESULTS We recorded clinical and ultrasound [lung B-lines; inferior vena cava (IVC) diameter; internal jugular vein diameter before and after a Valsalva manoeuvre (JVD ratio)] features of congestion in heart failure patients during a routine check-up. Of 342 patients who attended, predominantly in New York Heart Association class I or II (n = 257; 75%), 242 (71%) had at least one feature of congestion, either clinical (n = 139; 41%) or by ultrasound (n = 199; 58%). Amongst patients (n = 203, 59%) clinically free of congestion, 31 (15%) had ≥ 14 B-lines, 57 (29%) had a dilated IVC (> 2.0 cm), 38 (20%) had an abnormal JVD ratio (< 4), 87 (43%) had at least one of these, and 27 (13%) had two or more. During a median follow-up of 234 (interquartile range 136-351) days, 60 patients (18%) died or were hospitalized for heart failure. In univariable analysis, each clinical and ultrasound measure of congestion was associated with increased risk but, in multivariable models, only higher N-terminal pro-B-type natriuretic peptide and IVC, and lower JVD ratio, were associated with the composite outcome. CONCLUSIONS Many patients with chronic heart failure with few symptoms have objective evidence of congestion and this is associated with an adverse prognosis. Whether using these measures of congestion to guide management improves outcomes requires investigation.
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Affiliation(s)
- Pierpaolo Pellicori
- Department of Cardiology, Castle Hill Hospital, Hull York Medical School (at University of Hull), Kingston upon Hull, UK.,Robertson Institute of Biostatistics and Clinical Trials Unit, University of Glasgow, Glasgow, UK
| | - Parin Shah
- Department of Cardiology, Castle Hill Hospital, Hull York Medical School (at University of Hull), Kingston upon Hull, UK
| | - Joe Cuthbert
- Department of Cardiology, Castle Hill Hospital, Hull York Medical School (at University of Hull), Kingston upon Hull, UK
| | - Alessia Urbinati
- Department of Cardiology, Castle Hill Hospital, Hull York Medical School (at University of Hull), Kingston upon Hull, UK
| | - Jufen Zhang
- Department of Cardiology, Castle Hill Hospital, Hull York Medical School (at University of Hull), Kingston upon Hull, UK.,Faculty of Medical Science, Anglia Ruskin University, Chelmsford, UK
| | - Anna Kallvikbacka-Bennett
- Department of Cardiology, Castle Hill Hospital, Hull York Medical School (at University of Hull), Kingston upon Hull, UK
| | - Andrew L Clark
- Department of Cardiology, Castle Hill Hospital, Hull York Medical School (at University of Hull), Kingston upon Hull, UK
| | - John G F Cleland
- Robertson Institute of Biostatistics and Clinical Trials Unit, University of Glasgow, Glasgow, UK.,National Heart & Lung Institute and National Institute of Health Research Cardiovascular Biomedical Research Unit, Royal Brompton & Harefield Hospitals, Imperial College London, London, UK
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27
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White RD, Kirsch J, Bolen MA, Batlle JC, Brown RK, Eberhardt RT, Hurwitz LM, Inacio JR, Jin JO, Krishnamurthy R, Leipsic JA, Rajiah P, Shah AB, Singh SP, Villines TC, Zimmerman SL, Abbara S. ACR Appropriateness Criteria® Suspected New-Onset and Known Nonacute Heart Failure. J Am Coll Radiol 2018; 15:S418-S431. [DOI: 10.1016/j.jacr.2018.09.031] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Accepted: 09/07/2018] [Indexed: 12/21/2022]
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28
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Bekfani T, Pellicori P, Morris D, Ebner N, Valentova M, Sandek A, Doehner W, Cleland JG, Lainscak M, Schulze PC, Anker SD, von Haehling S. Iron deficiency in patients with heart failure with preserved ejection fraction and its association with reduced exercise capacity, muscle strength and quality of life. Clin Res Cardiol 2018; 108:203-211. [PMID: 30051186 DOI: 10.1007/s00392-018-1344-x] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Accepted: 07/19/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND The prevalence of iron deficiency (ID) in outpatients with heart failure with preserved ejection fraction (HFpEF) and its relation to exercise capacity and quality of life (QoL) is unknown. METHODS 190 symptomatic outpatients with HFpEF (LVEF 58 ± 7%; age 71 ± 9 years; NYHA 2.4 ± 0.5; BMI 31 ± 6 kg/m2) were enrolled as part of SICA-HF in Germany, England and Slovenia. ID was defined as ferritin < 100 or 100-299 µg/L with transferrin saturation (TSAT) < 20%. Anemia was defined as Hb < 13 g/dL in men, < 12 g/dL in women. Low ferritin-ID was defined as ferritin < 100 µg/L. Patients were divided into 3 groups according to E/e' at echocardiography: E/e' ≤ 8; E/e' 9-14; E/e' ≥ 15. All patients underwent echocardiography, cardiopulmonary exercise test (CPX), 6-min walk test (6-MWT), and QoL assessment using the EQ5D questionnaire. RESULTS Overall, 111 patients (58.4%) showed ID with 89 having low ferritin-ID (46.84%). 78 (41.1%) patients had isolated ID without anemia and 54 patients showed anemia (28.4%). ID was more prevalent in patients with more severe diastolic dysfunction: E/e' ≤ 8: 44.8% vs. E/e': 9-14: 53.2% vs. E/e' ≥ 15: 86.5% (p = 0.0004). Patients with ID performed worse during the 6MWT (420 ± 137 vs. 344 ± 124 m; p = 0.008) and had worse exercise time in CPX (645 ± 168 vs. 538 ± 178 s, p = 0.03). Patients with low ferritin-ID had lower QoL compared to those without ID (p = 0.03). CONCLUSION ID is a frequent co-morbidity in HFpEF and is associated with reduced exercise capacity and QoL. Its prevalence increases with increasing severity of diastolic dysfunction.
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Affiliation(s)
- Tarek Bekfani
- Department of Cardiology, Campus Virchow-Klinikum, Charité Medical School, Berlin, Germany.
- Division of Cardiology, Angiology, Pneumology and Intensive Medical Care, Department of Internal Medicine I, University Hospital Jena, Friedrich-Schiller-University, Jena, Germany.
| | | | - Daniel Morris
- Department of Cardiology, Campus Virchow-Klinikum, Charité Medical School, Berlin, Germany
| | - Nicole Ebner
- Department of Cardiology and Pneumology, University of Göttingen Medical Center, Göttingen, Germany
| | - Miroslava Valentova
- Department of Cardiology and Pneumology, University of Göttingen Medical Center, Göttingen, Germany
- Department of Internal Medicine, Comenius University, Bratislava, Slovakia
| | - Anja Sandek
- Department of Cardiology and Pneumology, University of Göttingen Medical Center, Göttingen, Germany
| | - Wolfram Doehner
- Department of Cardiology, Campus Virchow-Klinikum, Charité Medical School, Berlin, Germany
- Center for Stroke Research Berlin, Charité Medical School, Berlin, Germany
| | | | - Mitja Lainscak
- Department of Cardiology, Golnik University, Golnik, Slovenia
| | - P Christian Schulze
- Division of Cardiology, Angiology, Pneumology and Intensive Medical Care, Department of Internal Medicine I, University Hospital Jena, Friedrich-Schiller-University, Jena, Germany
| | - Stefan D Anker
- Division of Cardiology and Metabolism-Heart Failure, Cachexia and Sarcopenia, Department of Cardiology, Campus Virchow-Klinikum, Charité Medical School, Berlin, Germany
- Berlin-Brandenburg Center for Regenerative Therapies (BCRT), Charité Medical School Berlin, Berlin, Germany
| | - Stephan von Haehling
- Department of Cardiology, Campus Virchow-Klinikum, Charité Medical School, Berlin, Germany
- Department of Cardiology and Pneumology, University of Göttingen Medical Center, Göttingen, Germany
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29
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Pellicori P, Cleland JG, Clark AL. Losing Track by Tracking Speckles. JACC Cardiovasc Imaging 2018; 11:1038-1039. [DOI: 10.1016/j.jcmg.2018.04.027] [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: 04/19/2018] [Accepted: 04/25/2018] [Indexed: 11/25/2022]
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30
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Nauta JF, Hummel YM, van der Meer P, Lam CSP, Voors AA, van Melle JP. Correlation with invasive left ventricular filling pressures and prognostic relevance of the echocardiographic diastolic parameters used in the 2016 ESC heart failure guidelines and in the 2016 ASE/EACVI recommendations: a systematic review in patients with heart failure with preserved ejection fraction. Eur J Heart Fail 2018; 20:1303-1311. [PMID: 29877602 DOI: 10.1002/ejhf.1220] [Citation(s) in RCA: 133] [Impact Index Per Article: 22.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Revised: 04/10/2018] [Accepted: 04/22/2018] [Indexed: 12/28/2022] Open
Abstract
AIMS Five echocardiographic parameters-left atrial volume index, left ventricular mass index, tricuspid regurgitation velocity, myocardial tissue velocity, and the ratio of early mitral inflow to tissue velocity of the mitral annulus (E/e')-are recommended in both the current European Society of Cardiology heart failure guidelines and the American Society of Echocardiography/European Association of Cardiovascular Imaging recommendations for the evaluation of left ventricular diastolic function. We aimed to perform a systematic review of these echocardiographic parameters at resting conditions for their correlation with left ventricular filling pressures in patients with heart failure with preserved ejection fraction (HFpEF). In addition, the prognostic value of these parameters was assessed. METHODS AND RESULTS Nine studies reported the correlation between echocardiography and invasive haemodynamics, and 18 papers reported on the prognostic value of echocardiography in HFpEF. Among the parameters, most data were reported for E/e'. The pooled correlation coefficient r was 0.56 for the relation between E/e' and invasively measured filling pressures. Combined weighted-mean meta-analysis of prognostic studies resulted in a hazard ratio of 1.05 (95% confidence interval 1.03-1.06) per unit increase in E/e' for the combined outcome of all-cause mortality and cardiovascular hospitalization. The other echocardiographic parameters, when taken individually, had similar or lower association with prognosis. CONCLUSION Only a small number of studies validated the use of echocardiographic parameters at rest in patients with HFpEF. The best established parameter appears to be E/e', but the existing data only show modest correlations of E/e' with invasive filling pressures and outcomes in HFpEF.
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Affiliation(s)
- Jan F Nauta
- Department of Cardiology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Yoran M Hummel
- Department of Cardiology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Peter van der Meer
- Department of Cardiology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Carolyn S P Lam
- Department of Cardiology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands.,Department of Cardiology, National Heart Centre Singapore, Duke-National University of Singapore, Singapore
| | - Adriaan A Voors
- Department of Cardiology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Joost P van Melle
- Department of Cardiology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
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31
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Kale P, Afzal A. Stage B Heart Failure: To Strain or Not to Strain. JACC Cardiovasc Imaging 2018; 11:1401-1404. [PMID: 29778858 DOI: 10.1016/j.jcmg.2018.04.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 04/26/2018] [Indexed: 11/26/2022]
Affiliation(s)
- Parag Kale
- Division of Cardiology, Department of Internal Medicine, Baylor University Medical Center, Dallas, Texas; Center for Advanced Heart and Lung Disease, Baylor University Medical Center, Dallas, Texas; Annette C. and Harold C. Simmons Transplant Institute, Baylor Scott and White Research Institute, Dallas, Texas.
| | - Aasim Afzal
- Division of Cardiology, Department of Internal Medicine, Baylor University Medical Center, Dallas, Texas; Annette C. and Harold C. Simmons Transplant Institute, Baylor Scott and White Research Institute, Dallas, Texas
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Curbelo J, Aguilera M, Rodriguez-Cortes P, Gil-Martinez P, Suarez Fernandez C. Usefulness of inferior vena cava ultrasonography in outpatients with chronic heart failure. Clin Cardiol 2018; 41:510-517. [PMID: 29664116 DOI: 10.1002/clc.22915] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Revised: 01/25/2018] [Accepted: 01/30/2018] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Inferior vena cava (IVC) ultrasonography has been used for the diagnosis and prognosis of acute heart failure (HF). Its usefulness in chronic HF is less known. HYPOTHESIS IVC ultrasonography is a useful tool in the care of patients with chronic HF. METHODS For this prospective cohort study, 95 patients with chronic HF were included consecutively as they attended scheduled medical visits. Ultrasound was done with a 5-MHz convex probe device, calculating IVC collapse index (IVCCI). Follow-up time was 1 year. Outcome events were worsening HF, hospital admission for HF, HF mortality, and all-cause mortality. RESULTS Worsening HF occurred in 70.9% of patients with IVCCI <30% and 39.1% of patients with IVCCI >50%, with a hazard ratio (HR) of 2.8 (95% CI: 1.3-6.2) adjusted by multivariable analysis. Regarding hospitalization, 45.3% of patients with IVCCI <30% required admission, compared with 5.9% of patients with IVCCI >50%; the adjusted HR was 13.9 (95% CI: 1.7-113.0). Mortality was higher in the IVCCI <30% group, with 25.7% all-cause mortality and 18.6% HF mortality, whereas in the IVCCI >50% group these values were 13% and 4.7%, respectively. However, these differences did not reach statistical significance. ROC analysis was performed and the AUC for IVCCI was not higher than that for NTproBNP for any of the outcomes studied. CONCLUSIONS IVC ultrasonography is a useful tool in follow-up of patients with chronic HF, allowing identification of patients at high risk of worsening and hospitalization. However, its usefulness is not higher than that of NTproBNP.
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Affiliation(s)
- Jose Curbelo
- Internal Medicine Department, Instituto de Investigación Sanitaria, Hospital Universitario La Princesa, Madrid, Spain.,Medicine Department, Universidad Autónoma de Madrid, Madrid, Spain
| | - Maria Aguilera
- Internal Medicine Department, Instituto de Investigación Sanitaria, Hospital Universitario La Princesa, Madrid, Spain.,Medicine Department, Universidad Autónoma de Madrid, Madrid, Spain
| | - Pablo Rodriguez-Cortes
- Internal Medicine Department, Instituto de Investigación Sanitaria, Hospital Universitario La Princesa, Madrid, Spain.,Medicine Department, Universidad Autónoma de Madrid, Madrid, Spain
| | - Paloma Gil-Martinez
- Internal Medicine Department, Instituto de Investigación Sanitaria, Hospital Universitario La Princesa, Madrid, Spain.,Medicine Department, Universidad Autónoma de Madrid, Madrid, Spain
| | - Carmen Suarez Fernandez
- Internal Medicine Department, Instituto de Investigación Sanitaria, Hospital Universitario La Princesa, Madrid, Spain.,Medicine Department, Universidad Autónoma de Madrid, Madrid, Spain
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Pellicori P, Urbinati A, Zhang J, Joseph AC, Costanzo P, Lukaschuk E, Capucci A, Cleland JGF, Clark AL. Clinical and prognostic relationships of pulmonary artery to aorta diameter ratio in patients with heart failure: a cardiac magnetic resonance imaging study. Clin Cardiol 2018; 41:20-27. [PMID: 29359813 DOI: 10.1002/clc.22840] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Revised: 10/16/2017] [Accepted: 10/19/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The pulmonary artery (PA) distends as pressure increases. HYPOTHESIS The ratio of PA to aortic (Ao) diameter may be an indicator of pulmonary hypertension and consequently carry prognostic information in patients with chronic heart failure (HF). METHODS Patients with chronic HF and control subjects undergoing cardiac magnetic resonance imaging were evaluated. The main PA diameter and the transverse axial Ao diameter at the level of bifurcation of the main PA were measured. The maximum diameter of both vessels was measured throughout the cardiac cycle and the PA/Ao ratio was calculated. RESULTS A total of 384 patients (mean age, 69 years; mean left ventricular ejection fraction, 40%; median NT-proBNP, 1010 ng/L [interquartile range, 448-2262 ng/L]) and 38 controls were included. Controls and patients with chronic HF had similar maximum Ao and PA diameters and PA/Ao ratio. During a median follow-up of 1759 days (interquartile range, 998-2269 days), 181 patients with HF were hospitalized for HF or died. Neither PA diameter nor PA/Ao ratio predicted outcome in univariable analysis. In a multivariable model, only age and NT-proBNP were independent predictors of adverse events. CONCLUSIONS The PA/Ao ratio is not a useful method to stratify prognosis in patients with HF.
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Affiliation(s)
- Pierpaolo Pellicori
- Department of Cardiology, Castle Hill Hospital, Hull York Medical School (at University of Hull), Kingston upon Hull, HU16 5JQ, United Kingdom
| | - Alessia Urbinati
- Department of Cardiology, Castle Hill Hospital, Hull York Medical School (at University of Hull), Kingston upon Hull, HU16 5JQ, United Kingdom.,Cardiology and Arrhythmology Clinic, Marche Polytechnic University, University Hospital "Ospedali Riuniti,", Ancona, Italy
| | - Jufen Zhang
- Department of Cardiology, Castle Hill Hospital, Hull York Medical School (at University of Hull), Kingston upon Hull, HU16 5JQ, United Kingdom
| | - Anil C Joseph
- Department of Cardiology, Castle Hill Hospital, Hull York Medical School (at University of Hull), Kingston upon Hull, HU16 5JQ, United Kingdom
| | - Pierluigi Costanzo
- Department of Cardiology, Castle Hill Hospital, Hull York Medical School (at University of Hull), Kingston upon Hull, HU16 5JQ, United Kingdom
| | - Elena Lukaschuk
- Department of Cardiology, Castle Hill Hospital, Hull York Medical School (at University of Hull), Kingston upon Hull, HU16 5JQ, United Kingdom
| | - Alessandro Capucci
- Cardiology and Arrhythmology Clinic, Marche Polytechnic University, University Hospital "Ospedali Riuniti,", Ancona, Italy
| | - John G F Cleland
- Department of Cardiology, Castle Hill Hospital, Hull York Medical School (at University of Hull), Kingston upon Hull, HU16 5JQ, United Kingdom.,National Heart & Lung Institute and National Institute of Health Research Cardiovascular Biomedical Research Unit, Royal Brompton & Harefield Hospitals, Imperial College, London, United Kingdom
| | - Andrew L Clark
- Department of Cardiology, Castle Hill Hospital, Hull York Medical School (at University of Hull), Kingston upon Hull, HU16 5JQ, United Kingdom
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Gorter TM, van Veldhuisen DJ, Bauersachs J, Borlaug BA, Celutkiene J, Coats AJS, Crespo-Leiro MG, Guazzi M, Harjola VP, Heymans S, Hill L, Lainscak M, Lam CSP, Lund LH, Lyon AR, Mebazaa A, Mueller C, Paulus WJ, Pieske B, Piepoli MF, Ruschitzka F, Rutten FH, Seferovic PM, Solomon SD, Shah SJ, Triposkiadis F, Wachter R, Tschöpe C, de Boer RA. Right heart dysfunction and failure in heart failure with preserved ejection fraction: mechanisms and management. Position statement on behalf of the Heart Failure Association of the European Society of Cardiology. Eur J Heart Fail 2017; 20:16-37. [PMID: 29044932 DOI: 10.1002/ejhf.1029] [Citation(s) in RCA: 207] [Impact Index Per Article: 29.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2017] [Revised: 08/16/2017] [Accepted: 09/05/2017] [Indexed: 12/28/2022] Open
Abstract
There is an unmet need for effective treatment strategies to reduce morbidity and mortality in patients with heart failure with preserved ejection fraction (HFpEF). Until recently, attention in patients with HFpEF was almost exclusively focused on the left side. However, it is now increasingly recognized that right heart dysfunction is common and contributes importantly to poor prognosis in HFpEF. More insights into the development of right heart dysfunction in HFpEF may aid to our knowledge about this complex disease and may eventually lead to better treatments to improve outcomes in these patients. In this position paper from the Heart Failure Association of the European Society of Cardiology, the Committee on Heart Failure with Preserved Ejection Fraction reviews the prevalence, diagnosis, and pathophysiology of right heart dysfunction and failure in patients with HFpEF. Finally, potential treatment strategies, important knowledge gaps and future directions regarding the right side in HFpEF are discussed.
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Affiliation(s)
- Thomas M Gorter
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Dirk J van Veldhuisen
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Johann Bauersachs
- Department of Cardiology and Angiology, Medical School Hannover, Hannover, Germany
| | - Barry A Borlaug
- Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Jelena Celutkiene
- Clinic of Cardiac and Vascular Diseases, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Andrew J S Coats
- Monash University, Clayton Campus, Melbourne, Victoria 3800, Australia.,University of Warwick, Kirby Corner Road, Coventry CV4 8UW, UK
| | - Marisa G Crespo-Leiro
- Advanced Heart Failure and Heart Transplant Unit, Servicio de Cardiologia-CIBERCV, Complejo Hospitalario Universitario A Coruña (CHUAC), Instituto Investigación Biomedica A Coruña (INIBIC), Universidad da Coruña (UDC), La Coruña, Spain
| | - Marco Guazzi
- Heart Failure Unit, University of Milan, IRCCS Policlinico San Donato, Milan, Italy
| | - Veli-Pekka Harjola
- Emergency Medicine, University of Helsinki, Department of Emergency Medicine and Services, Helsinki University Hospital, Helsinki, Finland
| | - Stephane Heymans
- Department of Cardiology, CARIM, Maastricht University Medical Centre, Maastricht, the Netherlands
| | | | - Mitja Lainscak
- Department of Internal Medicine, General Hospital Murska Sobota, Murska Sobota, Slovenia
| | - Carolyn S P Lam
- Department of Cardiology, National Heart Center Singapore, Singapore Duke-NUS Graduate Medical School, Singapore
| | - Lars H Lund
- Department of Medicine, Karolinska Institutet and Heart and Vascular Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Alexander R Lyon
- National Heart and Lung Institute, Imperial College London and Royal Brompton Hospital, London, UK
| | - Alexandre Mebazaa
- Department of Anesthesiology and Critical Care, APHP - Saint Louis Lariboisière University Hospitals, University Paris Diderot, Paris, France
| | - Christian Mueller
- Department of Cardiology, Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland
| | - Walter J Paulus
- Department of Cardiology, VU University Medical Center, Amsterdam, the Netherlands
| | - Burkert Pieske
- Department of Internal Medicine and Cardiology, Charité University Medicine, Berlin, Germany, and Department of Internal Medicine Cardiology, German Heart Center Berlin, DZHK (German Center for Cardiovascular Research) and Berlin Institute of Health (BIH), Berlin, Germany
| | - Massimo F Piepoli
- Heart Failure Unit, Cardiac Department, G. da Saliceto Hospital, Piacenza, Italy
| | - Frank Ruschitzka
- Clinic for Cardiology, University Hospital Zurich, Zürich, Switzerland
| | - Frans H Rutten
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Petar M Seferovic
- Cardiology Department, Clinical Centre Serbia, Medical School, Belgrade, Serbia
| | - Scott D Solomon
- Cardiovascular Division, Brigham and Women's Hospital, Boston, MA, USA
| | - Sanjiv J Shah
- Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | - Rolf Wachter
- Clinic and Policlinic for Cardiology, University Hospital Leipzig, Leipzig, Germany and German Cardiovascular Research Center, partner site Göttingen
| | - Carsten Tschöpe
- Department of Internal Medicine and Cardiology, Charité University Medicine, Berlin, Germany, and Department of Internal Medicine Cardiology, German Heart Center Berlin, DZHK (German Center for Cardiovascular Research) and Berlin Institute of Health (BIH), Berlin, Germany
| | - Rudolf A de Boer
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
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Morris DA, Ma XX, Belyavskiy E, Aravind Kumar R, Kropf M, Kraft R, Frydas A, Osmanoglou E, Marquez E, Donal E, Edelmann F, Tschöpe C, Pieske B, Pieske-Kraigher E. Left ventricular longitudinal systolic function analysed by 2D speckle-tracking echocardiography in heart failure with preserved ejection fraction: a meta-analysis. Open Heart 2017; 4:e000630. [PMID: 29018535 PMCID: PMC5623331 DOI: 10.1136/openhrt-2017-000630] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Revised: 06/23/2017] [Accepted: 07/18/2017] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND The purpose of this meta-analysis was to confirm if the global longitudinal systolic function of the left ventricle (LV) is altered in patients with heart failure with preserved ejection fraction (HFpEF). METHODS We searched in different databases (Medline, Embase and Cochrane) studies that analysed LV global longitudinal systolic strain (GLS) in patients with HFpEF and in controls (such as healthy subjects or asymptomatic patients with arterial hypertension, diabetes mellitus or coronary artery disease). RESULTS Twenty-two studies (2284 patients with HFpEF and 2302 controls) were included in the final analysis. Patients with HFpEF had significantly lower GLS than healthy subjects (mean -15.7% (range -12% to -18.9%) vs mean -19.9% (range -17.1% to -21.5%), weighted mean difference -4.2% (95% CI -3.3% to -5.0%), p < 0.001, respectively). In addition, patients with HFpEF had also significantly lower GLS than asymptomatic patients (mean -15.5% (range -13.4% to -18.4%) vs mean -18.3% (range -15.1% to -20.4%), weighted mean difference -2.8%(95% CI -1.9% to -3.6%), p < 0.001, respectively). In line, 10 studies showed that the rate of abnormal GLS was significantly higher in patients with HFpEF (mean 65.4% (range 37%-95%)) than in asymptomatic subjects (mean 13% (range 0%-29.6%)). Regarding the prognostic relevance of abnormal GLS in HFpEF, two multicentre studies with large sample size (447 and 348) and high number of events (115 and 177) showed that patients with abnormal GLS had worse cardiovascular (CV) outcomes than those with normal GLS (HR for CV mortality and HF hospitalisation 2.14 (95% CI 1.26 to 3.66) and 1.94 (95% CI 1.22 to 3.07)), even adjusting these analyses for multiples clinical and echocardiographic variables. CONCLUSION The present meta-analysis analysing 2284 patients with HFpEF and 2302 controls confirms that the longitudinal systolic function of the LV is significantly altered in high proportion of patients with HFpEF. Further large multicentre studies with the aim to confirm the prognostic role of abnormal GLS in HFpEF are warranted.
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Affiliation(s)
- Daniel Armando Morris
- Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin, DZHK (German Centre for Cardiovascular Research) partner site Berlin and Berlin Institute of Health (BIH), Berlin, Germany
| | - Xin-Xin Ma
- Department of Ultrasound in Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai Institute of Ultrasound in Medicine, Shanghai, China
| | - Evgeny Belyavskiy
- Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin, DZHK (German Centre for Cardiovascular Research) partner site Berlin and Berlin Institute of Health (BIH), Berlin, Germany
| | - Radhakrishnan Aravind Kumar
- Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin, DZHK (German Centre for Cardiovascular Research) partner site Berlin and Berlin Institute of Health (BIH), Berlin, Germany
| | - Martin Kropf
- Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin, DZHK (German Centre for Cardiovascular Research) partner site Berlin and Berlin Institute of Health (BIH), Berlin, Germany
| | - Robin Kraft
- Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin, DZHK (German Centre for Cardiovascular Research) partner site Berlin and Berlin Institute of Health (BIH), Berlin, Germany
| | - Athanasios Frydas
- Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin, DZHK (German Centre for Cardiovascular Research) partner site Berlin and Berlin Institute of Health (BIH), Berlin, Germany
| | - Engin Osmanoglou
- Department of Internal Medicine and Cardiology, Meoclinic, Berlin, Germany
| | - Esteban Marquez
- Department of Radiology, Private Clinic of Radiology (Q-Diagnostica-Scanner Murcia), Murcia, Spain
| | - Erwan Donal
- Department of Cardiology, CHU Rennes, Pontchaillou Hospital, Rennes, France
| | - Frank Edelmann
- Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin, DZHK (German Centre for Cardiovascular Research) partner site Berlin and Berlin Institute of Health (BIH), Berlin, Germany
| | - Carsten Tschöpe
- Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin, DZHK (German Centre for Cardiovascular Research) partner site Berlin and Berlin Institute of Health (BIH), Berlin, Germany
| | - Burkert Pieske
- Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin, DZHK (German Centre for Cardiovascular Research) partner site Berlin and Berlin Institute of Health (BIH), Berlin, Germany.,Department of Internal Medicine and Cardiology, German Heart Institute, Berlin, Germany
| | - Elisabeth Pieske-Kraigher
- Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin, DZHK (German Centre for Cardiovascular Research) partner site Berlin and Berlin Institute of Health (BIH), Berlin, Germany
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Buggey J, Alenezi F, Yoon HJ, Phelan M, DeVore AD, Khouri MG, Schulte PJ, Velazquez EJ. Left ventricular global longitudinal strain in patients with heart failure with preserved ejection fraction: outcomes following an acute heart failure hospitalization. ESC Heart Fail 2017; 4:432-439. [PMID: 29154416 PMCID: PMC5695196 DOI: 10.1002/ehf2.12159] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Revised: 02/27/2017] [Accepted: 02/28/2017] [Indexed: 12/20/2022] Open
Abstract
AIMS While abnormal resting LV GLS has been described in patients with chronic heart failure with preserved ejection fraction (HFpEF), its prognostic significance when measured during an acute heart failure hospitalization remains unclear. We assessed the association between left ventricular global longitudinal strain (LV GLS) and outcomes in patients hospitalized with acute HFpEF. METHODS AND RESULTS We studied patients discharged alive for acute HFpEF from Duke University Medical Center between 2007 and 2010. Among patients with measurable LV GLS, we performed 2D, speckle-tracking analysis and Cox proportional hazards models assessed the association between continuous LV GLS and outcomes. Baseline characteristics were stratified by normal (≤-16%) or abnormal (>-16%) LV GLS for comparison. Among 463 patients, the median LV GLS was -12.8% (Interquartile range, -15.8 to -10.8%) and was abnormal in 352 (76%). Overall patients in the cohort were generally elderly, female and had hypertension. After multivariable adjustment, worse outcomes were noted between LV GLS and mortality (HR 1.19 per 1% increase; 95% CI 1.00-1.42; P = 0.046) and a composite endpoint of mortality or rehospitalization at 30 days (HR 1.08 per 1% increase; 95% CI 0.99-1.18; P = 0.08). There was no association between LV GLS and mortality or a composite of mortality or rehospitalization at 1 year. CONCLUSIONS A high prevalence of patients hospitalized with acute HFpEF have abnormal LV GLS suggesting unrecognized myocardial systolic dysfunction. Furthermore, worse LV GLS is associated with worse clinical outcomes at 30 days but not by1 year.
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Affiliation(s)
- Jonathan Buggey
- Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | - Fawaz Alenezi
- Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | - Hyun Ju Yoon
- Chonnam National University Hospital, Donggu, Gwangju, Korea
| | - Matthew Phelan
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA
| | - Adam D DeVore
- Department of Medicine, Duke University Medical Center, Durham, NC, USA.,Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA
| | - Michel G Khouri
- Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | - Phillip J Schulte
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA
| | - Eric J Velazquez
- Department of Medicine, Duke University Medical Center, Durham, NC, USA.,Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA
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Pellicori P, Salekin D, Pan D, Clark AL. This patient is not breathing properly: is this COPD, heart failure, or neither? Expert Rev Cardiovasc Ther 2017; 15:389-396. [DOI: 10.1080/14779072.2017.1317592] [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: 12/25/2022]
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Pellicori P, Clark AL, Kallvikbacka-Bennett A, Zhang J, Urbinati A, Monzo L, Dierckx R, Anker SD, Cleland JG. Non-invasive measurement of right atrial pressure by near-infrared spectroscopy: preliminary experience. A report from the SICA-HF study. Eur J Heart Fail 2017; 19:883-892. [DOI: 10.1002/ejhf.825] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Revised: 02/13/2017] [Accepted: 02/28/2017] [Indexed: 12/28/2022] Open
Affiliation(s)
- Pierpaolo Pellicori
- Department of Cardiology; Castle Hill Hospital, Hull York Medical School (at University of Hull); Kingston upon Hull HU16 5JQ UK
| | - Andrew L. Clark
- Department of Cardiology; Castle Hill Hospital, Hull York Medical School (at University of Hull); Kingston upon Hull HU16 5JQ UK
| | - Anna Kallvikbacka-Bennett
- Department of Cardiology; Castle Hill Hospital, Hull York Medical School (at University of Hull); Kingston upon Hull HU16 5JQ UK
| | - Jufen Zhang
- Department of Cardiology; Castle Hill Hospital, Hull York Medical School (at University of Hull); Kingston upon Hull HU16 5JQ UK
| | - Alessia Urbinati
- Department of Cardiology; Castle Hill Hospital, Hull York Medical School (at University of Hull); Kingston upon Hull HU16 5JQ UK
| | - Luca Monzo
- Department of Cardiology; Castle Hill Hospital, Hull York Medical School (at University of Hull); Kingston upon Hull HU16 5JQ UK
| | - Riet Dierckx
- Department of Cardiology; Castle Hill Hospital, Hull York Medical School (at University of Hull); Kingston upon Hull HU16 5JQ UK
| | - Stefan D. Anker
- University of Göttingen Medical School; Department of Cardiology and Pneumology; Göttingen Germany
| | - John G.F. Cleland
- Department of Cardiology; Castle Hill Hospital, Hull York Medical School (at University of Hull); Kingston upon Hull HU16 5JQ UK
- National Heart & Lung Institute and National Institute of Health Research Cardiovascular Biomedical Research Unit; Royal Brompton & Harefield Hospitals, Imperial College; London UK
- Robertson Centre for Biostatistics and Clinical Trials; University of Glasgow; Glasgow UK
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Cardiac Dysfunction, Congestion and Loop Diuretics: their Relationship to Prognosis in Heart Failure. Cardiovasc Drugs Ther 2017; 30:599-609. [PMID: 27819111 DOI: 10.1007/s10557-016-6697-7] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Diuretics are the mainstay of treatment for congestion but concerns exist that they adversely affect prognosis. We explored whether the relationship between loop diuretic use and outcome is explained by the underlying severity of congestion amongst patients referred with suspected heart failure. METHOD AND RESULTS Of 1190 patients, 712 had a left ventricular ejection fraction (LVEF) ≤50 %, 267 had LVEF >50 % with raised plasma NTproBNP (>400 ng/L) and 211 had LVEF >50 % with NTproBNP ≤400 ng/L; respectively, 72 %, 68 % and 37 % of these groups were treated with loop diuretics including 28 %, 29 % and 10 % in doses ≥80 mg furosemide equivalent/day. Compared to patients with cardiac dysfunction (either LVEF ≤50 % or NT-proBNP >400 ng/L) but not taking a loop diuretic, those taking a loop diuretic were older and had more clinical evidence of congestion, renal dysfunction, anaemia and hyponatraemia. During a median follow-up of 934 (IQR: 513-1425) days, 450 patients were hospitalized for HF or died. Patients prescribed loop diuretics had a worse outcome. However, in multi-variable models, clinical, echocardiographic (inferior vena cava diameter), and biochemical (NTproBNP) measures of congestion were strongly associated with an adverse outcome but not the use, or dose, of loop diuretics. CONCLUSIONS Prescription of loop diuretics identifies patients with more advanced features of heart failure and congestion, which may account for their worse prognosis. Further research is needed to clarify the relationship between loop diuretic agents and outcome; imaging and biochemical measures of congestion might be better guides to diuretic dose than symptoms or clinical signs.
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DeVore AD, McNulty S, Alenezi F, Ersboll M, Vader JM, Oh JK, Lin G, Redfield MM, Lewis G, Semigran MJ, Anstrom KJ, Hernandez AF, Velazquez EJ. Impaired left ventricular global longitudinal strain in patients with heart failure with preserved ejection fraction: insights from the RELAX trial. Eur J Heart Fail 2017; 19:893-900. [PMID: 28194841 DOI: 10.1002/ejhf.754] [Citation(s) in RCA: 117] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Revised: 11/23/2016] [Accepted: 11/24/2016] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND While abnormal left ventricular (LV) global longitudinal strain (GLS) has been described in patients with heart failure with preserved ejection fraction (HFpEF), its prevalence and clinical significance are poorly understood. METHODS AND RESULTS Patients enrolled in the RELAX trial of sildenafil in HFpEF (LV ejection fraction ≥50%) in whom two-dimensional, speckle-tracking LV GLS was possible (n = 187) were analysed. The distribution of LV GLS and its associations with clinical characteristics, LV structure and function, biomarkers, exercise capacity and quality of life were assessed. Baseline median LV GLS was -14.6% (25th and 75th percentile, -17.0% and -11.9%, respectively) and abnormal (≥ - 16%) in 122/187 (65%) patients. Patients in the tertile with the best LV GLS had lower N-terminal pro-brain natriuretic peptide (NT-proBNP) [median 505 pg/mL (161, 1065) vs. 875 pg/mL (488, 1802), P = 0.008) and lower collagen III N-terminal propeptide (PIIINP) levels [median 6.7 µg/L (5.1, 8.1) vs. 8.1 µg/L (6.5, 10.5), P = 0.001] compared with the tertile with the worst LV GLS. There was also a modest linear relationship with LV GLS and log-transformed NT-proBNP and PIIINP (r = 0.29, P < 0.001 and r = 0.19, P = 0.009, respectively). We observed no linear association of LV GLS with Minnesota Living with Heart Failure scores, 6-min walk distance, peak oxygen consumption, or expiratory minute ventilation/carbon dioxide excretion slope. CONCLUSIONS Impaired LV GLS is common among HFpEF patients, indicating the presence of covert systolic dysfunction despite normal LV ejection fraction. Impaired LV GLS was associated with biomarkers of wall stress and collagen synthesis and diastolic dysfunction but not with quality of life or exercise capacity, suggesting other processes may be more responsible for these aspects of the HFpEF syndrome.
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Affiliation(s)
- Adam D DeVore
- Duke Clinical Research Institute, Durham, NC, USA.,Department of Medicine, Duke University School of Medicine, 2400 Pratt Street, NP-8064, Durham, NC, 27705, USA
| | | | - Fawaz Alenezi
- Department of Medicine, Duke University School of Medicine, 2400 Pratt Street, NP-8064, Durham, NC, 27705, USA
| | - Mads Ersboll
- Department of Cardiology, The Heart Centre, University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Justin M Vader
- Department of Medicine, Division of Cardiology, Washington University School of Medicine, St. Louis, MO, USA
| | - Jae K Oh
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
| | - Grace Lin
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
| | | | - Gregory Lewis
- Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Marc J Semigran
- Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Kevin J Anstrom
- Duke Clinical Research Institute, Durham, NC, USA.,Department of Medicine, Duke University School of Medicine, 2400 Pratt Street, NP-8064, Durham, NC, 27705, USA
| | - Adrian F Hernandez
- Duke Clinical Research Institute, Durham, NC, USA.,Department of Medicine, Duke University School of Medicine, 2400 Pratt Street, NP-8064, Durham, NC, 27705, USA
| | - Eric J Velazquez
- Duke Clinical Research Institute, Durham, NC, USA.,Department of Medicine, Duke University School of Medicine, 2400 Pratt Street, NP-8064, Durham, NC, 27705, USA
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Sanchis L, Andrea R, Falces C, Lopez-Sobrino T, Montserrat S, Perez-Villa F, Bijnens B, Sitges M. Prognostic Value of Left Atrial Strain in Outpatients with De Novo Heart Failure. J Am Soc Echocardiogr 2016; 29:1035-1042.e1. [DOI: 10.1016/j.echo.2016.07.012] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Indexed: 11/26/2022]
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Gorter TM, Hoendermis ES, van Veldhuisen DJ, Voors AA, Lam CS, Geelhoed B, Willems TP, van Melle JP. Right ventricular dysfunction in heart failure with preserved ejection fraction: a systematic review and meta-analysis. Eur J Heart Fail 2016; 18:1472-1487. [DOI: 10.1002/ejhf.630] [Citation(s) in RCA: 158] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Revised: 07/08/2016] [Accepted: 07/09/2016] [Indexed: 12/12/2022] Open
Affiliation(s)
- Thomas M. Gorter
- Department of Cardiology, University of Groningen; University Medical Centre Groningen; Groningen The Netherlands
| | - Elke S. Hoendermis
- Department of Cardiology, University of Groningen; University Medical Centre Groningen; Groningen The Netherlands
| | - Dirk J. van Veldhuisen
- Department of Cardiology, University of Groningen; University Medical Centre Groningen; Groningen The Netherlands
| | - Adriaan A. Voors
- Department of Cardiology, University of Groningen; University Medical Centre Groningen; Groningen The Netherlands
| | - Carolyn S.P. Lam
- Department of Cardiology, National Heart Centre Singapore; Singapore Duke-NUS Graduate Medical School; Singapore
| | - Bastiaan Geelhoed
- Department of Cardiology, University of Groningen; University Medical Centre Groningen; Groningen The Netherlands
| | - Tineke P. Willems
- Department of Radiology, University of Groningen; University Medical Centre Groningen; Groningen The Netherlands
| | - Joost P. van Melle
- Department of Cardiology, University of Groningen; University Medical Centre Groningen; Groningen The Netherlands
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Bekfani T, Pellicori P, Morris DA, Ebner N, Valentova M, Steinbeck L, Wachter R, Elsner S, Sliziuk V, Schefold JC, Sandek A, Doehner W, Cleland JG, Lainscak M, Anker SD, von Haehling S. Sarcopenia in patients with heart failure with preserved ejection fraction: Impact on muscle strength, exercise capacity and quality of life. Int J Cardiol 2016; 222:41-46. [PMID: 27454614 DOI: 10.1016/j.ijcard.2016.07.135] [Citation(s) in RCA: 148] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Accepted: 07/08/2016] [Indexed: 12/13/2022]
Abstract
BACKGROUND To describe the prevalence of sarcopenia in ambulatory patients with heart failure with preserved ejection fraction (HFpEF) and its relation to reduced exercise capacity, muscle strength, and quality of life (QoL). METHODS AND RESULTS A total of 117 symptomatic outpatients with HFpEF were prospectively enrolled in Germany, England, and Slovenia as part of the Studies Investigating Co-morbidities Aggravating Heart Failure (SICA-HF). Appendicular skeletal muscle (ASM) mass (the sum of muscle mass in both arms and legs) was assessed by DEXA. Echocardiography, 6-minute walk testing (6-MWT), muscle strength assessment, spiroergometry and QoL evaluation using EQ-5D Questionnaire were performed. Sarcopenia was defined as ASM 2 standard deviations below the mean of a healthy reference group aged 18-40years. Patients were divided into 3 groups according to the E/e' value: ≤8, 9-14, and ≥15. Sarcopenia was detected in 19.7% of all patients. These patients performed worse during 6-MWT (404±116 vs. 307±145m, p=0.003) and showed lower absolute peak oxygen consumption (1579±474 vs. 1211±442mL/min, p<0.05). Both ASM and muscle strength were lowest in patients with E/e' >15 (p<0.05). Higher values of muscle strength/ASM were associated with a better QoL (r=0.5, p<0.0005). Logistic regression showed ASM to be independently associated with reduced distance walked during the 6-MWT adjusted for NYHA, height, left atrium diameter, ferritin and forced expiratory volume in 1s (FEV1) (odds ratio 1.2, p=0.02). CONCLUSION Sarcopenia affects a clinically relevant proportion of patients with HFpEF. Low ASM is strongly linked to reduced muscle strength, exercise capacity and QoL in these patients.
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Affiliation(s)
- Tarek Bekfani
- Charité Medical School, Campus Virchow-Klinikum, Department of Cardiology, Berlin, Germany; Department of Internal Medicine I, Division of Cardiology, Angiology, Pneumology and Intensive Medical Care, Friedrich-Schiller-University, Jena, Germany.
| | | | - Daniel A Morris
- Charité Medical School, Campus Virchow-Klinikum, Department of Cardiology, Berlin, Germany.
| | - Nicole Ebner
- Charité Medical School, Campus Virchow-Klinikum, Department of Cardiology, Berlin, Germany; University of Göttingen Medical School, Department of Cardiology and Pneumology, Göttingen, Germany.
| | - Miroslava Valentova
- University of Göttingen Medical School, Department of Cardiology and Pneumology, Göttingen, Germany; Department of Internal Medicine, Comenius University, Bratislava, Slovak Republic.
| | - Lisa Steinbeck
- Charité Medical School, Campus Virchow-Klinikum, Department of Cardiology, Berlin, Germany.
| | - Rolf Wachter
- University of Göttingen Medical School, Department of Cardiology and Pneumology, Göttingen, Germany.
| | - Sebastian Elsner
- Charité Medical School, Campus Virchow-Klinikum, Department of Cardiology, Berlin, Germany.
| | - Veronika Sliziuk
- Charité Medical School, Campus Virchow-Klinikum, Department of Cardiology, Berlin, Germany.
| | - Joerg C Schefold
- Department of Intensive Care Medicine, Inselspital, University Hospital of Bern, Bern, Switzerland.
| | - Anja Sandek
- University of Göttingen Medical School, Department of Cardiology and Pneumology, Göttingen, Germany.
| | - Wolfram Doehner
- Charité Medical School, Campus Virchow-Klinikum, Department of Cardiology, Berlin, Germany; Center for Stroke Research Berlin, Charité Medical School, Berlin, Germany.
| | - John G Cleland
- University of Hull, Department of Cardiology, Hull, United Kingdom.
| | - Mitja Lainscak
- Golnik University, Department of Cardiology, Golnik, Slovenia.
| | - Stefan D Anker
- University of Göttingen Medical School, Department of Cardiology and Pneumology, Göttingen, Germany.
| | - Stephan von Haehling
- Charité Medical School, Campus Virchow-Klinikum, Department of Cardiology, Berlin, Germany; University of Göttingen Medical School, Department of Cardiology and Pneumology, Göttingen, Germany.
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New ways to visualize and combat congestion in heart failure. Rev Clin Esp 2016; 216:202-4. [PMID: 27129360 DOI: 10.1016/j.rce.2016.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Accepted: 03/31/2016] [Indexed: 11/20/2022]
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Pellicori P, Goode KM, Nicholls R, Ahmed D, Clark AL, Cleland JG. Regional circulatory distribution of novel cardiac bio-markers and their relationships with haemodynamic measurements. Int J Cardiol 2016; 210:149-55. [DOI: 10.1016/j.ijcard.2016.02.081] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Revised: 12/30/2015] [Accepted: 02/02/2016] [Indexed: 01/19/2023]
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Shah AM, Claggett B, Sweitzer NK, Shah SJ, Anand IS, Liu L, Pitt B, Pfeffer MA, Solomon SD. Prognostic Importance of Impaired Systolic Function in Heart Failure With Preserved Ejection Fraction and the Impact of Spironolactone. Circulation 2015; 132:402-14. [PMID: 26130119 PMCID: PMC4526442 DOI: 10.1161/circulationaha.115.015884] [Citation(s) in RCA: 343] [Impact Index Per Article: 38.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Accepted: 05/22/2015] [Indexed: 12/17/2022]
Abstract
BACKGROUND Impairment in left ventricular systolic function has been described in heart failure (HF) with preserved ejection fraction (HFpEF), but its prognostic relevance is not known. We determined whether left ventricular longitudinal strain (LS) is predictive of cardiovascular outcomes in HFpEF beyond clinical and conventional echocardiographic measures. METHODS AND RESULTS LS was assessed by 2-dimensional speckle-tracking echocardiography at baseline in 447 patients with HFpEF enrolled in the Treatment of Preserved Cardiac Function Heart Failure With an Aldosterone Antagonist (TOPCAT) trial. At a median follow-up of 2.6 years (interquartile range, 1.5-3.9 years), 115 patients experienced the primary composite outcome of cardiovascular death, HF hospitalization, or aborted cardiac arrest. Impaired LS, defined as an absolute LS <15.8%, was present in 52% of patients and was predictive of the composite outcome (adjusted hazard ratio, 2.14; 95% confidence interval, 1.26-3.66; P=0.005), cardiovascular death alone (adjusted hazard ratio, 3.20; 95% confidence interval, 1.44-7.12; P=0.004), and HF hospitalization alone (adjusted hazard ratio, 2.23; 95% confidence interval, 1.16-4.28; P=0.016) after adjustment for clinical and conventional echocardiographic variables. LS was the strongest echocardiographic predictor of the composite outcome. Exploratory analysis in a subset of 131 patients with follow-up LS assessed after 12 to 18 months demonstrated a trend toward improvement in LS associated with spironolactone in patients enrolled in the Americas but not in Russia or Georgia. CONCLUSIONS Impaired left ventricular systolic function is a powerful predictor of HF hospitalization, cardiovascular death, or aborted cardiac arrest in HFpEF independent of clinical predictors. Impaired LS represents a novel imaging biomarker to identify patients with HFpEF at particularly high risk for cardiovascular morbidity and mortality. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT00094302.
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Affiliation(s)
- Amil M Shah
- From Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA (A.M.S., B.C., L.L., M.A.P., S.D.S.); Sarver Heart Center, University of Arizona College of Medicine, Tucson (N.K.S.); Cardiology Division, Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S.); Cardiovascular Division, VA Medical Center, Minneapolis, MN (I.S.A.); and Cardiology Division, University of Michigan School of Medicine, Ann Arbor (B.P.).
| | - Brian Claggett
- From Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA (A.M.S., B.C., L.L., M.A.P., S.D.S.); Sarver Heart Center, University of Arizona College of Medicine, Tucson (N.K.S.); Cardiology Division, Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S.); Cardiovascular Division, VA Medical Center, Minneapolis, MN (I.S.A.); and Cardiology Division, University of Michigan School of Medicine, Ann Arbor (B.P.)
| | - Nancy K Sweitzer
- From Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA (A.M.S., B.C., L.L., M.A.P., S.D.S.); Sarver Heart Center, University of Arizona College of Medicine, Tucson (N.K.S.); Cardiology Division, Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S.); Cardiovascular Division, VA Medical Center, Minneapolis, MN (I.S.A.); and Cardiology Division, University of Michigan School of Medicine, Ann Arbor (B.P.)
| | - Sanjiv J Shah
- From Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA (A.M.S., B.C., L.L., M.A.P., S.D.S.); Sarver Heart Center, University of Arizona College of Medicine, Tucson (N.K.S.); Cardiology Division, Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S.); Cardiovascular Division, VA Medical Center, Minneapolis, MN (I.S.A.); and Cardiology Division, University of Michigan School of Medicine, Ann Arbor (B.P.)
| | - Inder S Anand
- From Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA (A.M.S., B.C., L.L., M.A.P., S.D.S.); Sarver Heart Center, University of Arizona College of Medicine, Tucson (N.K.S.); Cardiology Division, Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S.); Cardiovascular Division, VA Medical Center, Minneapolis, MN (I.S.A.); and Cardiology Division, University of Michigan School of Medicine, Ann Arbor (B.P.)
| | - Li Liu
- From Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA (A.M.S., B.C., L.L., M.A.P., S.D.S.); Sarver Heart Center, University of Arizona College of Medicine, Tucson (N.K.S.); Cardiology Division, Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S.); Cardiovascular Division, VA Medical Center, Minneapolis, MN (I.S.A.); and Cardiology Division, University of Michigan School of Medicine, Ann Arbor (B.P.)
| | - Bertram Pitt
- From Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA (A.M.S., B.C., L.L., M.A.P., S.D.S.); Sarver Heart Center, University of Arizona College of Medicine, Tucson (N.K.S.); Cardiology Division, Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S.); Cardiovascular Division, VA Medical Center, Minneapolis, MN (I.S.A.); and Cardiology Division, University of Michigan School of Medicine, Ann Arbor (B.P.)
| | - Marc A Pfeffer
- From Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA (A.M.S., B.C., L.L., M.A.P., S.D.S.); Sarver Heart Center, University of Arizona College of Medicine, Tucson (N.K.S.); Cardiology Division, Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S.); Cardiovascular Division, VA Medical Center, Minneapolis, MN (I.S.A.); and Cardiology Division, University of Michigan School of Medicine, Ann Arbor (B.P.)
| | - Scott D Solomon
- From Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA (A.M.S., B.C., L.L., M.A.P., S.D.S.); Sarver Heart Center, University of Arizona College of Medicine, Tucson (N.K.S.); Cardiology Division, Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S.); Cardiovascular Division, VA Medical Center, Minneapolis, MN (I.S.A.); and Cardiology Division, University of Michigan School of Medicine, Ann Arbor (B.P.)
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Pellicori P, Kallvikbacka-Bennett A, Dierckx R, Zhang J, Putzu P, Cuthbert J, Boyalla V, Shoaib A, Clark AL, Cleland JGF. Prognostic significance of ultrasound-assessed jugular vein distensibility in heart failure. Heart 2015; 101:1149-58. [PMID: 26006717 DOI: 10.1136/heartjnl-2015-307558] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Accepted: 04/29/2015] [Indexed: 11/03/2022] Open
Abstract
AIMS Jugular venous distension is a classical sign of heart failure (HF) but it can be difficult to assess clinically. METHODS AND RESULTS Outpatients with HF and control subjects were assessed. Internal jugular vein diameter (JVD) was measured using a linear high-frequency ultrasound probe (10 MHz) at rest, after a Valsalva manoeuvre and during deep inspiration. JVD ratio was calculated as the maximum diameter during Valsalva to that measured at rest. 311 patients (mean age 71 years, mean left ventricular EF 42%, median (IQR) amino-terminal pro-brain natriuretic peptide 979 (441-2007) ng/L) and 66 controls were included. JVD (median and IQR range) at rest was smaller in controls (0.16 (0.14-0.20) cm) than in patients with HF (0.23 (0.17-0.33) cm; p<0.001) but similar during Valsalva (1.03 (0.90-1.16) cm vs 1.08 (0.90-1.25) cm; p=0.28). Consequently, JVD ratio was greater in controls (6.3 (4.9-7.6)) than in patients (4.5 (2.9-6.1); p<0.001). During a median follow-up of 516 (IQR 335-622) days, 48 patients (15%) with HF died or were hospitalised for HF. In multivariable models, among clinical, echocardiographic or biochemical variables, only increasing NT-proBNP and ultrasound assessment of internal jugular vein were independently associated with prognosis. Comparing top and bottom tertiles of JVD ratio (2.3 (IQR 1.7-2.9) versus 6.8 (6.1-7.7)), the tertile with lower values had a 10-fold greater risk of an adverse event (HR 10.05, 95% CI 3.07 to 32.93). CONCLUSIONS Ultrasound assessment of the internal jugular vein identifies outpatients with HF who have a higher risk of an adverse outcome. CLINICAL TRIAL REGISTRATION NCT01872299.
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Affiliation(s)
- Pierpaolo Pellicori
- Department of Cardiology, Hull York Medical School (University of Hull), Castle Hill Hospital, Kingston upon Hull, UK
| | - Anna Kallvikbacka-Bennett
- Department of Cardiology, Hull York Medical School (University of Hull), Castle Hill Hospital, Kingston upon Hull, UK
| | - Riet Dierckx
- Department of Cardiology, Hull York Medical School (University of Hull), Castle Hill Hospital, Kingston upon Hull, UK
| | - Jufen Zhang
- Department of Cardiology, Hull York Medical School (University of Hull), Castle Hill Hospital, Kingston upon Hull, UK
| | - Paola Putzu
- Department of Cardiology, Hull York Medical School (University of Hull), Castle Hill Hospital, Kingston upon Hull, UK
| | - Joe Cuthbert
- Department of Cardiology, Hull York Medical School (University of Hull), Castle Hill Hospital, Kingston upon Hull, UK
| | - Vennela Boyalla
- Department of Cardiology, Hull York Medical School (University of Hull), Castle Hill Hospital, Kingston upon Hull, UK
| | - Ahmed Shoaib
- Department of Cardiology, Hull York Medical School (University of Hull), Castle Hill Hospital, Kingston upon Hull, UK
| | - Andrew L Clark
- Department of Cardiology, Hull York Medical School (University of Hull), Castle Hill Hospital, Kingston upon Hull, UK
| | - John G F Cleland
- Department of Cardiology, Hull York Medical School (University of Hull), Castle Hill Hospital, Kingston upon Hull, UK National Heart & Lung Institute and National Institute of Health Research Cardiovascular Biomedical Research Unit, Royal Brompton & Harefield Hospitals, Imperial College, London, UK
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48
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Cleland JGF, Pellicori P, Dierckx R. Clinical trials in patients with heart failure and preserved left ventricular ejection fraction. Heart Fail Clin 2015; 10:511-23. [PMID: 24975913 DOI: 10.1016/j.hfc.2014.04.011] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
There is no robust evidence that any treatment can modify the natural history of patients with heart failure and preserved left ventricular ejection fraction (HFpEF), although most agree that diuretics can control congestion and improve symptoms. HFpEF is often complicated by systemic and pulmonary hypertension, atrial fibrillation, obesity, chronic lung and kidney disease, lack of physical fitness, and old age that can complicate both diagnosis and management. Further trials should phenotype patients precisely and create better definitions of HFpEF based on biomarkers.
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Affiliation(s)
- John G F Cleland
- National Heart & Lung Institute, NIHR Cardiovascular Biomedical Research Unit, Royal Brompton and Harefield Hospitals NHS Trust, Imperial College, London, UK.
| | - Pierpaolo Pellicori
- Department of Cardiology, Castle Hill Hospital, Hull and York Medical School, University of Hull, Kingston-upon-Hull, UK
| | - Riet Dierckx
- Department of Cardiology, Castle Hill Hospital, Hull and York Medical School, University of Hull, Kingston-upon-Hull, UK
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49
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Cardiovascular imaging 2014 in the International Journal of Cardiovascular Imaging. Int J Cardiovasc Imaging 2015; 31:447-61. [DOI: 10.1007/s10554-015-0627-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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50
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Caselli S, Montesanti D, Autore C, Di Paolo FM, Pisicchio C, Squeo MR, Musumeci B, Spataro A, Pandian NG, Pelliccia A. Patterns of Left Ventricular Longitudinal Strain and Strain Rate in Olympic Athletes. J Am Soc Echocardiogr 2015; 28:245-53. [DOI: 10.1016/j.echo.2014.10.010] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2014] [Indexed: 02/06/2023]
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