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Left atrial structure and function in heart failure with reduced (HFrEF) versus preserved ejection fraction (HFpEF): systematic review and meta-analysis. Heart Fail Rev 2022; 27:1933-1955. [PMID: 35079942 PMCID: PMC9388424 DOI: 10.1007/s10741-021-10204-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/09/2021] [Indexed: 01/10/2023]
Abstract
Left atrial (LA) structure and function in heart failure with reduced (HFrEF) versus preserved ejection fraction (HFpEF) is only established in small studies. Therefore, we conducted a systematic review of LA structure and function in order to find differences between patients with HFrEF and HFpEF. English literature on LA structure and function using echocardiography was reviewed to calculate pooled prevalence and weighted mean differences (WMD). A total of 61 studies, comprising 8806 patients with HFrEF and 9928 patients with HFpEF, were included. The pooled prevalence of atrial fibrillation (AF) was 34.4% versus 42.8% in the acute inpatient setting, and 20.1% versus 33.1% in the chronic outpatient setting when comparing between HFrEF and HFpEF. LA volume index (LAVi), LA reservoir global longitudinal strain (LAGLSR), and E/e’ was 59.7 versus 52.7 ml/m2, 9.0% versus 18.9%, and 18.5 versus 14.0 in the acute inpatient setting, and 48.3 versus 38.2 ml/m2, 12.8% versus 23.4%, and 16.9 versus 13.5 in the chronic outpatient setting when comparing HFrEF versus HFpEF, respectively. The relationship between LAVi and LAGLSR was significant in HFpEF, but not in HFrEF. Also, in those studies that directly compared patients with HFrEF versus HFpEF, those with HFrEF had worse LAGLSR [WMD = 16.3% (22.05,8.61); p < 0.001], and higher E/e’ [WMD = −0.40 (−0.56, −0.24); p < 0.05], while LAVi was comparable. When focusing on acute hospitalized patients, E/e’ was comparable between patients with HFrEF and HFpEF. Despite the higher burden of AF in HFpEF, patients with HFrEF had worse LA global function. Left atrial myopathy is not specifically related to HFpEF.
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Arques S, Chelaifa H, Vieillard M, Roux E. Clinical relevance of spectral tissue Doppler-derived E/e' in older patients with preserved ejection fraction. Ann Cardiol Angeiol (Paris) 2021; 70:286-293. [PMID: 34130804 DOI: 10.1016/j.ancard.2021.05.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 05/07/2021] [Indexed: 01/09/2023]
Abstract
BACKGROUND The E/e' index measured in spectral tissue Doppler is included in the recommendations for the diagnosis by transthoracic Doppler echocardiography of left ventricular diastolic dysfunction and heart failure with preserved ejection fraction. While E/e' is influenced by age in healthy individuals, no studies have evaluated this index in elderly patients. This study addressed the clinical relevance of E/e' in assessment of left ventricular diastolic function in elderly patients with preserved ejection fraction and its relevance from both a diagnostic and prognostic perspective based on the existing literature. METHODS A total of 76 patients≥70years of age were prospectively included. The analysis of left ventricular diastolic function was adapted from the 2016 ASE/EACVI recommendations without consideration of E/e'. RESULTS The mean age was 85years. In all, 42 patients had moderate-to-severe diastolic dysfunction (elevated left atrial pressure). Mean E/e' was significantly correlated with diastolic function (r=0.58, P<0.001). Mean E/e'>13.3 had a sensitivity of 86% and a specificity of 91% in the diagnosis of moderate-to-severe diastolic dysfunction (AUC: 0.92). E/(e'xs') (AUC: 0.89) and NT pro-BNP (AUC: 0.80) did not perform better than E/e'. The existing literature offers large body of evidence that E/e' provides essential diagnostic and prognostic information in older patients with cardiovascular disease. CONCLUSION E/e' is accurate in the diagnosis of significant diastolic dysfunction, in the diagnosis of heart failure with preserved ejection fraction and in risk stratification in older patients with cardiovascular disease.
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Affiliation(s)
- S Arques
- Structure de cardiologie, centre hospitalier Edmond-Garcin, avenue des Sœurs-Gastine, 13400 Aubagne, France.
| | - H Chelaifa
- Structure de cardiologie, centre hospitalier Edmond-Garcin, avenue des Sœurs-Gastine, 13400 Aubagne, France
| | - M Vieillard
- Structure de cardiologie, centre hospitalier Edmond-Garcin, avenue des Sœurs-Gastine, 13400 Aubagne, France
| | - E Roux
- Structure de cardiologie, centre hospitalier Edmond-Garcin, avenue des Sœurs-Gastine, 13400 Aubagne, France
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Tanase DM, Radu S, Al Shurbaji S, Baroi GL, Florida Costea C, Turliuc MD, Ouatu A, Floria M. Natriuretic Peptides in Heart Failure with Preserved Left Ventricular Ejection Fraction: From Molecular Evidences to Clinical Implications. Int J Mol Sci 2019; 20:E2629. [PMID: 31142058 PMCID: PMC6600439 DOI: 10.3390/ijms20112629] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Revised: 05/21/2019] [Accepted: 05/24/2019] [Indexed: 12/11/2022] Open
Abstract
The incidence of heart failure with preserved ejection fraction (HFpEF) is increasing and its challenging diagnosis and management combines clinical, imagistic and biological data. Natriuretic peptides (NPs) are hormones secreted in response to myocardial stretch that, by increasing cyclic guanosine monophosphate (cGMP), counteract myocardial fibrosis and hypertrophy, increase natriuresis and determine vasodilatation. While their role in HFpEF is controversial, most authors focused on b-type natriuretic peptides (BNPs) and agreed that patients may show lower levels. In this setting, newer molecules with an increased specificity, such as middle-region pro-atrial natriuretic peptide (MR-proANP), emerged as promising markers. Augmenting NP levels, either by NP analogs or breakdown inhibition, could offer a new therapeutic target in HFpEF (already approved in their reduced EF counterparts) by increasing the deficient cGMP levels found in patients. Importantly, these peptides also retain their prognostic value. This narrative review focuses on NPs' physiology, diagnosis, therapeutic and prognostic implication in HFpEF.
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Affiliation(s)
- Daniela Maria Tanase
- Department of Internal Medicine, "Grigore T. Popa" University of Medicine and Pharmacy, 700111 Iasi, Romania.
- Internal Medicine Clinic, "Sf. Spiridon" County Clinical Emergency Hospital Iasi, 700115 Iasi, Romania.
| | - Smaranda Radu
- Department of Internal Medicine, "Grigore T. Popa" University of Medicine and Pharmacy, 700111 Iasi, Romania.
- Cardiology Clinic, "Prof. Dr. George I.M. Georgescu" Institute of Cardiovascular Diseases, 700503 Iasi, Romania.
| | - Sinziana Al Shurbaji
- Department of Internal Medicine, "Grigore T. Popa" University of Medicine and Pharmacy, 700111 Iasi, Romania.
- Institute of Gastroenterology and Hepatology, 700115 Iasi, Romania.
| | - Genoveva Livia Baroi
- Department of Surgery, "Grigore T. Popa" University of Medicine and Pharmacy, 700111 Iasi, Romania.
- Vascular Surgery Clinic, "Sf. Spiridon" County Clinical Emergency Hospital Iasi, 700115 Iasi, Romania.
| | - Claudia Florida Costea
- Department of Ophthalmology, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iasi, Romania.
- 2nd Ophthalmology Clinic, "Prof. Dr. Nicolae Oblu" Emergency Clinical Hospital, 700115 Iași, Romania.
| | - Mihaela Dana Turliuc
- Department of Neurosurgery, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iași, Romania.
- 2nd Neurosurgery Clinic, "Prof. Dr. Nicolae Oblu" Emergency Clinical Hospital, 700115 Iași, Romania.
| | - Anca Ouatu
- Department of Internal Medicine, "Grigore T. Popa" University of Medicine and Pharmacy, 700111 Iasi, Romania.
- Internal Medicine Clinic, "Sf. Spiridon" County Clinical Emergency Hospital Iasi, 700115 Iasi, Romania.
| | - Mariana Floria
- Department of Internal Medicine, "Grigore T. Popa" University of Medicine and Pharmacy, 700111 Iasi, Romania.
- Internal Medicine Clinic, "Sf. Spiridon" County Clinical Emergency Hospital Iasi, 700115 Iasi, Romania.
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Kadri AN, Kaw R, Al-Khadra Y, Abuamsha H, Ravakhah K, Hernandez AV, Tang WHW. The role of B-type natriuretic peptide in diagnosing acute decompensated heart failure in chronic kidney disease patients. Arch Med Sci 2018; 14:1003-1009. [PMID: 30154881 PMCID: PMC6111357 DOI: 10.5114/aoms.2018.77263] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Accepted: 01/26/2018] [Indexed: 01/01/2023] Open
Abstract
INTRODUCTION Chronic kidney disease (CKD) and congestive heart failure (CHF) patients have higher serum B-type natriuretic peptide (BNP), which alters the test interpretation. We aim to define BNP cutoff levels to diagnose acute decompensated heart failure (ADHF) in CKD according to CHF subtype: heart failure with preserved ejection fraction (HFpEF) and heart failure with reduced ejection fraction (HFrEF). MATERIAL AND METHODS We reviewed 1,437 charts of consecutive patients who were admitted for dyspnea. We excluded patients with normal kidney function, without measured BNP, echocardiography, or history of CHF. BNP cutoff values to diagnose ADHF for CKD stages according to CHF subtype were obtained for the highest pair of sensitivity (Sn) and specificity (Sp). We calculated positive and negative likelihood ratios (LR+ and LR-, respectively), and diagnostic odds ratios (DOR), as well as the area under the receiver operating characteristic curves (AUC) for BNP. RESULTS We evaluated a cohort of 348 consecutive patients: 152 had ADHF, and 196 had stable CHF. In those with HFpEF with CKD stages 3-4, BNP < 155 pg/ml rules out ADHF (Sn90%, LR- = 0.26 and DOR = 5.75), and BNP > 670 pg/ml rules in ADHF (Sp90%, LR+ = 4 and DOR = 6), with an AUC = 0.79 (95% CI: 0.71-0.87). In contrast, in those with HFrEF with CKD stages 3-4, BNP < 412.5 pg/ml rules out ADHF (Sn90%, LR- = 0.19 and DOR = 9.37), and BNP > 1166.5 pg/ml rules in ADHF (Sp87%, LR+ = 3.9 and DOR = 6.97) with an AUC = 0.78 (95% CI: 0.69-0.86). All LRs and DOR were statistically significant. CONCLUSIONS BNP cutoff values for the diagnosis of ADHF in HFrEF were higher than those in HFpEF across CKD stages 3-4, with moderate discriminatory diagnostic ability.
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Affiliation(s)
| | - Roop Kaw
- Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | | | - Hasan Abuamsha
- St. Vincent Charity Medical Center – Case Western Reserve University, Cleveland, Ohio, USA
| | - Keyvan Ravakhah
- St. Vincent Charity Medical Center – Case Western Reserve University, Cleveland, Ohio, USA
| | - Adrian V. Hernandez
- University of Connecticut, Hartford Hospital Evidence-based Practice Center, Hartford, CT, USA
- School of Medicine, Universidad Peruana de Ciencias Aplicadas (UPC), Lima, Peru
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Sharifov OF, Schiros CG, Aban I, Denney TS, Gupta H. Diagnostic Accuracy of Tissue Doppler Index E/e' for Evaluating Left Ventricular Filling Pressure and Diastolic Dysfunction/Heart Failure With Preserved Ejection Fraction: A Systematic Review and Meta-Analysis. J Am Heart Assoc 2016; 5:JAHA.115.002530. [PMID: 26811160 PMCID: PMC4859370 DOI: 10.1161/jaha.115.002530] [Citation(s) in RCA: 143] [Impact Index Per Article: 17.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Background Tissue Doppler index E/è is used clinically and in multidisciplinary research for estimation of left ventricular filling pressure (LVFP) and diastolic dysfunction (DD)/heart failure with preserved ejection fraction (HFpEF). Its diagnostic accuracy is not well studied. Methods and Results From the PubMed, Scopus, Embase, and Cochrane databases, we identified 24 studies reporting E/è and invasive LVFP in preserved EF (≥50%). In random‐effects models, E/è had poor to mediocre linear correlation with LVFP. Summary sensitivity and specificity (with 95% CIs) for the American Society of Echocardiography–recommended E/è cutoffs (lateral, mean, and septal, respectively) to identify elevated LVFP was estimated by using hierarchical summary receiver operating characteristic analysis. Summary sensitivity was 30% (9–48%), 37% (13–61%), and 24% (6–46%), and summary specificity was 92% (82–100%), 91% (80–99%), and 98% (92–100%). Positive likelihood ratio (LR+) was <5 for lateral and mean E/è. LR+ was slightly >10 for septal E/è obtained from 4 studies (cumulative sample size <220). For excluding elevated LVFP, summary sensitivity for E/è (lateral, mean, and septal, respectively) was 64% (38–86%), 36% (3–74%), and 50% (14–81%), while summary specificity was 73% (54–89%), 83% (49–100%), and 89% (66–100%). Because of data set limitations, meaningful inference for identifying HFpEF by using E/è could not be drawn. With the use of quality assessment tool for diagnostic accuracy studies (Quality Assessment of Diagnostic Accuracy Studies questionnaire), we found substantial risks of bias and/or applicability. Conclusions There is insufficient evidence to support that E/è can reliably estimate LVFP in preserved EF. The diagnostic accuracy of E/è to identify/exclude elevated LVFP and DD/HFpEF is limited and requires further validation in a well‐designed prospective clinical trial.
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Affiliation(s)
- Oleg F Sharifov
- Department of Medicine, University of Alabama at Birmingham, AL (O.F.S., C.G.S., H.G.)
| | - Chun G Schiros
- Department of Medicine, University of Alabama at Birmingham, AL (O.F.S., C.G.S., H.G.)
| | - Inmaculada Aban
- Department of Biostatistcs, University of Alabama at Birmingham, AL (I.A.)
| | - Thomas S Denney
- Department of Electrical and Computer Engineering, Auburn University, Auburn, AL (T.S.D.)
| | - Himanshu Gupta
- Department of Medicine, University of Alabama at Birmingham, AL (O.F.S., C.G.S., H.G.) VA Medical Center, Birmingham, AL (H.G.)
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Sattarzadeh R, Tavoosi A, Tajik P. Echocardiographic estimation of left ventricular filling pressures in patients with mitral valve stenosis. Cardiovasc J Afr 2014; 25:34-9. [PMID: 24626519 PMCID: PMC3959187 DOI: 10.5830/cvja-2013-088] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2013] [Accepted: 12/09/2013] [Indexed: 11/23/2022] Open
Abstract
Background Estimation of left ventricular end-diastolic pressure (LVEDP) among patients with mitral valve disease may help to explain their symptoms. However, conventional Doppler measurements have limitations in predicting LVEDP in this group of patients. The aim of this study was to construct a Doppler-derived LVEDP prediction model based on the combined analysis of transmitral and pulmonary venous flow velocity curves. Methods Thirty-three patients with moderate to severe mitral stenosis (MS) who had indications for left heart catheterisation enrolled. Two-dimensional, M-mode, colour Doppler and tissue Doppler imaging indices, such as annular early diastolic velocity (Ea), isovolumic relaxation time (IVRT), pulmonary vein systolic and diastolic flow velocities, velocity propagation, left atrium area (LAA), interval between the onset of mitral E and annular Ea (TE–Ea), and Tei index were obtained. LVEDP was measured in all patients during left cardiac catheterisation. Linear correlation and multiple linear regressions were used for analysis. Results The mean of LVEDP was 9.9 ± 5.3 mmHg. In univariate analysis, the only significant relationship was noted with LAA (p = 0.05, R2 = 0.11). However, in multivariate regression, LAA, Tei index and Ea remained in the model to predict LVEDP (p = 0.02, R2 = 0.26). For prediction of LVEDP ≥ 15 mmHg, the best model consisted of LAA, IVRT and Ea, and had a sensitivity of 85% and specificity of 85%. Conclusion Our results provided evidence that, in patients with moderate to severe MS, LVEDP can be estimated by combining Doppler echocardiographic variables of mitral flow. However, more studies are required to confirm these results.
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Affiliation(s)
- Roya Sattarzadeh
- Cardiology Department of Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Anahita Tavoosi
- Cardiology Department of Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Parvin Tajik
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands
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Richards AM, Januzzi JL, Troughton RW. Natriuretic Peptides in Heart Failure with Preserved Ejection Fraction. Heart Fail Clin 2014; 10:453-70. [DOI: 10.1016/j.hfc.2014.04.006] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Tate S, Griem A, Durbin-Johnson B, Watt C, Schaefer S. Marked elevation of B-type natriuretic peptide in patients with heart failure and preserved ejection fraction. J Biomed Res 2014; 28:255-61. [PMID: 25050108 PMCID: PMC4102838 DOI: 10.7555/jbr.28.20140021] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2014] [Revised: 04/08/2014] [Accepted: 04/15/2014] [Indexed: 11/03/2022] Open
Abstract
UNLABELLED Marked elevations of B-type natriuretic peptide (BNP) are not generally seen in patients with heart failure and preserved ejection fraction (HFpEF). The objective of this study was to examine the clinical and laboratory characteristics of a large cohort of patients with HFpEF and markedly elevated BNP. A retrospective examination of 421 inpatients at a university hospital admitted with a diagnosis of HFpEF was performed. Clinical and echocardiographic data in 4 groups of patients with levels of BNP ≤ 100 pg/mL, 100-400 pg/mL, 400-1,000 pg/mL and > 1,000 pg/mL were compared. Patients with HFpEF and BNP > 1,000 pg/mL (28% of the population) were characterized by impaired renal function and greater use of anti-hypertensive medications. A subset of these patients with BNP > 1,000 pg/mL had normal renal function (21%) and were significantly older, more frequently female, and tended to have lower ejection fractions. Conversely, patients with HFpEF and BNP ≤ 100 pg/mL were younger and had preserved renal function. BNP was inversely related to the likelihood of subsequent admission for heart failure, but not to myocardial infarction or death. IN CONCLUSION BNP > 1,000 pg/mL is seen in almost 1/3 of patients hospitalized with HFpEF. This elevation of BNP often reflects impaired renal function, but can also be seen in patients with preserved renal function but relatively impaired systolic function.
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Affiliation(s)
- Samuel Tate
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of California Davis, Davis, CA, USA
| | - Andrea Griem
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of California Davis, Davis, CA, USA
| | - Blythe Durbin-Johnson
- Department of Public Health Sciences, Division of Biostatistics, University of California Davis, Davis, CA, USA
| | - Clifton Watt
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of California Davis, Davis, CA, USA
| | - Saul Schaefer
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of California Davis, Davis, CA, USA. ; Cardiology Section, Department of Veteran Affairs, Northern California Health Care System, Mather, CA, USA
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Collier P, Watson CJ, Waterhouse DF, Dawkins IR, Patle AK, Horgan S, Conlon CM, O'Hanlon R, Baugh JA, Ledwidge MT, McDonald K. Progression of left atrial volume index in a population at risk for heart failure: a substudy of the STOP-HF (St Vincent's Screening TO Prevent Heart Failure) trial. Eur J Heart Fail 2014; 14:957-64. [DOI: 10.1093/eurjhf/hfs084] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Affiliation(s)
- Patrick Collier
- Heart Failure Unit; St Vincent's University Hospital; Elm Park, Dublin 4 Ireland
| | - Chris J. Watson
- UCD Conway Institute of Biomolecular and Biomedical Research, Belfield; University College Dublin 4; Ireland
| | - Deidre F. Waterhouse
- Heart Failure Unit; St Vincent's University Hospital; Elm Park, Dublin 4 Ireland
| | - Ian R. Dawkins
- Heart Failure Unit; St Vincent's University Hospital; Elm Park, Dublin 4 Ireland
| | - Anil K. Patle
- Heart Failure Unit; St Vincent's University Hospital; Elm Park, Dublin 4 Ireland
| | - Stephen Horgan
- Heart Failure Unit; St Vincent's University Hospital; Elm Park, Dublin 4 Ireland
| | - Carmel M. Conlon
- Heart Failure Unit; St Vincent's University Hospital; Elm Park, Dublin 4 Ireland
| | - Rory O'Hanlon
- Heart Failure Unit; St Vincent's University Hospital; Elm Park, Dublin 4 Ireland
| | - John A. Baugh
- UCD Conway Institute of Biomolecular and Biomedical Research, Belfield; University College Dublin 4; Ireland
| | - Mark T. Ledwidge
- Heart Failure Unit; St Vincent's University Hospital; Elm Park, Dublin 4 Ireland
| | - Kenneth McDonald
- Heart Failure Unit; St Vincent's University Hospital; Elm Park, Dublin 4 Ireland
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Arques S. Shortened mitral A wave deceleration time: an under-recognized but promising Doppler-derived index of left ventricular myocardial dysfunction in patients with normal left ventricular ejection fraction. Int J Cardiol 2012; 167:3076-7. [PMID: 23228213 DOI: 10.1016/j.ijcard.2012.11.068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2012] [Accepted: 11/11/2012] [Indexed: 11/25/2022]
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Kurt M, Tanboga IH, Aksakal E, Kaya A, Isik T, Ekinci M, Bilen E. Relation of left ventricular end-diastolic pressure and N-terminal pro-brain natriuretic peptide level with left atrial deformation parameters. Eur Heart J Cardiovasc Imaging 2011; 13:524-30. [DOI: 10.1093/ejechocard/jer283] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Collier P, Watson CJ, Voon V, Phelan D, Jan A, Mak G, Martos R, Baugh JA, Ledwidge MT, McDonald KM. Can emerging biomarkers of myocardial remodelling identify asymptomatic hypertensive patients at risk for diastolic dysfunction and diastolic heart failure? Eur J Heart Fail 2011; 13:1087-95. [PMID: 21719449 DOI: 10.1093/eurjhf/hfr079] [Citation(s) in RCA: 142] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
AIMS Hypertension is one of the main drivers of the heart failure (HF) epidemic. The aims of this study were to profile fibro-inflammatory biomarkers across stages of the hypertensive heart disease (HHD) spectrum and to examine whether particular biochemical profiles in asymptomatic patients identify a higher risk of evolution to HF. METHODS AND RESULTS This was a cross-sectional observational study involving a population of 275 stable hypertensive patients divided into two different cohorts: Group 1, asymptomatic hypertension (AH) (n= 94); Group 2, HF with preserved ejection fraction (n= 181). Asymptomatic hypertension patients were further subdivided according to left atrial volume index ≥34 mL/m(2) (n= 30) and <34 mL/m(2) (n= 64). Study assays involved inflammatory markers [interleukin 6 (IL6), interleukin 8 (IL8), monocyte chemoattractant protein 1 (MCP1), and tumour necrosis factor α], collagen 1 and 3 metabolic markers [carboxy-terminal propeptide of collagen 1, amino-terminal propeptide of collagen 1, amino-terminal propeptide of collagen 3 (PIIINP), and carboxy-terminal telopeptide of collagen 1 (CITP)], extra-cellular matrix turnover markers [matrix metalloproteinase 2 (MMP2), matrix metalloproteinase 9 (MMP9), and tissue inhibitor of metalloproteinase 1 (TIMP1)], and the brain natriuretic peptide. Data were adjusted for age, sex, systolic blood pressure, and creatinine. Heart failure with preserved ejection fraction was associated with an increased inflammatory signal (IL6, IL8, and MCP1), an increased fibrotic signal (PIIINP and CITP), and an increased matrix turnover signal (MMP2 and MMP9). Alterations in MMP and TIMP enzymes were found to be significant indicators of greater degrees of asymptomatic left ventricular diastolic dysfunction. CONCLUSION These data define varying fibro-inflammatory profiles throughout different stages of HHD. In particular, the observations on MMP9 and TIMP1 raise the possibility of earlier detection of those at risk of evolution to HF which may help focus effective preventative strategies.
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Affiliation(s)
- Patrick Collier
- UCD Conway Institute of Biomolecular and Biomedical Research, University College Dublin, Belfield, Dublin 4, Ireland
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Khoo CW, Krishnamoorthy S, Lim HS, Lip GYH. Assessment of left atrial volume: a focus on echocardiographic methods and clinical implications. Clin Res Cardiol 2010; 100:97-105. [PMID: 20821219 DOI: 10.1007/s00392-010-0222-y] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2010] [Accepted: 08/25/2010] [Indexed: 11/28/2022]
Abstract
Left atrial enlargement is an important predictor of cardiovascular events such as atrial fibrillation, stroke, heart failure and mortality. A number of methods of left atrial size assessment by echocardiography have been reported, from the simple antero-posterior diameter in the parasternal long axis view to the more complex ellipsoid, area-length and Simpson's method of estimating left atrial volume. These different methods of left atrial size assessment, their clinical implications and some common pitfalls are discussed in this review.
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Affiliation(s)
- Chee W Khoo
- City Hospital, University of Birmingham Centre for Cardiovascular Sciences, Birmingham, B18 7QH, UK
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