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Lin Y, Zhang L, Hu X, Gao L, Ji M, He Q, Xie M, Li Y. Clinical Usefulness of Speckle-Tracking Echocardiography in Patients with Heart Failure with Preserved Ejection Fraction. Diagnostics (Basel) 2023; 13:2923. [PMID: 37761290 PMCID: PMC10529773 DOI: 10.3390/diagnostics13182923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 08/20/2023] [Accepted: 08/31/2023] [Indexed: 09/29/2023] Open
Abstract
Heart failure with preserved ejection fraction (HFpEF) is defined as HF with left ventricular ejection fraction (LVEF) not less than 50%. HFpEF accounts for more than 50% of all HF patients, and its prevalence is increasing year to year with the aging population, with its prognosis worsening. The clinical assessment of cardiac function and prognosis in patients with HFpEF remains challenging due to the normal range of LVEF and the nonspecific symptoms and signs. In recent years, new echocardiographic techniques have been continuously developed, particularly speckle-tracking echocardiography (STE), which provides a sensitive and accurate method for the comprehensive assessment of cardiac function and prognosis in patients with HFpEF. Therefore, this article reviewed the clinical utility of STE in patients with HFpEF.
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Affiliation(s)
- Yixia Lin
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; (Y.L.); (L.Z.); (X.H.); (L.G.); (M.J.); (Q.H.)
- Clinical Research Center for Medical Imaging in Hubei Province, Wuhan 430022, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Li Zhang
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; (Y.L.); (L.Z.); (X.H.); (L.G.); (M.J.); (Q.H.)
- Clinical Research Center for Medical Imaging in Hubei Province, Wuhan 430022, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Xiaoqing Hu
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; (Y.L.); (L.Z.); (X.H.); (L.G.); (M.J.); (Q.H.)
- Clinical Research Center for Medical Imaging in Hubei Province, Wuhan 430022, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Lang Gao
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; (Y.L.); (L.Z.); (X.H.); (L.G.); (M.J.); (Q.H.)
- Clinical Research Center for Medical Imaging in Hubei Province, Wuhan 430022, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Mengmeng Ji
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; (Y.L.); (L.Z.); (X.H.); (L.G.); (M.J.); (Q.H.)
- Clinical Research Center for Medical Imaging in Hubei Province, Wuhan 430022, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Qing He
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; (Y.L.); (L.Z.); (X.H.); (L.G.); (M.J.); (Q.H.)
- Clinical Research Center for Medical Imaging in Hubei Province, Wuhan 430022, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Mingxing Xie
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; (Y.L.); (L.Z.); (X.H.); (L.G.); (M.J.); (Q.H.)
- Clinical Research Center for Medical Imaging in Hubei Province, Wuhan 430022, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Yuman Li
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; (Y.L.); (L.Z.); (X.H.); (L.G.); (M.J.); (Q.H.)
- Clinical Research Center for Medical Imaging in Hubei Province, Wuhan 430022, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
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Alhadramy O, Alahmadi RA, Alameen AM, Ashmawi NS, Alrehaili NA, Afandi RA, Alrehaili TA, Kassim S. Differentiating Characteristics and Responses to Treatment of New-Onset Heart Failure With Preserved and Reduced Ejection Fraction in Ambulatory Patients. Cardiol Res 2023; 14:201-210. [PMID: 37304918 PMCID: PMC10257507 DOI: 10.14740/cr1483] [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: 02/19/2023] [Accepted: 05/06/2023] [Indexed: 06/13/2023] Open
Abstract
Background Differences in clinical presentation and therapy outcomes between heart failure with preserved ejection fraction (HFpEF) and heart failure with reduced ejection fraction (HFrEF) have been reported but described mainly among hospitalized patients. Because the population of outpatients with heart failure (HF) is increasing, we sought to discriminate the clinical presentation and responses to medical therapy in ambulatory patients with new-onset HFpEF vs. HFrEF. Methods We retrospectively included all patients with new-onset HF treated at a single HF clinic in the past 4 years. Clinical data and electrocardiography (ECG) and echocardiography findings were recorded. Patients were followed up once weekly, and treatment response was evaluated according to symptoms resolution within 30 days. Univariate and multivariate regression analyses were performed. Results A total of 146 patients were diagnosed with new-onset HF: 68 with HFpEF and 78 with HFrEF. The patients with HFrEF were older than those with HFpEF (66.9 vs. 62 years, respectively, P = 0.008). Patients with HFrEF were more likely to have coronary artery disease, atrial fibrillation, or valvular heart disease than those with HFpEF (P < 0.05 for all). Patients with HFrEF rather than HFpEF were more likely to present with New York Heart Association class 3 - 4 dyspnea, orthopnea, paroxysmal nocturnal dyspnea or low cardiac output (P < 0.007 for all). Patients with HFpEF were more likely than those with HFpEF to have normal ECG at presentation (P < 0.001), and left bundle branch block (LBBB) was observed only in patients with HFrEF (P < 0.001). Resolution of symptoms within 30 days occurred in 75% of patients with HFpEF and 40% of patients with HFrEF (P < 0.001). Conclusions Ambulatory patients with new-onset HFrEF were older, and had higher incidence of structural heart disease, in comparison to those with new-onset HFpEF. Patients presenting with HFrEF had more severe functional symptoms than those with HFpEF. Patients with HFpEF were more likely than those with HFpEF to have normal ECG at the time of presentation, and LBBB was strongly associated with HFrEF. Outpatients with HFrEF rather than HFpEF were less likely to respond to treatment.
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Affiliation(s)
- Osama Alhadramy
- Department of Medicine, College of Medicine, Taibah University, Almadinah Almonawarah, Saudi Arabia
| | - Refal A. Alahmadi
- Department of Medicine, College of Medicine, Taibah University, Almadinah Almonawarah, Saudi Arabia
| | - Afrah M. Alameen
- Department of Medicine, College of Medicine, Taibah University, Almadinah Almonawarah, Saudi Arabia
| | - Nada S. Ashmawi
- Department of Medicine, College of Medicine, Taibah University, Almadinah Almonawarah, Saudi Arabia
| | - Nadeen A. Alrehaili
- Department of Medicine, College of Medicine, Taibah University, Almadinah Almonawarah, Saudi Arabia
| | - Rahaf A. Afandi
- Department of Medicine, College of Medicine, Taibah University, Almadinah Almonawarah, Saudi Arabia
| | - Tahani A. Alrehaili
- Department of Medicine, College of Medicine, Taibah University, Almadinah Almonawarah, Saudi Arabia
| | - Saba Kassim
- Department of Preventive Dental Sciences, College of Dentistry, Taibah University, Almadinah Almonawarah, Saudi Arabia
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Lee MP, Glynn RJ, Schneeweiss S, Lin KJ, Patorno E, Barberio J, Levin R, Evers T, Wang SV, Desai RJ. Risk Factors for Heart Failure with Preserved or Reduced Ejection Fraction Among Medicare Beneficiaries: Application of Competing Risks Analysis and Gradient Boosted Model. Clin Epidemiol 2020; 12:607-616. [PMID: 32606986 PMCID: PMC7304674 DOI: 10.2147/clep.s253612] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 05/16/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND The differential impact of various demographic characteristics and comorbid conditions on development of heart failure (HF) with preserved (pEF) and reduced ejection fraction (rEF) is not well studied among the elderly. METHODS Using Medicare claims data linked to electronic health records, we conducted an observational cohort study of individuals ≥65 years of age without HF. A Cox proportional hazards model accounting for competing risk of HFrEF and HFpEF incidence was constructed. A gradient-boosted model (GBM) assessed the relative influence (RI) of each predictor in the development of HFrEF and HFpEF. RESULTS Among 138,388 included individuals, 9701 developed HF (incidence rate = 20.9 per 1000 person-years). Males were more likely to develop HFrEF than HFpEF (HR = 2.07, 95% CI: 1.81-2.37 vs. 1.11, 95% CI: 1.02-1.20, P for heterogeneity <0.01). Atrial fibrillation and pulmonary hypertension had stronger associations with the risk of HFpEF (HR = 2.02, 95% CI: 1.80-2.26 and 1.66, 95% CI: 1.23-2.22) while cardiomyopathy and myocardial infarction were more strongly associated with HFrEF (HR = 4.37, 95% CI: 3.21-5.97 and 1.94, 95% CI: 1.23-3.07). Age was the strongest predictor across all HF subtypes with RI from GBM >35%. Atrial fibrillation was the most influential comorbidity for the development of HFpEF (RI = 8.4%) while cardiomyopathy was the most influential comorbidity for the development of HFrEF (RI = 20.7%). CONCLUSION These findings of heterogeneous relationships between several important risk factors and heart failure types underline the potential differences in the etiology of HFpEF and HFrEF.
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Affiliation(s)
- Moa P Lee
- Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women’s Hospital & Harvard Medical School, Boston, MA, USA
- Department of Epidemiology, University of North Carolina, Chapel Hill, NC, USA
| | - Robert J Glynn
- Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women’s Hospital & Harvard Medical School, Boston, MA, USA
| | - Sebastian Schneeweiss
- Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women’s Hospital & Harvard Medical School, Boston, MA, USA
| | - Kueiyu Joshua Lin
- Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women’s Hospital & Harvard Medical School, Boston, MA, USA
- Department of Medicine, Massachusetts General Hospital & Harvard Medical School, Boston, MA, USA
| | - Elisabetta Patorno
- Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women’s Hospital & Harvard Medical School, Boston, MA, USA
| | - Julie Barberio
- Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women’s Hospital & Harvard Medical School, Boston, MA, USA
| | - Raisa Levin
- Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women’s Hospital & Harvard Medical School, Boston, MA, USA
| | | | - Shirley V Wang
- Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women’s Hospital & Harvard Medical School, Boston, MA, USA
| | - Rishi J Desai
- Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women’s Hospital & Harvard Medical School, Boston, MA, USA
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Zhang Y, Li SY, Xie JJ, Wu Y. Twist/untwist parameters are promising evaluators of myocardial mechanic changes in heart failure patients with preserved ejection fraction. Clin Cardiol 2020; 43:587-593. [PMID: 32212277 PMCID: PMC7298990 DOI: 10.1002/clc.23353] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2019] [Revised: 12/20/2019] [Accepted: 02/19/2020] [Indexed: 12/01/2022] Open
Abstract
Background This study aimed to evaluate the twist/untwist parameters of the left ventricle (LV) in patients with heart failure with preserved ejection fraction (HFpEF) measured by ultrasonic two‐dimensional speckle tracking echocardiography (STE) and to examine the correlations between twist parameters and serum N‐terminal pro b‐type natriuretic peptide (NT‐proBNP) as well as conventional two‐dimensional echocardiography (2DE) indexes. Hypothesis Changes in twist/untwist parameters can be used to evaluate LV function in HFpEF patients. Methods In 63 HFpEF patients and 40 healthy controls, we analyzed LV twist/untwist parameters by STE, cardiac function by 2DE, and serum NT‐proBNP by enzyme‐linked immunosorbent assay (ELISA). The correlations between twist/untwist parameters and 2DE parameters and serum NT‐proBNP were examined by Pearson correlation analysis. Results Left ventricular end diastolic inner diameter and ejection fraction in HFpEF patients were within the normal range, whereas other 2DE parameters including left ventricular posterior wall end diastolic thickness, interventricular septal thickness, left atrial volume index, E, E/A, and E/e' differed significantly between HFpEF patients and control subjects. The twist/untwist parameters such as peak apical rotation (Par), peak untwisting velocity (PUWV), and isovolumic diastole untwisting percentage (Iutw%) were significantly decreased in HFpEF patients compared with control participants. Positive correlations between PUWV/Iutw% and E/A/E/e' and a significant negative correlation between PUWV/Iutw% and left atrial volume index (LAVI) were observed. The plasma NT‐proBNP concentration was positively correlated with LAVI, but negatively correlated with PUWV and Iutw%. Conclusions Changes in twist/untwist parameters correlate well with conventional 2DE parameters and plasma levels of NT‐proBNP, and can be used to evaluate LV function in HFpEF patients. Par is sensitive to the LV myocardial function damage.
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Affiliation(s)
- Yi Zhang
- Department of Ultrasonography, People's Hospital of Hunan Province, Changsha, China
| | - Shen-Yi Li
- Department of Ultrasonography, People's Hospital of Hunan Province, Changsha, China
| | - Juan-Juan Xie
- Department of Ultrasonography, People's Hospital of Hunan Province, Changsha, China
| | - Yuan Wu
- Department of Ultrasonography, People's Hospital of Hunan Province, Changsha, China
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Wallner M, Eaton DM, Berretta RM, Borghetti G, Wu J, Baker ST, Feldsott EA, Sharp TE, Mohsin S, Oyama MA, von Lewinski D, Post H, Wolfson MR, Houser SR. A Feline HFpEF Model with Pulmonary Hypertension and Compromised Pulmonary Function. Sci Rep 2017; 7:16587. [PMID: 29185443 PMCID: PMC5707379 DOI: 10.1038/s41598-017-15851-2] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Accepted: 11/02/2017] [Indexed: 01/08/2023] Open
Abstract
Heart Failure with preserved Ejection Fraction (HFpEF) represents a major public health problem. The causative mechanisms are multifactorial and there are no effective treatments for HFpEF, partially attributable to the lack of well-established HFpEF animal models. We established a feline HFpEF model induced by slow-progressive pressure overload. Male domestic short hair cats (n = 20), underwent either sham procedures (n = 8) or aortic constriction (n = 12) with a customized pre-shaped band. Pulmonary function, gas exchange, and invasive hemodynamics were measured at 4-months post-banding. In banded cats, echocardiography at 4-months revealed concentric left ventricular (LV) hypertrophy, left atrial (LA) enlargement and dysfunction, and LV diastolic dysfunction with preserved systolic function, which subsequently led to elevated LV end-diastolic pressures and pulmonary hypertension. Furthermore, LV diastolic dysfunction was associated with increased LV fibrosis, cardiomyocyte hypertrophy, elevated NT-proBNP plasma levels, fluid and protein loss in pulmonary interstitium, impaired lung expansion, and alveolar-capillary membrane thickening. We report for the first time in HFpEF perivascular fluid cuff formation around extra-alveolar vessels with decreased respiratory compliance. Ultimately, these cardiopulmonary abnormalities resulted in impaired oxygenation. Our findings support the idea that this model can be used for testing novel therapeutic strategies to treat the ever growing HFpEF population.
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Affiliation(s)
- Markus Wallner
- Temple University Lewis Katz School of Medicine, Cardiovascular Research Center, Philadelphia, PA, United States.,Division of Cardiology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Deborah M Eaton
- Temple University Lewis Katz School of Medicine, Cardiovascular Research Center, Philadelphia, PA, United States
| | - Remus M Berretta
- Temple University Lewis Katz School of Medicine, Cardiovascular Research Center, Philadelphia, PA, United States
| | - Giulia Borghetti
- Temple University Lewis Katz School of Medicine, Cardiovascular Research Center, Philadelphia, PA, United States
| | - Jichuan Wu
- Temple University Lewis Katz School of Medicine, Departments of Physiology, Thoracic Medicine and Surgery, Pediatrics, Center for Inflammation, Translational and Clinical Lung Research, CENTRe: Consortium for Environmental and Neonatal Therapeutics Research, Philadelphia, PA, United States
| | - Sandy T Baker
- Temple University Lewis Katz School of Medicine, Departments of Physiology, Thoracic Medicine and Surgery, Pediatrics, Center for Inflammation, Translational and Clinical Lung Research, CENTRe: Consortium for Environmental and Neonatal Therapeutics Research, Philadelphia, PA, United States
| | - Eric A Feldsott
- Temple University Lewis Katz School of Medicine, Cardiovascular Research Center, Philadelphia, PA, United States
| | - Thomas E Sharp
- Temple University Lewis Katz School of Medicine, Cardiovascular Research Center, Philadelphia, PA, United States
| | - Sadia Mohsin
- Temple University Lewis Katz School of Medicine, Cardiovascular Research Center, Philadelphia, PA, United States
| | - Mark A Oyama
- School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA, United States.,Institute for Translational Medicine and Therapeutics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Dirk von Lewinski
- Division of Cardiology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Heiner Post
- Department of Cardiology, Campus Virchow-Klinikum, Charite Universitätsmedizin, Berlin, Germany
| | - Marla R Wolfson
- Temple University Lewis Katz School of Medicine, Departments of Physiology, Thoracic Medicine and Surgery, Pediatrics, Center for Inflammation, Translational and Clinical Lung Research, CENTRe: Consortium for Environmental and Neonatal Therapeutics Research, Philadelphia, PA, United States
| | - Steven R Houser
- Temple University Lewis Katz School of Medicine, Cardiovascular Research Center, Philadelphia, PA, United States.
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Gheorghiu V, Barkley TW. Identification and Prevention of Secondary Heart Failure: A Case Study. Crit Care Nurse 2017; 37:29-35. [PMID: 28765352 DOI: 10.4037/ccn2017478] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
Heart failure, a complex clinical syndrome affecting millions of Americans, is associated with high morbidity and mortality and a significant financial burden on the health care system. Recent health care reform efforts have focused on reducing 30-day heart failure hospital readmissions, increasing the cost-effectiveness of care provided to heart failure patients, and improving health outcomes for these patients. This case report describes an acutely ill patient with multiple comorbidities who was not initially admitted for heart failure but who developed acute decompensated heart failure during his hospital stay. The purpose of this in-depth analysis is to discuss the role of bedside nurses and advanced practice nurses in managing heart failure, describe the challenges of identifying secondary heart failure in patients with complex conditions, and suggest methods of improving health-related outcomes to prevent hospital readmissions.
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Affiliation(s)
- Vlad Gheorghiu
- Vlad Gheorghiu is a graduate student in the Adult-Gerontology Acute Care Nurse Practitioner Program at the School of Nursing at California State University, Los Angeles, California. .,Thomas W. Barkley Jr is coordinator of the Adult-Gerontology Acute Care Nurse Practitioner Program and director of nurse practitioner programs at the School of Nursing at California State University, Los Angeles, California.
| | - Thomas W Barkley
- Vlad Gheorghiu is a graduate student in the Adult-Gerontology Acute Care Nurse Practitioner Program at the School of Nursing at California State University, Los Angeles, California.,Thomas W. Barkley Jr is coordinator of the Adult-Gerontology Acute Care Nurse Practitioner Program and director of nurse practitioner programs at the School of Nursing at California State University, Los Angeles, California
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Tomek J, Bub G. Hypertension-induced remodelling: on the interactions of cardiac risk factors. J Physiol 2017; 595:4027-4036. [PMID: 28217927 PMCID: PMC5471416 DOI: 10.1113/jp273043] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2016] [Accepted: 01/25/2017] [Indexed: 12/19/2022] Open
Abstract
Hypertension induces considerable cardiac remodelling, such as hypertrophy, interstitial fibrosis, and abnormal activity of the cardiac sympathetic nervous system, which are established risk factors in several highly dangerous heart diseases, such as ventricular fibrillation and congestive heart failure. All these risk factors and heart diseases are studied extensively in isolation, but to our knowledge, there is no comprehensive review of their interactions. At the same time, there is growing evidence suggesting that such interactions are numerous and that a successful therapy against a particular condition may have unexpectedly weak effects on mortality, as treated patients may die of a different cause exacerbated by the therapy. In this article, we present a multiscale review of the literature focusing on the relationships between the above‐mentioned risk factors and heart diseases, and introduce a framework that gives insight into their possible interactions. We use this framework to demonstrate that conditions such as fibrosis and elevated activity of the sympathetic nervous system may be compensatory, rather than purely pathological, mechanisms in certain contexts. Finally, we show why the described mechanisms are relevant not only in hypertension, but also in the case of healed myocardial infarction.
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Affiliation(s)
- Jakub Tomek
- Department of Physiology Anatomy and Genetics, University of Oxford, Oxford, UK
| | - Gil Bub
- Department of Physiology, McGill University, Canada
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9
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Xavier SDO, Ferretti-Rebustini REDL, Santana-Santos E, Lucchesi PADO, Hohl KG. [Heart failure as a predictor of functional dependence in hospitalized elderly]. Rev Esc Enferm USP 2015; 49:790-6. [PMID: 26516749 DOI: 10.1590/s0080-623420150000500012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Accepted: 06/10/2015] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE Identify whether Heart Failure (HF) is a predictor of functional dependence for Basic Activities of Daily Living (BADL) in hospitalized elderly. METHODS We investigated medical records and assessed dependence to BADL (by the Katz Index) of 100 elderly admitted to a geriatric ward of a university hospital. In order to verify if HF is a predictor of functional dependence, linear regression analyzes were performed. RESULTS The prevalence of HF was 21%; 95% of them were dependent for BADLs. Bathing was the most committed ADL. HF is a predictor of dependence in hospitalized elderlies, increasing the chance of functional decline by 5 times (95% CI, 0.94-94.48), the chance of functional deterioration by 3.5 times (95% CI, 1.28-11.66; p <0.02) and reducing 0.79 points in the Katz Index score (p <0.05). CONCLUSION HF is a dependency predictor of ADL in hospitalized elderly, who tend to be more dependent, especially for bathing.
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Affiliation(s)
| | | | - Eduesley Santana-Santos
- Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | | | - Karine Generoso Hohl
- Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
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10
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Pandey A, Garg S, Matulevicius SA, Shah AM, Garg J, Drazner MH, Amin A, Berry JD, Marwick TH, Marso SP, de Lemos JA, Kumbhani DJ. Effect of Mineralocorticoid Receptor Antagonists on Cardiac Structure and Function in Patients With Diastolic Dysfunction and Heart Failure With Preserved Ejection Fraction: A Meta-Analysis and Systematic Review. J Am Heart Assoc 2015; 4:e002137. [PMID: 26459931 PMCID: PMC4845109 DOI: 10.1161/jaha.115.002137] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Accepted: 07/28/2015] [Indexed: 01/01/2023]
Abstract
BACKGROUND There has been an increasing interest in use of mineralocorticoid receptor antagonists (MRAs) in patients with heart failure with preserved ejection fraction (HFPEF). However, a comprehensive evaluation of MRA effects on left ventricular (LV) structure and function in these patients is lacking. In this meta-analysis, we evaluated the effects of MRAs on LV structure and function among patients with diastolic dysfunction or HFPEF. METHODS & RESULTS Randomized, controlled clinical trials evaluating the efficacy of MRAs in patients with diastolic dysfunction or HFPEF were included. The primary outcome was change in E/e', a specific measure of diastolic function. Secondary outcomes included changes in other measures of diastolic function, LV structure, surrogate markers for myocardial fibrosis (carboxy-terminal peptide of procollagen type I [PICP] and amino-terminal peptide of pro-collagen type-II [PIIINP]), blood pressure, and exercise tolerance. In the pooled analysis, MRA use was associated with significant reduction in E/e' (weighted mean difference [WMD] [95% confidence interval {CI}]: -1.68 [-2.03 to -1.33]; P<0.0001) and deceleration time (WMD [95% CI]: -12.0 ms [-23.3 to -0.7]; P=0.04) as compared with control, suggesting and improvement in diastolic function. Furthermore, blood pressure and levels of PIIINP and PICP were also significantly reduced with MRA therapy with no significant change in LV mass or dimensions. CONCLUSION MRA therapy in patients with asymptomatic diastolic dysfunction or HFPEF is associated with significant improvement in diastolic function and markers of cardiac fibrosis without a significant change in LV mass or dimensions.
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Affiliation(s)
| | - Sushil Garg
- University of Minnesota Medical CenterMinneapolisMNAustralia
| | | | | | - Jalaj Garg
- New York Medical CenterValhallaNYAustralia
| | | | - Alpesh Amin
- UT Southwestern Medical CenterDallasTXAustralia
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11
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Singh JSS, Lang CC. Angiotensin receptor-neprilysin inhibitors: clinical potential in heart failure and beyond. Vasc Health Risk Manag 2015; 11:283-95. [PMID: 26082640 PMCID: PMC4459540 DOI: 10.2147/vhrm.s55630] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Heart failure remains a major concern across the globe as life expectancies and delivery of health care continue to improve. There has been a dearth of new developments in heart failure therapies in the last decade until last year, with the release of the results from the PARADIGM-HF Trial heralding the arrival of a promising new class of drug, ie, the angiotensin receptor-neprilysin inhibitor. In this review, we discuss the evolution of our incremental understanding of the neurohormonal mechanisms involved in the pathophysiology of heart failure, which has led to our success in modulating its various pathways. We start by examining the renin-angiotensin-aldosterone system, followed by the challenges of modulating the natriuretic peptide system. We then delve deeper into the pharmacology and mechanisms by which angiotensin receptor-neprilysin inhibitors achieve their significant cardiovascular benefits. Finally, we also consider the potential application of this new class of drug in other areas, such as heart failure with preserved ejection fraction, hypertension, patients with renal impairment, and following myocardial infarction.
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Affiliation(s)
- Jagdeep S S Singh
- Division of Cardiovascular and Diabetes Medicine, Ninewells Hospital and Medical School, University of Dundee, Dundee, UK
| | - Chim C Lang
- Division of Cardiovascular and Diabetes Medicine, Ninewells Hospital and Medical School, University of Dundee, Dundee, UK
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12
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Prognostic value of sST2 added to BNP in acute heart failure with preserved or reduced ejection fraction. Clin Res Cardiol 2015; 104:491-9. [PMID: 25586507 DOI: 10.1007/s00392-015-0811-x] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Accepted: 01/08/2015] [Indexed: 01/06/2023]
Abstract
BACKGROUND Natriuretic peptides and suppression of tumorigenicity 2 (ST2) represent two different physiopathological pathways. We evaluated the prognostic accuracy and complementarity of B-type natriuretic peptide (BNP) and soluble ST2 (sST2) plasma levels at discharge from a hospital admission for acute heart failure, both in patients with preserved (HFpEF) and depressed (HFrEF) systolic function. METHODS AND RESULTS We enrolled 195 consecutive patients discharged alive and followed them prospectively for 6 months. The endpoint was all-cause death or hospital readmission for heart failure. Seventy-six patients had HFpEF and 119 had HFrEF, of whom 23 (30.3%) and 43 (36.1%) reached the combined endpoint, respectively. In both HFpEF and HFrEF, having the two biomarkers into account added prognostic information, with the highest risk in patients with both biomarkers above the median in their group (approximately 40% hospitalization-free survival in both groups at 6 months). These associations translated into a significant fourfold increase in risk of the endpoint for one elevated biomarker and sevenfold for both biomarkers elevated in HFrEF, and no association for one elevated biomarker and fivefold increase in risk for both biomarkers elevated in HFpEF. Considering the reclassification of risk added to BNP by measurement of sST2, net reclassification index was 0.31 (p = 0.21) among patients with HFpEF and 0.70 (p < 0.001) among patients with HFrEF. CONCLUSIONS sST2 provides robust prognostic information in acute heart failure with HFrEF, while this pattern was less clear in HFpEF. When sST2 was measured together with BNP, it improved prognostic accuracy in both groups, more clearly in HFrEF.
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Abnousi F, Yock P, Heidenreich P. A call to arms: new approaches to an old heart failure problem. J Card Fail 2014; 20:878-80. [PMID: 25267078 DOI: 10.1016/j.cardfail.2014.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2014] [Revised: 09/10/2014] [Accepted: 09/19/2014] [Indexed: 11/30/2022]
Affiliation(s)
- Freddy Abnousi
- Stanford University, Department of Medicine, Division of Cardiology, Stanford, California
| | - Paul Yock
- Stanford University, Department of Medicine, Division of Cardiology, Stanford, California
| | - Paul Heidenreich
- Stanford University, Department of Medicine, Division of Cardiology, Stanford, California.
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