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Wang W, Mu G, Liu C, Xie J, Zhang H, Zhang X, Che J, Tse G, Liu T, Li G, Fu H. A Novel Three-Dimensional and Tissue Doppler Echocardiographic Index for Diagnosing and Prognosticating Heart Failure With Preserved Ejection Fraction. Front Cardiovasc Med 2022; 9:822314. [PMID: 35224053 PMCID: PMC8866454 DOI: 10.3389/fcvm.2022.822314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 01/18/2022] [Indexed: 11/29/2022] Open
Abstract
Introduction The diagnosis of heart failure with preserved ejection fraction (HFpEF) remains challenging. In this study, a novel echocardiography index based on three-dimensional and tissue Doppler echocardiography for diagnosing and estimating prognosis in HFpEF. Materials and Methods Patients with symptoms and/or signs of heart failure and normal left ventricular ejection fraction (LVEF ≥50%) who underwent right heart catheterization were screened. Patients were divided based on pulmonary capillary wedge pressure (PCWP) of ≥15 mmHg and PCWP <15 mmHg. A diagnosis of HFpEF was confirmed by PCWP of ≥15 mmHg according to ESC guidelines. A novel index was calculated by the ratio between stroke volume standardized to body surface area (SVI) and tissue Doppler mitral annulus systolic peak velocity S' (SVI/S'). Its diagnostic and prognostic values were determined. Results A total of 104 patients (mean age 64 ± 12 years) were included. Of these, 63 had PCWP ≥15 mmHg and 41 patients had PCWP <15 mmHg. Compared to the PCWP <15 mmHg group, the ≥15 mmHg group had a significantly lower SVI/S' (P < 0.001). Logistic regression showed that SVI/S' was associated with high PCWP measured invasively. The SVI/S' had an area under the curve of 0.761 for diagnosing classifying between PCWP ≥15 mmHg and <15 mmHg. Kaplan–Meier analysis showed that the lower SVI/S' group showed a poorer prognosis. Conclusions SVI/S' is a non-invasive index calculated by three-dimensional and tissue Doppler echocardiography. It is a surrogate measure of PCWP and can be used to diagnose and determine prognosis in HFpEF.
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Affiliation(s)
- Weiding Wang
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, The Second Hospital of Tianjin Medical University, Tianjin, China
| | - Guanyu Mu
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, The Second Hospital of Tianjin Medical University, Tianjin, China
| | - Changle Liu
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, The Second Hospital of Tianjin Medical University, Tianjin, China
| | - Juan Xie
- School of Public Health, Tianjin Medical University, Tianjin, China
| | - Hao Zhang
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, The Second Hospital of Tianjin Medical University, Tianjin, China
| | - Xiaowei Zhang
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, The Second Hospital of Tianjin Medical University, Tianjin, China
| | - Jingjin Che
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, The Second Hospital of Tianjin Medical University, Tianjin, China
| | - Gary Tse
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, The Second Hospital of Tianjin Medical University, Tianjin, China
- Faculty of Health and Medical Sciences, University of Surrey, Guildford, United Kingdom
- Kent and Medway Medical School, Canterbury, United Kingdom
| | - Tong Liu
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, The Second Hospital of Tianjin Medical University, Tianjin, China
| | - Guangping Li
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, The Second Hospital of Tianjin Medical University, Tianjin, China
- Guangping Li
| | - Huaying Fu
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, The Second Hospital of Tianjin Medical University, Tianjin, China
- *Correspondence: Huaying Fu
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Slobodan O, Boris D, Bojana S, Jovan M, Zorica M, Aleksandar B, Jadranka T, Sandra P, Sonja S, Ljiljana J, Ljiljana K, Tamara K, Maja N, Vladimir M, Ana K, Nenad Z, Natasa M, Ilija S, Zoran G, Srdjan K, Sasa P, Aleksandar N, Stavros K. Predictive value of heart failure with reduced versus preserved ejection fraction for outcome in pulmonary embolism. ESC Heart Fail 2020; 7:4061-4070. [PMID: 32936530 PMCID: PMC7754916 DOI: 10.1002/ehf2.13015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 08/20/2020] [Accepted: 09/02/2020] [Indexed: 12/24/2022] Open
Abstract
AIMS This study aimed to investigate whether the risk of short-term mortality is different in pulmonary embolism (PE) patients who have heart failure with reduced ejection fraction (HFrEF) as compared with those with heart failure with preserved ejection fraction (HFpEF). METHODS AND RESULTS Predictive value of HFrEF or HFpEF for 7-day (intrahospital) and 30-day all-cause mortality was determined in the cohort of 1055 out of 1201 consecutive acute PE patients from the Serbian multicentre PE registry. Patients were classified into either HFrEF or HFpEF group, according to guideline-proposed criteria. A 7-day (intrahospital) and 30-day all-cause mortality was 18.5% vs. 7.3% vs. 4.5% (P < 0.001) and 22.2% vs. 16.3% vs. 7.9% (P < 0.001) for patients with the history of HFrEF, HFpEF, and without HF, respectively. Multivariable analysis adjusted to age, gender, history of chronic obstructive pulmonary disease, diabetes mellitus, arterial hypertension, presence of atrial fibrillation, and mortality risk assessment at admission has shown that only HFrEF, but not HFpEF, was an independent predictor for 7-day mortality (hazard ratio 2.22, 95% confidence interval 1.25-4,38.41, P = 0.021) and neither HFrEF or HFpEF was an independent predictor for 30-day mortality. Among various admission parameters associated to PE outcome, only systolic pressure in HFrEF patients (P < 0.001), heart rate (P = 0.01), and right ventricle systolic pressure (P = 0.039) in HFpEF patients were significantly different in patients who died compared with those who survived at 7 days. CONCLUSIONS Our study has shown that the presence of previous history of HFrEF, but not HFpEF, in acute PE is an independent risk factor for mortality at 7 days.
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Affiliation(s)
- Obradovic Slobodan
- Clinic of Cardiology and Emergency Internal MedicineMilitary Medical AcademyBelgradeSerbia
- School of MedicineUniversity of DefenseBelgradeSerbia
| | - Dzudovic Boris
- Clinic of Cardiology and Emergency Internal MedicineMilitary Medical AcademyBelgradeSerbia
| | - Subotic Bojana
- Clinic of Cardiology and Emergency Internal MedicineMilitary Medical AcademyBelgradeSerbia
| | - Matijasevic Jovan
- Institute for Pulmonary Diseases of VojvodinaSremska KamenicaSerbia
- School of MedicineUniversity of Novi SadNovi SadSerbia
| | - Mladenovic Zorica
- Clinic of Cardiology and Emergency Internal MedicineMilitary Medical AcademyBelgradeSerbia
- School of MedicineUniversity of DefenseBelgradeSerbia
| | - Bokan Aleksandar
- Institute for Pulmonary Diseases of VojvodinaSremska KamenicaSerbia
| | - Trobok Jadranka
- Institute for Pulmonary Diseases of VojvodinaSremska KamenicaSerbia
| | - Pekovic Sandra
- Institute for Pulmonary Diseases of VojvodinaSremska KamenicaSerbia
| | | | | | - Kos Ljiljana
- Clinic of Cardiology, Clinical Center Banja Luka, School of MedicineUniversity of Banja LukaBanja LukaRepublic of Srpska, Bosnia and Herzegovina
| | - Kovacevic‐Preradovic Tamara
- Clinic of Cardiology, Clinical Center Banja Luka, School of MedicineUniversity of Banja LukaBanja LukaRepublic of Srpska, Bosnia and Herzegovina
| | - Nikolic Maja
- Clinic of Cardiology, Clinical Center Kragujevac, School of MedicineUniversity of KragujevacKragujevacSerbia
| | - Miloradovic Vladimir
- Clinic of Cardiology, Clinical Center Kragujevac, School of MedicineUniversity of KragujevacKragujevacSerbia
| | | | - Zec Nenad
- Department for Internal MedicineGeneral Hospital PancevoPancevoSerbia
| | - Markovic‐Nikolic Natasa
- Clinic of CardiologyUniversity Hospital ZvezdaraBelgradeSerbia
- Faculty of MedicineUniversity of BelgradeBelgradeSerbia
| | - Srdanovic Ilija
- Institute for Cardiovascular Medicine Vojvodina, School of MedicineUniversity of Novi SadNovi SadSerbia
| | - Gluvic Zoran
- Intensive Care Unit, Clinic of Internal MedicineClinical Hospital Center ZemunBelgradeSerbia
| | - Kafedzic Srdjan
- Intensive Care Unit, Clinic of Internal MedicineClinical Hospital Center ZemunBelgradeSerbia
| | - Pancevacki Sasa
- Intensive Care Unit, Clinic of Internal MedicineClinical Hospital Center ZemunBelgradeSerbia
| | - Neskovic Aleksandar
- Faculty of MedicineUniversity of BelgradeBelgradeSerbia
- Department of CardiologyClinical Hospital Center ZemunBelgradeSerbia
| | - Konstantinides Stavros
- Center for Thrombosis and HemostasisJohannes Gutenberg University of MainzMainzGermany
- Department of CardiologyDemocritus University of ThraceKomotiniGreece
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Yu HY, Park YS, Son YJ. Combined effect of left ventricular ejection fraction and post-cardiac depressive symptoms on major adverse cardiac events after successful primary percutaneous coronary intervention: a 12-month follow-up. Eur J Cardiovasc Nurs 2016; 16:37-45. [PMID: 26888962 DOI: 10.1177/1474515116634530] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Despite the technical advancement of percutaneous coronary intervention, major adverse cardiac events after percutaneous coronary intervention are still a critical issue in Korea as well as in western society. Recently, low left ventricular ejection fraction and depressive symptoms have been regarded as independent predictors of adverse outcomes after successful primary percutaneous coronary intervention. However, there are few studies on the combined effect of left ventricular ejection fraction at baseline and post-cardiac depressive symptoms on major adverse cardiac events after percutaneous coronary intervention. AIM The aim of the current study is to examine the combined effect of low left ventricular ejection fraction and post-cardiac depressive symptoms on major adverse cardiac events after successful primary percutaneous coronary intervention. METHODS A total of 221 patients who underwent successful percutaneous coronary intervention were assessed for left ventricular ejection fraction and depressive symptoms at baseline and 1 month after discharge, using the patient health questionnaire 9. Major adverse cardiac event-free survival rates during the 12-month follow-up period were analysed by Kaplan-Meier survival curves and Cox proportional hazard regression methods. RESULTS We found that the combined effect of baseline left ventricular ejection fraction less than 60% and depressive symptoms at 1 month after discharge were significantly correlated with increased incidence of major adverse cardiac events after successful primary percutaneous coronary intervention (hazard ratio 4.049; 95% confidence interval 1.365-12.011) after adjusting for sex, high sensitivity C-reactive protein, depressive symptoms at baseline and comorbidity. CONCLUSIONS Our results suggest that healthcare professionals should be aware of the necessity of early screening for post-cardiac depressive symptoms after discharge in percutaneous coronary intervention patients with a low left ventricular ejection fraction.
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Affiliation(s)
- Hye Yon Yu
- 1 Red Cross College of Nursing, Chung-Ang University, Republic of Korea
| | - Young-Su Park
- 2 College of Nursing, Yonsei University, Republic of Korea
| | - Youn-Jung Son
- 1 Red Cross College of Nursing, Chung-Ang University, Republic of Korea
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Campbell KS, Sorrell VL. Cell- and molecular-level mechanisms contributing to diastolic dysfunction in HFpEF. J Appl Physiol (1985) 2015; 119:1228-32. [PMID: 25911687 DOI: 10.1152/japplphysiol.01168.2014] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Accepted: 04/12/2015] [Indexed: 02/08/2023] Open
Abstract
Heart failure with preserved ejection fraction (HFpEF) is the default diagnosis for patients who have symptoms of heart failure, an ejection fraction >0.5, and evidence of diastolic dysfunction. The clinical condition, which was largely unrecognized 30 years ago, is now a major health problem and currently accounts for 50% of all patients with heart failure. Clinical studies show that patients with HFpEF exhibit increased passive stiffness of the ventricles and a slower rate of pressure decline during diastole. This review discusses some of the cell- and molecular-level mechanisms that contribute to these effects and focuses on data obtained using human samples. Collagen cross linking, modulation of protein kinase G-related pathways, Ca(2+) handling, and strain-dependent detachment of cross bridges are highlighted as potential factors that could be modulated to improve ventricular function in patients with HFpEF.
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Affiliation(s)
- Kenneth S Campbell
- Department of Physiology and Center for Muscle Biology, Linda and Jack Gill Heart Institute, University of Kentucky, Lexington, Kentucky; and
| | - Vincent L Sorrell
- Division of Cardiovascular Medicine, Linda and Jack Gill Heart Institute, University of Kentucky, Lexington, Kentucky
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