1
|
Abraham JD, Shavik SM, Mitchell TR, Lee LC, Ray B, Leonardi CR. Computational investigation of the role of ventricular remodelling in HFpEF: The key to phenotype dissection. Comput Biol Med 2024; 180:109019. [PMID: 39153393 DOI: 10.1016/j.compbiomed.2024.109019] [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: 03/15/2024] [Revised: 07/30/2024] [Accepted: 08/09/2024] [Indexed: 08/19/2024]
Abstract
Recent clinical studies have reported that heart failure with preserved ejection fraction (HFpEF) can be divided into two phenotypes based on the range of ejection fraction (EF), namely HFpEF with higher EF and HFpEF with lower EF. These phenotypes exhibit distinct left ventricle (LV) remodelling patterns and dynamics. However, the influence of LV remodelling on various LV functional indices and the underlying mechanics for these two phenotypes are not well understood. To address these issues, this study employs a coupled finite element analysis (FEA) framework to analyse the impact of various ventricular remodelling patterns, specifically concentric remodelling (CR), concentric hypertrophy (CH), and eccentric hypertrophy (EH), with and without LV wall thickening on LV functional indices. Further, the geometries with a moderate level of remodelling from each pattern are subjected to fibre stiffening and contractile impairment to examine their effect in replicating the different features of HFpEF. The results show that with severe CR, LV could exhibit the characteristics of HFpEF with higher EF, as observed in recent clinical studies. Controlled fibre stiffening can simultaneously increase the end-diastolic pressure (EDP) and reduce the peak longitudinal strain (ell) without significant reduction in EF, facilitating the moderate CR geometries to fit into this phenotype. Similarly, fibre stiffening can assist the CH and 'EH with wall thickening' cases to replicate HFpEF with lower EF. These findings suggest that potential treatment for these two phenotypes should target the bio-origins of their distinct ventricular remodelling patterns and the extent of myocardial stiffening.
Collapse
Affiliation(s)
- Jijo Derick Abraham
- University of Queensland - IIT Delhi Academy of Research (UQIDAR), Indian Institute of Technology Delhi, Hauz Khas, New Delhi, 110016, India; School of Mechanical and Mining Engineering, The University of Queensland, St Lucia, QLD 4072, Australia; Department of Mechanical Engineering, Indian Institute of Technology Delhi, Hauz Khas, New Delhi, 110016, India.
| | - Sheikh Mohammad Shavik
- Department of Mechanical Engineering, Bangladesh University of Engineering and Technology, Dhaka, 1000, Bangladesh
| | - Travis R Mitchell
- School of Mechanical and Mining Engineering, The University of Queensland, St Lucia, QLD 4072, Australia
| | - Lik Chuan Lee
- Department of Mechanical Engineering, Michigan State University, 428 S Shaw Lane, East Lansing, MI, 48824, USA
| | - Bahni Ray
- Department of Mechanical Engineering, Indian Institute of Technology Delhi, Hauz Khas, New Delhi, 110016, India
| | - Christopher R Leonardi
- School of Mechanical and Mining Engineering, The University of Queensland, St Lucia, QLD 4072, Australia
| |
Collapse
|
2
|
Gozdzik A, Marwick TH, Przewlocka-Kosmala M, Jankowska EA, Ponikowski P, Kosmala W. Comparison of left ventricular longitudinal systolic function parameters in the prediction of adverse outcome in heart failure with preserved ejection fraction. ESC Heart Fail 2021; 8:1531-1540. [PMID: 33570238 PMCID: PMC8006621 DOI: 10.1002/ehf2.13247] [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: 11/05/2020] [Revised: 01/10/2021] [Accepted: 01/25/2021] [Indexed: 01/19/2023] Open
Abstract
AIMS Several different diagnostic parameters can be used to assess left ventricular (LV) longitudinal systolic function, but no studies comparing their predictive value have been conducted. We sought to compare the prognostic value of LV long-axis function parameters at rest and exercise using the population with heart failure with preserved ejection fraction (HFpEF). METHODS AND RESULTS Clinical and biochemical variables were collected at baseline in 201 patients with HFpEF. Echocardiography was performed at rest and immediately after exercise, with measurement of mitral annular plane systolic excursion, systolic tissue velocity (s'), global longitudinal strain (GLS), and global longitudinal strain rate (GLSR). Participants were followed for 48 (24-60) months for heart failure hospitalization and cardiovascular death. Seventy-four patients (36.8%) met the study endpoint. Cox regression analysis revealed that after adjustment for Meta-Analysis Global Group in Chronic Heart Failure risk score, brain natriuretic peptide (BNP), and peak VO2 , heart failure hospitalization and cardiovascular death were significantly associated with GLS at rest [hazard ratio (HR) 0.91; 95% confidence interval (CI) 0.84-0.98; P = 0.016], GLS after exercise (HR 0.84; 95% CI 0.77-0.91; P < 0.001), and GLSR after exercise (HR 0.13; 95% CI 0.04-0.48; P = 0.002). The addition of each of the following: exercise GLS and GLSR and resting GLS to the base model including Meta-Analysis Global Group in Chronic Heart Failure, BNP, and peak VO2 improved predictive power for the study endpoint [net reclassification improvement (NRI) = 49%, P < 0.001; NRI = 42%, P = 0.004; and NRI = 38%, P = 0.009, respectively]. Exercise GLS was the only longitudinal parameter significantly improving c-statistics of the base model (0.68 vs. 0.73; P = 0.047). CONCLUSIONS Echocardiographic parameters of LV longitudinal function are not equipotential in predicting adverse outcomes in HFpEF. LV deformation indices, especially assessed with exercise, show the highest predictive utility independent from and incremental to clinical data and BNP.
Collapse
Affiliation(s)
- Anna Gozdzik
- Wroclaw Medical University, Borowska 213, Wroclaw, 50-556, Poland
| | - Thomas H Marwick
- Baker Heart and Diabetes Institute, Melbourne, Australia.,Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Monika Przewlocka-Kosmala
- Wroclaw Medical University, Borowska 213, Wroclaw, 50-556, Poland.,Baker Heart and Diabetes Institute, Melbourne, Australia.,Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Ewa A Jankowska
- Wroclaw Medical University, Borowska 213, Wroclaw, 50-556, Poland
| | - Piotr Ponikowski
- Wroclaw Medical University, Borowska 213, Wroclaw, 50-556, Poland
| | - Wojciech Kosmala
- Wroclaw Medical University, Borowska 213, Wroclaw, 50-556, Poland.,Baker Heart and Diabetes Institute, Melbourne, Australia.,Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| |
Collapse
|
3
|
Valsartan Versus Amlodipine Effect on Left Ventricular Multidirectional Deformation and Adipocytokines Levels in Hypertensive Patients: Speckle Tracking Echocardiography. High Blood Press Cardiovasc Prev 2020; 27:379-388. [PMID: 32705504 DOI: 10.1007/s40292-020-00398-7] [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: 01/14/2020] [Accepted: 06/27/2020] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Structural and functional properties of the left ventricle (LV) wall have been reported to be altered in hypertension, even at early stages of the disease. Abnormal adipokine levels affect blood pressure regulation. Hypo-adiponectinaemia and hyper-leptinaemia were reported in hypertension. AIM To evaluate the effects of valsartan versus amlodipine on LV deformation also, on plasma adiponectin and leptin levels in hypertensive individuals. METHODS LV strain was measured by two-dimensional speckle tracking echocardiography, plasma levels of adiponectin and leptin was determined in 30 healthy individuals served as control group and in 200 hypertensive patients before and after treatment for 6 months with either valsartan 160 mg or amlodipine 10 mg. RESULTS Compared to control group longitudinal strain was significantly affected in hypertensive patients, adiponectin was significantly lower while TNF-α, hs-CRP and leptin levels were significantly higher in hypertensive group. A significant improvement in LV functions, along with a decrease in leptin and increase in adiponectin levels in valsartan group compared to amlodipine group. CONCLUSIONS Our results indicate that valsartan is superior to amlodipine when it comes to affecting the hormonal function of human adipose tissue. Valsartan has a beneficial effect on LV deformation and function presented in GLS.
Collapse
|
4
|
Left Ventricular End-Systolic Volume Is a Reliable Predictor of New-Onset Heart Failure with Preserved Left Ventricular Ejection Fraction. Cardiol Res Pract 2020; 2020:3106012. [PMID: 32670635 PMCID: PMC7341373 DOI: 10.1155/2020/3106012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 05/07/2020] [Accepted: 06/04/2020] [Indexed: 01/15/2023] Open
Abstract
Background Left ventricular (LV) ejection fraction (EF) and LV volumes were reported to have prognostic efficacy in cardiac diseases. In particular, the end-systolic volume index (LVESVI) has been featured as the most reliable prognostic indicator. However, such efficacy in patients with LVEF ≥ 50% has not been elucidated. Methods We screened the patients who received cardiac catheterization to evaluate coronary artery disease concomitantly with both left ventriculography and LV pressure recording using a catheter-tipped micromanometer and finally enrolled 355 patients with LVEF ≥ 50% and no history of heart failure (HF) after exclusion of the patients with severe coronary artery stenosis requiring early revascularization. Cardiovascular death or hospitalization for HF was defined as adverse events. The prognostic value of LVESVI was investigated using a Cox proportional hazards model. Results A univariable analysis demonstrated that age, log BNP level, tau, peak − dP/dt, LVEF, LV end-diastolic volume index (LVEDVI), and LVESVI were associated with adverse events. A correlation analysis revealed that LVESVI was significantly associated with log BNP level (r = 0.356, p < 0.001), +dP/dt (r = −0.324, p < 0.001), −dP/dt (r = 0.391, p < 0.001), and tau (r = 0.337, p < 0.001). Multivariable analysis with a stepwise procedure using the variables with statistical significance in the univariable analysis revealed that aging, an increase in BNP level, and enlargement of LVESVI were significant prognostic indicators (age: HR: 1.071, 95% CI: 1.009–1.137, p=0.024; log BNP : HR : 1.533, 95% CI: 1.090–2.156, p=0.014; LVESVI : HR : 1.051, 95% CI: 1.011–1.093, p=0.013, respectively). According to the receiver-operating characteristic curve analysis for adverse events, log BNP level of 3.23 pg/ml (BNP level: 25.3 pg/ml) and an LVESVI of 24.1 ml/m2 were optimal cutoff values (BNP : AUC : 0.753, p < 0.001, LVESVI : AUC : 0.729, p < 0.001, respectively). Conclusion In patients with LVEF ≥ 50%, an increased LVESVI is related to the adverse events. LV contractile performance even in the range of preserved LVEF should be considered as a role of a prognostic indicator.
Collapse
|
5
|
Kitada S, Kawada Y, Osaga S, Kato M, Kikuchi S, Wakami K, Seo Y, Ohte N. Left ventricular contractile performance and heart failure in patients with left ventricular ejection fraction more than 40. Heart Vessels 2020; 35:1689-1698. [PMID: 32504319 PMCID: PMC7595999 DOI: 10.1007/s00380-020-01641-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Accepted: 05/29/2020] [Indexed: 01/06/2023]
Abstract
Heart failure (HF) with mid-range left ventricular ejection fraction (LVEF) (HFmrEF) is considered a new category of HF and LVEF < 50%, which is the upper threshold of LVEF for HFmrEF, is thought to represent a mild decrease in LV contractile performance. We aimed to consider an LVEF threshold value to be taken as a surrogate for impairment of LV contractile performance, resulting in new-onset HF. We enrolled 398 patients with LVEF ≥ 40% that underwent cardiac catheterization. Using the LV pressure recording with a catheter-tipped micromanometer, we calculated the inertia force of late systolic aortic flow (IFLSAF), which was sensitive to the slight impairment in LV contractile performance. We evaluated the utility of the IFLSAF for predicting future cardiovascular death or hospitalization for HF. We performed a receiver operating characteristic (ROC) curve analysis to determine the best LVEF threshold value for distinguishing whether the LV maintained the IFLSAF. A multivariate Cox proportional-hazards model revealed that the loss of IFLSAF was significantly associated with the future adverse events (HR: 7.798, 95%CI 2.174–27.969, p = 0.002). According to the ROC curve analysis, an LVEF ≥ 58% indicated that the LV could maintain the IFLSAF. We concluded that the loss of IFLSAF, which could reflect even slight impairment in LV contractile performance, was a reliable indicator for new-onset HF in patients with LVEF ≥ 40%. LVEF ≥ 58% could be taken as a surrogate for the IFLSAF maintenance; this threshold could be useful for risk stratification of new-onset HF in patients with preserved LVEF.
Collapse
Affiliation(s)
- Shuichi Kitada
- Department of Cardiology, Nagoya City University, 1 Kawasumi, Mizuho-cho, Mizuho-Ku, Nagoya, Japan.
| | - Yu Kawada
- Department of Cardiology, Nagoya City University, 1 Kawasumi, Mizuho-cho, Mizuho-Ku, Nagoya, Japan
| | - Satoshi Osaga
- Department of Medical Innovation, Nagoya City University, Nagoya, Japan
| | - Marina Kato
- Department of Cardiology, Nagoya City University, 1 Kawasumi, Mizuho-cho, Mizuho-Ku, Nagoya, Japan
| | - Shohei Kikuchi
- Department of Cardiology, Nagoya City University, 1 Kawasumi, Mizuho-cho, Mizuho-Ku, Nagoya, Japan
| | - Kazuaki Wakami
- Department of Cardiology, Nagoya City University, 1 Kawasumi, Mizuho-cho, Mizuho-Ku, Nagoya, Japan
| | - Yoshihiro Seo
- Department of Cardiology, Nagoya City University, 1 Kawasumi, Mizuho-cho, Mizuho-Ku, Nagoya, Japan
| | - Nobuyuki Ohte
- Department of Cardiology, Nagoya City University, 1 Kawasumi, Mizuho-cho, Mizuho-Ku, Nagoya, Japan
| |
Collapse
|
6
|
Wang W, Wang Y, Chen X, Yuan L, Bai H. Evaluation of left ventricular diastolic function based on flow energetic parameters in chronic kidney disease with diastolic dysfunction. Echocardiography 2019; 36:567-576. [PMID: 30677176 DOI: 10.1111/echo.14264] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 12/27/2018] [Accepted: 12/28/2018] [Indexed: 10/27/2022] Open
Affiliation(s)
- Wei Wang
- Department of Cardiac Ultrasound; The Second Hospital of He bei Medical University; Shijiazuhang China
| | - Yueheng Wang
- Department of Cardiac Ultrasound; The Second Hospital of He bei Medical University; Shijiazuhang China
| | - Xiaoxue Chen
- Department of Cardiac Ultrasound; The Second Hospital of He bei Medical University; Shijiazuhang China
| | - Lijun Yuan
- Department of Cardiac Ultrasound; The Second Hospital of He bei Medical University; Shijiazuhang China
| | - Hui Bai
- Department of Cardiac Ultrasound; The Second Hospital of He bei Medical University; Shijiazuhang China
| |
Collapse
|
7
|
Cong Z, Jiang B, Lu J, Cong Y, Fu J, Jin M, Wang X. A potentially new phase of the cardiac cycle: Pre-isovolumic contraction recognized by echocardiography. Medicine (Baltimore) 2018; 97:e10770. [PMID: 29794754 PMCID: PMC6392727 DOI: 10.1097/md.0000000000010770] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Clinically the isovolumic contraction time (IVCT) can be measured by 3 echocardiographic methods of M-mode, pulse-wave Doppler (PWD), and tissue Doppler imaging (TDI). But IVCT can be clinically different by the 3 methods. This study is to investigate whether there is a potentially unidentified phase causing the discrepancies by analyzing electric mechanical delay time (EMD), IVCT, and pre-ejection period (PEP).A total of 30 healthy subjects were recruited for the study. EMD, IVCT, and PEP were obtained by the 3 methods, respectively. MCT (the interval from the onset of the QRS wave to the closure point of the mitral valve measured by TDI) and ICMC (the interval from the onset of IVC wave S1 to the closure point of the mitral valve measured by TDI) were both measured by color TDI.IVCTt (IVCT measured by TDI) was significantly longer than IVCTm or IVCTd (IVCT measured by M-mode or PWD) (both P < .0001), while EMDt (EMD measured by TDI) was significantly shorter than EMDm or EMDd (EMD measured by M-mode or PWD) (both P < .0001). But MCT was not significantly different from EMDm or EMDd (P > .05) and ICMC did not differ significantly from EMDm or EMDd minus EMDt or IVCTt minus IVCTm or IVCTd (P > .05), in other words, ICMC almost equaled to (EMDm or EMDd minus EMDt) or (IVCTt minus IVCTm or IVCTd).There may be an unidentified phase between the end of atrial contraction and the closure of mitral valve causing the discrepancies in IVCT, which is named as the pre-isovolumic contraction phase. It is a non-isovolumic phase and is included in the traditional isovolumic contraction phase.
Collapse
Affiliation(s)
- Zhibin Cong
- Department of Electrodiagnosis, Changchun University of Traditional Chinese Medicine, Changchun
| | - Bin Jiang
- Department of Ultrasonography, The First Hospital of China Medical University, Shengyang
| | - Jianbo Lu
- Department of Electrodiagnosis, Changchun University of Traditional Chinese Medicine, Changchun
| | - Yunyi Cong
- Bethune Medical College, Jilin University, Changchun, China
| | - Jili Fu
- Department of Electrodiagnosis, Changchun University of Traditional Chinese Medicine, Changchun
| | - Mingyue Jin
- Department of Electrodiagnosis, Changchun University of Traditional Chinese Medicine, Changchun
| | - Xue Wang
- Department of Electrodiagnosis, Changchun University of Traditional Chinese Medicine, Changchun
| |
Collapse
|
8
|
Grue JF, Storve S, Dalen H, Salvesen Ø, Mjølstad OC, Samstad SO, Torp H, Haugen BO. Automatic Measurements of Mitral Annular Plane Systolic Excursion and Velocities to Detect Left Ventricular Dysfunction. ULTRASOUND IN MEDICINE & BIOLOGY 2018; 44:168-176. [PMID: 29033095 DOI: 10.1016/j.ultrasmedbio.2017.09.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Revised: 07/21/2017] [Accepted: 09/01/2017] [Indexed: 06/07/2023]
Abstract
The purpose of the study described here was to evaluate an automatic algorithm for detection of left ventricular dysfunction, based on measurements of mitral annular motion indices from color tissue Doppler apical four-chamber recordings. Two hundred twenty-one patients, among whom 49 had systolic and 11 had diastolic dysfunction, were included. Echocardiographic evaluation by cardiologists was the reference. Twenty patients were also examined by medical students. The ability of the indices to detect systolic and diastolic dysfunction were compared in receiver operating characteristic analyses, and the agreement between automatic and reference measurements was evaluated. Mitral annular plane systolic excursion ≤10 mm detected left ventricular dysfunction with 82% specificity, 76% specificity, 56% positive predictive value and 92% negative predictive value. The automatic measurements acquired from expert recordings better agreed better with the reference than those acquired from student recordings. We conclude that automatic measurements of systolic mitral annular motion indices can be helpful in detection of left ventricular dysfunction.
Collapse
Affiliation(s)
- Jahn Frederik Grue
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
| | - Sigurd Storve
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
| | - Håvard Dalen
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, NTNU, Norwegian University of Science and Technology, Trondheim, Norway; Department of Cardiology, St. Olavs hospital, Trondheim University Hospital, Trondheim, Norway; Department of Internal Medicine, Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
| | - Øyvind Salvesen
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
| | - Ole Christian Mjølstad
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, NTNU, Norwegian University of Science and Technology, Trondheim, Norway; Department of Cardiology, St. Olavs hospital, Trondheim University Hospital, Trondheim, Norway
| | - Stein O Samstad
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, NTNU, Norwegian University of Science and Technology, Trondheim, Norway; Department of Cardiology, St. Olavs hospital, Trondheim University Hospital, Trondheim, Norway
| | - Hans Torp
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
| | - Bjørn Olav Haugen
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, NTNU, Norwegian University of Science and Technology, Trondheim, Norway.
| |
Collapse
|
9
|
Kitada S, Kikuchi S, Tsujino T, Masuyama T, Ohte N. The prognostic value of brain natriuretic peptide in patients with heart failure and left ventricular ejection fraction higher than 60%: a sub-analysis of the J-MELODIC study. ESC Heart Fail 2017; 5:36-45. [PMID: 28941144 PMCID: PMC5793961 DOI: 10.1002/ehf2.12206] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Revised: 07/23/2017] [Accepted: 07/26/2017] [Indexed: 12/02/2022] Open
Abstract
Aims Cardiac function varies in the population of patients with heart failure (HF) with preserved left ventricular ejection fraction (LVEF; HFpEF). This study investigated the heterogeneity of clinical features associated with HF and the prognostic value of BNP levels in patients with HFpEF. Methods and results The study enrolled 288 patients with stable HF and serum creatinine <1.5 mg/dL who were part of the original J‐MELODIC study cohort. They were categorized as having HF with reduced LVEF (HFrEF; EF ≤ 40%, n = 83) or as having HFpEF (EF > 40%, n = 205). Patients with HFpEF were further categorized as having relatively low LVEF (HFrlEF; EF 40–60%, n = 107) or as having relatively high LVEF (HFrhEF; EF ≥ 60%, n = 98). We defined cardiovascular death and hospitalization for HF as adverse events and evaluated the prognostic value of the BNP levels in each group. There was no significant difference in event‐free survival between HFpEF and HFrEF patients or between HFrhEF and HFrlEF patients. A multivariate Cox proportional hazards model revealed that the BNP level was an independent predictor of adverse events in HFrEF patients (hazard ratio: 4.088, 95% confidence interval: 1.178–14.179, P = 0.027) and in HFrlEF patients (hazard ratio: 14.888, 95% confidence interval: 4.969–44.608, P < 0.001) but not in HFrhEF patients (P = 0.767). Conclusions The BNP level has prognostic value in HFrlEF but not in HFrhEF. This indicates that HFrhEF and HFrlEF are distinct entities that may require different approaches for the management of HF.
Collapse
Affiliation(s)
- Shuichi Kitada
- Department of Cardio-Renal Medicine and Hypertension, Nagoya City University, Nagoya, Japan
| | - Shohei Kikuchi
- Department of Cardio-Renal Medicine and Hypertension, Nagoya City University, Nagoya, Japan
| | - Takeshi Tsujino
- Department of Pharmacy, School of Pharmacy, Hyogo University of Health Sciences, Kobe, Japan
| | - Tohru Masuyama
- Cardiovascular Division, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan
| | - Nobuyuki Ohte
- Department of Cardio-Renal Medicine and Hypertension, Nagoya City University, Nagoya, Japan
| | | |
Collapse
|
10
|
Hu Y, Jiang S, Lu S, Xu R, Huang Y, Zhao Z, Qu Y. Echocardiography and Electrocardiography Variables Correlate With the New York Heart Association classification: An Observational Study of Ischemic Cardiomyopathy Patients. Medicine (Baltimore) 2017; 96:e7071. [PMID: 28658100 PMCID: PMC5500022 DOI: 10.1097/md.0000000000007071] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
The aim of our study was to determine whether combinations of ultrasound echocardiography (UCG) and electrocardiography (EKG) parameters correlated with the functional status of ischemic cardiomyopathy (ICM) patients according to the New York Heart Association (NYHA) classification system.We assessed 536 elderly Chinese ICM patients according to the NYHA criteria, which included 196 patients with type 2 diabetes mellitus (T2DM). All of the patients underwent UCG. Transmural dispersion of ventricular repolarization was examined using EKG. Cumulative odds logistic regression was performed to evaluate associations between NYHA class and the demographic, clinical, UCG, and EKG variables based on the odds ratio (OR) and 95% confidence interval (CI). A Pearson analysis was also performed to examine correlations between the NYHA classification and the UCG and EKG variables.Based on the NYHA assessment, 140, 147, 138, and 111 patients were identified as class I, II, III and IV, respectively. A comparison of UCG and EKG variables based on T2DM status showed that CO and Tp-e differed significantly between all NYHA classes (P < .05 for all), with values of each increasing with increasing NYHA class regardless of T2DM status. Multivariate logistic regression analysis showed that the disease course (OR: 1.30; 95% CI: 1.20-1.40), heart rate (OR: 1.16; 95% CI: 1.12-1.21), T wave peak to endpoint (Tp-e; OR: 1.22; 95% CI: 1.18-1.27), dispersion of the QT interval (OR: 0.98; 95% CI: 0.95-1.22), left ventricular fractional shortening (OR: 0.82; 95% CI: 0.78-0.87), cardiac output (CO; OR: 5.58; 95% CI: 3.08-10.13) were significantly associated with the NYHA class (P < .0001 for all). A Pearson correlation analysis showed that Tp-e (r = 0.75982, P < .0001), CO (r = 0.56072, P < .0001), and stroke volume (r = -0.14839, P = .0006) significantly correlated with the NYHA class.An index consisting of Tp-e and CO will be useful for corroborating the results of the NYHA assessment of ICM patients.
Collapse
Affiliation(s)
- Ying Hu
- Department of Geriatrics, Xuhui District Central Hospital
| | - Shifeng Jiang
- Department of Geriatrics, Qingpu Branch of Zhongshan Hospital, Fudan University
| | - Siyuan Lu
- Department of Geriatrics, Xuhui District Central Hospital
| | - Rong Xu
- Department of Geriatrics, Xuhui District Central Hospital
| | - Yunping Huang
- Department of Geriatrics, Xuhui District Central Hospital
| | - Zongliang Zhao
- Geriatric Nursing Services, Xuhui District Tianlin Street Community Health Service Center General, Shanghai, China
| | - Yi Qu
- Department of Geriatrics, Xuhui District Central Hospital
| |
Collapse
|
11
|
Speckle tracking echocardiography and tissue Doppler imaging reveal beneficial effect of pharmacotherapy in hypertensives with asymptomatic left ventricular dysfunction. ACTA ACUST UNITED AC 2017; 11:334-342. [DOI: 10.1016/j.jash.2017.03.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Revised: 03/04/2017] [Accepted: 03/29/2017] [Indexed: 12/26/2022]
|
12
|
Todaro MC, Khandheria BK, Longobardo L, Zito C, Cusmà-Piccione M, Di Bella G, Oreto L, Mohammed M, Oreto G, Carerj S. New diagnostic perspectives on heart failure with preserved ejection fraction: systolic function beyond ejection fraction. J Cardiovasc Med (Hagerstown) 2016; 16:527-37. [PMID: 25469729 DOI: 10.2459/jcm.0000000000000199] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Although preserved ejection fraction is found in more than 50% of patients with heart failure, its acceptance as a specific clinical entity is limited. More understanding of the physiopathology, early diagnosis and medical management is needed. With no existing systematic information in the literature, the aim of this review is to provide a comprehensive overview of the new imaging techniques for diagnosing heart failure with preserved ejection fraction, particularly in the early stages of the disease, underlying the pivotal role of new technologies such as two-dimensional speckle tracking echocardiography and vascular stiffness.
Collapse
Affiliation(s)
- Maria Chiara Todaro
- aClinical and Experimental Department of Medicine and Pharmacology, University of Messina, Messina, Italy bAurora Cardiovascular Services, Aurora Sinai/Aurora St. Luke's Medical Centers, University of Wisconsin School of Medicine and Public Health, Milwaukee, Wisconsin, USA
| | | | | | | | | | | | | | | | | | | |
Collapse
|
13
|
Krzesiński P, Stańczyk A, Piotrowicz K, Gielerak G, Uziębło-Zyczkowska B, Skrobowski A. Abdominal obesity and hypertension: a double burden to the heart. Hypertens Res 2016; 39:349-55. [DOI: 10.1038/hr.2015.145] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Revised: 09/02/2015] [Accepted: 11/05/2015] [Indexed: 01/22/2023]
|
14
|
Krzesiński P, Uziębło-Życzkowska B, Gielerak G, Stańczyk A, Kurpaska M, Piotrowicz K. Global longitudinal two-dimensional systolic strain is associated with hemodynamic alterations in arterial hypertension. ACTA ACUST UNITED AC 2015; 9:680-9. [PMID: 26233299 DOI: 10.1016/j.jash.2015.06.014] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Revised: 06/15/2015] [Accepted: 06/22/2015] [Indexed: 11/17/2022]
Abstract
Arterial hypertension can lead to the progressive deterioration of the left ventricular (LV) performance. The aim of this study was to estimate the relation of global longitudinal systolic strain (GLSS) with central and systemic hemodynamics assessed by applanation tonometry and impedance cardiography in 125 hypertensive patients. Those with more impaired GLSS characterized with 1/worse diastolic function (mitral inflow early phase (E) to mitral septal annulus early diastolic velocity (e') ratio, 8.0 vs. 7.0, P = .014); 2/lower LV performance (cardiac index, 3.14 vs. 3.64 l/min/m(2); P = .007), and 3/higher afterload (systemic vascular resistance index, 2506 vs. 2107 dyn s m(2)/cm(5); P = .008). No relevant differences in, that is, gender, age, blood pressure, LV mass index, left chambers dimensions, and central blood pressure characteristics were identified. The results revealed that impaired GLSS is related to LV diastolic dysfunction and altered hemodynamics which may be markers of early systolic LV dysfunction related to arterial hypertension.
Collapse
Affiliation(s)
- Paweł Krzesiński
- Department of Cardiology and Internal Diseases, Military Institute of Medicine, Warsaw, Poland.
| | | | - Grzegorz Gielerak
- Department of Cardiology and Internal Diseases, Military Institute of Medicine, Warsaw, Poland
| | - Adam Stańczyk
- Department of Cardiology and Internal Diseases, Military Institute of Medicine, Warsaw, Poland
| | - Małgorzata Kurpaska
- Department of Cardiology and Internal Diseases, Military Institute of Medicine, Warsaw, Poland
| | - Katarzyna Piotrowicz
- Department of Cardiology and Internal Diseases, Military Institute of Medicine, Warsaw, Poland
| |
Collapse
|
15
|
Ogawa T, Koeda M, Nitta K. Left Ventricular Diastolic Dysfunction in End-Stage Kidney Disease: Pathogenesis, Diagnosis, and Treatment. Ther Apher Dial 2015; 19:427-35. [PMID: 25916171 DOI: 10.1111/1744-9987.12301] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Diastolic dysfunction is frequently observed in end-stage kidney disease (ESKD), and ESKD patients have many risk factors for heart failure (HF), including hypertension, diabetes, and coronary artery disease. Diastolic HF, also called HF with preserved ejection fraction, refers to a clinical syndrome in which patients have symptoms and signs of HF, normal or near normal left ventricular (LV) systolic function, and evidence of diastolic dysfunction manifested by abnormal LV filling and elevated filling pressure. Recent reports suggest that HF with preserved ejection fraction is more common in hemodialysis patients than HF with low ejection fraction. Diastolic HF in ESKD patients is a strong predictor of death. In this article, we review the information available in the literature on the pathogenesis, diagnosis, and potential treatment strategies of diastolic dysfunction or diastolic HF based on evidence obtained in the general population that is potentially applicable to ESKD patients.
Collapse
Affiliation(s)
- Tetsuya Ogawa
- Department of Medicine, Medical Center East and Kidney Center, Tokyo Women's Medical University, Tokyo, Japan
| | - Misato Koeda
- Department of Medicine, Medical Center East and Kidney Center, Tokyo Women's Medical University, Tokyo, Japan
| | - Kosaku Nitta
- Department of Medicine, Medical Center East and Kidney Center, Tokyo Women's Medical University, Tokyo, Japan
| |
Collapse
|
16
|
ZHONG LIANG, WANG YIJIA, HUANG FEIQIONG, GHISTA DHANJOO, TAN RUSAN. DECREASED LEFT VENTRICULAR CONTRACTILITY AND VENTRICULAR-ARTERIAL MATCHING INDEX CORRELATION WITH N-TERMINAL PRO B-TYPE NATRIURETIC PEPTIDE IN HEART FAILURE. J MECH MED BIOL 2015. [DOI: 10.1142/s0219519415400163] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
This study is aimed to assess (1) Left ventricle (LV) contractile function and ventricular-arterial matching from echocardiography; (2) whether ventricular-arterial matching (VAM) is associated with N-terminal pro B-type natriuretic peptide (NT-proBNP), and stroke output in patients with heart failure. Normal subjects (n = 81) and heart failure patients (n = 80) underwent echocardiography, Doppler echocardiography and tissue Doppler imaging. Only heart failure patients underwent blood test for NT-proBNP. The LV contractility was calculated as dσ ⁎ /dt max = 3 × (dV/dt) max /2V m = 3 × V peak × (π × D2/4)/(2V m ), and the arterial elastance was calculated as Ea = SBP × 0.9/ SV , wherein V peak and D are peak velocity and diameter of LV outflow tract, Vm is myocardial volume, SBP is the systolic blood pressure and SV is stroke volume measured from LVOT. The VAM index was expressed as the ratio of LV contractility to arterial elastance (dσ ⁎ /dt max /Ea). We found that HF patients had (i) decreased dσ ⁎ /dt max (1.46 ± 0.73 versus 4.06 ± 1.06 s-1), (ii) increased Ea (2.90 ± 0.87 versus 1.81 ± 0.38 mmHg/mL), and (iii) attenuated ventricular-arterial matching index (0.66 ± 0.57 versus 2.38 ± 0.91 mL/mmHg⋅s) (all p < 0.001) compared with normal subjects. The VAM index was correlated inversely with NT-proBNP (r = -0.32, p < 0.05), but positively with the stroke volume (r = 0.85, p < 0.001). The VAM index of < 1.51 was able to clearly differentiate the failing heart from normal hearts (AUC = 0.959, Sensitivity = 0.911, Specificity = 0.905). Heart failure patients demonstrated impaired ventricular contractility, enhanced arterial stiffening, and attenuated ventricular-arterial matching index. The attenuated ventricular-arterial matching index value was associated with elevated NT-proBNP levels and lower cardiac output.
Collapse
Affiliation(s)
- LIANG ZHONG
- National Heart Centre Singapore, 5 Hospital Drive, Singapore 169609, Singapore
- Duke-NUS Graduate Medical School Singapore, 8 College Road, Singapore 169857, Singapore
| | - YI-JIA WANG
- SIM University, 416 Clementi Road, Singapore 599491, Singapore
| | - FEI-QIONG HUANG
- National Heart Centre Singapore, 5 Hospital Drive, Singapore 169609, Singapore
| | | | - RU-SAN TAN
- National Heart Centre Singapore, 5 Hospital Drive, Singapore 169609, Singapore
- Duke-NUS Graduate Medical School Singapore, 8 College Road, Singapore 169857, Singapore
| |
Collapse
|
17
|
Ueda T, Kawakami R, Nishida T, Onoue K, Soeda T, Okayama S, Takeda Y, Watanabe M, Kawata H, Uemura S, Saito Y. Left Ventricular Ejection Fraction (EF) of 55% as Cutoff for Late Transition From Heart Failure (HF) With Preserved EF to HF With Mildly Reduced EF. Circ J 2015; 79:2209-15. [DOI: 10.1253/circj.cj-15-0425] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Tomoya Ueda
- First Department of Internal Medicine, Nara Medical University
| | - Rika Kawakami
- First Department of Internal Medicine, Nara Medical University
| | - Taku Nishida
- First Department of Internal Medicine, Nara Medical University
| | - Kenji Onoue
- First Department of Internal Medicine, Nara Medical University
| | - Tsunenari Soeda
- First Department of Internal Medicine, Nara Medical University
| | - Satoshi Okayama
- First Department of Internal Medicine, Nara Medical University
| | - Yukiji Takeda
- First Department of Internal Medicine, Nara Medical University
| | - Makoto Watanabe
- First Department of Internal Medicine, Nara Medical University
| | - Hiroyuki Kawata
- First Department of Internal Medicine, Nara Medical University
| | - Shiro Uemura
- First Department of Internal Medicine, Nara Medical University
| | - Yoshihiko Saito
- First Department of Internal Medicine, Nara Medical University
- Department of Regulatory Medicine for Blood Pressure, Nara Medical University
| |
Collapse
|
18
|
Erturk M, Buturak A, Pusuroglu H, Kalkan AK, Gurdogan M, Akturk IF, Akgul O, Aksu HU, Uzun F, Uslu N. Comparison of subclinical left and right ventricular systolic dysfunction in non-dipper and dipper hypertensives: impact of isovolumic acceleration. Clin Exp Hypertens 2014; 36:572-8. [PMID: 24490754 DOI: 10.3109/10641963.2014.881844] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
UNLABELLED Abstract Objectives: To evaluate subclinical left ventricular and right ventricular systolic impairment in dipper and non-dipper hypertensives by using isovolumic acceleration. METHODS About 45 normotensive healthy volunteers (20 men, mean age 43 ± 9 years), 45 dipper (27 men, mean age 45 ± 9 years) and 45 non-dipper (25 men, 47 ± 7 years) hypertensives were enrolled. Isovolumic acceleration was measured by dividing the peak myocardial isovolumic contraction velocity by isovolumic acceleration time. RESULTS Non-dippers indicated lower left ventricular (2.2 ± 0.4 m/s(2) versus 2.8 ± 1.0 m/s(2), p < 0.01) and right ventricular isovolumic acceleration values (2.8 ± 0.8 m/s(2) versus 3.5 ± 1.0 m/s(2), p = 0.012) compared with dippers. Left ventricular mass index (p = 0.001), interventricular septal thickness (p = 0.002) and myocardial performance index (p < 0.001) were negatively correlated with left ventricular isovolumic acceleration. Left ventricular septal thickness (p = 0.002), mass index (p = 0.001) and right ventricular myocardial performance index (p < 0.001) were negatively correlated with right ventricular isovolumic acceleration. CONCLUSION The present study demonstrates that non-dipper hypertensives have increased left and right ventricular subclinical systolic dysfunction compared with dippers. Isovolumic acceleration is the only echocardiographic parameter in predicting this subtle impairment.
Collapse
Affiliation(s)
- Mehmet Erturk
- Department of Cardiology, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital , Istanbul , Turkey
| | | | | | | | | | | | | | | | | | | |
Collapse
|
19
|
Similarities and Differences between the Pathogenesis and Pathophysiology of Diastolic and Systolic Heart Failure. Cardiol Res Pract 2013; 2013:824135. [PMID: 24459600 PMCID: PMC3891535 DOI: 10.1155/2013/824135] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2013] [Revised: 10/08/2013] [Accepted: 10/10/2013] [Indexed: 01/26/2023] Open
Abstract
Pathophysiology of heart failure has been considered to be a damaged state of systolic function of the heart followed by a state of low cardiac output that is, systolic heart failure. Even if systolic function is preserved, left ventricular filling in diastole can be impeded and resulted in elevation of filling pressure and symptoms of heart failure. This kind of heart failure is called diastolic heart failure. Nowadays, diastolic heart failure is referred to as heart failure with preserved ejection fraction (HFpEF), whereas systolic heart failure is referred to as heart failure with reduced ejection fraction (HFrEF). In this paper, the similarities and differences between the pathogenesis and pathophysiology of diastolic and systolic heart failure were reviewed. Although diastolic heart failure is a common condition of heart failure worldwide, its pathophysiology has not been sufficiently elucidated. This is thought to be the most significant reason for a lack of established treatment methods for diastolic heart failure. We hope to proceed with future studies on this topic.
Collapse
|
20
|
Abnormal left ventricular longitudinal function assessed by echocardiographic and tissue Doppler imaging is a powerful predictor of diastolic dysfunction in hypertensive patients: The SPHERE study. Int J Cardiol 2013; 168:3351-8. [DOI: 10.1016/j.ijcard.2013.04.122] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2012] [Revised: 12/13/2012] [Accepted: 04/11/2013] [Indexed: 11/30/2022]
|
21
|
de Knegt MC, Biering-Sorensen T, Sogaard P, Sivertsen J, Jensen JS, Mogelvang R. Concordance and reproducibility between M-mode, tissue Doppler imaging, and two-dimensional strain imaging in the assessment of mitral annular displacement and velocity in patients with various heart conditions. ACTA ACUST UNITED AC 2013; 15:62-9. [DOI: 10.1093/ehjci/jet119] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
22
|
Alagiakrishnan K, Banach M, Jones LG, Datta S, Ahmed A, Aronow WS. Update on diastolic heart failure or heart failure with preserved ejection fraction in the older adults. Ann Med 2013; 45:37-50. [PMID: 22413912 DOI: 10.3109/07853890.2012.660493] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Nearly half of all heart failure (HF) patients have diastolic HF (DHF) or clinical HF with normal or near-normal left ventricular ejection fraction (LVEF). Although the terminology has not been clearly defined, it is increasingly being referred to as HF with preserved ejection fraction (HFPEF). The prevalence of HFPEF increases with age, especially among older women. Identifying HFPEF is important because the etiology, pathogenesis, prognosis, and optimal management may differ from that for systolic HF (SHF) or HF with reduced ejection fraction. The clinical presentation of HF is similar for both SHF and HFPEF. As in SHF, HFPEF is a clinical diagnosis. Once a clinical diagnosis of HF has been made, the presence of HFPEF can be established by confirming a normal or near-normal LVEF, often by an echocardiogram. HFPEF is often associated with a history of hypertension, concentric left ventricular hypertrophy, vascular stiffness, and left ventricular diastolic dysfunction. As in SHF, HFPEF is also associated with poor outcomes. While therapies with angiotensin-converting enzyme inhibitors and beta-blockers improve outcomes in SHF, there is currently no such evidence of their benefits in older HFPEF patients. In this review recent advances in the diagnosis and management of HFPEF in older adults are discussed.
Collapse
Affiliation(s)
- Kannayiram Alagiakrishnan
- Division of Geriatric Medicine, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada T6G 2G3.
| | | | | | | | | | | |
Collapse
|
23
|
Jovin IS, Ebisu K, Liu YH, Finta LA, Oprea AD, Brandt CA, Dziura J, Wackers FJ. Left Ventricular Ejection Fraction and Left Ventricular End-Diastolic Volume in Patients With Diastolic Dysfunction. ACTA ACUST UNITED AC 2012; 19:130-4. [DOI: 10.1111/chf.12013] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2012] [Revised: 10/08/2012] [Accepted: 10/10/2012] [Indexed: 01/19/2023]
Affiliation(s)
- Ion S. Jovin
- Department of Medicine/Cardiovascular Medicine; Yale University School of Medicine; New Haven; CT
| | | | - Yi-Hwa Liu
- Department of Medicine/Cardiovascular Medicine; Yale University School of Medicine; New Haven; CT
| | - Laurie A. Finta
- Department of Medicine/Cardiovascular Medicine; Yale University School of Medicine; New Haven; CT
| | - Adriana D. Oprea
- Department of Medicine/Cardiovascular Medicine; Yale University School of Medicine; New Haven; CT
| | - Cynthia A. Brandt
- General Clinical Research Center; Yale University School of Medicine; New Haven; CT
| | - James Dziura
- General Clinical Research Center; Yale University School of Medicine; New Haven; CT
| | - Frans J. Wackers
- Department of Medicine/Cardiovascular Medicine; Yale University School of Medicine; New Haven; CT
| |
Collapse
|
24
|
Perna ER, Aspromonte N, Cimbaro Canella JP, Di Tano G, Macin SM, Feola M, Coronel ML, Milani L, Parras JI, Milli M, García EH, Valle R. Minor Myocardial Damage is a Prevalent Condition in Patients With Acute Heart Failure Syndromes and Preserved Systolic Function With Long-Term Prognostic Implications. A Report From the CIAST-HF (Collaborative Italo-Argentinean Study on Cardiac Troponin T in Heart Failure) Study. J Card Fail 2012; 18:822-30. [DOI: 10.1016/j.cardfail.2012.10.008] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2012] [Revised: 09/30/2012] [Accepted: 10/02/2012] [Indexed: 11/26/2022]
|
25
|
Dunlay SM, Roger VL, Weston SA, Jiang R, Redfield MM. Longitudinal changes in ejection fraction in heart failure patients with preserved and reduced ejection fraction. Circ Heart Fail 2012; 5:720-6. [PMID: 22936826 DOI: 10.1161/circheartfailure.111.966366] [Citation(s) in RCA: 242] [Impact Index Per Article: 20.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND Heart failure (HF) can occur in patients with preserved (HFpEF, EF≥50%) or reduced (HFrEF, EF<50%) ejection fraction (EF), but changes in EF after HF diagnosis are not well described. METHODS AND RESULTS Among a community cohort of incident HF patients diagnosed from 1984 to 2009 in Olmsted County, Minnesota, we obtained all EFs assessed by echocardiography from initial HF diagnosis until death or last follow-up through March 2010. Mixed effects models fit a unique linear regression line for each person using serial EF data. Compiled results allowed estimates of the change in EF over time in HFpEF and HFrEF. Among 1233 HF patients (48.3% male, mean age 75.0 years, mean follow-up 5.1 years), 559 (45.3%) had HFpEF at diagnosis. In HFpEF, on average, EF decreased by 5.8% over 5 years (P<0.001) with greater declines in older individuals and those with coronary disease. Conversely, EF increased in HFrEF (average increase 6.9% over 5 years, P<0.001). Greater increases were noted in women, younger patients, individuals without coronary disease, and those treated with evidence-based medications. Overall, 39% of HFpEF patients had an EF<50% and 39% of HFrEF patients had an EF≥50% at some point after diagnosis. Decreases in EF over time were associated with reduced survival whereas increases in EF were associated with improved survival. CONCLUSIONS These data suggest that progressive contractile dysfunction may contribute to the pathophysiology of HFpEF. Prospective longitudinal studies are needed to confirm these observations and establish the mechanism and clinical relevance of decline in EF over time in HFpEF.
Collapse
Affiliation(s)
- Shannon M Dunlay
- Division of Cardiovascular Diseases in the Department of Internal Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | | | | | | | | |
Collapse
|
26
|
ElGuindy A, Yacoub MH. Heart failure with preserved ejection fraction. Glob Cardiol Sci Pract 2012; 2012:10. [PMID: 25610841 PMCID: PMC4239812 DOI: 10.5339/gcsp.2012.10] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2012] [Accepted: 05/23/2012] [Indexed: 12/13/2022] Open
Abstract
Heart failure with preserved ejection fraction (HFpEF) has recently emerged as a major cause of cardiovascular morbidity and mortality. Contrary to initial beliefs, HFpEF is now known to be as common as heart failure with reduced ejection fraction (HFrEF) and carries an unacceptably high mortality rate. With a prevalence that has been steadily rising over the past two decades, it is very likely that HFpEF will represent the dominant heart failure phenotype over the coming few years. The scarcity of trials in this semi-discrete form of heart failure and lack of unified enrolment criteria in the studies conducted to date might have contributed to the current absence of specific therapies. Understanding the epidemiological, pathophysiological and molecular differences (and similarities) between these two forms of heart failure is cornerstone to the development of targeted therapies. Carefully designed studies that adhere to unified diagnostic criteria with the recruitment of appropriate controls and adoption of practical end-points are urgently needed to help identify effective treatment strategies.
Collapse
Affiliation(s)
- Ahmed ElGuindy
- Department of Cardiology, Aswan Heart Centre, Aswan, Egypt
| | - Magdi H Yacoub
- Harefield Heart Science Centre, National Heart and Lung Institute, Imperial College London, UK
| |
Collapse
|
27
|
Cioffi G, Senni M, Tarantini L, Faggiano P, Rossi A, Stefenelli C, Russo TE, Alessandro S, Furlanello F, de Simone G. Analysis of circumferential and longitudinal left ventricular systolic function in patients with non-ischemic chronic heart failure and preserved ejection fraction (from the CARRY-IN-HFpEF study). Am J Cardiol 2012; 109:383-9. [PMID: 22112740 DOI: 10.1016/j.amjcard.2011.09.022] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2011] [Revised: 09/14/2011] [Accepted: 09/14/2011] [Indexed: 10/15/2022]
Abstract
Heart failure with preserved left ventricular ejection fraction (HFpEF) is implicitly attributed to diastolic dysfunction, often recognized in elderly patients with hypertension, diabetes, and renal dysfunction. In these patients, left ventricular circumferential and longitudinal shortening is often impaired despite normal ejection fraction. The aim of this prospective study was to analyze circumferential and longitudinal shortening and their relations in patients with nonischemic HFpEF. Stress-corrected midwall shortening (sc-MS) and mitral annular peak systolic velocity (S') were measured in 60 patients (mean age 73 ± 13 years) with chronic nonischemic HFpEF in stable New York Heart Association functional class II or III and compared to the values in 120 healthy controls and 120 patients with hypertension without HFpEF. Sc-MS was classified as low if <89% and S' as low if <8.5 cm/s (the 10th-percentile values of healthy controls). Isolated low sc-MS was detected in 46% of patients with HFpEF, 27% of patients with hypertension, and 2% of controls; isolated low S' was detected in 11% of patients with HFpEF, 7% of patients with hypertension, and 5% of controls; and combined low sc-MS and low S' was detected in 26% of patients with HFpEF, 9% of patients with hypertension, and 5% of controls (HFpEF vs others, all p values <0.001). Thus, any alteration of systolic function was found in 83% of patients with HFpEF. The relation between sc-MS and S' was nonlinear (cubic). Changes in S' within normal values corresponded to negligible variations in sc-MS, whereas the progressive decrease below 8.5 cm/s was associated with substantial decrease in sc-MS. In conclusion, circumferential and/or longitudinal systolic dysfunction is present in most patients with HFpEF. Circumferential shortening normalized by wall stress identifies more patients with concealed left ventricular systolic dysfunction than longitudinal shortening.
Collapse
|
28
|
MacIver DH, Dayer MJ. An alternative approach to understanding the pathophysiological mechanisms of chronic heart failure. Int J Cardiol 2012; 154:102-10. [DOI: 10.1016/j.ijcard.2011.05.075] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2010] [Revised: 03/16/2011] [Accepted: 05/13/2011] [Indexed: 11/29/2022]
|
29
|
Bellsham-Revell HR, Tibby SM, Bell AJ, Miller OI, Razavi R, Greil GF, Simpson JM. Tissue Doppler time intervals and derived indices in hypoplastic left heart syndrome. Eur Heart J Cardiovasc Imaging 2011; 13:400-7. [DOI: 10.1093/ejechocard/jer271] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
30
|
Panovský R, Kukla P, Jančár R, Meluzín J, Jančík J, Kincl V, Poloková K, Mífková L, Havelková A, Látalová R, Dobšák P, Pešl M. The effect of regular physical activity on the left ventricle systolic function in patients with chronic coronary artery disease. Physiol Res 2011; 60:869-75. [PMID: 21995899 DOI: 10.33549/physiolres.932162] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The purpose of this study was to assess the influence of aerobic training on the left ventricular (LV) systolic function. Thirty patients with stable coronary artery disease, who had participated in the conducted 3-month physical training, were retrospectively divided into 2 cohorts. While patients in the cohort I (n=14) had continued training individually for 12 months, patients in the cohort II (n=16) had stopped training after finishing the conducted program. Rest and stress dobutamine/atropine echocardiography was performed in all patients before the training program and 1 year later. The peak systolic velocities of mitral annulus (Sa) were assessed by tissue Doppler imaging for individual LV walls. In addition, to determine global LV systolic longitudinal function, the four-site mean systolic velocity was calculated (Sa glob). According to the blood supply, left ventricular walls were divided into 5 groups: A- walls supplied by nonstenotic artery; B- walls supplied by coronary artery with stenosis ≤50 %; C- walls supplied by coronary artery with stenosis 51-70 %; D- walls with stenosis of supplying artery 71-99 %; and E- walls with totally occluded supplying artery. In global systolic function, the follow-up values of Sa glob in cohort I were improved by 0.23±0.36 as compared with baseline values at rest, and by 1.26±0.65 cm/s at the maximal load, while the values of Sa glob in cohort II were diminished by 0.53±0.22 (p=NS), and by 1.25±0.45 cm/s (p<0.05), respectively. Concerning the resting regional function, the only significant difference between cohorts in follow-up changes was found in walls E: 0.37±0.60 versus -1.76±0.40 cm/s (p<0.05). At the maximal load, the significant difference was found only in walls A (0.16±0.84 versus -2.67±0.87 cm/s; p<0.05). Patients with regular 12-month physical activity improved their global left ventricle systolic function mainly due to improvement of contractility in walls supplied by a totally occluded coronary artery.
Collapse
Affiliation(s)
- R Panovský
- First Department of Internal Medicine/Cardioangiology, International Clinical Research Center-ICRC, St. Anne´s Hospital, Masaryk University, Brno, Czech Republic.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
31
|
Shah SJ. Evolving approaches to the management of heart failure with preserved ejection fraction in patients with coronary artery disease. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2011; 12:58-75. [PMID: 20842482 DOI: 10.1007/s11936-009-0060-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OPINION STATEMENT Coronary artery disease (CAD) is a major cause of heart failure with preserved ejection fraction (HFpEF). In studies of HFpEF, the reported prevalence of CAD varies widely, which may be the result of inconsistent definitions of CAD, geographic and ethnic differences in CAD burden, varying definitions of HFpEF (including different cutoffs for "preserved ejection fraction"), and differences in study design. Despite these limitations, pooled analysis of prospective HFpEF studies demonstrates that CAD is common in HFpEF, with an estimated prevalence of approximately 50%. Based on available data, patients with signs and symptoms of heart failure who have preserved left ventricular ejection fraction and evidence of CAD (HFpEF-CAD) most likely comprise a distinct etiologic and pathophysiologic subset of HFpEF. Therefore, future clinical trials in HFpEF should a priori stratify by CAD or specifically target patients with CAD, strategies that may improve the disappointing track record of therapies tested in HFpEF. The combination of systematic evaluation and management of CAD in HFpEF, along with promising future therapies for HFpEF-CAD, may lead to improved outcomes for this challenging clinical syndrome.
Collapse
Affiliation(s)
- Sanjiv J Shah
- Bluhm Cardiovascular Institute, Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, 676 North St. Clair Street, Suite 600, Chicago, IL, 60611, USA,
| |
Collapse
|
32
|
Meluzín J, Sitar J, Krístek J, Prosecky R, Pesl M, Podrouzková H, Soska V, Panovsky R, Dusek L. The role of exercise echocardiography in the diagnostics of heart failure with normal left ventricular ejection fraction. EUROPEAN JOURNAL OF ECHOCARDIOGRAPHY 2011; 12:591-602. [PMID: 21685198 DOI: 10.1093/ejechocard/jer082] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
AIMS Few data are available on the exercise-induced abnormalities of myocardial function in patients with exertional dyspnoea and normal left ventricular ejection fraction (LV EF). The main aims of this study were to determine the prevalence of isolated exercise-induced heart failure with normal ejection fraction (HFNEF) and to assess whether disturbances in LV or right ventricular longitudinal systolic function are associated with the diagnosis of HFNEF. METHODS AND RESULTS Eighty-four patients with exertional dyspnoea and normal LV EF and 14 healthy controls underwent spirometry, NT-proBNP plasma analysis, and exercise echocardiography. Doppler LV inflow and tissue mitral and tricuspid annular velocities were analysed at rest and immediately after the termination of exercise. Of the 30 patients with the evidence of HFNEF, 6 (20%) patients had only isolated exercise-induced HFNEF. When compared with the remaining patients, those with HFNEF had a significantly lower resting and exercise peak mitral annular systolic velocity (Sa) and the mitral annular velocity during atrial contraction, lower exercise peak mitral annular velocity at early diastole, and lower exercise peak systolic velocity of tricuspid annular motion. The multivariate logistic regression analysis including both parameters standardly defining HFNEF and the new Doppler variables potentially associated with the diagnosis of HFNEF revealed that NT-proBNP, LV mass index, left atrial volume index, and Sa significantly and independently predict the diagnosis of HFNEF. CONCLUSION A significant proportion of patients require exercise to diagnose HFNEF. Sa appears to be a significant independent predictor of HFNEF, which may increase the diagnostic value of models utilizing the variables recommended by the European Society of Cardiology guidelines.
Collapse
Affiliation(s)
- Jaroslav Meluzín
- 1st Department of Internal Medicine/Cardioangiology , ICRC, St Anna Hospital, Masaryk University, Pekařská 53, 65691 Brno, Czech Republic.
| | | | | | | | | | | | | | | | | |
Collapse
|
33
|
Imbalzano E, Zito C, Carerj S, Oreto G, Mandraffino G, Cusmà-Piccione M, Di Bella G, Saitta C, Saitta A. Left Ventricular Function in Hypertension: New Insight by Speckle Tracking Echocardiography. Echocardiography 2011; 28:649-57. [DOI: 10.1111/j.1540-8175.2011.01410.x] [Citation(s) in RCA: 106] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
|
34
|
MacIver DH. A new method for quantification of left ventricular systolic function using a corrected ejection fraction. EUROPEAN JOURNAL OF ECHOCARDIOGRAPHY 2011; 12:228-34. [DOI: 10.1093/ejechocard/jeq185] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
|
35
|
Prasad A, Hastings JL, Shibata S, Popovic ZB, Arbab-Zadeh A, Bhella PS, Okazaki K, Fu Q, Berk M, Palmer D, Greenberg NL, Garcia MJ, Thomas JD, Levine BD. Characterization of static and dynamic left ventricular diastolic function in patients with heart failure with a preserved ejection fraction. Circ Heart Fail 2010; 3:617-26. [PMID: 20682947 DOI: 10.1161/circheartfailure.109.867044] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Congestive heart failure in the setting of a preserved left ventricular (LV) ejection fraction is increasing in prevalence among the senior population. The underlying pathophysiologic abnormalities in ventricular function and structure remain unclear for this disorder. We hypothesized that patients with heart failure with preserved ejection fraction (HFPEF) would have marked abnormalities in LV diastolic function with increased static diastolic stiffness and slowed myocardial relaxation compared with age-matched healthy controls. METHODS AND RESULTS Eleven highly screened patients (4 men, 7 women) aged 73±7 years with HFPEF were recruited to participate in this study. Thirteen sedentary healthy controls (7 men, 6 women) aged 70±4 years also were recruited. All subjects underwent pulmonary artery catheterization with measurement of cardiac output, end-diastolic volumes, and pulmonary capillary wedge pressures at baseline; cardiac unloading (lower-body negative pressure or upright tilt); and cardiac loading (rapid saline infusion). The data were used to define the Frank-Starling and LV end-diastolic pressure-volume relationships. Doppler echocardiographic data (tissue Doppler velocities, isovolumic relaxation time, propagation velocity of early mitral inflow , E/A-wave ratio) were obtained at each level of cardiac preload. Compared with healthy controls, patients with HFPEF had similar LV contractile function and static LV compliance but reduced LV chamber distensibility with elevated filling pressures and slower myocardial relaxation as assessed by tissue Doppler imaging. CONCLUSIONS In this small, highly screened patient population with hemodynamically confirmed HFPEF, increased end-diastolic static ventricular stiffness relative to age-matched controls was not a universal finding. Nevertheless, patients with HFPEF, even when well compensated, had elevated filling pressures, reduced distensibility, and increased diastolic wall stress compared with controls. In contrast, LV relaxation as assessed by tissue Doppler variables appeared consistently impaired in patients with HFPEF.
Collapse
Affiliation(s)
- Anand Prasad
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Dallas, Dallas, Tex 75231, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
36
|
Tissue Doppler Imaging as a Prognostic Marker for Cardiovascular Events in Heart Failure with Preserved Ejection Fraction and Atrial Fibrillation. J Am Soc Echocardiogr 2010; 23:755-61. [DOI: 10.1016/j.echo.2010.05.003] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2009] [Indexed: 11/24/2022]
|
37
|
Helin LM, Tamás É, Nylander E. Preoperative Longitudinal Left Ventricular Function by Tissue Doppler Echocardiography at Rest and During Exercise Is Valuable in Timing of Aortic Valve Surgery in Male Aortic Regurgitation Patients. J Am Soc Echocardiogr 2010; 23:387-95. [DOI: 10.1016/j.echo.2010.01.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2009] [Indexed: 10/19/2022]
|
38
|
MacIver DH. Current controversies in heart failure with a preserved ejection fraction. Future Cardiol 2010; 6:97-111. [DOI: 10.2217/fca.09.56] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Heart failure with a preserved ejection fraction is a fascinating and multifaceted condition that has provoked enormous debate and a wealth of mechanistic studies. Controversies exist with regard to its nomenclature. If its nomenclature is questioned, one can be certain the pathogenesis is ill understood. If the pathogenesis is disputed, the diagnosis becomes difficult and inconsistent. These diagnostic challenges result in inappropriate recruitment to clinical trials. Therefore, the trials may be underpowered and difficult to interpret. This paper examines contemporary theories of heart failure with a preserved ejection fraction, clarifies the controversies and attempts to resolve the divergences of opinion.
Collapse
Affiliation(s)
- David H MacIver
- Consultant cardiologist, Department of Cardiology, Taunton & Somerset Hospital, Musgrove Park, Taunton, TA1 5DA, UK
| |
Collapse
|
39
|
Is remodeling the dominant compensatory mechanism in both chronic heart failure with preserved and reduced left ventricular ejection fraction? Basic Res Cardiol 2009; 105:227-34. [DOI: 10.1007/s00395-009-0063-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2009] [Accepted: 09/16/2009] [Indexed: 10/20/2022]
|
40
|
Evaluación diagnóstica. Rev Clin Esp 2009. [DOI: 10.1016/s0014-2565(09)73251-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
|
41
|
Greco S, Troisi F, Brunetti ND, Di Biase M. Tei index correlates with tissue Doppler parameters and reflects neurohormonal activation in patients with an abnormal transmitral flow pattern. Echocardiography 2009; 26:1012-8. [PMID: 19558518 DOI: 10.1111/j.1540-8175.2009.00920.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Tei index (TI) is a Doppler parameter which reflects combined systolic and diastolic function. We aimed to study the relationship between TI, both traditional and tissue Doppler imaging (TDI) echocardiographic parameters and neurohormonal profile in outpatients with diastolic dysfunction expressed by an abnormal transmitral flow pattern. METHODS AND RESULTS A total of 67 consecutive outpatients with diastolic dysfunction (abnormal transmitral flow pattern) were studied; all patients underwent clinical evaluation, blood sampling for B-type natriuretic peptide (BNP) plasma assaying, echocardiography for the determination of left ventricular ejection fraction (LVEF), dP/dt, left atrium (LA) dimensions, longitudinal systolic (S) and diastolic wall velocities (E'and A'), TI measured with Doppler echocardiography, and mitral regurgitation (MR) quantified on a semicontinuous scale. TI values were significantly correlated with BNP levels (r = 0.33; P < 0.01), LVEF (r =-0.56; P < 0.001), dP/dt (r =-0.52; P < 0.01), S (r =-0.45; P < 0.001), E'(r =-0.36; P < 0.01), A'(r =-0.27; P < 0.05), LA volume (r = 0.35; P < 0.01), and MR (P for trend < 0.05). In a multivariate regression analysis, TI was an independent predictor of increased BNP levels (beta= 0.32; P < 0.05), even after correction for potential confounders. ROC analysis showed as values of TI >0.59 identified subjects with combined systolic and diastolic dysfunction with a sensitivity of 73.8% and a specificity of 71.4%. CONCLUSIONS In outpatients with diastolic dysfunction, TI, an easy to perform parameter for global ventricular performance assessment, might be useful in identifying subjects with concomitant systolic impairment and neurohormonal activation.
Collapse
Affiliation(s)
- Stefania Greco
- Department of Cardiology, University of Foggia, Foggia, Italy
| | | | | | | |
Collapse
|
42
|
Abstract
PURPOSE OF REVIEW A substantial proportion of patients with heart failure have preserved ejection fraction. Though patients with preserved ejection fraction experience a substantial burden of morbidity and mortality, the understanding of heart failure pathophysiology in this group remains incomplete and evidence-based therapeutic options are limited. RECENT FINDINGS The prevalence of heart failure in patients with preserved ejection fraction is increasing and prognosis in this population remains poor despite modern medical therapy. Though diastolic dysfunction is typically present, increasing evidence suggests that extracardiac factors such as renal dysfunction and enhanced central aortic stiffness may play an important role in the development and progression of heart failure symptoms. Results of the first randomized, controlled clinical trials in this population suggest a possible therapeutic role for renin-angiotensin system blockade in reducing heart failure-associated morbidity, but there is still no evidence-supported strategy for reducing mortality in this population. SUMMARY Though the epidemiology and impact of heart failure with preserved ejection fraction are increasingly clear, consensus regarding pathophysiology and the optimal therapeutic approach is still lacking. Pending completion of additional therapeutic trials in this population, treatment remains largely empiric and focused on optimizing myocardial performance in diastole by control of blood pressure, restoration or maintenance of sinus rhythm, and relief of volume overload.
Collapse
|
43
|
Nishikage T, Nakai H, Lang RM, Takeuchi M. Subclinical Left Ventricular Longitudinal Systolic Dysfunction in Hypertension With No Evidence of Heart Failure. Circ J 2008; 72:189-94. [DOI: 10.1253/circj.72.189] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Tomoko Nishikage
- Department of Cardiology and Internal Medicine, Tane General Hospital
| | - Hiromi Nakai
- Department of Cardiology and Internal Medicine, Tane General Hospital
| | - Roberto M Lang
- Cardiac Imaging Center, Department of Medicine and Radiology, University of Chicago
| | - Masaaki Takeuchi
- Department of Cardiology and Internal Medicine, Tane General Hospital
| |
Collapse
|
44
|
El-Menyar AA, Galzerano D, Asaad N, Al-Mulla A, Arafa SEO, Al Suwaidi J. Detection of myocardial dysfunction in the presence of normal ejection fraction. J Cardiovasc Med (Hagerstown) 2007; 8:923-33. [PMID: 17906478 DOI: 10.2459/jcm.0b013e328014daf2] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Detection of subclinical myocardial involvement is of utmost importance in risk stratification and prognosis; the role of ejection fraction in the detection of subclinical disease may be unhelpful. Our aim was to evaluate the methodology and importance of early detection of myocardial involvement in the presence of normal ejection fraction. Most of the pertinent English and non-English articles published from 1980 to 2006 in Medline, Scopus, and EBSCO Host research databases have been reviewed. Serial assessment of systolic function with different techniques should be avoided, since imaging modalities and ejection fraction measurements are not interchangeable. Additional non-invasive tools still are needed for the identification of subclinical left ventricular dysfunction in certain diseases. The recognition of subclinical involvement will prompt initiation of specific therapy to prevent the development of overt left ventricular dysfunction. This also is needed for determining the best timing for intervention in asymptomatic patients with metabolic and valvular disorders.
Collapse
Affiliation(s)
- Ayman A El-Menyar
- Department of Cardiology and Cardiovascular Surgery, Hamad Medical Corporation, Hamad General Hospital, Doha, Qatar.
| | | | | | | | | | | |
Collapse
|
45
|
Ozdogru I, Tanriverdi F, Dogan A, Gungor Kaya M, Tugrul Inanc M, Kalay N, Topsakal R, Unluhizarci K, Atmaca H, Kemal Eryol N, Kelestimur F. Impaired Longitudinal Myocardial Velocities in Patients with Growth Hormone Deficiency Improves After Hormone Replacement Therapy. J Am Soc Echocardiogr 2007; 20:1093-9. [DOI: 10.1016/j.echo.2007.01.035] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2006] [Indexed: 11/30/2022]
|
46
|
Kasner M, Westermann D, Steendijk P, Gaub R, Wilkenshoff U, Weitmann K, Hoffmann W, Poller W, Schultheiss HP, Pauschinger M, Tschöpe C. Utility of Doppler echocardiography and tissue Doppler imaging in the estimation of diastolic function in heart failure with normal ejection fraction: a comparative Doppler-conductance catheterization study. Circulation 2007; 116:637-47. [PMID: 17646587 DOI: 10.1161/circulationaha.106.661983] [Citation(s) in RCA: 446] [Impact Index Per Article: 26.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Various conventional and tissue Doppler echocardiographic indexes were compared with pressure-volume loop analysis to assess their accuracy in detecting left ventricular (LV) diastolic dysfunction in patients with heart failure with normal ejection fraction (HFNEF). METHODS AND RESULTS Diastolic dysfunction was confirmed by pressure-volume loop analysis obtained by conductance catheter in 43 patients (19 men) with HFNEF. Their Doppler indexes were compared with those of 12 control patients without heart failure symptoms and with normal ejection fraction. Invasively measured indexes for diastolic relaxation (tau, dP/dt(min)), LV end-diastolic pressure, and LV end-diastolic pressure-volume relationship (stiffness, b [dP/dV], and stiffness constant, beta) were correlated with several conventional mitral flow and tissue Doppler imaging indexes. Conventional Doppler indexes correlated moderately with the degree of LV relaxation index, tau (E/A: r=-0.36, P=0.013; isovolumic relaxation time: r=0.31, P=0.040) and b (deceleration time: r=0.39, P=0.012) but not with beta, in contrast to the tissue Doppler imaging indexes E'/A'(lateral) (r=-0.37, P=0.008) and E/E'(lateral) (r=0.53, P<0.001). Diastolic dysfunction was detected in 70% of the HFNEF patients by mitral flow Doppler but in 81% and 86% by E'/A'(lateral), and E/E'(lateral), respectively. CONCLUSIONS Of all echocardiographic parameters investigated, the LV filling index E/E'(lateral) was identified as the best index to detect diastolic dysfunction in HFNEF in which the diagnosis of diastolic dysfunction was confirmed by conductance catheter analysis. We recommend its use as an essential tool for noninvasive diagnostics of diastolic function in patients with HFNEF.
Collapse
Affiliation(s)
- Mario Kasner
- Department of Cardiology and Pneumology, Charité-University Medicine Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12200 Berlin, Germany
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
47
|
Ballo P, Quatrini I, Giacomin E, Motto A, Mondillo S. Circumferential Versus Longitudinal Systolic Function in Patients with Hypertension: A Nonlinear Relation. J Am Soc Echocardiogr 2007; 20:298-306. [PMID: 17336758 DOI: 10.1016/j.echo.2006.08.024] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2006] [Indexed: 11/22/2022]
Abstract
BACKGROUND Depressed circumferential midwall performance and impaired left ventricular (LV) longitudinal function are both early markers of LV systolic dysfunction in patients with hypertension. The relation between midwall and longitudinal indices in these patients has never been analyzed. METHODS In 126 patients with hypertension, midwall fractional shortening (mFS), stress-corrected mFS, M-mode left atrioventricular plane displacement, and tissue Doppler-derived peak mitral annular systolic velocity were determined. RESULTS Regression analysis showed that the relations of midwall indices to atrioventricular plane displacement and mitral annular systolic velocity were all nonlinear. Reductions in atrioventricular plane displacement or mitral annular systolic velocity within their higher ranges corresponded to relatively smaller decreases in mFS and stress-corrected mFS. Relative wall thickness was the strongest determinant of the relative efficiency of circumferential and longitudinal LV contraction. CONCLUSION The relation between circumferential midwall and longitudinal function in patients with hypertension is nonlinear and dependent on LV geometry. In these patients, systolic impairment occurs earlier in longitudinal than circumferential performance.
Collapse
Affiliation(s)
- Piercarlo Ballo
- Cardiology Operative Unit, S. Andrea Hospital, La Spezia, Italy.
| | | | | | | | | |
Collapse
|
48
|
Macin SM, Perna ER, Cimbaro Canella JP, Augier N, Riera Stival JL, Cialzeta J, Pitzus AE, Obregon R, Garcia E, Medina F, Badaracco RJ. Increased levels of cardiac troponin-T in outpatients with heart failure and preserved systolic function are related to adverse clinical findings and outcome. Coron Artery Dis 2006; 17:685-91. [PMID: 17119377 DOI: 10.1097/01.mca.0000236287.56435.14] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The implications of increased levels of cardiac troponin T in congestive heart failure with preserved systolic function have been poorly evaluated. We hypothesized that its presence might be related to disease severity and prognosis in this setting. METHODS Clinical, echocardiographic, 6-min walking test and laboratory data were prospectively obtained in 69 congestive heart failure outpatients with ejection fraction > or = 40%. Serial blood samples were assayed for cardiac troponin T with a third-generation immunoassay and values > or = 0.02 ng/ml were considered abnormal. RESULTS Abnormal cardiac troponin T levels in at least one sample were found in 27 patients (39%, group 1). These patients were older (71.7 +/- 11 vs. 63 +/- 12.4 years, P = 0.002); more frequently hospitalized during the previous year (63 vs. 26.2%, P = 0.003), had lower systolic blood pressure (129.3 +/- 19.6 vs. 140.4 +/- 23.5 mmHg, P = 0.04), but had similar proportion of ischemic etiology (55.6 vs. 42.9%, P = 0.21) than those with normal cardiac troponin T (group 2). In groups 1 and 2, the functional class was 2.8 +/- 0.8 and 2.1 +/- 0.9 (P = 0.03), and the distance covered in 6 min was 339 +/- 100 and 386 +/- 103 m (P = 0.05), respectively. In groups 1 and 2, the 18-month congestive heart failure hospitalization-free survival was 22 and 87%, respectively (log-rank test P = 0.0003). In a Cox-proportional hazard model, functional class III-IV (hazard ratio = 5.21, 95% confidence interval: 1.43-18.96) and myocardial injury (hazard ratio = 5.51, confidence interval: 1.58-19.24) were independently associated with prognosis. CONCLUSION Increased levels of cardiac troponin T were detected in one out of three congestive heart failure outpatients with preserved systolic function and correlated with clinical measures of disease severity and poor outcome. These findings suggest a link between ongoing myocardial injury and progressive impairment in congestive heart failure despite preserved systolic function.
Collapse
Affiliation(s)
- Stella M Macin
- Heart Failure Clinic, Instituto de Cardiologia J.F. Cabral, Corrientes, Argentina.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
49
|
Abstract
Translating research into clinical practice has been a challenge throughout medical history. From the present review, it should be clear that this is particularly the case for heart failure. As a consequence, public awareness of this disease has been disillusionedly low, despite its prognosis being worse than that of most cancers and many other chronic diseases. We explore how over the past 150 years since Ludwig and Marey concepts about the evaluation of cardiac performance in patients with heart failure have emerged. From this historical-physiologic perspective, we have seen how 3 increasingly reductionist approaches or schools of thought have evolved in parallel, that is, an input-output approach, a hemodynamic pump approach, and a muscular pump approach. Each one of these has provided complementary insights into the pathophysiology of heart failure and has resulted in measurements or derived indices, some of which still being in use in present-day cardiology. From the third, most reductionist muscular pump approach, we have learned that myocardial and ventricular relaxation properties as well as temporal and spatial nonuniformities have been largely overlooked in the 2 other, input-output and hemodynamic pump, approaches. A key message from the present review is that relaxation and nonuniformities can be fully understood only from within the time-space continuum of cardiac pumping. As cyclicity and rhythm are, in some way, the most basic aspects of cardiac function, considerations of time should dominate over any measurement of cardiac performance as a muscular pump. Any measurement that is blind for the arrow of cardiac time should therefore be interpreted with caution. We have seen how the escape from the time domain-as with the calculation of LV ejection fraction-fascinating though as it may be, has undoubtedly served to hinder a rational scientific debate on the recent, so-called systolic-diastolic heart failure controversy. Lacking appreciation of early relaxation abnormalities and inappropriate degrees of nonuniformities has, indeed, led to some unfortunate misunderstandings about the pathophysiologic time progression of heart failure, in particular, heart failure with compensated hemodynamic pump function (ie, with normal or preserved LV ejection fraction). We have seen that with the introduction of newer powerful diagnostic techniques, as, for example, TDI and MRI, to evaluate ventricular "muscular pump" function, this debate can now be held in a more serene physiologic context. These aspects will be elaborated further in subsequent chapter papers of this symposium. With ongoing stem and other cell-based therapies and future reductionistic insights into cardiac cellular performance, we foresee the emergence of a fourth simple-parallel school of thought viewing the heart as a network of communicating different cell types, that is, cardiomyocytes, endothelial cells, fibroblasts, neurons. In this postgenomic age with the introduction of the rapidly evolving discipline of in vivo molecular imaging techniques, we anticipate that novel measurements of cardiac performance in patients with heart failure will soon become available and complement biopsy and other already available cardiac cellular biomarkers (cardiac troponin I; creatine kinase-MB; myoglobin; BNP). Through the use of these novel biomarkers as a fourth diagnostic track in the evaluation of cardiac performance in patients with heart failure, we will soon be able to increasingly understand the behavior of the heart as a complex biologic system-in other words, how these "low-level" biologic functions and signal transduction pathways at a cellular level contribute to the above "high-level" or system-level approach of cardiac performance at the muscular, the hemodynamic, and the input-output pump system levels and, hopefully, how they could contribute to an early diagnosis of chronic heart failure, in patients.
Collapse
|
50
|
Sanderson JE, Fraser AG. Systolic Dysfunction in Heart Failure with a Normal Ejection Fraction: Echo-Doppler Measurements. Prog Cardiovasc Dis 2006; 49:196-206. [PMID: 17084179 DOI: 10.1016/j.pcad.2006.08.005] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Heart failure with a normal ejection fraction, also called heart failure with preserved ejection fraction or diastolic heart failure, is thought to be characterized by normal systolic function and disturbed diastolic function only. However, studies using newer Doppler-echocardiographic techniques have shown that ventricular function is not normal particularly in the long axis. Ejection is relatively preserved because of increased radial function. Similar findings are seen with normal ageing and the typical precursors of heart failure with a normal ejection fraction such as hypertension, diabetes, and ischemia. There appears to be a spectrum of abnormalities of systolic function from the truly normal to systolic heart failure with heart failure with a normal ejection fraction occupying an intermediate position. The use of ejection fraction, which has a normal distribution, to dichotomize patients with heart failure is not supported on theoretical or experimental grounds, and any cutoff is arbitrary. Patients with heart failure have a mixture of systolic and diastolic abnormalities and variable degrees of remodeling. It is more important to correctly identify these in the individual patient.
Collapse
|