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Bshiebish HAH, Al-Musawi AH, Khudeir SA. Role of global longitudinal strain in assessment of left ventricular systolic function in patients with heart failure with preserved ejection fraction. J Saudi Heart Assoc 2019; 31:100-105. [PMID: 30766004 PMCID: PMC6360320 DOI: 10.1016/j.jsha.2018.12.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2018] [Revised: 11/16/2018] [Accepted: 12/16/2018] [Indexed: 01/19/2023] Open
Abstract
Objectives To detect systolic dysfunction in heart failure with preserved ejection fraction (HFpEF) patients by using global longitudinal strain (GLS). Methods This study included 46 heart failure patients: 24 with heart failure with reduced ejection fraction (HFrEF) and 22 with heart failure with preserved ejection fraction (HFpEF), and 20 patients with similar risk factor but no symptoms or signs of heart failure, matched for age and sex, as controls. All patients were screened by echocardiography. The ejection fraction of left ventricle was measured using Simpson’s method and the GLS of the left ventricle was measured by using two-dimensional speckle tracking. Results Left ventricular ejection fraction (LVEF) was 61.90 ± 2.94% in the controls, 60.45 ± 7.4% in the HFpEF group (p = 0.421), and 32.75 ± 8.45% in the HFrEF group (p = 0.001). The value of left ventricle (LV) GLS (controls = −19.74 ± 1.12%, HFpEF = −15.03 ± 2.03%, HFrEF = −10.72 ± 1.99%, p = 0.0001) was significantly impaired in the HFpEF group despite normal LVEF. Conclusion There is significant left ventricular systolic impairment detected by GLS despite preserved LVEF.
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de Knegt MC, Biering-Sørensen T, Søgaard P, Sivertsen J, Jensen JS, Møgelvang R. Total average diastolic longitudinal displacement by colour tissue doppler imaging as an assessment of diastolic function. Cardiovasc Ultrasound 2016; 14:41. [PMID: 27639377 PMCID: PMC5027100 DOI: 10.1186/s12947-016-0083-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Accepted: 09/09/2016] [Indexed: 11/15/2022] Open
Abstract
Background The current method for a non-invasive assessment of diastolic dysfunction is complex with the use of algorithms of many different echocardiographic parameters. Total average diastolic longitudinal displacement (LD), determined by colour tissue Doppler imaging (TDI) via the measurement of LD during early diastole and atrial contraction, can potentially be used as a simple and reliable alternative. Methods In 206 patients, using GE Healthcare Vivid E7 and 9 and Echopac BT11 software, we determined both diastolic LD, measured in the septal and lateral walls in the apical 4-chamber view by TDI, and the degree of diastolic dysfunction, based on current guidelines. Of these 206 patients, 157 had cardiac anomalies that could potentially affect diastolic LD such as severe systolic heart failure (n = 45), LV hypertrophy (n = 49), left ventricular (LV) dilation (n = 30), and mitral regurgitation (n = 33). Intra and interobserver variability of diastolic LD measures was tested in 125 patients. Results A linear relationship between total average diastolic LD and the degree of diastolic dysfunction was found. A total average diastolic LD of 10 mm was found to be a consistent threshold for the general discrimination of patients with or without diastolic dysfunction. Using linear regression, total average diastolic LD was estimated to fall by 2.4 mm for every increase in graded severity of diastolic dysfunction (β = −0.61, p-value <0.001). Patients with LV hypertrophy had preserved total average diastolic LD despite being classified as having diastolic dysfunction. Reproducibility of LD measures was acceptable. Conclusions There is strong evidence suggesting that patients with a total average diastolic LD under 10 mm have diastolic dysfunction. Electronic supplementary material The online version of this article (doi:10.1186/s12947-016-0083-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Martina Chantal de Knegt
- Herlev and Gentofte Hospital, Department of Cardiology, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark.
| | - Tor Biering-Sørensen
- Herlev and Gentofte Hospital, Department of Cardiology, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Peter Søgaard
- Department of Cardiology, Centre for Cardiovascular Research, Aalborg University Hospital, Aalborg, Denmark
| | - Jacob Sivertsen
- Herlev and Gentofte Hospital, Department of Cardiology, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jan Skov Jensen
- Herlev and Gentofte Hospital, Department of Cardiology, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Rasmus Møgelvang
- Rigshospitalet, Department of Cardiology, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
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Kasner M, Sinning D, Lober J, Post H, Fraser AG, Pieske B, Burkhoff D, Tschöpe C. Heterogeneous responses of systolic and diastolic left ventricular function to exercise in patients with heart failure and preserved ejection fraction. ESC Heart Fail 2015; 2:121-132. [PMID: 27708854 PMCID: PMC5042029 DOI: 10.1002/ehf2.12049] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2015] [Revised: 06/10/2015] [Accepted: 06/17/2015] [Indexed: 01/08/2023] Open
Abstract
Aims This study aimed to evaluate ventricular diastolic properties using three‐dimensional echocardiography and tissue Doppler imaging at rest and during exercise in heart failure with preserved ejection fraction (HFpEF) patients with borderline evidence of diastolic dysfunction at rest. Methods and results Results obtained from 52 HFpEF patients (left ventricular ejection fraction ≥ 50%) identified on the basis of heart failure symptoms and E/E′ values between 8 and 15 were compared with those obtained in 26 control patients with no evidence of cardiovascular disease. Mitral flow patterns, tissue Doppler imaging, and volume analysis obtained by three‐dimensional echocardiography were performed at rest and during bicycle exercise. Diastolic compliance was indexed by the E/E′ ratio and left ventricular end‐diastolic volume [(E/E′)/EDV]. There were no significant differences in end‐diastolic volume (EDV), stroke volume (SV), or ejection fraction at rest between groups. In 27 of the 52 patients, E/E′ increased during exercise (11.2 ± 3.7 to 16.8 ± 10.5), driven by a failure to augment early diastole (E′). This correlated with a fall in SV and was associated with an increase in the diastolic index (E/E′)/EDV as a measure for LV stiffness (0.122 ± 0.038 to 0.217 ± 0.14/mL), indicating that impaired diastolic reserve (designated PEF‐IDR) contributed to exercise intolerance. Of the 52 patients, 25 showed no changes in E/E′ during exercise associated with a significant rise in SV and cardiac output, still inappropriate compared with controls. Despite disturbed early diastole (E′), a blunted increase in estimated systolic LV elastance indicated that impaired systolic reserve and chronotropic incompetence rather than primarily diastolic disturbances contributed to exercise intolerance in this group (designated PEF). Conclusion Three‐dimensional stress echocardiography may allow non‐invasive analysis of changes in cardiac output that can differentiate HFpEF patients with an inappropriate increase or a fall in SV during exercise. Impaired systolic or diastolic reserve can contribute to these haemodynamic abnormalities, which may arise from different underlying pathophysiologic mechanisms.
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Affiliation(s)
- Mario Kasner
- Department of Cardiology Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin Hindenburgdamm 30 Berlin Germany
| | - David Sinning
- Department of Cardiology Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin Hindenburgdamm 30 Berlin Germany
| | - Jil Lober
- Department of Cardiology Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin Hindenburgdamm 30 Berlin Germany
| | - Heiner Post
- Department of Cardiology Charité-Universitätsmedizin Berlin, Campus Virchow Berlin Germany
| | - Alan G Fraser
- Wales Heart Research Institute, Cardiff University Cardiff UK
| | - Burkert Pieske
- Department of CardiologyCharité-Universitätsmedizin Berlin, Campus VirchowBerlinGermany; Germany Centre for Cardiovascular Research (DZHK)BerlinGermany
| | | | - Carsten Tschöpe
- Department of CardiologyCharité-Universitätsmedizin Berlin, Campus VirchowBerlinGermany; Germany Centre for Cardiovascular Research (DZHK)BerlinGermany; Berlin-Brandenburg Center for Regenerative TherapiesCharité-Universitätsmedizin Berlin, Campus VirchowBerlinGermany
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Alvarez Escudero J, Calvo Vecino JM, Veiras S, García R, González A. Clinical Practice Guideline (CPG). Recommendations on strategy for reducing risk of heart failure patients requiring noncardiac surgery: reducing risk of heart failure patients in noncardiac surgery. ACTA ACUST UNITED AC 2015; 62:359-419. [PMID: 26164471 DOI: 10.1016/j.redar.2015.05.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Accepted: 05/04/2015] [Indexed: 12/29/2022]
Affiliation(s)
- J Alvarez Escudero
- Professor and Head of the Department of Anesthesiology, University Hospital, Santiago de Compostela, La Coruña, Spain
| | - J M Calvo Vecino
- Professor and Head of the Department of Anesthesiology, University Hospital, Santiago de Compostela, La Coruña, Spain; Associated Professor and Head of the Department of Anesthesiology, Infanta Leonor University Hospital, Complutense University of Madrid, Madrid, Spain.
| | - S Veiras
- Department of Anesthesiology, University Hospital, Santiago de Compostela, La Coruña, Spain
| | - R García
- Department of Anesthesiology, Puerta del Mar University Hospital. Cadiz, Spain
| | - A González
- Department of Anesthesiology, Puerta de Hierro University Hospital. Madrid, Spain
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Rienzo M, Bizé A, Pongas D, Michineau S, Melka J, Chan HL, Sambin L, Su JB, Dubois-Randé JL, Hittinger L, Berdeaux A, Ghaleh B. Impaired left ventricular function in the presence of preserved ejection in chronic hypertensive conscious pigs. Basic Res Cardiol 2012; 107:298. [PMID: 22961595 DOI: 10.1007/s00395-012-0298-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2012] [Revised: 07/23/2012] [Accepted: 08/24/2012] [Indexed: 12/28/2022]
Abstract
Systolic function is often evaluated by measuring ejection fraction and its preservation is often assimilated with the lack of impairment of systolic left ventricular (LV) function. Considering the left ventricle as a muscular pump, we explored LV function during chronic hypertension independently of increased afterload conditions. Fourteen conscious and chronically instrumented pigs received continuous infusion of either angiotensin II (n = 8) or saline (n = 6) during 28 days. Hemodynamic recordings were regularly performed in the presence and 1 h after stopping angiotensin II infusion to evaluate intrinsic LV function. Throughout the protocol, the mean arterial pressure steadily increased by 55 ± 4 mmHg in angiotensin II-treated animals. There were no significant changes in stroke volume, LV fractional shortening or LV wall thickening, indicating the lack of alterations in LV ejection. In contrast, we observed maladaptive changes with (1) the lack of reduction in isovolumic contraction and relaxation durations with heart rate increases, (2) abnormally blunted isovolumic contraction and relaxation responses to dobutamine and (3) a linear correlation between isovolumic contraction and relaxation durations. None of these changes were observed in saline-infused animals. In conclusion, we provide evidence of impaired LV function with concomitant isovolumic contraction and relaxation abnormalities during chronic hypertension while ejection remains preserved and no sign of heart failure is present. The evaluation under unloaded conditions shows intrinsic LV abnormalities.
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Affiliation(s)
- Mario Rienzo
- Faculté de Médecine, INSERM Unité U, Créteil, France
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Bernard S, Maurer MS. Heart Failure With a Normal Ejection Fraction: Treatments for a Complex Syndrome? CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2012; 14:305-18. [DOI: 10.1007/s11936-012-0187-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Poh KK, Lee LC, Shen L, Chong E, Tan YL, Chai P, Yeo TC, Wood MJ. Left ventricular fluid dynamics in heart failure: echocardiographic measurement and utilities of vortex formation time. Eur Heart J Cardiovasc Imaging 2011; 13:385-93. [DOI: 10.1093/ejechocard/jer288] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Abstract
The evaluation of ischemic heart disease is the cornerstone of clinical Cardiology. Although there are many means of ischemic evaluation, all are with their own limitations. While perfusion-based studies are highly sensitive, they lack specificity. Conversely, systolic wall motion analysis with echocardiography tends to have high specificity; however, the sensitivity may be limited by short duration of systolic abnormalities when present. With the advent of Doppler echocardiography, and more specifically tissue Doppler imaging, and strain and strain rate imaging, a more comprehensive evaluation of the left ventricular function is available, including diastole. Diastolic abnormalities in the setting of ischemia are now being studied using these new parameters and have been suggested as a reliable marker of ischemia. Exercise-induced abnormalities in diastolic parameters have improved sensitivities and specificities over traditional stress testing and persist longer than systolic abnormalities. A review of the medical literature regarding the subject will be discussed here.
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Affiliation(s)
- Kamran A Shaikh
- Department of Cardiology, Henry Ford Hospital, 2799 West Grand Blvd, Detroit, MI 48236, USA.
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10
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Lam CSP, Liu X, Yang Q, Larson MG, Pencina MJ, Aragam J, Redfield MM, Benjamin EJ, Vasan RS. Familial aggregation of left ventricular geometry and association with parental heart failure: the Framingham Heart Study. ACTA ACUST UNITED AC 2010; 3:492-8. [PMID: 20884845 DOI: 10.1161/circgenetics.110.941088] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Data regarding the familial aggregation of left ventricular (LV) geometry and its relations to parental heart failure (HF) are limited. METHODS AND RESULTS We evaluated concordance of LV geometry within 1093 nuclear families in 5758 participants of the original (parents) (n=2351) and offspring (n=3407) cohorts of the Framingham Heart Study undergoing routine echocardiography in mid- to late adulthood. LV geometry was categorized based on cohort- and sex-specific 80th percentile cutoffs of LV mass and relative wall thickness (RWT) into normal (both <80th percentile), concentric remodeling (LV mass <80th percentile; RWT >80th percentile), concentric hypertrophy (both >80th percentile), and eccentric hypertrophy (LV mass >80th percentile; RWT <80th percentile). Within nuclear families, LV geometry was concordant among related pairs (parent-child, sibling-sibling) (P=0.0015) but not among unrelated spousal pairs (P=0.60), a finding that remained unchanged after adjusting for clinical covariates known to influence LV remodeling (age, systolic blood pressure, body mass index), excluding individuals with prevalent HF and myocardial infarction, and varying the thresholds for defining LV geometry. The prevalence of abnormal LV geometry was higher in family members of affected individuals, with recurrence risks of 1.4 for concentric remodeling (95% CI, 1.2 to 1.7) and eccentric hypertrophy (95% CI, 1.1 to 1.8) and 3.9 (95% CI, 3.2 to 4.6) for concentric hypertrophy. In a subset of 1497 offspring, we observed an association between parental HF (n=458) and eccentric hypertrophy in offspring (P<0.0001). CONCLUSIONS Our investigation of a 2-generational community-based sample demonstrates familial aggregation of LV geometry, with the greatest recurrence risk for concentric LV geometry, and establishes an association between eccentric LV geometry and parental HF.
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Affiliation(s)
- Carolyn S P Lam
- National Heart, Lung, and Blood Institute Framingham Heart Study, 73 Mt Wayte Ave, Framingham, MA 01702, USA
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11
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Donal E, Lund L, Linde C, Daubert JC. Is cardiac resynchronization therapy an option in heart failure patients with preserved ejection fraction? Justification for the ongoing KaRen project. Arch Cardiovasc Dis 2010; 103:404-10. [DOI: 10.1016/j.acvd.2010.01.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2009] [Revised: 01/23/2010] [Accepted: 01/25/2010] [Indexed: 10/19/2022]
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Raschi E, Vasina V, Ursino MG, Boriani G, Martoni A, De Ponti F. Anticancer drugs and cardiotoxicity: Insights and perspectives in the era of targeted therapy. Pharmacol Ther 2010; 125:196-218. [DOI: 10.1016/j.pharmthera.2009.10.002] [Citation(s) in RCA: 99] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2009] [Accepted: 10/05/2009] [Indexed: 01/01/2023]
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13
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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.
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Affiliation(s)
- David H MacIver
- Consultant cardiologist, Department of Cardiology, Taunton & Somerset Hospital, Musgrove Park, Taunton, TA1 5DA, UK
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14
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15
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Brenner S, Störk S, Angermann CE. [Treatment of chronic left ventricular failure]. Internist (Berl) 2009; 50:1325-36. [PMID: 19921109 DOI: 10.1007/s00108-009-2466-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Rising prevalence and disease-related costs render chronic heart failure a rapidly growing socioeconomic challenge. Guideline-adjusted diagnosis and appropriate therapy are successful in improving mortality, morbidity, functional status and quality of life of patients with chronic left ventricular failure. Corresponding state-of-art recommendations were recently published in the updated European and American treatment guidelines. They determine a stepwise escalation of pharmacological and surgical treatment measures according to increasing disease severity. Still, the complexity of the heart failure syndrome demands to tailor diagnostic procedures and therapy to the patients' individual needs and circumstances.
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Affiliation(s)
- S Brenner
- Medizinische Klinik und Poliklinik I, Universität Würzburg, Oberdürrbacher Strasse 6, 97080, Würzburg, Deutschland
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16
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Insuficiencia cardíaca con función sistólica conservada. Definición y epidemiología. Rev Clin Esp 2009. [DOI: 10.1016/s0014-2565(09)73249-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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17
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Najjar SS. Evolving insights into the pathophysiology of heart failure with preserved ejection fraction. CURRENT CARDIOVASCULAR RISK REPORTS 2009. [DOI: 10.1007/s12170-009-0054-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Bench T, Burkhoff D, O'Connell JB, Costanzo MR, Abraham WT, St John Sutton M, Maurer MS. Heart failure with normal ejection fraction: consideration of mechanisms other than diastolic dysfunction. Curr Heart Fail Rep 2009; 6:57-64. [PMID: 19265594 DOI: 10.1007/s11897-009-0010-z] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
More than half of patients with heart failure (HF) have a normal ejection fraction (EF). These patients are typically elderly, are predominantly female, and have a high incidence of multiple comorbid conditions associated with development of ventricular hypertrophy and/or interstitial fibrosis. Thus, the cause of HF has been attributed to diastolic dysfunction. However, the same comorbidities may also impact myocardial systolic, ventricular, vascular, renal, and extracardiovascular properties in ways that can also contribute to symptoms of HF by way of mechanisms not related to diastolic dysfunction. Accordingly, the descriptive term HF with normal EF has been suggested as an alternative to the mechanistic term diastolic HF. In this article, we review the current understanding of nondiastolic mechanisms that may contribute to the HF with normal EF syndrome to highlight potential pathways for research that may lead to new targets for therapy.
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Affiliation(s)
- Travis Bench
- Division of Cardiology, Columbia University, 177 Fort Washington Avenue, New York, NY 10032, USA.
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Liu YW, Tsai WC, Su CT, Lin CC, Chen JH. Evidence of left ventricular systolic dysfunction detected by automated function imaging in patients with heart failure and preserved left ventricular ejection fraction. J Card Fail 2009; 15:782-9. [PMID: 19879465 DOI: 10.1016/j.cardfail.2009.05.006] [Citation(s) in RCA: 79] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2009] [Revised: 05/05/2009] [Accepted: 05/11/2009] [Indexed: 12/19/2022]
Abstract
BACKGROUND Left ventricular ejection fraction (LVEF) cannot reflect cardiac contractile function in patients with heart failure and preserved LVEF (HFPEF). LV systolic impairment is actually debated in HFPEF patients. Automated function imaging (AFI) is a novel algorithm of speckle-tracking echocardiography and efficiently to assess global LV peak systolic longitudinal strain (PSLS), an index for systolic function. The purpose of the study is to examine whether contractile function is impaired in HFPEF patients. METHODS AND RESULTS This study included 49 heart failure patients (23 with systolic dysfunction [SHF] and 26 with HFPEF), and 40 patients, matched for age, sex, as well as concomitant disease and without heart failure as controls. All patients underwent transthoracic echocardiography. LVEF was measured by Simpson's method. Two-dimensional speckle tracking imaging with AFI assessment was applied to measure longitudinal strain. LVEF was 66+/-5% in the controls, 63+/-8% in the HFPEF group (P=.14), and 34+/-10% in the SHF group (P < .001). The value of LV global PSLS (controls: -20%, HFPEF: -14%, SHF: -8%, P < .001) was significantly less negative in both heart failure groups. CONCLUSIONS Deteriorated LV systolic function is demonstrated by decreased global PSLS in HFPEF patients. AFI is an effective and facile method for assessing LV systolic abnormalities.
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Affiliation(s)
- Yen-Wen Liu
- Department of Internal Medicine, National Cheng Kung University Medical Center, Tainan, Taiwan
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Lee DS, Gona P, Vasan RS, Larson MG, Benjamin EJ, Wang TJ, Tu JV, Levy D. Relation of disease pathogenesis and risk factors to heart failure with preserved or reduced ejection fraction: insights from the framingham heart study of the national heart, lung, and blood institute. Circulation 2009; 119:3070-7. [PMID: 19506115 DOI: 10.1161/circulationaha.108.815944] [Citation(s) in RCA: 543] [Impact Index Per Article: 36.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND The contributions of risk factors and disease pathogenesis to heart failure with preserved ejection fraction (HFPEF) versus heart failure with reduced ejection fraction (HFREF) have not been fully explored. METHODS AND RESULTS We examined clinical characteristics and risk factors at time of heart failure onset and long-term survival in Framingham Heart Study participants according to left ventricular ejection fraction < or =45% (n=314; 59%) versus >45% (n=220; 41%) and hierarchical causal classification. Heart failure was attributed to coronary heart disease in 278 participants (52%), valvular heart disease in 42 (8%), hypertension in 140 (26%), or other/unknown causes in 74 (14%). Multivariable predictors of HFPEF (versus HFREF) included elevated systolic blood pressure (odds ratio [OR]=1.13 per 10 mm Hg; 95% confidence interval [CI], 1.04 to 1.22), atrial fibrillation (OR=4.23; 95% CI, 2.38 to 7.52), and female sex (OR=2.29; 95% CI, 1.35 to 3.90). Conversely, prior myocardial infarction (OR=0.32; 95% CI, 0.19 to 0.53) and left bundle-branch block QRS morphology (OR=0.21; 95% CI, 0.10 to 0.46) reduced the odds of HFPEF. Long-term prognosis was grim, with a median survival of 2.1 years (5-year mortality rate, 74%), and was equally poor in men and women with HFREF or HFPEF. CONCLUSIONS Among community patients with new-onset heart failure, there are differences in causes and time-of-onset clinical characteristics between those with HFPEF versus HFREF. In people with HFREF, mortality is increased when coronary heart disease is the underlying cause. These findings suggest that heart failure with reduced left ventricular systolic function and heart failure with preserved left ventricular systolic function are partially distinct entities, with potentially different approaches to early detection and prevention.
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Affiliation(s)
- Douglas S Lee
- Director, Framingham Heart Study, 73 Mt Wayte Ave, Suite 2, Framingham, MA 01702-5827, USA
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He KL, Burkhoff D, Leng WX, Liang ZR, Fan L, Wang J, Maurer MS. Comparison of ventricular structure and function in Chinese patients with heart failure and ejection fractions >55% versus 40% to 55% versus <40%. Am J Cardiol 2009; 103:845-51. [PMID: 19268743 DOI: 10.1016/j.amjcard.2008.11.050] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2008] [Revised: 11/13/2008] [Accepted: 11/13/2008] [Indexed: 01/20/2023]
Abstract
Subjects with heart failure (HF) and a preserved ejection fraction (EF) are heterogenous and the EF used to define this syndrome varies considerably among studies. We sought to determine if physiologic differences exist between subjects with a normal EF (>55%) or mildly decreased EF (40% to 55%). 357 consecutive Chinese patients who were healthy (n = 93) or had HF (n = 264) underwent comprehensive echocardiography, Doppler analysis, and measurement of neurohormones. Subjects with HF were stratified by EF into those with normal EF (>55%, n = 128), mildly decreased EF (40% to 55%, n = 38), or moderate to severely decreased EF (<40%, n = 100). Employing noninvasive pressure-volume analysis, estimated end-systolic and end-diastolic pressure-volume relations were calculated. Subjects with HF and an EF 40% to 55% more often had a previous myocardial infarction and diabetes than those with HF and an EF >55%. Physiologically, the cohort with a mildly decreased EF had eccentrically enlarged ventricles with evidence of remodeling (rightward shifted end-diastolic pressure-volume relation) and decreased chamber contractility (downward shifted end-systolic pressure-volume relation) most comparable to subjects with overt systolic HF. In conclusion, in subjects with HF and a preserved EF, there are distinct physiologic differences between those with a normal (>55%) and a mildly decreased (40% to 55%) EF.
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Borg AN, Ray SG. A unifying framework for understanding heart failure? Response to "Left Ventricular Torsion By Two-Dimensional Speckle Tracking Echocardiography in Patients With Diastolic Dysfunction and Normal Ejection Fraction" by Park SJ et al. J Am Soc Echocardiogr 2009; 22:318-20; author reply 321-2. [PMID: 19131209 DOI: 10.1016/j.echo.2008.11.026] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2008] [Indexed: 11/25/2022]
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Seymour EM, Singer AAM, Bennink MR, Parikh RV, Kirakosyan A, Kaufman PB, Bolling SF. Chronic intake of a phytochemical-enriched diet reduces cardiac fibrosis and diastolic dysfunction caused by prolonged salt-sensitive hypertension. J Gerontol A Biol Sci Med Sci 2008; 63:1034-42. [PMID: 18948553 DOI: 10.1093/gerona/63.10.1034] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Salt-sensitive hypertension is common in the aged population. Increased fruit and vegetable intake reduces hypertension, but its effect on eventual diastolic dysfunction is unknown. This relationship is tested in the Dahl Salt-Sensitive (Dahl-SS) rat model of salt-sensitive hypertension and diastolic dysfunction. Table grape powder contains phytochemicals that are relevant to human diets. For 18 weeks, male Dahl-SS rats were fed one of five diets: low salt (LS), a low salt + grape powder (LSG), high salt (HS), a high salt + grape powder (HSG), or high salt + vasodilator hydralazine (HSH). Compared to the HS diet, the HSG diet lowered blood pressure and improved cardiac function; reduced systemic inflammation; reduced cardiac hypertrophy, fibrosis, and oxidative damage; and increased cardiac glutathione. The HSH diet similarly reduced blood pressure but did not reduce cardiac pathogenesis. The LSG diet reduced cardiac oxidative damage and increased cardiac glutathione. In conclusion, physiologically relevant phytochemical intake reduced salt-sensitive hypertension and diastolic dysfunction.
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Affiliation(s)
- E M Seymour
- Department of Food Science and Human Nutrition, Michigan State University, East Lansing, MI, USA
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Guía de práctica clínica de la Sociedad Europea de Cardiología (ESC) para el diagnóstico y tratamiento de la insuficiencia cardiaca aguda y crónica (2008). Rev Esp Cardiol 2008. [DOI: 10.1016/s0300-8932(08)75740-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Dickstein K, Cohen-Solal A, Filippatos G, McMurray JJV, Ponikowski P, Poole-Wilson PA, Strömberg A, van Veldhuisen DJ, Atar D, Hoes AW, Keren A, Mebazaa A, Nieminen M, Priori SG, Swedberg K, Vahanian A, Camm J, De Caterina R, Dean V, Dickstein K, Filippatos G, Funck-Brentano C, Hellemans I, Kristensen SD, McGregor K, Sechtem U, Silber S, Tendera M, Widimsky P, Zamorano JL, Tendera M, Auricchio A, Bax J, Bohm M, Corra U, della Bella P, Elliott PM, Follath F, Gheorghiade M, Hasin Y, Hernborg A, Jaarsma T, Komajda M, Kornowski R, Piepoli M, Prendergast B, Tavazzi L, Vachiery JL, Verheugt FWA, Zamorano JL, Zannad F. ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2008: the Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2008 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association of the ESC (HFA) and endorsed by the European Society of Intensive Care Medicine (ESICM). Eur Heart J 2008; 29:2388-442. [PMID: 18799522 DOI: 10.1093/eurheartj/ehn309] [Citation(s) in RCA: 1956] [Impact Index Per Article: 122.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Affiliation(s)
- Kenneth Dickstein
- University of Bergen, Cardiology Division, Stavanger University Hospital, Norway.
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ESC guidelines for the diagnosis and treatment of acute and chronic heart failure 2008: the Task Force for the diagnosis and treatment of acute and chronic heart failure 2008 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association of the ESC (HFA) and endorsed by the European Society of Intensive Care Medicine (ESICM). Eur J Heart Fail 2008; 10:933-89. [PMID: 18826876 DOI: 10.1016/j.ejheart.2008.08.005] [Citation(s) in RCA: 1328] [Impact Index Per Article: 83.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Abstract
Approximately 5 million people in the United States have heart failure. Epidemiologic studies have demonstrated that at least one half of patients who have clinically overt heart failure have diastolic heart failure (DHF), or heart failure with preserved ejection fraction. DHF is characterized by concentric remodeling with normal left ventricular end-diastolic volume, abnormalities of active relaxation, and increased passive ventricular stiffness. Diuretics are an essential component of therapy for most patients who have DHF, and treatment of hypertension is a cornerstone of therapy designed to prevent or to treat DHF. Several antihypertensive agents have been shown to effectively reduce wave reflection, including angiotensin-converting enzyme inhibitors, angiotensin-receptor blockers, calcium antagonists, and nitrates. Lifestyle changes may also be helpful.
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Affiliation(s)
- Dinko Susic
- Ochsner Clinic Foundation, New Orleans, LA 70121, USA
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Sengupta PP, Northfelt DW, Gentile F, Zamorano JL, Khandheria BK. Trastuzumab-induced cardiotoxicity: heart failure at the crossroads. Mayo Clin Proc 2008; 83:197-203. [PMID: 18241629 DOI: 10.4065/83.2.197] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Trastuzumab, a drug targeting human epidermal growth factor receptor 2, improves survival rate in women with metastatic breast cancer. Symptomatic heart failure, a serious adverse effect of trastuzumab, occurs in 1% to 4% of patients treated with the antibody, whereas left ventricular ejection fraction declines substantially in 10% of patients. The prevalence of cardiotoxic effects of trastuzumab appears to increase with exposure to anthracyclines. Serial assessment of left ventricular function with 2-dimensional echocardiography or radionuclide ventriculography is the most practical means of monitoring cardiotoxicity. Patients who develop cardiotoxicity while receiving trastuzumab therapy generally improve once use of the agent is discontinued.
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Affiliation(s)
- Partho P Sengupta
- Division of Cardiovascular Diseases, Mayo Clinic, 13400 E Shea Blvd, Scottsdale, AZ 85259, USA
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