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Ohte N, Kikuchi S, Iwahashi N, Kinugasa Y, Dohi K, Takase H, Masai K, Inoue K, Okumura T, Hachiya K, Kitada S, Seo Y. Distinctive left ventricular-arterial and right ventricular-pulmonary arterial coupling observed in patients with heart failure and a higher left ventricular ejection fraction range. Eur Heart J Cardiovasc Imaging 2024; 25:774-781. [PMID: 38284416 DOI: 10.1093/ehjci/jeae033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Revised: 12/23/2023] [Accepted: 01/23/2024] [Indexed: 01/30/2024] Open
Abstract
AIMS Higher left ventricular (LV) ejection fraction (EF) is related to unfavourable prognosis in patients with heart failure (HF) with preserved ejection fraction (HFpEF). The cause of this finding needs to be haemodynamically explained. Thus, we investigated this crucial issue from the perspective of LV-arterial (A) and right ventricular (RV)-pulmonary arterial (PA) coupling. METHODS AND RESULTS Study patients were derived from our prospective cohort study of patients hospitalized due to acute decompensated HF and LVEF > 40%. We divided the 255 patients into three groups: HF with mildly reduced EF (HFmrEF), HFpEF with 50% ≤ LVEF < 60%, and HFpEF with LVEF ≥ 60%. We compared LV end-systolic elastance (Ees), effective arterial elastance (Ea), and Ees/Ea as a representative of LV-A coupling among groups and compared the ratio of tricuspid annular plane excursion to peak pulmonary arterial systolic pressure (TAPSE/PASP) as a representative of RV-PA coupling. All-cause death and readmission due to HF-free survival was worse in the group with a higher LVEF range. Ees/Ea was greater in HFpEF patients with LVEF ≥ 60% (2.12 ± 0.57) than in those with 50% ≤ LVEF < 60% (1.20 ± 0.14) and those with HFmrEF (0.82 ± 0.09) (P < 0.001). PASP was increased in the groups with higher LVEF; however, TAPSE/PASP did not differ among groups (n = 168, P = 0.17). In a multivariate Cox proportional hazard model, TAPSE/PASP but not PASP was significantly related to event-free survival independent of LVEF. CONCLUSION HFpEF patients with higher LVEF have unfavourable prognosis and distinctive LV-A coupling: Ees/Ea is elevated up to 2.0 or more. Impaired RV-PA coupling also worsens prognosis in such patients. CLINICAL TRIAL REGISTRATION URL: https://www.umin.ac.jp/ctr/index.htm Unique identifier: UMIN000017725.
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Affiliation(s)
- Nobuyuki Ohte
- Department of Cardiology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya 467-8601, Japan
| | - Shohei Kikuchi
- Department of Cardiology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya 467-8601, Japan
| | - Noriaki Iwahashi
- Cardiovascular Center, Yokohama City University Medical Center, Yokohama, Japan
| | - Yoshiharu Kinugasa
- Department of Cardiovascular Medicine and Endocrinology and Metabolism, Faculty of Medicine, Tottori University, Yonago, Japan
| | - Kaoru Dohi
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, Tsu, Japan
| | - Hiroyuki Takase
- Department of Internal Medicine, Enshu Hospital, Hamamatsu, Japan
| | - Kumiko Masai
- Department of Cardiovascular and Renal Medicine, Hyogo College of Medicine, Nishinomiya, Japan
| | - Katsuji Inoue
- Department of Cardiology, Pulmonology, Hypertension & Nephrology, Ehime University Graduate School of Medicine, Toon, Japan
| | - Takahiro Okumura
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kenta Hachiya
- Department of Cardiology, Nagoya City University East Medical Center, Nagoya, Japan
| | - Shuichi Kitada
- Department of Cardiology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya 467-8601, Japan
| | - Yoshihiro Seo
- Department of Cardiology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya 467-8601, Japan
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Weerts J, Raafs AG, Sandhoefner B, van der Heide FCT, Mourmans SGJ, Wolff N, Finger RP, Falahat P, Wintergerst MWM, van Empel VPM, Heymans SRB. Retinal Vascular Changes in Heart Failure with Preserved Ejection Fraction Using Optical Coherence Tomography Angiography. J Clin Med 2024; 13:1892. [PMID: 38610657 PMCID: PMC11012357 DOI: 10.3390/jcm13071892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 03/18/2024] [Accepted: 03/22/2024] [Indexed: 04/14/2024] Open
Abstract
Background: Systemic microvascular regression and dysfunction are considered important underlying mechanisms in heart failure with preserved ejection fraction (HFpEF), but retinal changes are unknown. Methods: This prospective study aimed to investigate whether retinal microvascular and structural parameters assessed using optical coherence tomography angiography (OCT-A) differ between patients with HFpEF and control individuals (i.e., capillary vessel density, thickness of retina layers). We also aimed to assess the associations of retinal parameters with clinical and echocardiographic parameters in HFpEF. HFpEF patients, but not controls, underwent echocardiography. Macula-centered 6 × 6 mm volume scans were computed of both eyes. Results: Twenty-two HFpEF patients and 24 controls without known HFpEF were evaluated, with an age of 74 [68-80] vs. 68 [58-77] years (p = 0.027), and 73% vs. 42% females (p = 0.034), respectively. HFpEF patients showed vascular degeneration compared to controls, depicted by lower macular vessel density (p < 0.001) and macular ganglion cell-inner plexiform layer thickness (p = 0.025), and a trend towards lower total retinal volume (p = 0.050) on OCT-A. In HFpEF, a lower total retinal volume was associated with markers of diastolic dysfunction (septal e', septal and average E/e': R2 = 0.38, 0.36, 0.25, respectively; all p < 0.05), even after adjustment for age, sex, diabetes mellitus, or atrial fibrillation. Conclusions: Patients with HFpEF showed clear levels of retinal vascular changes compared to control individuals, and retinal alterations appeared to be associated with markers of more severe diastolic dysfunction in HFpEF. OCT-A may therefore be a promising technique for monitoring systemic microvascular regression and cardiac diastolic dysfunction.
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Affiliation(s)
- Jerremy Weerts
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre+ (MUMC+), P.O. Box 616, 6200 MD Maastricht, The Netherlands; (A.G.R.); (S.G.J.M.); (V.P.M.v.E.)
| | - Anne G. Raafs
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre+ (MUMC+), P.O. Box 616, 6200 MD Maastricht, The Netherlands; (A.G.R.); (S.G.J.M.); (V.P.M.v.E.)
| | - Birgit Sandhoefner
- Carl ZEISS Meditec Inc., 5300 Central Parkway, Dublin, CA 94568, USA (N.W.)
| | - Frank C. T. van der Heide
- Department of Internal Medicine, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre+ (MUMC+), 6200 MD Maastricht, The Netherlands;
- University Eye Clinic Maastricht, Maastricht University Medical Centre+ (MUMC+), 6200 MD Maastricht, The Netherlands
- MHeNS, School for Mental Health and NeuroScience, Maastricht University, 6200 MD Maastricht, The Netherlands
| | - Sanne G. J. Mourmans
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre+ (MUMC+), P.O. Box 616, 6200 MD Maastricht, The Netherlands; (A.G.R.); (S.G.J.M.); (V.P.M.v.E.)
| | - Nicolas Wolff
- Carl ZEISS Meditec Inc., 5300 Central Parkway, Dublin, CA 94568, USA (N.W.)
| | - Robert P. Finger
- Department of Ophthalmology, University Hospital Bonn, 53127 Bonn, Germany; (R.P.F.); (P.F.); (M.W.M.W.)
| | - Peyman Falahat
- Department of Ophthalmology, University Hospital Bonn, 53127 Bonn, Germany; (R.P.F.); (P.F.); (M.W.M.W.)
| | | | - Vanessa P. M. van Empel
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre+ (MUMC+), P.O. Box 616, 6200 MD Maastricht, The Netherlands; (A.G.R.); (S.G.J.M.); (V.P.M.v.E.)
| | - Stephane R. B. Heymans
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre+ (MUMC+), P.O. Box 616, 6200 MD Maastricht, The Netherlands; (A.G.R.); (S.G.J.M.); (V.P.M.v.E.)
- Department of Cardiovascular Research, University of Leuven, 3000 Leuven, Belgium
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Tang W, Zhang Y, Wang Z, Yuan X, Chen X, Yang X, Qi Z, Zhang J, Li J, Xie X. Development and validation of a multivariate model for predicting heart failure hospitalization and mortality in patients receiving maintenance hemodialysis. Ren Fail 2023; 45:2255686. [PMID: 37732398 PMCID: PMC10515690 DOI: 10.1080/0886022x.2023.2255686] [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: 05/15/2023] [Accepted: 08/31/2023] [Indexed: 09/22/2023] Open
Abstract
BACKGROUND Heart failure (HF) in patients undergoing maintenance hemodialysis (MHD) increases their hospitalization rates, mortality, and economic burden significantly. We aimed to develop and validate a predictive model utilizing contemporary deep phenotyping for individual risk assessment of all-cause mortality or HF hospitalization in patients on MHD. MATERIALS AND METHODS A retrospective review was conducted from January 2017 to October 2022, including 348 patients receiving MHD from four centers. The variables were adjusted by Cox regression analysis, and the clinical prediction model was constructed and verified. RESULTS The median follow-up durations were 14 months (interquartile range [IQR] 9-21) for the modeling set and 14 months (9-20) for the validation set. The composite outcome occurred in 72 (29.63%) of 243 patients in the modeling set and 39 (37.14%) of 105 patients in the validation set. The model predictors included age, albumin, history of cerebral hemorrhage, use of angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers/"sacubitril/valsartan", left ventricular ejection fraction, urea reduction ratio, N-terminal prohormone of brain natriuretic peptide, and right atrial size. The C-index was 0.834 (95% CI 0.784-0.883) for the modeling set and 0.853 (0.798, 0.908) for the validation set. The model exhibited excellent calibration across the complete risk profile, and the decision curve analysis (DCA) suggested its ability to maximize patient benefits. CONCLUSION The developed prediction model offered an accurate and personalized assessment of HF hospitalization risk and all-cause mortality in patients with MHD. It can be employed to identify high-risk patients and guide treatment and follow-up.
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Affiliation(s)
- Wenwu Tang
- Department of Nephrology, Second Clinical College of Nanchong North Sichuan Medical College, Nanchong Central Hospital, Nanchong, P.R. China
| | - Ying Zhang
- Department of Nephrology, Second Clinical College of Nanchong North Sichuan Medical College, Nanchong Central Hospital, Nanchong, P.R. China
| | - Zhixin Wang
- Department of Nephrology, Second Clinical College of Nanchong North Sichuan Medical College, Nanchong Central Hospital, Nanchong, P.R. China
| | - Xinzhu Yuan
- Department of Nephrology, Second Clinical College of Nanchong North Sichuan Medical College, Nanchong Central Hospital, Nanchong, P.R. China
| | - Xiaoxia Chen
- Department of Nephrology, Suining Central Hospital, Suining, P.R. China
| | - Xiaohua Yang
- Department of Nephrology, Guangyuan Central Hospital, Guangyuan, P.R. China
| | - Zhirui Qi
- North Sichuan Medical College, Nanchong, P.R. China
| | - Ju Zhang
- Department of Nephrology, Guangyuan Central Hospital, Guangyuan, P.R. China
| | - Jie Li
- General Practice Department of Nanchong North, Sichuan Medical College, Nanchong, P.R. China
| | - Xisheng Xie
- Department of Nephrology, Second Clinical College of Nanchong North Sichuan Medical College, Nanchong Central Hospital, Nanchong, P.R. China
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Zhang T, Wang X, Wang Z, Zhai J, He L, Wang Y, Zuo Q, Ma S, Zhang G, Guo Y. Canagliflozin Ameliorates Ventricular Remodeling through Apelin/Angiotensin-Converting Enzyme 2 Signaling in Heart Failure with Preserved Ejection Fraction Rats. Pharmacology 2023; 108:478-491. [PMID: 37611563 DOI: 10.1159/000533277] [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: 03/04/2023] [Accepted: 07/24/2023] [Indexed: 08/25/2023]
Abstract
INTRODUCTION The aim of this study was to investigate the effect of canagliflozin (CANA) on ventricular remodeling in patients with preserved ejection fraction (HFpEF) heart failure and to further investigate its possible molecular mechanisms. METHODS A high-salt diet was used to induce the formation of HFpEF model in salt-sensitive rats. The rats were fed with CANA and irbesartan, respectively. The mice were divided into control group, model group, CANA group, irbesartan group, and combined drug group. After 12 weeks of feeding, the rats were evaluated by measuring the relevant indexes and echocardiography for cardiac function. Histological analysis was performed using Masson trichrome staining and immunohistochemical staining. RT-qPCR and Western blot were used to quantify the relevant genes and proteins. RESULTS In this study, CANA exhibited diuresis, decreased blood pressure, weight loss, and increased food and water intake. Following a high-salt diet, Dahl salt-sensitive rats developed hypertension followed by left ventricular diastolic dysfunction, myocardial fibrosis, and left ventricular remodeling. Myocardial hypertrophy and fibrosis were reduced, and left ventricular diastolic function and ventricular remodeling improved after CANA treatment. The combination of CANA and irbesartan was superior to monotherapy in reducing blood pressure and improving cardiac insufficiency and left ventricular diastolic dysfunction in rats. CANA improves myocardial fibrosis, left ventricular diastolic dysfunction, and ventricular remodeling by upregulating apelin, activating angiotensin-converting enzyme 2 (ACE2), and increasing ACE2/Ang (1-7)/MASR axis levels. CONCLUSION CANA improves myocardial fibrosis, left ventricular diastolic dysfunction, and ventricular remodeling in HFpEF rats through upregulation of apelin/ACE2 signaling.
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Affiliation(s)
- Tingting Zhang
- Department of Internal Medicine, Hebei Medical University, Shijiazhuang, China,
- Department of Geriatric Cardiology, Hebei General Hospital, Shijiazhuang, China,
| | - Xinyu Wang
- College of Postgraduate, Hebei North University, Zhangjiakou, China
| | - Zhongli Wang
- Department of Physical Examination Center, Hebei General Hospital, Shijiazhuang, China
| | - Jianlong Zhai
- Department of Cardiology, Hebei General Hospital, Shijiazhuang, China
| | - Lili He
- Department of Geriatric Cardiology, Hebei General Hospital, Shijiazhuang, China
| | - Yan Wang
- Department of Geriatric Cardiology, Hebei General Hospital, Shijiazhuang, China
| | - Qingjuan Zuo
- Department of Geriatric Cardiology, Hebei General Hospital, Shijiazhuang, China
| | - Sai Ma
- Department of Internal Medicine, Hebei General Hospital, Shijiazhuang, China
| | - Guorui Zhang
- Department of Cardiology, The Third Hospital of Shijiazhuang City Affiliated to Hebei Medical University, Shijiazhuang, China
| | - Yifang Guo
- Department of Internal Medicine, Hebei Medical University, Shijiazhuang, China
- Department of Geriatric Cardiology, Hebei General Hospital, Shijiazhuang, China
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Smiseth OA, Fernandes JF, Lamata P. The challenge of understanding heart failure with supernormal left ventricular ejection fraction: time for building the patient's 'digital twin'. Eur Heart J Cardiovasc Imaging 2023; 24:301-303. [PMID: 36637135 PMCID: PMC9936833 DOI: 10.1093/ehjci/jeac268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Affiliation(s)
| | - Joao F Fernandes
- Department of Biomedical Engineering, School of Biomedical Engineering and Imaging Sciences, King’s College London, 5th Floor Becket House, Lambeth Palace Road, London, SE1 7EUUK
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