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Bayram Z, Dogan C, Efe SC, Karagoz A, Guvendi B, Uysal S, Akbas RB, Acar RD, Akbal OY, Yilmaz F, Tokgoz HC, Kirali MK, Kaymaz C, Ozdemir N. Prognostic Importance of Pulmonary Artery Pulsatility Index and Right Ventricular Stroke Work Index in End-Stage Heart Failure Patients. Cardiology 2022; 147:143-153. [PMID: 34979515 DOI: 10.1159/000521205] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 11/16/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Right ventricular (RV) failure is an important cause of morbidity and mortality in patients with left ventricular (LV) end-stage heart failure (ESHF). Pulmonary artery pulsatility index (PAPi) and right ventricular stroke work index (RVSWI) are invasive parameters related to RV function. This study aimed to investigate the prognostic impact of PAPi and RVSWI in these patients. METHODS AND RESULTS In this study, 416 patients with ESHF were included. The adverse cardiac event (ACE) was defined as left ventricular assist device (LVAD) implantation, urgent heart transplantation, or cardiac mortality. There were 218 ACE cases and 198 non-ACE cases over a median follow-up of 503.50 days. Patients with ACE had lower PAPi and similar RVSWI compared to those without ACE (3.1±1.9 vs. 3.7±2.3, P=0.003 and 7.3±4.9 vs. 6.9±4.4, P=0.422, respectively). According to the results of multivariate analysis, while PAPi (from 2 to 5.65) was associated with ACE, RVSWI (from 3.62 to 9.75) was not associated with ACE (HR: 0.75, 95% CI (0.55-0.95), P=0.031; HR: 0.79, 95% CI: (0.58-1.09), P=0.081, , respectively). Survival analysis revealed that PAPi ≤2.56 was associated with a higher ACE risk compared to PAPi >2.56 (HR: 1.46, 95% CI: 1.11-1.92, P=0.006). PAPi ≤2.56 could predict ACE with 56.7% sensitivity and 51.3% specificity at one year. Furthermore, the association between RVSWI and ACE was nonlinear (J-curve pattern). Low and high values seem to be associated with higher ACE risk compared to intermediate values. CONCLUSION The low PAPi was an independent risk for ACE and it had a linear association with it. However, RVSWI seems to be have a nonlinear association with ACE (J-curve pattern).
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Affiliation(s)
- Zubeyde Bayram
- Department of Cardiology, Kosuyolu Heart Training and Research Hospital, Istanbul, Turkey
| | - Cem Dogan
- Department of Cardiology, Kosuyolu Heart Training and Research Hospital, Istanbul, Turkey
| | - Suleyman Cagan Efe
- Department of Cardiology, Kosuyolu Heart Training and Research Hospital, Istanbul, Turkey
| | - Ali Karagoz
- Department of Cardiology, Kosuyolu Heart Training and Research Hospital, Istanbul, Turkey
| | - Busra Guvendi
- Department of Cardiology, Kosuyolu Heart Training and Research Hospital, Istanbul, Turkey
| | - Samet Uysal
- Department of Cardiology, Kosuyolu Heart Training and Research Hospital, Istanbul, Turkey
| | - Ravza Betul Akbas
- Department of Cardiology, Kosuyolu Heart Training and Research Hospital, Istanbul, Turkey
| | - Rezzan Deniz Acar
- Department of Cardiology, Kosuyolu Heart Training and Research Hospital, Istanbul, Turkey
| | - Ozgur Yasar Akbal
- Department of Cardiology, Kosuyolu Heart Training and Research Hospital, Istanbul, Turkey
| | - Fatih Yilmaz
- Department of Cardiology, Kosuyolu Heart Training and Research Hospital, Istanbul, Turkey
| | - Hacer Ceren Tokgoz
- Department of Cardiology, Kosuyolu Heart Training and Research Hospital, Istanbul, Turkey
| | - Mehmet Kaan Kirali
- Department of Cardiovascular Surgery, Kosuyolu Heart Training and Research Hospital, Istanbul, Turkey
| | - Cihangir Kaymaz
- Department of Cardiology, Kosuyolu Heart Training and Research Hospital, Istanbul, Turkey
| | - Nihal Ozdemir
- Department of Cardiology, Kosuyolu Heart Training and Research Hospital, Istanbul, Turkey
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Rosa GM, Scagliola R, Ghione P, Valbusa A, Brunelli C, Carbone F, Montecucco F, Monacelli F. Predictors of cardiovascular outcome and rehospitalization in elderly patients with heart failure. Eur J Clin Invest 2019; 49:e13044. [PMID: 30368802 DOI: 10.1111/eci.13044] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Revised: 10/22/2018] [Accepted: 10/23/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND Heart failure (HF) is a major public health problem and represents the only cardiac disease continuing to increase in prevalence, in particular among elderly patients. The frequent rehospitalizations have a negative impact on quality of life of patients with HF, constituting a substantial cost for patients and the health system. The aim of this review was to look into biochemical, echocardiographic and socioeconomical parameters as predictors of clinical outcomes and rehospitalizations. METHODS This narrative review is based on the material searched for and obtained via PubMed from January 2000 up to March 2018. The search terms we used were as follows: "elderly, heart failure, cardiovascular" in combination with "biomarker, echocardiography and hospitalization." RESULTS This review analyses the potential predictive role of biochemical and echocardiographic and socioeconomical parameters on clinical outcomes (particularly cardiovascular) and hospital readmissions in patients with chronic HF. We focused on risk stratification of elderly patients with HF, who constitute a category of frail subjects at higher risk for readmission to hospital. CONCLUSIONS In elderly subjects with chronic HF, the risk stratification could benefit of a multiparametric approach combining biochemical, echocardiographic, demographic and socioeconomical parameters, thus ensuring a better quality of life and at the same time a better allocation of financial resources.
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Affiliation(s)
- Gian M Rosa
- Clinic of Cardiovascular Diseases, University of Genoa, Genoa, Italy.,IRCCS Ospedale Policlinico San Martino Genoa - Italian Cardiovascular Network, Genoa, Italy
| | | | - Paola Ghione
- Clinic of Cardiovascular Diseases, University of Genoa, Genoa, Italy
| | - Alberto Valbusa
- IRCCS Ospedale Policlinico San Martino Genoa - Italian Cardiovascular Network, Genoa, Italy
| | - Claudio Brunelli
- Clinic of Cardiovascular Diseases, University of Genoa, Genoa, Italy.,IRCCS Ospedale Policlinico San Martino Genoa - Italian Cardiovascular Network, Genoa, Italy
| | - Federico Carbone
- Department of Internal Medicine, First Clinic of Internal Medicine, University of Genoa, Genoa, Italy
| | - Fabrizio Montecucco
- IRCCS Ospedale Policlinico San Martino Genoa - Italian Cardiovascular Network, Genoa, Italy.,Department of Internal Medicine, and Centre of Excellence for Biomedical Research (CEBR), First Clinic of Internal Medicine, University of Genoa, Genoa, Italy
| | - Fiammetta Monacelli
- IRCCS Ospedale Policlinico San Martino Genoa, Genoa, Italy.,Department of Internal Medicine, Geriatric Unit, University of Genoa, Genoa, Italy
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Akintunde AA. Right ventricular function in patients with heart failure in a cardiac clinic in Southwest Nigeria. Niger Med J 2017; 58:7-12. [PMID: 29238122 PMCID: PMC5715568 DOI: 10.4103/0300-1652.218411] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background Right ventricular (RV) function is an important entity in heart failure. Patients with RV dysfunction (RVD) have poorer prognosis and exercise tolerance than those with preserved RV systolic function. Tricuspid annular plane systolic excursion (TAPSE) has been proposed as a simple and reproducible parameter for the qualitative assessment of RV systolic function/ejection fraction (EF). This study aims at describing RV function/RVD among heart failure patients in a specialized cardiac facility in Southwestern Nigeria. Materials and Methods One hundred and thirty-two patients with clinical diagnosis of heart failure were recruited into the study between June 2011 and December 2014. Baseline data, laboratory investigations, electrocardiography, and echocardiography were taken for the participants. RV function was assessed with TAPSE. Statistical analysis was done using Statistical Package for Social Sciences 16.0 (Chicago Ill. USA). P < 0.05 was considered statistically significant. Results The mean age of study participants was 62.1 ± 14.2 years. RV systolic dysfunction (TAPSE <20 mm) was found in 86 (65.2%) of all patients while moderate-to-severe RVD (TAPSE <15 mm) was found in 26 (19.7%) patients. Those with RVD are more likely to be older and had a larger left ventricular internal diastolic dimension than those without RVD. Systolic blood pressure, diastolic blood pressure, and EF were significantly lower among patients with RVD than those with normal RV function. Conclusion RVD is common and is associated with more advanced heart failure and possibly worse prognosis among Nigerians with heart failure. Screening for RVD is encouraged to identify and aggressively treat to reduce the associated increased mortality.
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Affiliation(s)
- Adeseye A Akintunde
- Goshen Heart Clinic, Osogbo, Osun State, Ogbomoso, Nigeria.,Department of Medicine, Ladoke Akintola University of Technology and LAUTECH Teaching Hospital, Ogbomoso, Nigeria
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4
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Gilewski W, Pietrzak J, Banach J, Bujak R, Błażejewski J, Karasek D, Wołowiec Ł, Sinkiewicz W. Prognostic value of selected echocardiographic, impedance cardiographic, and hemodynamic parameters determined during right heart catheterization in patients qualified for heart transplantation. Heart Vessels 2017; 33:180-190. [PMID: 28939932 DOI: 10.1007/s00380-017-1044-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2017] [Accepted: 08/18/2017] [Indexed: 11/27/2022]
Abstract
The aim of the study was to verify prognostic value of selected echocardiographic (UKG), impedance cardiography (ICG), and right heart catheterization (RHC) parameters in systolic heart failure (HF). UKG, ICG, and RHC were performed in 46 patients with chronic HF with ejection fraction <35%. During a 1-year follow-up, composite endpoint (death or hospitalization due to HF exacerbation) was achieved by 23 (50.0%) patients. Analysis of receiver operating characteristic (ROC) curves identified UKG parameters: inferior vena cava diameter on inspiration (IVCinsp) >13 mm [area under curve (AUC), 0.791], right atrial (RA) >5.2 cm (AUC 0.710) and ventricular dimension (RVD) >3.5 cm (AUC 0.717), tricuspid annular plane systolic excursion (TAPSE) <17 mm (AUC 0.682), and its velocity (S'RV) <6.07 cm/s (AUC 0.716) as unfavorable prognostic factors. RHC parameters: low values of cardiac index (CI < 2.1 L/min; AUC 0.846) and high pulmonary capillary wedge pressure (PCWP > 24 mmHg; AUC 0.773) turned out to be the most accurate single predictors of worse outcome. Prognostic value of non-invasive parameters was improved due to the use of their composite measures: IVC% × TAPSE (<430%/mm; AUC 0.826), RVSP/TAPSE (>2.4 mmHg/mm; AUC 0.800), IVC% × SBP (>2097% mmHg; AUC 0.826), and RA × IVCinsp/S'RV (>11.8 cm s; AUC 0.839). In conclusion, composite measures based on non-invasive parameters, such as IVC%/TAPSE, RVSP/TAPSE and RA × IVCinsp/S'RV, may provide equally accurate prognosis as the invasive examination. PCWP and CI determined during RHC were the best individual predictors of the composite endpoint. In addition, echocardiographic parameters: RVD, RA, IVC, TAPSE, and S'RV are accurate predictors of the unfavorable outcome.
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Affiliation(s)
- Wojciech Gilewski
- 2nd Chair of Cardiology, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Bydgoszcz, Poland.
| | - Jarosław Pietrzak
- 2nd Chair of Cardiology, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Bydgoszcz, Poland
| | - Joanna Banach
- 2nd Chair of Cardiology, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Bydgoszcz, Poland
| | - Robert Bujak
- 2nd Chair of Cardiology, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Bydgoszcz, Poland
| | - Jan Błażejewski
- 2nd Chair of Cardiology, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Bydgoszcz, Poland
| | - Danuta Karasek
- 2nd Chair of Cardiology, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Bydgoszcz, Poland
| | - Łukasz Wołowiec
- 2nd Chair of Cardiology, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Bydgoszcz, Poland
| | - Władysław Sinkiewicz
- 2nd Chair of Cardiology, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Bydgoszcz, Poland
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Masithulela F. Bi-ventricular finite element model of right ventricle overload in the healthy rat heart. Biomed Mater Eng 2016; 27:507-525. [PMID: 27885998 DOI: 10.3233/bme-161604] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The recognition of RV overpressure is critical to human life, as this may signify morbidity and mortality. Right ventricle (RV) dysfunction is understood to have an impact on the performance of the left ventricle (LV), but the mechanisms remain poorly understood. It is understood that ventricular compliance has the ability to affect cardiac performance. In this study, a bi-ventricular model of the rat heart was used in preference to other, single-ventricle models. Finite element analysis (FEA) of the bi-ventricular model provides important information on the function of the healthy heart. METHODS The passive myocardium was modelled as a nearly incompressible, hyperelastic, transversely isotropic material using finite element (FE) methods. Bi-ventricular geometries of healthy rat hearts reconstructed from magnetic resonance images were imported in Abaqus©. In simulating the normal passive filling of the rat heart, pressures of 4.8 kPa and 0.0098 kPa were applied to the inner walls of the LV and RV respectively. In addition, to simulate the overpressure of the RV, pressures of 2.4 kPa and 4.8 kPa were applied to the endocardial walls of the LV and RV respectively. As boundary conditions, the circumferential and longitudinal displacements at the base were set to zero. The radial displacements at the base were left free. RESULTS The results show that the average circumferential stress at the mid-wall in the overloaded model increased from 2.8 kPa to 18.2 kPa. The average longitudinal stress increased from 1.5 kPa to 9.7 kPa. Additionally, in the radial direction, the average stress increased from 0.1 kPa to 0.6 kPa in the mid-wall. The average circumferential strain was found to be 0.138 and 0.100 on the endocardium of the over pressured and healthy model respectively. The average circumferential stress at the epicardium, mid-wall and endocardium in the case of a normal heart is 10 times lower than in the overloaded heart model. CONCLUSION The finite analysis method is able to provide insights into the behaviour of the over pressured model (myocardium). In the overloaded model the high stresses and strains were observed on the septal wall. The bi-ventricular model was shown to provide useful information relating to the over pressured ventricle. The possible heart dysfunction may be attributable to high stress and strain in the over pressured heart.
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Affiliation(s)
- Fulufhelo Masithulela
- Department of Mechanical and Industrial Engineering, College of Science and Engineering, University of South Africa, Pretoria, South Africa. E-mail: .,Chris Barnard Division of Cardiothoracic Surgery, University of Cape Town, Observatory, South Africa
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6
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Wasemiller S, Earle T, Kashner M, Foster G, Silvet H. Right Ventricular Ejection Fraction in Ischemic Versus Nonischemic Cardiomyopathy. Am J Cardiol 2016; 117:278-81. [PMID: 26684512 DOI: 10.1016/j.amjcard.2015.10.033] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Revised: 10/14/2015] [Accepted: 10/14/2015] [Indexed: 10/22/2022]
Abstract
The relation between the etiology of cardiomyopathy and the function of the right ventricle (RV) has not been well described in the current era of 3-dimensional cardiac imaging. New advances in cardiac imaging with computed tomography (CT) have allowed accurate measurements of ejection fraction (EF), often a challenging task considering the unique RV shape. We evaluated 130 patients at the Loma Linda Veterans Affairs Healthcare System with cardiomyopathy and a left ventricular (LV) EF ≤ 40%. Etiology of cardiomyopathy was determined by CT angiography as ischemic (n = 56) or nonischemic (n = 74). RV volumes and RVEF were calculated based on 3-dimensional data set from CT images. Baseline LVEF was similar with a mean LVEF of 28% (± 6%) in the ischemic group and 28% (± 9%) in the nonischemic group (p = 0.46). RV function and volumes were moderately decreased in both cohorts, without significant difference between the groups (mean RVEF 34 ± 11% in ischemic group and 32 ± 10% in nonischemic group, p = 0.26). In conclusion, most patients with LV dysfunction also have RV dysfunction. The degree of RV dysfunction is not dependent on the etiology of cardiomyopathy.
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Affiliation(s)
| | - Tiffany Earle
- Loma Linda University Health, Loma Linda, California
| | - Michael Kashner
- Loma Linda University Health, Loma Linda, California; Veterans Affairs Loma Linda Healthcare System, Loma Linda, California
| | - Gary Foster
- Loma Linda University Health, Loma Linda, California; Veterans Affairs Loma Linda Healthcare System, Loma Linda, California
| | - Helme Silvet
- Loma Linda University Health, Loma Linda, California; Veterans Affairs Loma Linda Healthcare System, Loma Linda, California
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7
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Abstract
Background The significance of right ventricular ejection fraction (RVEF), independent of left ventricular ejection fraction (LVEF), following isolated coronary artery bypass grafting (CABG) and valve procedures remains unknown. The aim of this study is to examine the significance of abnormal RVEF by cardiac magnetic resonance (CMR), independent of LVEF in predicting outcomes of patients undergoing isolated CABG and valve surgery. Methods From 2007 to 2009, 109 consecutive patients (mean age, 66 years; 38% female) were referred for pre-operative CMR. Abnormal RVEF and LVEF were considered <35% and <45%, respectively. Elective primary procedures include CABG (56%) and valve (44%). Thirty-day outcomes were perioperative complications, length of stay, cardiac re-hospitalizations and early mortaility; long-term (> 30 days) outcomes included, cardiac re-hospitalization, worsening congestive heart failure and mortality. Mean clinical follow up was 14 months. Findings Forty-eight patients had reduced RVEF (mean 25%) and 61 patients had normal RVEF (mean 50%) (p<0.001). Fifty-four patients had reduced LVEF (mean 30%) and 55 patients had normal LVEF (mean 59%) (p<0.001). Patients with reduced RVEF had a higher incidence of long-term cardiac re-hospitalization vs. patients with normal RVEF (31% vs.13%, p<0.05). Abnormal RVEF was a predictor for long-term cardiac re-hospitalization (HR 3.01 [CI 1.5-7.9], p<0.03). Reduced LVEF did not influence long-term cardiac re-hospitalization. Conclusion Abnormal RVEF is a stronger predictor for long-term cardiac re-hospitalization than abnormal LVEF in patients undergoing isolated CABG and valve procedures.
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Henein MY, Grönlund C, Tossavainen E, Söderberg S, Gonzalez M, Lindqvist P. Right and left heart dysfunction predict mortality in pulmonary hypertension. Clin Physiol Funct Imaging 2015; 37:45-51. [PMID: 26096286 DOI: 10.1111/cpf.12266] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Accepted: 05/04/2015] [Indexed: 12/21/2022]
Abstract
In pulmonary hypertension (PH), the right heart dysfunction is a strong predictor of adverse clinical outcome, while the role of the left heart is not fully determined. The aim of this study was to identify predictors of mortality in precapillary PH including measures of both right and left heart function. We studied 34 patients (mean age 64 ± 13, range 31-82 years, 24 females) with precapillary PH, all of whom underwent detailed Doppler echocardiographic examination of the right and left heart function using conventional and speckle-tracking echocardiography. Patients were followed up for up to 8 years (mean 4·2 ± 1·9 years). At follow-up, 16 patients survived. Left ventricular (LV) filling time (P = 0·007), pulmonary artery acceleration time (P = 0·009), right atrial pressure (RAP) (P<0·001) and tricuspid regurgitation (TR) severity (P = 0·007) were worse in the deceased group. RV global longitudinal strain (GLS) (P = 0·001), RAP (P≤0·001), LV filling time (P<0·001) and TR severity (P<0·001) were the most accurate predictors, having the largest AUC (>0·65) and carried the highest risk for mortality (P<0·001 for all). The strongest predictors of mortality in precapillary PH indirectly reflect both left and right heart dysfunction including atrial structure and function disturbances. While an interaction pattern is observed, it needs to be confirmed in a larger cohort.
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Affiliation(s)
- Michael Y Henein
- Department of Cardiology, Heart Centre, Umeå University, Umeå, Sweden.,Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Christer Grönlund
- Department of Biomedical Engineering - R&D, Radiation sciences, Umeå University, Umeå, Sweden
| | - Erik Tossavainen
- Department of Cardiology, Heart Centre, Umeå University, Umeå, Sweden
| | - Stefan Söderberg
- Department of Cardiology, Heart Centre, Umeå University, Umeå, Sweden.,Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Manuel Gonzalez
- Department of Cardiology, Heart Centre, Umeå University, Umeå, Sweden
| | - Per Lindqvist
- Department of Clinical Physiology, Heart Centre, Umeå University, Umeå, Sweden.,Department of Surgical and Peri-Operative Sciences, Umeå University, Umeå, Sweden
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9
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Mohammed SF, Hussain I, AbouEzzeddine OF, Abou Ezzeddine OF, Takahama H, Kwon SH, Forfia P, Roger VL, Redfield MM. Right ventricular function in heart failure with preserved ejection fraction: a community-based study. Circulation 2014; 130:2310-20. [PMID: 25391518 DOI: 10.1161/circulationaha.113.008461] [Citation(s) in RCA: 331] [Impact Index Per Article: 33.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND The prevalence and clinical significance of right ventricular (RV) systolic dysfunction (RVD) in patients with heart failure and preserved ejection fraction (HFpEF) are not well characterized. METHODS AND RESULTS Consecutive, prospectively identified HFpEF (Framingham HF criteria, ejection fraction ≥50%) patients (n=562) from Olmsted County, Minnesota, underwent echocardiography at HF diagnosis and follow-up for cause-specific mortality and HF hospitalization. RV function was categorized by tertiles of tricuspid annular plane systolic excursion and by semiquantitative (normal, mild RVD, or moderate to severe RVD) 2-dimensional assessment. Whether RVD was defined by semiquantitative assessment or tricuspid annular plane systolic excursion ≤15 mm, HFpEF patients with RVD were more likely to have atrial fibrillation, pacemakers, and chronic diuretic therapy. At echocardiography, patients with RVD had slightly lower left ventricular ejection fraction, worse diastolic dysfunction, lower blood pressure and cardiac output, higher pulmonary artery systolic pressure, and more severe RV enlargement and tricuspid valve regurgitation. After adjustment for age, sex, pulmonary artery systolic pressure, and comorbidities, the presence of any RVD by semiquantitative assessment was associated with higher all-cause (hazard ratio=1.35; 95% confidence interval, 1.03-1.77; P=0.03) and cardiovascular (hazard ratio=1.85; 95% confidence interval, 1.20-2.80; P=0.006) mortality and higher first (hazard ratio=1.99; 95% confidence interval, 1.35-2.90; P=0.0006) and multiple (hazard ratio=1.81; 95% confidence interval, 1.18-2.78; P=0.007) HF hospitalization rates. RVD defined by tricuspid annular plane systolic excursion values showed similar but weaker associations with mortality and HF hospitalizations. CONCLUSIONS In the community, RVD is common in HFpEF patients, is associated with clinical and echocardiographic evidence of more advanced HF, and is predictive of poorer outcomes.
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Affiliation(s)
- Selma F Mohammed
- From the Division of Cardiovascular Diseases (S.F.M., I.H., O.F.A.E., H.T., S.H.K., V.L.R., M.M.R.), Mayo Graduate School (S.F.M.), and Department of Health Sciences Research (V.L.R.), Mayo Clinic, Rochester, MN; and Division of Cardiovascular Medicine, Temple University, Philadelphia, PA (P.F.).
| | - Imad Hussain
- From the Division of Cardiovascular Diseases (S.F.M., I.H., O.F.A.E., H.T., S.H.K., V.L.R., M.M.R.), Mayo Graduate School (S.F.M.), and Department of Health Sciences Research (V.L.R.), Mayo Clinic, Rochester, MN; and Division of Cardiovascular Medicine, Temple University, Philadelphia, PA (P.F.)
| | | | - Omar F Abou Ezzeddine
- From the Division of Cardiovascular Diseases (S.F.M., I.H., O.F.A.E., H.T., S.H.K., V.L.R., M.M.R.), Mayo Graduate School (S.F.M.), and Department of Health Sciences Research (V.L.R.), Mayo Clinic, Rochester, MN; and Division of Cardiovascular Medicine, Temple University, Philadelphia, PA (P.F.)
| | - Hiroyuki Takahama
- From the Division of Cardiovascular Diseases (S.F.M., I.H., O.F.A.E., H.T., S.H.K., V.L.R., M.M.R.), Mayo Graduate School (S.F.M.), and Department of Health Sciences Research (V.L.R.), Mayo Clinic, Rochester, MN; and Division of Cardiovascular Medicine, Temple University, Philadelphia, PA (P.F.)
| | - Susan H Kwon
- From the Division of Cardiovascular Diseases (S.F.M., I.H., O.F.A.E., H.T., S.H.K., V.L.R., M.M.R.), Mayo Graduate School (S.F.M.), and Department of Health Sciences Research (V.L.R.), Mayo Clinic, Rochester, MN; and Division of Cardiovascular Medicine, Temple University, Philadelphia, PA (P.F.)
| | - Paul Forfia
- From the Division of Cardiovascular Diseases (S.F.M., I.H., O.F.A.E., H.T., S.H.K., V.L.R., M.M.R.), Mayo Graduate School (S.F.M.), and Department of Health Sciences Research (V.L.R.), Mayo Clinic, Rochester, MN; and Division of Cardiovascular Medicine, Temple University, Philadelphia, PA (P.F.)
| | - Véronique L Roger
- From the Division of Cardiovascular Diseases (S.F.M., I.H., O.F.A.E., H.T., S.H.K., V.L.R., M.M.R.), Mayo Graduate School (S.F.M.), and Department of Health Sciences Research (V.L.R.), Mayo Clinic, Rochester, MN; and Division of Cardiovascular Medicine, Temple University, Philadelphia, PA (P.F.)
| | - Margaret M Redfield
- From the Division of Cardiovascular Diseases (S.F.M., I.H., O.F.A.E., H.T., S.H.K., V.L.R., M.M.R.), Mayo Graduate School (S.F.M.), and Department of Health Sciences Research (V.L.R.), Mayo Clinic, Rochester, MN; and Division of Cardiovascular Medicine, Temple University, Philadelphia, PA (P.F.)
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10
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Dzudie A, Kengne AP, Thienemann F, Sliwa K. Predictors of hospitalisations for heart failure and mortality in patients with pulmonary hypertension associated with left heart disease: a systematic review. BMJ Open 2014; 4:e004843. [PMID: 25011987 PMCID: PMC4120416 DOI: 10.1136/bmjopen-2014-004843] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVES Left heart disease (LHD) is the main cause of pulmonary hypertension (PH), but little is known regarding the predictors of adverse outcome of PH associated with LHD (PH-LHD). We conducted a systematic review to investigate the predictors of hospitalisations for heart failure and mortality in patients with PH-LHD. DESIGN Systematic review. DATA SOURCES PubMed MEDLINE and SCOPUS from inception to August 2013 were searched, and citations identified via the ISI Web of Science. STUDY SELECTION Studies that reported on hospitalisation and/or mortality in patients with PH-LHD were included if the age of participants was greater than 18 years and PH was diagnosed using Doppler echocardiography and/or right heart catheterisation. Two reviewers independently selected studies, assessed their quality and extracted relevant data. RESULTS In all, 45 studies (38 from Europe and USA) were included among which 71.1% were of high quality. 39 studies were published between 2003 and 2013. The number of participants across studies ranged from 46 to 2385; the proportion of men from 21% to 91%; mean/median age from 63 to 82 years; and prevalence of PH from 7% to 83.3%. PH was consistently associated with increased mortality risk in all forms of LHD, except for aortic valve disease where findings were inconsistent. Six of the nine studies with data available on hospitalisations reported a significant adverse effect of PH on hospitalisation risk. Other predictors of adverse outcome were very broad and heterogeneous including right ventricular dysfunction, functional class, left ventricular function and presence of kidney disease. CONCLUSIONS PH is almost invariably associated with increased mortality risk in patients with LHD. However, effects on hospitalisation risk are yet to be fully characterised; while available evidence on the adverse effects of PH have been derived essentially from Caucasians.
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Affiliation(s)
- Anastase Dzudie
- Douala General Hospital and Buea Faculty of Health Sciences, Douala, Cameroon
- Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Andre Pascal Kengne
- Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- Non-Communicable Diseases Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Friedrich Thienemann
- Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- Faculty of Health Sciences, Clinical Infectious Diseases Research Initiative, Institute of Infectious Diseases and Molecular Medicine, University of Cape Town, Cape Town, South Africa
- Division of Infectious Diseases and HIV Medicine, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Karen Sliwa
- Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- Non-Communicable Diseases Research Unit, South African Medical Research Council, Cape Town, South Africa
- Cape Heart Group, Hatter Institute for Cardiovascular Research in Africa, University of Cape Town, Cape Town, South Africa
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Kalogeropoulos AP, Georgiopoulou VV, Borlaug BA, Gheorghiade M, Butler J. Left ventricular dysfunction with pulmonary hypertension: part 2: prognosis, noninvasive evaluation, treatment, and future research. Circ Heart Fail 2013; 6:584-93. [PMID: 23694772 PMCID: PMC3662027 DOI: 10.1161/circheartfailure.112.000096] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
| | | | | | - Mihai Gheorghiade
- Center for Cardiovascular Innovation, Northwestern University Feinberg, Chicago, IL
| | - Javed Butler
- Division of Cardiology, Emory University, Atlanta, GA
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Georgiopoulou VV, Kalogeropoulos AP, Borlaug BA, Gheorghiade M, Butler J. Left Ventricular Dysfunction With Pulmonary Hypertension. Circ Heart Fail 2013; 6:344-54. [DOI: 10.1161/circheartfailure.112.000095] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Vasiliki V. Georgiopoulou
- From the Division of Cardiology, Emory University, Atlanta, GA (V.V.G., A.P.K., J.B.); Division of Cardiology, Mayo Clinic, Rochester, MN (B.A.B.); and Center for Cardiovascular Innovation, Northwestern University, Feinberg School of Medicine, Chicago, IL (M.G.)
| | - Andreas P. Kalogeropoulos
- From the Division of Cardiology, Emory University, Atlanta, GA (V.V.G., A.P.K., J.B.); Division of Cardiology, Mayo Clinic, Rochester, MN (B.A.B.); and Center for Cardiovascular Innovation, Northwestern University, Feinberg School of Medicine, Chicago, IL (M.G.)
| | - Barry A. Borlaug
- From the Division of Cardiology, Emory University, Atlanta, GA (V.V.G., A.P.K., J.B.); Division of Cardiology, Mayo Clinic, Rochester, MN (B.A.B.); and Center for Cardiovascular Innovation, Northwestern University, Feinberg School of Medicine, Chicago, IL (M.G.)
| | - Mihai Gheorghiade
- From the Division of Cardiology, Emory University, Atlanta, GA (V.V.G., A.P.K., J.B.); Division of Cardiology, Mayo Clinic, Rochester, MN (B.A.B.); and Center for Cardiovascular Innovation, Northwestern University, Feinberg School of Medicine, Chicago, IL (M.G.)
| | - Javed Butler
- From the Division of Cardiology, Emory University, Atlanta, GA (V.V.G., A.P.K., J.B.); Division of Cardiology, Mayo Clinic, Rochester, MN (B.A.B.); and Center for Cardiovascular Innovation, Northwestern University, Feinberg School of Medicine, Chicago, IL (M.G.)
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13
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Bursi F, McNallan SM, Redfield MM, Nkomo VT, Lam CSP, Weston SA, Jiang R, Roger VL. Pulmonary pressures and death in heart failure: a community study. J Am Coll Cardiol 2012; 59:222-31. [PMID: 22240126 DOI: 10.1016/j.jacc.2011.06.076] [Citation(s) in RCA: 205] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2010] [Revised: 06/20/2011] [Accepted: 06/28/2011] [Indexed: 12/31/2022]
Abstract
OBJECTIVES The purpose of this study was to determine among community patients with heart failure (HF) whether pulmonary artery systolic pressure (PASP) assessed by Doppler echocardiography was associated with death and improved risk prediction over established factors, using the integrated discrimination improvement and net reclassification improvement. BACKGROUND Although several studies have focused on idiopathic pulmonary arterial hypertension, less is known about pulmonary hypertension among patients with HF, particularly about its prognostic value in the community. METHODS Between 2003 and 2010, Olmsted County residents with HF prospectively underwent assessment of ejection fraction, diastolic function, and PASP by Doppler echocardiography. RESULTS PASP was recorded in 1,049 of 1,153 patients (mean age 76 ± 13; 51% women). Median PASP was 48 mm Hg (25th to 75th percentile: 37.0 to 58.0). There were 489 deaths after a follow-up of 2.7 ± 1.9 years. There was a strong positive graded association between PASP and mortality. Increasing PASP was associated with an increased risk of death (hazard ratio [HR]: 1.45, 95% confidence interval [CI]: 1.13 to 1.85 for tertile 2; HR: 2.07, 95% CI: 1.62 to 2.64 for tertile 3 vs. tertile 1), independently of age, sex, comorbidities, ejection fraction, and diastolic function. Adding PASP to models including these clinical characteristics resulted in an increase in the c-statistic from 0.704 to 0.742 (p = 0.007), an integrated discrimination improvement gain of 4.2% (p < 0.001), and a net reclassification improvement of 14.1% (p = 0.002), indicating that PASP improved prediction of death over traditional prognostic factors. All results were similar for cardiovascular death. CONCLUSIONS Among community patients with HF, PASP strongly predicts death and provides incremental and clinically relevant prognostic information independently of known predictors of outcomes.
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Affiliation(s)
- Francesca Bursi
- Division of Cardiovascular Diseases, Department of Internal Medicine, 200 First Street SW, Mayo Clinic, Rochester, MN 55905, USA
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Arena R, Guazzi M, Myers J, Grinnen D, Forman DE, Lavie CJ. Cardiopulmonary exercise testing in the assessment of pulmonary hypertension. Expert Rev Respir Med 2011; 5:281-93. [PMID: 21510737 DOI: 10.1586/ers.11.4] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The assessment of patients with suspected or confirmed pulmonary arterial hypertension (PAH) and secondary pulmonary hypertension (PH) continues to evolve and, in recent years, evidence demonstrating that cardiopulmonary exercise testing (CPX) provides valuable information has grown at an impressive rate. The key premise supporting the use of CPX is that certain variables obtained provide insight into the degree of ventilation/perfusion mismatching secondary to altered pulmonary hemodynamics. In this article, we discuss the pathophysiology of PAH and secondary PH and its impact on cardiac function, review the clinical presentation of patients with elevated pulmonary pressures and outline a case for the use of CPX as an integral assessment technique, discuss CPX technology and testing procedures, and review the current state of available evidence and provide clinical recommendations for CPX in the setting of known or suspected PAH and secondary PH.
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Affiliation(s)
- Ross Arena
- Virginia Commonwealth University, Richmond, VA, USA.
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Shizukuda Y, Bhatti S, Munjal J, Hu YL, Harrelson A. Personalized echocardiography: clinical applications of advanced echocardiography and future directions. Future Cardiol 2010; 6:833-44. [PMID: 21142639 DOI: 10.2217/fca.10.103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Future cardiology practice will be increasingly individualized, and thus to maintain its central role, echocardiography must keep pushing to expand the boundaries of real-time data acquisition from tissue and fluid motion, and yet still provide efficient and timely data analysis that leads to succinct, clear clinical recommendations tailored to each person in our care. In this article, recent efforts to expand echocardiography techniques into an era of increasingly personalized cardiology, including advances in color-coded tissue Doppler, 3D echocardiography and complex exercise stress echocardiography are described. The common metric for success in each of these efforts is the development of robust and institutionally supportable echocardiography protocols for specific cardiology disease populations that currently may be underdiagnosed and/or undertreated. The common result in each case should be the creation of new guidelines that can supplement the current standard protocols advocated by professional echocardiography organizations.
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Affiliation(s)
- Yukitaka Shizukuda
- Division of Cardiovascular Diseases, Department of Internal Medicine, University of Cincinnati, Cincinnati, OH, USA.
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