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Yalçin F, Yalçin H, Küçükler N, Arslan S, Akkuş O, Kurtul A, Abraham MR. Basal Septal Hypertrophy as the Early Imaging Biomarker for Adaptive Phase of Remodeling Prior to Heart Failure. J Clin Med 2021; 11:75. [PMID: 35011816 PMCID: PMC8745483 DOI: 10.3390/jcm11010075] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 11/01/2021] [Accepted: 11/15/2021] [Indexed: 01/19/2023] Open
Abstract
Hypertension plays a dominant role in the development of left ventricular (LV) remodeling and heart failure, in addition to being the main risk factor for coronary artery disease. In this review, we focus on the focal geometric and functional tissue aspects of the LV septal base, since basal septal hypertrophy (BSH), as the early imaging biomarker of LV remodeling due to hypertensive heart disease, is detected in cross-sectional clinic studies. In addition, the validation of BSH by animal studies using third generation microimaging and relevant clinical observations are also discussed in the report. Finally, an evaluation of both human and animal quantitative imaging studies and the importance of combined cardiac imaging methods and stress-induction in the separation of adaptive and maladaptive phases of the LV remodeling are pointed out. As a result, BSH, as the early imaging biomarker and quantitative follow-up of functional analysis in hypertension, could possibly contribute to early treatment in a timely fashion in the prevention of hypertensive disease progression to heart failure. A variety of stress stimuli in etiopathogenesis and the difficulty of diagnosing pure hemodynamic overload mediated BSH lead to an absence of the certain prevalence of this particular finding in the population.
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Affiliation(s)
- Fatih Yalçin
- Cardiology UCSF Health, Department of Medicine, University of California at San Francisco, San Francisco, CA 94143, USA; (H.Y.); (M.R.A.)
- Department of Cardiology, Mustafa Kemal University, Antakya 31100, Turkey; (N.K.); (S.A.); (O.A.); (A.K.)
| | - Hulya Yalçin
- Cardiology UCSF Health, Department of Medicine, University of California at San Francisco, San Francisco, CA 94143, USA; (H.Y.); (M.R.A.)
- Department of Cardiology, Mustafa Kemal University, Antakya 31100, Turkey; (N.K.); (S.A.); (O.A.); (A.K.)
| | - Nagehan Küçükler
- Department of Cardiology, Mustafa Kemal University, Antakya 31100, Turkey; (N.K.); (S.A.); (O.A.); (A.K.)
| | - Serbay Arslan
- Department of Cardiology, Mustafa Kemal University, Antakya 31100, Turkey; (N.K.); (S.A.); (O.A.); (A.K.)
| | - Oguz Akkuş
- Department of Cardiology, Mustafa Kemal University, Antakya 31100, Turkey; (N.K.); (S.A.); (O.A.); (A.K.)
| | - Alparslan Kurtul
- Department of Cardiology, Mustafa Kemal University, Antakya 31100, Turkey; (N.K.); (S.A.); (O.A.); (A.K.)
| | - Maria Roselle Abraham
- Cardiology UCSF Health, Department of Medicine, University of California at San Francisco, San Francisco, CA 94143, USA; (H.Y.); (M.R.A.)
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The Impact of Preeclampsia on Women's Health: Cardiovascular Long-term Implications. Obstet Gynecol Surv 2021; 75:703-709. [PMID: 33252700 DOI: 10.1097/ogx.0000000000000846] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Importance Women with a history of preeclampsia have a 2- to 5-fold increased risk of cardiovascular diseases, which represent almost half of mortality in the female population worldwide. Objective To summarize the current evidence concerning women's future cardiovascular risk after pregnancies complicated by preeclampsia. Evidence Acquisition A PubMed and Web of Science search was conducted in English, supplemented by hand searching for additional references. Retrieved articles were reviewed, synthesized, and summarized. Relevant studies on cardiovascular risk after preeclampsia were included. Results Evidence suggests that the cardiovascular implications of preeclampsia do not cease with delivery, with a significant proportion of women demonstrating persistent asymptomatic myocardial impairment, aortic stiffening, and microcirculatory dysfunction. More severe and early-onset preeclampsia, as well as preeclampsia with concurrent neonatal morbidity, increases the risk of cardiovascular disease later in life. Conclusions and Relevance As former preeclamptics have been shown to be at increased cardiovascular risk, this identifies a subgroup of women who may benefit from early preventive measures.
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Affiliation(s)
- Basky Thilaganathan
- From the Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, United Kingdom (B.T.).,Molecular and Clinical Sciences Research Institute, St George's University of London, United Kingdom (B.T.)
| | - Erkan Kalafat
- Faculty of Medicine, Department of Obstetrics and Gynecology, Ankara University, Turkey (E.K.)
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Coculescu BI, Dincă GV, Bălăeţ C, Manole G, Bălăeţ M, Stocheci CM. Myeloperoxidase, a possible biomarker for the early diagnosis of cardiac diastolic dysfunction with preserved ejection fraction. J Enzyme Inhib Med Chem 2018; 33:1292-1298. [PMID: 30165747 PMCID: PMC6127850 DOI: 10.1080/14756366.2018.1499626] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Revised: 07/05/2018] [Accepted: 07/06/2018] [Indexed: 11/03/2022] Open
Abstract
The current study was conducted on a sample of 91 patients diagnosed with diastolic dysfunction (DD) with preserved systolic function caused by a painful chronic ischaemic cardiopathy - angina pectoris stable at the effort. The diagnosis was established following anamnesis, electrocardiogram, and echocardiography. Myeloperoxidase (MPO) serum levels were assessed in all patients and then these values were correlated with some of the echocardiography parameters that proved the mentioned diagnosis. In conclusion, the execution of this investigation triad (electrocardiogram, echocardiography, and MPO) allows: Stratifying the patients depending on the disease risk by early detecting of any possible DD with preserved systolic function. The use of the MPO increased circulating levels as a biomarker for diagnosis and risk due to the statistically significant correlation between those and the results of the other two aforementioned paraclinical investigation.
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Affiliation(s)
- Bogdan Ioan Coculescu
- Faculty of Medicine, Titu Maiorescu University, Bucharest, Romania
- Center for Military Medical Scientific Research, Bucharest, Romania
- Faculty of General Nursing, Bioterra University, Bucharest, Romania
| | | | - Constantin Bălăeţ
- Faculty of General Nursing, Bioterra University, Bucharest, Romania
- Lil Med Clinic, Bucharest, Romania
| | - Gheorghe Manole
- Faculty of Medicine, Titu Maiorescu University, Bucharest, Romania
- Clinical Hospital Colentina, Bucharest, Romania
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Medvedofsky D, Kebed K, Laffin L, Stone J, Addetia K, Lang RM, Mor-Avi V. Reproducibility and experience dependence of echocardiographic indices of left ventricular function: Side-by-side comparison of global longitudinal strain and ejection fraction. Echocardiography 2017; 34:365-370. [PMID: 28185312 DOI: 10.1111/echo.13446] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Although left ventricular (LV) ejection fraction (EF) and global longitudinal strain (GLS) are recommended by the current echocardiographic chamber quantification guidelines, these measurements are not performed routinely. Because EF measurements rely on manual tracing of LV boundaries, and are subject to inter-reader variability and experience dependence, we hypothesized that semiautomated GLS measurements using speckle tracking would be more reproducible and less experience-dependent. METHODS Images from 30 patients were analyzed to obtain biplane EF using manual tracing. GLS was measured in three long-axis views using EchoInsight software (Epsilon Imaging) that automatically detects LV endocardial boundary, which is edited manually as necessary and is then automatically tracked throughout the cardiac cycle. All measurements were performed by an expert echocardiographer and three first-year cardiology fellows. RESULTS Semiautomated GLS analysis showed excellent correlation (r=.98) and small bias (-1.0±13% of measured value) between the experienced and less experienced readers, superior to EF (r=.91, bias 7.3±16%). Also, in repeated measurements, GLS showed higher intra-class correlation (ICC=.98) than EF (ICC=.89). Additionally, GLS analysis required ~1 minute per patient, while biplane EF measurements took twice as long. CONCLUSIONS Semiautomated GLS measurements are fast, less experience-dependent, and more reproducible than conventional EF measurements. This is probably because, irrespective of experience, the readers' choice of boundary position varies less when asked to refine the automated detection than to draw borders without initial clues. This technique may facilitate the workflow of a busy laboratory and make a step forward toward incorporating quantitative analysis into everyday echocardiography practice.
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Affiliation(s)
- Diego Medvedofsky
- Department of Medicine, University of Chicago Medical Center, Chicago, IL, USA
| | - Kalie Kebed
- Department of Medicine, University of Chicago Medical Center, Chicago, IL, USA
| | - Luke Laffin
- Department of Medicine, University of Chicago Medical Center, Chicago, IL, USA
| | - Jeremy Stone
- Department of Medicine, University of Chicago Medical Center, Chicago, IL, USA
| | - Karima Addetia
- Department of Medicine, University of Chicago Medical Center, Chicago, IL, USA
| | - Roberto M Lang
- Department of Medicine, University of Chicago Medical Center, Chicago, IL, USA
| | - Victor Mor-Avi
- Department of Medicine, University of Chicago Medical Center, Chicago, IL, USA
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De Zan M, Carrascosa P, Deviggiano A, Capunay C, Rodríguez-Granillo GA. Association between ventricular filling patterns and the extent of late enhancement on magnetic resonance imaging in patients with hypertrophic cardiomyopathy. RADIOLOGIA 2017; 59:56-63. [PMID: 27720181 DOI: 10.1016/j.rx.2016.08.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Revised: 07/15/2016] [Accepted: 08/08/2016] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To explore the relationship between ventricular filling curves and the extent of late enhancement on cardiac magnetic resonance imaging (MRI) in patients with hypertrophic cardiomyopathy. MATERIAL AND METHODS We retrospectively included consecutive patients with suspected and/or confirmed hypertrophic cardiomyopathy and a control group of patients matched for age and sex who underwent cardiac MRI with evaluation of late enhancement. Among other determinations, we evaluated the following parameters on cine sequences: peak filling rate, time to the first peak filling rate, and filling rate normalized to the filling volume. RESULTS Late enhancement was observed in 29 (73%) of the 40 patients with hypertrophic cardiomyopathy. The normalized peak filling rate was significantly lower in patients with late enhancement (4.9 ± 1.6 in those with hypertrophic cardiomyopathy positive for late enhancement vs. 5.8 ± 2.2 in those with hypertrophic cardiomyopathy negative for late enhancement vs. 6.3 ± 1.5 in controls, p = 0.008) and the time to peak filling was longer in patients with late enhancement (540.6 ± 89.7 ms vs. 505.5 ± 99.3 ms in those with hypertrophic cardiomyopathy negative for late enhancement vs. 486.9 ± 86.3 ms in controls, p = 0.02). When the population was stratified into three groups in function of the normalized peak filling rate, significant differences were observed among groups for age (p = 0.002), mean wall thickness (p = 0.036), and myocardial mass (p = 0.046) and atrial dimensions, whereas no significant differences with respect to late enhancement were seen. CONCLUSIONS In patients with hypertrophic cardiomyopathy, we found a significant association between ventricular filling patterns and age, wall thicknesses, and atrial dimensions, but not with the extent of late enhancement.
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Affiliation(s)
- M De Zan
- Departamento de Estudios Cardiovasculares no Invasivos de Diagnóstico, Maipú, Buenos Aires, Argentina
| | - P Carrascosa
- Departamento de Estudios Cardiovasculares no Invasivos de Diagnóstico, Maipú, Buenos Aires, Argentina
| | - A Deviggiano
- Departamento de Estudios Cardiovasculares no Invasivos de Diagnóstico, Maipú, Buenos Aires, Argentina
| | - C Capunay
- Departamento de Estudios Cardiovasculares no Invasivos de Diagnóstico, Maipú, Buenos Aires, Argentina
| | - G A Rodríguez-Granillo
- Departamento de Estudios Cardiovasculares no Invasivos de Diagnóstico, Maipú, Buenos Aires, Argentina.
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De Zan M, Carrascosa P, Deviggiano A, Capunay C, Rodríguez-Granillo G. Association between ventricular filling patterns and the extent of late enhancement on magnetic resonance imaging in patients with hypertrophic cardiomyopathy. RADIOLOGIA 2017. [DOI: 10.1016/j.rxeng.2016.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abebe TB, Gebreyohannes EA, Tefera YG, Abegaz TM. Patients with HFpEF and HFrEF have different clinical characteristics but similar prognosis: a retrospective cohort study. BMC Cardiovasc Disord 2016; 16:232. [PMID: 27871223 PMCID: PMC5117494 DOI: 10.1186/s12872-016-0418-9] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Accepted: 11/16/2016] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Globally, heart failure (HF) has been recognized as one of the major cardiovascular disorder with high morbidity, mortality and considerable social impact. In Sub Saharan African countries, HF has turned out as a leading form of cardiovascular diseases, and has considerable socioeconomic impact. However, there are differences in clinical characteristics and survival status among patients with preserved (HFpEF) and reduced (HFrEF) ejection fraction. The aim of this study is to outline the clinical characteristics and medication profile, assess the survival status and prognostic factors of Ethiopian HF patients with HFrEF and HFpEF. METHODS A retrospective cohort study was carried out and we employed medical records of patient's, admitted as a result of HF to the University of Gondar Referral Hospital in the period between December 02, 2010 and December 01, 2015 due to HF. Kaplan Meier curve was used to analyze the survival status and log rank test was used to compare the curves. Cox regression was used to analyze independent predictors of mortality in all HF patients. RESULTS Of the 850 patients who were admitted due to HF, 311 patients met the inclusion criteria. Majority of the patients had HFpEF (52.73%) and tend to be women (76.22%). They predominantly had etiologies of valvular and hypertensive heart diseases, and took calcium channel blockers and anticoagulants. Conversely, patients with HFrEF had etiologies of ischemic heart disease and dilated cardiomyopathy and were prescribed angiotensine converting inhibitors (ACEI) and beta blockers. Kaplan Meier curves and Log rank test (p = 0.807) showed that there was no statistically significant difference in the mortality difference among patients with HFpEF and HFrEF. On the other hand, Cox regression analysis showed advanced age, lower sodium level, higher creatinine level and absence of medications like ACEI, spironolactone and statins independently predicted mortality in all HF patients. CONCLUSIONS Different clinical characteristics were found in both groups of HF patients. There was no difference in survival outcome between patients with HFrEF and HFpEF.
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Affiliation(s)
- Tamrat Befekadu Abebe
- Department of Clinical Pharmacy, School of Pharmacy, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia.
| | - Eyob Alemayehu Gebreyohannes
- Department of Clinical Pharmacy, School of Pharmacy, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Yonas Getaye Tefera
- Department of Clinical Pharmacy, School of Pharmacy, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Tadesse Melaku Abegaz
- Department of Clinical Pharmacy, School of Pharmacy, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
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Mwita JC, Dewhurst MJ, Magafu MG, Goepamang M, Omech B, Majuta KL, Gaenamong M, Palai TB, Mosepele M, Mashalla Y. Presentation and mortality of patients hospitalised with acute heart failure in Botswana. Cardiovasc J Afr 2016; 28:112-117. [PMID: 27701482 PMCID: PMC5488055 DOI: 10.5830/cvja-2016-067] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Accepted: 06/19/2016] [Indexed: 12/04/2022] Open
Abstract
INTRODUCTION Heart failure is a common cause of hospitalisation and therefore contributes to in-hospital outcomes such as mortality. In this study we describe patient characteristics and outcomes of acute heart failure (AHF) in Botswana. METHODS Socio-demographic, clinical and laboratory data were collected from 193 consecutive patients admitted with AHF at Princess Marina Hospital in Gaborone between February 2014 and February 2015. The length of hospital stay and 30-, 90- and 180-day in-hospital mortality rates were assessed. RESULTS The mean age was 54 ± 17.1 years, and 53.9% of the patients were male. All patients were symptomatic (77.5% in NYHA functional class III or IV) and the majority (64.8%) presented with significant left ventricular dysfunction. The most common concomitant medical conditions were hypertension (54.9%), human immuno-deficiency virus (HIV) (33.9%), anaemia (23.3%) and prior diabetes mellitus (15.5%). Moderate to severe renal dysfunction was detected in 60 (31.1%) patients. Peripartum cardiomyopathy was one of the important causes of heart failure in female patients. The most commonly used treatment included furosemide (86%), beta-blockers (72.1%), angiotensin converting enzyme inhibitors (67.4%), spironolactone (59.9%), digoxin (22.1%), angiotensin receptor blockers (5.8%), nitrates (4.7%) and hydralazine (1.7%). The median length of stay was nine days, and the in-hospital mortality rate was 10.9%. Thirty-, 90- and 180-day case fatality rates were 14.7, 25.8 and 30.8%, respectively. Mortality at 180 days was significantly associated with increasing age, lower haemoglobin level, lower glomerular filtration rate, hyponatraemia, higher N-terminal pro-brain natriuretic peptide levels, and prolonged hospital stay. CONCLUSIONS AHF is a major public health problem in Botswana, with high in-hospital and post-discharge mortality rates and prolonged hospital stays. Late and symptomatic presentation is common, and the most common aetiologies are preventable and/or treatable co-morbidities, including hypertension, diabetes mellitus, renal failure and HIV.
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Affiliation(s)
- Julius Chacha Mwita
- Department of Internal Medicine, University of Botswana, Gaborone, Botswana; Department of Internal medicine, Princess Marina Hospital, Gaborone,Botswana.
| | - Matthew J Dewhurst
- Department of Cardiology, North Tees and Hartlepool NHS Foundation Trust, UK
| | - Mgaywa G Magafu
- Department of Family Medicine and Public Health, University of Botswana, Gaborone, Botswana
| | - Monkgogi Goepamang
- Department of Internal medicine, Princess Marina Hospital, Gaborone,Botswana
| | - Bernard Omech
- Department of Internal Medicine, University of Botswana, Gaborone, Botswana; Department of Internal medicine, Princess Marina Hospital, Gaborone,Botswana
| | | | - Marea Gaenamong
- Department of Internal Medicine, University of Botswana, Gaborone, Botswana
| | - Tommy Baboloki Palai
- Department of Internal Medicine, University of Botswana, Gaborone, Botswana; Department of Internal medicine, Princess Marina Hospital, Gaborone,Botswana
| | - Mosepele Mosepele
- Department of Internal Medicine, University of Botswana, Gaborone, Botswana; Department of Internal medicine, Princess Marina Hospital, Gaborone,Botswana
| | - Yohana Mashalla
- Department of Biomedical Sciences, University of Botswana, Gaborone, Botswana
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The change in the atrial fibrillation type as a prognosis marker in a community study: long-term data from AFBAR (Atrial Fibrillation in the BARbanza) study. Int J Cardiol 2013; 168:2146-52. [PMID: 23452888 DOI: 10.1016/j.ijcard.2013.01.261] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2012] [Revised: 12/31/2012] [Accepted: 01/18/2013] [Indexed: 01/19/2023]
Abstract
BACKGROUND The aim is to describe the prognosis role of the change in the atrial fibrillation (AF) type in an unselected population of patients with AF currently attending primary care in a single health-service area in Galicia, north-western Spain. METHODS AFBAR is a cohort study that was carried out by 35 primary care providers in 2008. Participants were followed up for a mean of 2.8 ± 0.7 years. 798 patients with the diagnosis of AF who presented at their clinics during a three-month period were recruited. Primary endpoint was mortality or hospital admission. RESULTS 778 patients (413 male) were analyzed; mean age 74.8 years old. Hypertension was the most prevalent risk factor (76.5%). Permanent AF was diagnosed in 529 patients (68.0%). Change of AF status occurred in 76 patients (9.8%). During follow-up 52.1% of the patients underwent a primary endpoint and the overall survival was 83.4%. The following independent determinants of primary endpoint were identified: change in AF status (Hazard Ratio (HR) 1.41 (95%-confidence interval (CI) 1.04-1.92); p=0.026); previous heart failure (HR 1.28 (95%-CI 1.00-1.65); p=0.050); previous cardiovascular admission (HR 1.54 (95%-CI 1.16-2.03); p=0.002); stroke (HR 2.02 (95%-CI 1.35-3.03); p=0.001);ischemic heart disease (HR 1.28 (95%-CI 1.00-1.65); p=0.050); chronic obstructive pulmonary disease (HR 1.28 (95%-CI 1.00-1.64);p=0.042); anemia (HR 1.37 (95% CI 1.08-1.75); p=0.010); or AF-related complications (HR 1.45 (95%-CI 1.18-1.78); p<0.001). CONCLUSIONS The change in AF status showed to be an important prognosis marker for death or hospital admissions in a primary care cohort.
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Vidal-Perez R, Otero-Raviña F, Franco M, Rodríguez Garcia JM, Liñares Stolle R, Esteban Alvarez R, Iglesias Díaz C, Outeiriño López E, Vázquez López MJ, Gonzalez-Juanatey JR. Determinants of cardiovascular mortality in a cohort of primary care patients with chronic ischemic heart disease. BARBANZA Ischemic Heart Disease (BARIHD) study. Int J Cardiol 2013; 167:442-50. [PMID: 22305776 DOI: 10.1016/j.ijcard.2012.01.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2011] [Revised: 12/31/2011] [Accepted: 01/06/2012] [Indexed: 01/13/2023]
Abstract
BACKGROUND Prognosis of chronic patients with established ischemic heart disease (IHD) is not fully understood. The objective was to determine which factors are related to cardiovascular death and hospitalizations in patients with IHD within a primary care network. MATERIALS AND METHODS A cohort study was carried out by 69 primary care providers in Spain in 2007. Participants were followed up for a mean of 2.2 ± 0.3 years. 1095 patients were recruited if they had established (at least 1 year of known disease) IHD (myocardial infarction or and stable or unstable angina). Several hypothesized determinants of cardiovascular mortality were studied, using Cox proportional hazard regression models. Subgroup analysis was also performed for participants without cardiovascular admissions within the last year. RESULTS Mean time since first IHD diagnosis was 7.6 ± 6.0 years. Annual all-cause mortality rate was 3.25%, with 44 cardiovascular deaths and 119 cardiovascular admissions. The main prognostic factor for cardiovascular death was previous heart failure (hazard ratio [HR] 4.32, 95% confidence interval [CI] 2.30 to 8.11, p<0.001). Recent cardiovascular admission doubled the risk for death (HR 2.01, CI 1.06 to 3.81, p=0.031). Results showed that use of beta blockers and increased physical activity were the main protective factors. Patients without a recent cardiovascular admission showed previous heart failure as the main significant factor for cardiovascular death. CONCLUSIONS Patients with chronic IHD in a primary care setting may need a closer follow-up in the presence of previous conditions such as heart failure. Physical activity and treatment with beta blockers were the factors giving these patients the greatest protection.
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Affiliation(s)
- Rafael Vidal-Perez
- Cardiology Department, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, Spain.
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van der Bijl P, Heradien M, Doubell A, Brink P. QTc prolongation prior to angiography predicts poor outcome and associates significantly with lower left ventricular ejection fractions and higher left ventricular end-diastolic pressures. Cardiovasc J Afr 2012. [PMID: 23192258 PMCID: PMC3721884 DOI: 10.5830/cvja-2012-060] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Background QT prolongation on the surface ECG is associated with sudden cardiac death. The cause of QT prolongation in ischaemic heart disease (IHD) patients remains unknown, but may be due to a complex interplay between genetic factors and impaired systolic and/or diastolic function through as yet unexplained mechanisms. It was hypothesised that QT prolongation before elective coronary angiography is associated with an increased mortality at six months. Methods Complete records of 321 patients who underwent coronary angiography were examined for QT interval corrected for heart rate (QTc), left ventricular ejection fraction (LVEF), left ventricular end-diastolic pressure (LVEDP) and known ischaemic heart disease risk factors. Patients were designated long QTc (LQTc) when they had prolonged QTc intervals or normal QTc (NQTc) when the QTc interval was normal. Patients with atrial fibrillation, bundle branch blocks, no ECG in the 24 hours before angiography, or a creatinine level > 200 μmol/l were excluded. Survival was determined telephonically at six months. Results Twenty-eight per cent of the total population had LQTc. During follow up, 15 patients (4.7%) died suddenly, 73% of whom had a LQTc. LQTc was significantly associated with mortality (LQTc 12% vs NQTc 1.7%; p < 0.01), and with lower but normal LVEF (LQTc 52.9 ± 15.4% vs NQTc 61.6 ± 13.6%; p < 0.01), higher LVEDP at LVEF > 45% (LQTc 19.2 ± 9.0 mmHg vs NQTc 15.95 ± 7.5 mmHg; p < 0.05), hypercholesterolaemia and a negative family history of IHD. Conclusion In patients with sinus rhythm and normal QRS width, QTc prolongation before coronary angiography predicted increased mortality at six months. QTc also associated strongly with left ventricular systolic and diastolic dysfunction, hypercholesterolaemia and a negative family history of IHD.
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Affiliation(s)
- P van der Bijl
- Division of Cardiology, Department of Medicine, Stellenbosch University and Tygerberg Academic Hospital, Western Cape, South Africa
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Sekizuka H, Osada N, Miyake F. Sleep disordered breathing in heart failure patients with reduced versus preserved ejection fraction. Heart Lung Circ 2012; 22:104-9. [PMID: 23107286 DOI: 10.1016/j.hlc.2012.08.006] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2012] [Revised: 08/01/2012] [Accepted: 08/03/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND This study aimed to investigate and compare prevalence of sleep disordered breathing (SDB) in Japanese patients with heart failure with reduced ejection fraction (HFrEF) versus those with HF with preserved EF (HFpEF). METHODS This study consecutively included 101 Japanese patients (77 males) with de novo CHF. Echocardiography was performed twice, on admission and at discharge. All patients underwent portable overnight polygraphy within one week before discharge. The patients were stratified into two groups based on LVEF on admission, HFrEF (R group; LVEF<50%, n=82) or HFpEF (P group; LVEF≧50%, n=19); the prevalence of SDB and sleep study data were assessed. RESULTS When patients with the apnea hypopnea index ≥15 were defined as having SDB, 50% of the study patients had SDB (OSA, 10%; CSA, 39%; MSA, 1%). No significant differences in the prevalence of SDB or sleep data as well as RVSP, E/e' or plasma brain natriuretic peptide (BNP) were found between the two groups. CONCLUSIONS SDB was identified in 50% of de novo Japanese HF patients. When E/e', RVSP and plasma BNP did not significantly differ between the two groups, the prevalence of SDB was similar regardless of LVEF.
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Affiliation(s)
- Hiromitsu Sekizuka
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Japan.
| | - Naohiko Osada
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Japan
| | - Fumihiko Miyake
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Japan
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Anguita M, Castillo JC, Ruiz M, Castillo F, Jiménez-Navarro M, Crespo M, Alonso-Pulpón L, de Teresa E, Castro-Beiras A, Roig E, Artigas R, Zapata A, López de Ullibarri I, Muñiz J. Diferencias en el pronóstico de la insuficiencia cardiaca con función sistólica conservada o deprimida en pacientes mayores de 70 años que toman bloqueadores beta. Rev Esp Cardiol 2012; 65:22-8. [DOI: 10.1016/j.recesp.2011.07.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2011] [Accepted: 07/06/2011] [Indexed: 01/01/2023]
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Abstract
The natural course of heart failure with decreased and preserved systolic function is almost identical. The current concept of heart failure where decreased cardiac output plays the major role does not explain this similarity. We suggest a revised concept of heart failure where congestion plays the leading role. While congestion is almost invariably present in heart failure with normal and with reduced systolic function, the low output syndrome is only present in heart failure with reduced systolic function. The small difference in morbidity and mortality in favor of heart failure with preserved systolic function reflects the contribution of low output syndrome to the natural course of the disease. Congestion can result from low output or from multiple other conditions, but severity of congestion is the major determinant of progression of heart failure.
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Affiliation(s)
- Maya Guglin
- University of South Florida, Tampa, FL, USA.
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17
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Abstract
Increased intracardiac filling pressure or congestion causes symptoms and leads to hospital admissions in patients with heart failure, regardless of their systolic function. A history of hospital admission, in turn, predicts further hospitalizations and morbidity, and a higher number of hospitalizations determine higher mortality. Congestion is therefore the driving force of the natural history of heart failure. Congestion is the syndrome shared by heart failure with preserved and reduced systolic function. These two conditions have almost identical morbidity, mortality, and survival because the outcomes are driven by congestion. A small difference in favor of heart failure with preserved systolic function comes from decreased ejection fraction and left ventricular remodeling which is only present in heart failure with decreased systolic function. The magnitude of this difference reflects the contribution of decreased systolic function and ventricular remodeling to the progression of heart failure. The only treatment available for congestion is fluid removal via diuretics, ultrafiltration, or dialysis. It is the only treatment that works equally well for heart failure with reduced and preserved systolic function because it affects congestion, the main pathogenetic feature of the disease. Diuretics are pathogenetic therapy for heart failure.
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Affiliation(s)
- Maya Guglin
- University of South Florida, Tampa, FL, USA.
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18
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Noveanu M, Breidthardt T, Potocki M, Reichlin T, Twerenbold R, Uthoff H, Socrates T, Arenja N, Reiter M, Meissner J, Heinisch C, Stalder S, Mueller C. Direct comparison of serial B-type natriuretic peptide and NT-proBNP levels for prediction of short- and long-term outcome in acute decompensated heart failure. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2011; 15:R1. [PMID: 21208408 PMCID: PMC3222028 DOI: 10.1186/cc9398] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/19/2010] [Revised: 09/09/2010] [Accepted: 01/05/2011] [Indexed: 12/20/2022]
Abstract
Introduction Monitoring treatment efficacy and assessing outcome by serial measurements of natriuretic peptides in acute decompensated heart failure (ADHF) patients may help to improve outcome. Methods This was a prospective multi-center study of 171 consecutive patients (mean age 80 73-85 years) presenting to the emergency department with ADHF. Measurement of BNP and NT-proBNP was performed at presentation, 24 hours, 48 hours and at discharge. The primary endpoint was one-year all-cause mortality; secondary endpoints were 30-days all-cause mortality and one-year heart failure (HF) readmission. Results During one-year follow-up, a total of 60 (35%) patients died. BNP and NT-proBNP levels were higher in non-survivors at all time points (all P < 0.001). In survivors, treatment reduced BNP and NT-proBNP levels by more than 50% (P < 0.001), while in non-survivors treatment did not lower BNP and NT-proBNP levels. The area under the ROC curve (AUC) for the prediction of one-year mortality increased during the course of hospitalization for BNP (AUC presentation: 0.67; AUC 24 h: 0.77; AUC 48 h: 0.78; AUC discharge: 0.78) and NT-proBNP (AUC presentation: 0.67; AUC 24 h: 0.73; AUC 48 h: 0.75; AUC discharge: 0.77). In multivariate analysis, BNP at 24 h (1.02 [1.01-1.04], P = 0.003), 48 h (1.04 [1.02-1.06], P < 0.001) and discharge (1.02 [1.01-1.03], P < 0.001) independently predicted one-year mortality, while only pre-discharge NT-proBNP was predictive (1.07 [1.01-1.13], P = 0.016). Comparable results could be obtained for the secondary endpoint 30-days mortality but not for one-year HF readmissions. Conclusions BNP and NT-proBNP reliably predict one-year mortality in patients with ADHF. Prognostic accuracy of both biomarker increases during the course of hospitalization. In survivors BNP levels decline more rapidly than NT-proBNP levels and thus seem to allow earlier assessment of treatment efficacy. Ability to predict one-year HF readmission was poor for BNP and NT-proBNP. Trial registration ClinicalTrials.gov identifier: NCT00514384.
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Affiliation(s)
- Markus Noveanu
- Department of Internal Medicine, University Hospital Basel, Petersgraben 4, 4053 Basel, Switzerland.
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Tribouilloy C, Buiciuc O, Rusinaru D, Malaquin D, Lévy F, Peltier M. Long-term outcome after a first episode of heart failure. A prospective 7-year study. Int J Cardiol 2010; 140:309-14. [DOI: 10.1016/j.ijcard.2008.11.087] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2008] [Accepted: 11/15/2008] [Indexed: 10/21/2022]
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Valencia JF, Vallverdú M, Schroeder R, Voss A, Vázquez R, Bayés de Luna A, Caminal P. Complexity of the short-term heart-rate variability. ACTA ACUST UNITED AC 2010; 28:72-8. [PMID: 19914891 DOI: 10.1109/memb.2009.934621] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This work has proposed a methodology based on the concept of entropy rates to study the complexity of the short-term heart-rate variability (HRV) for improving risk stratification to predict sudden cardiac death (SCD) of patients with established ischemic-dilated cardiomyopathy (IDC). The short-term HRV was analyzed during daytime and nighttime by means of RR series. An entropy rate was calculated on the RR series, previously transformed to symbol sequences by means of an alphabet. A statistical analysis permitted to stratify high- and low-risk patients of suffering SCD, with a specificity (SP) of 95% and sensitivity (SE) of 83.3%.
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Affiliation(s)
- Jose F Valencia
- Department ESAII, Universitat Politecnica de Catalunya, C/Pau Gargallo 5, 08028 Barcelona, Spain.
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Tsutsui H, Tsuchihashi-Makaya M, Kinugawa S. Clinical characteristics and outcomes of heart failure with preserved ejection fraction: Lessons from epidemiological studies. J Cardiol 2010; 55:13-22. [DOI: 10.1016/j.jjcc.2009.09.003] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2009] [Accepted: 09/30/2009] [Indexed: 11/27/2022]
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Adebayo AK, Adebiyi AA, Oladapo OO, Ogah OS, Aje A, Ojji DB, Falase AO. Characterisation of heart failure with normal ejection fraction in a tertiary hospital in Nigeria. BMC Cardiovasc Disord 2009; 9:52. [PMID: 19922629 PMCID: PMC2785749 DOI: 10.1186/1471-2261-9-52] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2009] [Accepted: 11/18/2009] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The study aimed to determine the frequency and characteristics of heart failure with normal EF in a native African population with heart failure. METHODS It was a hospital cohort study. Subjects were 177 consecutive individuals with heart failure and ninety apparently normal control subjects. All the subjects underwent transthoracic echocardiography. The group with heart failure was further subdivided into heart failure with normal EF (EF > or = 50) (HFNEF) and heart failure with low EF(EF <50)(HFLEF). RESULTS The subjects with heart failure have a mean age of 52.3 +/- 16.64 years vs 52.1 +/- 11.84 years in the control subjects; p = 0.914. Other baseline characteristics except blood pressure parameters and height were comparable between the group with heart failure and the control subjects. The frequency of HFNEF was 39.5%. Compared with the HFLEF group, the HFNEF group have a smaller left ventricular diameter (in diastole and systole): (5.2 +/- 1.22 cm vs 6.2 +/- 1.39 cm; p < 0.0001 and 3.6 +/- 1.24 cm vs 5.4 +/- 1.35 cm;p < 0.0001) respectively, a higher relative wall thickness and deceleration time of the early mitral inflow velocity: (0.4 +/- 0.12 vs 0.3 +/- 0.14 p < 0.0001 and 149.6 +/- 72.35 vs 110.9 +/- 63.40 p = 0.001) respectively. The two groups with heart failure differed significantly from the control subjects in virtually all echocardiographic measurements except aortic root diameter, LV posterior wall thickness(HFLEF), and late mitral inflow velocity(HFNEF). HFNEF accounted for 70(39.5%) of cases of heart failure in this study. Hypertension is the underlying cardiovascular disease in 134(75.7%) of the combined heart failure population, 58 (82.9%) of the subjects with HFNEF group and 76(71%) of the HFLEF group. Females accounted for 44 (62.9%) of the subjects with HFNEF against 42(39.3%) in the HFLEF group (p = 0.002). CONCLUSION The frequency of heart failure with normal EF in this native African cohort with heart failure is comparable with the frequency in other populations. These groups of patients are more likely female, hypertensive with concentric pattern of left ventricular hypertrophy.
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Affiliation(s)
- Adedeji K Adebayo
- Division of Cardiovascular Medicine, Department of Medicine, University College Hospital, Ibadan, Oyo State, Nigeria
- College of Medicine University of Ibadan, Ibadan, Nigeria
| | - Adewole A Adebiyi
- Division of Cardiovascular Medicine, Department of Medicine, University College Hospital, Ibadan, Oyo State, Nigeria
- College of Medicine University of Ibadan, Ibadan, Nigeria
| | - Olulola O Oladapo
- Division of Cardiovascular Medicine, Department of Medicine, University College Hospital, Ibadan, Oyo State, Nigeria
- College of Medicine University of Ibadan, Ibadan, Nigeria
| | - Okechukwu S Ogah
- Division of Cardiovascular Medicine, Department of Medicine, University College Hospital, Ibadan, Oyo State, Nigeria
- College of Medicine University of Ibadan, Ibadan, Nigeria
| | - Akinyemi Aje
- Division of Cardiovascular Medicine, Department of Medicine, University College Hospital, Ibadan, Oyo State, Nigeria
- College of Medicine University of Ibadan, Ibadan, Nigeria
| | - Dike B Ojji
- Division of Cardiovascular Medicine, Department of Medicine, University College Hospital, Ibadan, Oyo State, Nigeria
- College of Medicine University of Ibadan, Ibadan, Nigeria
| | - Ayodele O Falase
- Division of Cardiovascular Medicine, Department of Medicine, University College Hospital, Ibadan, Oyo State, Nigeria
- College of Medicine University of Ibadan, Ibadan, Nigeria
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Montero Pérez-Barquero M. Insuficiencia cardíaca con función sistólica preservada: pronóstico. Rev Clin Esp 2009. [DOI: 10.1016/s0014-2565(09)73253-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Somaratne JB, Berry C, McMurray JJV, Poppe KK, Doughty RN, Whalley GA. The prognostic significance of heart failure with preserved left ventricular ejection fraction: a literature-based meta-analysis. Eur J Heart Fail 2009; 11:855-62. [PMID: 19654140 DOI: 10.1093/eurjhf/hfp103] [Citation(s) in RCA: 102] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
AIMS Heart failure (HF) with normal or preserved left ventricular (LV) ejection fraction (HFPEF) has been reported to be associated with similar outcome as HF with reduced EF (HFREF) in registry-based and epidemiological analyses, but many of these studies excluded patients who did not have EF measurements. Conversely, prior prospective studies have reported better outcome for patients with HFPEF. We performed a meta-analysis of prospective observational studies comparing all-cause mortality in patients with HFREF and HFPEF. METHODS AND RESULTS We searched several online databases for studies comparing outcome in HFREF and HFPEF, published before 2007. INCLUSION CRITERIA prospective, clinical HF, near complete EF data, and mortality outcome. Review Manager version 4.2.3 software was used for the analysis. Overall, 24 501 patients [9299 deaths (38%)] from 17 studies are included. Average follow-up was 47 months; the HFPEF group was older (69 vs. 66 years) and more likely to be female (44% vs. 26%). Of the 7688 patients with HFPEF 2468 died (32.1%), compared with 6831 of the 16 813 patients with HFREF (40.6%): odds ratio 0.51 (95% CI: 0.48, 0.55). CONCLUSION This literature-based meta-analysis demonstrates that mortality among patients with HFPEF was half that observed in those with HFREF, in contrast to previous reports suggesting that mortality may be similar between both groups.
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Affiliation(s)
- Jithendra B Somaratne
- Department of Medicine, Faculty of Medicine and Health Sciences, The University of Auckland, Private Bag 92019, Auckland Mail Centre, Auckland 1142, New Zealand
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Maestre A, Gil V, Gallego J, García M, García de Burgos F, Martín-Hidalgo A. Prediction clinical profile to distinguish between systolic and diastolic heart failure in hospitalized patients. Eur J Intern Med 2009; 20:313-8. [PMID: 19393500 DOI: 10.1016/j.ejim.2008.09.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2007] [Revised: 08/12/2008] [Accepted: 09/03/2008] [Indexed: 10/21/2022]
Abstract
BACKGROUND In recent decades, the growing incidence of patients with heart failure who have preserved systolic function, underlines the need to differentiate between heart failure due to diastolic dysfunction and that due to systolic dysfunction. OBJECTIVE To develop a prediction profile of clinical parameters that enables clinicians to differentiate between patients with systolic and diastolic heart failure. METHODS 164 patients admitted for congestive heart failure to the cardiology department of an academic tertiary care hospital, whose left ventricular systolic and diastolic function had been evaluated echocardiographically and who satisfied the Framingham criteria for heart failure, were prospectively recruited. All patients answered a questionnaire which included, in addition to other clinical variables, the Framingham criteria. RESULTS Patients with diastolic heart failure (61.6%) were more likely to be older, female, and to present left ventricular hypertrophy (LVH), with a lower proportion of smokers, alcohol drinkers, coronary disease, q wave and left bundle branch block (all p<0.005). The predicting model obtained on the logistic regression analysis was very significant, with three variables and 72.3% of correct predictions (x(2) value=40,457, p<0.001). These three variables, predictors of diastolic as opposed to systolic heart failure, were female sex (OR=3.546), left ventricle hypertrophy (OR=4.011) and absence of coronary disease (OR=3.547). CONCLUSION Three variables which can be easily evaluated, female sex, left ventricular hypertrophy and presence or absence of coronary disease, may enable clinicians to differentiate between patients with systolic or diastolic heart failure.
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Affiliation(s)
- Ana Maestre
- Internal Medicine Department. Hospital General Universitario de Elche, Spain.
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26
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Anguita M, Toledano F, León C, Castillo JC. Hipertensión arterial, cardiopatía hipertensiva e insuficiencia cardíaca. Papel de los diuréticos de asa. Med Clin (Barc) 2008; 131:660-4. [DOI: 10.1157/13128726] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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27
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Otero-Raviña F, Grigorian-Shamagian L, Fransi-Galiana L, Názara-Otero C, Fernández-Villaverde JMA, del Alamo-Alonso A, Nieto-Pol E, de Santiago-Boullón M, López-Rodríguez I, Cardona-Vidal JMA, Varela-Román A, González-Juanatey JR. Morbidity and mortality among heart failure patients in Galicia, N.W. Spain: the GALICAP Study. Int J Cardiol 2008; 136:56-63. [PMID: 18617282 DOI: 10.1016/j.ijcard.2008.04.025] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2007] [Revised: 09/30/2007] [Accepted: 04/23/2008] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Characterization of current morbidity and mortality among heart failure (HF) outpatients in Galicia (N.W. Spain), together with their main determinants. DESIGN Prospective multicentre study involving 149 primary care physicians. SETTING Primary care physicians selected randomly from among all (1959) primary care physicians in Galicia. PATIENTS Clinical and epidemiological information for 1195 outpatients with HF were collected in 2006, with a mean follow-up of 6.5+/-1.5 months. MAIN OUTCOME MEASURES Survival rates were calculated by Cox's proportional hazard model. RESULTS Mean patient age was 76 years, 48% were male, 82% had a history of arterial hypertension, and 32% ischaemic cardiopathy. Echocardiography had been performed in 67%, showing preserved systolic function in 61%. Ninety-two (8%) died during follow-up [74 (80%) of them from cardiac causes], and 313 (29%) were re-admitted to hospital [230 (73%) of them for cardiac reasons]. Multivariate analysis identified the following independent predictors of cardiovascular death and/or readmission: ischaemic cardiopathy [hazard ratio (HR) 1.76, 95% confidence interval (CI) 1.29-4.40], stroke (HR 1.79, CI 1.18-2.73), oedema (HR 1.49, CI 1.10-2.03), anaemia (HR 1.66, CI 1.21-2.27), deteriorated systolic function (HR 1.62, CI 1.19-2.20), and previous cardiovascular admissions (HR 2.33, CI 1.67-3.24). Residence in the Barbanza district was identified as an independent predictor of survival free from cardiovascular admission (HR 0.56, CI 0.37-0.86). CONCLUSION Morbidity and mortality are currently high among Galician HF patients, and their best single predictor is previous hospitalization for cardiovascular reasons.
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Austin BA, Wang Y, Smith GL, Vaccarine V, Krumholz HM, McNamara RL. Systolic function as a predictor of mortality and quality of life in long-term survivors with heart failure. Clin Cardiol 2008; 31:119-24. [PMID: 18383045 DOI: 10.1002/clc.20118] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Patients with heart failure (HF) and preserved ejection fraction (EF) have been shown to have high mortality rates, comparable to those with reduced EF. Thus, long-term survivors of HF, regardless of ejection fraction, are a select group. Little is known about disease-related quality of life (QOL) and health status in these patients. HYPOTHESIS Preserved EF in patients with heart failure independently predicts long-term survival, health related quality of life (QOL), or functional status. METHODS The study followed a cohort of 413 patients consecutively hospitalized for HF between March 1996 and September 1998. In July 2005, information was collected about their mortality, health related QOL as defined by disease-specific Kansas City Cardiomyopathy Questionnaire (KCCQ) scores, and functional decline as defined by limitations in Activities of Daily Living (ADL) scores. RESULTS The primary outcomes were mortality, QOL, and functional decline. At follow-up, 8.1 years after enrollment, overall mortality was 76% (314/413). Adjusted for age, gender, renal insufficiency, diabetes mellitus, hypertension, HF, and respiratory disease, those with decreased ejection fraction (EF < 40%) had higher mortality compared with those with preserved ejection fraction (hazard ratio [HR] 1.42; confidence interval [CI] = 1.13, 1.80, p = 0.003). The KCCQ scores, including Clinical Summary Scores and Symptom Limitation Scores, as well as ADL limitations, were not significantly different in the survivors with preserved or decreased EF. CONCLUSIONS Heart failure patients with preserved EF have a modest survival advantage compared with those with decreased EF, but health related QOL scores and functional decline in survivors are similar regardless of systolic function.
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Affiliation(s)
- Bethany A Austin
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut, USA
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Zanchetti A, Cuspidi C, Comarella L, Rosei EA, Ambrosioni E, Chiariello M, Leonetti G, Mancia G, Pessina AC, Salvetti A, Trimarco B, Volpe M, Grassivaro N, Vargiu G. Left ventricular diastolic dysfunction in elderly hypertensives: results of the APROS-diadys study. J Hypertens 2008; 25:2158-67. [PMID: 17885561 DOI: 10.1097/hjh.0b013e3282eee9cf] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND A number of patients with chronic heart failure (CHF) have diastolic but not systolic dysfunction. This occurs particularly in the elderly and in hypertension, but the prevalence of diastolic dysfunction in elderly hypertensives without CHF has never been investigated systematically. METHODS AND RESULTS The Assessment of PRevalence Observational Study of Diastolic Dysfunction (APROS-diadys) project was a cross-sectional observational study on elderly (age >/= 65 years) hypertensives without systolic dysfunction [left ventricular ejection fraction (LVEF) >/= 45%] consecutively attending hospital outpatient clinics in Italy, in order to establish the prevalence of echocardiographic signs of diastolic dysfunction according to various criteria, and to correlate them with a number of demographic and clinical characteristics. Primary criteria for diastolic dysfunction was an E/A ratio (ratio between transmitral peak velocities of E and A waves) < 0.7 or > 1.5 on echocardiographic Doppler examination. Secondary criteria were: E/A < 0.5 and deceleration time (DT) > 280 ms, or isovolumic relaxation time (IVRT) > 105 ms or pulmonary vein (PV) peak systolic/peak diastolic flow (S/D) ratio > 2.5 or PV atrial retrograde flow (PV A) > 35 cm/s. Throughout Italy, 27 447 patients were screened in 107 clinics, with 24 141 excluded according to protocol. Among the remaining 3336 patients, 754 (22.6%) had signs of CHF. After exclusion of 37 protocol violators, 2545 patients (49.0% men, mean age 70.3 years, 95.4% under antihypertensive treatment) were studied ultrasonographically. Diastolic dysfunction (primary criteria) was found in 649 (25.8%) patients. Multiple logistic regression analysis found age, gender, left ventricular mass, systolic and pulse pressures and midwall shortening fraction as significant covariates. Using secondary criteria, the prevalence of diastolic dysfunction was higher (45.6%), mostly because of IVRT > 105 ms or PVA flow > 35 cm/s. CONCLUSION CHF and diastolic dysfunction are highly prevalent in elderly hypertensives attending hospital clinics.
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Affiliation(s)
- Alberto Zanchetti
- Centro di Fisiologia Clinica, University of Milan, Ospedale Maggiore Milan, Italy.
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Jucker BM, Doe CP, Schnackenberg CG, Olzinski AR, Maniscalco K, Williams C, Hu TCC, Lenhard SC, Costell M, Bernard R, Sarov-Blat L, Steplewski K, Willette RN. PPARdelta activation normalizes cardiac substrate metabolism and reduces right ventricular hypertrophy in congestive heart failure. J Cardiovasc Pharmacol 2007; 50:25-34. [PMID: 17666912 DOI: 10.1097/fjc.0b013e31804b4163] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Previously, it was shown that selective deletion of peroxisome proliferator activated receptor delta (PPARdelta) in the heart resulted in a cardiac lipotoxicity, hypertrophy, and heart failure. The aim of the present study was to determine the effects of chronic and selective pharmacological activation of PPARdelta in a model of congestive heart failure. PPARdelta-specific agonist treatment (GW610742X at 30 and 100 mg/kg/day for 6-9 weeks) was initiated immediately postmyocardial infarction (MI) in Sprague-Dawley rats. Magnetic resonance imaging/spectroscopy was used to assess cardiac function and energetics. A 1-(13)C glucose clamp was performed to assess relative cardiac carbohydrate versus fat oxidation. Additionally, cardiac hemodynamics and reverse-transcription polymerase chain reaction gene expression analysis was performed. MI rats had significantly reduced left ventricle (LV) ejection fractions and whole heart phosphocreatine/adenosine triphosphate ratio compared with Sham animals (reduction of 43% and 14%, respectively). However, GW610742X treatment had no effect on either parameter. In contrast, the decrease in relative fat oxidation rate observed in both LV and right ventricle (RV) following MI (decrease of 58% and 54%, respectively) was normalized in a dose-dependent manner following treatment with GW610742X. These metabolic changes were associated with an increase in lipid transport/metabolism target gene expression (eg, CD36, CPT1, UCP3). Although there was no difference between groups in LV weight or infarct size measured upon necropsy, there was a dramatic reduction in RV hypertrophy and lung congestion (decrease of 22-48%, P<0.01) with treatment which was associated with a >7-fold decrease (P<0.05) in aterial natriuretic peptide gene expression in RV. Diuretic effects were not observed with GW610742X. In conclusion, chronic treatment with a selective PPARdelta agonist normalizes cardiac substrate metabolism and reduces RV hypertrophy and pulmonary congestion consistent with improvement in congestive heart failure.
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Affiliation(s)
- Beat M Jucker
- Cardiovascular and Urogenital Center of Excellence for Drug Discovery, and Genomics Research, GlaxoSmithKline, King of Prussia, PA 19406, USA
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Fung JW, Sanderson JE, Yip GW, Zhang Q, Yu CM. Impact of Atrial Fibrillation in Heart Failure With Normal Ejection Fraction: A Clinical and Echocardiographic Study. J Card Fail 2007; 13:649-55. [DOI: 10.1016/j.cardfail.2007.04.014] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2006] [Revised: 04/25/2007] [Accepted: 04/26/2007] [Indexed: 11/24/2022]
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Barrios V, Escobar C, Calderon A. Candesartan: from left ventricular hypertrophy to heart failure, a global approach. Expert Rev Cardiovasc Ther 2007; 5:825-34. [PMID: 17867913 DOI: 10.1586/14779072.5.5.825] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Cardiovascular disease is a continuum, starting with risk factors resulting from physiological changes and extending to vascular pathology associated with adverse clinical outcomes. The overactivation of the renin-angiotensin-aldosterone system has been related to the development and worsening of risk factors associated with cardiovascular diseases such as hypertension and heart failure. Treatment at each stage along the continuum may prevent, or at least delay, the next one, and so it is crucial to initiate therapy as early as possible in such patients so as to provide optimal care. Candesartan, a long-acting angiotensin receptor antagonist, has been shown to be an effective, and well-tolerated therapy, in both the early and late phases of cardiovascular disease (prehypertension, hypertension, left ventricular hypertrophy and heart failure). This article reviews the data supporting the use of candesartan in cardiovascular medicine, with a focus on left ventricular hypertrophy and ultimately heart failure. Particular emphasis is given to the Candesartan in Heart Failure Assessment of Reduction in Mortality and Morbidity (CHARM) program, which has shown a positive impact of candesartan in patients with chronic heart failure in terms of reducing the incidence of cardiovascular deaths and chronic heart failure hospitalizations.
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Affiliation(s)
- Vivencio Barrios
- Department of Cardiology, Hospital Ramón y Cajal, Ctra. Colmenar km 9.100, 28034 Madrid, Spain.
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Bayes-Genis A, Vazquez R, Puig T, Fernandez-Palomeque C, Fabregat J, Bardají A, Pascual-Figal D, Ordoñez-Llanos J, Valdes M, Gabarrús A, Pavon R, Pastor L, Gonzalez Juanatey JR, Almendral J, Fiol M, Nieto V, Macaya C, Cinca J, Bayes de Luna A. Left atrial enlargement and NT-proBNP as predictors of sudden cardiac death in patients with heart failure. Eur J Heart Fail 2007; 9:802-7. [PMID: 17569580 DOI: 10.1016/j.ejheart.2007.05.001] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2006] [Revised: 03/05/2007] [Accepted: 05/01/2007] [Indexed: 11/22/2022] Open
Abstract
AIMS The identification of valuable markers of sudden cardiac death (SCD) in patients with established HF remains a challenge. We sought to assess the value of clinical, echocardiographic and biochemical variables to predict SCD in a consecutive cohort of patients with heart failure (HF) due to systolic dysfunction. METHODS A cohort of 494 patients with established HF had baseline echocardiographic and NT-proBNP measurements and were followed for 942+/-323 days. RESULTS Fifty patients suffered SCD. Independent predictors of SCD were indexed LA size>26 mm/m2 (HR 2.8; 95% CI 1.5-5.0; p=0.0007), NT-proBNP>908 ng/L (HR 3.1; 95% CI 1.5-6.7; p=0.003), history of myocardial infarction (HR 2.3; 95% CI 1.3-4.1; p=0.007), peripheral oedema (HR 2.1; 95% CI 1.1-3.9; p=0.02), and diabetes mellitus (HR 1.9; 95% CI 1.1-3.3; p=0.03). NYHA functional class, left ventricular ejection fraction and glomerular filtration rate were not independent predictors of SCD in this cohort. Notably, the combination of both LA size>26 mm/m2 and NT-proBNP>908 ng/L increased the risk of SCD (HR 4.3; 95% CI 2.5-7.6; p<0.0001). At 36 months, risk of SCD in patients with indexed LA size<or=26 mm/m2 and NT-proBNP<or=908 ng/L was 3%, while in patients with indexed LA size>26 mm/m2 and NT-proBNP>908 ng/L reached 25% (p<0.0001). CONCLUSIONS Among HF patients, indexed LA size and NT-proBNP levels are more useful to stratify risk of SCD than other clinical, echocardiographic or biochemical variables. The combination of these two parameters should be considered for predicting SCD in patients with HF.
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Affiliation(s)
- Antoni Bayes-Genis
- Cardiology Service, Hospital Santa Creu i Sant Pau-ICCC, Barcelona, and Hospital Universitario, Santiago de Compostela, Spain.
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Otero-Raviña F, Grigorian-Shamagian L, Fransi-Galiana L, Názara-Otero C, Fernández-Villaverde JM, del Álamo-Alonso A, Nieto-Pol E, de Santiago-Boullón M, López-Rodríguez I, Cardona-Vidal JM, Varela-Román A, González-Juanatey JR. Estudio gallego de insuficiencia cardiaca en atención primaria (estudio GALICAP). Rev Esp Cardiol 2007. [DOI: 10.1157/13101641] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Shapiro M, Moyers B, Marcus GM, Gerber IL, McKeown BH, Vessey JC, Jordan MV, Huddleston M, Foster E, Chatterjee K, Michaels AD. Diagnostic characteristics of combining phonocardiographic third heart sound and systolic time intervals for the prediction of left ventricular dysfunction. J Card Fail 2007; 13:18-24. [PMID: 17338999 DOI: 10.1016/j.cardfail.2006.09.009] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2006] [Revised: 09/12/2006] [Accepted: 09/29/2006] [Indexed: 11/20/2022]
Abstract
BACKGROUND The third heart sound (S3) and systolic time intervals (STIs) are validated clinical indicators of left ventricular (LV) dysfunction. We investigated the test characteristics of a combined score summarizing S3 and STI results for predicting LV dysfunction. METHODS AND RESULTS A total of 81 adults underwent computerized phonelectrocardiography for S3 and STI (Audicor, Inovise Medical Inc), cardiac catheterization for LV end-diastolic pressure (LVEDP), echocardiography for LV ejection fraction (LVEF), and B-type natriuretic peptide (BNP) testing. LV dysfunction was defined as both an LVEDP >15 mm Hg and LVEF <50%. The STI measured was the electromechanical activation time (EMAT) divided by LV systolic time (LVST). Z-scores for the S3 confidence score and EMAT/LVST were summed to generate the LV dysfunction index. The LV dysfunction index had a correlation coefficient of 0.38 for LVEDP (P = .0003), -0.53 for LVEF (P < .0001), and 0.35 for BNP (P = .0008). This index had a receiver operative curve c-statistic of 0.89 for diagnosis of LV dysfunction; a cutoff >1.87 yielded 72% sensitivity, 92% specificity, 9.0 positive likelihood ratio, and 88% accuracy. CONCLUSIONS In this preliminary study, the LV dysfunction index combined S3 and STI data from noninvasive electrophonocardiography, and yielded superior test characteristics compared to the individual tests for the diagnosis of LV dysfunction.
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Affiliation(s)
- Mia Shapiro
- Division of Cardiology, Department of Medicine, University of California at San Francisco Medical Center, San Francisco, California, USA
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Otero-Raviña F, Grigorian-Shamagian L, Fransi-Galiana L, Názara-Otero C, Fernández-Villaverde JM, del Álamo-Alonso A, Nieto-Pol E, de Santiago-Boullón M, López-Rodríguez I, Cardona-Vidal JM, Varela-Román A, González-Juanatey JR. Galician Study of Heart Failure in Primary Care (GALICAP Study). ACTA ACUST UNITED AC 2007. [DOI: 10.1016/s1885-5857(07)60170-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Hawkins NM, Wang D, McMurray JJV, Pfeffer MA, Swedberg K, Granger CB, Yusuf S, Pocock SJ, Ostergren J, Michelson EL, Dunn FG. Prevalence and prognostic implications of electrocardiographic left ventricular hypertrophy in heart failure: evidence from the CHARM programme. Heart 2006; 93:59-64. [PMID: 16952975 PMCID: PMC1861335 DOI: 10.1136/hrt.2005.083949] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Electrocardiographic left ventricular hypertrophy (ECG LVH) is a powerful independent predictor of cardiovascular morbidity and mortality in hypertension. OBJECTIVE To determine the contemporary prevalence and prognostic implications of ECG LVH in a broad spectrum of patients with heart failure with and without reduced left ventricular ejection fraction (LVEF). METHODS AND OUTCOME: The Candesartan in Heart failure: Assessment of Reduction in Mortality and morbidity (CHARM) programme randomised 7599 patients with symptomatic heart failure to receive candesartan or placebo. The primary outcome comprised cardiovascular death or hospital admission for worsening heart failure. The relative risk (RR) conveyed by ECG LVH compared with a normal ECG was examined in a Cox model, adjusting for as many as 31 covariates of prognostic importance. RESULTS The prevalence of ECG LVH was similar in all three CHARM trials (Alternative, 15.4%; Added, 17.1%; Preserved, 14.7%; Overall, 15.7%) despite a more frequent history of hypertension in CHARM-Preserved. ECG LVH was an independent predictor of worse prognosis in CHARM-Overall. RR for the primary outcome was 1.27 (95% confidence interval (CI) 1.04 to 1.55, p = 0.018). The risk of secondary end points was also increased: cardiovascular death, 1.50 (95% CI 1.13 to 1.99, p = 0.005); hospitalisation due to heart failure, 1.19 (95% CI 0.94 to 1.50, p = 0.148); and composite major cardiovascular events, 1.35 (95% CI 1.12 to 1.62, p = 0.002). CONCLUSION ECG LVH is similarly prevalent in patients with symptomatic heart failure regardless of LVEF. The simple clinical finding of ECG LVH was an independent predictor of a worse clinical outcome in a broad spectrum of patients with heart failure receiving extensive contemporary treatment. Candesartan had similar benefits in patients with and without ECG LVH.
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Affiliation(s)
- N M Hawkins
- Department of Cardiology, Stobhill Hospital, Balornock Road, Springburn, Glasgow G21 3UW, UK.
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Kovacs I, Toth J, Tarjan J, Koller A. Correlation of flow mediated dilation with inflammatory markers in patients with impaired cardiac function. Beneficial effects of inhibition of ACE. Eur J Heart Fail 2006; 8:451-9. [PMID: 16325470 DOI: 10.1016/j.ejheart.2005.10.011] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2005] [Revised: 07/30/2005] [Accepted: 10/17/2005] [Indexed: 11/27/2022] Open
Abstract
Impaired cardiac function is frequently accompanied by peripheral vascular dysfunction and a pro-inflammatory condition, which may be associated with elevated levels of angiotensin II. We hypothesized that the magnitude of flow mediated dilatation (FMD) of the brachial artery of post myocardial infarction patients will correlate with serum levels of tumor necrosis factor alpha (TNFalpha) and C-reactive protein (CRP), and that treatment with angiotensin converting enzyme inhibitors (ACEI) will increase FMD by reducing TNFalpha and CRP. Patients were treated with low dose (10 mg/day) quinapril (Q) or enalapril (E) and their effects on FMD and inflammatory markers were evaluated after 8 and 12 weeks. Before treatment, in both groups FMD showed a low value (Q: 2.95+0.42% and E: 3.3+/-0.33%), whereas TNF-alpha (Q: 31.65+/-8.23 pg/ml and E: 29.5+/-5.9 pg/ml) and CRP (Q: 7.28+/-2.96 mg/ml and E: 7.08+/-3.02 mg/ml) were elevated. In the Q group, but not in the E group FMD increased significantly, (to 5.96+1.10%), whereas TNF-alpha (19.0+/-12.21 pg/ml) and CRP (to 3.91+/-1.82 mg/L) significantly decreased after 8 and 12 weeks of Q treatment. Moreover, the magnitude of FMD showed a strong inverse correlation with serum levels of TNF-alpha and CRP after Q treatment. Thus, in post myocardial infarction patients endothelial dysfunction assessed by FMD correlates with elevated levels of plasma inflammatory markers, and low dose quinapril improves endothelial function, likely by reducing vascular inflammation.
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Affiliation(s)
- Imre Kovacs
- Markusovszky Hospital, Endothelium study group, H-9700, Szombathely, Hungary
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Hernández G, Anguita M, Ojeda S, Durán C, Rodríguez A, Ruiz M, Moreno Á, López-Granados A, Castillo JC, Arizón JM, de Lezo JS. Insuficiencia cardiaca con función sistólica conservada. Diferencias pronósticas según la etiología. Rev Esp Cardiol 2006. [DOI: 10.1157/13087056] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Ahmed A. Association of diastolic dysfunction and outcomes in ambulatory older adults with chronic heart failure. J Gerontol A Biol Sci Med Sci 2006; 60:1339-44. [PMID: 16282571 PMCID: PMC2628479 DOI: 10.1093/gerona/60.10.1339] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Studies of patients with heart failure and preserved systolic function report variable outcomes compared with those of patients with impaired systolic function. OBJECTIVE To study outcomes of diastolic (vs systolic) heart failure in older adults with chronic heart failure. METHODS Patients were ambulatory chronic heart failure patients 65 years and older (N = 3984) who participated in the Digitalis Investigation Group trial. Of these, 3405 had systolic heart failure (ejection fraction < or =45%) and 579 had diastolic heart failure (ejection fraction >45%). By using a 1:1 match by age, sex, and race, 571 diastolic heart failure patients were matched with 571 systolic heart failure patients. Kaplan-Meier survival analyses and multivariable Cox proportional hazard analyses were used to estimate the risk of various outcomes between the groups. RESULTS During the 1044 mean days of follow up, compared with 41% of systolic heart failure patients, 27% of diastolic heart failure patients died (p <.001). Presence of diastolic heart failure was independently associated with a 27% decreased risk of all-cause death (adjusted hazard ratio [HR] = 0.73; 95% confidence interval [CI], 0.58-0.91) and a 32% reduction in risk of hospitalization due to heart failure (adjusted HR = 0.68; 95% CI, 0.52-0.88). There was no difference in overall hospitalization between the groups. However, compared with systolic heart failure patients, diastolic heart failure patients were more likely to be hospitalized due to noncardiovascular causes (adjusted HR = 1.38; 95% CI, 1.02-1.88). CONCLUSIONS Older adults with diastolic heart failure had lower risk of all-cause mortality and heart failure-related hospitalizations, but higher risk of noncardiovascular hospitalization.
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Affiliation(s)
- Ali Ahmed
- Geriatric Heart Failure Clinic, and Division of Gerontology and Geriatric Medicine, Department of Medicine, University of Alabama at Birmingham, 35294, USA.
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Ahmed A, Aban IB, Weaver MT, Aronow WS, Fleg JL. Serum digoxin concentration and outcomes in women with heart failure: A bi-directional effect and a possible effect modification by ejection fraction. Eur J Heart Fail 2005; 8:409-19. [PMID: 16311070 PMCID: PMC2708081 DOI: 10.1016/j.ejheart.2005.10.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2005] [Revised: 07/01/2005] [Accepted: 10/03/2005] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND The association between serum digoxin concentration (SDC) and outcomes in women with heart failure (HF) has not been well studied. AIMS To test the hypothesis that the effect of digoxin on outcomes in women with HF is bi-directional and dependent on SDC, as in men, and is modified by ejection fraction (EF). METHODS We studied 1366 female participants of the Digitalis Investigation Group trial in whom data on SDC (ng/ml) were available. We calculated adjusted odds ratios (AOR) and Bonferroni-adjusted 97.5% confidence intervals (CI) for various outcomes at a median follow up of 41 months, in all women and stratified by EF 35%. RESULTS Compared with placebo (26.9%), 40.3% with SDC> or =1.2 (AOR=1.80; CI=1.14-2.86; p=0.004) and 26.6% with SDC 0.5-1.1 (AOR=1.05; CI=0.73-1.51; p=0.762) died. Respective rates for HF-hospitalizations were: placebo (32.8%), SDC> or =1.2 (38.0%) and SDC 0.5-1.1 (25.5%). For women with EF<35% (N=677), SDC 0.5-1.1 lowered odds for HF-hospitalizations (AOR=0.63; CI=0.39-1.00; p=0.026) without increasing odds for death (AOR=0.77; CI=0.47-1.26; p=0.233). In women with EF> or =35% (N=689), SDC 0.5-1.1 had a borderline association with death (AOR=1.58; CI=0.92-2.72; p=0.058) but not with HF-hospitalization (AOR=0.95; CI=0.54-1.66; p=0.826). CONCLUSIONS As in men, in women with HF, digoxin has a bi-directional effect based on SDC, and the beneficial effects were significant only among women with EF<35%.
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Affiliation(s)
- Ali Ahmed
- Division of Gerontology and Geriatric Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA.
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Weber KT. Are Myocardial Fibrosis and Diastolic Dysfunction Reversible in Hypertensive Heart Disease? ACTA ACUST UNITED AC 2005; 11:322-4; quiz 325. [PMID: 16330908 DOI: 10.1111/j.1527-5299.2005.04479.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Diastolic dysfunction is an important factor contributing to the appearance of symptomatic heart failure, particularly among elderly women with arterial hypertension. In hypertensive heart disease, the presence of cardiac fibrosis is an important determinant of abnormal myocardial stiffness that contributes to diastolic dysfunction. Recent studies indicate the feasibility of a pharmacology-based regression of fibrosis and improvement in diastolic stiffness.
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Affiliation(s)
- Karl T Weber
- Division of Cardiovascular Diseases, University of Tennessee Health Science Center, Memphis, TN 38163, USA.
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van Jaarsveld CHM, Ranchor AV, Kempen GIJM, Coyne JC, van Veldhuisen DJ, Sanderman R. Epidemiology of heart failure in a community-based study of subjects aged > or = 57 years: incidence and long-term survival. Eur J Heart Fail 2005; 8:23-30. [PMID: 16209932 DOI: 10.1016/j.ejheart.2005.04.012] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2004] [Accepted: 04/27/2005] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND Survival data from hospital-based or clinical trial studies of patients with chronic heart failure (CHF) do not represent survival in community-based settings. AIMS To determine the incidence of CHF and the associated long-term survival in a community-based sample aged > or = 57 years and to assess the mortality risk associated with sex and age. METHODS This study was part of the Groningen Longitudinal Aging Study. RESULTS Annual incidence of CHF per 1000 ranged from 2.5 in middle aged adults (57-60 years) up to 22.4 in older females (> or = 80 years) and 28.2 in older males (> or = 80 years). The 1, 2, 5 and 7-year survival rates were 74%, 65%, 45%, 32% for patients with CHF, compared to 97%, 94%, 80% and 70% in a matched reference group without CHF. Higher age (> or = 76 years) was a risk factor for mortality (OR = 2.1) and male sex was a risk factor in those aged < or = 75 years (OR = 1.9) but not for older patients. CONCLUSION Long-term survival rates for patients with CHF in the community were worse than the known survival rates from clinical trials. There is a need for studies describing the care of patients with CHF in the community, including the type of care, the provider, the quality of care and the outcome.
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Affiliation(s)
- Cornelia H M van Jaarsveld
- Northern Centre for Healthcare Research, Department of Public Health and Health Psychology, University Medical Centre Groningen, PO Box 196, 9700 AD Groningen, The Netherlands.
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Varela Román A, Grigorian Shamagian L, Bandín Diéguez MA, Rigueiro Veloso P, González-Juanatey JR. Influencia del sexo en la mortalidad a largo plazo de pacientes hospitalizados por insuficiencia cardíaca con función sistólica conservada o deprimida. Rev Esp Cardiol 2005. [DOI: 10.1157/13079911] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Varela-Roman A, Grigorian Shamagian L, Barge Caballero E, Mazon Ramos P, Rigueiro Veloso P, Gonzalez-Juanatey JR. Influence of diabetes on the survival of patients hospitalized with heart failure: A 12-year study. Eur J Heart Fail 2005; 7:859-64. [PMID: 15923138 DOI: 10.1016/j.ejheart.2005.01.017] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2004] [Revised: 10/27/2004] [Accepted: 01/27/2005] [Indexed: 11/17/2022] Open
Abstract
AIM To investigate the influence of diabetes mellitus (DM) on the prognosis of heart failure (HF) patients, focussing specifically on aetiology and patients with preserved left ventricular systolic function (LVSF), which to date has not been fully investigated. METHOD AND RESULTS 1659 Patients hospitalized for HF between 1991 and 2002 in the Cardiology Department of a tertiary hospital, aged 69+/-12 years, 60% male were studied prospectively. Arterial hypertension was present in 54% of patients, DM in 26% and ischaemic cardiomyopathy in 51%. A survival analysis performed in April 2003 showed that DM worsens the prognosis of the whole group (median survival (MS): 3.6 vs. 5.4 years; p<0.001), of ischaemic and non-ischaemic patients (MS: 3.8 vs. 4.9 years; p=0.13 and 3.6 vs. 6.0 years; p<0.001, respectively). A similar effect of DM was shown in patients with preserved LVSF (MS: 3.8 vs. 5.8 years; p=0.03) and in patients with impaired LVSF (3.6 vs. 6.3 years; p<0.0001). CONCLUSION DM increases mortality among HF patients with preserved and impaired LVSF and those without ischaemic cardiomyopathy.
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Thune JJ, Carlsen C, Buch P, Seibaek M, Burchardt H, Torp-Pedersen C, Køber L. Different prognostic impact of systolic function in patients with heart failure and/or acute myocardial infarction. Eur J Heart Fail 2005; 7:852-8. [PMID: 15923139 DOI: 10.1016/j.ejheart.2005.01.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2004] [Revised: 12/20/2004] [Accepted: 01/27/2005] [Indexed: 11/18/2022] Open
Abstract
AIMS To study the prognostic importance of left ventricular systolic function in patients with heart failure (HF) and acute myocardial infarction (AMI) with respect to the presence of prior heart failure and known ischemic heart disease. METHODS In 13,084 consecutive patients diagnosed with either AMI or HF, a medical history and an echocardiographic assessment of left ventricular systolic function by wall motion index (WMI) were obtained. Patients were divided into four groups: AMI with or without a history of HF, and primary HF (no recent AMI) with or without a history of ischemic heart disease (IHD). Mortality was assessed after nine years of follow-up. RESULTS WMI stratified patients according to all-cause mortality in all four groups of patients (p<0.0001). For a decrease in WMI of 0.3 (corresponding to a decrease in left ventricular ejection fraction of 0.1), the hazard ratio was 1.61 (95% CI: 1.48-1.76) for AMI patients without prior HF, 1.43 (1.38-1.48) for AMI patients with prior HF, 1.26 (1.22-1.30) for primary HF patients with IHD and 1.23 (1.18-1.27) for HF patients without IHD. CONCLUSION WMI stratifies patients with IHD and/or HF according to risk of all-cause death. The presence of HF attenuates the prognostic power of WMI.
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Affiliation(s)
- Jens Jakob Thune
- Department of Cardiology, B2141, The Heart Centre, University Hospital of Copenhagen, Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen O, Denmark.
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Bayés-Genís A, Lopez L, Zapico E, Cotes C, Santaló M, Ordonez-Llanos J, Cinca J. NT-ProBNP reduction percentage during admission for acutely decompensated heart failure predicts long-term cardiovascular mortality. J Card Fail 2005; 11:S3-8. [PMID: 15948093 DOI: 10.1016/j.cardfail.2005.04.006] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND N-terminal brain natriuretic peptide (NT-proBNP) improves emergency room diagnosis of acutely decompensated heart failure. Less evidence is available on the usefulness of NT-proBNP as a prognostic marker after hospitalization for acute heart failure. The percentage of NT-proBNP reduction during admission and its prognostic significance were studied. METHODS AND RESULTS This was a prospective study of 74 patients in the emergency department who were diagnosed with acute heart failure and who had follow-up evaluation for 6 and 12 months after admission. Plasma NT-proBNP concentrations were measured on admission, at 24 hours, at day 7, and at 6 and 12 months. Eighteen patients died during the 12-month follow-up; 12 deaths were from cardiovascular causes. NT-proBNP concentrations were significantly higher in the emergency department and at 24 hours than those concentrations that were found at day 7 and beyond (P < .001). During admission, the NT-proBNP concentration fell a mean of 15% in patients who died of cardiovascular causes during the 1-year follow-up evaluation, in 75% in those patients who died of non-cardiovascular causes, and in 50% in survivors (P = .004). The area under the receiver operator characteristic curve for NT-proBNP reduction percentage to predict cardiovascular death was 0.78 (95% CI, 0.66-0.90; P = .002). A 30% NT-proBNP reduction percentage cutoff value had 75% accuracy for the identification of high-risk patients and was the only variable that was associated with cardiovascular death in multivariate analysis (odds ratio, 4.4; 95% CI, 1.12-17.4; P = .03). CONCLUSION NT-proBNP reduction percentage during admission for acutely decompensated heart failure appeared to be the best predictor of cardiovascular death during the follow-up period. A <30% NT-proBNP reduction percentage identified a subgroup of high-risk patients.
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Affiliation(s)
- Antoni Bayés-Genís
- Department of Cardiology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
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Varela-Roman A, Grigorian L, Barge E, Bassante P, de la Peña MG, Gonzalez-Juanatey JR. Heart failure in patients with preserved and deteriorated left ventricular ejection fraction. Heart 2005; 91:489-94. [PMID: 15772209 PMCID: PMC1768853 DOI: 10.1136/hrt.2003.031922] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES To determine clinical and prognostic differences between preserved and deteriorated systolic function (defined as left ventricular (LV) ejection fractions > or = 50% and < 50%, respectively) in patients with heart failure satisfying modified Framingham criteria. PATIENTS AND METHODS Records were studied of 1252 patients with congestive heart failure (CHF) (mean (SD) age 69.4 (11.7) years; 485 women, 767 men) who had been admitted to a cardiology service for CHF in the period 1991-2002 and whose LV systolic function had been echocardiographically evaluated within two weeks of admission. Data were collected on the main clinical findings, supplementary examinations, treatment, and duration of hospitalisation. Whether the patient was alive in the spring of 2003 was evaluated by searching the general archives of the hospital and by telephone survey. RESULTS LV systolic function was preserved in 39.8% of patients. Age, female to male sex ratio, and prevalence of atrial fibrillation, valve disease, and other non-ischaemic, non-dilated cardiopathies were all significantly greater in the group with preserved systolic function. New York Heart Association functional class IV, third heart sound, jugular vein congestion, cardiomegaly, radiological signs of lung oedema, pathological Q waves, left bundle branch block, sinus rhythm, ischaemic cardiopathy, and dilated cardiomyopathy were all significantly more prevalent in the group with deteriorated systolic function, as was treatment with angiotensin converting enzyme inhibitors and most other antihypertensive drugs on discharge from hospital. There was no significant difference in survival between the groups with preserved and deteriorated systolic function (either survival regardless of age at admission or in subgroups aged < 75 and > or = 75 years at admission). In the whole group, survival rates after one, three, and five years were 84.0%, 66.7%, and 50.9%, respectively. CONCLUSION In view of the poor prognosis of patients with CHF with preserved LV systolic function, who are currently treated empirically, it is to be hoped that relevant controlled clinical trials under way will afford information allowing optimisation of their treatment.
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Affiliation(s)
- A Varela-Roman
- Clinical University Hospital, Santiago de Compostela 15706, Spain.
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Hogg K, Swedberg K, McMurray J. Heart failure with preserved left ventricular systolic function; epidemiology, clinical characteristics, and prognosis. J Am Coll Cardiol 2004; 43:317-27. [PMID: 15013109 DOI: 10.1016/j.jacc.2003.07.046] [Citation(s) in RCA: 553] [Impact Index Per Article: 27.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2003] [Revised: 06/26/2003] [Accepted: 07/21/2003] [Indexed: 11/30/2022]
Abstract
Recent cross-sectional, population-based echocardiographic studies show that about half of all patients with heart failure have preserved left ventricular systolic function (HF-PSF). Cohort studies of hospitalized patients show a smaller proportion of HF-PSF. Compared to those with reduced systolic function, patients with HF-PSF are more often female, older, less likely to have coronary artery disease, and more likely to have hypertension. Patients with HF-PSF are less symptomatic and receive different pharmacologic therapy than patients with reduced systolic function. Morbidity and mortality rates in patients with HF-PSF are high but not quite as high as in patients with reduced systolic function. Though much has recently been learned about the syndrome of HF-PSF, many questions remain to be answered, not least how it should be treated.
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Affiliation(s)
- Karen Hogg
- Department of Cardiology, Western Infirmary, Glasgow G12 8QQ, Scotland, United Kingdom
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Abstract
Chronic heart failure is widely recognised as a common and escalating problem that causes major disability and often shortens life. Diuretics and digoxin have formed the mainstay of treatment for many years. Clinical trials have demonstrated that angiotensin converting enzymes and beta-blockers, in selected patients, improve symptoms and reduce mortality. Angiotensin-II antagonists and spironolactone may also have a role in certain individuals. Newer pharmacological approaches to the management of this complex disease are being developed, but await full evaluation.
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Affiliation(s)
- D B McKenzie
- Department of Cardiovascular Medicine, University Hospital, Nottingham, UK.
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