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Hou W, Wang Z, Huang J, Fan F, Yang F, Qiu L, Zhao K, Qiu J, Yang Y, Ma W, Gong Y, Hong T. Early diagnostic and prognostic value of myocardial strain derived from cardiovascular magnetic resonance in patients with cardiac amyloidosis. Cardiovasc Diagn Ther 2023; 13:979-993. [PMID: 38162105 PMCID: PMC10753247 DOI: 10.21037/cdt-23-205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 10/13/2023] [Indexed: 01/03/2024]
Abstract
Background Cardiac amyloidosis (CA) is one of the causes of heart failure with preserved ejection fraction. Cardiac magnetic resonance (CMR) with late gadolinium enhancement (LGE) and extracellular volume (ECV) fractions is a preferred method to identify CA. However, the requirement of contrast limits its use in renal deficiency patients. Myocardial strain is a promising method without contrast. We sought to assess the early diagnostic and prognostic value of strain. Methods This retrospective study enrolled 31 patients with systemic amyloidosis (SA) in Peking University First Hospital from January 2014 to January 2019. The patients were categorized into three groups, including 11 CA patients with left ventricular hypertrophy (CA-LVH group), 9 CA patients without LVH (CA-NLVH group), and 11 patients with extracardiac SA (SA group). Strain analysis was performed with CMR images. A least absolute shrinkage and selection operator (LASSO) was used to generate strain score. The receiver operating characteristic (ROC) curve was used to evaluate the early diagnostic efficacy of strain score and other single strain parameter. The primary endpoint was defined as death from all cause or rehospitalization for heart failure. A Cox proportional hazards model was used to assess the index value on the prognosis. Results In CA patients, as the left ventricular wall thickens, the global and regional strain decrease significantly. A new strain score (strain score = 0.00893 × mid-septal circumferential peak strain + 0.02285 × apical radial peak strain + 0.1541 × apical circumferential peak strain + 0.33097 × epicardial circumferential average peak strain + 0.42232 × endocardial longitudinal average peak strain) generated using LASSO showed that the area under the ROC curve was 0.909. All the patients with outcome events were in CA groups, four were in CA-LVH group and one in CA-NLVH group. New York Heart Association (NYHA) grade [hazard ratio (HR) =14.29, 95% confidence interval (CI): 2.34-87.34, P<0.01], brain natriuretic peptide (HR =20.05, 95% CI: 2.21-182.36, P=0.008), cardiac injury biomarker (HR =11.59, 95% CI: 1.03-130.36, P=0.047), E/E' (mitral inflow to mitral relaxation velocity ratio) (HR =1.09, 95% CI: 1.00-1.18, P=0.040), end-systolic left ventricular volume (HR =1.04, 95% CI: 1.00-1.18, P=0.039) and LGE volume (HR =1.11, 95% CI: 1.02-1.20, P=0.012) positively correlate with events. Better renal function (HR =0.92, 95% CI: 0.86-0.98, P=0.011) and ejection fraction (HR =0.94, 95% CI: 0.88-0.99, P=0.027) appear to be protective factors. Although with no statistical difference, the strain damage had a tendency to predict poor prognosis, i.e., mid-ventricular circumferential strain with HR of 1.25 (95% CI: 1.0-1.57, P=0.050) and strain score with HR of 1.30 (95% CI: 0.98-1.73, P=0.067). Conclusions Myocardial strain decreased in CA patients. The integrated magnetic resonance imaging (MRI) strain score can serve as a useful tool to identify early myocardial involvement in amyloidosis. The strain damage had a tendency to predict poor prognosis.
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Affiliation(s)
- Weijie Hou
- Department of Cardiology, Peking University First Hospital, Beijing, China
| | - Zhi Wang
- Department of Cardiology, Peking University First Hospital, Beijing, China
| | - Jingzhou Huang
- Department of Cardiology, Peking University First Hospital, Beijing, China
| | - Fangfang Fan
- Department of Cardiology, Peking University First Hospital, Beijing, China
| | - Fan Yang
- Department of Cardiology, Peking University First Hospital, Beijing, China
| | - Lin Qiu
- Department of Cardiology, Peking University First Hospital, Beijing, China
| | - Kai Zhao
- Department of Radiology, Peking University First Hospital, Beijing, China
| | - Jianxing Qiu
- Department of Radiology, Peking University First Hospital, Beijing, China
| | - Ying Yang
- Department of Cardiology, Peking University First Hospital, Beijing, China
- Echocardiography Core Laboratory, Institute of Cardiovascular Disease, Peking University First Hospital, Beijing, China
| | - Wei Ma
- Department of Cardiology, Peking University First Hospital, Beijing, China
| | - Yanjun Gong
- Department of Cardiology, Peking University First Hospital, Beijing, China
| | - Tao Hong
- Department of Cardiology, Peking University First Hospital, Beijing, China
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Kanda T, Tawarahara K, Kato H, Ishibashi H, Nakamura N, Tokonami Y, Matsukura G, Ozeki M, Ukigai H, Takeuchi R. Subclinical and latent cardiac dysfunction in obstructive sleep apnea and effectiveness of continuous positive airway pressure. Sleep Breath 2023; 27:1709-1716. [PMID: 36585605 PMCID: PMC10539454 DOI: 10.1007/s11325-022-02774-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 12/20/2022] [Accepted: 12/22/2022] [Indexed: 12/31/2022]
Abstract
PURPOSE Obstructive sleep apnea (OSA) is associated with various cardiovascular disorders. This study aimed to investigate the effects of OSA on left ventricular (LV) function in patients with OSA who were at risk for heart failure but who had not yet developed structural heart changes. The study also sought to determine the effects of continuous positive airway pressure (CPAP) in these patients. METHODS In a retrospective study, consecutive patients with polysomnographic OSA (apnea-hypopnea index [AHI] >5) were categorized into mild (AHI < 15), moderate (15 ≤ AHI < 30), and severe OSA (AHI ≥ 30) groups. The subjects were patients with OSA and at risk for heart failure who had not yet developed structural heart changes. All study participants underwent echocardiography and two-dimensional speckle tracking analysis, and their global longitudinal strain (GLS) was calculated. RESULTS Of 275 patients, there were 31 with mild, 92 with moderate, and 152 with severe OSA. Of patients with moderate to severe OSA (AHI ≥ 20), 206 started CPAP and 92 patients underwent follow-up echocardiogram and speckle tracking echo analysis (median period of CPAP use: 283 days [258 to 391]). GLS was significantly reduced in patients with moderate and severe OSA compared with mild OSA (-17.8±3.1 vs. -18.0±2.6 vs. -19.3±2.8%, p=0.038). The proportion of patients with GLS ≥ -18% was significantly higher among the patients with moderate to severe OSA than among those with mild OSA. GLS improved after CPAP therapy in patients with moderate to severe OSA (GLS: -18.1±2.7% to -19.0±2.8%, p=0.004). Significant improvement in GLS was confirmed, particularly among patients with good CPAP adherence. CONCLUSION Moderate to severe OSA is associated with LV dysfunction and can be significantly improved by CPAP therapy.
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Affiliation(s)
- Takahiro Kanda
- Department of Internal Medicine, Division of Cardiology, Hamamatsu Red Cross Hospital, Shizuoka, Japan.
| | - Kei Tawarahara
- Department of Internal Medicine, Division of Cardiology, Hamamatsu Red Cross Hospital, Shizuoka, Japan
| | - Haruta Kato
- Department of Internal Medicine, Division of Cardiology, Hamamatsu Red Cross Hospital, Shizuoka, Japan
| | - Humimaro Ishibashi
- Department of Internal Medicine, Division of Cardiology, Hamamatsu Red Cross Hospital, Shizuoka, Japan
| | - Naoki Nakamura
- Department of Internal Medicine, Division of Cardiology, Hamamatsu Red Cross Hospital, Shizuoka, Japan
| | - Yuki Tokonami
- Department of Internal Medicine, Division of Cardiology, Hamamatsu Red Cross Hospital, Shizuoka, Japan
| | - Gaku Matsukura
- Department of Internal Medicine, Division of Cardiology, Hamamatsu Red Cross Hospital, Shizuoka, Japan
| | - Mariko Ozeki
- Department of Internal Medicine, Division of Cardiology, Hamamatsu Red Cross Hospital, Shizuoka, Japan
| | - Hiroshi Ukigai
- Department of Internal Medicine, Division of Cardiology, Hamamatsu Red Cross Hospital, Shizuoka, Japan
| | - Ryosuke Takeuchi
- Department of Internal Medicine, Division of Cardiology, Hamamatsu Red Cross Hospital, Shizuoka, Japan
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Dalal J, Chandra P, Ray S, Hazra PK, Hiremath J, Kumar V, Shah MK, Abdullakutty J, Ghosh D, Vasudevan K, Sahoo P. Practical Recommendations for the Use of Angiotensin Receptor-Neprilysin Inhibitors (ARNI) in Heart Failure: Insights from Indian Cardiologists. Cardiol Ther 2023; 12:445-471. [PMID: 37382802 PMCID: PMC10423183 DOI: 10.1007/s40119-023-00323-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 06/01/2023] [Indexed: 06/30/2023] Open
Abstract
Heart failure is a significant public health concern characterized by notable rates of morbidity and mortality. Despite the presence of guideline-directed medical therapy (GDMT), its utilization remains inadequate. This practical recommendation paper focuses on the utilization of angiotensin receptor-neprilysin inhibitor (ARNI) as a pivotal treatment for heart failure with reduced ejection fraction (HFrEF), heart failure with preserved ejection fraction (HFpEF), and heart failure with improved ejection fraction (HFimpEF). The recommendations presented in this paper have been developed by a group of cardiologists in India who convened six advisory board meetings to discuss the utilization of ARNI in the management of heart failure. The paper emphasizes the importance of accurate biomarkers for diagnosing heart failure, particularly N-terminal pro-B-type natriuretic peptide (NT-proBNP) and B-type natriuretic peptide (BNP), which are commonly used. Additionally, the paper advocates the use of imaging, specifically echocardiography, in diagnosing and monitoring heart failure patients. Moreover, the paper highlights the role of ARNI in heart failure management, with numerous clinical trials that have demonstrated its effectiveness in reducing cardiovascular death or heart failure hospitalization, enhancing quality of life, and diminishing the risk of ventricular arrhythmias. This practical recommendation paper offers valuable insights into the utilization of ARNI in the management of heart failure, aiming to enhance the implementation of GDMT and ultimately alleviate the burden of heart failure on society.
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Affiliation(s)
| | | | | | | | | | | | - Mahesh K Shah
- PD Hinduja Hospital and Medical Research Center, Mumbai, India
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Shahnazaryan S, Pepoyan S, Sisakian H. Heart Failure with Reduced Ejection Fraction: The Role of Cardiovascular and Lung Ultrasound beyond Ejection Fraction. Diagnostics (Basel) 2023; 13:2553. [PMID: 37568916 PMCID: PMC10416843 DOI: 10.3390/diagnostics13152553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 07/21/2023] [Accepted: 07/22/2023] [Indexed: 08/13/2023] Open
Abstract
Heart failure with reduced ejection fraction (HFrEF) is considered a major health care problem with frequent decompensations, high hospitalization and mortality rates. In severe heart failure (HF), the symptoms are refractory to medical treatment and require advanced therapeutic strategies. Early recognition of HF sub- and decompensation is the cornerstone of the timely treatment intensification and, therefore, improvement in the prognosis. Echocardiography is the gold standard for the assessment of systolic and diastolic functions. It allows one to obtain accurate and non-invasive measurements of the ventricular function in HF. In severely compromised HF patients, advanced cardiovascular ultrasound modalities may provide a better assessment of intracardiac hemodynamic changes and subclinical congestion. Particularly, cardiovascular and lung ultrasound allow us to make a more accurate diagnosis of subclinical congestion in HFrEF. The aim of this review was to summarize the advantages and limitations of the currently available ultrasound modalities in the ambulatory monitoring of patients with HFrEF.
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Affiliation(s)
| | | | - Hamayak Sisakian
- Clinic of General and Invasive Cardiology, “Heratsi” Hospital Complex #1, Yerevan State Medical University, 2 Koryun Street, Yerevan 375025, Armenia; (S.S.); (S.P.)
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Sheng Y, Ma X, Liu Y, Yang X, Sun F. Study on the Efficacy of Sacubitril/Valsartan in Patients with Heart Failure with Preserved Ejection Fraction Undergoing Peritoneal Dialysis. Cardiology 2023; 148:385-394. [PMID: 37253340 DOI: 10.1159/000531217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 05/22/2023] [Indexed: 06/01/2023]
Abstract
INTRODUCTION Cardiovascular disease is the most common cause of death and morbidity in patients with end-stage renal disease. Sacubitril/valsartan (SAC/VAL) can reduce the risk of cardiovascular mortality among patients with heart failure (HF). The present study set out to evaluate the efficacy of SAC/VAL in the treatment of patients with HF with preserved ejection fraction (HFpEF) undergoing peritoneal dialysis (PD) (HFpEF&PD). METHODS A total of 160 patients with HFpEF&PD were enrolled and randomly divided into the control group (N = 80) and SAC/VAL group (N = 80). The cardiac function efficacy, HF scoring efficacy, echocardiographic parameters, serological indicators, and 6-minute walking test were compared before and after treatment. RESULTS After 6 months of treatment, the total number of patients who responded to treatment in the SAC/VAL group was higher than that of the control group in terms of cardiac function and HF scoring efficacy. After treatment, levels of early diastolic/late diastolic filling velocity and left ventricular ejection fraction were increased in both groups, while the levels of left atrial diameter, left ventricular end-diastolic diameter, left ventricular end-systolic diameter, inter-ventricular septal diameter, and left ventricular posterior wall diameter were decreased; the NT-proBNP levels were diminished in both groups, while hemoglobin levels and the 6-minute walk distance were increased; the systolic blood pressure, diastolic blood pressure, and 24-h ultrafiltration volume were lowered in all patients. The changes in these indexes in the SAC/VAL group were more obvious than those in the controls. CONCLUSION SAC/VAL can significantly improve cardiac function in patients with HFpEF&PD.
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Affiliation(s)
- Yuping Sheng
- Department of Nephrology, Cangzhou Central Hospital, Cangzhou, China
| | - Xiaoying Ma
- Department of Nephrology, Cangzhou Central Hospital, Cangzhou, China
| | - Ye Liu
- Department of Nephrology, Cangzhou Central Hospital, Cangzhou, China
| | - Xingmeng Yang
- Department of Nephrology, Cangzhou Central Hospital, Cangzhou, China
| | - Fuyun Sun
- Department of Nephrology, Cangzhou Central Hospital, Cangzhou, China
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Ng ML, Ang X, Yap KY, Ng JJ, Goh ECH, Khoo BBJ, Richards AM, Drum CL. Novel Oxidative Stress Biomarkers with Risk Prognosis Values in Heart Failure. Biomedicines 2023; 11:biomedicines11030917. [PMID: 36979896 PMCID: PMC10046491 DOI: 10.3390/biomedicines11030917] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 02/17/2023] [Accepted: 02/26/2023] [Indexed: 03/18/2023] Open
Abstract
Oxidative stress (OS) is mediated by reactive oxygen species (ROS), which in cardiovascular and other disease states, damage DNA, lipids, proteins, other cellular and extra-cellular components. OS is both initiated by, and triggers inflammation, cardiomyocyte apoptosis, matrix remodeling, myocardial fibrosis, and neurohumoral activation. These have been linked to the development of heart failure (HF). Circulating biomarkers generated by OS offer potential utility in patient management and therapeutic targeting. Novel OS-related biomarkers such as NADPH oxidases (sNox2-dp, Nrf2), advanced glycation end-products (AGE), and myeloperoxidase (MPO), are signaling molecules reflecting pathobiological changes in HF. This review aims to evaluate current OS-related biomarkers and their associations with clinical outcomes and to highlight those with greatest promise in diagnosis, risk stratification and therapeutic targeting in HF.
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Affiliation(s)
- Mei Li Ng
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore
| | - Xu Ang
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore
| | - Kwan Yi Yap
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore
| | - Jun Jie Ng
- Vascular Surgery, Department of Cardiac, Thoracic and Vascular Surgery, National University Heart Centre, Singapore 119074, Singapore
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore
| | - Eugene Chen Howe Goh
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore
| | - Benjamin Bing Jie Khoo
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore
| | - Arthur Mark Richards
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore
- Cardiovascular Research Institute, Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, NUHS Tower Block, Level 9, NUHCS, Singapore 119228, Singapore
- Department of Biochemistry, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117599, Singapore
| | - Chester Lee Drum
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore
- Cardiovascular Research Institute, Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, NUHS Tower Block, Level 9, NUHCS, Singapore 119228, Singapore
- Department of Biochemistry, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117599, Singapore
- Correspondence:
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Park J, Hwang IC, Yoon YE, Park JB, Park JH, Cho GY. Predicting Long-Term Mortality in Patients With Acute Heart Failure by Using Machine Learning. J Card Fail 2022; 28:1078-1087. [PMID: 35301108 DOI: 10.1016/j.cardfail.2022.02.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 01/19/2022] [Accepted: 02/19/2022] [Indexed: 01/15/2023]
Abstract
BACKGROUND High mortality rates in patients with acute heart failure (AHF) necessitate proper risk stratification. However, risk-assessment tools for long-term mortality are largely lacking. We aimed to develop a machine-learning (ML)-based risk-prediction model for long-term all-cause mortality in patients admitted for AHF. METHODS AND RESULTS The ML model, based on boosted a Cox regression algorithm (CoxBoost), was trained with 2704 consecutive patients hospitalized for AHF (median age 73 years, 55% male, and median left ventricular ejection fraction 38%). We selected 27 input variables, including 19 clinical features and 8 echocardiographic parameters, for model development. The best-performing model, along with pre-existing risk scores (BIOSTAT-CHF and AHEAD scores), was validated in an independent test cohort of 1608 patients. During the median 32 months (interquartile range 12-54 months) of the follow-up period, 1050 (38.8%) and 690 (42.9%) deaths occurred in the training and test cohorts, respectively. The area under the receiver operating characteristic curve (AUROC) of the ML model for all-cause mortality at 3 years was 0.761 (95% CI: 0.754-0.767) in the training cohort and 0.760 (95% CI: 0.752-0.768) in the test cohort. The discrimination performance of the ML model significantly outperformed those of the pre-existing risk scores (AUROC 0.714, 95% CI 0.706-0.722 by BIOSTAT-CHF; and 0.681, 95% CI 0.672-0.689 by AHEAD). Risk stratification based on the ML model identified patients at high mortality risk regardless of heart failure phenotypes. CONCLUSIONS The ML-based mortality-prediction model can predict long-term mortality accurately, leading to optimal risk stratification of patients with AHF.
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Affiliation(s)
- Jiesuck Park
- Department of Cardiology, Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do, 13620, Republic of Korea; Department of Internal Medicine, Seoul National University College of Medicine, 101 Daehak-ro, Jongro-gu, Seoul, 03080, South Korea
| | - In-Chang Hwang
- Department of Cardiology, Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do, 13620, Republic of Korea; Department of Internal Medicine, Seoul National University College of Medicine, 101 Daehak-ro, Jongro-gu, Seoul, 03080, South Korea
| | - Yeonyee E Yoon
- Department of Cardiology, Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do, 13620, Republic of Korea; Department of Internal Medicine, Seoul National University College of Medicine, 101 Daehak-ro, Jongro-gu, Seoul, 03080, South Korea
| | - Jun-Bean Park
- Department of Internal Medicine, Seoul National University College of Medicine, 101 Daehak-ro, Jongro-gu, Seoul, 03080, South Korea; Cardiovascular Center and Department of Internal Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongro-gu, Seoul, 03080, South Korea
| | - Jae-Hyeong Park
- Department of Cardiology, Internal Medicine, Chungnam National University Hospital, 282 Munhwa-ro, Jung-gu Daejeon, 35015, South Korea
| | - Goo-Yeong Cho
- Department of Cardiology, Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do, 13620, Republic of Korea; Department of Internal Medicine, Seoul National University College of Medicine, 101 Daehak-ro, Jongro-gu, Seoul, 03080, South Korea.
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8
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Braisch U, Koenig W, Rothenbacher D, Denkinger M, Friedrich N, Felix SB, Ittermann T, Dörr M, Dallmeier D. N-terminal pro brain natriuretic peptide reference values in community-dwelling older adults. ESC Heart Fail 2022; 9:1703-1712. [PMID: 35199488 PMCID: PMC9065825 DOI: 10.1002/ehf2.13834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 01/17/2022] [Accepted: 01/23/2022] [Indexed: 11/06/2022] Open
Abstract
AIMS Available upper reference levels (URLs) in older adults for N-terminal pro brain natriuretic peptide (NT-proBNP), an established biomarker for heart failure, are mainly based on small samples. We aimed to identify NT-proBNP URL in a population-based reference sample of individuals aged ≥65 years. METHODS AND RESULTS We analysed established NT-proBNP predictors using quantile regression among 2459 participants of two-independent population-based cohorts located in Germany, the Activity and Function in the Elderly Study (ActiFE, n = 1450) and the Study of Health in Pomerania (SHIP-TREND-0, n = 1009). Based on predictors a reference population of 441 subjects (ActiFE, n = 227; SHIP-TREND-0, n = 214) without history of diabetes, cardiovascular, or pulmonary diseases and with systolic blood pressure (BP) <140 mmHg, diastolic BP ≥60 and ≤90 mmHg, haemoglobin in men ≥14 and ≤18 g/dL and in women ≥12 and ≤16 g/dL, GFR ≥60 mL/min/1.73 m2 , CRP <5 mg/L, BMI ≥18 and ≤33 kg/m2 , and hs-cTnI <40 ng/L were built with NT-proBNP median levels and 97.5% quantiles reported stratified by sex and age. In a secondary analysis the URL among 97 SHIP-TREND-0 participants with a left ventricular ejection fraction (LVEF) ≥50 and no diastolic dysfunction were estimated. The median age in the identified reference sample was 70 years, with 41.9% and 40.2% male participants in ActiFE and SHIP-TREND-0, respectively. We observed an age-dependent increment of NT-proBNP levels with higher values in women compared to men. Notably, NT-proBNP levels were >125 ng/L in 165 participants (37.4%), with NT-proBNP URL (97.5% quantiles) equal to 663, 824, 592, and 697 ng/L in men, and 343, 463, 2641, 1276 ng/L in women for ages 65-69, 70-74, 75-79, and 80+ years, respectively. In the secondary analysis with a LVEF ≥50 and no diastolic dysfunction (35 men and 62 women) NT-proBNP levels >125 ng/L were still observed in 38 (39.2%) participants. CONCLUSIONS This reference sample of apparently healthy asymptomatic older adults showed an age-related increment of NT-proBNP levels with URL markedly higher than the European Society of Cardiology recommended cut-off of 125 ng/L for the diagnosis of heart failure in ambulatory settings. Identifying URL in those ≥80 years remains complex. Our results attempt to provide a frame for the further investigation of age-specific NT-proBNP cut-offs in older adults. Considering the demographic changes, further evaluation of NT-proBNP URL in larger samples of older adults followed by the validation of age-specific cut-off values for the identification of heart failure in those 65 years or older are urgently needed.
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Affiliation(s)
- Ulrike Braisch
- Research Unit on Ageing, AGAPLESION Bethesda Clinic, Ulm, Germany.,Geriatric Center Ulm/Alb-Donau, Ulm, Germany.,Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Wolfgang Koenig
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany.,German Heart Center Munich, Technical University of Munich, Munich, Germany.,German Centre for Cardiovascular Research, partner site Munich Heart Alliance, Munich, Germany
| | | | - Michael Denkinger
- Research Unit on Ageing, AGAPLESION Bethesda Clinic, Ulm, Germany.,Geriatric Center Ulm/Alb-Donau, Ulm, Germany.,Institute for Geriatric Research, Ulm University, Ulm, Germany
| | - Nele Friedrich
- Institute for Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, Greifswald, Germany.,German Centre for Cardiovascular Research, partner site Greifswald, Greifswald, Germany
| | - Stephan B Felix
- German Centre for Cardiovascular Research, partner site Greifswald, Greifswald, Germany.,Department of Internal Medicine B, University Medicine Greifswald, Greifswald, Germany
| | - Till Ittermann
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Marcus Dörr
- German Centre for Cardiovascular Research, partner site Greifswald, Greifswald, Germany.,Department of Internal Medicine B, University Medicine Greifswald, Greifswald, Germany
| | - Dhayana Dallmeier
- Research Unit on Ageing, AGAPLESION Bethesda Clinic, Ulm, Germany.,Geriatric Center Ulm/Alb-Donau, Ulm, Germany.,Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
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9
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Ji M, Wu W, He L, Gao L, Zhang Y, Lin Y, Qian M, Wang J, Zhang L, Xie M, Li Y. Right Ventricular Longitudinal Strain in Patients with Heart Failure. Diagnostics (Basel) 2022; 12:diagnostics12020445. [PMID: 35204536 PMCID: PMC8871506 DOI: 10.3390/diagnostics12020445] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 02/03/2022] [Accepted: 02/04/2022] [Indexed: 11/16/2022] Open
Abstract
Patients with heart failure (HF) have high morbidity and mortality. Accurate assessment of right ventricular (RV) function has important prognostic significance in patients with HF. However, conventional echocardiographic parameters of RV function have limitations in RV assessments due to the complex geometry of right ventricle. In recent years, speckle tracking echocardiography (STE) has been developed as promising imaging technique to accurately evaluate RV function. RV longitudinal strain (RVLS) using STE, as a sensitive index for RV function evaluation, displays the powerfully prognostic value in patients with HF. Therefore, the aim of the present review was to summarize the utility of RVLS in patients with HF.
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Affiliation(s)
- Mengmeng Ji
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; (M.J.); (W.W.); (L.H.); (L.G.); (Y.Z.); (Y.L.); (M.Q.); (J.W.); (L.Z.)
- Clinical Research Center for Medical Imaging in Hubei Province, Wuhan 430022, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Wenqian Wu
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; (M.J.); (W.W.); (L.H.); (L.G.); (Y.Z.); (Y.L.); (M.Q.); (J.W.); (L.Z.)
- Clinical Research Center for Medical Imaging in Hubei Province, Wuhan 430022, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Lin He
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; (M.J.); (W.W.); (L.H.); (L.G.); (Y.Z.); (Y.L.); (M.Q.); (J.W.); (L.Z.)
- Clinical Research Center for Medical Imaging in Hubei Province, Wuhan 430022, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Lang Gao
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; (M.J.); (W.W.); (L.H.); (L.G.); (Y.Z.); (Y.L.); (M.Q.); (J.W.); (L.Z.)
- Clinical Research Center for Medical Imaging in Hubei Province, Wuhan 430022, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Yanting Zhang
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; (M.J.); (W.W.); (L.H.); (L.G.); (Y.Z.); (Y.L.); (M.Q.); (J.W.); (L.Z.)
- Clinical Research Center for Medical Imaging in Hubei Province, Wuhan 430022, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Yixia Lin
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; (M.J.); (W.W.); (L.H.); (L.G.); (Y.Z.); (Y.L.); (M.Q.); (J.W.); (L.Z.)
- Clinical Research Center for Medical Imaging in Hubei Province, Wuhan 430022, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Mingzhu Qian
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; (M.J.); (W.W.); (L.H.); (L.G.); (Y.Z.); (Y.L.); (M.Q.); (J.W.); (L.Z.)
- Clinical Research Center for Medical Imaging in Hubei Province, Wuhan 430022, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Jing Wang
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; (M.J.); (W.W.); (L.H.); (L.G.); (Y.Z.); (Y.L.); (M.Q.); (J.W.); (L.Z.)
- Clinical Research Center for Medical Imaging in Hubei Province, Wuhan 430022, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Li Zhang
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; (M.J.); (W.W.); (L.H.); (L.G.); (Y.Z.); (Y.L.); (M.Q.); (J.W.); (L.Z.)
- Clinical Research Center for Medical Imaging in Hubei Province, Wuhan 430022, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
- Shenzhen Huazhong University of Science and Technology Research Institute, Shenzhen 518057, China
| | - Mingxing Xie
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; (M.J.); (W.W.); (L.H.); (L.G.); (Y.Z.); (Y.L.); (M.Q.); (J.W.); (L.Z.)
- Clinical Research Center for Medical Imaging in Hubei Province, Wuhan 430022, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
- Shenzhen Huazhong University of Science and Technology Research Institute, Shenzhen 518057, China
- Tongji Medical College and Wuhan National Laboratory for Optoelectronics, Huazhong University of Science and Technology, Wuhan 430022, China
- Correspondence: (M.X.); (Y.L.); Tel.: +86-27-8572-6430 (M.X.); +86-27-8572-6386 (Y.L.); Fax: +86-27-8572-6386 (M.X.); +86-27-8572-6386 (Y.L.)
| | - Yuman Li
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; (M.J.); (W.W.); (L.H.); (L.G.); (Y.Z.); (Y.L.); (M.Q.); (J.W.); (L.Z.)
- Clinical Research Center for Medical Imaging in Hubei Province, Wuhan 430022, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
- Correspondence: (M.X.); (Y.L.); Tel.: +86-27-8572-6430 (M.X.); +86-27-8572-6386 (Y.L.); Fax: +86-27-8572-6386 (M.X.); +86-27-8572-6386 (Y.L.)
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10
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Chuda A, Banach M, Maciejewski M, Bielecka-Dabrowa A. Role of confirmed and potential predictors of an unfavorable outcome in heart failure in everyday clinical practice. Ir J Med Sci 2022; 191:213-227. [PMID: 33595788 PMCID: PMC8789698 DOI: 10.1007/s11845-020-02477-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 12/14/2020] [Indexed: 01/09/2023]
Abstract
Heart failure (HF) is the only cardiovascular disease with an ever increasing incidence. HF, through reduced functional capacity, frequent exacerbations of disease, and repeated hospitalizations, results in poorer quality of life, decreased work productivity, and significantly increased costs of the public health system. The main challenge in the treatment of HF is the availability of reliable prognostic models that would allow patients and doctors to develop realistic expectations about the prognosis and to choose the appropriate therapy and monitoring method. At this moment, there is a lack of universal parameters or scales on the basis of which we could easily capture the moment of deterioration of HF patients' condition. Hence, it is crucial to identify such factors which at the same time will be widely available, cheap, and easy to use. We can find many studies showing different predictors of unfavorable outcome in HF patients: thorough assessment with echocardiography imaging, exercise testing (e.g., 6-min walk test, cardiopulmonary exercise testing), and biomarkers (e.g., N-terminal pro-brain type natriuretic peptide, high-sensitivity troponin T, galectin-3, high-sensitivity C-reactive protein). Some of them are very promising, but more research is needed to create a specific panel on the basis of which we will be able to assess HF patients. At this moment despite identification of many markers of adverse outcomes, clinical decision-making in HF is still predominantly based on a few basic parameters, such as the presence of HF symptoms (NYHA class), left ventricular ejection fraction, and QRS complex duration and morphology.
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Affiliation(s)
- Anna Chuda
- Heart Failure Unit, Department of Cardiology and Congenital Diseases of Adults, Polish Mother's Memorial Hospital Research Institute, Rzgowska 281/289, 93-338, Lodz, Poland.
- Department of Hypertension, Chair of Nephrology and Hypertension, Medical University of Lodz, Zeromskiego 113, 90-549, Lodz, Poland.
| | - Maciej Banach
- Heart Failure Unit, Department of Cardiology and Congenital Diseases of Adults, Polish Mother's Memorial Hospital Research Institute, Rzgowska 281/289, 93-338, Lodz, Poland
- Department of Hypertension, Chair of Nephrology and Hypertension, Medical University of Lodz, Zeromskiego 113, 90-549, Lodz, Poland
| | - Marek Maciejewski
- Department of Cardiology and Congenital Diseases of Adults, Polish Mother's Memorial Hospital Research Institute, Rzgowska 281/289, 93-338, Lodz, Poland
| | - Agata Bielecka-Dabrowa
- Heart Failure Unit, Department of Cardiology and Congenital Diseases of Adults, Polish Mother's Memorial Hospital Research Institute, Rzgowska 281/289, 93-338, Lodz, Poland
- Department of Hypertension, Chair of Nephrology and Hypertension, Medical University of Lodz, Zeromskiego 113, 90-549, Lodz, Poland
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11
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Ghanaym A, Elkhashab K, AbdelRazek G, Mahmoud E. Evaluation of left atrial dysfunction by speckle tracking echocardiography in systolic and diastolic heart failure. Monaldi Arch Chest Dis 2022; 92. [PMID: 35086330 DOI: 10.4081/monaldi.2022.2109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 12/10/2021] [Indexed: 11/22/2022] Open
Abstract
The study aimed to assess the accuracy of two-dimensional speckle tracking echocardiography (2DSTE) to evaluate the left atrial (LA) function in patients with heart failure. And can it differentiate accurately between heart failure preserved ejection fraction (HFpEF, HF with mid-range ejection fraction (HFmrEF=EF 41-49%) and heart failure with reduced ejection fraction (HFrEF= EF<40%)? It included 186 patients of heart failure who were classified into 74 patients with HFpEF (LVEF>50%), 56 patients with HFmrEF (LVEF 41-49%), 56 patients with HFrEF (LVEF<40%), and 50 normal matched subjects. B-type natriuretic peptide (BNP) was more than 35 pg/mL for all patients. The conventional echocardiography evaluated left ventricle systolic and diastolic functions. The 2DSTE evaluated the LV global strain (LVGS), and strain and strain rate (SR) in each phase of LA function. LVGS was -19.3±2.3%, -18.0±1.7%, -16.1±2.0%, and -14.3±2.2 in controls, HFpEF, and HFmrEF, and HFrEF, respectively (p<0.0001); GPALS was 34.1±6.7%, 27.5±4.7%, 21.7±4.8% and 16.9±4.9% in controls, HFpEF, HFmrEF, HFrEF, respectively (p<0.0001); The GPACS was 14.8±4.3%, 12.3±2.2%, 9.7±2.3%, and 7.5±2.6% in controls, HFpEF, HFmrEF, and HFrEF, respectively (p<0.0001); The PALS-PACS was 19.4±3%, 15.1±4.4%, 12.0±3.4%, and 9.3±3.3% in controls, HFpEF, HFmrEF, and HFrEF (p<0.0001). Therefore, early LA dysfunction in heart failure can be detected accurately and easily by speckle tracking technique that could be a promising independent tool to better understand of heart failure and its classification.
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Affiliation(s)
- Ahmed Ghanaym
- Cardiology Department, Zagazig Insurance Institute, Zagazig.
| | - Khaled Elkhashab
- Cardiology Department, Faculty of Medicine, Fayoum University, Faiyum.
| | - Gomaa AbdelRazek
- Cardiology Department, Faculty of Medicine, Fayoum University, Faiyum.
| | - Eman Mahmoud
- Cardiology Department, Faculty of Medicine, Fayoum University, Faiyum.
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12
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Kushner PR, Cavender MA, Mende CW. Role of Primary Care Clinicians in the Management of Patients With Type 2 Diabetes and Cardiorenal Diseases. Clin Diabetes 2022; 40:401-412. [PMID: 36381309 PMCID: PMC9606551 DOI: 10.2337/cd21-0119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Individuals with type 2 diabetes are at increased risk of both renal and cardiovascular events. The convergence of type 2 diabetes, chronic kidney disease, and cardiovascular disease, including heart failure, requires management by a multidisciplinary health care team. Primary care clinicians are likely to be the first and most frequent point of contact for individuals with type 2 diabetes who are at high risk of cardiorenal disease and therefore play a pivotal role in early diagnosis, establishment of effective treatment strategies, and coordination of care. This article presents a clinical perspective with multidisciplinary collaboration on a patient case representative of those seen in routine clinical practice. The authors assess reasons why patients may not receive evidence-based care and identify opportunities to initiate therapies that reduce cardiovascular and renal events in the primary care setting.
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Affiliation(s)
- Pamela R. Kushner
- University of California, Irvine, CA
- Corresponding author: Pamela R. Kushner,
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13
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Daal MRR, Strijkers GJ, Hautemann DJ, Nederveen AJ, Wüst RCI, Coolen BF. Longitudinal CMR assessment of cardiac global longitudinal strain and hemodynamic forces in a mouse model of heart failure. Int J Cardiovasc Imaging 2022; 38:2385-2394. [PMID: 36434328 PMCID: PMC9700588 DOI: 10.1007/s10554-022-02631-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 04/22/2022] [Indexed: 12/14/2022]
Abstract
To longitudinally assess left ventricle (LV) global longitudinal strain (GLS) and hemodynamic forces during the early stages of cardiac dysfunction in a mouse model of heart failure with preserved ejection fraction (HFpEF). Cardiac MRI measurements were performed in control mice (n = 6), and db/db mice (n = 7), whereby animals were scanned four times between the age of 11-15 weeks. After the first scan, the db/db animals received a doxycycline intervention to accelerate progression of HFpEF. Systolic function was evaluated based on a series of prospectively ECG-triggered short-axis CINE images acquired from base to apex. Cardiac GLS and hemodynamic forces values were evaluated based on high frame rate retrospectively gated 2-, 3-, and 4-chamber long-axis CINE images. Ejection fraction (EF) was not different between control and db/db animals, despite that cardiac output, as well as end systolic and end diastolic volume were significantly higher in control animals. Whereas GLS parameters were not significantly different between groups, hemodynamic force root mean square (RMS) values, as well as average hemodynamic forces and the ratio between hemodynamic forces in the inferolateral-anteroseptal and apical-basal direction were lower in db/db mice compared to controls. More importantly, hemodynamic forces parameters showed a significant interaction effect between time and group. Our results indicated that hemodynamic forces parameters were the only functional outcome measure that showed distinct temporal differences between groups. As such, changes in hemodynamic forces reflect early alterations in cardiac function which can be of added value in (pre)clinical research on HFpEF.
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Affiliation(s)
- Mariah R. R. Daal
- Department of Biomedical Engineering and Physics, Amsterdam University Medical Centers, Amsterdam Cardiovascular Sciences, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Gustav J. Strijkers
- Department of Biomedical Engineering and Physics, Amsterdam University Medical Centers, Amsterdam Cardiovascular Sciences, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | | | - Aart J. Nederveen
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, Amsterdam Cardiovascular Sciences, University of Amsterdam, Amsterdam, The Netherlands
| | - Rob C. I. Wüst
- Laboratory for Myology, Department of Human Movement Sciences, Faculty of Behavioral and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - Bram F. Coolen
- Department of Biomedical Engineering and Physics, Amsterdam University Medical Centers, Amsterdam Cardiovascular Sciences, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
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14
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Purwowiyoto SL, Prawara AS. Metabolic syndrome and heart failure: mechanism and management. Med Pharm Rep 2021; 94:15-21. [PMID: 33629043 PMCID: PMC7880077 DOI: 10.15386/mpr-1884] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 10/15/2020] [Accepted: 11/06/2020] [Indexed: 12/14/2022] Open
Abstract
Heart failure (HF) and metabolic syndrome (MetS) are syndromes that affect a large proportion of the world population. MetS is known to be one of the risk factors of HF, and it can also act as comorbidity in HF. This review aims to further discuss the mechanism of MetS in causing HF, the management of MetS in order to prevent HF, and the management of MetS in HF patients. Visceral adiposity is the primary trigger of MetS which is followed by chronic inflammation, insulin resistance, and neurohormonal activation. All the mechanisms causing MetS play also an important role in the progression of HF. The MetS approach can be achieved by managing its components according to the current guidelines and careful management of MetS should be done in patients with HF. MetS is closely related to the progression of HF so that comprehensive management which involves a multidisciplinary team is necessary for managing patients with metabolic syndrome and heart failure.
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Affiliation(s)
- Sidhi Laksono Purwowiyoto
- Cardiac Catheterization Laboratory, Department of Cardiology and Vascular Medicine, RSUD Pasar Rebo, East Jakarta, Indonesia.,Faculty of Medicine, Universitas Muhammadiyah Prof. DR. Hamka, Tangerang, Indonesia
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15
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Wood C. Fluid management: An update for perioperative practitioners. J Perioper Pract 2021; 31:71-79. [PMID: 33472531 DOI: 10.1177/1750458920964174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
An interprofessional team approach is required to achieve optimum fluid balance for patients during the perioperative period. Incorrect management of fluid assessment and monitoring is associated with adverse outcomes. The scientific understanding of perioperative fluid balance has improved over recent years leading to changes in clinical practice with regard to volume and choice of intravenous fluid. It is important that perioperative practitioners have an understanding of intravenous fluid, fluid compartmentalisation, fluid mechanics and intravascular fluid control mechanisms. Optimum fluid status not only shortens hospital stay but also reduces the incidence of postoperative nausea and vomiting and complication profiles. This article aims to provide perioperative practitioners with a comprehensive overview of fluid management. It will cover important issues surrounding physiological control of fluid balance, choice of intravenous fluid therapy, methods to monitor intravascular volume and factors which influence delivery.
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16
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Prediction of cardiac events using fully automated GLS and BNP titers in patients with known or suspected heart failure. PLoS One 2020; 15:e0234294. [PMID: 32542005 PMCID: PMC7295200 DOI: 10.1371/journal.pone.0234294] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 05/24/2020] [Indexed: 12/28/2022] Open
Abstract
Background Although global longitudinal strain (GLS) measurements provide useful predictive information, measurement variability is still a major concern. We sought to determine whether fully automated GLS measurements could predict future cardiac events in patients with known or suspected heart failure (HF). Methods GLS was measured using fully automated 2D speckle tracking analysis software (AutoStrain, TomTec) in 3,150 subjects who had undergone clinically indicated brain natriuretic peptide (BNP) assays and echocardiographic examinations. Among 1,514 patients in the derivation cohort, optimal cut-off values of BNP and GLS for cardiac death (CD) and major adverse cardiovascular events (MACEs) were determined using survival classification and regression tree (CART) analysis. The remaining 1,636 patients, comprising the validation cohort, were stratified into subgroups according to predefined cut-off values, and survival curves were compared. Results Survival CART analysis selected GLS with cut-off values of 6.2% and 14.0% for predicting CD. GLS of 6.9% and 13.9% and BNP of 83.2 pg/mL and 206.3 pg/mL were selected for predicting MACEs. For simplicity, we defined GLS of 7% and 14% and BNP of 100 pg/mL and 200 pg/mL as cut-off values. These cut-off values stratify high-risk patients in the validation cohort with known or suspected HF for both CD and MACEs. Conclusions In addition to BNP, fully automated GLS measurements provide prognostic information for patients with known or suspected HF, and this approach facilitates clinical work flow.
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Yeganeh M, Jaweed SS, Woei KSS, Zakaria MIB, Loch A. Accuracy of B-type natriuretic peptide in a multiethnic Asian population with acute dyspnea. HONG KONG J EMERG ME 2020. [DOI: 10.1177/1024907920910623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: Optimal cut-offs for B-type natriuretic peptide (BNP) for the diagnosis of heart failure differ based on ethnicity. There are no data for Southeast Asian patients. We aimed to define the optimal cut-off points and the strength of B-type natriuretic peptide as a predictor of heart failure in Southeast Asian multiethnic population. Methods: Bedside B-type natriuretic peptide (SOB panel (Biosite®)) was measured for patients (>50 years) presenting with dyspnea. Emergency physicians (blinded to B-type natriuretic peptide result) assessed the probability of acute heart failure on a scale of 0%–100%. Heart failure diagnosis was adjudicated by two cardiologists. Results: In all, 43% (n = 87) of the 203 dyspneic patients (54.7% males, 453% females) had a final diagnosis of acute heart failure. B-type natriuretic peptide values ranged from 3.2 to 4960 pg/mL (median, 189 pg/mL). Median B-type natriuretic peptide values of patients with the final diagnosis of “acute heart failure,” “no acute heart failure but history of heart failure,” and “no heart failure” were 600, 301, and 68 pg/mL, respectively. The optimum cut-off was 186 pg/mL. The receiver operating characteristic curve of the emergency physician’s assessment of the probability of heart failure based on clinical assessment had an area under the curve of 85% (95% confidence interval: 80%–90%). Combining receiver operating characteristic curves of physician assessment and B-type natriuretic peptide values yielded an area under the curve of 96% (95% confidence interval: 93%–98%). B-type natriuretic peptide levels less than 100 pg/mL were the strongest predictor of heart failure (odds ratio: 26.36; confidence interval: 6.85–101.41), followed by upper lobe diversion and cardiomegaly. Conclusion: The accuracy of bedside B-type natriuretic peptide was validated in a multiethnic Asian population. Optimum cut-off is 186 pg/mL. A B-type natriuretic peptide >100 pg/mL is the single strongest independent predictor of heart failure.
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Affiliation(s)
- Mojdeh Yeganeh
- Department of Emergency Medicine, University of Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Syed Saleem Jaweed
- Department of Emergency Medicine, University of Malaya Medical Centre, Kuala Lumpur, Malaysia
| | | | - Mohd Idzwan bin Zakaria
- Department of Emergency Medicine, University of Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Alexander Loch
- Department of Medicine, University of Malaya Medical Centre, Kuala Lumpur, Malaysia
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18
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Čelutkienė J, Spoletini I, Coats AJS, Chioncel O. Left ventricular function monitoring in heart failure. Eur Heart J Suppl 2019; 21:M17-M19. [PMID: 31908610 PMCID: PMC6937514 DOI: 10.1093/eurheartj/suz218] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Imaging modalities are used for screening, risk stratification and monitoring of heart failure (HF). In particular, echocardiography represents the cornerstone in the assessment of left ventricular (LV) dysfunction. Despite the well-known limitations of LV ejection fraction, this parameter, repeated assessment of LV function is recommended for the diagnosis and care of patients with HF and provides prognostic information. Left ventricular ejection fraction (LVEF) has an essential role in phenotyping and appropriate guiding of the therapy of patients with chronic HF. This document reflects the key points concerning monitoring LV function discussed at a consensus meeting on physiological monitoring in the complex multi-morbid HF patient under the auspices of the Heart Failure Association of the ESC.
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Affiliation(s)
- Jelena Čelutkienė
- Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Medical Faculty of Vilnius University, Santariskiu str. 2, Vilnius, Lithuania
| | - Ilaria Spoletini
- Department of Medical Sciences, Centre for Clinical and Basic Research, IRCCS San Raffaele Pisana, Rome, Italy
| | - Andrew J S Coats
- Department of Medical Sciences, Centre for Clinical and Basic Research, IRCCS San Raffaele Pisana, Rome, Italy
| | - Ovidiu Chioncel
- Emergency Institute for Cardiovascular Diseases-"Prof. C.C.Iliescu", Bucharest; University of Medicine Carol Davila, Bucharest, Romania
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Abstract
Heart failure (HF) has evolved in an epidemic manner and constitutes a major public health issue. Currently, several prognostic markers and treatment options exist to guide treatment of HF with reduced ejection fraction, but echocardiographic deformation imaging suggests novel pathophysiologic aspects that could help optimize treatment further. Even though no formal treatment options currently exist for patients with HF with preserved ejection fraction, some HF medication does seem to attenuate strain measures. Speckle tracking has furthermore helped characterize this condition and to confer prognostic information. Thus, strain imaging could facilitate novel trials, and thereby hopefully introduce treatment opportunities.
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Affiliation(s)
- Flemming J Olsen
- Gentofte Hospital, Department of Cardiology, Niels Andersens Vej 65, Hellerup 2900, Denmark
| | - Tor Biering-Sørensen
- Gentofte Hospital, Department of Cardiology, Niels Andersens Vej 65, Hellerup 2900, Denmark.
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