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Zhang JF, Pan YW, Li J, Kong XG, Wang M, Xue ZM, Gao J, Fu GS. Comparison of His-Purkinje Conduction System Pacing with Atrial-Ventricular Node Ablation and Pharmacotherapy in HFpEF Patients with Recurrent Persistent Atrial Fibrillation (HPP-AF study). Cardiovasc Drugs Ther 2024; 38:847-858. [PMID: 36749453 DOI: 10.1007/s10557-023-07435-2] [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] [Accepted: 01/23/2023] [Indexed: 02/08/2023]
Abstract
BACKGROUND There is currently no particularly effective strategy for patients with persistent atrial fibrillation accompanying heart failure with preserved ejection fraction (HFpEF), especially with recurrent atrial fibrillation after ablation. In this study, we will evaluate a new treatment strategy for patients with persistent atrial fibrillation who had at least two attempts (≧2 times) of radio-frequency catheter ablation but experienced recurrence, and physiologic conduction was reconstructed after atrioventricular node ablation or drug therapy, to control the patient's ventricular rate to maintain a regular heart rhythm, which is called His-Purkinje conduction system pacing (HPCSP) with atrioventricular node ablation. METHODS AND RESULTS This investigator-initiated, multicenter prospective randomized controlled trial aimed to recruit 296 randomized HFpEF patients with recurrent atrial fibrillation. All the enrolled patients were randomly assigned to the pacing group or the drug treatment group. The primary endpoint is differences in cardiovascular events and clinical composite endpoints (all-cause mortality) between patients in the HPCSP and drug-treated groups. Secondary endpoints included heart failure hospitalization, exercise capacity assessed by cardiopulmonary exercise tests, quality of life, echocardiogram parameters, 6-minute walk distance, NT-ProBNP, daily patient activity levels, and heart failure management report recorded by the CIED. It is planned to compete recruitment by the end of 2023 and report in 2025. CONCLUSIONS The study aims to determine whether His-Purkinje conduction system pacing with atrioventricular node ablation can better improve patients' symptoms and quality of life, postpone the progression of heart failure, and reduce the rate of rehospitalization and mortality of patients with heart failure. CLINICAL TRIAL REGISTRATION NUMBER ChiCTR1900027723, URL: http://www.chictr.org.cn/edit.aspx?pid=46128&htm=4.
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Affiliation(s)
- J F Zhang
- Department of Cardiology, Sir Run Run Shaw Hospital, Zhejiang University of Medicine, 3 East Qingchun Road, Hangzhou, 310016, Zhejiang Province, People's Republic of China.
| | - Y W Pan
- Department of Cardiology, Sir Run Run Shaw Hospital, Zhejiang University of Medicine, 3 East Qingchun Road, Hangzhou, 310016, Zhejiang Province, People's Republic of China
| | - J Li
- Department of Cardiology, Jinhua Wenrong Hospital, Jinhua, 3121000, Zhejiang, People's Republic of China
| | - X G Kong
- Department of Cardiology, Sir Run Run Shaw Hospital, Zhejiang University of Medicine, 3 East Qingchun Road, Hangzhou, 310016, Zhejiang Province, People's Republic of China
| | - M Wang
- Department of Cardiology, Sir Run Run Shaw Hospital, Zhejiang University of Medicine, 3 East Qingchun Road, Hangzhou, 310016, Zhejiang Province, People's Republic of China
| | - Z M Xue
- Department of Cardiology, Sir Run Run Shaw Hospital, Zhejiang University of Medicine, 3 East Qingchun Road, Hangzhou, 310016, Zhejiang Province, People's Republic of China
| | - J Gao
- Department of Cardiology, Sir Run Run Shaw Hospital, Zhejiang University of Medicine, 3 East Qingchun Road, Hangzhou, 310016, Zhejiang Province, People's Republic of China
| | - G S Fu
- Department of Cardiology, Sir Run Run Shaw Hospital, Zhejiang University of Medicine, 3 East Qingchun Road, Hangzhou, 310016, Zhejiang Province, People's Republic of China
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Kourek C, Briasoulis A, Magouliotis DE, Georgoulias P, Giamouzis G, Triposkiadis F, Skoularigis J, Xanthopoulos A. Recent advances in the diagnostic methods and therapeutic strategies of transthyretin cardiac amyloidosis. World J Cardiol 2024; 16:370-379. [PMID: 39086890 PMCID: PMC11287460 DOI: 10.4330/wjc.v16.i7.370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Revised: 06/06/2024] [Accepted: 06/25/2024] [Indexed: 07/23/2024] Open
Abstract
Cardiac amyloidosis is a progressive disease characterized by the buildup of amyloid fibrils in the extracellular space of the heart. It is divided in 2 main types, immunoglobulin light chain amyloidosis and transthyretin amyloidosis (ATTR), and ATTR amyloidosis is further divided in 2 subtypes, non-hereditary wild type ATTR and hereditary mutant variant amyloidosis. Incidence and prevalence of ATTR cardiac amyloidosis is increasing over the last years due to the improvements in diagnostic methods. Survival rates are improving due to the development of novel therapeutic strategies. Tafamidis is the only disease-modifying approved therapy in ATTR amyloidosis so far. However, the most recent advances in medical therapies have added more options with the potential to become part of the therapeutic armamentarium of the disease. Agents including acoramidis, eplontersen, vutrisiran, patisiran and anti-monoclonal antibody NI006 are being investigated on cardiac function in large, multicenter controlled trials which are expected to be completed within the next 2-3 years, providing promising results in patients with ATTR cardiac amyloidosis. However, further and ongoing research is required in order to improve diagnostic methods that could provide an early diagnosis, as well as survival and quality of life of these patients.
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Affiliation(s)
- Christos Kourek
- Clinical Ergospirometry, Exercise and Rehabilitation Laboratory, 1 Critical Care Medicine Department, Evangelismos Hospital, National and Kapodistrian University of Athens, Athens 10676, Greece
| | - Alexandros Briasoulis
- Department of Clinical Therapeutics, Alexandra Hospital, Faculty of Medicine, National and Kapodistrian University of Athens, Athens 11528, Greece
| | - Dimitrios E Magouliotis
- Department of Cardiothoracic Surgery, University of Thessaly, Larissa Biopolis, Larissa 41110, Greece
| | | | - Grigorios Giamouzis
- Department of Cardiology, School of Medicine, University Hospital of Larissa, Larissa 41110, Greece
| | - Filippos Triposkiadis
- Department of Cardiology, School of Medicine, University Hospital of Larissa, Larissa 41110, Greece
| | - John Skoularigis
- Department of Cardiology, School of Medicine, University Hospital of Larissa, Larissa 41110, Greece
| | - Andrew Xanthopoulos
- Department of Cardiology, School of Medicine, University Hospital of Larissa, Larissa 41110, Greece.
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3
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Yu Y, Ge X, Cao L, Li F. Diagnostic and Prognostic Value of Plasma lncRNA SRA1 in Chronic Heart Failure. Rev Cardiovasc Med 2024; 25:178. [PMID: 39076490 PMCID: PMC11267213 DOI: 10.31083/j.rcm2505178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 12/17/2023] [Accepted: 12/22/2023] [Indexed: 07/31/2024] Open
Abstract
Background The pathogenesis and development of chronic heart failure (CHF) may involve long non-coding ribonucleic acid (lncRNA) steroid receptor RNA activator 1 (SRA1), a known cardiomyopathy risk factor and regulator of cardiac myofibroblast activation. This study aimed to investigate the application of SRA1 in the early detection and prediction of CHF. Methods SRA1 plasma expression was determined in CHF patients and healthy individuals/using real time-quantitative polymerase chain reaction (RT-qPCR). The diagnostic and prognostic value of SRA1 was assessed using receiver operating curve (ROC) and Cox regression analyses. Results Compared with the healthy controls, the patients with CHF had increased brain natriuretic peptide (BNP) levels, left atrial end-systolic diameter (LAD), left ventricular end-diastolic diameter (LVDd), and decreased left ventricular ejection fraction (LVEF). SRA1 was significantly upregulated in CHF patients as well as positively correlated with BNP level, LAD, and LVDd, and negatively correlated with LVEF. SRA1 could sensitively discriminate CHF patients from healthy individuals and was an independent predictor of adverse event-free survival in CHF patients. Conclusions Upregulated plasma SRA1 can discriminate patients with CHF from healthy individuals and predict adverse outcomes in CHF patients. Thus, SRA1 is a potential molecular indicator for monitoring chronic heart failure development.
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Affiliation(s)
- Yiming Yu
- Department of General Practice, The First Affiliated Hospital of Weifang Medical University, Weifang People's Hospital, 261041 Weifang, Shandong, China
| | - Xiao Ge
- Department of General Practice, The First Affiliated Hospital of Weifang Medical University, Weifang People's Hospital, 261041 Weifang, Shandong, China
| | - Lifang Cao
- Department of General Practice, The First Affiliated Hospital of Weifang Medical University, Weifang People's Hospital, 261041 Weifang, Shandong, China
| | - Feng Li
- Department of General Practice, The First Affiliated Hospital of Weifang Medical University, Weifang People's Hospital, 261041 Weifang, Shandong, China
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4
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Fazio S, Mercurio V, Fazio V, Ruvolo A, Affuso F. Insulin Resistance/Hyperinsulinemia, Neglected Risk Factor for the Development and Worsening of Heart Failure with Preserved Ejection Fraction. Biomedicines 2024; 12:806. [PMID: 38672161 PMCID: PMC11047865 DOI: 10.3390/biomedicines12040806] [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: 03/12/2024] [Revised: 03/27/2024] [Accepted: 04/03/2024] [Indexed: 04/28/2024] Open
Abstract
Heart failure (HF) has become a subject of continuous interest since it was declared a new pandemic in 1997 because of the exponential increase in hospitalizations for HF in the latest years. HF is the final state to which all heart diseases of different etiologies lead if not adequately treated. It is highly prevalent worldwide, with a progressive increase with age, reaching a prevalence of 10% in subjects over the age of 65 years. During the last two decades, it was possible to see that the prevalence of heart failure with preserved ejection fraction (HFpEF) was increasing while that of heart failure with reduced ejection fraction (HFrEF) was decreasing. HFpEF is typically characterized by concentric remodeling of the left ventricle (LV) with impaired diastolic function and increased filling pressures. Over the years, also the prevalence of insulin resistance (IR)/hyperinsulinemia (Hyperins) in the general adult population has progressively increased, primarily due to lifestyle changes, particularly in developed and developing countries, with a range that globally ranges between 15.5% and 46.5%. Notably, over 50% of patients with HF also have IR/Hyperins, and the percentage is even higher in those with HFpEF. In the scientific literature, it has been well highlighted that the increased circulating levels of insulin, associated with conditions of insulin resistance, are responsible for progressive cardiovascular alterations over the years that could stimulate the development and/or the worsening of HFpEF. The aim of this manuscript was to review the scientific literature that supports a pathophysiologic connection between IR/Hyperins and HFpEF to stimulate the scientific community toward the identification of hyperinsulinemia associated with insulin resistance as an independent cardiovascular risk factor in the development and worsening of HF, believing that its adequate screening in the general population and an appropriate treatment could reduce the prevalence of HFpEF and improve its progression.
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Affiliation(s)
- Serafino Fazio
- Department of Internal Medicine, School of Medicine, Federico II University, Via Sergio Pansini 5, 80135 Naples, Italy
| | - Valentina Mercurio
- Department of Translational Medical Sciences, Federico II University, Via Sergio Pasini 5, 80135 Naples, Italy;
| | - Valeria Fazio
- UOC Medicina Interna, Azienda Ospedaliera di Caserta, 81100 Caserta, Italy;
| | - Antonio Ruvolo
- UOC Cardiologia AORN dei colli PO CTO, Viale Colli Aminei 21, 80100 Naples, Italy;
| | - Flora Affuso
- Independent Researcher, Viale Raffaello 74, 80129 Naples, Italy;
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5
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Iacovelli JJ, Alpenglow JK, Ratchford SM, Craig JC, Simmons JM, Zhao J, Reese V, Bunsawat K, Ma CL, Ryan JJ, Wray DW. Statin administration improves vascular function in heart failure with preserved ejection fraction. J Appl Physiol (1985) 2024; 136:877-888. [PMID: 38385181 DOI: 10.1152/japplphysiol.00775.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 02/16/2024] [Accepted: 02/18/2024] [Indexed: 02/23/2024] Open
Abstract
Heart failure with preserved ejection fraction (HFpEF) is characterized by impaired vascular endothelial function that may be improved by hydroxy-methylglutaryl-CoA (HMG-CoA) reductase enzyme inhibition. Thus, using a parallel, double-blind, placebo-controlled design, this study evaluated the efficacy of 30-day atorvastatin administration (10 mg daily) on peripheral vascular function and biomarkers of inflammation and oxidative stress in 16 patients with HFpEF [Statin: n = 8, 74 ± 6 yr, ejection fraction (EF) 52-73%; Placebo: n = 8, 67 ± 9 yr, EF 56-72%]. Flow-mediated dilation (FMD) and sustained-stimulus FMD (SS-FMD) during handgrip (HG) exercise, reactive hyperemia (RH), and blood flow during HG exercise were evaluated to assess conduit vessel function, microvascular function, and exercising muscle blood flow, respectively. FMD improved following statin administration (pre, 3.33 ± 2.13%; post, 5.23 ± 1.35%; P < 0.01), but was unchanged in the placebo group. Likewise, SS-FMD, quantified using the slope of changes in brachial artery diameter in response to increases in shear rate, improved following statin administration (pre: 5.31e-5 ± 3.85e-5 mm/s-1; post: 8.54e-5 ± 4.98e-5 mm/s-1; P = 0.03), with no change in the placebo group. Reactive hyperemia and exercise hyperemia responses were unchanged in both statin and placebo groups. Statin administration decreased markers of lipid peroxidation (malondialdehyde, MDA) (pre, 0.652 ± 0.095; post, 0.501 ± 0.094; P = 0.04), whereas other inflammatory and oxidative stress biomarkers were unchanged. Together, these data provide new evidence for the efficacy of low-dose statin administration to improve brachial artery endothelium-dependent vasodilation, but not microvascular function or exercising limb blood flow, in patients with HFpEF, which may be due in part to reductions in oxidative stress.NEW & NOTEWORTHY This is the first study to investigate the impact of statin administration on vascular function and exercise hyperemia in patients with heart failure with preserved ejection fraction (HFpEF). In support of our hypothesis, both conventional flow-mediated dilation (FMD) testing and brachial artery vasodilation in response to sustained elevations in shear rate during handgrip exercise increased significantly in patients with HFpEF following statin administration, beneficial effects that were accompanied by a decrease in biomarkers of oxidative damage. However, contrary to our hypothesis, reactive hyperemia and exercise hyperemia were unchanged in patients with HFpEF following statin therapy. These data provide new evidence for the efficacy of low-dose statin administration to improve brachial artery endothelium-dependent vasodilation, but not microvascular reactivity or exercising muscle blood flow in patients with HFpEF, which may be due in part to reductions in oxidative stress.
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Affiliation(s)
- Jarred J Iacovelli
- Department of Nutrition and Integrative Physiology, University of Utah, Salt Lake City, Utah, United States
| | - Jeremy K Alpenglow
- Department of Nutrition and Integrative Physiology, University of Utah, Salt Lake City, Utah, United States
| | - Stephen M Ratchford
- Geriatric Research, Education, and Clinical Center, Veterans Affairs Medical Center, Salt Lake City, Utah, United States
| | - Jesse C Craig
- Geriatric Research, Education, and Clinical Center, Veterans Affairs Medical Center, Salt Lake City, Utah, United States
| | - Jonah M Simmons
- Department of Nutrition and Integrative Physiology, University of Utah, Salt Lake City, Utah, United States
- Department of Chemistry, University of Utah, Salt Lake City, Utah, United States
| | - Jia Zhao
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Utah, Salt Lake City, Utah, United States
| | - Van Reese
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Utah, Salt Lake City, Utah, United States
| | - Kanokwan Bunsawat
- Division of Geriatrics, Department of Internal Medicine, University of Utah, Salt Lake City, Utah, United States
- Geriatric Research, Education, and Clinical Center, Veterans Affairs Medical Center, Salt Lake City, Utah, United States
| | - Christy L Ma
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Utah, Salt Lake City, Utah, United States
| | - John J Ryan
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Utah, Salt Lake City, Utah, United States
| | - D Walter Wray
- Department of Nutrition and Integrative Physiology, University of Utah, Salt Lake City, Utah, United States
- Division of Geriatrics, Department of Internal Medicine, University of Utah, Salt Lake City, Utah, United States
- Geriatric Research, Education, and Clinical Center, Veterans Affairs Medical Center, Salt Lake City, Utah, United States
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6
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Dimond MG, Ibrahim NE, Fiuzat M, McMurray JJV, Lindenfeld J, Ahmad T, Bozkurt B, Bristow MR, Butler J, Carson PE, Felker GM, Jessup M, Murillo J, Kondo T, Solomon SD, Abraham WT, O'Connor CM, Psotka MA. Left Ventricular Ejection Fraction and the Future of Heart Failure Phenotyping. JACC. HEART FAILURE 2024; 12:451-460. [PMID: 38099892 DOI: 10.1016/j.jchf.2023.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 10/19/2023] [Accepted: 11/04/2023] [Indexed: 02/04/2024]
Abstract
Heart failure (HF) is a complex syndrome traditionally classified by left ventricular ejection fraction (LVEF) cutpoints. Although LVEF is prognostic for risk of events and predictive of response to some HF therapies, LVEF is a continuous variable and cutpoints are arbitrary, often based on historical clinical trial enrichment decisions rather than physiology. Holistic evaluation of the treatment effects for therapies throughout the LVEF range suggests the standard categorization paradigm for HF merits modification. The multidisciplinary Heart Failure Collaboratory reviewed data from large-scale HF clinical trials and found that many HF therapies have demonstrated therapeutic benefit across a large range of LVEF, but specific treatment effects vary across that range. Therefore, HF should practically be classified by association with an LVEF that is reduced or not reduced, while acknowledging uncertainty around the precise LVEF cutpoint, and future research should evaluate new therapies across the continuum of LVEF.
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Affiliation(s)
| | | | - Mona Fiuzat
- Duke University Medical Center, Durham, North Carolina, USA
| | - John J V McMurray
- British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom
| | - JoAnn Lindenfeld
- Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Tariq Ahmad
- Yale University School of Medicine, New Haven, Connecticut, USA
| | | | - Michael R Bristow
- University of Colorado Anschutz School of Medicine, Aurora, Colorado, USA
| | - Javed Butler
- Baylor Scott and White Research Institute, Dallas, Texas, USA
| | | | | | | | | | - Toru Kondo
- British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom; Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | | | | | - Christopher M O'Connor
- Inova Schar Heart and Vascular, Falls Church, Virginia, USA; Duke University Medical Center, Durham, North Carolina, USA
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7
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Pawar SG, Saravanan PB, Gulati S, Pati S, Joshi M, Salam A, Khan N. Study the relationship between left atrial (LA) volume and left ventricular (LV) diastolic dysfunction and LV hypertrophy: Correlate LA volume with cardiovascular risk factors. Dis Mon 2024; 70:101675. [PMID: 38262769 DOI: 10.1016/j.disamonth.2024.101675] [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] [Indexed: 01/25/2024]
Abstract
Heart failure (HF) with normal ejection fraction - the isolated diastolic heart failure, depicts increasing prevalence and health care burden in recent times. Having less mortality rate compared to systolic heart failure but high morbidity, it is evolving as a major cardiac concern. With increasing clinical use of Left atrial volume (LAV) quantitation in clinical settings, LAV has emerged as an important independent predictor of cardiovascular outcome in HF with normal ejection fraction. This article is intended to review the diastolic and systolic heart failure, their association with left atrial volume, in depth study of Left atrial function dynamics with determinants of various functional and structural changes.
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Affiliation(s)
| | | | | | | | - Muskan Joshi
- Tbilisi State Medical University, Tbilisi, Georgia
| | - Ajal Salam
- Government Medical College, Kottayam, Kerala, India
| | - Nida Khan
- Jinnah Sindh Medical University, Karachi, Pakistan
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Song B, Zhang H, Zhou B. RETRACTED ARTICLE: Effects of Dapagliflozin on myocardial remodeling, inflammatory factors, and cardiac events in heart failure with preserved ejection fraction. NAUNYN-SCHMIEDEBERG'S ARCHIVES OF PHARMACOLOGY 2024; 397:629. [PMID: 37368031 DOI: 10.1007/s00210-023-02590-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Accepted: 06/17/2023] [Indexed: 06/28/2023]
Affiliation(s)
- BoFan Song
- Department of Cardiology, The First Affiliated Hospital of Anhui Medical University, No. 218 Jixi Road, Shushan District, Anhui, 230022, Hefei, People's Republic of China
| | - Hao Zhang
- Department of Cardiology, The First Affiliated Hospital of Anhui Medical University, No. 218 Jixi Road, Shushan District, Anhui, 230022, Hefei, People's Republic of China
| | - Birong Zhou
- Department of Cardiology, The First Affiliated Hospital of Anhui Medical University, No. 218 Jixi Road, Shushan District, Anhui, 230022, Hefei, People's Republic of China.
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9
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Abubakar M, Saleem A, Hajjaj M, Faiz H, Pragya A, Jamil R, Salim SS, Lateef IK, Singla D, Ramar R, Damara I, Shahid L. Sex-specific differences in risk factors, comorbidities, diagnostic challenges, optimal management, and prognostic outcomes of heart failure with preserved ejection fraction: A comprehensive literature review. Heart Fail Rev 2024; 29:235-256. [PMID: 37996694 DOI: 10.1007/s10741-023-10369-4] [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] [Accepted: 11/06/2023] [Indexed: 11/25/2023]
Abstract
Due to hormonal variations, heart failure with preserved ejection fraction (HFpEF) remains prevalent in women and affects almost half of the heart failure (HF) patients. Given the yearly death rate of 10-30% and the unavailability of medications targeting HFpEF, the need arises for a better understanding of the fundamental mechanisms of this syndrome. This comprehensive review explores sex-specific differences in traditional risk factors; female-specific factors that may impact HFpEF development and response to therapy, including variations in hormone levels that may occur pre- and post-menopausal or during pregnancy; and disparities in comorbidities, clinical presentation, and diagnostic challenges. Lastly, the review addresses prognostic outcomes, noting that women with HFpEF have a poor quality of life but a higher survival rate. It also discusses novel biomarkers and precision medicine, emphasizing their potential to improve early detection and personalized treatment.
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Affiliation(s)
- Muhammad Abubakar
- Department of Internal Medicine, Ameer-Ud-Din Medical College, Lahore General Hospital, 6 Birdwood Road, Jinnah Town, Lahore, Punjab, 54000, Pakistan.
| | - Ayesha Saleem
- Department of Internal Medicine, Jinnah Hospital, Lahore, Punjab, Pakistan
| | - Mohsin Hajjaj
- Department of Internal Medicine, Jinnah Hospital, Lahore, Punjab, Pakistan
| | - Haseeb Faiz
- Department of Internal Medicine, Jinnah Hospital, Lahore, Punjab, Pakistan
| | - Aastha Pragya
- Department of Internal Medicine, Bangalore Medical College and Research Institute, Bengaluru, Karnataka, India
| | - Rosheen Jamil
- Department of Internal Medicine, Mayo Hospital, Lahore, Punjab, Pakistan
| | - Siffat Saima Salim
- Department of Surgery, Holy Family Red Crescent Medical College Hospital, Dhaka, Bangladesh
| | | | - Deepak Singla
- Department of Internal Medicine, Government Medical College, Patiala, Punjab, India
| | - Rajasekar Ramar
- Department of Internal Medicine, Rajah Muthiah Medical College, Chidambaram, Tamil Nadu, India
| | - Ivan Damara
- Department of Internal Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Laraib Shahid
- Department of Dermatology, Lahore General Hospital, Lahore, Punjab, Pakistan
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10
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Fazio S, Mercurio V, Affuso F, Bellavite P. The Negative Impact of Insulin Resistance/Hyperinsulinemia on Chronic Heart Failure and the Potential Benefits of Its Screening and Treatment. Biomedicines 2023; 11:2928. [PMID: 38001929 PMCID: PMC10669553 DOI: 10.3390/biomedicines11112928] [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: 09/21/2023] [Revised: 10/25/2023] [Accepted: 10/26/2023] [Indexed: 11/26/2023] Open
Abstract
This opinion article highlights the potential alterations caused by insulin resistance and hyperinsulinemia on the cardiovascular system and their negative impact on heart failure (HF), and describes the potential benefits of an early screening with consequent prompt treatment. HF is the final event of several different cardiovascular diseases. Its incidence has been increasing over the last decades because of increased survival from ischemic heart disease thanks to improvements in its treatment (including myocardial revascularization interventions) and the increase in life span. In particular, incidence of HF with preserved ejection fraction (HFpEF) is significantly increasing, and patients with HFpEF often are also affected by diabetes mellitus and insulin resistance (IR), with a prevalence > 45%. Concentric left ventricular (LV) remodeling and diastolic dysfunction are the main structural abnormalities that characterize HFpEF. It is well documented in the literature that IR with chronic hyperinsulinemia, besides causing type 2 diabetes mellitus, can cause numerous cardiovascular alterations, including endothelial dysfunction and increased wall thicknesses of the left ventricle with concentric remodeling and diastolic dysfunction. Therefore, it is conceivable that IR might play a major role in the pathophysiology and the progressive worsening of HF. To date, several substances have been shown to reduce IR/hyperinsulinemia and have beneficial clinical effects in patients with HF, including SGLT2 inhibitors, metformin, and berberine. For this reason, an early screening of IR could be advisable in subjects at risk and in patients with heart failure, to promptly intervene with appropriate therapy. Future studies aimed at comparing the efficacy of the substances used both alone and in association are needed.
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Affiliation(s)
- Serafino Fazio
- Department of Internal Medicine, University of Naples Federico II, 80138 Naples, Italy
| | - Valentina Mercurio
- Department of Translational Medical Sciences, University of Naples Federico II, 80131 Naples, Italy;
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11
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Sivri F, Icen YK, Koca H, Coşkun M, Ardınç M, Deniz O, Arici FN, Koc M, Güngör H. Selvester QRS Score is a Predictor of Mortality in Heart Failure with Preserved Ejection Fraction. Arq Bras Cardiol 2023; 120:e20230235. [PMID: 37820175 PMCID: PMC10519357 DOI: 10.36660/abc.20230235] [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: 12/03/2022] [Revised: 06/15/2023] [Accepted: 07/17/2023] [Indexed: 10/13/2023] Open
Abstract
BACKGROUND The Selvester QRS (S-QRS) score on a 12-lead electrocardiogram (ECG) is associated with both the amount of myocardial scar and poor prognosis in myocardial infarction patients. However, its prognostic value in heart failure (HF) with preserved ejection fraction (HFpEF) is unknown. OBJECTIVE This study aims to investigate the predictive value of the S-QRS score for mortality in HFpEF. METHODS 359 patients were retrospectively enrolled in this study. Electrocardiographic, echocardiographic, and laboratory features of the patients were recorded. The simplified S-QRS score was measured and recorded. The mean follow-up time of the patients was 38.1±9.5 months. Statistical significance was set at p < 0.05. RESULTS Of 359 patients, 270 were in the survivor group, and 89 were in the deceased group. Age, Hs-CRP, troponin, pro-BNP, left atrial (LA) diameter, LA volume index, QRS duration, Tpe, and S-QRS score were statistically high in the deceased group. In multivariate logistic regression analysis, age, Hs-CRP, NT-proBNP, LA diameter, LA volume index, Tpe, and S-QRS score were shown to be independent risk factors for mortality. In the receiver-operating characteristic (ROC) analysis, the cut-off value of the S-QRS score was 5.5, the sensitivity was 80.8%, and the specificity was 77.2% (AUC:0.880, p:0.00). In Kaplan-Meier analysis, it was found that mortality was higher in the group with S-QRS score ≥ 5.5 than in the group with S-QRS score < 5.5. (Long-rank, p:0.00). CONCLUSIONS We think that the S-QRS score can be used as a prognostic indicator of long-term mortality in patients with HFpEF.
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Affiliation(s)
- Fatih Sivri
- Nazilli State HospitalDepartment of CardiologyAydinTurquiaNazilli State Hospital – Department of Cardiology, Aydin – Turquia
| | - Yahya Kemal Icen
- Adana Health Practice and Research CenterDepartment of CardiologyAdanaTurquiaAdana Health Practice and Research Center – Department of Cardiology, Adana – Turquia
| | - Hasan Koca
- Adana Health Practice and Research CenterDepartment of CardiologyAdanaTurquiaAdana Health Practice and Research Center – Department of Cardiology, Adana – Turquia
| | - Mükremin Coşkun
- Adana Health Practice and Research CenterDepartment of CardiologyAdanaTurquiaAdana Health Practice and Research Center – Department of Cardiology, Adana – Turquia
| | - Mustafa Ardınç
- Adana Health Practice and Research CenterDepartment of CardiologyAdanaTurquiaAdana Health Practice and Research Center – Department of Cardiology, Adana – Turquia
| | - Orshan Deniz
- Adana Health Practice and Research CenterDepartment of CardiologyAdanaTurquiaAdana Health Practice and Research Center – Department of Cardiology, Adana – Turquia
| | - Fatih Necip Arici
- Adana Health Practice and Research CenterDepartment of CardiologyAdanaTurquiaAdana Health Practice and Research Center – Department of Cardiology, Adana – Turquia
| | - Mevlüt Koc
- Adana Health Practice and Research CenterDepartment of CardiologyAdanaTurquiaAdana Health Practice and Research Center – Department of Cardiology, Adana – Turquia
| | - Hasan Güngör
- Adnan Menderes UniversityDepartment of CardiologyAydinTurquiaAdnan Menderes University – Department of Cardiology, Aydin – Turquia
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12
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Zhao W, Shan X, Li X, Lu S, Xia L, Chen H, Zhang C, Guo W, Xu M, Lu R, Zhao P. Icariin inhibits hypertrophy by regulation of GPER1 and CaMKII/HDAC4/MEF2C signaling crosstalk in ovariectomized mice. Chem Biol Interact 2023; 384:110728. [PMID: 37739049 DOI: 10.1016/j.cbi.2023.110728] [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: 11/19/2022] [Revised: 08/16/2023] [Accepted: 09/20/2023] [Indexed: 09/24/2023]
Abstract
Icariin (ICA), a flavonoid phytoestrogen, was isolated from traditional Chinese medicine Yin Yang Huo (Epimedium brevicornu Maxim.). Previous studies reporting the cardioprotective effects of ICA are available; however, little is known about the impact of ICA on cardioprotection under conditions of reduced estrogen levels. This study aimed to provide detailed information regarding the antihypertrophic effects of ICA in ovariectomized female mice. Female mice were subjected to ovariectomy (OVX) and transverse aortic constriction and then orally treated with ICA at doses of 30, 60 or 120 mg/kg/day for 4 weeks. Morphological assessments, echocardiographic parameters, histological analyses, and immunofluorescence were performed to evaluate cardiac hypertrophy. Cardiomyocytes from mice or rats were stimulated using phenylephrine, and cell surface and hypertrophy markers were tested using immunofluorescence and qPCR. Western blotting, qPCR, and luciferase reporter gene assays were used to assess the expression of proteins and mRNA and further investigate the proteins related to the G-protein coupled estrogen receptor (GPER1) and CaMKII/HDAC4/MEF2C signaling pathways in vivo and in vitro. ICA blocks cardiac hypertrophy induced by pressure overload in OVX mice. Additionally, we demonstrated that ICA activated GPER1 and inhibited the nuclear export or promoted the nuclear import of histone deacetylase 4 (HDAC4) through regulation of phosphorylation of calmodulin-dependent protein kinase II (CaMKII) and further improved the repression of myocyte enhancer factor-2C (MEF2C). ICA ameliorated cardiac hypertrophy in OVX mice by activating GPER1 and inhibiting the CaMKII/HDAC4/MEF2 signaling pathway.
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Affiliation(s)
- Wenxia Zhao
- School of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China; School of Public Health, Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Xiaoli Shan
- School of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Xueqin Li
- School of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Shuang Lu
- School of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Lei Xia
- School of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Huihua Chen
- School of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Chen Zhang
- School of Integrative Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Wei Guo
- School of Integrative Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Ming Xu
- School of Integrative Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Rong Lu
- School of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China.
| | - Pei Zhao
- School of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China.
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13
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Roberts LM, Moreira-Bouchard JD. Impaired functional sympatholysis during exercise in HFpEF: toward understanding exercise intolerance. Am J Physiol Heart Circ Physiol 2023; 325:H892-H895. [PMID: 37682235 DOI: 10.1152/ajpheart.00552.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 09/05/2023] [Indexed: 09/09/2023]
Affiliation(s)
- Lisa M Roberts
- Q.U.E.E.R. Lab, Programs in Human Physiology, Department of Health Sciences, Boston University Sargent College, Boston, Massachusetts, United States
| | - Jesse D Moreira-Bouchard
- Q.U.E.E.R. Lab, Programs in Human Physiology, Department of Health Sciences, Boston University Sargent College, Boston, Massachusetts, United States
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14
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Kerstens TP, Weerts J, van Dijk APJ, Weijers G, Knackstedt C, Eijsvogels TMH, Oxborough D, van Empel VPM, Thijssen DHJ. Association of left ventricular strain-volume loop characteristics with adverse events in patients with heart failure with preserved ejection fraction. Eur Heart J Cardiovasc Imaging 2023; 24:1168-1176. [PMID: 37259911 PMCID: PMC10445262 DOI: 10.1093/ehjci/jead117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 04/24/2023] [Accepted: 05/15/2023] [Indexed: 06/02/2023] Open
Abstract
AIMS Patients with heart failure with preserved ejection fraction (HFpEF) are characterized by impaired diastolic function. Left ventricular (LV) strain-volume loops (SVL) represent the relation between strain and volume during the cardiac cycle and provide insight into systolic and diastolic function characteristics. In this study, we examined the association of SVL parameters and adverse events in HFpEF. METHODS AND RESULTS In 235 patients diagnosed with HFpEF, LV-SVL were constructed based on echocardiography images. The endpoint was a composite of all-cause mortality and Heart Failure (HF)-related hospitalization, which was extracted from electronic medical records. Cox-regression analysis was used to assess the association of SVL parameters and the composite endpoint, while adjusting for age, sex, and NYHA class. HFpEF patients (72.3% female) were 75.8 ± 6.9 years old, had a BMI of 29.9 ± 5.4 kg/m2, and a left ventricular ejection fraction of 60.3 ± 7.0%. Across 2.9 years (1.8-4.1) of follow-up, 73 Patients (31%) experienced an event. Early diastolic slope was significantly associated with adverse events [second quartile vs. first quartile: adjusted hazards ratio (HR) 0.42 (95%CI 0.20-0.88)] after adjusting for age, sex, and NYHA class. The association between LV peak strain and adverse events disappeared upon correction for potential confounders [adjusted HR 1.02 (95% CI 0.96-1.08)]. CONCLUSION Early diastolic slope, representing the relationship between changes in LV volume and strain during early diastole, but not other SVL-parameters, was associated with adverse events in patients with HFpEF during 2.9 years of follow-up.
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Affiliation(s)
- Thijs P Kerstens
- Department of Medical BioSciences, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands
- Department of Cardiology, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands
| | - Jerremy Weerts
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre+ (MUMC+), P. Debyeplein 25, 6200 MD Maastricht, The Netherlands
| | - Arie P J van Dijk
- Department of Cardiology, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands
| | - Gert Weijers
- Medical UltraSound Imaging Center (MUSIC), Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands
| | - Christian Knackstedt
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre+ (MUMC+), P. Debyeplein 25, 6200 MD Maastricht, The Netherlands
| | - Thijs M H Eijsvogels
- Department of Medical BioSciences, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands
| | - David Oxborough
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool L3 5UX, UK
| | - Vanessa P M van Empel
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre+ (MUMC+), P. Debyeplein 25, 6200 MD Maastricht, The Netherlands
| | - Dick H J Thijssen
- Department of Medical BioSciences, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool L3 5UX, UK
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15
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Leancă SA, Afrăsânie I, Crișu D, Matei IT, Duca ȘT, Costache AD, Onofrei V, Tudorancea I, Mitu O, Bădescu MC, Șerban LI, Costache II. Cardiac Reverse Remodeling in Ischemic Heart Disease with Novel Therapies for Heart Failure with Reduced Ejection Fraction. Life (Basel) 2023; 13:1000. [PMID: 37109529 PMCID: PMC10143569 DOI: 10.3390/life13041000] [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: 03/07/2023] [Revised: 04/03/2023] [Accepted: 04/11/2023] [Indexed: 04/29/2023] Open
Abstract
Despite the improvements in the treatment of coronary artery disease (CAD) and acute myocardial infarction (MI) over the past 20 years, ischemic heart disease (IHD) continues to be the most common cause of heart failure (HF). In clinical trials, over 70% of patients diagnosed with HF had IHD as the underlying cause. Furthermore, IHD predicts a worse outcome for patients with HF, leading to a substantial increase in late morbidity, mortality, and healthcare costs. In recent years, new pharmacological therapies have emerged for the treatment of HF, such as sodium-glucose cotransporter-2 inhibitors, angiotensin receptor-neprilysin inhibitors, selective cardiac myosin activators, and oral soluble guanylate cyclase stimulators, demonstrating clear or potential benefits in patients with HF with reduced ejection fraction. Interventional strategies such as cardiac resynchronization therapy, cardiac contractility modulation, or baroreflex activation therapy might provide additional therapeutic benefits by improving symptoms and promoting reverse remodeling. Furthermore, cardiac regenerative therapies such as stem cell transplantation could become a new therapeutic resource in the management of HF. By analyzing the existing data from the literature, this review aims to evaluate the impact of new HF therapies in patients with IHD in order to gain further insight into the best form of therapeutic management for this large proportion of HF patients.
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Affiliation(s)
- Sabina Andreea Leancă
- Cardiology Clinic, “St. Spiridon” County Clinical Emergency Hospital, 700111 Iași, Romania
- Department of Internal Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iași, Romania
| | - Irina Afrăsânie
- Cardiology Clinic, “St. Spiridon” County Clinical Emergency Hospital, 700111 Iași, Romania
- Department of Internal Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iași, Romania
| | - Daniela Crișu
- Cardiology Clinic, “St. Spiridon” County Clinical Emergency Hospital, 700111 Iași, Romania
| | - Iulian Theodor Matei
- Cardiology Clinic, “St. Spiridon” County Clinical Emergency Hospital, 700111 Iași, Romania
- Department of Internal Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iași, Romania
| | - Ștefania Teodora Duca
- Cardiology Clinic, “St. Spiridon” County Clinical Emergency Hospital, 700111 Iași, Romania
- Department of Internal Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iași, Romania
| | - Alexandru Dan Costache
- Department of Internal Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iași, Romania
- Department of Cardiovascular Rehabilitation, Clinical Rehabilitation Hospital, 700661 Iași, Romania
| | - Viviana Onofrei
- Cardiology Clinic, “St. Spiridon” County Clinical Emergency Hospital, 700111 Iași, Romania
- Department of Internal Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iași, Romania
| | - Ionuţ Tudorancea
- Cardiology Clinic, “St. Spiridon” County Clinical Emergency Hospital, 700111 Iași, Romania
- Department of Physiology, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iași, Romania
| | - Ovidiu Mitu
- Cardiology Clinic, “St. Spiridon” County Clinical Emergency Hospital, 700111 Iași, Romania
- Department of Internal Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iași, Romania
| | - Minerva Codruța Bădescu
- Department of Internal Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iași, Romania
- Internal Medicine Clinic, “St. Spiridon” County Clinical Emergency Hospital, 700111 Iași, Romania
| | - Lăcrămioara Ionela Șerban
- Department of Physiology, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iași, Romania
| | - Irina Iuliana Costache
- Cardiology Clinic, “St. Spiridon” County Clinical Emergency Hospital, 700111 Iași, Romania
- Department of Internal Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iași, Romania
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16
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Saleem S, Khandoker AH, Alkhodari M, Hadjileontiadis LJ, Jelinek HF. Investigating the effects of beta-blockers on circadian heart rhythm using heart rate variability in ischemic heart disease with preserved ejection fraction. Sci Rep 2023; 13:5828. [PMID: 37037871 PMCID: PMC10086029 DOI: 10.1038/s41598-023-32963-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 04/05/2023] [Indexed: 04/12/2023] Open
Abstract
Heart failure is characterized by sympathetic activation and parasympathetic withdrawal leading to an abnormal autonomic modulation. Beta-blockers (BB) inhibit overstimulation of the sympathetic system and are indicated in heart failure patients with reduced ejection fraction. However, the effect of beta-blocker therapy on heart failure with preserved ejection fraction (HFpEF) is unclear. ECGs of 73 patients with HFpEF > 55% were recruited. There were 56 patients in the BB group and 17 patients in the without BB (NBB) group. The HRV analysis was performed for the 24-h period using a window size of 1,4 and 8-h. HRV measures between day and night for both the groups were also compared. Percentage change in the BB group relative to the NBB group was used as a measure of difference. RMSSD (13.27%), pNN50 (2.44%), HF power (44.25%) and LF power (13.53%) showed an increase in the BB group relative to the NBB group during the day and were statistically significant between the two groups for periods associated with high cardiac risk during the morning hours. LF:HF ratio showed a decrease of 3.59% during the day. The relative increase in vagal modulated RMSSD, pNN50 and HF power with a decrease in LF:HF ratio show an improvement in the parasympathetic tone and an overall decreased risk of a cardiac event especially during the morning hours that is characterized by a sympathetic surge.
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Affiliation(s)
- Shiza Saleem
- Department of Biomedical Engineering, Khalifa University, 127788, Abu Dhabi, United Arab Emirates.
| | - Ahsan H Khandoker
- Department of Biomedical Engineering, Khalifa University, 127788, Abu Dhabi, United Arab Emirates
- Healthcare Engineering Innovation Center, Khalifa University, 127788, Abu Dhabi, United Arab Emirates
| | - Mohanad Alkhodari
- Healthcare Engineering Innovation Center, Khalifa University, 127788, Abu Dhabi, United Arab Emirates
- Cardiovascular Clinical Research Facility, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Leontios J Hadjileontiadis
- Department of Biomedical Engineering, Khalifa University, 127788, Abu Dhabi, United Arab Emirates
- Healthcare Engineering Innovation Center, Khalifa University, 127788, Abu Dhabi, United Arab Emirates
| | - Herbert F Jelinek
- Department of Biomedical Engineering, Khalifa University, 127788, Abu Dhabi, United Arab Emirates
- Healthcare Engineering Innovation Center, Khalifa University, 127788, Abu Dhabi, United Arab Emirates
- Biotechnology Center, Khalifa University, 127788, Abu Dhabi, United Arab Emirates
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17
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Wan Ahmad WA, Mohd Ghazi A, Abdul Ghapar AK, Muthusamy TS, Liew HB, Zainal Abidin I, Ong ML, Ross NT, Cham YL, Ho WS, Fegade M, Chew DSP. From Primary to Tertiary Care: Expert Position Statements to Guide Heart Failure with Preserved Ejection Fraction Diagnosis. Malays J Med Sci 2023; 30:49-66. [PMID: 36875198 PMCID: PMC9984115 DOI: 10.21315/mjms2023.30.1.5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 07/31/2022] [Indexed: 03/05/2023] Open
Abstract
Globally, heart failure with preserved ejection fraction (HFpEF) is quickly becoming the dominant form of heart failure (HF) in ageing populations. However, there are still multiple gaps and challenges in making a firm diagnosis of HFpEF in many low-to-middle income Asian countries. In response to this unmet need, the Malaysian HFpEF Working Group (MY-HPWG) gathered and reviewed evidence surrounding the use of different diagnostic modalities indicated for patients with HFpEF to identify diagnostic tools that could be conveniently accessed across different healthcare settings. As a result, five recommendation statements were proposed and an accompanying algorithm was developed, with the aim of improving the diagnostic rate of HFpEF. The MY-HPWG recommends using more easily accessible and non-invasive tools, such as natriuretic peptide (NP) biomarkers and basic echocardiogram (ECHO), to ensure timely HFpEF diagnosis in the primary and secondary care settings, and prompt referral to a tertiary care centre for more comprehensive assessments in uncertain cases.
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Affiliation(s)
- Wan Azman Wan Ahmad
- Division of Cardiology, Department of Medicine, University Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Azmee Mohd Ghazi
- Cardiology Department, The National Heart Institute of Malaysia, Kuala Lumpur, Malaysia
| | | | | | - Houng Bang Liew
- Cardiology Department, Queen Elizabeth Hospital II, Sabah, Malaysia
| | - Imran Zainal Abidin
- Department of Medicine, University Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Mei Lin Ong
- Cardiology Department, Gleneagles Hospital Penang, Pulau Pinang, Malaysia
| | - Noel Thomas Ross
- Medical Department, Kuala Lumpur Hospital, Kuala Lumpur, Malaysia
| | - Yee Ling Cham
- Cardiology Department, Sarawak Heart Centre, Sarawak, Malaysia
| | - Wing Sze Ho
- Novartis Corporation (Malaysia) Sdn. Bhd., Selangor, Malaysia
| | - Mayuresh Fegade
- Novartis Corporation (Malaysia) Sdn. Bhd., Selangor, Malaysia
| | - David Soon Ping Chew
- Cardiology Department, Cardiac Vascular Sentral Kuala Lumpur, Kuala Lumpur, Malaysia
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18
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Li K, Cardoso C, Moctezuma-Ramirez A, Elgalad A, Perin E. Evaluation of large animal models for preclinical studies of heart failure with preserved ejection fraction using clinical score systems. Front Cardiovasc Med 2023; 10:1099453. [PMID: 37034319 PMCID: PMC10076838 DOI: 10.3389/fcvm.2023.1099453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 03/02/2023] [Indexed: 04/11/2023] Open
Abstract
Heart failure with preserved ejection fraction (HFpEF) is characterized by a complex, heterogeneous spectrum of pathologic features combined with average left ventricular volume and diastolic dysfunction. HFpEF is a significant public health problem associated with high morbidity and mortality rates. Currently, effective treatments for HFpEF represent the greatest unmet need in cardiovascular medicine. A lack of an efficient preclinical model has hampered the development of new devices and medications for HFpEF. Because large animal models have similar physiologic traits as humans and appropriate organ sizes, they are the best option for limiting practical constraints. HFpEF is a highly integrated, multiorgan, systemic disorder requiring a multipronged investigative approach. Here, we review the large animal models of HFpEF reported to date and describe the methods that have been used to create HFpEF, including surgery-induced pressure overloading, medicine-induced pressure overloading, and diet-induced metabolic syndrome. In addition, for the first time to our knowledge, we use two established clinical HFpEF algorithms (HFA-PEFF and H2FPEF scores) to evaluate the currently available large animal models. We also discuss new technologies, such as continuous remote pressure monitors and inflatable aortic cuffs, as well as how the models could be improved. Based on current progress and our own experience, we believe an efficient large animal model of HFpEF should simultaneously encompass multiple pathophysiologic factors, along with multiorgan dysfunction. This could be fully evaluated through available methods (imaging, blood work). Although many models have been studied, only a few studies completely meet clinical score standards. Therefore, it is critical to address the deficiencies of each model and incorporate novel techniques to establish a more reliable model, which will help facilitate the understanding of HFpEF mechanisms and the development of a treatment.
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Affiliation(s)
- Ke Li
- Center for Preclinical Cardiovascular Research, The Texas Heart Institute, Houston, TX, United States
| | - Cristiano Cardoso
- Center for Preclinical Cardiovascular Research, The Texas Heart Institute, Houston, TX, United States
| | - Angel Moctezuma-Ramirez
- Center for Preclinical Cardiovascular Research, The Texas Heart Institute, Houston, TX, United States
| | - Abdelmotagaly Elgalad
- Center for Preclinical Cardiovascular Research, The Texas Heart Institute, Houston, TX, United States
- Correspondence: Abdelmotagaly Elgalad
| | - Emerson Perin
- Center for Clinical Research, The Texas Heart Institute, Houston, TX, United States
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19
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Oeun B, Hikoso S, Nakatani D, Mizuno H, Kitamura T, Okada K, Dohi T, Sotomi Y, Kida H, Sunaga A, Sato T, Matsuoka Y, Kurakami H, Yamada T, Tamaki S, Seo M, Yano M, Hayashi T, Nakagawa A, Nakagawa Y, Yamada T, Yasumura Y, Sakata Y, Watanabe T, Yamada T, Hayashi T, Higuchi Y, Masuda M, Asai M, Mano T, Fuji H, Tamaki S, Masuda D, Shutta R, Yamashita S, Sairyo M, Nakagawa Y, Abe H, Ueda Y, Matsumura Y, Nagai K, Yano M, Nishino M, Tanouchi J, Arita Y, Ogasawara N, Ishizu T, Ichikawa M, Takano Y, Rin E, Shinoda Y, Tachibana K, Hoshida S, Izumi M, Yamamoto H, Kato H, Nakatani K, Yasuga Y, Nishio M, Hirooka K, Yoshimura T, Kashiwase K, Hasegawa S, Tani A, Okumoto Y, Makino Y, Onishi T, Iwakura K, Kijima Y, Kitao T, Fujita M, Harada K, Kumada M, Nakagawa O, Nakagawa A, Yasumura Y, Matsuoka Y, Sato T, Sunaga A, Oeun B, Kida H, Sotomi Y, Dohi T, Akazawa Y, Nakamoto K, Okada K, Sera F, Kioka H, Ohtani T, Takeda T, Nakatani D, Mizuno H, Hikoso S, Sakata Y. Clinical trajectories and outcomes of patients with heart failure with preserved ejection fraction with normal or indeterminate diastolic function. Clin Res Cardiol 2023; 112:145-157. [PMID: 36357804 DOI: 10.1007/s00392-022-02121-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Accepted: 10/19/2022] [Indexed: 11/12/2022]
Abstract
BACKGROUND We recently reported that nearly half of patients with heart failure with preserved ejection fraction (HFpEF) did not show echocardiographic diastolic dysfunction (DD), but had normal diastolic function (ND) or indeterminate diastolic function (ID). However, the clinical course and outcomes of patients with HFpEF with ND or ID (ND/ID) remain unknown. METHODS From the PURSUIT-HFpEF registry, we extracted 289 patients with HFpEF with ND/ID at discharge who had echocardiographic data at 1-year follow-up. Patients were classified according to the status of progression from ND/ID to DD at 1 year. Primary endpoint was a composite of all-cause death or HF rehospitalization. RESULTS Median age was 81 years, and 138 (47.8%) patients were female. At 1 year, 107 (37%) patients had progressed to DD. The composite endpoint occurred in 90 (31.1%) patients. Compared to patients without progression to DD, those with progression had a significantly higher cumulative rate of the composite endpoint (P < 0.001) and HF rehospitalization (P < 0.001) after discharge and at the 1-year landmark (P = 0.030 and P = 0.001, respectively). Progression to DD was independently associated with the composite endpoint (hazard ratio (HR): 2.014, 95%CI 1.239-3.273, P = 0.005) and HF rehospitalization (HR: 2.362, 95%CI 1.402-3.978) after discharge. Age (odds ratio (OR): 1.043, 95%CI 1.004-1.083, P = 0.031), body mass index (BMI) (OR: 1.110, 95%CI 1.031-1.195, P = 0.006), and albumin (OR: 0.452, 95%CI 0.211-0.969, P = 0.041) were independently associated with progression from ND/ID to DD. CONCLUSIONS More than one-third of HFpEF patients with ND/ID progressed to DD at 1 year and had poor outcomes. Age, BMI and albumin were independently associated with this progression. UMIN-CTR ID UMIN000021831.
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Affiliation(s)
- Bolrathanak Oeun
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, 565-0871, Japan
| | - Shungo Hikoso
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, 565-0871, Japan.
| | - Daisaku Nakatani
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, 565-0871, Japan
| | - Hiroya Mizuno
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, 565-0871, Japan
| | - Tetsuhisa Kitamura
- Department of Social and Environmental Medicine, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, 565-0871, Japan
| | - Katsuki Okada
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, 565-0871, Japan.,Department of Transformative System for Medical Information, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, 565-0871, Japan
| | - Tomoharu Dohi
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, 565-0871, Japan
| | - Yohei Sotomi
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, 565-0871, Japan
| | - Hirota Kida
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, 565-0871, Japan
| | - Akihiro Sunaga
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, 565-0871, Japan
| | - Taiki Sato
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, 565-0871, Japan
| | - Yuki Matsuoka
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, 565-0871, Japan
| | - Hiroyuki Kurakami
- Department of Medical Innovation, Osaka University Hospital, 2-15 Yamadaoka, Suita, 565-0871, Japan
| | - Tomomi Yamada
- Department of Medical Innovation, Osaka University Hospital, 2-15 Yamadaoka, Suita, 565-0871, Japan
| | - Shunsuke Tamaki
- Department of Cardiology, Rinku General Medical Center, 2-23 Ourai-Kita, Rinku, Izumisano, Osaka, 598-8577, Japan
| | - Masahiro Seo
- Division of Cardiology, Osaka General Medical Center, 3-1-56 Bandaihigashi, Osaka, 558-8558, Japan
| | - Masamichi Yano
- Division of Cardiology, Osaka Rosai Hospital, 3-1179 Nagasonecho, Kita-Ku, Sakai, Osaka, 591-8025, Japan
| | - Takaharu Hayashi
- Cardiovascular Division, Osaka Police Hospital, 10-31 Kitayamacho, Tennojiku, Osaka, 543-0035, Japan
| | - Akito Nakagawa
- Division of Cardiology, Amagasaki Chuo Hospital, 1-12-1 Shioe, Amagasaki, Hyogo, 661-0976, Japan.,Department of Medical Informatics, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, 565-0871, Japan
| | - Yusuke Nakagawa
- Division of Cardiology, Kawanishi City Hospital, 5-21-1 Higashiuneno, Kawanishi, 666-0117, Japan
| | - Takahisa Yamada
- Division of Cardiology, Osaka General Medical Center, 3-1-56 Bandaihigashi, Osaka, 558-8558, Japan
| | - Yoshio Yasumura
- Division of Cardiology, Amagasaki Chuo Hospital, 1-12-1 Shioe, Amagasaki, Hyogo, 661-0976, Japan
| | - Yasushi Sakata
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, 565-0871, Japan
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20
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Zhan Q, Peng W, Wang S, Gao J. Heart Failure with Preserved Ejection Fraction: Pathogenesis, Diagnosis, Exercise, and Medical Therapies. J Cardiovasc Transl Res 2022; 16:310-326. [PMID: 36171526 DOI: 10.1007/s12265-022-10324-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Accepted: 09/13/2022] [Indexed: 11/30/2022]
Abstract
Heart failure with preserved ejection fraction (HFpEF) accounts for more than one-half of total heart failure cases, with a high prevalence and poor prognosis, especially in older and female patients. Patients with HFpEF are characterized by hypertension, left ventricular hypertrophy, and diastolic dysfunction, and the main symptoms are dyspnea and exercise intolerance. HFpEF is currently poorly studied, and pharmacological treatment for HFpEF is still underexplored. Accumulating clinical trials have shown that exercise could exert benefits on diastolic dysfunction and quality of life in patients with HFpEF. However, there is a high limitation for applying exercise therapy due to exercise intolerance in patients with HFpEF. Key effectors of exercise-protection could be novel therapeutic targets for developing drugs to prevent and treat HFpEF. In this review article, we provide an overview of the pathogenic factors, diagnostic methods, research animal models, the mechanisms of exercise-mediated cardiac protection, and current treatments for HFpEF.
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Affiliation(s)
- Qingyi Zhan
- Cardiac Regeneration and Ageing Lab, Institute of Cardiovascular Sciences, School of Life Science, Shanghai University, Shanghai, 200444, China
| | - Wenjing Peng
- Cardiac Regeneration and Ageing Lab, Institute of Cardiovascular Sciences, School of Life Science, Shanghai University, Shanghai, 200444, China
| | - Siqi Wang
- Cardiac Regeneration and Ageing Lab, Institute of Cardiovascular Sciences, School of Life Science, Shanghai University, Shanghai, 200444, China
| | - Juan Gao
- Cardiac Regeneration and Ageing Lab, Institute of Cardiovascular Sciences, School of Life Science, Shanghai University, Shanghai, 200444, China. .,Shanghai Engineering Research Center of Organ Repair, School of Medicine, Shanghai University, Shanghai, 200444, China.
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21
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Yu W, Zhang H, Shen W, Luo F, Yang S, Gan L, Zhao Y, Yang P, Wu Q. Efficacy and safety of sacubitril/valsartan on heart failure with preserved ejection fraction: A meta-analysis of randomized controlled trials. Front Cardiovasc Med 2022; 9:897423. [PMID: 36158828 PMCID: PMC9492872 DOI: 10.3389/fcvm.2022.897423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 08/15/2022] [Indexed: 11/13/2022] Open
Abstract
AimsThe efficacy and safety of sacubitril/valsartan for patients with heart failure with preserved ejection fraction (HFpEF) are controversial. Hence, the primary objective of the study was to evaluate the efficacy and safety of sacubitril/valsartan treatment for patients with HFpEF.Methods and resultsWe used the PubMed, Embase, and Web of Science databases to search for randomized controlled trials of sacubitril–valsartan in patients with HFpEF. Three studies, involving a total of 7,663 patients, were eligible for inclusion. Sacubitril–valsartan reduced the risk of hospitalization for heart failure (HF) [odds ratio (OR): 0.78; 95% CI: 0.70–0.88; p < 0.0001] and the incidence of worsening renal function [risk ratio (RR): 0.79, p = 0.002] among patients with HFpEF in the three trials, but there was no significant reduction in all-cause mortality (0.99, 95% CI: 0.84–1.15; p = 0.86) or cardiovascular mortality (0.95, 95% CI: 0.78–1.15; p = 0.16). Moreover, sacubitril/valsartan was associated with an increased risk of symptomatic hypotension (RR: 1.44; p < 0.00001) and angioedema (RR: 2.66; p < 0.04); there was no difference for decreasing the incidence of hyperkalemia (RR: 0.89; p = 0.11).ConclusionCompared with valsartan or individualized medical therapy (IMT), sacubitril/valsartan significantly decreased the risk of hospitalization for HF and reduced the incidence of renal dysfunction.
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Affiliation(s)
- Wanqian Yu
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Hongzhou Zhang
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Wen Shen
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Fan Luo
- Medical Center of the Graduate School, Nanchang University, Nanchang, China
| | - Shuai Yang
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Lujin Gan
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Yuanbin Zhao
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Pingping Yang
- Department of Endocrinology and Metabolism, The Second Affiliated Hospital of Nanchang University, Nanchang, China
- *Correspondence: Pingping Yang
| | - Qinghua Wu
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, China
- Qinghua Wu
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22
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Stoichescu-Hogea G, Buleu FN, Christodorescu R, Sosdean R, Tudor A, Ember A, Brie DM, Drăgan S. Contribution of Global and Regional Longitudinal Strain for Clinical Assessment of HFpEF in Coronary and Hypertensive Patients. Medicina (B Aires) 2021; 57:medicina57121372. [PMID: 34946317 PMCID: PMC8707191 DOI: 10.3390/medicina57121372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 12/12/2021] [Accepted: 12/15/2021] [Indexed: 11/16/2022] Open
Abstract
Background: Contribution of global and regional longitudinal strain (GLS) for clinical assessment of patients with heart failure with preserved ejection fraction (HFpEF) is not well established. We sought to evaluate subclinical left ventricular dysfunction secondary to coronary artery disease (CAD) in HFpEF patients compared with hypertensive patients and age-matched healthy subjects. Material and methods: This was a retrospective study that included 148 patients (group 1 = 62 patients with HFpEF, group 2 = 46 hypertensive patients, and group 3 = 40 age-matched control subjects). Peak systolic segmental, regional (basal, mid, and apical), and global longitudinal strain were assessed for each study group using two-dimensional speckle-tracking echocardiography (2D-STE). Results: GLS values presented statistically significant differences between the three groups (p < 0.001); markedly increased values (more negative) were observed in the control group (−20.2 ± 1.4%) compared with HTN group values (−18.4 ± 3.0%, p = 0.031) and with HFpEF group values (−17.6 ± 2.3%, p < 0.001). The correlation between GLS values and HTN stages was significant, direct, and average (Spearman coefficient rho = 0.423, p < 0.001). GLS had the greatest ability to detect patients with HFpEF when HFpEF + CAD + HTN diastolic dysfunction (n = 30) + CON diastolic dysfunction (n = 2) from HFpEF + CAD + HTN + CON was analyzed. (optimal GLS limit of −19.35%, area under curve = 0.833, p < 0.001). Conclusions: Global longitudinal strain can be used for clinical assessment in differentiating coronary and hypertensive patients at higher risk for development of systolic dysfunction.
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Affiliation(s)
- Gheorghe Stoichescu-Hogea
- Department of Cardiology, “Victor Babes” University of Medicine and Pharmacy, E. Murgu Square No. 2, 300041 Timisoara, Romania; (G.S.-H.); (R.S.); (A.E.); (D.M.B.); (S.D.)
| | - Florina Nicoleta Buleu
- Department of Cardiology, “Victor Babes” University of Medicine and Pharmacy, E. Murgu Square No. 2, 300041 Timisoara, Romania; (G.S.-H.); (R.S.); (A.E.); (D.M.B.); (S.D.)
- Correspondence: (F.N.B.); (R.C.); Tel.: +40-724-351-393 (F.N.B.); +40-744-641-279 (R.C.)
| | - Ruxandra Christodorescu
- Department of Internal Medicine, “Victor Babes” University of Medicine and Pharmacy, E. Murgu Square No. 2, 300041 Timisoara, Romania
- Correspondence: (F.N.B.); (R.C.); Tel.: +40-724-351-393 (F.N.B.); +40-744-641-279 (R.C.)
| | - Raluca Sosdean
- Department of Cardiology, “Victor Babes” University of Medicine and Pharmacy, E. Murgu Square No. 2, 300041 Timisoara, Romania; (G.S.-H.); (R.S.); (A.E.); (D.M.B.); (S.D.)
- Institute of Cardiovascular Diseases Timișoara, 13 Gheorghe Adam Street, 300310 Timișoara, Romania
| | - Anca Tudor
- Department of Functional Sciences, “Victor Babes” University of Medicine and Pharmacy, E. Murgu Square No. 2, 300041 Timisoara, Romania;
| | - Andreea Ember
- Department of Cardiology, “Victor Babes” University of Medicine and Pharmacy, E. Murgu Square No. 2, 300041 Timisoara, Romania; (G.S.-H.); (R.S.); (A.E.); (D.M.B.); (S.D.)
| | - Daniel Miron Brie
- Department of Cardiology, “Victor Babes” University of Medicine and Pharmacy, E. Murgu Square No. 2, 300041 Timisoara, Romania; (G.S.-H.); (R.S.); (A.E.); (D.M.B.); (S.D.)
- Department of Functional Sciences, “Victor Babes” University of Medicine and Pharmacy, E. Murgu Square No. 2, 300041 Timisoara, Romania;
| | - Simona Drăgan
- Department of Cardiology, “Victor Babes” University of Medicine and Pharmacy, E. Murgu Square No. 2, 300041 Timisoara, Romania; (G.S.-H.); (R.S.); (A.E.); (D.M.B.); (S.D.)
- Department of Functional Sciences, “Victor Babes” University of Medicine and Pharmacy, E. Murgu Square No. 2, 300041 Timisoara, Romania;
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23
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Adekunle AO, Adzika GK, Mprah R, Ndzie Noah ML, Adu-Amankwaah J, Rizvi R, Akhter N, Sun H. Predominance of Heart Failure With Preserved Ejection Fraction in Postmenopausal Women: Intra- and Extra-Cardiomyocyte Maladaptive Alterations Scaffolded by Estrogen Deficiency. Front Cell Dev Biol 2021; 9:685996. [PMID: 34660569 PMCID: PMC8511782 DOI: 10.3389/fcell.2021.685996] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 09/09/2021] [Indexed: 12/11/2022] Open
Abstract
Heart failure (HF) remains a public health concern as it is associated with high morbidity and death rates. In particular, heart failure with preserved ejection fraction (HFpEF) represents the dominant (>50%) form of HF and mostly occurring among postmenopausal women. Hence, the initiation and progression of the left ventricular diastolic dysfunctions (LVDD) (a typically clinical manifestation of HFpEF) in postmenopausal women have been attributed to estrogen deficiency and the loss of its residue cardioprotective effects. In this review, from a pathophysiological and immunological standpoint, we discuss the probable multiple pathomechanisms resulting in HFpEF, which are facilitated by estrogen deficiency. The initial discussions recap estrogen and estrogen receptors (ERs) and β-adrenergic receptors (βARs) signaling under physiological/pathological states to facilitate cardiac function/dysfunction, respectively. By reconciling these prior discussions, attempts were made to explain how the loss of estrogen facilitates the disruptions both ERs and βARs-mediated signaling responsible for; the modulation of intra-cardiomyocyte calcium homeostasis, maintenance of cardiomyocyte cytoskeletal and extracellular matrix, the adaptive regulation of coronary microvascular endothelial functions and myocardial inflammatory responses. By scaffolding the disruption of these crucial intra- and extra-cardiomyocyte physiological functions, estrogen deficiency has been demonstrated to cause LVDD and increase the incidence of HFpEF in postmenopausal women. Finally, updates on the advancements in treatment interventions for the prevention of HFpEF were highlighted.
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Affiliation(s)
| | | | - Richard Mprah
- Department of Physiology, Xuzhou Medical University, Xuzhou, China
| | | | | | | | - Nazma Akhter
- Department of Physiology, Xuzhou Medical University, Xuzhou, China
| | - Hong Sun
- Department of Physiology, Xuzhou Medical University, Xuzhou, China.,Xuzhou Medical University, Xuzhou, China
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24
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Sharma AK, Kumar H, Razi MM, Sinha SK, Pandey U, Shukla P, Thakur R, Verma CM, Bansal RK, Krishna V. To determine the correlation between echocardiographic diastolic parameters and invasively measured left ventricular end diastolic pressure in patients with heart failure with preserved ejection fraction- an observational, descriptive study. (CEAL-HFpEF study). Indian Heart J 2021; 73:470-475. [PMID: 34474760 PMCID: PMC8424284 DOI: 10.1016/j.ihj.2021.06.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 01/18/2021] [Accepted: 06/27/2021] [Indexed: 12/28/2022] Open
Abstract
Objectives Though invasive monitoring is the most accurate to estimate diastolic dysfunction but it has its own risk. The purpose of this study was to find out any standardized correlation between invasive and non -invasive parameters. Methods It is an observational, descriptive study comprising of a total of 500 patients. The primary objective of the study was to determine the correlation between echocardiographic diastolic parameters and invasively measured left ventricular end diastolic pressure (LVEDP). Results On studying correlation of different invasive and non-invasive data it was reported that there was a weak correlation between peak E velocity (r = 0.14, p = 0.631), Peak A velocity (r = 0.67, p = 0.59), IVRT (r = −0.35, p = 0.178), Mitral deceleration time (DT) (r = −0.06, p = 0.842), pulmonary venous peak systolic (r = −0.02, p = 0.966) and diastolic flows (r = 0.47, p = 0.201) to LVEDP. There was a good positive correlation between elevated LVEDP and difference in duration of pulmonary venous and mitral flow at atrial contraction (A-Ard) and E/Ea at all four longitudinal segments of the left ventricle. The sensitivity and specificity for detecting an elevated LVEDP of more than 12 mm Hg, using a cut off value of E/Ea< 8, were 89% and 90%.Lateral E/Ea ≥ 12, LAVI ≥34 mL/m2, and Ard–Ad > 30 msec have the greatest diagnostic value for diagnosing diastolic dysfunction in HFpEF patients. Conclusion Lateral E/Ea ≥ 12, LAVI ≥34 mL/m2, and Ard–Ad > 30 msec have the greatest diagnostic value for diagnosing diastolic dysfunction in HFpEF patients and have good correlation with invasively measured LVEDP.
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Affiliation(s)
- Awadhesh Kumar Sharma
- Department of Cardiology, LPS Institute of Cardiology, GSVM Medical College, Kanpur, UP, 208019, India.
| | - Hitender Kumar
- Department of Cardiology, LPS Institute of Cardiology, GSVM Medical College, Kanpur, UP, 208019, India
| | - M M Razi
- Department of Cardiology, LPS Institute of Cardiology, GSVM Medical College, Kanpur, UP, 208019, India
| | - Santosh Kumar Sinha
- Department of Cardiology, LPS Institute of Cardiology, GSVM Medical College, Kanpur, UP, 208019, India
| | - Umeshwar Pandey
- Department of Cardiology, LPS Institute of Cardiology, GSVM Medical College, Kanpur, UP, 208019, India
| | - Praveen Shukla
- Department of Cardiology, LPS Institute of Cardiology, GSVM Medical College, Kanpur, UP, 208019, India
| | - Ramesh Thakur
- Department of Cardiology, LPS Institute of Cardiology, GSVM Medical College, Kanpur, UP, 208019, India
| | - C M Verma
- Department of Cardiology, LPS Institute of Cardiology, GSVM Medical College, Kanpur, UP, 208019, India
| | - R K Bansal
- Department of Cardiology, LPS Institute of Cardiology, GSVM Medical College, Kanpur, UP, 208019, India
| | - Vinay Krishna
- Department of Cardiothoracic Surgury, LPS Institute of Cardiology, GSVM Medical College, Kanpur, UP, 208019, India
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25
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KUŞ Ö, ŞENSOY B, TEMIZHAN A. Heart Failure and Aortic Stiffening in Patients with Preserved Ejection Fraction. TURKISH JOURNAL OF INTERNAL MEDICINE 2021. [DOI: 10.46310/tjim.949832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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