Assessment of right ventricular function in advanced heart failure with nonischemic dilated cardiomyopathy: insights of right ventricular elastance

Clinical characteristics, etiological profile, treatment and long term outcomes in patients with non ischemic systolic heart failure; Himachal Pradesh Heart failure registry (HP-HF registry)

BACKGROUND

The data on clinical characteristics, treatment practices and out comes in patients with Non- ischemic Systolic Heart Failure (NISHF) is limited. We report clinical characteristics, treatment and outcomes in patients with NISHF.

METHODS

1004 patients with NISHF were prospectively enrolled and their demographics, clinical characteristics, and treatment were recorded systematically. Patients were followed annually for a median of 3 years (1 year to 8 years) for allcause death, major adverse cardiovascular events (MACE); composite of all-cause death, hospitalization of heart failure, and or for stroke.

RESULTS

Patients of NISHF were middle-aged (58.8±16.2 years) population with severely depressed left ventricular ejection fraction (29.3±7.02%) and 31.1% had symptoms of advanced Heart failure. Hypertension (43.6%), obesity and or overweight (28.0%), Diabetes (15.0%), and valvular heart disease (11.8%) were the common risk factors. The guideline directed medical treatment was prescribed in more than 80% of the study cohort. Incidence of all cause death and MACE was 7 (6.8, 8.8) per 100 person years and 11(10, 13) per 100 person years respectively. The cumulative incidence of deaths and MACE was 35% (30%, 40%) and 49% (44%, 53%) at 8 years of follow-up.

CONCLUSIONS

Patients of NISHF were middle-aged population with severely depressed LV systolic function with significant incident morbidity and mortality. Early detection of risk factors and their risk management and enhancing the use of guideline directed treatment may improve the outcomes.

Updates in heart failure: sodium glucose co-transporter 2 inhibitors and beyond – major changes are coming

Prevalence of heart failure is increasing worldwide mainly due to the ageing of the population and the improvement in diagnosis and treatment. In recent years, huge progress has been made in the management of heart failure patients. A new definition of chronic heart failure based on left ventricular ejection fraction and its possible trajectories has been reported. New drug classes have been introduced for the treatment of chronic heart failure. In particular, the prognostic benefit of sodium glucose co-transporter 2 inhibitors was demonstrated across all the heart failure phenotypes. Therapies for patients with advanced heart failure (long-term mechanical circulatory supports and heart transplantation) are now indicated also in the case of mild-to-moderate symptoms but with high risk of progression. In patients with acute heart failure, monitoring of urinary sodium and the use of acetazolamide may lead to better decongestion. Importantly, pre- and postdischarge assessment should lead to optimal treatment. Devices and telemonitoring can also be of help. Cardiovascular and noncardiovascular comorbidities are major determinants of the clinical course and need proper management. This review will summarize these important advances.

Sensitivity and Specificity of Pulmonary Artery Pressure Measurement in Echocardiography and Correlation with Right Heart Catheterization

Objective

Echocardiography is helpful in assessment of pulmonary hemodynamic, however its correlation with Right heart catheterization (RHC) is conflicting. We conducted a study to evaluate sensitivity and specificity of pulmonary hemodynamic parameters measured in echocardiography. Furthermore its correlation with the values measured in RHC was assessed.

Method

Retrospective, cross-sectional study conducted at King Fahad medical City, Riyadh, Saudi Arabia. 95 adult patients referred for right heart catheterization were enrolled in the study. All the patients had echocardiography and RHC within one week of each other.

Result

Diabetes mellitus, hypertension and dyslipidemia were present among 55%, 66% and 41% of patients respectively. 85% of the study participants were diagnosed to have pulmonary hypertension and 79% of the study participants had postcapillary pulmonary hypertension. Sensitivity of pulmonary artery systolic pressure (PAPs), mean pulmonary artery pressure (PAPm) using PAPs and pulmonary artery acceleration velocity (PAcT) were 86%, 93% and 89% respectively. Correlation of PAPs, PAPm using PAPs and PAcT on echo with invasive hemodynamic in RHC were 0.56, 0.43 and 0.24 respectively. Among patients with moderate to severe Tricuspid Regurgitation (TR) and tricuspid annular plane systolic excursion (TAPSE) <1.5cm correlation of PAPs, PAPm using PAPs and PAcT on echocardiography with right heart catheterization were 0.31, 0.24 and 0.42 respectively.

Conclusion

Echocardiographic assessment of PAPs and PAPm has high sensitivity and weak to moderate correlation with hemodynamic data in RHC. PAPs measurement on echocardiogram has best correlation with invasive measurement followed by PAPm measurement using PAPs. Among patients with moderate to severe TR and TAPSE <1.5cm PAPm measurement using PAcT has better correlation than using PAPs.

Relationships between Pulmonary Hypertension Risk, Clinical Profiles, and Outcomes in Dilated Cardiomyopathy

Pulmonary hypertension (PH) in patients with heart failure (HF) contributes to a poorer prognosis. However, in those with dilated cardiomyopathy (DCM), the true prevalence and role of PH is unclear. Therefore, this study aimed to analyze the profile of DCM patients at various levels of PH risk, determined via echocardiography, and its impact on outcomes. The 502 DCM in- and out-patient records were retrospectively analyzed. Information on patient status was gathered after 45.9 ± 31.3 months. Patients were divided into 3 PH-risk groups based on results from echocardiography measurements: low (L, n = 239, 47.6%), intermediate (I, n = 153, 30.5%), and high (H, n = 110, 21.9%). Symptom duration, atrial fibrillation, ventricular tachyarrhythmia, ejection fraction, right atrial area, and moderate or severe mitral regurgitation were found to be independently associated with PH risk. During the follow-up period, 83 (16.5%) DCM patients died: 29 (12.1%) in L, 31 (20.3%) in I, and 23 (20.9%) in H. L-patients had a significantly lower risk of all-cause death (L to H: HR 0.55 (95%CI 0.32–0.98), p = 0.01), while no differences in prognosis were found between I and H. In conclusion, over one in five DCM patients had a high PH risk, and low PH risk was associated with better prognoses.