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Mezue K, Driggin E. Genetic Variation in Intercellular Adhesion Molecule-1 (ICAM-1) and Diastolic Heart Failure in the Black Population in the United States. J Card Fail 2023; 29:1173-1174. [PMID: 37062471 DOI: 10.1016/j.cardfail.2023.03.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 03/30/2023] [Indexed: 04/18/2023]
Affiliation(s)
- Kenechukwu Mezue
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT.
| | - Elissa Driggin
- Division of Cardiology, Columbia University Irving Medical Center, New York, NY
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Fu EL, Patorno E, Everett BM, Vaduganathan M, Solomon SD, Levin R, Schneeweiss S, Desai RJ. Sodium-glucose cotransporter 2 inhibitors vs. sitagliptin in heart failure and type 2 diabetes: an observational cohort study. Eur Heart J 2023; 44:2216-2230. [PMID: 37259575 PMCID: PMC10290872 DOI: 10.1093/eurheartj/ehad273] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Revised: 03/08/2023] [Accepted: 04/26/2023] [Indexed: 06/02/2023] Open
Abstract
AIMS The effectiveness of sodium-glucose cotransporter 2 inhibitors (SGLT2i) in patients with heart failure (HF) in routine clinical practice is not extensively studied. This study aimed to evaluate the comparative effectiveness of SGLT2i vs. sitagliptin in older adults with HF and type 2 diabetes and to investigate whether there were any differences between agents within the SGLT2i class or for reduced and preserved ejection fraction. METHODS AND RESULTS Using Medicare claims data (April 2013 to December 2019), 16 253 SGLT2i initiators vs. 43 352 initiators of sitagliptin aged ≥65 years with type 2 diabetes and HF were included. The primary outcome was a composite of all-cause mortality, hospitalization for HF or urgent visit requiring intravenous diuretics; secondary outcomes included its individual components. Propensity score fine stratification weighted Cox regression was used to adjust for 100 pre-exposure characteristics. Mean age was 74 years; 49.8% were women. Initiation of SGLT2i vs. sitagliptin was associated with a lower risk of the primary composite outcome [adjusted hazard ratio (HR) 0.72; 95% confidence interval 0.67-0.77]. The adjusted HRs were 0.70 (0.63-0.78) for all-cause mortality, 0.64 (0.58-0.70) for hospitalization for HF, and 0.77 (0.69-0.86) for urgent visit requiring intravenous diuretics. Similar associations with the primary composite outcome were observed for all three agents within the SGLT2i class, for reduced and preserved ejection fraction, and subgroups based on demographics, comorbidities, and other HF treatments. Bias-calibrated HRs for the primary endpoint using negative and positive control outcomes ranged between 0.81 and 0.89, suggesting that the observed benefit could not be fully explained by residual confounding. CONCLUSION In routine US clinical practice, SGLT2i demonstrated robust clinical effectiveness in older adults with HF and type 2 diabetes compared with sitagliptin, with no evidence of heterogeneity across the SGLT2i class or across ejection fraction.
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Affiliation(s)
- Edouard L Fu
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, 1620 Tremont St., BC-3030, Boston, MA 02120, USA
| | - Elisabetta Patorno
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, 1620 Tremont St., BC-3030, Boston, MA 02120, USA
| | - Brendan M Everett
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, USA
- Division of Preventive Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, USA
| | - Muthiah Vaduganathan
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, USA
| | - Scott D Solomon
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, USA
| | - Raisa Levin
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, 1620 Tremont St., BC-3030, Boston, MA 02120, USA
| | - Sebastian Schneeweiss
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, 1620 Tremont St., BC-3030, Boston, MA 02120, USA
| | - Rishi J Desai
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, 1620 Tremont St., BC-3030, Boston, MA 02120, USA
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3
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Wan SH, Slusser JP, Hodge DO, Chen HH. Outcomes of Patients With Diabetes Versus Patients Without Diabetes Hospitalized With Acute Heart Failure. Am J Cardiol 2022; 165:65-71. [PMID: 34930613 DOI: 10.1016/j.amjcard.2021.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 10/29/2021] [Accepted: 11/02/2021] [Indexed: 11/16/2022]
Abstract
The objective is to define the clinical echocardiographic characteristics and cardiovascular outcome in patients with acute heart failure (HF) with versus without diabetes mellitus (DM). Demographic, clinical, laboratory, and echocardiographic data were collected in Olmsted County adults hospitalized for acute HF between 2005 and 2008. Analyses were performed for mortality and acute HF hospitalization outcomes stratified by diabetic status, systolic function, and diastolic function. There were 912 subjects who met inclusion criteria, and mean age was 79 (SD 13.1) years with 53% women. Prevalence of DM was 42% in the study population, and those with DM had worse diastolic function and increased mortality and HF rehospitalization. Among those with DM and acute HF, reduced left ventricular ejection fraction and worse diastolic function conferred increased HF rehospitalization (p = 0.010 and p = 0.022, respectively). In conclusion, DM is common in those hospitalized for acute HF and is associated with worse long-term clinical outcomes. The subgroup of DM with acute HF and left ventricular systolic dysfunction or diastolic dysfunction had worse HF rehospitalization outcomes.
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Affiliation(s)
- Siu-Hin Wan
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas.
| | | | | | - Horng H Chen
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
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Romero Funes D, Gutierrez Blanco D, Botero-Fonnegra C, Hong L, Lo Menzo E, Szomstein S, Rosenthal RJ. Bariatric surgery decreases the number of future hospital admissions for diastolic heart failure in subjects with severe obesity: a retrospective analysis of the US National Inpatient Sample database. Surg Obes Relat Dis 2021; 18:1-8. [PMID: 34756668 DOI: 10.1016/j.soard.2021.09.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 09/09/2021] [Accepted: 09/10/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Considerable evidence documents the effectiveness and efficacy of bariatric surgery (BaS) in reducing the prevalence and severity of obesity-related co-morbidities. Diastolic heart failure (DHF) is a condition with considerable morbidity and mortality, yet recalcitrant to medical therapy. OBJECTIVE Our objectives were to assess whether BaS is associated with a decrease in hospital admissions for DHF and determine its impact upon DHF hospital admissions among patients with hypertension (HTN) and coronary artery disease (CAD). SETTING Academic institution. METHODS Data on 296 041 BaS cases and 2 004 804 controls with severe obesity were extracted from the US National Inpatient Sample database for the years 2010 to 2015 and compared. Univariate and multivariable analysis were performed to assess the impact of pre-2010 BaS on the rate of hospital admissions for DHF, adjusting for demographics, co-morbidities, and other risk factors associated with cardiovascular disease (CVD). RESULTS Relative to controls, all baseline CVD risk factors were less common among BaS cases. Nonetheless, even after adjusting for all CVD risk factors, controls exhibited marked increases in the odds of DHF overall (odds ratio = 2.80; 95% confidence interval = 2.52-3.10). Controls with HTN and CAD demonstrated an almost 3-fold increase in odds of DHF admissions. Similarly, controls with no HTN demonstrated a 5-fold increase in odds of admissions for DHF when compared to the surgical group. CONCLUSIONS In this retrospective, case control study of a large, representative national sample of patients with severely obesity, BaS was found to be associated with significantly reduced hospitalizations for DHF when adjusted for baseline CVD risk factors. It also reduced DHF incidence in high-risk patients with HTN and CAD.
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Affiliation(s)
- David Romero Funes
- Department of General Surgery, Cleveland Clinic Florida, Weston, Florida; Bariatric and Metabolic Institute, Cleveland Clinic Florida, Weston, Florida
| | - David Gutierrez Blanco
- Department of General Surgery, Cleveland Clinic Florida, Weston, Florida; Bariatric and Metabolic Institute, Cleveland Clinic Florida, Weston, Florida
| | - Cristina Botero-Fonnegra
- Department of General Surgery, Cleveland Clinic Florida, Weston, Florida; Bariatric and Metabolic Institute, Cleveland Clinic Florida, Weston, Florida
| | - Liang Hong
- Department of Clinical Research, Cleveland Clinic Florida, Weston, Florida
| | - Emanuele Lo Menzo
- Department of General Surgery, Cleveland Clinic Florida, Weston, Florida; Bariatric and Metabolic Institute, Cleveland Clinic Florida, Weston, Florida
| | - Samuel Szomstein
- Department of General Surgery, Cleveland Clinic Florida, Weston, Florida; Bariatric and Metabolic Institute, Cleveland Clinic Florida, Weston, Florida
| | - Raul J Rosenthal
- Department of General Surgery, Cleveland Clinic Florida, Weston, Florida; Bariatric and Metabolic Institute, Cleveland Clinic Florida, Weston, Florida.
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Wan SH, Pumerantz AS, Dong F, Ochoa C, Chen HH. Comparing the influence of 2009 versus 2016 ASE/EACVI diastolic function guidelines on the prevalence and echocardiographic characteristics of preclinical diastolic dysfunction (stage B heart failure) in a Hispanic population with type 2 diabetes mellitus. J Diabetes Complications 2019; 33:579-584. [PMID: 31155469 PMCID: PMC6830437 DOI: 10.1016/j.jdiacomp.2019.04.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 04/09/2019] [Accepted: 04/28/2019] [Indexed: 12/25/2022]
Abstract
AIMS To identify prevalence and predictors of undetected pre-clinical diastolic dysfunction (PDD) in a cohort of adult Hispanic patients with type 2 diabetes (T2D), and compare variations in epidemiology and echocardiographic characteristics between categorization based on the 2009 versus 2016 guidelines. METHODS From 2013 to 2016, a cross-sectional cohort study of adults with T2D was performed. Patients without signs/symptoms of heart failure (HF) underwent 2D/Doppler echocardiographic screening, and were grouped into two subcohorts: 1) normal diastolic function, and 2) PDD, defined by the 2009 or 2016 ASE/EACVI criteria. RESULTS Among 307 Hispanic subjects, by 2009 criteria, 193 (62.9%) had normal diastolic function, 113 (36.8%) diastolic dysfunction and 1 (0.3%) indeterminate. Those that had diastolic dysfunction (DD) were older (mean age 59.1 ± 12.7 vs 52.2 ± 12.2 years, p< 0.0001), with higher proportion female (69.0 vs 53.9%, p = 0.0092), and higher systolic blood pressure (136.5 ± 18.6 vs 131.7 ± 19.9, p = 0.0372). By 2016 criteria, 261 (85%) had normal diastolic function, 22 (7.2%) diastolic dysfunction and 24 (7.8%) indeterminate. Among those that had normal diastolic function (n = 261) by 2016 criteria, 29% (n = 76) had DD by 2009 criteria, and they were more likely to have higher E/e' and left atrial volume index (LAVI). CONCLUSIONS By applying the 2016 versus the 2009 diastolic function criteria to a Hispanic population with T2D, the prevalence of PDD decreased significantly from 37% to 7%. These findings are consistent with recent studies demonstrating that the 2016 ASE/EACVI guidelines are more specific for diagnosing DD and hence less sensitive leading to lower prevalence of diastolic dysfunction.
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Affiliation(s)
- Siu-Hin Wan
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
| | - Andrew S Pumerantz
- Western Diabetes Institute, Western University of Health Sciences, Pomona, CA, USA; Department of Population Health, College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, Pomona, CA, USA
| | - Fanglong Dong
- Graduate College of Biomedical Sciences, Western University of Health Sciences, Pomona, CA, USA
| | - Cesar Ochoa
- Western Diabetes Institute, Western University of Health Sciences, Pomona, CA, USA
| | - Horng H Chen
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA.
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Park J, Lee J, Kwon A, Choi HJ, Chung HS, Hong SH, Park CS, Choi JH, Chae MS. The 2016 ASE/EACVI recommendations may be able to more accurately identify patients at risk for diastolic dysfunction in living donor liver transplantation. PLoS One 2019; 14:e0215603. [PMID: 31013321 PMCID: PMC6478297 DOI: 10.1371/journal.pone.0215603] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 04/05/2019] [Indexed: 12/20/2022] Open
Abstract
Background The aim of this study was to compare the prevalence of diastolic dysfunction between the 2016 American Society of Echocardiography (ASE)/European Association of Cardiovascular Imaging and 2009 ASE/European Association of Echocardiography recommendations in patients undergoing living-donor liver transplantation (LDLT). Patients and methods A total of 312 adult patients who underwent LDLT at our hospital from January 2010 to December 2017 were retrospectively analyzed. Exclusion criteria were systolic dysfunction, arrhythmia, myocardial ischemia, and mitral or aortic valvular insufficiency. Results The study population was largely male (68.3%), and the median age was 54 (49–59) years. The median model for end-stage liver disease score was 12 (6–22) points. A predominant difference in the prevalence rates of diastolic dysfunction was observed between the two recommendations. The prevalence rates of diastolic dysfunction and indeterminate diastolic function were lower according to the 2016 recommendations than the 2009 recommendations. The level of concordance between the two recommendations was poor. The proportion of patients with a high brain natriuretic peptide level (> 100 pg/mL) decreased significantly during surgery in the normal and indeterminate groups according to the 2009 recommendations; however, only the normal group showed an intraoperative decrease in the proportion according to the 2016 recommendations. Patients with diastolic dysfunction showed a poorer overall-survival rate than those with normal function according to both recommendations. However, there was a difference in the survival rate in the indeterminate group between the two recommendations. A significant difference in patient survival rate was observed between the dysfunction and indeterminate groups according to the 2009 recommendations; however, the difference was not significant in the 2016 recommendations. Conclusions The 2016 classification may be better able to identify patients with a risk for diastolic dysfunction. Particularly, patients in the 2016 indeterminate group seemed to require a cardiac diastolic functional evaluation more frequently during and after surgery than those in the 2009 indeterminate group.
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Affiliation(s)
- Jaesik Park
- Department of Anesthesiology and Pain Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jiyoung Lee
- Department of Anesthesiology and Pain Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Ami Kwon
- Department of Cardiology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Ho Joong Choi
- Department of Surgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Hyun Sik Chung
- Department of Anesthesiology and Pain Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sang Hyun Hong
- Department of Anesthesiology and Pain Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Chul Soo Park
- Department of Anesthesiology and Pain Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jong Ho Choi
- Department of Anesthesiology and Pain Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Min Suk Chae
- Department of Anesthesiology and Pain Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
- * E-mail:
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Woo J, Yang X, Tin Lui L, Li Q, Fai Cheng K, Fan Y, Yau F, Lee APW, Lee JSW, Fung E. Utility of the FRAIL Questionnaire in Detecting Heart Failure with Preserved Ejection Fraction. J Nutr Health Aging 2019; 23:373-377. [PMID: 30932136 DOI: 10.1007/s12603-019-1158-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVE To test the utility of the FRAIL questionnaire as a screening tool for heart failure. DESIGN Cross sectional study. SETTING Chinese older people in Hong Kong. PARTICIPANTS Participants aged 60 years and over were recruited from a territory-wide primary care needs assessment for older people based in community centers as well as two nonacute hospitals. MEASUREMENTS Questionnaire administered included the five-item FRAIL scale, and information regarding sociodemographic data, smoking and alcohol use, history of cardiovascular disease and diabetes, and heart failure symptoms. Handgrip strength, walking speed and 6 minute walk distance were recorded. Cardiac assessment included electrocardiogram, echocardiography, and blood assay for N-terminal prohormone of B-type natriuretic peptide (NT-proBNP). RESULTS The prevalence of diastolic dysfunction was high, being 52% in the robust group, increasing to 65% in the pre-frail and 85% in the frail group. This finding is accompanied by a corresponding increase in NT-proBNP from 64.18 pg/ml in the robust group, to 118.57 pg/ml in the pre-frail and 167.98 pg/ml in the frail group. Three of the five components of the FRAIL scale, fatigue, resistance and ambulation, were associated with increased odds ratios of diastolic dysfunction among those aged 75 years and older, while resistance alone was associated with increased odds ratio among those less than 75 years old. CONCLUSION Frailty is associated with heart failure with preserved ejection fraction (HFpEF), and frailty screening may be used to detect undiagnosed HFpEF. The findings support the proposal that HFpEF be considered a geriatric syndrome.
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Affiliation(s)
- J Woo
- Prof Jean Woo, Department of Medicine and Therapeutics, Prince of Wales Hospital, Shatin, N.T. Hong Kong, Tel: 852-3505-3493, Fax: 852-2637-3852,
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8
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Abstract
Atrial fibrillation often occurs as a cause or consequence of heart failure. Clinical outcomes are worse when atrial fibrillation and heart failure coexist. There are important sex-related differences in the incidence, prevalence, pathophysiology, treatment, and outcomes of these patients. Women with heart failure are at greater risk of developing atrial fibrillation than men, and more women with atrial fibrillation develop heart failure. More women die of atrial fibrillation-related strokes. Despite significant morbidity and mortality, current treatments for women are inadequate. This review explores sex differences in atrial fibrillation and heart failure, emphasizing risk stratification and treatments to improve clinical outcomes.
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Affiliation(s)
- Nidhi Madan
- Department of Medicine, Cardiology Division, Rush University Medical Center, 1653 West Congress Parkway, Chicago, IL 60612, USA
| | - Dipti Itchhaporia
- Department of Medicine, Cardiology Division, Hoag Memorial Hospital, University of California, Irvine, 520 Superior Avenue, Newport Beach, CA 92663, USA
| | - Christine M Albert
- Department of Medicine, Cardiology Division, Brigham and Women's Medical Center, 75 Francis Street Towers 3a, Boston, MA 02115, USA
| | - Neelum T Aggarwal
- Department of Neurological Sciences, Rush Alzheimer's Disease Center, Rush University Medical Center, 1750 W. Harrison, Suite 1000, Chicago, IL 60612, USA
| | - Annabelle Santos Volgman
- Department of Medicine, Cardiology Division, Rush University Medical Center, 1725 W. Harrison Street, Room 1159, Chicago, IL 60612, USA.
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Taqueti VR, Solomon SD, Shah AM, Desai AS, Groarke JD, Osborne MT, Hainer J, Bibbo CF, Dorbala S, Blankstein R, Di Carli MF. Coronary microvascular dysfunction and future risk of heart failure with preserved ejection fraction. Eur Heart J 2018; 39:840-849. [PMID: 29293969 PMCID: PMC5939665 DOI: 10.1093/eurheartj/ehx721] [Citation(s) in RCA: 348] [Impact Index Per Article: 58.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Revised: 10/08/2017] [Accepted: 12/04/2017] [Indexed: 01/09/2023] Open
Abstract
Aims Coronary microvascular ischaemia, cardiomyocyte injury and stiffness may play an important role in the pathophysiology of heart failure with preserved ejection fraction (HFpEF). To date, the relationship between coronary flow reserve (CFR), myocardial injury, diastolic dysfunction, and future HFpEF risk is unknown. Methods and results Consecutive patients (n = 201) undergoing evaluation for suspected coronary artery disease (CAD) with stress myocardial perfusion positron emission tomography, serum troponin, and transthoracic echocardiography who did not have flow-limiting CAD or reduced left ventricular ejection fraction were identified. Patients were followed up (median 4.1 years) for cardiovascular death and hospitalization for non-fatal myocardial infarction or heart failure. Coronary flow reserve was quantified as stress/rest myocardial blood flow. Early diastolic flow (E) and relaxation (e') velocities were obtained via transmitral and tissue Doppler, respectively. Patients with impaired CFR (<2, n = 108) demonstrated linearly decreasing e' and increasing E/e' consistent with worsening diastolic function (P for trend <0.0001). A detectable troponin was associated with diastolic dysfunction only in the presence of impaired CFR (interaction P = 0.002). In adjusted analyses, impaired CFR was independently associated with diastolic dysfunction (E/e'septal > 15, adjusted OR 2.58, 95%CI 1.22-5.48) and composite cardiovascular outcomes or HFpEF hospitalization alone (adjusted HR 2.47, 95%CI 1.09-5.62). Patients with both impaired CFR and diastolic dysfunction demonstrated >five-fold increased risk of HFpEF hospitalization (P < 0.001). Conclusion In symptomatic patients without overt CAD, impaired CFR was independently associated with diastolic dysfunction and adverse events, especially HFpEF hospitalization. The presence of both coronary microvascular and diastolic dysfunctions was associated with a markedly increased risk of HFpEF events.
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Affiliation(s)
- Viviany R Taqueti
- Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Scott D Solomon
- Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Amil M Shah
- Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Akshay S Desai
- Center for Advanced Heart Diseases, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - John D Groarke
- Center for Advanced Heart Diseases, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Michael T Osborne
- Cardiac MR/PET/CT Program, Departments of Medicine and Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Jon Hainer
- Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Courtney F Bibbo
- Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Sharmila Dorbala
- Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Ron Blankstein
- Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Marcelo F Di Carli
- Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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Rasmussen-Torvik LJ, Colangelo LA, Lima JAC, Jacobs DR, Rodriguez CJ, Gidding SS, Lloyd-Jones DM, Shah SJ. Prevalence and Predictors of Diastolic Dysfunction According to Different Classification Criteria: The Coronary Artery Risk Development in Young in Adults Study. Am J Epidemiol 2017; 185:1221-1227. [PMID: 28453616 PMCID: PMC5860331 DOI: 10.1093/aje/kww214] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Revised: 06/16/2016] [Accepted: 07/20/2016] [Indexed: 01/20/2023] Open
Abstract
Heart failure with preserved ejection fraction is often preceded by diastolic dysfunction (DD). Of several published DD criteria, it is unclear which, if any, are applicable to data obtained in epidemiologic cohorts. We evaluated the prevalence of DD using previously published definitions in a population-based study, the Coronary Artery Risk Development in Young Adults (CARDIA) Study, using data gathered in 2010-2011. Echocardiography was performed on 3,474 individuals (mean age = 50.2 years) at the CARDIA year 25 examination. Four published definitions of DD were studied. We calculated DD prevalence for each definition and determined the overlap between definitions. We used logistic regression to assess the strength of associations between demographic and clinical factors and the definitions of DD. Prevalence of DD ranged from 2% to 32% across the 4 definitions, with a minority of cases identified by more than 1 definition. Two definitions classified 38%-39% of the study sample as indeterminate for DD. Associations of risk factors with DD varied considerably, with male sex being associated positively with DD for one definition (odds ratio = 1.4, 95% confidence interval: 1.2, 1.6) and inversely for another (odds ratio = 0.7, 95% confidence interval: 0.6, 0.8). Prevalence of DD varies markedly in CARDIA by the definition applied. A uniform, reliable, and accurate definition of DD for epidemiologic studies is needed.
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Affiliation(s)
- Laura J. Rasmussen-Torvik
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Laura A. Colangelo
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Joao A. C. Lima
- Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - David R. Jacobs
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota
| | - Carlos J. Rodriguez
- Department of Medicine and Public Health Sciences, School of Medicine, Wake Forest University, Winston-Salem, North Carolina
| | | | - Donald M. Lloyd-Jones
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
- Division of Cardiology, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Sanjiv J. Shah
- Division of Cardiology, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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11
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Solomon SD. Diagnostic evaluation: target organ damage: cardiac. J Am Soc Hypertens 2014; 8:848-850. [PMID: 25455010 DOI: 10.1016/j.jash.2014.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
MESH Headings
- Age Distribution
- Aged
- Aged, 80 and over
- Echocardiography, Doppler/methods
- Electrocardiography/methods
- Female
- Follow-Up Studies
- Heart Failure, Diastolic/diagnosis
- Heart Failure, Diastolic/epidemiology
- Heart Failure, Diastolic/etiology
- Humans
- Hypertension/complications
- Hypertension/diagnosis
- Hypertension/drug therapy
- Hypertrophy, Left Ventricular/diagnosis
- Hypertrophy, Left Ventricular/epidemiology
- Hypertrophy, Left Ventricular/etiology
- Incidence
- Magnetic Resonance Imaging, Cine/methods
- Male
- Middle Aged
- Practice Guidelines as Topic
- Risk Assessment
- Severity of Illness Index
- Sex Distribution
- Societies, Medical
- Survival Analysis
- Time Factors
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Ismailova NR, Kuliev FA, Faradzheva NA, Zeĭnalov FA, Sultanova SS. [Disordered diastolic function of the left ventricle in patients with coronary heart disease depending on ejection fraction]. Klin Med (Mosk) 2014; 92:35-37. [PMID: 25775902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The authors present data on the occurrence of different types of left ventricular diastolic function in patients with coronary heart disease collected in the course of population-based epidemiological study. The diastolic function was evaluated from parameters of transmitral blood flow depending on ejection fraction.
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Isiguzo GC, Okeahialam BN, Danbauchi SS, Odili AN, Iroezindu MO, Placid U. Contributions of pulmonary hypertension to HIV-related cardiac dysfunction. Indian Heart J 2013; 65:644-9. [PMID: 24206894 PMCID: PMC3860612 DOI: 10.1016/j.ihj.2013.08.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2013] [Revised: 04/25/2013] [Accepted: 08/10/2013] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND/AIM To evaluate the prevalence of pulmonary hypertension among patients living with HIV/AIDS and to determine its contribution to cardiac dysfunction. METHOD A hospital based cross sectional study was carried out over a 6-month period at the Jos University Teaching Hospital. The subjects were 200 confirmed HIV positive patients, ≥18 years of age who consented to the study. Physical examination, laboratory investigations, 2 dimensional and Doppler echocardiography were conducted on the subjects. RESULTS The mean age of the patients was 38 ± 9 years, and there were 142 females (71%). Females were younger, mean age 36 ± 8 years versus 41 ± 10 years for males (p-value <0.01). The median CD4 cell count was 312 cells/μl, there were no homosexual or intravenous drug user among the subjects. Eight of the subjects had pulmonary hypertension, with a case prevalence of 4%, and this had no relationship to CD4 cell count. Both systolic and diastolic functions were worse in subjects with pulmonary hypertension, with a negative correlation between mean pulmonary arterial systolic pressure (mPASP) and parameters like ejection fraction (r = -0.28, p-value 0.0003), fractional shortening (r = -0.21, p-value 0.003), deceleration time (r = -0.13. p-value 0.09). CONCLUSION Immune-suppression affects the cardiac function adversely and coexisting pulmonary hypertension contributes to poor systolic and diastolic function in affected patients. The subtle nature of presentation of pulmonary hypertension and other cardiac dysfunctions in HIV/AIDS patients demand a high-index of suspicion and early intervention if detected, to ensure better care for these emerging threats to our patients.
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MESH Headings
- Adult
- Age Distribution
- Comorbidity
- Cross-Sectional Studies
- Disease Progression
- Echocardiography, Doppler
- Female
- Follow-Up Studies
- HIV Infections/diagnosis
- HIV Infections/drug therapy
- HIV Infections/epidemiology
- Heart Failure, Diastolic/diagnosis
- Heart Failure, Diastolic/epidemiology
- Heart Failure, Systolic/diagnosis
- Heart Failure, Systolic/epidemiology
- Humans
- Hypertension, Pulmonary/diagnosis
- Hypertension, Pulmonary/epidemiology
- Hypertension, Pulmonary/therapy
- Male
- Middle Aged
- Prevalence
- Reference Values
- Risk Assessment
- Severity of Illness Index
- Sex Distribution
- Stroke Volume/physiology
- Survival Analysis
- Ventricular Dysfunction, Left/diagnostic imaging
- Ventricular Dysfunction, Left/epidemiology
- Ventricular Dysfunction, Left/physiopathology
- Young Adult
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Affiliation(s)
- Godsent C Isiguzo
- Internal Medicine Department, Federal Teaching Hospital Abakaliki, Ebonyi State, Nigeria.
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Rifaie O, El-Damanhory H, Amr M, Nammas W. Prevalence and predictors of pulmonary hypertension in elderly patients with isolated diastolic heart failure. Kardiol Pol 2010; 68:655-661. [PMID: 20806196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
BACKGROUND Despite the growing recognition that pulmonary hypertension can develop in diastolic heart failure; its clinical significance remains poorly defined. AIM We sought to explore the prevalence and predictors of pulmonary hypertension in elderly patients with isolated diastolic heart failure. METHODS We enrolled 100 consecutive elderly patients with isolated diastolic heart failure. All patients underwent transthoracic echocardiography to measure the pulmonary artery systolic pressure, diastolic function indices (mitral E peak deceleration time, isovolumetric relaxation time, early mitral annular diastolic velocity), left atrial diameter and left ventricular mass index. Pulmonary hypertension was defined as pulmonary artery systolic pressure > or = 37 mm Hg. We classified patients into two groups: one with diastolic heart failure and concomitant pulmonary hypertension, and one with diastolic heart failure but without concomitant pulmonary hypertension. RESULTS The mean age of the whole series was 65.4 + or - 5.4 years, 49 (49%) being female. Patients with pulmonary hypertension (20% of the whole series) were more often females, hypertensive, more likely to have atrial fibrillation, pulmonary congestion symptoms, larger left atrial diameter, lower early mitral annular diastolic velocity, lower left ventricular ejection fraction, and more likely to have mitral regurgitation (p < 0.05 for all). Multivariate logistic regression analysis identified female gender, atrial fibrillation, and early mitral annular diastolic velocity (e') as the independent predictors of the presence of pulmonary hypertension. CONCLUSIONS Pulmonary hypertension is fairly prevalent in elderly patients with diastolic heart failure. Female gender, atrial fibrillation, and early mitral annular diastolic velocity (e') were the independent predictors of the presence of pulmonary hypertension in this patient group.
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Affiliation(s)
- Osama Rifaie
- Cardiology Department, Faculty of Medicine, Ain Shams University, Abbassia, Cairo, Egypt
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Lewczuk J. [Comment to article Prevalence and predictors of pulmonary hypertension in elderly patients with isolated diastolic heart failure]. Kardiol Pol 2010; 68:662-663. [PMID: 20806197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
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Wong DT, Clark RA, Dundon BK, Philpott A, Molaee P, Shakib S. Caveat anicula! Beware of quiet little old ladies: demographic features, pharmacotherapy, readmissions and survival in a 10-year cohort of patients with heart failure and preserved systolic function. Med J Aust 2010; 192:9-13. [PMID: 20047541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2008] [Accepted: 08/03/2009] [Indexed: 05/28/2023]
Abstract
OBJECTIVE To determine whether heart failure with preserved systolic function (HFPSF) has different natural history from left ventricular systolic dysfunction (LVSD). DESIGN AND SETTING A retrospective analysis of 10 years of data (for patients admitted between 1 July 1994 and 30 June 2004, and with a study census date of 30 June 2005) routinely collected as part of clinical practice in a large tertiary referral hospital. MAIN OUTCOME MEASURES Sociodemographic characteristics, diagnostic features, comorbid conditions, pharmacotherapies, readmission rates and survival. RESULTS Of the 2961 patients admitted with chronic heart failure, 753 had echocardiograms available for this analysis. Of these, 189 (25%) had normal left ventricular size and systolic function. In comparison to patients with LVSD, those with HFPSF were more often female (62.4% v 38.5%; P = 0.001), had less social support, and were more likely to live in nursing homes (17.9% v 7.6%; P < 0.001), and had a greater prevalence of renal impairment (86.7% v 6.2%; P = 0.004), anaemia (34.3% v 6.3%; P = 0.013) and atrial fibrillation (51.3% v 47.1%; P = 0.008), but significantly less ischaemic heart disease (53.4% v 81.2%; P = 0.001). Patients with HFPSF were less likely to be prescribed an angiotensin-converting enzyme inhibitor (61.9% v 72.5%; P = 0.008); carvedilol was used more frequently in LVSD (1.5% v 8.8%; P < 0.001). Readmission rates were higher in the HFPSF group (median, 2 v 1.5 admissions; P = 0.032), particularly for malignancy (4.2% v 1.8%; P < 0.001) and anaemia (3.9% v 2.3%; P < 0.001). Both groups had the same poor survival rate (P = 0.912). CONCLUSIONS Patients with HFPSF were predominantly older women with less social support and higher readmission rates for associated comorbid illnesses. We therefore propose that reduced survival in HFPSF may relate more to comorbid conditions than suboptimal cardiac management.
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Lam CSP. Diastolic heart failure: what, so what and now what? Ann Acad Med Singap 2009; 38:663-666. [PMID: 19736568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
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Maestre A, Gil V, Gallego J, García M, García de Burgos F, Martín-Hidalgo A. Prediction clinical profile to distinguish between systolic and diastolic heart failure in hospitalized patients. Eur J Intern Med 2009; 20:313-8. [PMID: 19393500 DOI: 10.1016/j.ejim.2008.09.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2007] [Revised: 08/12/2008] [Accepted: 09/03/2008] [Indexed: 10/21/2022]
Abstract
BACKGROUND In recent decades, the growing incidence of patients with heart failure who have preserved systolic function, underlines the need to differentiate between heart failure due to diastolic dysfunction and that due to systolic dysfunction. OBJECTIVE To develop a prediction profile of clinical parameters that enables clinicians to differentiate between patients with systolic and diastolic heart failure. METHODS 164 patients admitted for congestive heart failure to the cardiology department of an academic tertiary care hospital, whose left ventricular systolic and diastolic function had been evaluated echocardiographically and who satisfied the Framingham criteria for heart failure, were prospectively recruited. All patients answered a questionnaire which included, in addition to other clinical variables, the Framingham criteria. RESULTS Patients with diastolic heart failure (61.6%) were more likely to be older, female, and to present left ventricular hypertrophy (LVH), with a lower proportion of smokers, alcohol drinkers, coronary disease, q wave and left bundle branch block (all p<0.005). The predicting model obtained on the logistic regression analysis was very significant, with three variables and 72.3% of correct predictions (x(2) value=40,457, p<0.001). These three variables, predictors of diastolic as opposed to systolic heart failure, were female sex (OR=3.546), left ventricle hypertrophy (OR=4.011) and absence of coronary disease (OR=3.547). CONCLUSION Three variables which can be easily evaluated, female sex, left ventricular hypertrophy and presence or absence of coronary disease, may enable clinicians to differentiate between patients with systolic or diastolic heart failure.
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Affiliation(s)
- Ana Maestre
- Internal Medicine Department. Hospital General Universitario de Elche, Spain.
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Abstract
Diabetes mellitus (DM) is highly prevalent and is an important risk factor for congestive heart failure (HF). Increased left ventricular (LV) diastolic stiffness is recognized as the earliest manifestation of DM-induced LV dysfunction, but its pathophysiology remains incompletely understood. Mechanisms whereby DM increases LV diastolic stiffness differ between HF with normal LV ejection fraction (EF) (HFNEF) and HF with reduced LVEF (HFREF). In diabetic HFREF, fibrosis and deposition of advanced glycation end products (AGEs) are the most important contributors to high LV diastolic stiffness, whereas in diabetic HFNEF, elevated resting tension of hypertrophied cardiomyocytes is the most important contributor to high LV diastolic stiffness. As HF mortality remains high in DM despite proven efficacy of current treatments, better understanding of the pathophysiology of high LV diastolic stiffness could be beneficial for novel therapeutic strategies.
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Affiliation(s)
- Loek van Heerebeek
- Laboratory of Physiology, VU University Medical Center, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands
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Hale CS. Diastolic dysfunction: prevalence, mortality risk, and assessing severity to stratify risk. J Insur Med 2009; 41:254-263. [PMID: 20666104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Much of the mortality and morbidity of left ventricula failure evolves from diastolic dysfunction, yet because diastolic dysfunction is in part defined by a normal ejection fraction, identifying this risk before the onset of overt heart failure requires understanding its causes, the echocardiographic measurements that define it, and how this data is used to assess its severity. Some physicians, particularly those trained over 20 years ago, are not yet able to identify diastolic dysfunction and quantify its severity. This is in part because the echocardiographic trends used to grade severity appear counterintuitive and in part because the echocardiographics ability to accurately measure left ventricular filling hemodynamics has evolved only over the past 2 decades. This article provides a practical review of the etiology, prevalence, and mortality of diastolic dysfunction and failure, and then characterizes how the pathophysiology of this disorder translates into measurements from 2D, pulsed-wave, and tissue Doppler echocardiography that can be confidently used to identify those insurance applicants at risk for imminent morbidity and mortality.
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Affiliation(s)
- Clifford S Hale
- Jackson National Life Insurance Company, 1 Corporate Way, Lansing, Michigan 48951, USA.
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Dhar S, Koul D, D'Alonzo GE. Current concepts in diastolic heart failure. J Am Osteopath Assoc 2008; 108:203-209. [PMID: 18443028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Heart failure is a highly prevalent condition, particularly among elderly adults and women. In diastolic heart failure-or heart failure with normal ejection fraction-left ventricular systolic function is preserved. Although diastolic heart failure is clinically and radiographically indistinguishable from systolic heart failure, echocardiography can reveal a preserved ejection fraction with abnormal diastolic function. The present article reviews current medical concepts related to diastolic heart failure for medical practitioners, particularly primary care physicians, who play a vital role in the care of patients with heart failure. Treatment options, focusing on calcium channel blockers and angiotensin receptor blockers, are discussed. With early diagnosis and proper management, the prognosis of diastolic heart failure can be more favorable than that of systolic heart failure.
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Affiliation(s)
- Sunil Dhar
- Temple University Hospital-Episcopal Campus, 100 E Lehigh Ave, Philadelphia, PA 19125-1012, USA.
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Albert NM. Heart failure with preserved systolic function: giving well-deserved attention to the "other" heart failure. Crit Care Nurs Q 2007; 30:287-96; quiz 297-8. [PMID: 17873564 DOI: 10.1097/01.cnq.0000290361.72924.a4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Heart failure with preserved systolic function is common in patients hospitalized with decompensated heart failure and is associated with postdischarge morbidity and costs similar to patients with heart failure and systolic dysfunction. It is common in the older people, and hypertension and cardiac ischemia are often etiological factors. Nurses must be able to recognize left ventricular diastolic abnormalities and understand treatment priorities and treatment options on the basis of structural cardiovascular disease; etiology and risk factors; and signs, symptoms, and hemodynamic parameters. Currently, clinical treatments are on the basis of individual randomized clinical trials; however, there are general principles that should be followed during hospitalization and as part of general practice. As in the treatment of systolic heart failure, nurses have active roles in ensuring accurate assessment; optimal care planning; implementation of clinical, psychosocial; and education interventions; and timely and accurate evaluation so that patients have the best chance for successful hospital and postdischarge outcomes.
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Affiliation(s)
- Nancy M Albert
- Division of Nursing and Kaufman Center for Heart Failure, Cleveland Clinic, Ohio 44195, USA.
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Michowitz Y, Arbel Y, Wexler D, Sheps D, Rogowski O, Shapira I, Berliner S, Keren G, George J, Roth A. Predictive value of high sensitivity CRP in patients with diastolic heart failure. Int J Cardiol 2007; 125:347-51. [PMID: 17467828 DOI: 10.1016/j.ijcard.2007.02.037] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2006] [Revised: 01/24/2007] [Accepted: 02/17/2007] [Indexed: 12/23/2022]
Abstract
BACKGROUND C-reactive protein (CRP) has been tested in patients with systolic heart failure (HF) and mixed results have been obtained with regards to its potential predictive value. However, the role of C-reactive protein (CRP) in patients with diastolic HF is not established. We studied the predictive role of high sensitivity CRP (hsCRP) in patients with diastolic HF. METHODS HsCRP levels were measured in a cohort of CHF outpatients, 77 patients with diastolic HF and 217 patients with systolic HF. Concentrations were compared to a large cohort of healthy population (n=7701) and associated with the HF admissions and mortality of the patients. RESULTS Levels of hsCRP did not differ between patients with systolic and diastolic HF and were significantly elevated compared to the cohort of healthy subjects even after adjustment to various clinical parameters (p<0.0001). In patients with diastolic HF, hsCRP levels associated with New York Heart Association functional class (NYHA-FC) (r=0.31 p=0.01). On univariate Cox regression model hsCRP levels independently predicted hospitalizations in patients with systolic but not diastolic HF (p=0.047). CONCLUSION HsCRP concentrations are elevated in patients with diastolic HF and correlate with disease severity; their prognostic value in this patient population should be further investigated.
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Affiliation(s)
- Yoav Michowitz
- The Department of Cardiology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
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Belenkov IN, Agmanova ET. [Comparative features of the tissue as well as traditional Doppler echocardiography in the diagnosis of left ventricular diastolic dysfunction in patients with chronic functional class I - IV heart failure]. Kardiologiia 2007; 47:4-9. [PMID: 18260851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
UNLABELLED Although Doppler echocardiography methods (DM) of lung veins transmitral and blood flows analysis traditionally used in a left ventricular (LV) diastolic dysfunctions (DD) non-invasive diagnostics are positive they also have their considerable shortcomings. A Tissue Doppler echocardiography method (TDM) has its advantage as it is independent of haemodynamic heart function in an analysis of CHF patients. AIM To study capabilities of the both methods (DM and TDM) in an analysis of CHF patients diastolic left ventricular dysfunctions. To determinate sensitivity, specificity and reproductivity of TDM. MATERIALS AND METHODS 80 CHF I-IV NYHA classes patients and 20 healthy volunteers (a control group) are studied. The patients were divided into 3 groups depending on their transmitral flow specters: first with LV relaxation dysfunction (n=24), second with pseudonormal type (n=33), third with restrictive type (n=23). In the general group a LV DD comparative analysis on DM and TDM results is done. In the second group these methods were compared as giving diagnostically DD data. For far finer TDM results in the group of 30 patients the data were compared with radionuclear vetriculography. RESULTS The usage of two TDM diagnostic criteria gives more CHF patients than DD method (81.1% to 75.8%). TDM sensitivity in left ventricular DD is up to 70%, specificity--over 90%, reproductivity--73-87%.
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Belov VV, Il'icheva OE. [The role of brain natriuretic peptide in diagnosis of diastolic myocardial dysfunction in patients with predialysis chronic kidney disease]. Kardiologiia 2007; 47:10-13. [PMID: 18260852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Aim of the study was to elucidate possibility of the use of brain and atrial natriuretic peptide (BNP) as a diagnostic marker of diastolic dysfunction (DD) of the left ventricular myocardium in 37 patients with predialysis chronic kidney disease (CKD). We used data of echocardiography and Doppler echocardiography for detection of functional signs of DD and correlated with BNP levels. Patients with signs of DD (81.1%) had significantly higher BNP level than patients without these signs (214.3 +/- 12.3 and 60.6 +/- 17.7 pg/ml, respectively, p < 0.0001). Main parameters of DD correlated significantly with BNP level (r=0.51, p < 0.005) and were independently related to the level of the hormone according the data of multifactorial regression analysis (R2=0.76, p < 0.001). BNP concentration 100 pg/ml in predialysis patients with CKD appears to be not only diagnostic for DD, but also differential index of pseudonormal type of DD.
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