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Sample records for cardiac ejection fraction

  1. Association between Hypotension, Low Ejection Fraction and Cognitive Performance in Cardiac Patients

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    Rebecca F. Gottesman

    2010-01-01

    Full Text Available Background and Purpose: Impaired cardiac function can adversely affect the brain via decreased perfusion. The purpose of this study was to determine if cardiac ejection fraction (EF is associated with cognitive performance, and whether this is modified by low blood pressure.

  2. Impact of ejection fraction on the clinical response to cardiac resynchronization therapy in mild heart failure

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    Linde, Cecilia; Daubert, Claude; Abraham, William T;

    2013-01-01

    Current guidelines recommend cardiac resynchronization therapy (CRT) in mild heart failure (HF) patients with QRS prolongation and ejection fraction (EF) ≤30%. To assess the effect of CRT in less severe systolic dysfunction, outcomes in the REsynchronization reVErses Remodeling in Systolic left v...

  3. Interleukin-16 promotes cardiac fibrosis and myocardial stiffening in heart failure with preserved ejection fraction.

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    Shunsuke Tamaki

    Full Text Available BACKGROUND: Chronic heart failure (CHF with preserved left ventricular (LV ejection fraction (HFpEF is observed in half of all patients with CHF and carries the same poor prognosis as CHF with reduced LV ejection fraction (HFrEF. In contrast to HFrEF, there is no established therapy for HFpEF. Chronic inflammation contributes to cardiac fibrosis, a crucial factor in HFpEF; however, inflammatory mechanisms and mediators involved in the development of HFpEF remain unclear. Therefore, we sought to identify novel inflammatory mediators involved in this process. METHODS AND RESULTS: An analysis by multiplex-bead array assay revealed that serum interleukin-16 (IL-16 levels were specifically elevated in patients with HFpEF compared with HFrEF and controls. This was confirmed by enzyme-linked immunosorbent assay in HFpEF patients and controls, and serum IL-16 levels showed a significant association with indices of LV diastolic dysfunction. Serum IL-16 levels were also elevated in a rat model of HFpEF and positively correlated with LV end-diastolic pressure, lung weight and LV myocardial stiffness constant. The cardiac expression of IL-16 was upregulated in the HFpEF rat model. Enhanced cardiac expression of IL-16 in transgenic mice induced cardiac fibrosis and LV myocardial stiffening accompanied by increased macrophage infiltration. Treatment with anti-IL-16 neutralizing antibody ameliorated cardiac fibrosis in the mouse model of angiotensin II-induced hypertension. CONCLUSION: Our data indicate that IL-16 is a mediator of LV myocardial fibrosis and stiffening in HFpEF, and that the blockade of IL-16 could be a possible therapeutic option for HFpEF.

  4. Role of cardiac CTA in estimating left ventricular volumes and ejection fraction

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    Robin; Man; Singh; Balkrishna; Man; Singh; Jawahar; Lal; Mehta

    2014-01-01

    Left ventricular ejection fraction(LVEF)is an impor-tant predictor of cardiac outcome and helps in makingimportant diagnostic and therapeutic decisions suchas the treatment of different types of congestive heartfailure or implantation of devices like cardiac resynchro-nization therapy-defibrillator.LVEF can be measuredby various techniques such as transthoracic echo-cardiography,contrast ventriculography,radionuclidetechniques,cardiac magnetic resonance imaging andcardiac computed tomographic angiography(CTA).Thedevelopment of cardiac CTA using multi-detector rowCT(MDCT)has seen a very rapid improvement in thetechnology for identifying coronary artery stenosis andcoronary artery disease in the last decade.During theacquisition,processing and analysis of data to studycoronary anatomy,MDCT provides a unique opportunityto measure left ventricular volumes and LVEF simulta-neously with the same data set without the need foradditional contrast or radiation exposure.The develop-ment of semi-automated and automated software to measure LVEF has now added uniformity,efficiency and reproducibility of practical value in clinical practice rather than just being a research tool.This article will address the feasibility,the accuracy and the limitations of MDCT in measuring LVEF.

  5. Evaluation of postoperative cardiac function in severe ischemic heart disease associated with decreased ejection fraction

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    Natsuaki, Masafumi; Itoh, Tsuyoshi; Norita, Hiroaki; Naitoh, Kouzou; Suda, Hisao [Saga Medical School (Japan)

    1997-09-01

    This clinical study was performed to clarify the postoperative cardiac functions after coronary artery bypass graft surgery in the cases associated with decreased left ventricular ejection fraction (EF) or increased end-diastolic volume index (EDVI). The patients were divided into two groups by preoperative EF. The EF of Group I ranged from 31 to 39% in 42 cases, and the EF of Group II was below 30% in 27 cases. Several parameters of cardiac function such as EF, peak ejection rate (PER), peak filling rate (PFR) or early diastolic peak filling rate were evaluated with radionuclide ventriculography. Postoperative mean values of these parameters significantly improved in both Group I and Group II compared to preoperative values. Although these parameters and left ventricular wall motion did not improve in the 7 cases with an EDVI over 140 ml/m{sup 2} in Group II, the clinical results of these 7 cases were good during the follow-up period except one case which preoperatively had frequent ventricular arrythmia. The clinical condition improved remarkably in the 3 patients who had preoperative angina pectoris among these 7 cases. Surgical indications must be carefully determined in cases with increased EDVI and frequent ventricular arrythmia. (author)

  6. Electrophysiologic testing guided risk stratification approach for sudden cardiac death beyond the left ventricular ejection fraction

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    Konstantinos A Gatzoulis; Dimitris Tsiachris; Petros Arsenos; Dimitris Tousoulis

    2016-01-01

    Sudden cardiac death threats ischaemic and dilated cardiomyopathy patients. Anti- arrhythmic protection may be provided to these patients with implanted cardiac defibrillators(ICD), after an efficient risk stratification approach. The proposed risk stratifier of an impaired left ventricular ejection fraction has limited sensitivity meaning that a significant number of victims will remain undetectable by this risk stratification approach because they have a preserved left ventricular systolic function. Current risk stratification strategies focus on combinations of non invasive methods like T wave alternans, late potentials, heart rate turbulence, deceleration capacity and others, with invasive methods like the electrophysiologic study. In the presence of an electrically impaired substrate with formed post myocardial infarction fibrotic zones, programmed ventricular stimulation provides important prognostic information for the selection of the patients expected to benefit from an ICD implantation, while due to its high negative predictive value, patients at low risk level may also be detected. Clustering evidence from different research groups and electrophysiologic labs support an electrophysiologic testing guided risk stratification approach for sudden cardiac death.

  7. Electrophysiologic testing guided risk stratification approach for sudden cardiac death beyond the left ventricular ejection fraction.

    Science.gov (United States)

    Gatzoulis, Konstantinos A; Tsiachris, Dimitris; Arsenos, Petros; Tousoulis, Dimitris

    2016-01-26

    Sudden cardiac death threats ischaemic and dilated cardiomyopathy patients. Anti- arrhythmic protection may be provided to these patients with implanted cardiac defibrillators (ICD), after an efficient risk stratification approach. The proposed risk stratifier of an impaired left ventricular ejection fraction has limited sensitivity meaning that a significant number of victims will remain undetectable by this risk stratification approach because they have a preserved left ventricular systolic function. Current risk stratification strategies focus on combinations of non invasive methods like T wave alternans, late potentials, heart rate turbulence, deceleration capacity and others, with invasive methods like the electrophysiologic study. In the presence of an electrically impaired substrate with formed post myocardial infarction fibrotic zones, programmed ventricular stimulation provides important prognostic information for the selection of the patients expected to benefit from an ICD implantation, while due to its high negative predictive value, patients at low risk level may also be detected. Clustering evidence from different research groups and electrophysiologic labs support an electrophysiologic testing guided risk stratification approach for sudden cardiac death.

  8. Cardiac I123-MIBG Correlates Better than Ejection Fraction with Symptoms Severity in Systolic Heart Failure

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    Miranda, Sandra M.; Moscavitch, Samuel D.; Carestiato, Larissa R. [Programa de Pós-Graduação em Ciências Cardiovasculares, Hospital Universitário Antonio Pedro, Universidade Federal Fluminense, Rio de Janeiro, RJ (Brazil); Felix, Renata M. [Departamento de Medicina Nuclear, Hospital Pró-Cardíaco, Rio de Janeiro, RJ (Brazil); Rodrigues, Ronaldo C.; Messias, Leandro R. [Programa de Pós-Graduação em Ciências Cardiovasculares, Hospital Universitário Antonio Pedro, Universidade Federal Fluminense, Rio de Janeiro, RJ (Brazil); Azevedo, Jader C. [Programa de Pós-Graduação em Ciências Cardiovasculares, Hospital Universitário Antonio Pedro, Universidade Federal Fluminense, Rio de Janeiro, RJ (Brazil); Departamento de Medicina Nuclear, Hospital Pró-Cardíaco, Rio de Janeiro, RJ (Brazil); Nóbrega, Antonio Cláudio L.; Mesquita, Evandro Tinoco [Programa de Pós-Graduação em Ciências Cardiovasculares, Hospital Universitário Antonio Pedro, Universidade Federal Fluminense, Rio de Janeiro, RJ (Brazil); Mesquita, Claudio Tinoco, E-mail: ctinocom@cardiol.br [Programa de Pós-Graduação em Ciências Cardiovasculares, Hospital Universitário Antonio Pedro, Universidade Federal Fluminense, Rio de Janeiro, RJ (Brazil); Departamento de Medicina Nuclear, Hospital Pró-Cardíaco, Rio de Janeiro, RJ (Brazil)

    2013-07-15

    The association of autonomic activation, left ventricular ejection fraction (LVEF) and heart failure functional class is poorly understood. Our aim was to correlate symptom severity with cardiac sympathetic activity, through iodine-123-metaiodobenzylguanidine ({sup 123}I-MIBG) scintigraphy and with LVEF in systolic heart failure (HF) patients without previous beta-blocker treatment. Thirty-one patients with systolic HF, class I to IV of the New York Heart Association (NYHA), without previous beta-blocker treatment, were enrolled and submitted to {sup 123}I-MIBG scintigraphy and to radionuclide ventriculography for LVEF determination. The early and delayed heart/mediastinum (H/M) ratio and the washout rate (WR) were performed. According with symptom severity, patients were divided into group A, 13 patients in NYHA class I/II, and group B, 18 patients in NYHA class III/IV. Compared with group B patients, group A had a significantly higher LVEF (25% ± 12% in group B vs. 32% ± 7% in group A, p = 0.04). Group B early and delayed H/M ratios were lower than group A ratios (early H/M 1.49 ± 0.15 vs. 1.64 ± 0.14, p = 0.02; delayed H/M 1.39 ± 0.13 vs. 1.58 ± 0.16, p = 0.001, respectively). WR was significantly higher in group B (36% ± 17% vs. 30% ± 12%, p= 0.04). The variable that showed the best correlation with NYHA class was the delayed H/M ratio (r= -0.585; p=0.001), adjusted for age and sex. This study showed that cardiac {sup 123}I-MIBG correlates better than ejection fraction with symptom severity in systolic heart failure patients without previous beta-blocker treatment.

  9. Cardiac lipid content is unresponsive to a physical activity training intervention in type 2 diabetic patients, despite improved ejection fraction

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    Leiner Tim

    2011-05-01

    Full Text Available Abstract Background Increased cardiac lipid content has been associated with diabetic cardiomyopathy. We recently showed that cardiac lipid content is reduced after 12 weeks of physical activity training in healthy overweight subjects. The beneficial effect of exercise training on cardiovascular risk is well established and the decrease in cardiac lipid content with exercise training in healthy overweight subjects was accompanied by improved ejection fraction. It is yet unclear whether diabetic patients respond similarly to physical activity training and whether a lowered lipid content in the heart is necessary for improvements in cardiac function. Here, we investigated whether exercise training is able to lower cardiac lipid content and improve cardiac function in type 2 diabetic patients. Methods Eleven overweight-to-obese male patients with type 2 diabetes mellitus (age: 58.4 ± 0.9 years, BMI: 29.9 ± 0.01 kg/m2 followed a 12-week training program (combination endurance/strength training, three sessions/week. Before and after training, maximal whole body oxygen uptake (VO2max and insulin sensitivity (by hyperinsulinemic, euglycemic clamp was determined. Systolic function was determined under resting conditions by CINE-MRI and cardiac lipid content in the septum of the heart by Proton Magnetic Resonance Spectroscopy. Results VO2max increased (from 27.1 ± 1.5 to 30.1 ± 1.6 ml/min/kg, p = 0.001 and insulin sensitivity improved upon training (insulin stimulated glucose disposal (delta Rd of glucose improved from 5.8 ± 1.9 to 10.3 ± 2.0 μmol/kg/min, p = 0.02. Left-ventricular ejection fraction improved after training (from 50.5 ± 2.0 to 55.6 ± 1.5%, p = 0.01 as well as cardiac index and cardiac output. Unexpectedly, cardiac lipid content in the septum remained unchanged (from 0.80 ± 0.22% to 0.95 ± 0.21%, p = 0.15. Conclusions Twelve weeks of progressive endurance/strength training was effective in improving VO2max, insulin sensitivity

  10. Role of biomarkers in cardiac structure phenotyping in heart failure with preserved ejection fraction: critical appraisal and practical use.

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    D'Elia, Emilia; Vaduganathan, Muthiah; Gori, Mauro; Gavazzi, Antonello; Butler, Javed; Senni, Michele

    2015-12-01

    Heart failure (HF) with preserved ejection fraction (HFpEF) is a heterogeneous clinical syndrome characterized by cardiovascular, metabolic, and pro-inflammatory diseases associated with advanced age and extracardiac comorbidities. All of these conditions finally lead to impairment of myocardial structure and function. The large phenotypic heterogeneity of HFpEF from pathophysiological underpinnings presents a major hurdle to HFpEF therapy. The new therapeutic approach in HFpEF should be targeted to each HF phenotype, instead of the 'one-size-fits-all' approach, which has not been successful in clinical trials. Unless the structural and biological determinants of the failing heart are deeply understood, it will be impossible to appropriately differentiate HFpEF patients, identify subtle myocardial abnormalities, and finally reverse abnormal cardiac function. Based on evidence from endomyocardial biopsies, some of the specific cardiac structural phenotypes to be targeted in HFpEF may be represented by myocyte hypertrophy, interstitial fibrosis, myocardial inflammation associated with oxidative stress, and coronary disease. Once the diagnosis of HFpEF has been established, a potential approach could be to use a panel of biomarkers to identify the main cardiac structural HFpEF phenotypes, guiding towards more appropriate therapeutic strategies. Accordingly, the purpose of this review is to investigate the potential role of biomarkers in identifying different cardiac structural HFpEF phenotypes and to discuss the merits of a biomarker-guided strategy in HFpEF.

  11. Ejection Fraction Heart Failure Measurement

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    ... Disease Venous Thromboembolism Aortic Aneurysm More Ejection Fraction Heart Failure Measurement Updated:Feb 15,2017 The ejection fraction ( ... failure This content was last reviewed April 2015. Heart Failure • Home • About Heart Failure • Causes and Risks for ...

  12. Evaluation of Cardiac Function Index as Measured by Transpulmonary Thermodilution as an Indicator of Left Ventricular Ejection Fraction in Cardiogenic Shock

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    Jessica Perny

    2014-01-01

    Full Text Available Introduction. The PiCCO transpulmonary thermodilution technique provides two indices of cardiac systolic function, the cardiac function index (CFI and the global ejection fraction (GEF. Both appear to be correlated with left ventricular ejection fraction (LVEF measured by echocardiography in patients with circulatory failure, especially in septic shock. The aim of the present study was to test the reliability of CFI as an indicator of LVEF in patients with cardiogenic shock. Methods. In thirty-five patients with cardiogenic shock, we performed (i simultaneous measurements of echocardiography LVEF and cardiac function index assessed by transpulmonary thermodilution (n=72 and (ii transpulmonary thermodilution before/after increasing inotropic agents (n=18. Results. Mean LVEF was 31% (+/−11.7, CFI 3/min (+/−1, and GEF 14.2% (+/−6. CFI and GEF were both positively correlated with LVEF (P<0.0001, r2=0.27. CFI and GEF were significantly increased with inotropic infusion (resp., P=0.005, P=0.007. A cardiac function index <3.47/min predicted a left ventricular ejection fraction ≤35% (sensitivity 81.1% and specificity 63%. In patients with right ventricular dysfunction, CFI was not correlated with LVEF. Conclusion. CFI is correlated with LVEF provided that patient does not present severe right ventricular dysfunction. Thus, the PiCCO transpulmonary thermodilution technique is useful for the monitoring of inotropic therapy during cardiogenic shock.

  13. Predictive value of assessing diastolic strain rate on survival in cardiac amyloidosis patients with preserved ejection fraction.

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    Dan Liu

    Full Text Available Since diastolic abnormalities are typical findings of cardiac amyloidosis (CA, we hypothesized that speckle-tracking-imaging (STI derived longitudinal early diastolic strain rate (LSRdias could predict outcome in CA patients with preserved left ventricular ejection fraction (LVEF >50%.Diastolic abnormalities including altered early filling are typical findings and are related to outcome in CA patients. Reduced longitudinal systolic strain (LSsys assessed by STI predicts increased mortality in CA patients. It remains unknown if LSRdias also related to outcome in these patients.Conventional echocardiography and STI were performed in 41 CA patients with preserved LVEF (25 male; mean age 65±9 years. Global and segmental LSsys and LSRdias were obtained in six LV segments from apical 4-chamber views.Nineteen (46% out of 41 CA patients died during a median of 16 months (quartiles 5-35 months follow-up. Baseline mitral annular plane systolic excursion (MAPSE, 6 ± 2 vs. 8 ± 3 mm, global LSRdias and basal-septal LSRdias were significantly lower in non-survivors than in survivors (all p < 0.05. NYHA class, number of non-cardiac organs involved, MAPSE, mid-septal LSsys, global LSRdias, basal-septal LSRdias and E/LSRdias were the univariable predictors of all-cause death. Multivariable analysis showed that number of non-cardiac organs involved (hazard ratio [HR] = 1.96, 95% confidence interval [CI] 1.17-3.26, P = 0.010, global LSRdias (HR = 7.30, 95% CI 2.08-25.65, P = 0.002, and E/LSRdias (HR = 2.98, 95% CI 1.54-5.79, P = 0.001 remained independently predictive of increased mortality risk. The prognostic performance of global LSRdias was optimal at a cutoff value of 0.85 S-1 (sensitivity 68%, specificity 67%. Global LSRdias < 0.85 S-1 predicted a 4-fold increased mortality in CA patients with preserved LVEF.STI-derived early diastolic strain rate is a powerful independent predictor of survival in CA patients with preserved LVEF.

  14. Fetal cardiac ventricular volume, cardiac output, and ejection fraction determined with four-dimensional ultrasound using Spatio-Temporal Image Correlation (STIC) and Virtual Organ Computed-aided AnaLysis (VOCAL™)

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    Hamill, Neil; Yeo, Lami; Romero, Roberto; Hassan, Sonia S.; Myers, Stephen A.; Mittal, Pooja; Kusanovic, Juan Pedro; Balasubramaniam, Mamtha; Chaiworapongsa, Tinnakorn; Vaisbuch, Edi; Espinoza, Jimmy; Gotsch, Francesca; Goncalves, Luis F.; Lee, Wesley

    2011-01-01

    Objective To quantify fetal cardiovascular parameters with Spatio-Temporal Image Correlation (STIC) and Virtual Organ Computed-aided AnaLysis (VOCAL™) utilizing the sub-feature: “Contour Finder: Trace”. Study Design A cross-sectional study was designed consisting of patients with normal pregnancies between 19 and 40 weeks of gestation. After STIC datasets were acquired, analysis was performed offline (4DView) and the following cardiovascular parameters were evaluated: ventricular volume in end systole and end diastole, stroke volume, cardiac output, and ejection fraction. To account for fetal size, cardiac output was also expressed as a function of head circumference, abdominal circumference, or femoral diaphysis length. Regression models were fitted for each cardiovascular parameter to assess the effect of gestational age and paired comparisons were made between the left and right ventricles. Results 1) Two hundred and seventeen patients were retrospectively identified, of whom 184 had adequate STIC datasets (85% acceptance); 2) ventricular volume, stroke volume, cardiac output, and adjusted cardiac output increased with gestational age; whereas, the ejection fraction decreased as gestation advanced; 3) the right ventricle was larger than the left in both systole (Right: 0.50 ml, IQR: 0.2 – 0.9; vs. Left: 0.27 ml, IQR: 0.1 – 0.5; p<0.001) and diastole (Right: 1.20 ml, IQR: 0.7 – 2.2; vs. Left: 1.03 ml, IQR: 0.5 – 1.7; p<0.001); 4) there were no differences between the left and right ventricle with respect to stroke volume, cardiac output, or adjusted cardiac output; and 5) the left ventricular ejection fraction was greater than the right (Left: 72.2%, IQR: 64 – 78; vs. Right: 62.4%, IQR: 56 – 69; p<0.001). Conclusion Fetal echocardiography, utilizing STIC and VOCAL™ with the sub-feature: “Contour Finder: Trace”, allows assessment of fetal cardiovascular parameters. Normal fetal cardiovascular physiology is characterized by ventricular

  15. Cognitive function in ambulatory patients with systolic heart failure: insights from the warfarin versus aspirin in reduced cardiac ejection fraction (WARCEF trial.

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    Susan Graham

    Full Text Available We sought to determine whether cognitive function in stable outpatients with heart failure (HF is affected by HF severity. A retrospective, cross-sectional analysis was performed using data from 2, 043 outpatients with systolic HF and without prior stroke enrolled in the Warfarin versus Aspirin in Reduced Cardiac Ejection Fraction (WARCEF Trial. Multivariable regression analysis was used to assess the relationship between cognitive function measured using the Mini-Mental Status Exam (MMSE and markers of HF severity (left ventricular ejection fraction [LVEF], New York Heart Association [NYHA] functional class, and 6-minute walk distance. The mean (SD for the MMSE was 28.6 (2.0, with 64 (3.1% of the 2,043 patients meeting the cut-off of MMSE <24 that indicates need for further evaluation of cognitive impairment. After adjustment for demographic and clinical covariates, 6-minute walk distance (β-coefficient 0.002, p<0.0001, but not LVEF or NYHA functional class, was independently associated with the MMSE as a continuous measure. Age, education, smoking status, body mass index, and hemoglobin level were also independently associated with the MMSE. In conclusion, six-minute walk distance, but not LVEF or NYHA functional class, was an important predictor of cognitive function in ambulatory patients with systolic heart failure.

  16. Cognitive function in ambulatory patients with systolic heart failure: insights from the warfarin versus aspirin in reduced cardiac ejection fraction (WARCEF) trial.

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    Graham, Susan; Ye, Siqin; Qian, Min; Sanford, Alexandra R; Di Tullio, Marco R; Sacco, Ralph L; Mann, Douglas L; Levin, Bruce; Pullicino, Patrick M; Freudenberger, Ronald S; Teerlink, John R; Mohr, J P; Labovitz, Arthur J; Lip, Gregory Y H; Estol, Conrado J; Lok, Dirk J; Ponikowski, Piotr; Anker, Stefan D; Thompson, John L P; Homma, Shunichi

    2014-01-01

    We sought to determine whether cognitive function in stable outpatients with heart failure (HF) is affected by HF severity. A retrospective, cross-sectional analysis was performed using data from 2, 043 outpatients with systolic HF and without prior stroke enrolled in the Warfarin versus Aspirin in Reduced Cardiac Ejection Fraction (WARCEF) Trial. Multivariable regression analysis was used to assess the relationship between cognitive function measured using the Mini-Mental Status Exam (MMSE) and markers of HF severity (left ventricular ejection fraction [LVEF], New York Heart Association [NYHA] functional class, and 6-minute walk distance). The mean (SD) for the MMSE was 28.6 (2.0), with 64 (3.1%) of the 2,043 patients meeting the cut-off of MMSE <24 that indicates need for further evaluation of cognitive impairment. After adjustment for demographic and clinical covariates, 6-minute walk distance (β-coefficient 0.002, p<0.0001), but not LVEF or NYHA functional class, was independently associated with the MMSE as a continuous measure. Age, education, smoking status, body mass index, and hemoglobin level were also independently associated with the MMSE. In conclusion, six-minute walk distance, but not LVEF or NYHA functional class, was an important predictor of cognitive function in ambulatory patients with systolic heart failure.

  17. Impact of epoetin alfa on left ventricular structure, function, and pressure volume relations as assessed by cardiac magnetic resonance: the heart failure preserved ejection fraction (HFPEF) anemia trial.

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    Green, Philip; Babu, Benson A; Teruya, Sergio; Helmke, Stephen; Prince, Martin; Maurer, Mathew S

    2013-01-01

    Anemia, a common comorbidity in older adults with heart failure and a preserved ejection fraction (HFPEF), is associated with worse outcomes. The authors quantified the effect of anemia treatment on left ventricular (LV) structure and function as measured by cardiac magnetic resonance (CMR) imaging. A prospective, randomized single-blind clinical trial (NCT NCT00286182) comparing the safety and efficacy of epoetin alfa vs placebo for 24 weeks in which a subgroup (n=22) had cardiac magnetic resonance imaging (MRI) at baseline and after 3 and 6 months to evaluate changes in cardiac structure and function. Pressure volume (PV) indices were derived from MRI measures of ventricular volume coupled with sphygmomanometer-measured pressure and Doppler estimates of filling pressure. The end-systolic and end-diastolic PV relations and the area between them as a function of end-diastolic pressure, the isovolumic PV area (PVAiso), were calculated. Patients (75±10 years, 64% women) with HFPEF (EF=63%±15%) with an average hemoglobin of 10.3±1.1 gm/dL were treated with epoetin alfa using a dose-adjusted algorithm that increased hemoglobin compared with placebo (PHFPEF resulted in a significant increase in hemoglobin, without evident change in LV structure, function, or pressure volume relationships as measured quantitatively using CMR imaging.

  18. Assessment of left ventricular ejection fraction: comparison of two dimensional echocardiography, cardiac magnetic resonance imaging and 64-row multi-detector computed tomography

    Institute of Scientific and Technical Information of China (English)

    Chee Khoon LIEW; Kui Hian SIM; Rapaee ANNUAR; Tiong Kiam ONG; Sze Piaw CHIN; Tobias Seyfarth; Yean Yip FONG; Wei Ling CHAN; Choon Kiat ANG; Houng Bang LIEW

    2006-01-01

    Objectives To compare left ventricular ejection fraction (LVEF) determined from 64-row multi-detector computed tomography (64-row MDCT) with those determined from two dimensional echocardiography (2D echo) and cardiac magnetic resonance imaging (CMR). Methods Thirty-two patients with coronary artery disease underwent trans-thoracic 2D echo, CMR and contrast-enhanced 64-row MDCT for assessment of LVEF within 48 hours of each other. 64-row MDCT LVEF was derived using the Syngo Circulation software; CMR LVEF was by Area Length Ejection Fraction (ALEF) and Simpson method and 2D echo LVEF by Simpson method.Results The LVEF was 49.13 ± 15.91% by 2D echo, 50.72 ± 16.55% (ALEF method) and 47.65 ± 16.58%(Simpson method) by CMR and 50.00 ± 15.93% by 64-row MDCT. LVEF measurements by 64-row MDCT correlated well with LVEF measured with CMR using either the ALEF method (Pearson correlation r = 0.94, P <0.01) or Simpson method (r = 0.92, P<0.01). It also correlated well with LVEF measured using 2D echo (r = 0.80, P < 0.01). Conclusion LVEF measurements by 64-row MDCT correlated well with LVEF measured by CMR and 2D echo. The correlation between 64-row MDCT and CMR was better than the correlation between 2D echo with CMR. Standard data set from a 64-row MDCT coronary study can be reliably used to calculate the LVEF.

  19. The Correlation between Left and Right Ventricular Ejection Fractions in Patients with Ischemic Heart Disease, Documented by Cardiac Magnetic Resonance Imaging

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    Ali Eshraghi

    2016-03-01

    Full Text Available Introduction: The correlation between right and left ventricular ejection fractions (RVEF and LVEF, respectively has been studied in only a small number of patients with a marked decrease in RVEF and LVEF. The aim of the present study was to compare LVEF and RVEF in patients with ischemic heart disease. RVEF and LVEF were measured by Cardiovascular Magnetic Resonance (CMR imaging. Materials and Methods: This observational study was done in Ghaem general hospital in 2014.  LVEF and RVEF were measured in a series of 33 patients with ischemic heart disease, undergoing CMR for the evaluation of myocardial viability. The correlation between RVEF and LVEF in patients with ischemic heart disease was studied, using Pearson product-moment correlation coefficient analysis.   This study was done in Ghaem general hospital in 2014 with simple sapling. Results: Right ventricular end diastolic volume (186.33±58.90 and left ventricular end diastolic volume (121.72±61.64 were significantly correlated (r=0.223, P=0.005. Moreover, there was a significant correlation between right ventricular end systolic volume (88.18±40.90 and left ventricular end systolic volume (140.96±35.33 (r=0.329, P=0.000. The most significant association was observed between RVEF and LVEF (r=0.913, P=0.000. Conclusion: Based on the findings, RVEF and LVEF were significantly correlated in patients with ischemic heart disease, although this association was not always present in all cardiac patients. The cause of this discrepancy is still unknown.

  20. Quality of Anticoagulation Control in Preventing Adverse Events in Heart Failure Patients in Sinus Rhythm: A Warfarin Aspirin Reduced Cardiac Ejection Fraction Trial (WARCEF) Substudy

    Science.gov (United States)

    Homma, Shunichi; Thompson, John L.P.; Qian, Min; Ye, Siqin; Di Tullio, Marco R.; Lip, Gregory Y.H.; Mann, Douglas L.; Sacco, Ralph L.; Levin, Bruce; Pullicino, Patrick M.; Freudenberger, Ronald S.; Teerlink, John R.; Graham, Susan; Mohr, J.P.; Labovitz, Arthur J.; Buchsbaum, Richard; Estol, Conrado J.; Lok, Dirk J.; Ponikowski, Piotr; Anker, Stefan D.

    2015-01-01

    Background The aim of this study is to examine the relationship between time in therapeutic range (TTR) and clinical outcomes in heart failure (HF) patients in sinus rhythm (SR) treated with warfarin. Methods and Results We used data from the Warfarin vs. Aspirin in Reduced Cardiac Ejection Fraction Trial (WARCEF) to assess the relationship of TTR with the WARCEF primary outcome (ischemic stroke, intracerebral hemorrhage, or death); with death alone; ischemic stroke alone; major hemorrhage alone; and net clinical benefit (primary outcome and major hemorrhage combined). Multivariable Cox models were used to examine how the event risk changed with TTR and to compare the high TTR, low TTR, and aspirin patients, with TTR being treated as a time-dependent covariate. 2,217 patients were included in the analyses, among whom 1,067 were randomized to warfarin and 1,150 were randomized to aspirin. The median (IQR) follow-up duration was 3.6 (2.0–5.0) years. Mean (±SD) age was 61±11.3 years, with 80% being men. The mean (±SD) TTR was 57% (±28.5%). Increasing TTR was significantly associated with reduction in primary outcome (adjusted p<0.001), death alone (adjusted p=0.001), and improved net clinical benefit (adjusted p<0.001). A similar trend was observed for the other two outcomes but significance was not reached (adjusted p=0.082 for ischemic stroke, adjusted p=0.109 for major hemorrhage). Conclusions In HF patients in SR, increasing TTR is associated with better outcome and improved net clinical benefit. Patients in whom good quality anticoagulation can be achieved may benefit from the use of anticoagulants. Clinical Trial Registration URL: http://www.clinicaltrials.gov. Unique identifier: NCT00041938. PMID:25850425

  1. Animal models of heart failure with preserved ejection fraction

    NARCIS (Netherlands)

    G. Conceição; I. Heinonen (Ilkka); A.P. Lourenço; D.J.G.M. Duncker (Dirk); I. Falcão-Pires

    2016-01-01

    textabstractHeart failure with preserved ejection fraction (HFpEF) constitutes a clinical syndrome in which the diagnostic criteria of heart failure are not accompanied by gross disturbances of systolic function, as assessed by ejection fraction. In turn, under most circumstances, diastolic function

  2. Awake craniotomy in a patient with ejection fraction of 10%: considerations of cerebrovascular and cardiovascular physiology.

    Science.gov (United States)

    Meng, Lingzhong; Weston, Stephen D; Chang, Edward F; Gelb, Adrian W

    2015-05-01

    A 37-year-old man with nonischemic 4-chamber dilated cardiomyopathy and low-output cardiac failure (estimated ejection fraction of 10%) underwent awake craniotomy for a low-grade oligodendroglioma resection under monitored anesthesia care. The cerebrovascular and cardiovascular physiologic challenges and our management of this patient are discussed.

  3. No benefits of statins for sudden cardiac death prevention in patients with heart failure and reduced ejection fraction: A meta-analysis of randomized controlled trials

    Science.gov (United States)

    Le, Hai-Ha; Fall, Mor; Gueyffier, François; Burnand, Bernard

    2017-01-01

    Background and objectives Statins showed mixed results in heart failure (HF) patients. The benefits in major HF outcomes, including all-cause mortality and sudden cardiac death (SCD), have always been discordant across systematic reviews and meta-analyses. We intended to systematically identify and appraise the available evidence that evaluated the effectiveness of statins in clinical outcomes for HF patients. Design Systematic review and meta-analysis Data sources We searched, until April 28, 2016: Medline, Embase, ISI Web of Science and EBM reviews (Cochrane DSR, ACP journal club, DARE, CCTR, CMR, HTA, and NHSEED), checked clinicaltrials.gov for ongoing trials and manually searched references of included studies. Eligibility criteria for selecting studies We identified 24 randomized clinical trials that evaluated the efficacy of statins for HF patients. All randomized clinical trials were assessed for risk of bias and pooled together in a meta-analysis. Pre-specified outcomes were sudden cardiac death, all-cause mortality, and hospitalization for worsening heart failure. Results Statins did not reduce sudden cardiac death (SCD) events in HF patients [relative risk (RR) 0.92, 95% confidence interval (CI) 0.70 to 1.21], all-cause mortality [RR 0.88, 95% CI 0.75 to 1.02] but significantly reduced hospitalization for worsening heart failure (HWHF) although modestly [RR 0.79, 95% CI 0.66 to 0.94]. Nevertheless, estimated predictive intervals were insignificant in SCD, all-cause mortality and HWHF [RR, 0.54 to 1.63, 0.64 to 1.19, and 0.54 to 1.15], respectively. An important finding was the possible presence of publication bias, small-study effects and heterogeneity of the trials conducted in HF patients. Conclusions Statins do not reduce sudden cardiac death, all-cause mortality, but may slightly decrease hospitalization for worsening heart failure in HF patients. The evaluation of the risk of biases suggested moderate quality of the published results. Until new

  4. [Heart failure with preserved left ventricular ejection fraction].

    Science.gov (United States)

    Maeder, Micha T; Rickli, Hans

    2013-10-16

    Heart failure with preserved left ventricular ejection fraction (LVEF; HFpEF) is a common type of heart failure in the elderly, and it typically represents advanced hypertensive heart disease. The left ventricle in patients with HFpEF is characterized by concentric remodeling, normal LVEF, but reduced left longitudinal shortening, and importantly diastolic dysfunction. Dyspnoe and fatigue in patients with HFpEF are due to impaired left ventricular filling with a rapid increase in filling pressures and the lack of an increase in stroke volume during exercise. The diagnosis of HFpEF requires the careful exclusion of non-cardiac causes of dyspnoe as well as cardiac causes of dyspnoe associated with preserved LVEF other than HFpEF, primarily coronary artery disease and valve disease. Then, the following findings are required to make a diagnosis of HFpEF: a non-dilated left ventricle with an LVEF >50% and the presence of a significant diastolic impairment, which can be assessed using invasive haemodynamics, echocardiography, natriuretic peptides, or a combination of these tools. In contrast to patients with heart failure and reduced LVEF there is still no established treatment for patients with HFpEF, which prolongs survival or reduces the rate of hospitalizations for heart failure. There is currently however intense research going on in this field, and results from large trials evaluating the effects of various interventions on clinical endpoints are expected within the next years.

  5. Alteration of Mevalonate Pathway Related Enzyme Expressions in Pressure Overload-Induced Cardiac Hypertrophy and Associated Heart Failure with Preserved Ejection Fraction

    Directory of Open Access Journals (Sweden)

    Bin Chen

    2013-12-01

    Full Text Available Background: Abnormalities of the mevalonate pathway, an important cellular metabolic pathway, are common in many diseases including cardiovascular disease. The mevalonate pathway related enzyme expressions in pressure overload-induced cardiac hypertrophy and associated diastolic dysfunction remains largely unknown. This study aims to investigate whether the expression of mevalonate pathway related enzyme is altered during the progression of cardiac hypertrophy and associated diastolic dysfunction induced by pressure overload. Methods: Male Sprague-Dawley (SD rats were randomly divided into two groups: the suprarenal abdominal aortic coarctation (AAC group and the sham group. Results: Histological and echocardiographic assessments showed that there was a significant cardiovascular remodeling in the AAC group compared with the sham group after 3 weeks post-operatively, and the left ventricular (LV diastolic function was reduced at 8 and 14 weeks post-operatively in the AAC group, without any change in systolic function during the study. The tissue of the heart and the abdominal aorta proximal to the coarctation showed over-expression of several enzymes, including 3-hydroxy-3-methylglutaryl coenzyme A reductase (HMGR, farnesyl diphosphate synthase (FDPS, farnesyltransferase-α (FNTA, farnesyltransferase-β (FNTB, geranylgeranyltransferase type I (GGTase-I and the activation of their downstream proteins was enhanced. Conclusions: AAC induced compensatory LV hypertrophy to decompensatory diastolic dysfunction, accompanied by altered expression of several key enzymes in the mevalonate pathway.

  6. Animal models of heart failure with preserved ejection fraction

    OpenAIRE

    Conceição, G.; Heinonen, I.; Lourenço, A. P.; Duncker, D. J.; Falcão-Pires, I.

    2016-01-01

    Heart failure with preserved ejection fraction (HFpEF) constitutes a clinical syndrome in which the diagnostic criteria of heart failure are not accompanied by gross disturbances of systolic function, as assessed by ejection fraction. In turn, under most circumstances, diastolic function is impaired. Although it now represents over 50 % of all patients with heart failure, the mechanisms of HFpEF remain understood, precluding effective therapy. Understanding the pathophysiology of HFpEF has be...

  7. COMPARATIVE STUDY OF HEART FAILURE WITH PRESERVED EJECTION FRACTION VERSUS DECREASED EJECTION FRACTION

    Directory of Open Access Journals (Sweden)

    Chandrashekar

    2015-03-01

    Full Text Available BACKGROUND AND OBJECTIVES : To study the socio demographic profile , risk factors , clinical presentation and comorbidies in patients with heart failure. To compare the socio demographic profile , risk factors , clinical presentation and comorbidities in patients with Heart failure with normal ejection fraction (HFnEF and Heart failure with reduced ejection fraction (HFrEF. METHODS: The primary study population consisted of 100 cases of adult men and women aged more than 18 years with symptoms of Hea rt failure diagnosed by Framingham’s criteria . The study population was selected from inpatients and outpatients attending Department of Medicine of KIMS hospital between January to December 2012. The study was a hospital based observatory and comparative study. RESULTS: Out of 100 cases included in our study 50% cases had HFrEF & 50% cases had HFnEF as confirmed by echocardiographic parameters. There was no statistically significant difference between the two groups with respect to age and sex. However the re were significant statistical significant differences between the groups with respect to clinical features , risk factors and co morbidities. Clinical features like oedema , hepatomegaly and rales were common in HFrEF group (P<0.05. Also LVESD & LVEDD wer e increased in patients with HFrEF. Risk factors like prior MI/IHD were more common in patients with HfrEF (P<0.05 . History of hypertension and left ventricular hypertrophy were common in patients with HFnEF (P< 0.05. Among the comorbidities: IHD Conduct ion abnormalities were common in HFrEF group. Pericardial effusion was more common in HFnEFgroup.

  8. Value of left ventricular ejection fraction during exercise in predicting the extent of coronary artery disease.

    Science.gov (United States)

    DePace, N L; Iskandrian, A S; Hakki, A H; Kane, S A; Segal, B L

    1983-04-01

    To determine the relation between left ventricular performance during exercise and the extent of coronary artery disease, the results of exercise radionuclide ventriculography were analyzed in 65 patients who also underwent cardiac catheterization. A scoring system was used to quantitate the extent of coronary artery disease. This system takes into account the number and site of stenoses of the major coronary vessels and their secondary branches. The conventional method of interpreting the coronary angiograms indicated that 26 patients had significant coronary artery disease (defined as 70% or more narrowing of luminal diameter) of one vessel, 21 had multivessel disease and 18 had no significant coronary artery disease. Although the exercise left ventricular ejection fraction was significantly higher in patients with no coronary artery disease than in patients with one or multivessel disease (probability [p] less than 0.001), there was considerable overlap among the three groups. With the scoring system, a good correlation was found between the coronary artery disease score and the exercise left ventricular ejection fraction (r = -0.70; p less than 0.001). If the exercise heart rate was 130 beats/min or greater or the age of the patient was 50 years or less, an even better correlation was found (r = -0.73 and r = -0.82, respectively). The exercise ejection fraction (but not the change in ejection fraction, end-diastolic volume and end-systolic volume from rest to exercise) correlated with the extent of coronary artery disease. The exercise ejection fraction is the most important exercise variable that correlates with the extent of coronary artery disease when the latter is assessed quantitatively by a scoring system rather than the conventional method of reporting coronary angiograms. Young age and greater exercise heart rate strengthened the correlation. The change in ejection fraction from rest to exercise is useful in the diagnosis of coronary artery disease

  9. [What is new in heart failure with preserved ejection fraction within last five years?].

    Science.gov (United States)

    Gregorová, Zdeňka; Meluzín, Jaroslav; Spinarová, Lenka

    2014-01-01

    Heart failure with preserved ejection fraction of left ventricle (heart failure with normal ejection fraction, HFPEF, HFNEF) is frequent disease with serious consequences. Incidence of HFPEF in population is still growing. The exact pathophysiological mechanism of HFPEF remain unclear .Recent evidence suggests a relationship between inflammation associated with obesity or Diabetes mellitus and progression of HFPEF. Consistently, it has been reported that serum concentration of some pro-inflammatory markers such as adiponectin is positively related to HFPEF. By HFPEF is attended diastolic dysfunction. Diastolic dysfunction is linked to many other cardiac and non-cardiac diseases. Despite the great effort and new therapeutic approaches the prognosis of HFPEF does not improve. The gold standard in HFPEF diagnosis remains heart catheterization. Electrocardiography, chest X-ray, blood examination including diagnostic markers of heart failure and mainly echocardiography with Doppler imaging are used diagnose the underlying disease leading to heart failure.

  10. Diagnosis of heart failure with preserved ejection fraction.

    Science.gov (United States)

    Wachter, Rolf; Edelmann, Frank

    2014-07-01

    Heart failure with preserved ejection fraction (HFpEF) constitutes a growing health care burden worldwide. Although definitions vary somewhat among guidelines, in general the presence of typical heart failure symptoms and signs in combination with a preserved left ventricular ejection fraction (≥50%) and functional and/or structural left ventricular changes makes the diagnosis likely. This review focuses on the current understanding of diagnostic criteria, as presented in current guidelines and consensus recommendations, and on new insights from recent papers. The role of comorbidities that often contribute to symptoms and hamper the HFpEF diagnostics is also reviewed.

  11. Cardiac Myosin Binding Protein C and Heart Failure with Preserved Ejection Fraction%心脏型肌球蛋白结合蛋白与射血分数保留的心力衰竭

    Institute of Scientific and Technical Information of China (English)

    张晨(综述); 常静(审校)

    2015-01-01

    Cardiac myosin binding protein C ( cMyBP-C) is not only the main part of cardiac thick filament,but a key regulator of car-diac contraction and diastolic function.Early studies have focused on gene variants in cMyBP-C with hypertrophic cardiomyopathy and the value of serum cMyBP-C in the diagnosis and prognosis evaluation of patients with acute myocardial infarction.With the rapid development of medical molecular biology and genomics, studies show that cMyBP-C phosphorylation is directly linked to signaling of diastolic function.More research has found that level of cMyBP-C phosphorylation is significantly decreased during the end-stage heart failure,indicating that cMyBP-C plays an important role in heart failure with preserved ejection fraction( HFpEF).We discusss the latest progress in the structure,function and regulation of cMyBP-C.We also attempt to shed some light on the relationship between the cMyBP-C and HFpEF.%心脏型肌球蛋白结合蛋白C不仅是心肌粗肌丝的主要组成部分,还是参与调节心肌细胞收缩舒张功能的重要物质之一。过去几十年的研究主要集中在心脏型肌球蛋白结合蛋白基因突变致肥厚型心肌病,以及血清心脏型肌球蛋白结合蛋白水平在急性心肌梗死患者的诊断、判断预后作用。近年来对心脏型肌球蛋白结合蛋白C通过磷酸化来调节心肌舒张功能方面有了新进展,而且,多个研究又发现难治性终末期心力衰竭患者的心脏型肌球蛋白结合蛋白磷酸化水平显著降低。这表明心脏型肌球蛋白结合蛋白可能对于舒张功能不全为特征的射血分数保留心力衰竭的发生发展很重要。在这个情况下,现综述总结心脏型肌球蛋白结合蛋白结构和功能的最新研究进展,并对心脏型肌球蛋白结合蛋白与射血分数保留心力衰竭的关系进行简要综述。

  12. Galectin-3 in heart failure with preserved ejection fraction

    NARCIS (Netherlands)

    de Boer, Rudolf A.; Edelmann, Frank; Cohen-Solal, Alain; Mamas, Mamas A.; Maisel, Alan; Pieske, Burkert

    2013-01-01

    In the last decades it has been appreciated that many patients with heart failure (HF) suffer from HF with preserved ejection fraction (HFpEF). The diagnosis and treatment of HFpEF is difficult, as we lack specific markers of the disease and no specific treatments have been identified. Galectin-3 ha

  13. Phenotypic Spectrum of Heart Failure with Preserved Ejection Fraction

    OpenAIRE

    Sanjiv J Shah; Katz, Daniel H.; Rahul C Deo

    2014-01-01

    Heart failure with preserved ejection fraction (HFpEF) is a heterogeneous syndrome, with several underlying etiologic and pathophysiologic factors. While prior heart failure clinical trials have used a “one size fits all” approach, this approach has not proven successful for HFpEF. Furthermore, with the aging population and epidemics of obesity, diabetes, and hypertension, the prevalence of HFpEF will continue to grow over the foreseeable future. Coupled with the high morbidity and mortality ...

  14. The Emerging Epidemic of Heart Failure with Preserved Ejection Fraction

    OpenAIRE

    Oktay, A. Afşin; Rich, Jonathan D.; Sanjiv J Shah

    2013-01-01

    Heart failure with preserved ejection fraction (HFpEF), which currently represents approximately 50 % of heart failure (HF) cases, is common and associated with high morbidity and mortality. Understanding the epidemiology of HFpEF has been difficult due to the challenges in HFpEF diagnosis and the heterogeneous etiologies and pathophysiologies that underlie HFpEF. Nevertheless, several high-quality epidemiology and observational registry studies of HFpEF demonstrate that an increasing prevale...

  15. Pharmacotherapy of heart failure with preserved ejection fraction.

    Science.gov (United States)

    Basaraba, Jade E; Barry, Arden R

    2015-04-01

    Heart failure with preserved ejection fraction (HFpEF) constitutes ~50% of all heart failure diagnoses and is associated with considerable morbidity and mortality. The treatment of HFpEF can be challenging due to a lack of evidence supporting the benefit of various drug therapies. In practice, treatment can be divided into acute and chronic management. Acute therapy for decompensated heart failure is similar for both HFpEF and heart failure with reduced ejection fraction. The mainstay of treatment is diuretics to reduce volume overload and improve dyspnea. Patients with an acute exacerbation of HFpEF and rapid atrial fibrillation (AF) should be rate controlled with negative chronotropic agents. For chronic therapy, patients with HFpEF should not be treated like patients with heart failure with reduced ejection fraction. Chronic management of HFpEF can be simplified by using three strategies based on applicability: treat precipitating conditions (e.g., hypertension, AF), control symptoms by maintaining euvolemia with diuretics, and avoid therapies that have been shown not to be beneficial unless another compelling indication exists. Nondrug interventions for HFpEF include salt and fluid restriction, regular physical activity, and referral to a heart function clinic, if appropriate.

  16. Noncardiac Comorbidities in Heart Failure With Reduced Versus Preserved Ejection Fraction

    NARCIS (Netherlands)

    Mentz, Robert J.; Kelly, Jacob P.; von Lueder, Thomas G.; Voors, Adriaan A.; Lam, Carolyn S. P.; Cowie, Martin R.; Kjeldsen, Keld; Jankowska, Ewa A.; Atar, Dan; Butler, Javed; Fiuzat, Mona; Zannad, Faiez; Pitt, Bertram; O'Connor, Christopher M.

    2014-01-01

    Heart failure patients are classified by ejection fraction (EF) into distinct groups: heart failure with preserved ejection fraction (HFpEF) or heart failure with reduced ejection fraction (HFrEF). Although patients with heart failure commonly have multiple comorbidities that complicate management a

  17. Real-time three-dimensional echocardiographic left ventricular ejection fraction and volumes assessment: comparison with cardiac computed tomography; Comparacao entre a afericao da fracao de ejecao e dos volumes do ventriculo esquerdo, medidos com ecocardiografia tridimensional em tempo real e com tomografia computadorizada ultra-rapida

    Energy Technology Data Exchange (ETDEWEB)

    Vieira, Marcelo L.C.; Nomura, Cesar H.; Tranchesi Junior, Bernardino; Oliveira, Wercules A. de; Naccarato, Gustavo; Serpa, Bruna S.; Cury, Alexandre; Passos, Rodrigo B.D.; Nobrega, Marcel V. da; Funari, Marcelo B.G.; Pfefermam, Abhaham; Makdisse, Marcia; Fischer, Claudio H.; Morhy, Samira S., E-mail: luiz766@terra.com.br [Hospital Israelita Albert Einstein, Sao Paulo, SP (Brazil)

    2008-10-15

    Background and objective: Few studies addressed the comparison between real-time 3D echocardiography (RT3DE) and cardiac computed tomography (CCT) concerning left ventricular ejection fraction and volumes assessment. We sought to compare both techniques regarding left ventricle (LV) ejection fraction function and volumes analysis. Methods: we studied by RT3DE (Philips IE 33, And, MA, USA) and by CCT (Toshiba, 64-slice, Otawara, Japan) 41 consecutive patients (29 males, 58 ± 11 yrs). We analysed by both techniques LVEF, LVEDV, LVESV. RT3DE and CCT data were compared by coefficients of determination (r: Pearson), Bland and Altman test and linear regression, 95% CI. Results: RT3DE data: LVEF ranged from 56.7 to 78.9 % (65.3 + 5.7 ); LVEDV ranged from 49.6 to 178.2 (88 + 27.5) mL; LVESV from 11.4 to 78 ( 33.9 + 13.7) mL. CCT data: LVEF ranged from 53 to 86 % (67.3 + 7.9 ); LVEDV ranged from 51 to 186 (106.4 + 30.7) mL; LVESV from 7 to 72 ( 35.1 + 13.8) mL. Correlations relative to RT3DE and CCT were: LVEF (r: 0. 7877, p<0.0001, 95 % CI 0.6327 to 0.8853 ); LVEDV (r:0.7671, p<0.0001, 95 % CI 0.5974 to 0.8745); LVESV (r: 0.8121, p<0.0001, 95 % CI 0.6659 to 0.8957). Conclusions: it was observed adequate correlation between real-time 3D echocardiography and cardiac computed tomography concerning ejection fraction and volumes assessment. (author)

  18. Epidemiology of heart failure with preserved ejection fraction

    DEFF Research Database (Denmark)

    Andersson, Charlotte; Vasan, Ramachandran S

    2014-01-01

    Heart failure with preserved ejection fraction (HFPEF) is a common condition, and the prevalence is projected to increase further. Studies differ in the reported incidence and mortality associated with this condition, although there is agreement that between a third and one-half of all patients...... with heart failure have HFPEF. Although several consensus statements and guidelines have been published, some recent randomized clinical trials have reported low mortality, raising doubts about whether all patients diagnosed with HFPEF have HFPEF or whether the condition is heterogeneous in its cause...... and prognosis. The overall reported prognosis of patients with HFPEF remains poor....

  19. Invasive hemodynamic characterization of heart failure with preserved ejection fraction

    DEFF Research Database (Denmark)

    Andersen, Mads Jønsson; Borlaug, Barry A

    2014-01-01

    Recent hemodynamic studies have advanced our understanding of heart failure with preserved ejection fraction (HFpEF). Despite improved pathophysiologic insight, clinical trials have failed to identify an effective treatment for HFpEF. Invasive hemodynamic assessment can diagnose or exclude HFpEF......, making it invaluable in understanding the basis of the disease. This article reviews the hemodynamic mechanisms underlying HFpEF and how they manifest clinically, discusses invasive hemodynamic assessment as a diagnostic tool, and explores how invasive hemodynamic profiling may allow understanding...

  20. Exercise physiology in heart failure and preserved ejection fraction.

    Science.gov (United States)

    Haykowsky, Mark J; Kitzman, Dalane W

    2014-07-01

    Recent advances in the pathophysiology of exercise intolerance in patients with heart failure with preserved ejection fraction (HFPEF) suggest that noncardiac peripheral factors contribute to the reduced peak V(o2) (peak exercise oxygen uptake) and to its improvement after endurance exercise training. A greater understanding of the peripheral skeletal muscle vascular adaptations that occur with physical conditioning may allow for tailored exercise rehabilitation programs. The identification of specific mechanisms that improve whole body and peripheral skeletal muscle oxygen uptake could establish potential therapeutic targets for medical therapies and a means to follow therapeutic response.

  1. Follistatin like 1 Regulates Hypertrophy in Heart Failure with Preserved Ejection Fraction

    Science.gov (United States)

    Wilson, Richard M.; Essick, Eric E.; Fowler, Conor T.; Nakamura, Kazuto; van den Hoff, Maurice; Ouchi, Noriyuki; Sam, Flora

    2016-01-01

    Objective We sought to determine whether Fstl1 plays a role in the regulation of cardiac hypertrophy in HFpEF. Background Heart failure (HF) with preserved ejection fraction (HFpEF), accounts for ~50% of all clinical presentations of HF and its prevalence is expected to increase. However, there are no evidence-based therapies for HFpEF; thus, HFpEF represents a major unmet need. Although hypertension is the single most important risk factor for HFpEF, with a prevalence of 60-89% from clinical trials and human HF registries, blood pressure therapy alone is insufficient to prevent and treat HFpEF. Follistatin like 1 (Fstl1), a divergent member of the follistatin family of extracellular glycoproteins, has previously been shown to be elevated in HF with reduced ejection fraction (HFrEF) and associated with increased left ventricular mass. Methods and Results In this study, blood levels of Fstl1 were increased in humans with HFpEF. This increase was also evident in mice with hypertension-induced HFpEF and adult rat ventricular myocytes stimulated with aldosterone. Treatment with recombinant Fstl1 abrogated aldosterone-induced cardiac myocyte hypertrophy, suggesting a role for Fstl1 in the regulation of hypertrophy in HFpEF. There was also a reduction in the E/A ratio, a measure of diastolic dysfunction. Furthermore, HFpEF induced in a mouse model that specifically ablates Fstl1 in cardiac myocytes (cFstl1-KO), showed exacerbation of HFpEF with worsened diastolic dysfunction. In addition, cFstl1-KO-HFpEF mice demonstrated more marked cardiac myocyte hypertrophy with increased molecular markers of anp and bnp expression. Conclusions These findings indicate that Fstl1exerts therapeutic effects by modulating cardiac hypertrophy in HFpEF. PMID:27430031

  2. Case of Acute Graft Failure during Suspected Humoral Rejection with Preserved Ejection Fraction, but Severely Reduced Longitudinal Deformation Detected by 2D-Speckle Tracking

    Directory of Open Access Journals (Sweden)

    Tor Skibsted Clemmensen

    2014-01-01

    Full Text Available This case displays limited utility of left ventricular ejection fraction to detect acute graft failure due to microvascular vasculopathy and suspected humoral rejection. Despite severe and progressive graft failure, clinically and by right heart catheterizations, left ventricular ejection fraction remained unchanged, indicating need of more reliable noninvasive methods for graft function surveillance. Global longitudinal strain relates to clinical heart failure, filling pressure, and cardiac index during suspected humoral rejection and microvascular dysfunction in this HTX patient. We suggest routine monitoring of graft function by global longitudinal strain as supplement to routine left ventricular ejection fraction and diastolic Doppler measurements.

  3. Computer-based assessment of left ventricular regional ejection fraction in patients after myocardial infarction

    Science.gov (United States)

    Teo, S.-K.; Su, Y.; Tan, R. S.; Zhong, L.

    2014-03-01

    After myocardial infarction (MI), the left ventricle (LV) undergoes progressive remodeling which adversely affects heart function and may lead to development of heart failure. There is an escalating need to accurately depict the LV remodeling process for disease surveillance and monitoring of therapeutic efficacy. Current practice of using ejection fraction to quantitate LV function is less than ideal as it obscures regional variation and anomaly. Therefore, we sought to (i) develop a quantitative method to assess LV regional ejection fraction (REF) using a 16-segment method, and (ii) evaluate the effectiveness of REF in discriminating 10 patients 1-3 months after MI and 9 normal control (sex- and agematched) based on cardiac magnetic resonance (CMR) imaging. Late gadolinium enhancement (LGE) CMR scans were also acquired for the MI patients to assess scar extent. We observed that the REF at the basal, mid-cavity and apical regions for the patient group is significantly lower as compared to the control group (P infarction. The results suggest that REF could potentially be used as a discriminator for MI and employed to measure myocardium homogeneity with respect to degree of infarction. The computational performance per data sample took approximately 25 sec, which demonstrates its clinical potential as a real-time cardiac assessment tool.

  4. Metabolomic fingerprint of heart failure with preserved ejection fraction.

    Directory of Open Access Journals (Sweden)

    Beshay N Zordoky

    Full Text Available Heart failure (HF with preserved ejection fraction (HFpEF is increasingly recognized as an important clinical entity. Preclinical studies have shown differences in the pathophysiology between HFpEF and HF with reduced ejection fraction (HFrEF. Therefore, we hypothesized that a systematic metabolomic analysis would reveal a novel metabolomic fingerprint of HFpEF that will help understand its pathophysiology and assist in establishing new biomarkers for its diagnosis.Ambulatory patients with clinical diagnosis of HFpEF (n = 24, HFrEF (n = 20, and age-matched non-HF controls (n = 38 were selected for metabolomic analysis as part of the Alberta HEART (Heart Failure Etiology and Analysis Research Team project. 181 serum metabolites were quantified by LC-MS/MS and 1H-NMR spectroscopy. Compared to non-HF control, HFpEF patients demonstrated higher serum concentrations of acylcarnitines, carnitine, creatinine, betaine, and amino acids; and lower levels of phosphatidylcholines, lysophosphatidylcholines, and sphingomyelins. Medium and long-chain acylcarnitines and ketone bodies were higher in HFpEF than HFrEF patients. Using logistic regression, two panels of metabolites were identified that can separate HFpEF patients from both non-HF controls and HFrEF patients with area under the receiver operating characteristic (ROC curves of 0.942 and 0.981, respectively.The metabolomics approach employed in this study identified a unique metabolomic fingerprint of HFpEF that is distinct from that of HFrEF. This metabolomic fingerprint has been utilized to identify two novel panels of metabolites that can separate HFpEF patients from both non-HF controls and HFrEF patients.ClinicalTrials.gov NCT02052804.

  5. Metabolomic Fingerprint of Heart Failure with Preserved Ejection Fraction

    Science.gov (United States)

    Zordoky, Beshay N.; Sung, Miranda M.; Ezekowitz, Justin; Mandal, Rupasri; Han, Beomsoo; Bjorndahl, Trent C.; Bouatra, Souhaila; Anderson, Todd; Oudit, Gavin Y.; Wishart, David S.; Dyck, Jason R. B.

    2015-01-01

    Background Heart failure (HF) with preserved ejection fraction (HFpEF) is increasingly recognized as an important clinical entity. Preclinical studies have shown differences in the pathophysiology between HFpEF and HF with reduced ejection fraction (HFrEF). Therefore, we hypothesized that a systematic metabolomic analysis would reveal a novel metabolomic fingerprint of HFpEF that will help understand its pathophysiology and assist in establishing new biomarkers for its diagnosis. Methods and Results Ambulatory patients with clinical diagnosis of HFpEF (n = 24), HFrEF (n = 20), and age-matched non-HF controls (n = 38) were selected for metabolomic analysis as part of the Alberta HEART (Heart Failure Etiology and Analysis Research Team) project. 181 serum metabolites were quantified by LC-MS/MS and 1H-NMR spectroscopy. Compared to non-HF control, HFpEF patients demonstrated higher serum concentrations of acylcarnitines, carnitine, creatinine, betaine, and amino acids; and lower levels of phosphatidylcholines, lysophosphatidylcholines, and sphingomyelins. Medium and long-chain acylcarnitines and ketone bodies were higher in HFpEF than HFrEF patients. Using logistic regression, two panels of metabolites were identified that can separate HFpEF patients from both non-HF controls and HFrEF patients with area under the receiver operating characteristic (ROC) curves of 0.942 and 0.981, respectively. Conclusions The metabolomics approach employed in this study identified a unique metabolomic fingerprint of HFpEF that is distinct from that of HFrEF. This metabolomic fingerprint has been utilized to identify two novel panels of metabolites that can separate HFpEF patients from both non-HF controls and HFrEF patients. Clinical Trial Registration ClinicalTrials.gov NCT02052804 PMID:26010610

  6. Heart failure with preserved ejection fraction: emerging drug strategies.

    Science.gov (United States)

    Zouein, Fouad A; de Castro Brás, Lisandra E; da Costa, Danielle V; Lindsey, Merry L; Kurdi, Mazen; Booz, George W

    2013-07-01

    Approximately half of heart failure patients have a normal ejection fraction, a condition designated as heart failure with preserved ejection fraction (HFpEF). This heart failure subtype disproportionately affects women and the elderly and is commonly associated with other cardiovascular comorbidities, such as hypertension and diabetes. HFpEF is increasing at a steady rate and is predicted to become the leading cause of heart failure within a decade. HFpEF is characterized by impaired diastolic function, thought to be due to concentric remodeling of the heart along with increased stiffness of both the extracellular matrix and myofilaments. In addition, oxidative stress and inflammation are thought to have a role in HFpEF progression, along with endothelial dysfunction and impaired nitric oxide-cyclic guanosine monophosphate-protein kinase G signaling. Surprisingly a number of clinical studies have failed to demonstrate any benefit of drugs effective in heart failure with systolic dysfunction in HFpEF patients. Thus, HFpEF is one of the largest unmet needs in cardiovascular medicine, and there is a substantial need for new therapeutic approaches and strategies that target mechanisms specific for HFpEF. This conclusion is underscored by the recently reported disappointing results of the RELAX trial, which assessed the use of phosphodiesterase-5 inhibitor sildenafil for treating HFpEF. In animal models, endothelial nitric oxide synthase activators and If current inhibitors have shown benefit in improving diastolic function, and there is a rationale for assessing matrix metalloproteinase 9 inhibitors and nitroxyl donors. LCZ696, a combination drug of angiotensin II receptor blocker and neprilysin inhibitor, and the aldosterone receptor antagonist spironolactone are currently in clinical trial for treating HFpEF. Here we present an overview of the etiology and diagnosis of HFpEF that segues into a discussion of new therapeutic approaches emerging from basic research and

  7. How do patients with heart failure with preserved ejection fraction die?

    Science.gov (United States)

    Chan, Michelle M Y; Lam, Carolyn S P

    2013-06-01

    Understanding how patients with heart failure with preserved ejection fraction (HFPEF) die provides insight into the natural history and pathophysiology of this complex syndrome, thereby allowing better prediction of response to therapy in designing clinical trials. This review summarizes the current state of knowledge surrounding mortality rates, modes of death, and prognostic factors in HFPEF. Despite the lack of uniform reporting, the following conclusions may be drawn from previous studies. The mortality burden of HFPEF is substantial, ranging from 10% to 30% annually, and higher in epidemiological studies than in clinical trials. Mortality rates compared with heart failure with reduced ejection fraction (HFREF) appear to be strongly influenced by the type of study, but are clearly elevated compared with age- and co-morbidity-matched controls without heart failure. The majority of deaths in HFPEF are cardiovascular deaths, comprising 51-60% of deaths in epidemiological studies and ∼70% in clinical trials. Among cardiovascular deaths, sudden death and heart failure death are the leading cardiac modes of death in HFPEF clinical trials. Compared with HFREF, the proportions of cardiovascular deaths, sudden death, and heart failure deaths are lower in HFPEF. Conversely, non-cardiovascular deaths constitute a higher proportion of deaths in HFPEF than in HFREF, particularly in epidemiological studies, where this difference may be related to fewer coronary heart deaths in HFPEF. Key mortality risk factors, including age, gender, body mass index, burden of co-morbidities, and coronary artery disease, offer some explanation for the differences in mortality rates observed across studies.

  8. Heart failure with preserved ejection fraction in women : The dutch queen of hearts program

    NARCIS (Netherlands)

    den Ruijter, H.; Pasterkamp, G.; Rutten, F. H.; Lam, C. S P; Chi, C.; Tan, K. H.; van Zonneveld, A. J.; Spaanderman, M.; de Kleijn, D. P V

    2015-01-01

    Heart failure (HF) poses a heavy burden on patients, their families and society. The syndrome of HF comes in two types: with reduced ejection fraction (HFrEF) and preserved ejection fraction (HFpEF). The latter is on the increase and predominantly present in women, especially the older ones. There i

  9. Left ventricular dyssynchrony in patients with heart failure and preserved ejection fraction

    NARCIS (Netherlands)

    Santos, Angela B. S.; Kraigher-Krainer, Elisabeth; Bello, Natalie; Claggett, Brian; Zile, Michael R.; Pieske, Burkert; Voors, Adriaan A.; McMurray, John J. V.; Packer, Milton; Bransford, Toni; Lefkowitz, Marty; Shah, Amil M.; Solomon, Scott D.

    2014-01-01

    Aims Mechanical dyssynchrony has been postulated to play a pathophysiologic role in heart failure with preserved ejection fraction (HFpEF). Methods and results We quantified left ventricular (LV) systolic dyssynchrony in 130 HFpEF patients with NYHA class II-IV symptoms, ejection fraction (EF) 45, a

  10. Natriuretic peptides in the monitoring of anthracycline induced reduction in left ventricular ejection fraction

    DEFF Research Database (Denmark)

    Daugaard, Gedske; Lassen, Ulrik; Bie, Peter;

    2005-01-01

    BACKGROUND: The use of anthracyclines in treatment of cancer is limited by cardiotoxicity of these compounds and may lead to heart failure. Therefore monitoring of cardiac function is necessary during therapy. AIM: We evaluated the value of natriuretic peptides (N-terminal pro-atrial natriuretic...... measurements, 19% showed a significant EF decrease (>0.10) and ended with a final EF value below 0.50. Baseline EF was no predictor of a change in EF during treatment. Neither baseline levels of N-ANP or BNP nor a change in the same variables during therapy were predictive of a change in EF. CONCLUSIONS...... peptide (N-ANP) and brain natriuretic peptide (BNP)) for monitoring and predicting anthracycline induced cardiotoxicity using radionuclide left ventricular ejection fraction (EF) measurements as reference. METHODS AND RESULTS: A total of 107 consecutive patients receiving anthracycline as part...

  11. Left Atrial Structure and Function in Heart Failure with Preserved Ejection Fraction: A RELAX Substudy

    Science.gov (United States)

    McNulty, Steven E.; Hernandez, Adrian F.; Semigran, Marc J.; Lewis, Gregory D.; Jerosch-Herold, Michael; Kim, Raymond J.; Redfield, Margaret M.; Kwong, Raymond Y.

    2016-01-01

    Given the emerging recognition of left atrial structure and function as an important marker of disease in heart failure with preserved ejection fraction (HF-pEF), we investigated the association between left atrial volume and function with markers of disease severity and cardiac structure in HF-pEF. We studied 100 patients enrolled in the PhosphdiesteRasE-5 Inhibition to Improve CLinical Status and EXercise Capacity in Diastolic Heart Failure (RELAX) trial who underwent cardiac magnetic resonance (CMR), cardiopulmonary exercise testing, and blood collection before randomization. Maximal left atrial volume index (LAVi; N = 100), left atrial emptying fraction (LAEF; N = 99; including passive and active components (LAEFP, LAEFA; N = 80, 79, respectively) were quantified by CMR. After adjustment for multiple testing, maximal LAVi was only associated with age (ρ = 0.39), transmitral filling patterns (medial E/e’ ρ = 0.43), and N-terminal pro-BNP (NT-proBNP; ρ = 0.65; all pHFpEF. Further research to explore the relevance of left atrial structure and function in HF-pEF is warranted. PMID:27812147

  12. Reproducibility of gallbladder ejection fraction measured by fatty meal cholescintigraphy

    Energy Technology Data Exchange (ETDEWEB)

    Al-Muqbel, Kusai M.; Hani, M. N. Hani; Elheis, M. A.; Al-Omari, M. H. [School of Medicine, Jordan University of Science and Technology, Irbid (Jordan)

    2010-12-15

    There are conflicting data in the literature regarding the reproducibility of the gallbladder ejection fraction (GBEF) measured by fatty meal cholescintigraphy (CS). We aimed to test the reproducibility of GBEF measured by fatty meal CS. Thirty-five subjects (25 healthy volunteers and 10 patients with chronic abdominal pain) underwent fatty meal CS twice in order to measure GBEF1 and GBEF2. The healthy volunteers underwent a repeat scan within 1-13 months from the first scan. The patients underwent a repeat scan within 1-4 years from the first scan and were not found to have chronic acalculous cholecystitis (CAC). Our standard fatty meal was composed of a 60-g Snickers chocolate bar and 200 ml full-fat yogurt. The mean {+-} SD values for GBEF1 and GBEF2 were 52{+-}17% and 52{+-}16%, respectively. There was a direct linear correlation between the values of GBEF1 and GBEF2 for the subjects, with a correlation coefficient of 0.509 (p=0.002). Subgroup data analysis of the volunteer group showed that there was significant linear correlation between volunteer values of GBEF1 and GBEF2, with a correlation coefficient of 0.473 (p=0.017). Subgroup data analysis of the non-CAC patient group showed no significant correlation between patient values of GBEF1 and GBEF2, likely due to limited sample size. This study showed that fatty meal CS is a reliable test in gallbladder motility evaluation and that GBEF measured by fatty meal CS is reproducible

  13. Heart failure with preserved ejection fraction: uncertainties and dilemmas.

    Science.gov (United States)

    Ferrari, Roberto; Böhm, Michael; Cleland, John G F; Paulus, Walter J S; Pieske, Burkert; Rapezzi, Claudio; Tavazzi, Luigi

    2015-07-01

    Many uncertainties surround the syndrome of heart failure with preserved ejection fraction (HFpEF), which was the topic reviewed in an Expert Meeting at the University of Ferrara. This concluded that the absence of clear diagnostic clinical criteria was the major barrier to progress. There was general agreement that symptoms or signs of heart failure, normal LVEF despite an elevated plasma concentration of natriuretic peptides, and signs of abnormal LV relaxation, LV filling, LV hypertrophy, or left atrial enlargement, or diastolic dysfunction supported the diagnosis. However, HFpEF, like all heart failure syndromes, is heterogeneous in aetiology and pathophysiology, rather than being a single disease. HFpEF may account for about half of all patients with heart failure. The classical risk factors for developing HFpEF include age and co-morbidities, notably hypertension, atrial fibrillation, and the metabolic syndrome. When complicated by increasing congestion requiring hospital admission, the prognosis is poor; 30% or more of patients will die within 1 year (nearly two-thirds die from cardiovascular causes). Patients with chronic stable symptoms have a much better prognosis. Despite many clinical trials, there is no solid evidence that any treatment alters the natural history of HFpEF. Several treatments have shown promising early results and are now being tested in substantial randomized clinical trials. Further basic research is required to better characterize the disease and accelerate progress. Our review highlights the many difficulties encountered in performing randomized clinical trials in HFpEF, often due to difficulties in characterizing HFpEF itself.

  14. Case of Acute Graft Failure during Suspected Humoral Rejection with Preserved Ejection Fraction, but Severely Reduced Longitudinal Deformation Detected by 2D-Speckle Tracking

    DEFF Research Database (Denmark)

    Clemmensen, Tor Skibsted; Eiskjær, Hans; Kofoed-Nielsen, Pernille B;

    2014-01-01

    remained unchanged, indicating need of more reliable noninvasive methods for graft function surveillance. Global longitudinal strain relates to clinical heart failure, filling pressure, and cardiac index during suspected humoral rejection and microvascular dysfunction in this HTX patient. We suggest...... routine monitoring of graft function by global longitudinal strain as supplement to routine left ventricular ejection fraction and diastolic Doppler measurements....

  15. New Classification for Heart Failure with Mildly Reduced Ejection Fraction; Greater clarity or more confusion?

    Directory of Open Access Journals (Sweden)

    Sunil Nadar

    2017-03-01

    Full Text Available The latest European Society of Cardiology (ESC guidelines for the diagnosis and management of heart failure include a new patient group for those with heart failure with mildly reduced ejection fraction (HFmrEF. By defining this group of patients as a separate entity, the ESC hope to encourage more research focusing on patients with HFmrEF. Previously, patients with this condition were caught between two classifications—heart failure with reduced ejection fraction and heart failure with preserved ejection fraction. Hopefully, the inclusion of new terminology will not increase confusion, but rather aid our understanding of heart failure, a complex clinical syndrome.

  16. Current Treatment of Heart Failure with Preserved Ejection Fraction: Should We Add Life to the Remaining Years or Add Years to the Remaining Life?

    Directory of Open Access Journals (Sweden)

    Jia Li

    2013-01-01

    Full Text Available According to the ejection fraction, patients with heart failure may be divided into two different groups: heart failure with preserved or reduced ejection fraction. In recent years, accumulating studies showed that increased mortality and morbidity rates of these two groups are nearly equal. More importantly, despite decline in mortality after treatment in regard to current guideline in patients with heart failure with reduced ejection fraction, there are still no trials resulting in improved outcome in patients with heart failure with preserved ejection fraction so far. Thus, novel pathophysiological mechanisms are under development, and other new viewpoints, such as multiple comorbidities resulting in increased non-cardiac deaths in patients with heart failure and preserved ejection fraction, were presented recently. In this review, we will focus on the tested as well as the promising therapeutic options that are currently studied in patients with heart failure with preserved ejection fraction, along with a brief discussion of pathophysiological mechanisms and diagnostic options that are helpful to increase our understanding of novel therapeutic strategies.

  17. Sarcopenic obesity and the pathogenesis of exercise intolerance in heart failure with preserved ejection fraction.

    Science.gov (United States)

    Upadhya, Bharathi; Haykowsky, Mark J; Eggebeen, Joel; Kitzman, Dalane W

    2015-06-01

    Heart failure with preserved ejection fraction (HFpEF) is the most common form of heart failure (HF) in older adults. The primary chronic symptom in patients with HFpEF, even when well compensated, is severe exercise intolerance. Cardiac and peripheral functions contribute equally to exercise intolerance in HFpEF, though the latter has been the focus of fewer studies. Of note, multiple studies with exercise training have shown that exercise intolerance can improve significantly in the absence of improvements in exercise cardiac output, indicating a role of peripheral, noncardiac adaptations. In addition, clinical drug trials performed to date in HFpEF, all of which have focused on influencing cardiovascular function, have not been positive on primary clinical outcomes and most have not improved exercise capacity. Mounting evidence indicates that sarcopenic obesity, characterized by the coexistence of excess fat mass and decreased muscle mass, could contribute to the pathophysiology of exercise intolerance in older HFpEF patients and may provide avenues for novel treatments.

  18. Impaired myocardial oxygen availability contributes to abnormal exercise hemodynamics in heart failure with preserved ejection fraction

    NARCIS (Netherlands)

    van Empel, Vanessa P M; Mariani, Justin; Borlaug, Barry A; Kaye, David M

    2014-01-01

    BACKGROUND: Hypertension is a frequent risk factor for the development of heart failure with preserved ejection fraction (HFPEF). Progressive extracellular matrix accumulation has been presumed to be the fundamental pathophysiologic mechanism that leads to the transition to impaired diastolic reserv

  19. Predictors and progression of aortic stenosis in patients with preserved left ventricular ejection fraction

    DEFF Research Database (Denmark)

    Ersboll, Mads; Schulte, Phillip J; Al Enezi, Fawaz

    2015-01-01

    We aimed to characterize the hemodynamic progression of aortic stenosis (AS) in a contemporary unselected cohort of patients with preserved left ventricular ejection fraction. Current guidelines recommend echocardiographic surveillance of hemodynamic progression. However, limited data exist...

  20. Coronary stenting versus bypass surgery in heart failure patients with preserved ejection fraction

    Institute of Scientific and Technical Information of China (English)

    XUE Zeng-ming; WANG Xiao; CHEN Fang; ZHOU Yu-jie; L(0) Shu-zheng; HUANG Fang-jiong; GU Cheng-xiong; WU Xue-si; LI Wei-ju; MA Chang-sheng; NIE Shao-ping; DONG Jian-zeng; LIU Xiao-hui; KANG Jun-ping; L(O) Qiang; DU Xin

    2012-01-01

    Background The optimal revascularization strategy in patients with heart failure with preserved ejection fraction (HFPEF) remains unclear.The aim of the present study was to compare the effects of percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) in patients with HFPEF.Methods From July 2003 through September 2005,a total of 920 patients with coronary artery disease (CAD) and HFPEF (ejection fraction ≥50%) underwent PCI (n=350) or CABG (n=570).We compared the groups with respect to the primary outcome of mortality,and the secondary outcomes of main adverse cardiac and cerebral vascular events (MACCE),including death,myocardial infarction,stroke and repeat revascularization,at a median follow-up of 543 days.Results In-hospital mortality was significantly lower in the PCI group than in the CABG group (0.3% vs.2.5%,adjusted P=0.016).During follow-up,there was no significant difference in the two groups with regard to mortality rates (2.3% vs.3.5%,adjusted P=0.423).Patients receiving PCI had higher MACCE rates as compared with patients receiving CABG (13.4% vs.4.0%,adjusted P <0.001),mainly due to higher rate of repeat revascularization (adjusted P <0.001).Independent predictors of mortality were age,New York Heart Association (NYHA) class and chronic total occlusion.Conclusion Among patients with CAD and HFPEF,PCI was shown to be as good as CABG with respect to the mortality rate,although there was a higher rate of repeat revascularization in patients undergoing PCI.

  1. Assessment of poststress left ventricular ejection fraction by gated SPECT: comparison with equilibrium radionuclide angiocardiography

    Energy Technology Data Exchange (ETDEWEB)

    Acampa, Wanda; Liuzzi, Raffaele; De Luca, Serena; Capasso, Enza; Luongo, Luca; Cuocolo, Alberto [University Federico II, Department of Biomorphological and Functional Sciences, Institute of Biostructures and Bioimages, National Council of Research, Naples (Italy); Caprio, Maria Grazia [University Federico II, Department of Biomorphological and Functional Sciences, Institute of Biostructures and Bioimages, National Council of Research, Naples (Italy); SDN Foundation, Institute of Diagnostic and Nuclear Development, Naples (Italy); Nicolai, Emanuele [SDN Foundation, Institute of Diagnostic and Nuclear Development, Naples (Italy); Petretta, Mario [University Federico II, Department of Clinical Medicine, Cardiovascular and Immunological Sciences, Naples (Italy)

    2010-02-15

    We compared left ventricular (LV) ejection fraction obtained by gated SPECT with that obtained by equilibrium radionuclide angiocardiography in a large cohort of patients. Within 1 week, 514 subjects with suspected or known coronary artery disease underwent same-day stress-rest {sup 99m}Tc-sestamibi gated SPECT and radionuclide angiocardiography. For both studies, data were acquired 30 min after completion of exercise and after 3 h rest. In the overall study population, a good correlation between ejection fraction measured by gated SPECT and by radionuclide angiocardiography was observed at rest (r=0.82, p<0.0001) and after stress (r=0.83, p<0.0001). In Bland-Altman analysis, the mean differences in ejection fraction (radionuclide angiocardiography minus gated SPECT) were -0.6% at rest and 1.7% after stress. In subjects with normal perfusion (n=362), a good correlation between ejection fraction measured by gated SPECT and by radionuclide angiocardiography was observed at rest (r=0.72, p<0.0001) and after stress (r=0.70, p<0.0001) and the mean differences in ejection fraction were -0.9% at rest and 1.4% after stress. Also in patients with abnormal perfusion (n=152), a good correlation between the two techniques was observed both at rest (r=0.89, p<0.0001) and after stress (r=0.90, p<0.0001) and the mean differences in ejection fraction were 0.1% at rest and 2.5% after stress. In a large study population, a good agreement was observed in the evaluation of LV ejection fraction between gated SPECT and radionuclide angiocardiography. However, in patients with perfusion abnormalities, a slight underestimation in poststress LV ejection fraction was observed using gated SPECT as compared to equilibrium radionuclide angiocardiography. (orig.)

  2. Left ventricular ejection fraction is determined by both global myocardial strain and wall thickness

    Directory of Open Access Journals (Sweden)

    David H. MacIver

    2015-06-01

    Conclusion: The findings of this study explain the coexistence of reduced global myocardial strain and normal ejection fraction seen in clinical observational studies. Our understanding of the pathophysiological processes in heart failure and associated conditions is substantially enhanced. These results provide a much better insight into the biophysical inter-relationship between myocardial strain and ejection fraction. This improved understanding provides an essential foundation for the design and interpretation of future clinical mechanistic and prognostic studies.

  3. The survival of patients with heart failure with preserved or reduced left ventricular ejection fraction

    DEFF Research Database (Denmark)

    Boesgaard, Søren

    2012-01-01

    A substantial proportion of patients with heart failure have preserved left ventricular ejection fraction (HF-PEF). Previous studies have reported mixed results whether survival is similar to those patients with heart failure and reduced EF (HF-REF).......A substantial proportion of patients with heart failure have preserved left ventricular ejection fraction (HF-PEF). Previous studies have reported mixed results whether survival is similar to those patients with heart failure and reduced EF (HF-REF)....

  4. Heart Failure with Preserved Ejection Fraction in the Elderly: Scope of the Problem

    OpenAIRE

    Upadhya, Bharathi; Taffet, George E.; Cheng, Che Ping; Kitzman, Dalane W.

    2015-01-01

    Heart failure with preserved ejection fraction (HFpEF) is the most common form of heart failure (HF) in older adults, particularly women, and is increasing in prevalence as the population ages. With morbidity and mortality on par with HF with reduced ejection fraction, it remains a most challenging clinical syndrome for the practicing clinician and basic research scientist. Originally considered to be predominantly caused by diastolic dysfunction, more recent insights indicate that HFpEF in o...

  5. Understanding heart failure with preserved ejection fraction: where are we today?

    OpenAIRE

    van Heerebeek, L.; Paulus, W.J.

    2016-01-01

    Heart failure with preserved ejection fraction (HFpEF) represents a complex and heterogeneous clinical syndrome, which is increasingly prevalent and associated with poor outcome. In contrast to heart failure with reduced ejection fraction (HFrEF), modern heart failure pharmacotherapy did not improve outcome in HFpEF, which was attributed to incomplete understanding of HFpEF pathophysiology, patient heterogeneity and lack of insight into primary pathophysiological processes. HFpEF patients are...

  6. The hemodynamic effects of spinal block with low dose of bupivacaine and sufentanil in patients with low myocardial ejection fraction.

    Directory of Open Access Journals (Sweden)

    Mehdi Sanatkar

    2013-07-01

    Full Text Available The aim of this study was to assess the effect of spinal block with low dose of bupivacaine and sufentanil on patients with low cardiac output who underwent lower limb surgery. Fifteen patients who had ejection fraction less than 40% (group 1 were compared with 65 cases with ejection fraction more than 40% (group 2 in our study. Our subjects underwent spinal block with 7.5 mg hyperbaric bupivacaine 0.5% and 5 µg sufentanil. We recorded early events such as hypotension, bradycardia, vasopressor need and ST segment change in our cases. The average mean arterial pressure decreased 13% (110 mmHg to 95.7 mmHg in group 1 and 20% (160 mmHg to 128 mmHg in group 2 (P<0.001. Hypotension due to spinal anesthesia was observed in none of our subjects in both groups and none of our cases need to vasopressor support. All patients remained alert, and no ST segment changes were observed in two groups. In our study none of subjects complained of pain intraoperatively. The subjects were without complaints during the spinal anesthetic in both groups. Spinal block with low dose local anesthetic and sufentanil was a safe and effective method for lower limb surgery in patients with low ejection fraction.

  7. Inverse correlation between testosterone and ventricle ejection fraction, hemodynamics and exercise capacity in heart failure patients with erectile dysfunction

    Directory of Open Access Journals (Sweden)

    Edimar A. Bocchi

    2008-06-01

    Full Text Available BACKGROUND: Neurohormonal activation and abnormalities in growth hormone and testosterone concentrations have been reported in heart failure (HF. Erectile dysfunction(ED is common in these patients and contributes to a low quality of life. No data are known regarding the correlation between testosterone and hemodynamics, exercise capacity and cardiac function in HF patients with ED, a marker of endothelial dysfunction. The aim of this study was to correlate testosterone levels with cardiac function, hemodynamic and exercise capacity in HF patients with ED. MATERIALS AND METHODS: Fifteen HF patients underwent a six-minute treadmill cardiopulmonary walking test (6'CWT and, ten minutes later, a maximum cardiopulmonary exercise test. Also, testosterone and other hormones were determined at rest. RESULTS: Among hemodynamic variables only diastolic blood pressure on 6'CWT was correlated with testosterone levels(r =- 0.66, p = 0.007. The variables on exercise tests, VE/VCO2 slope and oxygen consumption did not show any correlation, except the distance at 6'CWT (r = 0.50, p = 0,047. Right and left ventricle ejection fraction showed inverse correlation with testosterone (r =- 0.55, p = 0.03 and r =- 0.69, p = 0.004 respectively. CONCLUSION: Testosterone levels correlated directly with distance at six-minute cardiopulmonary walk test and inversely with diastolic blood pressure, right and left ventricle ejection fraction in heart failure patients with erectile dysfunction. Further elucidation of mechanisms as regards testosterone action in these patients is warranted.

  8. Exercise intolerance in heart failure with preserved ejection fraction:more than a heart problem

    Institute of Scientific and Technical Information of China (English)

    Bharathi Upadhya; Mark J Haykowsky; Joel Eggebeen; Dalane W Kitzman

    2015-01-01

    Heart failure (HF) with preserved ejection fraction (HFpEF) is the most common form of HF in older adults, and is increasing in preva-lence as the population ages. Furthermore, HFpEF is increasing out of proportion to HF with reduced EF (HFrEF), and its prognosis is worsening while that of HFrEF is improving. Despite the importance of HFpEF, our understanding of its pathophysiology is incomplete, and optimal treatment remains largely undefined. A cardinal feature of HFpEF is reduced exercise tolerance, which correlates with symptoms as well as reduced quality of life. The traditional concepts of exercise limitations have focused on central dysfunction related to poor cardiac pump function. However, the mechanisms are not exclusive to the heart and lungs, and the understanding of the pathophysiology of this dis-ease has evolved. Substantial attention has focused on defining the central versus peripheral mechanisms underlying the reduced functional capacity and exercise tolerance among patients with HF. In fact, physical training can improve exercise tolerance via peripheral adaptive mechanisms even in the absence of favorable central hemodynamic function. In addition, the drug trials performed to date in HFpEF that have focused on influencing cardiovascular function have not improved exercise capacity. This suggests that peripheral limitations may play a significant role in HF limiting exercise tolerance, a hallmark feature of HFpEF.

  9. Tolvaptan Improves the Long-Term Prognosis in Patients With Congestive Heart Failure With Preserved Ejection Fraction as Well as in Those With Reduced Ejection Fraction.

    Science.gov (United States)

    Imamura, Teruhiko; Kinugawa, Koichiro

    2016-09-28

    Tolvaptan (TLV), an arginine vasopressin type 2 antagonist, has been shown to play a role in ameliorating symptomatic congestion and normalizing diluted hyponatremia in patients with congestive heart failure (HF). However, most evidence was derived from patients with HF with reduced ejection fraction (HFrEF), and the clinical efficacy of TLV in patients with HF with preserved ejection fraction (HFpEF) remains uncertain. In this study, we retrospectively enrolled 60 in-hospital patients with stage D HF, who had received TLV to treat symptomatic congestion at our institute between 2011 and 2013. As a control group, we also enrolled 60 background-matched HF patients who did not receive TLV therapy. Patients with HFpEF (n = 29), whose left ventricular ejection fraction was > 45%, had higher age and a lower urine aquaporin-2 level relative to the plasma arginine vasopressin concentration compared with those with HFrEF (n = 91). TLV therapy significantly reduced the 2-year readmission rates in both the HFrEF and HFpEF populations (P < 0.05 for both), indicating that TLV therapy may improve the long-term prognosis not only in patients with HFrEF but also in those with HFpEF.

  10. Ejection fraction and outcomes in patients with atrial fibrillation and heart failure

    DEFF Research Database (Denmark)

    Banerjee, Amitava; Taillandier, Sophie; Olesen, Jonas Bjerring;

    2012-01-01

    Heart failure (HF) increases the risk of stroke and thrombo-embolism (TE) in non-valvular atrial fibrillation (NVAF), and is incorporated in stroke risk stratification scores. We aimed to establish the role of ejection fraction (EF) in risk prediction in patients with NVAF and HF.......Heart failure (HF) increases the risk of stroke and thrombo-embolism (TE) in non-valvular atrial fibrillation (NVAF), and is incorporated in stroke risk stratification scores. We aimed to establish the role of ejection fraction (EF) in risk prediction in patients with NVAF and HF....

  11. Novel plasma and imaging biomarkers in heart failure with preserved ejection fraction

    Directory of Open Access Journals (Sweden)

    Prathap Kanagala

    2015-12-01

    Full Text Available Existing diagnostic guidelines for heart failure with preserved ejection fraction (HFPEF primarily comprise natriuretic peptides and echocardiographic assessment, highlighting the role of diastolic dysfunction. However, recent discoveries of novel plasma markers implicated in pathophysiology of heart failure and technological advances in imaging provide additional biomarkers which are potentially applicable to HFPEF. The evidence base for plasma extra-cellular matrix (ECM peptides, galectin-3, ST2, GDF-15 and pentraxin-3 is reviewed. Furthermore, the capabilities of novel imaging techniques to assess existing parameters (e.g. left ventricular ejection fraction, systolic & diastolic function, chamber size and additional derangements of the ECM, myocardial mechanics and ischaemia evaluation are addressed.

  12. Rapid estimation of left ventricular ejection fraction in acute myocardial infarction by echocardiographic wall motion analysis

    DEFF Research Database (Denmark)

    Berning, J; Rokkedal Nielsen, J; Launbjerg, J

    1992-01-01

    Echocardiographic estimates of left ventricular ejection fraction (ECHO-LVEF) in acute myocardial infarction (AMI) were obtained by a new approach, using visual analysis of left ventricular wall motion in a nine-segment model. The method was validated in 41 patients using radionuclide...

  13. Mineralocorticoid receptor antagonists for heart failure with reduced ejection fraction : integrating evidence into clinical practice

    NARCIS (Netherlands)

    Zannad, Faiez; Stough, Wendy Gattis; Rossignol, Patrick; Bauersachs, Johann; McMurray, John J. V.; Swedberg, Karl; Struthers, Allan D.; Voors, Adriaan A.; Ruilope, Luis M.; Bakris, George L.; O'Connor, Christopher M.; Gheorghiade, Mihai; Mentz, Robert J.; Cohen-Solal, Alain; Maggioni, Aldo P.; Beygui, Farzin; Filippatos, Gerasimos S.; Massy, Ziad A.; Pathak, Atul; Pina, Ileana L.; Sabbah, Hani N.; Sica, Domenic A.; Tavazzi, Luigi; Pitt, Bertram

    2012-01-01

    Mineralocorticoid receptor antagonists (MRAs) improve survival and reduce morbidity in patients with heart failure, reduced ejection fraction (HFREF), and mild-to-severe symptoms, and in patients with left ventricular systolic dysfunction and heart failure after acute myocardial infarction. These cl

  14. Impaired left atrial function in heart failure with preserved ejection fraction

    NARCIS (Netherlands)

    Santos, Angela B. S.; Kraigher-Krainer, Elisabeth; Gupta, Deepak K.; Claggett, Brian; Zile, Michael R.; Pieske, Burkert; Voors, Adriaan A.; Lefkowitz, Marty; Bransford, Toni; Shi, Victor; Packer, Milton; McMurray, John J. V.; Shah, Amil M.; Solomon, Scott D.

    2014-01-01

    AimsLeft atrial (LA) enlargement is present in the majority of heart failure with preserved ejection fraction (HFpEF) patients and is a marker of risk. However, the importance of LA function in HFpEF is less well understood. Methods and resultsThe PARAMOUNT trial enrolled HFpEF patients (LVEF 45%, N

  15. Heart Failure With Preserved Ejection Fraction and Atrial Fibrillation : Vicious Twins

    NARCIS (Netherlands)

    Kotecha, Dipak; Lam, Carolyn S. P.; Van Veldhuisen, Dirk J.; Van Gelder, Isabelle C.; Voors, Adriaan A.; Rienstra, Michiel

    2016-01-01

    Heart failure with preserved ejection fraction (HFpEF) and atrial fibrillation (AF) are age-related conditions that are increasing in prevalence, commonly coexist, and share clinical features. This review provides a practical update on the epidemiology, pathophysiology, diagnosis, and management of

  16. Impaired Systolic Function by Strain Imaging in Heart Failure With Preserved Ejection Fraction

    NARCIS (Netherlands)

    Kraigher-Krainer, Elisabeth; Shah, Amil M.; Gupta, Deepak K.; Santos, Angela; Claggett, Brian; Pieske, Burkert; Zile, Michael R.; Voors, Adriaan A.; Lefkowitz, Marty P.; Packer, Milton; McMurray, John J. V.; Solomon, Scott D.

    2014-01-01

    Objectives This study sought to determine the frequency and magnitude of impaired systolic deformation in heart failure with preserved ejection fraction (HFpEF). Background Although diastolic dysfunction is widely considered a key pathophysiologic mediator of HFpEF, the prevalence of concomitant sys

  17. Renin-Angiotensin Activation and Oxidative Stress in Early Heart Failure with Preserved Ejection Fraction

    Directory of Open Access Journals (Sweden)

    Smita I. Negi

    2015-01-01

    Full Text Available Animal models have suggested a role of renin-angiotensin system (RAS activation and subsequent cardiac oxidation in heart failure with preserved ejection fraction (HFpEF. Nevertheless, RAS blockade has failed to show efficacy in treatment of HFpEF. We evaluated the role of RAS activation and subsequent systemic oxidation in HFpEF. Oxidative stress markers were compared in 50 subjects with and without early HFpEF. Derivatives of reactive oxidative metabolites (DROMs, F2-isoprostanes (IsoPs, and ratios of oxidized to reduced glutathione (Eh GSH and cysteine (Eh CyS were measured. Angiotensin converting enzyme (ACE levels and activity were measured. On univariate analysis, HFpEF was associated with male sex (p=0.04, higher body mass index (BMI (p=0.003, less oxidized Eh CyS (p=0.001, lower DROMs (p=0.02, and lower IsoP (p=0.03. Higher BMI (OR: 1.3; 95% CI: 1.1–1.6 and less oxidized Eh CyS (OR: 1.2; 95% CI: 1.1–1.4 maintained associations with HFpEF on multivariate analysis. Though ACE levels were higher in early HFpEF (OR: 1.09; 95% CI: 1.01–1.05, ACE activity was similar to that in controls. HFpEF is not associated with significant systemic RAS activation or oxidative stress. This may explain the failure of RAS inhibitors to alter outcomes in HFpEF.

  18. Diagnostic and prognostic value of circulating micro RNAs in heart failure with preserved and reduced ejection fraction

    Institute of Scientific and Technical Information of China (English)

    Christian Schulte; Dirk Westermann; Stefan Blankenberg; Tanja Zeller

    2015-01-01

    micro RNAs(mi RNAs) are powerful regulators of posttranscriptional gene expression and play an important role in pathophysiological processes. Circulating mi RNAs can be quantified in body liquids and are promising biomarkers in numerous diseases. In cardiovascular disease mi RNAs have been proven to be reliable diagnostic biomarkers for different disease entities. In cardiac fibrosis(CF) and heart failure(HF) dysregulated circulating mi RNAs have been identified,indicating their promising applicability as diagnostic biomarkers. Some mi RNAs were successfully tested in risk stratification of HF implementing their potential use as prognostic biomarkers. In this respect mi RNAs might soon be implemented in diagnostic clinical routine. In the young field of mi RNA based research advances have been made in identifying mi RNAs as potential targets for the treatment of experimental CF and HF. Promising study results suggest their potential future application as therapeutic agents in treatment of cardiovascular disease. This article summarizes the current state of the various aspects of mi RNA research in the field of CF and HF with reduced ejection fraction as well as preserved ejection fraction. The review provides an overview of the application of circulating mi RNAs as biomarkers in CF and HF and current approaches to therapeutically utilize mi RNAs in this field of cardiovascular disease.

  19. The relationship between mitral regurgitation and ejection fraction as predictors for the prognosis of patients with heart failure

    DEFF Research Database (Denmark)

    Thune, Jens Jakob; Torp-Pedersen, Christian; Hassager, Christian;

    2011-01-01

    To study whether there is interaction between mitral regurgitation (MR) and left ventricular ejection fraction (LVEF) in the mortality risk of heart failure (HF) patients.......To study whether there is interaction between mitral regurgitation (MR) and left ventricular ejection fraction (LVEF) in the mortality risk of heart failure (HF) patients....

  20. Differing prognostic value of pulse pressure in patients with heart failure with reduced or preserved ejection fraction

    DEFF Research Database (Denmark)

    Jackson, Colette E.; Castagno, Davide; Maggioni, Aldo P.

    2015-01-01

    AIMS: Low pulse pressure is a marker of adverse outcome in patients with heart failure (HF) and reduced ejection fraction (HF-REF) but the prognostic value of pulse pressure in patients with HF and preserved ejection fraction (HF-PEF) is unknown. We examined the prognostic value of pulse pressure......) and 5008 with HF-PEF (828 deaths). Pulse pressure was analysed in quintiles in a multivariable model adjusted for the previously reported Meta-Analysis Global Group in Chronic Heart Failure prognostic variables. Heart failure and reduced ejection fraction patients in the lowest pulse pressure quintile had...... in patients with HF-PEF [ejection fraction (EF) ≥ 50%] and HF-REF. METHODS AND RESULTS: Data from 22 HF studies were examined. Preserved left ventricular ejection fraction (LVEF) was defined as LVEF ≥ 50%. All-cause mortality at 3 years was evaluated in 27 046 patients: 22 038 with HF-REF (4980 deaths...

  1. Connecting heart failure with preserved ejection fraction and renal dysfunction: the role of endothelial dysfunction and inflammation.

    Science.gov (United States)

    Ter Maaten, Jozine M; Damman, Kevin; Verhaar, Marianne C; Paulus, Walter J; Duncker, Dirk J; Cheng, Caroline; van Heerebeek, Loek; Hillege, Hans L; Lam, Carolyn S P; Navis, Gerjan; Voors, Adriaan A

    2016-06-01

    Renal dysfunction in heart failure with preserved ejection fraction (HFpEF) is common and is associated with increased mortality. Impaired renal function is also a risk factor for developing HFpEF. A new paradigm for HFpEF, proposing a sequence of events leading to myocardial remodelling and dysfunction in HFpEF, was recently introduced, involving inflammatory, microvascular, and cardiac components. The kidney might play a key role in this systemic process. Renal impairment causes metabolic and systemic derangements in circulating factors, causing an activated systemic inflammatory state and endothelial dysfunction, which may lead to cardiomyocyte stiffening, hypertrophy, and interstitial fibrosis via cross-talk between the endothelium and cardiomyocyte compartments. Here, we review the role of endothelial dysfunction and inflammation to explain the link between renal dysfunction and HFpEF, which allows for identification of new early risk markers, prognostic factors, and unique targets for intervention.

  2. [Heart failure with preserved ejection fraction (HFPEF). Impact of change in the paradigm of isolated diastolic dysfunction].

    Science.gov (United States)

    Magaña-Serrano, José Antonio; Rosas-Peralta, Martín; Candanosa-Arias, Carlos; Valencia-Sánchez, Salvador; Garrido-Garduño, Martín; Arriaga-Nava, Roberto; Calderón-Abbo, Moisés C

    2015-01-01

    Heart failure with preserved ejection fraction is a significant and growing public health problem, since it currently represents half of all patients with heart failure. Despite improvements in the understanding of the disease, there is no benefit form treatments tested at all. Advances in diagnostic imaging and invasive evaluation algorithms will allow a more accurate and early diagnosis so that treatment of earliest forms in the progression of the disease are applied since the potential for benefit may be higher. Although important progress has been made in our understanding of the pathophysiology, cardiac catheterization, and cellular of diastolic failure mechanisms and not diastolic mechanisms of disease, further research is required promptly to determine how best to address these anomalies to reduce the significant burden of morbidity and mortality in this form of heart failure, which is reaching pandemic proportions.

  3. Phenomapping for the Identification of Hypertensive Patients with the Myocardial Substrate for Heart Failure with Preserved Ejection Fraction.

    Science.gov (United States)

    Katz, Daniel H; Deo, Rahul C; Aguilar, Frank G; Selvaraj, Senthil; Martinez, Eva E; Beussink-Nelson, Lauren; Kim, Kwang-Youn A; Peng, Jie; Irvin, Marguerite R; Tiwari, Hemant; Rao, D C; Arnett, Donna K; Shah, Sanjiv J

    2017-03-03

    We sought to evaluate whether unbiased machine learning of dense phenotypic data ("phenomapping") could identify distinct hypertension subgroups that are associated with the myocardial substrate (i.e., abnormal cardiac mechanics) for heart failure with preserved ejection fraction (HFpEF). In the HyperGEN study, a population- and family-based study of hypertension, we studied 1273 hypertensive patients utilizing clinical, laboratory, and conventional echocardiographic phenotyping of the study participants. We used machine learning analysis of 47 continuous phenotypic variables to identify mutually exclusive groups constituting a novel classification of hypertension. The phenomapping analysis classified study participants into 2 distinct groups that differed markedly in clinical characteristics, cardiac structure/function, and indices of cardiac mechanics (e.g., phenogroup #2 had a decreased absolute longitudinal strain [12.8 ± 4.1 vs. 14.6 ± 3.5%] even after adjustment for traditional comorbidities [p < 0.001]). The 2 hypertension phenogroups may represent distinct subtypes that may benefit from targeted therapies for the prevention of HFpEF.

  4. [Automatic calculation of left ventricular volume and ejection fraction from gated myocardial perfusion SPECT--basic evaluation using phantom].

    Science.gov (United States)

    Kinoshita, Y; Nanbu, I; Tohyama, J; Ooba, S

    1998-02-01

    We evaluated accuracy of Quantitative Gated SPECT Program that enabled calculation of the left ventricular (LV) volume and ejection fraction by automatically tracing the contour of the cardiac surface. Cardiac phantoms filled with 99mTc-solution were used. Data acquisition was made by 180-degree projection in L type and 360-degree projection in opposed type. Automatic calculation could be done in all processes, which required 3-4 minutes. Reproducibility was sufficient. The adequate cut off value of a prefilter was 0.45. At this value LV volume was 93% of the actual volume in L type acquisition and 95.9% in opposed type acquisition. The LV volume obtained in L type was smaller than that obtained in opposed type (p defects was fair, on the cardiac phantoms with all of 90-degree defects and 180-degree defects of the septal and lateral wall. The LV volume was estimated to be larger on the phantom with 180-degree defect of the anterior wall, and to be smaller on the phantom of 180-degree defect of the inferoposterior wall. Because tracing was deviated anteriorly at the defects. In the patients with similar conditions to 180-degree defect of the anterior wall or inferoposterior wall, the LV volume should be carefully evaluated.

  5. Automatic calculation of left ventricular volume and ejection fraction from gated myocardial perfusion SPECT. Basic evaluation using phantom

    Energy Technology Data Exchange (ETDEWEB)

    Kinoshita, Yoshimi; Nanbu, Ichirou [Nagoya Daini Red Cross Hospital (Japan); Tohyama, Junko; Ooba, Satoru

    1998-02-01

    We evaluated accuracy of Quantitative Gated SPECT Program that enabled calculation of the left ventricular (LV) volume and ejection fraction by automatically tracing the contour of the cardiac surface. Cardiac phantoms filled with {sup 99m}Tc-solution were used. Data acquisition was made by 180-degree projection in L type and 360-degree projection in opposed type. Automatic calculation could be done in all processes, which required 3-4 minutes. Reproducibility was sufficient. The adequate cut off value of a prefilter was 0.45. At this value LV volume was 93% of the actual volume in L type acquisition and 95.9% in opposed type acquisition. The LV volume obtained in L type was smaller than that obtained in opposed type (p<0.05). The tracing of the defects was fair, on the cardiac phantoms with all of 90-degree defects and 180-degree defects of the septal and lateral wall. The LV volume was estimated to be larger on the phantom with 180-degree defect of the anterior wall, and to be smaller on the phantom of 180-degree defect of the inferoposterior wall. Because tracing was deviated anteriorly at the defects. In the patients with similar conditions to 180-degree defect of the anterior wall or inferoposterior wall, the LV volume should be carefully evaluated. (author)

  6. Influence of atorvastatin on the YKL-40 and cardiac function in patients with heart failure with pre-served ejection fraction%阿托伐他汀对射血分数保留心力衰竭患者YKL-40及心功能的影响

    Institute of Scientific and Technical Information of China (English)

    郭文玉; 王小庆; 徐验; 邹春霞; 杨碧芳; 余丹青

    2014-01-01

    目的:探讨几丁质酶-3样蛋白-1(YKL-40)在射血分数保留心力衰竭(HFPEF)患者诊断和评估病情严重程度中的临床价值及阿托伐他汀治疗HFPEF的有效性。方法选择70例HF-PEF患者及35名健康体检者,均于入组时测定血脂及 YKL-40水平,并进行6 min 步行试验(6MWT)。将70例HFPEF患者随机分为阿托伐他汀组35例(在基础治疗上予阿托伐他汀20 mg/d)、对照治疗组35例(仅予基础治疗),并于治疗12个月后再次检测2组患者的血清YKL-40、血脂水平及进行6 MWT。结果治疗前,阿托伐他汀组及对照治疗组患者YKL-40水平均明显高于健康对照组(P<0.05),且YKL-40水平与6MWT呈负相关(rs =-0.999,P<0.05)。治疗12个月时阿托伐他汀组YKL-40水平比对照治疗组下降更为明显,且6 MWT改善更明显(P均<0.05)。结论阿托伐他汀能够进一步降低HFPEF患者血清YKL-40水平及改善心功能,YKL-40在评价心功能方面有一定的临床价值。%Objective To evaluate the influence of atorvastatin on serum chitinase-3-like protein-1 (YKL-40)and cardiac function in patients with heart failure with preserved ejection fraction,and investigate the effect of YKL-40 in the diagnosis of HFPEF. Methods Serum YKL-40,serum lipid and 6-minute walk test (6MWT)were measured at baseline in both healthy control group (n=35)and patients with HFPEF (n=70). 70 patients with HFPEF were randomly assigned to control group who received routine therapy,and atorvastatin treatment group who received routine therapy and additional atorvastatin (20 mg/d). Serum YKL-40,lipid profiles and 6MWT were measured after 1 2-month treatment. Results The levels of YKL-40 were significantly higher in patients with HFPEF than healthy control group (P<0.05 ),the level of serum YKL-40 was strong negatively related with 6MWT (rs =-0.999,P<0.05). After 1 2 months treatment,the YKL-40 level in atorvastatin group is

  7. Heart Failure in Patients with Preserved Ejection Fraction: Questions Concerning Clinical Progression

    Directory of Open Access Journals (Sweden)

    George E. Louridas

    2016-09-01

    Full Text Available Over the last two decades, important advances have been made in explaining some pathophysiological aspects of heart failure with preserved ejection fraction (HFpEF with repercussions for the successful clinical management of the syndrome. Despite these gains, our knowledge for the natural history of clinical progression from the pre-clinical diastolic dysfunction (PDD until the final clinical stages is significantly limited. The subclinical progression of PDD to the clinical phenotype of HFpEF and the further clinical progression to some more complex clinical models with multi-organ involvement, similar to heart failure with reduced ejection fraction (HFrEF, continue to be poorly understood. Prospective studies are needed to elucidate the natural history of clinical progression in patients with HFpEF and to identify the exact left ventricular remodeling mechanism that underlies this progression.

  8. A transcatheter intracardiac shunt device for heart failure with preserved ejection fraction (REDUCE LAP-HF)

    DEFF Research Database (Denmark)

    Hasenfuß, Gerd; Hayward, Chris; Burkhoff, Dan

    2016-01-01

    BACKGROUND: Heart failure with preserved ejection fraction (HFPEF) is a common, globally recognised, form of heart failure for which no treatment has yet been shown to improve symptoms or prognosis. The pathophysiology of HFPEF is complex but characterised by increased left atrial pressure......, especially during exertion, which might be a key therapeutic target. The rationale for the present study was that a mechanical approach to reducing left atrial pressure might be effective in HFPEF. METHODS: The REDUCe Elevated Left Atrial Pressure in Patients with Heart Failure (REDUCE LAP-HF) study...... was an open-label, single-arm, phase 1 study designed to assess the performance and safety of a transcatheter interatrial shunt device (IASD, Corvia Medical, Tewkesbury, MA, USA) in patients older than 40 years of age with symptoms of HFPEF despite pharmacological therapy, left ventricular ejection fraction...

  9. Comparison of characteristics and outcomes of patients with heart failure preserved ejection fraction versus reduced left ventricular ejection fraction in an urban cohort.

    Science.gov (United States)

    Quiroz, Rene; Doros, Gheorghe; Shaw, Peter; Liang, Chang-Seng; Gauthier, Diane F; Sam, Flora

    2014-02-15

    Despite significant advances in therapies for patients with heart failure with reduced ejection fraction (HFrEF), there are no evidence-based therapies for heart failure with preserved ejection fraction (HFpEF), also known as diastolic heart failure (HF). Differences in pathophysiologic mechanisms are touted as to why patients with HFpEF purportedly do not derive similar therapeutic benefits compared with HFrEF. Similarly, the relative frequencies of HFpEF and HFrEF may differ between hospitalized and ambulatory settings. There are limited data on the prevalence, characteristics, treatment, and short-term outcomes of patients hospitalized with HFpEF. We sought to investigate these in patients hospitalized with HFpEF in an urban, hospitalized setting using the Get With The Guidelines registry. We retrospectively reviewed all consecutive discharges (n = 1,701) with a diagnosis of acute decompensated HF from December 1, 2006 to September 30, 2008. Patients with HFpEF (n = 499) were older, overweight, predominantly women, and had underlying hypertension and dyslipidemia. Presenting blood pressure and levels of creatinine were higher, with lower brain natriuretic peptide levels compared with patients with HFrEF (n = 598). Length of stay and 30-day mortality were comparable between patients with HFpEF and HFrEF. Thirty-day readmission was initially lower in patients with HFpEF. However 30-day mortality from any cause after the index HF hospitalization and survival curve at 1-year was no different between patients with HFpEF and HFrEF. In conclusion, lower 30-day readmissions do not translate into improved long-term outcome in patients with HFpEF.

  10. Débito cardíaco e fração de ejeção fetal por meio do spatio-temporal image correlation (STIC: comparação entre fetos masculinos e femininos Fetal cardiac output and ejection fraction by spatio-temporal image correlation (STIC: comparison between male and female fetuses

    Directory of Open Access Journals (Sweden)

    Christiane Simioni

    2012-06-01

    Full Text Available OBJETIVO: Comparar do débito cardíaco (DC e a fração de ejeção (FE do coração de fetos masculinos e femininos obtidos por meio da ultrassonografia tridimensional, utilizando o spatio-temporal image correlation (STIC. MÉTODOS: Realizou-se um estudo de corte transversal com 216 fetos normais, entre 20 a 34 semanas de gestação, sendo 108 masculinos e 108 femininos. Os volumes ventriculares no final da sístole e diástole foram obtidos por meio do STIC, sendo as avaliações volumétricas realizadas pelo virtual organ computer-aided analysis (VOCAL com rotação de 30º. Para o cálculo do DC utilizou-se a fórmula: DC= volume sistólico/frequência cardíaca fetal, enquanto que para a FE utilizou-se a fórmula: FE= volume sistólico/volume diastólico final. O DC (combinado, feminino e masculino e a FE (masculina e feminina foram comparadas utilizando-se o teste t não pareado e ANCOVA. Foram criados gráficos de dispersão com os percentis 5, 50 e 95. RESULTADOS: A média do DC combinado, DC direito, DC esquerdo, FE direita e FE esquerda, para feminino e masculino, foram 240,07 mL/min; 122,67 mL/min; 123,40 mL/min; 72,84%; 67,22%; 270,56 mL/min; 139,22 mL/min; 131,34 mL/min; 70,73% e 64,76%, respectivamente; sem diferença estatística (P> 0,05. CONCLUSÕES: O DC e a FE fetal obtidos por meio da ultrassonografia tridimensional (STIC não apresentaram diferença significativa em relação ao gênero.OBJECTIVE: To compare the cardiac output (CO and ejection fraction (EF of the heart of male and female fetuses obtained by 3D-ultrasonography using spatio-temporal image correlation (STIC. METHODS: We conducted a cross-sectional study with 216 normal fetuses, between 20 and 34 weeks of gestation, 108 male and 108 female. Ventricular volumes at the end of systole and diastole were obtained by STIC, and the volumetric assessments performed by the virtual organ computer-aided analysis (VOCAL rotated 30º. To calculate the DC used the formula

  11. 心脏超声三维斑点整体应变与SYNTAX评分及左室射血分数的相关性%Correlation between cardiac three-dimension global strain-speckle tracking imaging and SYNTAX scores or left ventricular ejection fraction

    Institute of Scientific and Technical Information of China (English)

    申静静; 李丹; 王建华; 石宇杰; 陈莹; 张健

    2015-01-01

    目的:观察冠状动脉三支病变和(或)左主干病变患者心脏超声三维斑点整体应变指标与SYNTAX评分及左室射血分数(LVEF)的相关性。方法纳入28例冠状动脉三支病变和(或)左主干病变的冠状动脉粥样硬化性心脏病(冠心病)患者,采用心脏超声三维斑点追踪技术进行心肌运动分析,超声仪自动计算左室整体短轴(GRS)、长轴(GLS)、圆周(GCS)与面积(GAS)应变,采用Simpon法计算LVEF。根据SYNTAX评分标准对纳入患者进行评分。分析三维斑点整体应变指标与SYNTAX评分及LVEF的相关性。结果心脏超声三维斑点整体短轴应变与SYNTAX评分呈负相关(r=-0.508, P<0.05),整体面积应变与SYNTAX评分呈正相关(r=0.569,P<0.05),整体长轴及圆周应变与SYNTAX无相关性(P>0.05)。左心室整体短轴、长轴、圆周与面积应变值均与LVEF具有相关性,相关系数分别为:-0.742、-0.747、0.739、-0.689, P均<0.01。结论心脏超声三维斑点整体应变指标与LVEF及短轴应变、圆周应变与SYNTAX评分具有相关性。%Objective To observe the correlation between cardiac three-dimension global strain-speckle tracking imaging (3D-STI) and SYNTAX scores or left ventricular ejection fraction (LVEF) in patients with coronary 3-vessel lesion and/or left main coronary lesion. Methods The patients (n=28) were chosen and given myocardial motion analysis by using 3D-STI. The global radial strain (GRS), global longitudinal strain (GLS), global circumferential strain (GCS) and global area strain (GAS) were calculated, and LVEF was calculated by using Simpon method. All patients were given scoring according to SYNTAX score standard. The correlation between 3D-STI indexes and SYNTAX scores or LVEF was analyzed. Results 3D-STI was negatively correlated to SYNTAX scores (r=-0.508, P0.05). GRS, GLS, GCS and GAS were all correlated to LVEF (r=-0.742, r=-0

  12. Comparison of Estimations Versus Measured Oxygen Consumption at Rest in Patients With Heart Failure and Reduced Ejection Fraction Who Underwent Right-Sided Heart Catheterization.

    Science.gov (United States)

    Chase, Paul J; Davis, Paul G; Wideman, Laurie; Starnes, Joseph W; Schulz, Mark R; Bensimhon, Daniel R

    2015-12-01

    Cardiac output during right-sided heart catheterization is an important variable for patient selection of advanced therapies (cardiac transplantation and left ventricular assist device implantation). The Fick method to determine cardiac output is commonly used and typically uses estimated oxygen consumption (VO2) from 1 of 3 published empirical formulas. However, these estimation equations have not been validated in patients with heart failure and reduced ejection fraction (HFrEF). The objectives of the present study were to determine the accuracy of 3 equations for estimating VO2 compared with direct measurement of VO2 and determine the extent clinically significant error occurred in calculating cardiac output of patients with HFrEF. Breath-by-breath measurements of VO2 from 44 patients who underwent cardiac catheterization (66% men; age, 65 ± 11 years, left ventricular ejection fraction, 22 ± 6%) were compared with the derived estimations of LaFarge and Miettinen, Dehmer et al, and Bergstra et al. Single-sample t tests found only the mean difference between the estimation of LaFarge and Miettinen and the measured VO2 to be nonsignificant (-10.3 ml/min ± 6.2 SE, p = 0.053). Bland-Altman plots demonstrated unacceptably large limits of agreement for all equations. The rate of ≥25% error in the equations by LaFarge and Miettinen, Dehmer et al, and Bergstra et al occurred in 11%, 23%, and 45% of patients, respectively. Misclassification of cardiac index derived from each equation for 2 clinically important classifications: cardiogenic shock-21%, 23%, and 32% and hypoperfusion-16%, 16%, and 25%; respectively. In conclusion, these findings do not support the use of these empiric formulas to estimate the VO2 at rest in patients with HFrEF who underwent right-sided heart catheterization.

  13. Prevalence and prognosis of heart failure with preserved ejection fraction and elevated N-terminal pro brain natriuretic peptide

    DEFF Research Database (Denmark)

    Carlsen, Christian Malchau; Bay, Morten; Kirk, Vibeke

    2012-01-01

    The aim of this study was to assess the epidemiological features and prognosis of heart failure with preserved ejection fraction (HFPEF) and to compare these findings with those from patients with reduced ejection fraction. Furthermore the effects of N-terminal pro brain natriuretic peptide (NT......-proBNP) requirement in the heart failure diagnosis were assessed by repeating the analyses in the subgroup of patients with elevated NT-proBNP....

  14. Pulmonary Hypertension in Elderly Patients with Diastolic Dysfunction and Preserved Ejection Fraction

    Science.gov (United States)

    Afshar, Majid; Collado, Fareed; Doukky, Rami

    2012-01-01

    Purpose: Patients with diastolic dysfunction may have a disproportionate degree of elevation in pulmonary pressure, particularly in the elderly. Higher pulmonary vascular resistance in the elderly patients with heart failure but preserved ejection fraction suggests that beyond the post-capillary contribution of pulmonary venous congestion, a pre-capillary component of pulmonary arterial hypertension occurs. We aim to identify if pulmonary vascular resistance in elderly patients with diastolic dysfunction is disproportionately higher than patients with systolic dysfunction independent of filling pressures. Methods: 389 patients identified retrospectively between 2003- 2010; elderly with preserved ejection fraction, elderly with depressed ejection fraction, and primary arterial hypertension who underwent right-heart catheterization at Rush University. Results: No significant difference in pulmonary vascular resistance between systolic and diastolic dysfunction. The mean difference in pulmonary vascular resistance was not statistically significant at 0.40 mmHg·min/l (95% CI -3.03 to 3.83) with similar left ventricular filling pressures with mean difference of 3.38 mmHg (95% CI, -1.27 to 8.02). When adjusted for filling pressures, there remained no difference in pulmonary vascular resistance for systolic and diastolic dysfunction. The mean pulmonary vascular resistance is more elevated in systolic heart failure compared to diastolic heart failure with means 3.13 mmHg·min/l and 3.52 mmHg·min/l, respectively. Conclusion: There was no other association identified for secondary pulmonary hypertension other than diastolic dysfunction and chronic venous pulmonary hypertension. Our results argue against any significant arterial remodeling that would lead to disproportionate pre-capillary hypertension, and implies that treatment should focus on lowering filling pressure rather than treating the pulmonary vascular tree. PMID:22282715

  15. Natriuretic peptides and Galectin-3 in senile heart failure patients with preserved ejection fraction.

    Directory of Open Access Journals (Sweden)

    Malinova L.I.

    2015-03-01

    Full Text Available Purpose: to characterize biomarker panel in senile patients with heart failure with preserved ejection fraction (HF-pEF. Material and Methods. 356 senile patients with chronic heart failure with preserved ejection fraction (HFpEF were examined to form the study sample of 48 male patients without atrium fibrillation, anemia, diabetes mellitus, onco-pathology and missing clinical data. NT-proBNP, galectin-3 (gal-3 and proANT assay was performed by commercially available ELISA kits. Results. In patients without left ventricular (LV regional wall motion abnormalities (RWMA. gal-3 (2,13 (0,98; 3,50 vs 5.16 (4,34;9.63 ng/mL, p = 0.011 and NT-proBNP (5,59 (1,00; 10.13 vs 32,04 (15,40; 46,18 fmol/mL, p=0,006 levels were significantly lower than in patients with LV RWMA. Contrarily proANP level was lower in patients with LV RWMA (3,24 (2,47; 3,75 vs 1,38 (0,83; 2,29 nmol/mL, p=0.071. proANP was the only biomarker to increase significantly in long livers (7,30 (4,52; 7,63 vs 2,68 (1,88; 3,32 nmol/mL, p=0.006. NT-proBNP positively correlated with glucose level and negatively with hsCRP (R=0,52, p=0,007. Conclusion. Biomarker panel in senile heart failure patients with preserved ejection fraction has characterized: increase in NT-proBNP and galectin-3 is associated with more severe clinical course and presence of regional wall motion abnormalities in senile patients.

  16. Time-Dependent Regional Myocardial Strains in Patients with Heart Failure with a Preserved Ejection Fraction

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    Shane P. Smith

    2016-01-01

    Full Text Available Objectives. To better understand the etiology of HFpEF in a controlled human population, regional time-varying strains were computed using echocardiography speckle tracking in patients with heart failure with a preserved ejection fraction and normal subjects. Methods. Eleven normal volunteers and ten patients with echo-graded diastolic dysfunction and symptoms of heart failure were imaged with echocardiography and longitudinal, circumferential, and rotational strains were determined using speckle-tracking. Diastolic strain rate was also determined. Patient demographics and echo-derived flows, volumes, and pressures were recorded. Results. Peak longitudinal and circumferential strain was globally reduced in patients (p<0.001, when compared to controls. The patients attained peak longitudinal and circumferential strain at a consistently later point in systole than controls. Rotational strains were not different in most LV regions. Early diastolic strain rate was significantly reduced in the patients (p<0.001. LV mass and wall thickness were significantly increased in the patients; however ejection fraction was preserved and stroke volume was diminished (p<0.001. Conclusions. This study shows that patients with HFpEF have reduced early diastolic strain rate and reduced peak strain that is regionally homogeneous and that they also utilize a longer fraction of systole to achieve peak axial strains.

  17. On improvement in ejection fraction with iron chelation in thalassemia major and the risk of future heart failure

    Directory of Open Access Journals (Sweden)

    Carpenter JP

    2011-09-01

    Full Text Available Abstract Background Trials of iron chelator regimens have increased the treatment options for cardiac siderosis in beta-thalassemia major (TM patients. Treatment effects with improved left ventricular (LV ejection fraction (EF have been observed in patients without overt heart failure, but it is unclear whether these changes are clinically meaningful. Methods This retrospective study of a UK database of TM patients modelled the change in EF between serial scans measured by cardiovascular magnetic resonance (CMR to the relative risk (RR of future development of heart failure over 1 year. Patients were divided into 2 strata by baseline LVEF of 56-62% (below normal for TM and 63-70% (lower half of the normal range for TM. Results A total of 315 patients with 754 CMR scans were analyzed. A 1% absolute increase in EF from baseline was associated with a statistically significant reduction in the risk of future development of heart failure for both the lower EF stratum (EF 56-62%, RR 0.818, p Conclusion These data show that during treatment with iron chelators for cardiac siderosis, small increases in LVEF in TM patients are associated with a significantly reduced risk of the development of heart failure. Thus the iron chelator induced improvements in LVEF of 2.6% to 3.1% that have been observed in randomized controlled trials, are associated with risk reductions of 25.5% to 46.4% for the development of heart failure over 12 months, which is clinically meaningful. In cardiac iron overload, heart mitochondrial dysfunction and its relief by iron chelation may underlie the changes in LV function.

  18. Clinical perspectives and evidence of diastolic stress test in heart failure with preserved ejection fraction

    Directory of Open Access Journals (Sweden)

    Evgeny Belyavskiy

    2015-12-01

    Full Text Available The diagnosis of heart failure with preserved ejection fraction (HFPEF remains on the basis of echocardiographic analyses at rest. However, some patients with HFPEF have symptoms such as dyspnea only during exercise. Accordingly, echocardiographic analyses at rest could be insufficiently sensitive to identify these patients. In line, recent studies demonstrated that in some patients with HFPEF left ventricular diastolic abnormalities occur only during exercise. This review discusses and analyzes the clinical relevance and evidence of using diastolic stress test echocardiography in patients with HFPEF.

  19. Diagnosis and Management of Heart Failure with Preserved Ejection Frac-tion: 10 Key Lessons

    OpenAIRE

    A, Afşin Oktay; Sanjiv J Shah

    2015-01-01

    Heart failure with preserved ejection fraction (HFpEF) is a common clinical syndrome associated with high rates of morbidi-ty and mortality. Due to the lack of evidence-based therapies and increasing prevalence of HFpEF, clinicians are often con-fronted with these patients and yet have little guidance on how to effectively diagnose and manage them. Here we offer 10 key lessons to assist with the care of patients with HFpEF: (1) Know the difference between diastolic dysfunction, diastolic hear...

  20. Assessment of right ventricular ejection fraction during intravenous /sup 133/Xe pulmonary ventilation study

    Energy Technology Data Exchange (ETDEWEB)

    Gupta, S.M.; Spencer, R.P.; Herrera, N.E.

    1985-01-01

    Intravenous /sup 133/Xe in saline was used to estimate right-ventricular ejection fraction (RVEF). In three healthy volunteers, the first pass RVEF with /sup 133/Xe was followed by RVEF estimation by intravenous /sup 99m/Tc-pertechnetate. There was agreement between the /sup 133/Xe and 99mTc determined values. Subjects rebreathed the liberated /sup 133/Xe gas, allowing an estimation of regional pulmonary ventilation. Intravenous /sup 133/Xe in saline may have potential use in measuring RVEF, as well as in evaluating pulmonary function in cor pulmonale.

  1. 射血分数正常的心力衰竭患者血清胆红素水平与舒张功能不全的相关性研究%The relation study between serum bilirubin and diastolic cardiac dysfunction in heart failure with preserved ejection fraction patients

    Institute of Scientific and Technical Information of China (English)

    袁博; 任晖; 巩洁; 李静; 郑时康; 王甲文; 王蕊; 高天林

    2015-01-01

    patients with HFpEF were enrolled .According to the results of ultrasound examination , patients were divided into 3 subgroups:mild subgroup with 13 cases, moderate sub group with 44 cases, severe sub group with 23 cases, 30 cases of healthy physical ex-amination were selected as healthy control group .Left atrial diameter , left ventricular end diastolic diameter , left ventricular ejection fraction, left ventricular end diastolic volume , E peak, A peak, early diastolic mitral annular velocity were measured by echocardiography , and E/Ea values were calculated .The relationship between bilirubin level and cardiac ultrasound and the results of echocardiography were analyzed .Results Moderate sub group and severe subgroups ’ total bilirubin ( TB) and direct bilirubin (DB) were significantly higher than those of healthy control group (TB in moderate subgroups:t =1.732, P =0.045;TB in severe sub group:t =2.032, P =0.025.DB in moderate subgroups:t =2.732, P =0.007;TB in severe sub group:t =2.036, P =0.026), comparison within HFpEF group, severe HFpEF subgroup’s serum TB and dB was sig-nificantly lower than that of the mild sub group (TB:t =1.715, P =0.047;DB:t =2.032, P =0.024).HFpEF group’s EA peak was significantly lower than that in healthy control group ( t =0.010, P =0.017) and E /EA was higher than that of healthy control group ( t =0.022, P =0.032).Severe subgroup’s EA peak and E /EA were significantly lower than mild sub group (EA peak:t =2.079, P =0.023;E /EA:t =2.411, P =0.011).A negative correlation between TB and DB levels and E/Ea were existed ( r =-0.401, P =0.040;r =-0.434, P =0.030).By multivariate stepwise regression analysis showed that serum level of TB can be as an independent variable into e peak ( P =0.003 ) and EA peak ( P =0.003) respectively as the dependent variable for linear regression equation .Conclusion Bilirubin level is closely related to ventricular diastolic function , which may be an important risk factor in the pathogenesis of HFpEF .

  2. Heart Failure with Preserved Ejection Fraction – Concept, Pathophysiology, Diagnosis and Challenges for Treatment

    Directory of Open Access Journals (Sweden)

    Lidija Veterovska Miljkovik

    2015-07-01

    Full Text Available Heart failure (HF with preserved left ventricular (LV ejection fraction (HFpEF occurs in 40 to 60% of the patients with HF, with a prognosis which is similar to HF with reduced ejection fraction (HFrEF. HFpEF pathophysiology is different from that of HFrEF, and has been characterized with diastolic dysfunction. Diastolic dysfunction has been defined with elevated left ventricular stiffness, prolonged iso-volumetric LV relaxation, slow LV filing and elevated LV end-diastolic pressure. Arterial hypertension occurs in majority cases with HFpEF worldwide. Patients are mostly older and obese. Diabetes mellitus and atrial fibrillation appear proportionally in a high frequency of patients with HFpEF. The HFpEF diagnosis is based on existence of symptoms and signs of heart failure, normal or approximately normal ejection and diagnosing of LV diastolic dysfunction by means of heart catheterization or Doppler echocardiography and/or elevated concentration of plasma natriuretic peptide. The present recommendations for HFpEF treatment include blood pressure control, heart chamber frequency control when atrial fibrillation exists, in some situations even coronary revascularization and an attempt for sinus rhythm reestablishment. Up to now, it is considered that no medication or a group of medications improve the survival of HFpEF patients. Due to these causes and the bad prognosis of the disorder, rigorous control is recommended of the previously mentioned precipitating factors for this disorder. This paper presents a universal review of the most important parameters which determine this disorder.

  3. Factors influencing the variations of ejection fraction during exercise in chronic aortic regurgitation

    Energy Technology Data Exchange (ETDEWEB)

    Bassand, J.P.; Faivre, R.; Berthout, P.; Maurat, J.P.; Cardot, J.C.; Verdenet, J.; Bidet, R.

    1987-11-01

    The influence of left ventricular volume variations and regurgitant fraction variations upon left ventricular ejection fraction during exercise was examined using equilibrium radionuclide angiography in patients suffering from aortic regurgitation. Ejection fraction (EF), regurgitant fraction (RF), end diastolic volume (EDV) and end systolic volume (ESV) variations from rest to peak exercise were determined in 44 patients suffering from chronic aortic regurgitation (AR) and in 8 healthy volunteers (C). In C, EF increased (+0.10+-0.03, P<0.01) and ESV decreased significantly (-23%+-12%, P<0.01), RF and EDV did not vary significantly. In AR patients, EF, EDV and ESV did not vary significantly because of important scattering of individual values. Changes in EF and ESV were inversely correlated (r=-0.79, P<0.01) and RF decreased significantly (-0.12+-0.10, P<0.01). Volumes and EF changes during exercise occurred in three different ways. In a 1st subgroup of 7 patients, EF increased (+0.09+-0.03, P<0.05) in conjunction with a reduction of ESV (-24%+-12%, P<0.05) without a significant change in EDV. In a 2nd group of 22 patients, EF decreased (-0.04+-0.07, P<0.01) in association with an increase in ESV (+17%+-16%, P<0.01) and no changes in EDV. In a 3rd subgroup of 15 patients, EF decreased (-0.02+-0.06, P<0.01) despite a reduction in ESV (-7%+-6%, P<0.01) because of a dramatic EDV decrease (-10%+-6%, P<0.05). In this subgroup, changes in EF were inversely correlated with changes in ESV (r=-0.55, P<0.01) and positively related to EDV variations (r=0.42, P=0.02). EDV changes were weakly, but significantly, correlated to RF decrease (r=0.39, P<0.05). We conclude that changes in left ventricular ejection fraction during exercise in patients with chronic aortic regurgitation are significantly related in some patients to changes in ventricular loading conditions as well as contractile state.

  4. Influence of ST-segment recovery on infarct size and ejection fraction in patients with ST-segment elevation myocardial infarction receiving primary percutaneous coronary intervention

    DEFF Research Database (Denmark)

    Hallén, Jonas; Ripa, Maria Sejersten; Johanson, Per;

    2010-01-01

    In patients with ST-segment elevation myocardial infarction treated with fibrinolytics, electrocardiogram-derived measures of ST-segment recovery guide therapy decisions and predict infarct size. The comprehension of these relationships in patients undergoing mechanical reperfusion is limited. We...... studied 144 patients treated with primary percutaneous coronary intervention. We aimed to define the association between infarct size as determined by cardiac magnetic resonance imaging and different metrics of ST-segment recovery. Electrocardiograms were assessed at baseline and 90 minutes after primary...... percutaneous coronary intervention. Three methods for calculating and categorizing ST-segment recovery were used: (1) summed ST-segment deviation (STD) resolution analyzed in 3 categories (> or = 70%, > or = 30% to or = 2 mm). Infarct size and ejection fraction were assessed at 4 months by cardiac magnetic...

  5. NEW EMPHASES ON THE STUDY OF THE PATHOGENESIS OF CHRONIC HEART FAILURE WITH PRESERVED EJECTION FRACTION: FOCUS ON INFLAMMATORY MARKERS

    Directory of Open Access Journals (Sweden)

    O. M. Drapkina

    2014-01-01

    Full Text Available For the long time the systolic myocardial dysfunction was traditionally associated with the severity of chronic heart failure (CHF. Increasing number of patients with symptoms of CHF but without systolic dysfunction has drawn the attention of specialists to so-called CHF with preserved ejection fraction. Prognosis in CHF with preserved ejection fraction may be as bad as in CHF with reduced ejection fraction. Significant changes in views on the pathogenesis of CHF led to the creation of new therapeutic approaches in the treatment of this disease. However, at present, convincing evidence base of mortality reduction in patients with CHF with preserved ejection fraction using well-known therapeutic agents is unavailable. It makes conduct active searches for new biological markers of diastolic heart function. Participation of proinflammatory cytokines, in particular GDF-15, in the process of elasticity reduction and relaxation disorders of left ventricular myocardium, may be of great importance in the development of new medical agents designed to delay the progression of CHF with preserved ejection fraction.

  6. Effects of renal denervation on vascular remodelling in patients with heart failure and preserved ejection fraction: A randomised control trial

    Science.gov (United States)

    Hayward, Carl; Keegan, Jennifer; Gatehouse, Peter D; Rajani, Ronak; Khattar, Rajdeep S; Mohiaddin, Raad H; Rosen, Stuart D; Lyon, Alexander R; di Mario, Carlo

    2017-01-01

    Objective To assess the effect of renal denervation (RDT) on micro- and macro-vascular function in patients with heart failure with preserved ejection fraction (HFpEF). Design A prospective, randomised, open-controlled trial with blinded end-point analysis. Setting A single-centre London teaching hospital. Participants Twenty-five patients with HFpEF who were recruited into the RDT-PEF trial. Main outcome measures Macro-vascular: 24-h ambulatory pulse pressure, aorta distensibilty (from cardiac magnetic resonance imaging (CMR), aorta pulse wave velocity (CMR), augmentation index (peripheral tonometry) and renal artery blood flow indices (renal MR). Micro-vascular: endothelial function (peripheral tonometry) and urine microalbuminuria. Results At baseline, 15 patients were normotensive, 9 were hypertensive and 1 was hypotensive. RDT did not lower any of the blood pressure indices. Though there was evidence of abnormal vascular function at rest, RDT did not affect these at 3 or 12 months follow-up. Conclusions RDT did not improve markers of macro- and micro-vascular function. PMID:28228942

  7. Outcome in Heart Failure with Preserved Ejection Fraction: The Role of Myocardial Structure and Right Ventricular Performance.

    Directory of Open Access Journals (Sweden)

    Georg Goliasch

    Full Text Available Heart failure with preserved ejection fraction (HFpEF is recognized as a major cause of cardiovascular morbidity and mortality. Thus, a profound understanding of the pathophysiologic changes in HFpEF is needed to identify risk factors and potential treatment targets in this specific patient population. Therefore, we aimed to comprehensively assess the impact of left- and right-ventricular function and hemodynamics on long-term mortality and morbidity in order to improve risk prediction in patients with HFpEF.We prospectively included 142 consecutive patients with HFpEF into our observational, non-interventional registry. Echocardiography, cardiac magnetic resonance imaging and invasive hemodynamic assessments including myocardial biopsy were performed at baseline. We detected significant correlations between left ventricular extracellular matrix and left ventricular end-diastolic diameter (r = -0.64;p = 0.03 and stroke volume (r = -0.53;p = 0.04. Hospitalization for heart failure and/or cardiac death was observed over a median follow up of 10 months. The strongest risk factors were reduced right ventricular function (adj. HR 6.62;95%CI 3.12- 14.02;p<0.001, systolic pulmonary arterial pressure (adj. HR per 1-SD 1.55;95%CI 1.15- 2.09;p = 0.004 and the pulmonary artery wedge pressure (adj. HR per 1-SD 1.51;95%CI 1.09-2.08; p = 0.012. The area under the ROC curve for right ventricular function was 0.63, for systolic pulmonary arterial pressure 0.75, and for pulmonary artery wedge pressure 0.68.The current study emphasizes the importance of right ventricular function and pulmonary pressures on outcome in patients with HFpEF providing pathophysiological insights into the hemodynamic changes in HFpEF.

  8. Extracellular matrix remodeling in patients with ischemic chronic heart failure with preserved ejection fraction

    Directory of Open Access Journals (Sweden)

    V. D. Syvolap

    2015-04-01

    Full Text Available Aim. To identify features, relationships between parameters of the extracellular matrix and renal function in 110 patients with ischemic chronic heart failure the activity of collagen metabolism markers (MMP-9, TIMP-1, PICP, cystatin C, structural and functional parameters of the heart were studied using ELISA, echocardiography. Results. It was established that imbalance in the system MMP/TIMP in ischemic heart failure with preserved left ventricular ejection fraction leads to disruption of the extracellular matrix structural functional sufficiency, increases functional failure and is associated with impaired renal function. Conclusion. Correlation analysis showed significant relationships between MMP/TIMP and GFR, cystatin C, indicating that the significant role of extracellular matrix imbalance in the development of renal dysfunction in patients with ischemic chronic heart failure.

  9. Pioglitazone-induced congestive heart failure and pulmonary edema in a patient with preserved ejection fraction

    Directory of Open Access Journals (Sweden)

    Vaneet Jearath

    2016-01-01

    Full Text Available Pioglitazone-induced heart failure is known in patients with underlying heart disease, but is not well documented in patients with normal left ventricular function. Pioglitazone has been very popular as it is an insulin sensitizer and insulin resistance is prevalent among Indians. Fluid retention exacerbates pre-existing heart failure or precipitates heart failure in a patient with underlying left ventricular dysfunction. However, pathogenesis of heart failure in a patient with normal left ventricular function is not known. Probably it is due to dose-related effect on pulmonary endothelial permeability, rather than alterations in left ventricular mass or ejection fraction. We report a patient who developed congestive heart failure and pulmonary edema with normal left ventricular function within 1 year of starting pioglitazone therapy. We have to be careful in monitoring all possible side effects during followup when patients are on pioglitazone therapy.

  10. Pioglitazone-induced congestive heart failure and pulmonary edema in a patient with preserved ejection fraction

    Science.gov (United States)

    Jearath, Vaneet; Vashisht, Rajan; Rustagi, Vipul; Raina, Sujeet; Sharma, Rajesh

    2016-01-01

    Pioglitazone-induced heart failure is known in patients with underlying heart disease, but is not well documented in patients with normal left ventricular function. Pioglitazone has been very popular as it is an insulin sensitizer and insulin resistance is prevalent among Indians. Fluid retention exacerbates pre-existing heart failure or precipitates heart failure in a patient with underlying left ventricular dysfunction. However, pathogenesis of heart failure in a patient with normal left ventricular function is not known. Probably it is due to dose-related effect on pulmonary endothelial permeability, rather than alterations in left ventricular mass or ejection fraction. We report a patient who developed congestive heart failure and pulmonary edema with normal left ventricular function within 1 year of starting pioglitazone therapy. We have to be careful in monitoring all possible side effects during followup when patients are on pioglitazone therapy. PMID:27127397

  11. Targeting heart failure with preserved ejection fraction: current status and future prospects

    Directory of Open Access Journals (Sweden)

    Kanwar M

    2016-04-01

    Full Text Available Manreet Kanwar, Claire Walter, Megan Clarke, Maria Patarroyo-Aponte Department of Cardiology, Allegheny General Hospital, Pittsburgh, PA, USA Abstract: Heart failure with preserved ejection fraction (HFpEF portrays a significant burden in terms of prevalence, morbidity, mortality, and health care costs. There is a lack of consensus on the basic pathophysiology, definition, and therapeutic targets for therapy for this syndrome. To date, there are no approved therapies available for reducing mortality or hospitalization for these patients. Several clinical trials have recently started to try and bridge this major gap. There is an urgent need to focus on drug and device development for HFpEF as well as to understand HFpEF pathophysiology. Keywords: HFpEF therapies, diastolic dysfunction

  12. Can Biomarkers Help to Diagnose Early Heart Failure with Preserved Ejection Fraction?

    Directory of Open Access Journals (Sweden)

    Jaroslav Meluzín

    2015-01-01

    Full Text Available Early heart failure with preserved ejection fraction (HFpEF is a frequent disease, but its diagnosis is difficult and relies mostly on the evidence of left ventricular filling pressure (LVFP elevation during exercise. Several reports have suggested that natriuretic peptides plasma levels reflect exercise-induced increase in LVFP, but they still have significant limitations. In this context, any new laboratory biomarker that can accurately reflect LVFP elevation during exercise is desirable. Recently, cardiotrophin-1, soluble endoglin, ST2, growth differentiation factor 15, galectin-3, and other new laboratory markers associated with LVFP have emerged. However, the current data on the relationship of these biomarkers and diastolic dysfunction are limited to resting conditions. Therefore, their secretion deserves to be tested under the exercise to determine their potential role in making a diagnosis of early HFpEF.

  13. Sildenafil and diastolic dysfunction after acute myocardial infarction in patients with preserved ejection fraction

    DEFF Research Database (Denmark)

    Andersen, Mads J; Ersbøll, Mads; Axelsson, Anna;

    2013-01-01

    BACKGROUND: Diastolic dysfunction is frequently seen after myocardial infarction and is characterized by a disproportionate increase in filling pressure during exercise to maintain stroke volume. We hypothesized that sildenafil would reduce filling pressure during exercise in patients...... with diastolic dysfunction after myocardial infarction. METHODS AND RESULTS: Seventy patients with diastolic dysfunction and near normal left ventricular ejection fraction on echocardiography were randomly assigned sildenafil 40 mg thrice daily or matching placebo for 9 weeks. Before randomization and after 9...... in the placebo group. CONCLUSIONS: Sildenafil did not decrease filling pressure at rest or during exercise in post-myocardial infarction patients with diastolic dysfunction. However, there were effects on secondary end points, which require further studies....

  14. Prognostic value of right ventricular ejection fraction in pulmonary arterial hypertension.

    Science.gov (United States)

    Courand, Pierre-Yves; Pina Jomir, Géraldine; Khouatra, Chahéra; Scheiber, Christian; Turquier, Ségolène; Glérant, Jean-Charles; Mastroianni, Bénédicte; Gentil, Béatrice; Blanchet-Legens, Anne-Sophie; Dib, Alfred; Derumeaux, Geneviève; Humbert, Marc; Mornex, Jean-François; Cordier, Jean-François; Cottin, Vincent

    2015-01-01

    Right ventricle ejection fraction (RVEF) evaluated with magnetic resonance imaging is a strong determinant of patient outcomes in pulmonary arterial hypertension. We evaluated the prognostic value of RVEF assessed with conventional planar equilibrium radionuclide angiography at baseline and change 3-6 months after initiating pulmonary arterial hypertension-specific therapy. In a prospective cohort of newly diagnosed patients with idiopathic, heritable or anorexigen-associated pulmonary arterial hypertension, RVEF was measured at baseline (n=100) and 3-6 months after initiation of therapy (n=78). After a median follow-up of 4.1 years, 41 deaths occurred, including 35 from cardiovascular causes. Patients with a (median) baseline RVEF >25% had better survival than those with a RVEF arterial hypertension.

  15. Urinary Proteomics Pilot Study for Biomarker Discovery and Diagnosis in Heart Failure with Reduced Ejection Fraction

    DEFF Research Database (Denmark)

    Rossing, Kasper; Bosselmann, Helle Skovmand; Gustafsson, Finn

    2016-01-01

    BACKGROUND: Biomarker discovery and new insights into the pathophysiology of heart failure with reduced ejection fraction (HFrEF) may emerge from recent advances in high-throughput urinary proteomics. This could lead to improved diagnosis, risk stratification and management of HFrEF. METHODS...... AND RESULTS: Urine samples were analyzed by on-line capillary electrophoresis coupled to electrospray ionization micro time-of-flight mass spectrometry (CE-MS) to generate individual urinary proteome profiles. In an initial biomarker discovery cohort, analysis of urinary proteome profiles from 33 HFr.......6%) in individuals with diastolic left ventricular dysfunction (N = 176). The HFrEF-related peptide biomarkers mainly included fragments of fibrillar type I and III collagen but also, e.g., of fibrinogen beta and alpha-1-antitrypsin. CONCLUSION: CE-MS based urine proteome analysis served as a sensitive tool...

  16. Pioglitazone-induced congestive heart failure and pulmonary edema in a patient with preserved ejection fraction.

    Science.gov (United States)

    Jearath, Vaneet; Vashisht, Rajan; Rustagi, Vipul; Raina, Sujeet; Sharma, Rajesh

    2016-01-01

    Pioglitazone-induced heart failure is known in patients with underlying heart disease, but is not well documented in patients with normal left ventricular function. Pioglitazone has been very popular as it is an insulin sensitizer and insulin resistance is prevalent among Indians. Fluid retention exacerbates pre-existing heart failure or precipitates heart failure in a patient with underlying left ventricular dysfunction. However, pathogenesis of heart failure in a patient with normal left ventricular function is not known. Probably it is due to dose-related effect on pulmonary endothelial permeability, rather than alterations in left ventricular mass or ejection fraction. We report a patient who developed congestive heart failure and pulmonary edema with normal left ventricular function within 1 year of starting pioglitazone therapy. We have to be careful in monitoring all possible side effects during followup when patients are on pioglitazone therapy.

  17. Heart failure with normal ejection fraction: consideration of mechanisms other than diastolic dysfunction.

    Science.gov (United States)

    Bench, Travis; Burkhoff, Daniel; O'Connell, John B; Costanzo, Maria Rosa; Abraham, William T; St John Sutton, Martin; Maurer, Mathew S

    2009-03-01

    More than half of patients with heart failure (HF) have a normal ejection fraction (EF). These patients are typically elderly, are predominantly female, and have a high incidence of multiple comorbid conditions associated with development of ventricular hypertrophy and/or interstitial fibrosis. Thus, the cause of HF has been attributed to diastolic dysfunction. However, the same comorbidities may also impact myocardial systolic, ventricular, vascular, renal, and extracardiovascular properties in ways that can also contribute to symptoms of HF by way of mechanisms not related to diastolic dysfunction. Accordingly, the descriptive term HF with normal EF has been suggested as an alternative to the mechanistic term diastolic HF. In this article, we review the current understanding of nondiastolic mechanisms that may contribute to the HF with normal EF syndrome to highlight potential pathways for research that may lead to new targets for therapy.

  18. Prognostic value of ejection fraction in patients admitted with acute coronary syndrome

    Science.gov (United States)

    Perelshtein Brezinov, Olga; Klempfner, Robert; Zekry, Sagit Ben; Goldenberg, Ilan; Kuperstein, Rafael

    2017-01-01

    Abstract There are limited data regarding factors affecting outcomes among acute coronary syndrome (ACS) patients presenting with varying degrees of left ventricle (LV) dysfunction. We aimed to identify factors associated with mortality according to LV ejection fraction (LVEF) at 1st admission in ACS patients. A total of 8983 ACS patients prospectively enrolled in the Acute Coronary Syndrome Israeli Survey (2000–2010) were categorized according to their LVEF at admission: severe LV dysfunction (LVEF ACS, and prognostic factors differ according to LVEF during admission. In patients with severe LV dysfunction signs of clinical instability are related to 1-year mortality; in patients with a more preserved LV function the prognosis is related to the presence of co-morbidities. PMID:28248882

  19. Outcomes and worsening renal function in patients hospitalized with heart failure with preserved ejection fraction.

    Science.gov (United States)

    Sharma, Kavita; Hill, Terence; Grams, Morgan; Daya, Natalie R; Hays, Allison G; Fine, Derek; Thiemann, David R; Weiss, Robert G; Tedford, Ryan J; Kass, David A; Schulman, Steven P; Russell, Stuart D

    2015-11-15

    Heart failure with preserved ejection fraction (HFpEF) has been described as a disease of elderly subjects with female predominance and hypertension. Our clinical experience suggests patients with HFpEF from an urban population are far more heterogenous, with greater co-morbidities and significant inhospital morbidity. There are limited data on the hospitalization course and outcomes in acute decompensated HFpEF. Hospitalizations for acute heart failure at our institution from July 2011 to June 2012 were identified by International Classification of Diseases, Ninth Revision, codes and physician review for left ventricular ejection fraction ≥50% and were reviewed for patient characteristics and clinical outcomes. Worsening renal function (WRF) was defined as creatinine increase of ≥0.3 mg/dl by 72 hours after admission. Hospital readmission and mortality data were captured from electronic medical records and the Social Security Death Index. Of 434 heart failure admissions, 206 patients (47%) with HFpEF were identified. WRF developed in 40%, the highest reported in HFpEF to date, and was associated with higher blood pressure and lower volume of diuresis. Compared to previous reports, hospitalized patients with HFpEF were younger (mean age 63.2 ± 13.6 years), predominantly black (74%), and had more frequent and severe co-morbidities: hypertension (89%), diabetes (56%), and chronic kidney disease (55%). There were no significant differences in 1- and 12-month outcomes by gender, race, or WRF. In conclusion, we found hospitalized patients with HFpEF from an urban population develop a high rate of WRF are younger than previous cohorts, often black, and have greater co-morbidities than previously described.

  20. Diagnosis and management of heart failure with preserved ejection fraction: 10 key lessons.

    Science.gov (United States)

    Oktay, A Afşin; Shah, Sanjiv J

    2015-01-01

    Heart failure with preserved ejection fraction (HFpEF) is a common clinical syndrome associated with high rates of morbidity and mortality. Due to the lack of evidence-based therapies and increasing prevalence of HFpEF, clinicians are often confronted with these patients and yet have little guidance on how to effectively diagnose and manage them. Here we offer 10 key lessons to assist with the care of patients with HFpEF: (1) Know the difference between diastolic dysfunction, diastolic heart failure, and HFpEF; (2) diagnosing HFpEF is challenging, so be thorough and consider invasive hemodynamic testing to confirm the diagnosis; (3) a normal B-type natriuretic peptide does not exclude the diagnosis of HFpEF; (4) elevated pulmonary artery systolic pressure on echocardiography in the presence of a normal ejection fraction should prompt consideration of HFpEF; (5) use dynamic testing in evaluating the possibility of HFpEF in patients with unexplained dyspnea or exercise tolerance; (6) all patients with HFpEF should be systematically evaluated for the presence of coronary artery disease; (7) use targeted treatment for HFpEF patients based on their phenotypic classification; (8) treat HFpEF patients now by treating their comorbidities; (9) understand the importance of heart rate in HFpEF- lower is not always better; and (10) do not forget to consider rare diseases ("zebras") as causes for HFpEF when evaluating and treating patients. Taken together, these 10 key lessons can help clinicians care for challenging patients with HFpEF while we eagerly await the results of ongoing HFpEF clinical trials and observational studies.

  1. Left-ventricular peak ejection rate, filling rate, and ejection fraction--frame rate requirements at rest and exercise: concise communication.

    Science.gov (United States)

    Bacharach, S L; Green, M V; Borer, J S; Hyde, J E; Farkas, S P; Johnston, G S

    1979-03-01

    The effect of framing rate on the measurement of left-ventricular (LV) ejection fraction (EF), peak ejection rate (PER), and peak filling rate (PFR) was evaluated at rest and during exercise in 11 normal subjects and 21 patients who underwent gated equilibrium blood-pool imaging. Left-ventricular time-activity curves were obtained in each subject, at rest and during stress, at temporal resolutions of 10, 20, 30, 40, and 50 msec per frame. Ejection fraction, PER, and PFR were determined for each frame duration. By observing changes in the measured values of these quantities with framing rate we conclude that: a) for the measurement of EF, 50 msec per frame at rest and 40 msec per frame at exercise is sufficient; b) PER requires 40 msec per frame at rest and 20 msec per frame during exercise; and c) for the measurement of PFR, at least 40 msec per frame at rest and 20 msec per frame during exercise are needed. These results should hold for both first-pass and gated equilibrium studies.

  2. The effects of bisoprolol on chromaffin grain protein A and cardiac function of heart failure patients with preserved left ventricular ejection fraction%比索洛尔对左室射血分数保留的心力衰竭患者嗜铬粒蛋白A及心功能的影响

    Institute of Scientific and Technical Information of China (English)

    甄宇治; 邓彦东; 段立楠; 战吟戈; 刘超; 刘坤申

    2016-01-01

    Objective To investigate the effects of bisoprolol on chromaffin granule protein A (CgA) in heart failure patients with preserved left ventricular ejection fraction (HFpEF), and to explore the role of CgA in HFpEF patients and the treatment effect of bisoprolol.Methods 66 chronic heart failure patients were randomly divided into treatment group and control group (33 patients in each group). Treatment group was given bisoprolol and standardized treatment, the control group was only given standardized treatment. CgA level and change of echocardiography were measured two weeks after treatment in two groups.Results There is no difference as to CgA level, left ventricular ejection fraction (LVEF), left ventricular end-diastolic diameter (LVEDD), left ventricular end-systolic diameter (LVESD), E peak, A peak, E/A and left ventricular isovolumic relaxation time (IVRT) between two groups before treatment (P>0.05). After treatment, all the indexes above in treatment group were improved better than control group (P<0.05). The total effective rate in treatment group was higher than control group (87.87%vs. 63.63%,P<0.05).Conclusion The effect of bisoprolol on HFpEF patients is remarkable. CgA is useful for condition judgment and prognosis of HFpEF patients.%目的:观察比索洛尔对左室射血分数保留的心力衰竭(HFpEF)患者嗜铬粒蛋白A(CgA)的影响,探讨CgA在HFpEF患者中的价值及比索洛尔的治疗效果。方法选取2014年1月~2015年12月于河北医科大学第一医院心血管内科住院并诊断为左室射血分数保留的心力衰竭患者66例,随机分为治疗组和对照组,每组各33例,治疗组给予比索洛尔加标准化治疗,对照组仅给予标准化治疗。2周后检测两组患者CgA水平、监测超声心动图变化。结果两组患者治疗前CgA、左室射血分数(LVEF)、左室舒张末期内径(LVEDD)、左室收缩末内经(LVESD)、E峰、A峰、E/A、左室等容舒

  3. Global Longitudinal Strain Is a Superior Predictor of All-Cause Mortality in Heart Failure With Reduced Ejection Fraction

    DEFF Research Database (Denmark)

    Sengeløv, Morten; Jørgensen, Peter Godsk; Jensen, Jan Skov;

    2015-01-01

    OBJECTIVES: The purpose of this study was to investigate the prognostic value of global longitudinal strain (GLS) in heart failure with reduced ejection fraction (HFrEF) patients in relation to all-cause mortality. BACKGROUND: Measurement of myocardial deformation by 2-dimensional speckle tracking...

  4. 39. Speckle tracking echocardiography in patients with severe aortic stenosis and preserved ejection fraction undergoing aortic valve replacement

    Directory of Open Access Journals (Sweden)

    Mohamad Abdelshafy

    2015-10-01

    Conclusions: following AVR a significant improvement in LV myocardial strain both longitudinal and circumferential occurred. Strain analysis by 2D-STE can detect early and subtle changes in LV systolic function and might play a role in early intervention for severe AS with preserved ejection fraction.

  5. Connecting heart failure with preserved ejection fraction and renal dysfunction : the role of endothelial dysfunction and inflammation

    NARCIS (Netherlands)

    ter Maaten, Jozine M.; Damman, Kevin; Verhaar, Marianne C.; Paulus, Walter J.; Duncker, Dirk J.; Cheng, Caroline; van Heerebeek, Loek; Hillege, Hans L.; Lam, Carolyn S. P.; Navis, Gerjan; Voors, Adriaan A.

    2016-01-01

    Renal dysfunction in heart failure with preserved ejection fraction (HFpEF) is common and is associated with increased mortality. Impaired renal function is also a risk factor for developing HFpEF. A new paradigm for HFpEF, proposing a sequence of events leading to myocardial remodelling and dysfunc

  6. Serelaxin in acute heart failure patients with preserved left ventricular ejection fraction : results from the RELAX-AHF trial

    NARCIS (Netherlands)

    Filippatos, Gerasimos; Teerlink, John R.; Farmakis, Dimitrios; Cotter, Gad; Davison, Beth A.; Felker, G. Michael; Greenberg, Barry H.; Hua, Tsushung; Ponikowski, Piotr; Severin, Thomas; Unemori, Elaine; Voors, Adriaan A.; Metra, Marco

    2014-01-01

    Aims Serelaxin is effective in relieving dyspnoea and improving multiple outcomes in acute heart failure (AHF). Many AHF patients have preserved ejection fraction (HFpEF). Given the lack of evidence-based therapies in this population, we evaluated the effects of serelaxin according to EF in RELAX-AH

  7. Effect of Metformin on Metabolites and Relation With Myocardial Infarct Size and Left Ventricular Ejection Fraction After Myocardial Infarction

    NARCIS (Netherlands)

    Eppinga, Ruben N; Kofink, Daniel; Dullaart, Robin P F; Dalmeijer, Geertje W; Lipsic, Erik; van Veldhuisen, Dirk J; van der Horst, Iwan C C; Asselbergs, Folkert W; van der Harst, Pim

    2017-01-01

    BACKGROUND: Left ventricular ejection fraction (LVEF) and infarct size (ISZ) are key predictors of long-term survival after myocardial infarction (MI). However, little is known about the biochemical pathways driving LV dysfunction after MI. To identify novel biomarkers predicting post-MI LVEF and IS

  8. RECURRENT STROKE IN THE WARFARIN VERSUS ASPIRIN IN REDUCED EJECTION FRACTION (WARCEF) TRIAL

    Science.gov (United States)

    Pullicino, Patrick M.; Qian, Min; Sacco, Ralph L.; Freudenberger, Ron; Graham, Susan; Teerlink, John R.; Mann, Douglas; Di Tullio, Marco R.; Ponikowski, Piotr; Lok, Dirk J.; Anker, Stefan D.; Lip, Gregory Y.H.; Estol, Conrado J.; Levin, Bruce; Mohr, J.P.; Thompson, John L. P.; Homma, Shunichi

    2014-01-01

    Background and Purpose WARCEF randomized 2305 patients in sinus rhythm with ejection fraction (EF) ≤35% to warfarin (INR 2.0–3.5) or aspirin 325 mg. Warfarin reduced the incident ischemic stroke (IIS) hazard rate by 48% over aspirin in a secondary analysis. The IIS rate in heart failure (HF) is too low to warrant routine anticoagulation but epidemiologic studies show that prior stroke increases the stroke risk in HF. We here explore IIS rates in WARCEF patients with and without baseline stroke to look for risk factors for IIS and determine if a subgroup with an IIS rate high enough to give a clinically relevant stroke risk reduction can be identified. Methods We compared potential stroke risk factors between patients with baseline stroke and those without using the exact conditional score test for Poisson variables. We looked for risk factors for IIS, by comparing IIS rates between different risk factors. For EF we tried cutoff points of 10%, 15% and 20%. 15% was used as it was the highest EF that was associated with a significant increase in IIS rate. IIS and EF strata were balanced as to warfarin/aspirin assignment by the stratified randomized design. A multiple Poisson regression examined the simultaneous effects of all risk factors on IIS rate. IIS rates per hundred patient years (/100PY) were calculated in patient groups with significant risk factors. Missing values were assigned the modal value. Results Twenty of 248 (8.1%) patients with baseline stroke and 64 of 2048 (3.1%) without had IIS. IIS rate in patients with baseline stroke (2.37/100PY) was greater than patients without (0.89/100PY)(rate ratio 2.68, p<0.001). Fourteen of 219 (6.4%) patients with ejection fraction (EF)<15% and 70 of 2079 (3.4%) with EF ≥15% had IIS. In the multiple regression analysis stroke at baseline (p<0.001) and EF<15% vs. ≥15% (p=.005) remained significant predictors of IIS. IIS rate was 2.04/100PY in patients with EF<15% and 0.95/100PY in patients with EF ≥15% (p=0

  9. Safety and efficacy of rennin-angiotensin system inhibitors in heart failure with preserved ejection fraction '

    Directory of Open Access Journals (Sweden)

    Mukesh Singh

    2011-04-01

    Full Text Available Background: Approximately half of the patients with chronic heart failure have preserved left ventricular systolic function. The trials of rennin-angiotensin system inhibitors (RASIs in this population have yielded mixed results. We performed a meta-analysis of these trials to evaluate the safety and efficacy of RASIs in heart failure with preserved ejection fraction patients.Methods: A total of 8425 patients from six prospective randomized controlled trials were analyzed. The end points extracted were total mortality, cardiovascular mortality, hospitalization for heart failure, worsening of heart failure, worsening of renal failure, hyperkalemia, hypotension, six minute walk test, quality of life score. RASIs evaluated were perindopril, enalapril, ramipril, valsartan, candesartan and irbesartan. Combined odds ratios (OR across all the studies and 95% confidence intervals (CI were computed. A two-sided alpha error <0.05 was considered to be statistically significant. All studies were homogeneous for outcomes studied, so fixed effect model was used for this meta- analysis.Results: Both groups share similar baseline characteristics. There was significant reduction in worsening of heart failure events [OR: 1.16, CI: 1.03-1.31; p<0.05] with RASIs compared to placebo group. This was associated with a tendency toward reduced hospitalizations due to heart failure [OR: 1.11, CI: 0.99-1.24; p=0.052] but it could not achieve statistical significance. RASIs also failed to show any benefit in total mortality [OR: 1.07, CI: 0.96-1.19; p=0.19] or cardiovascular mortality [OR: 1.01, CI: 0.89-1.15; p= 0.84] [Figure 1]. However, treatment with RASI lead to significant improvement in six minute walking distance [p<0.05] and quality of life score in RASIs group [p=0.002] [Figure 1]. Safety analysis, as expected, revealed significantly more hyperkalemic events [OR: 0.53, CI: 0.29-0.95; p<0.05] and worsening of renal failure [OR: 0.65, CI: 0.50-0.85; p<0.05] in RASI

  10. Potential clinical impact of cardiovascular magnetic resonance assessment of ejection fraction on eligibility for cardioverter defibrillator implantation

    Directory of Open Access Journals (Sweden)

    Joshi Subodh B

    2012-10-01

    Full Text Available Abstract Background For the primary prevention of sudden cardiac death, guidelines provide left ventricular ejection fraction (EF criteria for implantable cardioverter defibrillator (ICD placement without specifying the technique by which it should be measured. We sought to investigate the potential impact of performing cardiovascular magnetic resonance (CMR for EF on ICD eligibility. Methods The study population consisted of patients being considered for ICD implantation who were referred for EF assessment by CMR. Patients who underwent CMR within 30 days of echocardiography were included. Echocardiographic EF was determined by Simpson’s biplane method and CMR EF was measured by Simpson’s summation of discs method. Results Fifty-two patients (age 62±15 years, 81% male had a mean EF of 38 ± 14% by echocardiography and 35 ± 14% by CMR. CMR had greater reproducibility than echocardiography for both intra-observer (ICC, 0.98 vs 0.94 and inter-observer comparisons (ICC 0.99 vs 0.93. The limits of agreement comparing CMR and echocardiographic EF were – 16 to +10 percentage points. CMR resulted in 11 of 52 (21% and 5 of 52 (10% of patients being reclassified regarding ICD eligibility at the EF thresholds of 35 and 30% respectively. Among patients with an echocardiographic EF of between 25 and 40%, 9 of 22 (41% were reclassified by CMR at either the 35 or 30% threshold. Echocardiography identified only 1 of the 6 patients with left ventricular thrombus noted incidentally on CMR. Conclusions CMR resulted in 21% of patients being reclassified regarding ICD eligibility when strict EF criteria were used. In addition, CMR detected unexpected left ventricular thrombus in almost 10% of patients. Our findings suggest that the use of CMR for EF assessment may have a substantial impact on management in patients being considered for ICD implantation.

  11. Assessing left ventricular systolic dysfunction after myocardial infarction: are ejection fraction and dP/dt(max) complementary or redundant?

    Science.gov (United States)

    Ishikawa, Kiyotake; Chemaly, Elie R; Tilemann, Lisa; Fish, Kenneth; Ladage, Dennis; Aguero, Jaime; Vahl, Torsten; Santos-Gallego, Carlos; Kawase, Yoshiaki; Hajjar, Roger J

    2012-04-01

    Among the various cardiac contractility parameters, left ventricular (LV) ejection fraction (EF) and maximum dP/dt (dP/dt(max)) are the simplest and most used. However, these parameters are often reported together, and it is not clear if they are complementary or redundant. We sought to compare the discriminative value of EF and dP/dt(max) in assessing systolic dysfunction after myocardial infarction (MI) in swine. A total of 220 measurements were obtained. All measurements included LV volumes and EF analysis by left ventriculography, invasive ventricular pressure tracings, and echocardiography. Baseline measurements were performed in 132 pigs, and 88 measurements were obtained at different time points after MI creation. Receiver operator characteristic (ROC) curves to distinguish the presence or absence of an MI revealed a good predictive value for EF [area under the curve (AUC): 0.998] but not by dP/dt(max) (AUC: 0.69, P EF). Dividing dP/dt(max) by LV end-diastolic pressure and heart rate (HR) significantly increased the AUC to 0.87 (P EF). In naïve pigs, the coefficient of variation of dP/dt(max) was twice than that of EF (22.5% vs. 9.5%, respectively). Furthermore, in n = 19 pigs, dP/dt(max) increased after MI. However, echocardiographic strain analysis of 23 pigs with EF ranging only from 36% to 40% after MI revealed significant correlations between dP/dt(max) and strain parameters in the noninfarcted area (circumferential strain: r = 0.42, P = 0.05; radial strain: r = 0.71, P EF is a more accurate measure of systolic dysfunction than dP/dt(max) in a swine model of MI. Despite the variability of dP/dt(max) both in naïve pigs and after MI, it may sensitively reflect the small changes of myocardial contractility.

  12. Acute hemodynamic effects of inhaled sodium nitrite in pulmonary hypertension associated with heart failure with preserved ejection fraction

    Science.gov (United States)

    Simon, Marc A.; Vanderpool, Rebecca R.; Nouraie, Mehdi; Bachman, Timothy N.; White, Pamela M.; Sugahara, Masataka; Gorcsan, John; Parsley, Ed L.; Gladwin, Mark T.

    2016-01-01

    BACKGROUND. Pulmonary hypertension (PH) is associated with poor outcomes, yet specific treatments only exist for a small subset of patients. The most common form of PH is that associated with left heart disease (Group 2), for which there is no approved therapy. Nitrite has shown efficacy in preclinical animal models of Group 1 and 2 PH, as well as in patients with left heart failure with preserved ejection fraction (HFpEF). We evaluated the safety and efficacy of a potentially novel inhaled formulation of nitrite in PH-HFpEF patients as compared with Group 1 and 3 PH. METHODS. Cardiopulmonary hemodynamics were recorded after acute administration of inhaled nitrite at 2 doses, 45 and 90 mg. Safety endpoints included change in systemic blood pressure and methemoglobin levels. Responses were also compared with those administered inhaled nitric oxide. RESULTS. Thirty-six patients were enrolled (10 PH-HFpEF, 20 Group 1 pulmonary arterial hypertension patients on background PH-specific therapy, and 6 Group 3 PH). Drug administration was well tolerated. Nitrite inhalation significantly lowered pulmonary, right atrial, and pulmonary capillary wedge pressures, most pronounced in patients with PH-HFpEF. There was a modest decrease in cardiac output and systemic blood pressure. Pulmonary vascular resistance decreased only in Group 3 PH patients. There was substantial increase in pulmonary artery compliance, most pronounced in patients with PH-HFpEF. CONCLUSIONS. Inhaled nitrite is safe in PH patients and may be efficacious in PH-HFpEF and Group 3 PH primarily via improvements in left and right ventricular filling pressures and pulmonary artery compliance. The lack of change in pulmonary vascular resistance likely may limit efficacy for Group 1 patients. TRIAL REGISTRATION. ClinicalTrials.gov NCT01431313 FUNDING. This work was supported in part by the NIH grants P01HL103455 (to MAS and MTG), R01HL098032 (to MTG), and R01HL096973 (to MTG), and Mast Therapeutics, Inc. PMID

  13. Presence of ´isolated´ tricuspid regurgitation should prompt the suspicion of heart failure with preserved ejection fraction

    Science.gov (United States)

    Mascherbauer, Julia; Kammerlander, Andreas A.; Zotter-Tufaro, Caroline; Aschauer, Stefan; Duca, Franz; Dalos, Daniel; Winkler, Susanne; Schneider, Matthias; Bergler-Klein, Jutta; Bonderman, Diana

    2017-01-01

    Background Diastolic dysfunction of the left ventricle is common but frequently under-diagnosed. Particularly in advanced stages affected patients may present with significant functional tricuspid regurgitation (TR) as the most prominent sign on echocardiography. The underlying left ventricular pathology may eventually be missed and symptoms of heart failure are attributed to TR, with respective therapeutic consequences. The aim of the present study was to determine prevalence and mechanisms underlying TR evolution in heart failure with preserved ejection fraction (HFpEF). Methods and results Consecutive HFpEF patients were enrolled in this prospective, observational study. Confirmatory diagnostic tests including echocardiography and invasive hemodynamic assessments were performed. Of the 175 patients registered between 2010 and 2014, 51% had significant (moderate or severe) TR without structural abnormalities of the tricuspid valve. Significant hemodynamic differences between patients with and without relevant TR were encountered. These included elevated pulmonary vascular resistance (p = 0.038), reduced pulmonary arterial compliance (PAC, p = 0.005), and elevated left ventricular filling pressures (p = 0.039) in the TR group. Multivariable binary logistic regression analysis revealed diastolic pulmonary artery pressure (p = 0.029) and PAC (p = 0.048) as independent determinants of TR. Patients were followed for 18.1±14.1 months, during which 32% had a cardiac event. While TR was associated with outcome in the univariable analysis, it failed to predict event-free survival in the multivariable model. Conclusions The presence of ´isolated´ functional TR should prompt the suspicion of HFpEF. Our data show that significant TR is a marker of advanced HFpEF but neither an isolated entity nor independently associated with event-free survival. PMID:28199339

  14. Application of the Age, Creatinine, and Left Ventricular Ejection Fraction Score for Patients on Extracorporeal Membrane Oxygenation.

    Science.gov (United States)

    Tsai, Tsung-Yu; Tsai, Feng-Chun; Fan, Pei-Chun; Chang, Chih-Hsiang; Lin, Chan-Yu; Chang, Wei-Wen; Lee, Shen-Yang; Hsu, Hsiang-Hao; Tian, Ya-Chung; Fang, Ji-Tseng; Yang, Chih-Wei; Chen, Yung-Chang

    2017-02-01

    Patients on extracorporeal membrane oxygenation (ECMO) usually have high mortality rate and poor outcome. Age, Creatinine, and Left Ventricular Ejection Fraction (ACEF) score is an easy-calculating score and provides good performance on mortality prediction in patients undergoing cardiac operations or percutaneous coronary intervention, but it has not been applied to patients on ECMO before. In this study, we aimed to use ACEF score obtained within 1 week of ECMO support for in-hospital mortality prediction in patients on ECMO due to severe myocardial failure. This study reviewed the medical records of 306 patients on ECMO at a specialized intensive care unit (CVSICU) in a tertiary-care university hospital between March 2002 and December 2011, and 105 patients on veno-arterial ECMO due to severe myocardial failure were enrolled. Demographic, clinical, and laboratory variables were retrospectively collected as survival predictors. The overall mortality rate was 47.6%. The most frequent condition requiring ICU admission was postcardiotomy cardiogenic shock. Multiple logistic regression analysis indicated that post-ECMO ACEF score, Sequential Organ Failure Assessment score, and troponin I on day 1 of ECMO support were independent risk factors for in-hospital mortality. Using the area under the receiver operating characteristic curve (AUROC), the post-ECMO ACEF score indicated a good discriminative power (AUROC 0.801 ± 0.042). Finally, cumulative survival rates at 6-month follow-up differed significantly (P  2.22. After ECMO treatment due to severe myocardial failure, post-ECMO ACEF score provides an easy-calculating method with a reproducible evaluation tool with excellent prognostic abilities in these patients.

  15. Regional ejection fraction and regional area strain for left ventricular function assessment in male patients after first-time myocardial infarction.

    Science.gov (United States)

    Teo, Soo-Kng; Vos, F J A; Tan, Ru-San; Zhong, Liang; Su, Yi

    2015-04-01

    In this work, we present a method to assess left ventricle (LV) regional function from cardiac magnetic resonance (CMR) imaging based on the regional ejection fraction (REF) and regional area strain (RAS). CMR scans were performed for 30 patients after first-time myocardial infarction (MI) and nine age- and sex-matched healthy volunteers. The CMR images were processed to reconstruct three-dimensional LV geometry, and the REF and RAS in a 16-segment model were computed using our proposed methodology. The method of computing the REF was tested and shown to be robust against variation in user input. Furthermore, analysis of data was feasible in all patients and healthy volunteers without any exclusions. The REF correlated well with the RAS in a nonlinear manner (quadratic fit-R(2) = 0.88). In patients after first-time MI, the REF and RAS were significantly reduced across all 16 segments (REF: p function in the patients with preserved global ejection fraction with reasonable accuracy (more than 78%). These preliminary results confirmed the validity of our approach for accurate analysis of LV regional function. Our approach potentially offers physicians new insights into the local characteristics of the myocardial mechanics after a MI.

  16. Abnormal calcium homeostasis in heart failure with preserved ejection fraction is related to both reduced contractile function and incomplete relaxation: An electromechanically detailed biophysical modelling study

    Directory of Open Access Journals (Sweden)

    Ismail eAdeniran

    2015-03-01

    Full Text Available Heart failure with preserved ejection fraction (HFpEF accounts for about 50% of heart failure cases. It has features of incomplete relaxation and increased stiffness of the left ventricle. Studies from clinical electrophysiology and animal experiments have found that HFpEF is associated with impaired calcium homeostasis, ion channel remodelling and concentric left ventricle hypertrophy (LVH. However, it is still unclear how the abnormal calcium homeostasis, ion channel and structural remodelling affect the electro-mechanical dynamics of the ventricles. In this study we have developed multiscale models of the human left ventricle from single cells to the 3D organ, which take into consideration HFpEF-induced changes in calcium handling, ion channel remodelling and concentric LVH. Our simulation results suggest that at the cellular level, HFpEF reduces the systolic calcium level resulting in a reduced systolic contractile force, but elevates the diastolic calcium level resulting in an abnormal residual diastolic force. In our simulations, these abnormal electro-mechanical features of the ventricular cells became more pronounced with the increase of the heart rate. However, at the 3D organ level, the ejection fraction of the left ventricle was maintained due to the concentric LVH. The simulation results of this study mirror clinically observed features of HFpEF and provide new insights towards the understanding of the cellular bases of impaired cardiac electromechanical functions in heart failure.

  17. A novel paradigm for heart failure with preserved ejection fraction: comorbidities drive myocardial dysfunction and remodeling through coronary microvascular endothelial inflammation.

    Science.gov (United States)

    Paulus, Walter J; Tschöpe, Carsten

    2013-07-23

    Over the past decade, myocardial structure, cardiomyocyte function, and intramyocardial signaling were shown to be specifically altered in heart failure with preserved ejection fraction (HFPEF). A new paradigm for HFPEF development is therefore proposed, which identifies a systemic proinflammatory state induced by comorbidities as the cause of myocardial structural and functional alterations. The new paradigm presumes the following sequence of events in HFPEF: 1) a high prevalence of comorbidities such as overweight/obesity, diabetes mellitus, chronic obstructive pulmonary disease, and salt-sensitive hypertension induce a systemic proinflammatory state; 2) a systemic proinflammatory state causes coronary microvascular endothelial inflammation; 3) coronary microvascular endothelial inflammation reduces nitric oxide bioavailability, cyclic guanosine monophosphate content, and protein kinase G (PKG) activity in adjacent cardiomyocytes; 4) low PKG activity favors hypertrophy development and increases resting tension because of hypophosphorylation of titin; and 5) both stiff cardiomyocytes and interstitial fibrosis contribute to high diastolic left ventricular (LV) stiffness and heart failure development. The new HFPEF paradigm shifts emphasis from LV afterload excess to coronary microvascular inflammation. This shift is supported by a favorable Laplace relationship in concentric LV hypertrophy and by all cardiac chambers showing similar remodeling and dysfunction. Myocardial remodeling in HFPEF differs from heart failure with reduced ejection fraction, in which remodeling is driven by loss of cardiomyocytes. The new HFPEF paradigm proposes comorbidities, plasma markers of inflammation, or vascular hyperemic responses to be included in diagnostic algorithms and aims at restoring myocardial PKG activity.

  18. Incidence and epidemiology of new onset heart failure with preserved vs. reduced ejection fraction in a community-based cohort : 11-year follow-up of PREVEND

    NARCIS (Netherlands)

    Brouwers, Frank P.; de Boer, Rudolf A.; van der Harst, Pim; Voors, Adriaan A.; Gansevoort, Ron T.; Bakker, Stephan J.; Hillege, Hans L.; van Veldhuisen, Dirk J.; van Gilst, Wiek H.

    2013-01-01

    Differences in clinical characteristics and outcome of patients with established heart failure with preserved ejection fraction (HFpEF) and heart failure with reduced ejection fraction (HFrEF) are well established. Data on epidemiology and prediction of new onset HFpEF, compared with HFrEF, have not

  19. Sacubitril/Valsartan: A Review in Chronic Heart Failure with Reduced Ejection Fraction.

    Science.gov (United States)

    McCormack, Paul L

    2016-03-01

    Sacubitril/valsartan (Entresto™; LCZ696) is an orally administered supramolecular sodium salt complex of the neprilysin inhibitor prodrug sacubitril and the angiotensin receptor blocker (ARB) valsartan, which was recently approved in the US and the EU for the treatment of chronic heart failure (NYHA class II-IV) with reduced ejection fraction (HFrEF). In the large, randomized, double-blind, PARADIGM-HF trial, sacubitril/valsartan reduced the incidence of death from cardiovascular causes or first hospitalization for worsening heart failure (composite primary endpoint) significantly more than the angiotensin converting enzyme (ACE) inhibitor enalapril. Sacubitril/valsartan was also superior to enalapril in reducing death from any cause and in limiting the progression of heart failure. Sacubitril/valsartan was generally well tolerated, with no increase in life-threatening adverse events. Symptomatic hypotension was significantly more common with sacubitril/valsartan than with enalapril; the incidence of angio-oedema was low. Therefore, sacubitril/valsartan is a more effective replacement for an ACE inhibitor or an ARB in the treatment of HFrEF, and is likely to influence the basic approach to treatment.

  20. Heart Failure with a Preserved Ejection Fraction: From Pathophysiology to Biomarkers ... and Beyond!

    Directory of Open Access Journals (Sweden)

    Gilles De Keulenaer

    2011-02-01

    Full Text Available Diagnosing and managing heart failure according to the left ventricle’s ejection fraction (LVEF has become part of evidence-based medicine. Not surprisingly, LVEF - a powerful prognostic factor in heart failure - has caused a marked heterogeneity in the clinical benefit of various therapeutic interventions. From a pathophysiological point of view, however, many disease characteristics are shared among the entire heart failure spectrum (from low to high LVEF. The many functional and anatomical differences within the spectrum are merely quantitative, with an extensive overlap between the extremes of the spectrum and belonging to the same linear relation when plotted against LVEF. Therefore, although counter-intuitive from a clinical point of view, from a patho- physiological point of view heart failure seems to progress along a common disease trajectory independently of LVEF. In this review, we will scrutinise this apparent paradox, estimate how it relates to the recent biomarker-oriented (as opposed to a classic LVEF-oriented approach to heart failure and discuss to what extent it may affect conceptual progress in chronic heart failure

  1. Gallbladder ejection fraction using {sup 99m}Tc-DISIDA scan in diabetic autonomic neuropathy

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Seong Jang; Kim, In Ju; Kim, Yong Ki; An, Jun Hyup [Pusan National Univ. Hospital, Pusan (Korea, Republic of); Yoo, Seok Dong [Dongkuk Univ. College of Medicine, Seoul (Korea, Republic of)

    2000-02-01

    We performed this study to evaluate the changes of gallbladder ejection fraction (GBEF) in diabetic patients with or without autonomic neuropathy. This study included 37 diabetic patients (25 women, 12 men, mean age 51 years) and 24 normal controls (10 women, 14 men, mean age 38 years). After intravenous injection of 185 MBq of {sup 99m}T{sub c}-DISIDA, serial anterior abdominal images were acquired before and after fatty meal. Regions of interest were applied on gallbladder and right hepatic lobe on 60 and 90 minute images to calculate GBEF. GBEF was significantly reduced in diabetes with autonomic neuropathy (43{+-}12.3%) and without autonomic neuropathy (57.5{+-}13.2%) compared with normal controls (68{+-}11.6%, p<0.05). And also, GBEF was significantly reduced in diabetes with autonomic neuropathy compared with diabetes without autonomic neuropathy (p<0.05). Fasting blood glucose level, age, sex, hemoglobin A1c, body mass index, serum lipid level were not different in these two diabetic patient groups (p>0.05). When 50.2% of GBEF was used as the criteria for diabetic autonomic neuropathy, the sensitivity and specificity were 80%, 76.5%, respectively. The area under receiver operating characteristic curve was 0.846. GBEF of diabetic patients with autonomic neuropathy was significantly reduced than that of diabetic patients without autonomic neuropathy.

  2. Extraction of Left Ventricular Ejection Fraction Information from Various Types of Clinical Reports.

    Science.gov (United States)

    Kim, Youngjun; Garvin, Jennifer H; Goldstein, Mary K; Hwang, Tammy S; Redd, Andrew; Bolton, Dan; Heidenreich, Paul A; Meystre, Stéphane M

    2017-02-02

    Efforts to improve the treatment of congestive heart failure, a common and serious medical condition, include the use of quality measures to assess guideline-concordant care. The goal of this study is to identify left ventricular ejection fraction (LVEF) information from various types of clinical notes, and to then use this information for heart failure quality measurement. We analyzed the annotation differences between a new corpus of clinical notes from the Echocardiography, Radiology, and Text Integrated Utility package and other corpora annotated for natural language processing (NLP) research in the Department of Veterans Affairs. These reports contain varying degrees of structure. To examine whether existing LVEF extraction modules we developed in prior research improve the accuracy of LVEF information extraction from the new corpus, we created two sequence-tagging NLP modules trained with a new data set, with or without predictions from the existing LVEF extraction modules. We also conducted a set of experiments to examine the impact of training data size on information extraction accuracy. We found that less training data is needed when reports are highly structured, and that combining predictions from existing LVEF extraction modules improves information extraction when reports have less structured formats and a rich set of vocabulary.

  3. Digoxin in Heart Failure with a Reduced Ejection Fraction: A Risk Factor or a Risk Marker.

    Science.gov (United States)

    Konstantinou, Dimitrios M; Karvounis, Haralambos; Giannakoulas, George

    2016-01-01

    Digoxin is one of the oldest compounds used in cardiovascular medicine. Nevertheless, its mechanism of action and most importantly its clinical utility have been the subject of an endless dispute. Positive inotropic and neurohormonal modulation properties are attributed to digoxin, and it was the mainstay of heart failure therapeutics for decades. However, since the institution of β-blockers and aldosterone antagonists as part of modern heart failure medical therapy, digoxin prescription rates have been in free fall. The fact that digoxin is still listed as a valid therapeutic option in both American and European heart failure guidelines has not altered clinicians' attitude towards the drug. Since the publication of original Digitalis Investigation Group trial data, a series of reports based predominately on observational studies and post hoc analyses have raised concerns about the clinical efficacy and long-term safety of digoxin. In the present review, we will attempt a critical appraisal of the available clinical evidence regarding the efficacy and safety of digoxin in heart failure patients with a reduced ejection fraction. The methodological issues, strengths, and limitations of individual studies will be highlighted.

  4. Tensor Factorization for Precision Medicine in Heart Failure with Preserved Ejection Fraction.

    Science.gov (United States)

    Luo, Yuan; Ahmad, Faraz S; Shah, Sanjiv J

    2017-01-23

    Heart failure with preserved ejection fraction (HFpEF) is a heterogeneous clinical syndrome that may benefit from improved subtyping in order to better characterize its pathophysiology and to develop novel targeted therapies. The United States Precision Medicine Initiative comes amid the rapid growth in quantity and modality of clinical data for HFpEF patients ranging from deep phenotypic to trans-omic data. Tensor factorization, a form of machine learning, allows for the integration of multiple data modalities to derive clinically relevant HFpEF subtypes that may have significant differences in underlying pathophysiology and differential response to therapies. Tensor factorization also allows for better interpretability by supporting dimensionality reduction and identifying latent groups of data for meaningful summarization of both features and disease outcomes. In this narrative review, we analyze the modest literature on the application of tensor factorization to related biomedical fields including genotyping and phenotyping. Based on the cited work including work of our own, we suggest multiple tensor factorization formulations capable of integrating the deep phenotypic and trans-omic modalities of data for HFpEF, or accounting for interactions between genetic variants at different omic hierarchies. We encourage extensive experimental studies to tackle challenges in applying tensor factorization for precision medicine in HFpEF, including effectively incorporating existing medical knowledge, properly accounting for uncertainty, and efficiently enforcing sparsity for better interpretability.

  5. Heart failure preserved ejection fraction (HFpEF): an integrated and strategic review.

    Science.gov (United States)

    Lekavich, Carolyn L; Barksdale, Debra J; Neelon, Virginia; Wu, Jia-Rong

    2015-11-01

    In the USA, 5.7 million Americans ≥20 years have heart failure (HF) and heart failure preserved ejection fraction (HFpEF) accounts for at least 50 % of all hospital admissions for HF. HFpEF has no single guideline for diagnosis or treatment, the patient population is heterogeneously and inconsistently described, and longitudinal studies are lacking. The primary aims of this manuscript were to present an integrated review of the current state of the science on HFpEF, demonstrate gaps in the literature and provide the rationale for the design and implementation of future research to yield insights into the syndrome of HFpEF. The scientific literature was comprehensively reviewed on HFpEF pathophysiology, patient characteristics, diagnostic criteria, echocardiography biomarkers, treatment approaches and outcomes. Discrepancies in patient characteristics, diagnostic criteria, study methods and echocardiographic biomarkers were identified. This review indicates that no single test or guideline exists for diagnosis or treatment for HFpEF; heterogeneity of the population is complicated by multiple comorbidities that factor into etiology, race and age are likely important factors that define the phenotype, and limited information is available that designates early markers of impending HFpEF. Studies designed and adequately powered to study the impact of race and age along with consistent use of HFpEF diagnostic criteria are critically needed to further incident HFpEF research.

  6. Current Perspectives on Systemic Hypertension in Heart Failure with Preserved Ejection Fraction.

    Science.gov (United States)

    Tam, Marty C; Lee, Ran; Cascino, Thomas M; Konerman, Matthew C; Hummel, Scott L

    2017-02-01

    Heart failure with preserved ejection fraction (HFpEF) is a prevalent but incompletely understood syndrome. Traditional models of HFpEF pathophysiology revolve around systemic HTN and other causes of increased left ventricular afterload leading to left ventricular hypertrophy (LVH) and diastolic dysfunction. However, emerging models attribute the development of HFpEF to systemic proinflammatory changes secondary to common comorbidities which include HTN. Alterations in passive ventricular stiffness, ventricular-arterial coupling, peripheral microvascular function, systolic reserve, and chronotropic response occur. As a result, HFpEF is heterogeneous in nature, making it difficult to prescribe uniform therapies to all patients. Nonetheless, treating systemic HTN remains a cornerstone of HFpEF management. Antihypertensive therapies have been linked to LVH regression and improvement in diastolic dysfunction. However, to date, no therapies have definitive mortality benefit in HFpEF. Non-pharmacologic management for HTN, including dietary modification, exercise, and treating sleep disordered breathing, may provide some morbidity benefit in the HFpEF population. Future research is need to identify effective treatments, perhaps in more specific subgroups, and focus may need to shift from reducing mortality to improving exercise capacity and symptoms. Tailoring antihypertensive therapies to specific phenotypes of HFpEF may be an important component of this strategy.

  7. Left ventricular ejection fraction and left ventricular end-diastolic volume in patients with diastolic dysfunction.

    Science.gov (United States)

    Jovin, Ion S; Ebisu, Keita; Liu, Yi-Hwa; Finta, Laurie A; Oprea, Adriana D; Brandt, Cynthia A; Dziura, James; Wackers, Frans J

    2013-01-01

    Diastolic dysfunction can be diagnosed on equilibrium radionuclide angiocardiography (ERNA) by a low peak filling rate (PFR) in the setting of a normal left ventricular ejection fraction (LVEF). The authors evaluated the relationship between diastolic dysfunction, LVEF, and end-diastolic volume (EDV). A total of 408 predominantly asymptomatic patients with an LVEF ≥50% by ERNA were studied. LVEF of patients with a low PFR was compared with the LVEF of patients with a normal PFR. Correlation analyses to evaluate the association between PFR and EDV were also performed. The LVEF of patients with a low PFR was lower than the LVEF of patients with normal PFR (59±7 vs 63%±7%; PPFR (r=-0.04; P=.32). The results did not change when the EDV indices were used. In patients who had repeat scans, there was no correlation between the change in EDV and the change in PFR (r=0.16; P=.2). In asymptomatic patients undergoing ERNA who have normal systolic function, a low PFR can be associated with a lower LVEF, but it is not associated with changes in EDV. This suggests that diastolic dysfunction is associated with mild systolic dysfunction.

  8. Determination of right ventricular ejection fraction in children with cystic fibrosis, using krypton-81m

    Energy Technology Data Exchange (ETDEWEB)

    Piepsz, A.; Ham, H.R.; Millet, E.; Dab, I.

    1984-01-01

    The diagnosis of cor pulmonale and incipient heart failure remains difficult to assess in cystic fibrosis (CF) on the basis of the clinical as well as the biological parameters. The measurement of the right ventricular ejection fraction has been facilitated these last years by the introduction of the radionuclide methods. Methodological difficulties are however encountered when Tc-99m RBC are used, and are mainly related to heart chambers superposition (equilibrium method) or the low count density (first pass method). Few papers have been published on RVEF in cystic fibrosis and the results are somewhat contradictory. The authors have recently introduced a new method for the determination of RVEF, using equilibrium study during continuous injection of Kr-81m in glucose solution. This method offers several advantages related to an increased accuracy and a favorable dosimetry. In 25 patients aged 2 to 23 years with CF, one or more RVEF studies were performed. The severity of the disease was evaluated on the basis of the clinical Schwachman score, the lung function tests, the ventilation scan and the pa02. RVEF tended to decrease with the progression of the lung disease, although, owing to the spread of the results, no RVEF could be predicted on the basis of the other parameters. The decrease of RVEF in patients with advanced lung disease was moderate and terminal lung disease was sometimes associated with normal right heart contractility.

  9. Evaluation of biventricular ejection fraction with ECG-gated 16-slice CT: preliminary findings in acute pulmonary embolism in comparison with radionuclide ventriculography

    Energy Technology Data Exchange (ETDEWEB)

    Coche, Emmanuel; Goncette, Louis; Maldague, Baudouin [Universite Catholique de Louvain, Department of Medical Imaging, Cliniques Universitaires St-Luc, Brussels (Belgium); Vlassenbroek, Alain [Philips Medical Systems, Cleveland, OH (United States); Roelants, Veronique [Universite Catholique de Louvain, Department of Nuclear Medicine, Cliniques Universitaires St-Luc, Brussels (Belgium); D' Hoore, William [Catholic University of Louvain, Public Health, Brussels (Belgium); Verschuren, Franck [Universite Catholique de Louvain, Department of Emergency Medicine, Cliniques Universitaires St-Luc, Brussels (Belgium)

    2005-07-01

    This study aimed to assess the feasibility of cardiac global function evaluation during a whole-chest multi-slice CT (MSCT) acquisition in patients referred for suspicion of pulmonary embolism (PE), and to compare the results with planar equilibrium radionuclide ventriculography (ERNA). Ten consecutive haemodynamically stable patients (six female, four male; mean age 69.7 years; heart rate 65-99 bpm) with suspicion of PE underwent an MSCT and ERNA within a 6 h period. CT acquisition was performed after contrast medium injection by using 16 x 1.5 mm collimation and retrospective ECG gating. Left ventricular (LVEF) and right ventricular (RVEF) ejection fractions were calculated using dedicated three-dimensional software. Relationships between measurements obtained with MSCT and ERNA were assessed using linear regression analysis and reliability of MSCT was assessed with intra-class correlation coefficient. Bland-Altman analysis was performed to calculate limits of agreement between MSCT and ERNA. MSCT was performed successfully in ten patients with a mean acquisition time of 16.5{+-}2.8 s. Functional cardiac evaluation was possible on CT for all patients except for one due to poor opacification of right ventricle. Linear regression analysis showed a good correlation between MSCT and ERNA for the LVEF (R=0.91) and the RVEF (R=0.89) measurements. Intra-class correlation was superior for LVEF (0.92) than for the RVEF (0.68). Bland-Altman plots demonstrated that MSCT substantially overestimated the ERNA RVEF. Morphological CT data demonstrated PE in four of ten of patients and alternative diagnoses in five of ten patients. Our study reveals that MSCT with retrospective ECG gating may provide in one modality a morphological and a functional cardiopulmonary evaluation. Comparison with ERNA demonstrated a good correlation for both ventricular ejection fractions. (orig.)

  10. Evaluation of biventricular ejection fraction with ECG-gated 16-slice CT: preliminary findings in acute pulmonary embolism in comparison with radionuclide ventriculography.

    Science.gov (United States)

    Coche, Emmanuel; Vlassenbroek, Alain; Roelants, Véronique; D'Hoore, William; Verschuren, Franck; Goncette, Louis; Maldague, Baudouin

    2005-07-01

    This study aimed to assess the feasibility of cardiac global function evaluation during a whole-chest multi-slice CT (MSCT) acquisition in patients referred for suspicion of pulmonary embolism (PE), and to compare the results with planar equilibrium radionuclide ventriculography (ERNA). Ten consecutive haemodynamically stable patients (six female, four male; mean age 69.7 years; heart rate 65-99 bpm) with suspicion of PE underwent an MSCT and ERNA within a 6 h period. CT acquisition was performed after contrast medium injection by using 16x1.5 mm collimation and retrospective ECG gating. Left ventricular (LVEF) and right ventricular (RVEF) ejection fractions were calculated using dedicated three-dimensional software. Relationships between measurements obtained with MSCT and ERNA were assessed using linear regression analysis and reliability of MSCT was assessed with intra-class correlation coefficient. Bland-Altman analysis was performed to calculate limits of agreement between MSCT and ERNA. MSCT was performed successfully in ten patients with a mean acquisition time of 16.5+/-2.8 s. Functional cardiac evaluation was possible on CT for all patients except for one due to poor opacification of right ventricle. Linear regression analysis showed a good correlation between MSCT and ERNA for the LVEF (R=0.91) and the RVEF (R=0.89) measurements. Intra-class correlation was superior for LVEF (0.92) than for the RVEF (0.68). Bland-Altman plots demonstrated that MSCT substantially overestimated the ERNA RVEF. Morphological CT data demonstrated PE in four of ten of patients and alternative diagnoses in five of ten patients. Our study reveals that MSCT with retrospective ECG gating may provide in one modality a morphological and a functional cardiopulmonary evaluation. Comparison with ERNA demonstrated a good correlation for both ventricular ejection fractions.

  11. The Prognostic Value of the Left Ventricular Ejection Fraction Is Dependent upon the Severity of Mitral Regurgitation in Patients with Acute Myocardial Infarction.

    Science.gov (United States)

    Cho, Jung Sun; Youn, Ho-Joong; Her, Sung-Ho; Park, Maen Won; Kim, Chan Joon; Park, Gyung-Min; Jeong, Myung Ho; Cho, Jae Yeong; Ahn, Youngkeun; Kim, Kye Hun; Park, Jong Chun; Seung, Ki Bae; Cho, Myeong Chan; Kim, Chong Jin; Kim, Young Jo; Han, Kyoo Rok; Kim, Hyo Soo

    2015-07-01

    The prognostic value of the left ventricle ejection fraction (LVEF) after acute myocardial infarction (AMI) has been questioned even though it is an accurate marker of left ventricle (LV) systolic dysfunction. This study aimed to examine the prognostic impact of LVEF in patients with AMI with or without high-grade mitral regurgitation (MR). A total of 15,097 patients with AMI who received echocardiography were registered in the Korean Acute Myocardial Infarction Registry (KAMIR) between January 2005 and July 2011. Patients with low-grade MR (grades 0-2) and high-grade MR (grades 3-4) were divided into the following two sub-groups according to LVEF: LVEF ≤ 40% (n = 2,422 and 197, respectively) and LVEF > 40% (n = 12,252 and 226, respectively). The primary endpoints were major adverse cardiac events (MACE), cardiac death, and all-cause death during the first year after registration. Independent predictors of mortality in the multivariate analysis in AMI patients with low-grade MR were age ≥ 75 yr, Killip class ≥ III, N-terminal pro-B-type natriuretic peptide > 4,000 pg/mL, high-sensitivity C-reactive protein ≥ 2.59 mg/L, LVEF ≤ 40%, estimated glomerular filtration rate (eGFR), and percutaneous coronary intervention (PCI). However, PCI was an independent predictor in AMI patients with high-grade MR. No differences in primary endpoints between AMI patients with high-grade MR (grades 3-4) and EF ≤ 40% or EF > 40% were noted. MR is a predictor of a poor outcome regardless of ejection fraction. LVEF is an inadequate method to evaluate contractile function of the ischemic heart in the face of significant MR.

  12. Urinary Proteomics Pilot Study for Biomarker Discovery and Diagnosis in Heart Failure with Reduced Ejection Fraction.

    Directory of Open Access Journals (Sweden)

    Kasper Rossing

    Full Text Available Biomarker discovery and new insights into the pathophysiology of heart failure with reduced ejection fraction (HFrEF may emerge from recent advances in high-throughput urinary proteomics. This could lead to improved diagnosis, risk stratification and management of HFrEF.Urine samples were analyzed by on-line capillary electrophoresis coupled to electrospray ionization micro time-of-flight mass spectrometry (CE-MS to generate individual urinary proteome profiles. In an initial biomarker discovery cohort, analysis of urinary proteome profiles from 33 HFrEF patients and 29 age- and sex-matched individuals without HFrEF resulted in identification of 103 peptides that were significantly differentially excreted in HFrEF. These 103 peptides were used to establish the support vector machine-based HFrEF classifier HFrEF103. In a subsequent validation cohort, HFrEF103 very accurately (area under the curve, AUC = 0.972 discriminated between HFrEF patients (N = 94, sensitivity = 93.6% and control individuals with and without impaired renal function and hypertension (N = 552, specificity = 92.9%. Interestingly, HFrEF103 showed low sensitivity (12.6% in individuals with diastolic left ventricular dysfunction (N = 176. The HFrEF-related peptide biomarkers mainly included fragments of fibrillar type I and III collagen but also, e.g., of fibrinogen beta and alpha-1-antitrypsin.CE-MS based urine proteome analysis served as a sensitive tool to determine a vast array of HFrEF-related urinary peptide biomarkers which might help improving our understanding and diagnosis of heart failure.

  13. Relation of Pre-anthracycline Serum Bilirubin Levels to Left Ventricular Ejection Fraction After Chemotherapy.

    Science.gov (United States)

    Vera, Trinity; D'Agostino, Ralph B; Jordan, Jennifer H; Whitlock, Matthew C; Meléndez, Giselle C; Lamar, Zanetta S; Porosnicu, Mercedes; Bonkovsky, Herbert L; Poole, Leslie B; Hundley, W Gregory

    2015-12-01

    Myocardial injury because of oxidative stress manifesting through reductions in left ventricular ejection fraction (LVEF) may occur after the administration of anthracycline-based chemotherapy (A-bC). We hypothesized that bilirubin, an effective endogenous antioxidant, may attenuate the reduction in LVEF that sometimes occurs after receipt of A-bC. We identified 751 consecutively treated patients with cancer who underwent a pre-A-bC LVEF measurement, exhibited a serum total bilirubin level bilirubin and LVEF changes. The LVEF decreased by 10.7 ± 13.7%, 8.9 ± 11.8%, and 7.7 ± 11.5% in group 1 (bilirubin at baseline ≤0.5 mg/dl), group 2 (bilirubin 0.6 to 0.8 mg/dl), and group 3 (bilirubin 0.9 to 1.9 mg/dl), respectively. More group 1 patients experienced >15% decrease in LVEF compared with those in group 3 (p = 0.039). After adjusting for age, coronary artery disease/myocardial infarction, diabetes mellitus, hematocrit, and the use of cardioactive medications, higher precancer treatment bilirubin levels and lesser total anthracycline doses were associated with LVEF preservation (p = 0.047 and 0.011, respectively). In patients treated with anthracyclines who subsequently develop symptoms associated with heart failure, pre-anthracycline treatment serum bilirubin levels inversely correlate with subsequent deterioration in post-cancer treatment LVEF. In conclusion, these results suggest that increased levels of circulating serum total bilirubin, an intrinsic antioxidant, may facilitate preservation of LVEF in patients receiving A-bC for cancer.

  14. Prognostic value of ejection fraction in patients admitted with acute coronary syndrome: A real world study.

    Science.gov (United States)

    Perelshtein Brezinov, Olga; Klempfner, Robert; Zekry, Sagit Ben; Goldenberg, Ilan; Kuperstein, Rafael

    2017-03-01

    There are limited data regarding factors affecting outcomes among acute coronary syndrome (ACS) patients presenting with varying degrees of left ventricle (LV) dysfunction. We aimed to identify factors associated with mortality according to LV ejection fraction (LVEF) at 1st admission in ACS patients.A total of 8983 ACS patients prospectively enrolled in the Acute Coronary Syndrome Israeli Survey (2000-2010) were categorized according to their LVEF at admission: severe LV dysfunction (LVEF < 30% [n = 845]), mild-moderate LV dysfunction (LVEF 30%-49% [n = 4470]); preserved LV function (LVEF ≥ 50% [n = 3659]). Multivariable Cox proportional hazards regression modeling was used to assess the risk factors for 1-year mortality according to LVEF on admission.Over the past decade there was a gradual decline in the proportion of patients admitted with low LVEF. Mortality rates were highest among patients with severe LV dysfunction (36%), intermediate among those with mild-moderate LV dysfunction (10%), and lowest among those with preserved LV function (4%, P < 0.001). We recognized different risk factors for mortality according to LVEF at admission. Admission clinical features (syncope, anterior myocardial infarction, and ST elevation myocardial infarction [STEMI]) predicted mortality risk in patients with severe LV dysfunction (all P < 0.05), whereas the presence of comorbidities (hypertension, diabetes mellitus, chronic renal failure, and peripheral arterial disease) predicted mortality risk in patients with more preserved LV function. Age and admission Killip class ≥II were consistent predictors in all LVEF subsets.LVEF at admission is a strong predictor of mortality in ACS, and prognostic factors differ according to LVEF during admission. In patients with severe LV dysfunction signs of clinical instability are related to 1-year mortality; in patients with a more preserved LV function the prognosis is related to the presence of co-morbidities.

  15. Phenotype-Specific Treatment of Heart Failure With Preserved Ejection Fraction: A Multiorgan Roadmap.

    Science.gov (United States)

    Shah, Sanjiv J; Kitzman, Dalane W; Borlaug, Barry A; van Heerebeek, Loek; Zile, Michael R; Kass, David A; Paulus, Walter J

    2016-07-05

    Heart failure (HF) with preserved ejection fraction (EF; HFpEF) accounts for 50% of HF cases, and its prevalence relative to HF with reduced EF continues to rise. In contrast to HF with reduced EF, large trials testing neurohumoral inhibition in HFpEF failed to reach a positive outcome. This failure was recently attributed to distinct systemic and myocardial signaling in HFpEF and to diversity of HFpEF phenotypes. In this review, an HFpEF treatment strategy is proposed that addresses HFpEF-specific signaling and phenotypic diversity. In HFpEF, extracardiac comorbidities such as metabolic risk, arterial hypertension, and renal insufficiency drive left ventricular remodeling and dysfunction through systemic inflammation and coronary microvascular endothelial dysfunction. The latter affects left ventricular diastolic dysfunction through macrophage infiltration, resulting in interstitial fibrosis, and through altered paracrine signaling to cardiomyocytes, which become hypertrophied and stiff because of low nitric oxide and cyclic guanosine monophosphate. Systemic inflammation also affects other organs such as lungs, skeletal muscle, and kidneys, leading, respectively, to pulmonary hypertension, muscle weakness, and sodium retention. Individual steps of these signaling cascades can be targeted by specific interventions: metabolic risk by caloric restriction, systemic inflammation by statins, pulmonary hypertension by phosphodiesterase 5 inhibitors, muscle weakness by exercise training, sodium retention by diuretics and monitoring devices, myocardial nitric oxide bioavailability by inorganic nitrate-nitrite, myocardial cyclic guanosine monophosphate content by neprilysin or phosphodiesterase 9 inhibition, and myocardial fibrosis by spironolactone. Because of phenotypic diversity in HFpEF, personalized therapeutic strategies are proposed, which are configured in a matrix with HFpEF presentations in the abscissa and HFpEF predispositions in the ordinate.

  16. Mineralocorticoid receptor antagonists in heart failure with preserved ejection fraction (HFpEF).

    Science.gov (United States)

    Capuano, Annalisa; Scavone, Cristina; Vitale, Cristiana; Sportiello, Liberata; Rossi, Francesco; Rosano, Giuseppe M C; Coats, Andrew J Stewart

    2015-12-01

    The role of spironolactone and eplerenone in patients with Heart Failure with preserved Ejection Fraction (HFpEF) is not well defined. Since a growing medical literature has suggested that mineralocorticoid receptor antagonists may be beneficial for patients with HFpEF, this review gives an in-depth update on the role of spironolactone and eplerenone and their implications for therapy in the setting of HFpEF. Eleven clinical studies, including seven randomized trials, were reviewed. Two randomized controlled trials evaluated the effect of eplerenone on different end-points, including 6 minute walk distance (6 MWD), cardiovascular mortality, non-fatal reinfarction, hospitalization for unstable angina and congestive heart failure. Eplerenone did not affect either 6 MWD or event-free survival rates in the overall study population in these two reports. The effects of spironolactone on similar composite endpoints were evaluated in 7 studies in patients with HFpEF. Compared to placebo, hospitalization for heart failure was significantly lower in the spironolactone group and spironolactone was also shown to improve diastolic function and induced beneficial remodeling through a reduction in myocardial fibrosis. The safety profile of spironolactone and eplerenone has been assessed in two recent studies. Data showed that eplerenone and spironolactone are both associated with the occurrence of gynecomastia, mastodynia, and abnormal vaginal bleeding and in addition, they can increase natriuresis and cause renal retention of potassium; furthermore, eplerenone may cause hyperkalemia and promote the onset of metabolic acidosis or hyponatremia. In conclusion although the mineralocorticoid receptor antagonists eplerenone and spironolactone improve clinical outcomes in patients with HFrEF, additional data will be necessary to better define their risk-benefit profile, especially for eplerenone, in the treatment of HFpEF.

  17. Effects of beta-blockers on heart failure with preserved ejection fraction: a meta-analysis.

    Directory of Open Access Journals (Sweden)

    Feng Liu

    Full Text Available BACKGROUND: Effects of beta-blockers on the prognosis of the heart failure patients with preserved ejection fraction (HFpEF remain controversial. The aim of this meta-analysis was to determine the impact of beta-blockers on mortality and hospitalization in the patients with HFpEF. METHODS: A search of MEDLINE, EMBASE, and the Cochrane Library databases from 2005 to June 2013 was conducted. Clinical studies reporting outcomes of mortality and/or hospitalization for patients with HFpEF (EF ≥ 40%, being assigned to beta-blockers treatment and non-beta-blockers control group were included. RESULTS: A total of 12 clinical studies (2 randomized controlled trials and 10 observational studies involving 21,206 HFpEF patients were included for this meta-analysis. The pooled analysis demonstrated that beta-blocker exposure was associated with a 9% reduction in relative risk for all-cause mortality in patients with HFpEF (95% CI: 0.87 - 0.95; P < 0.001. Whereas, the all-cause hospitalization, HF hospitalization and composite outcomes (mortality and hospitalization were not affected by this treatment (P=0.26, P=0.97, and P=0.88 respectively. CONCLUSIONS: The beta-blockers treatment for the patients with HFpEF was associated with a lower risk of all-cause mortality, but not with a lower risk of hospitalization. These finding were mainly obtained from observational studies, and further investigations are needed to make an assertion.

  18. International Geographic Variation in Event Rates in Trials of Heart Failure With Preserved and Reduced Ejection Fraction

    DEFF Research Database (Denmark)

    Kristensen, Søren L; Køber, Lars; Jhund, Pardeep S

    2015-01-01

    BACKGROUND: International geographic differences in outcomes may exist for clinical trials of heart failure and reduced ejection fraction (HF-REF), but there are few data for those with preserved ejection fraction (HF-PEF). METHODS AND RESULTS: We analyzed outcomes by international geographic...... Trial in HF-REF (CORONA). Crude rates of heart failure hospitalization varied by geographic region, and more so for HF-PEF than for HF-REF. Rates in patients with HF-PEF were highest in the United States/Canada (HF hospitalization rate 7.6 per 100 patient-years in I-Preserve; 8.8 in CHARM...... region in the Irbesartan in Heart Failure with Preserved systolic function trial (I-Preserve), the Candesartan in Heart failure Assessment of Reduction in Mortality and morbidity (CHARM)-Preserved trial, the CHARM-Alternative and CHARM-Added HF-REF trials, and the Controlled Rosuvastatin Multinational...

  19. Systolic Longitudinal Function of the Left Ventricle Assessed by Speckle Tracking in Heart Failure Patients with Preserved Ejection Fraction

    Directory of Open Access Journals (Sweden)

    Mehrnoush Toufan

    2016-03-01

    Full Text Available Background: Echocardiographic evaluations of the longitudinal axis of the left ventricular (LV function have been used in the diagnosis and assessment of heart failure with normal ejection fraction (HFNEF. The evaluation of the global and segmental peak systolic longitudinal strains (PSLSs by two-dimensional speckle tracking echocardiography (STE may correlate with conventional echocardiography findings. We aimed to use STE to evaluate the longitudinal function of the LV in patients with HFNEF.Methods: In this study, 126 patients with HFNEF and diastolic dysfunction and 60 normal subjects on conventional echocardiography underwent STE evaluations, including LV end-diastolic and end-systolic dimensions; interventricular septal thickness; posterior wall thickness;  LV volume; LV ejection fraction; left atrial volume index; early diastolic peak flow velocity (

  20. Carotid Arterial Stiffness and Its Relationship to Exercise Intolerance in Older Patients with Heart Failure and Preserved Ejection Fraction

    OpenAIRE

    Kitzman, Dalane W.; Herrington, David M.; Brubaker, Peter H.; Moore, J. Brian; Eggebeen, Joel; Haykowsky, Mark J

    2012-01-01

    Heart failure with a preserved ejection fraction (HFpEF) is the dominant form of heart failure in the older population. The primary chronic symptom in HFpEF is severe exercise intolerance, however, its pathophysiology and therapy are not well understood. We tested the hypothesis that older patients with HFpEF have increased arterial stiffness beyond that which occurs with normal aging and that this contributes to their severe exercise intolerance.

  1. Anaesthetic management of laparoscopic surgery for rectal cancer in patients of dilated cardiomyopathy with poor ejection fraction: a case report

    Science.gov (United States)

    Wu, Yao-Hua; Hu, Liang; Xia, Jin; Hao, Quan-Shui; Feng, Li; Xiang, Hong-Bing

    2015-01-01

    A patient with dilated cardiomyopathy with poor ejection fraction posted for laparoscopic surgery for rectal cancer which was successfully performed under general anesthesia with endotracheal intubation and mechanical ventilation was reported. Our observations strongly indicate that detailed preoperative assessment, watchful intraoperative monitoring, and skillful optimization of fluid status and hemodynamic play important role in the high risk patient under general anesthesia with endotracheal intubation and mechanical ventilation. PMID:26309623

  2. Ergospirometry and Echocardiography in Early Stage of Heart Failure with Preserved Ejection Fraction and in Healthy Individuals

    Directory of Open Access Journals (Sweden)

    Eduardo Lima Garcia

    2015-01-01

    Full Text Available Abstract Background: Heart failure with preserved ejection fraction is a syndrome characterized by changes in diastolic function; it is more prevalent among the elderly, women, and individuals with systemic hypertension (SH and diabetes mellitus. However, in its early stages, there are no signs of congestion and it is identified in tests by adverse remodeling, decreased exercise capacity and diastolic dysfunction. Objective: To compare doppler, echocardiographic (Echo, and cardiopulmonary exercise test (CPET variables - ergospirometry variables - between two population samples: one of individuals in the early stage of this syndrome, and the other of healthy individuals. Methods: Twenty eight outpatients diagnosed with heart failure according to Framingham’s criteria, ejection fraction > 50% and diastolic dysfunction according to the european society of cardiology (ESC, and 24 healthy individuals underwent Echo and CPET. Results: The group of patients showed indexed atrial volume and left ventricular mass as well as E/E’ and ILAV/A´ ratios significantly higher, in addition to a significant reduction in peak oxygen consumption and increased VE/VCO2 slope, even having similar left ventricular sizes in comparison to those of the sample of healthy individuals. Conclusion: There are significant differences between the structural and functional variables analyzed by Echo and CPET when comparing two population samples: one of patients in the early stage of heart failure with ejection fraction greater than or equal to 50% and another of healthy individuals.

  3. Ventricular-arterial uncoupling in heart failure with preserved ejection fraction after myocardial infarction in dogs - invasive versus echocardiographic evaluation

    Directory of Open Access Journals (Sweden)

    Bartunek Jozef

    2010-06-01

    Full Text Available Abstract Background Heart failure with preserved left ventricular ejection fraction and abnormal diastolic function is commonly observed after recovery from an acute myocardial infarction. The aim of this study was to investigate the physiopathology of heart failure with preserved ejection fraction in a model of healed myocardial infarction in dogs. Methods Echocardiography, levels of neurohormones and conductance catheter measurements of left ventricular pressure-volume relationships were obtained in 17 beagle dogs 2 months after a coronary artery ligation, and in 6 controls. Results Healed myocardial infarction was associated with preserved echocardiographic left ventricular ejection fraction (0.57 ± 0.01, mean ± SEM and altered Doppler mitral indices of diastolic function. NT-proBNP was increased, aldosterone was decreased, and norepinephrine was unchanged. Invasive measurements showed a markedly decreased end-systolic elastance (2.1 ± 0.2 vs 6.1 ± 0.8, mmHg/ml, p Conclusions In the canine model of healed myocardial infarction induced by coronary ligation, heart failure is essentially characterized by an altered contractility with left ventricular-arterial uncoupling despite vascular compensation rather than by abnormal diastolic function

  4. Association between echocardiography derived right ventricular function parameters with cardiac magnetic resonance derived right ventricular ejection fraction and 6-minute walk distance in pulmonary hypertension patients%超声心动图与心脏核磁共振评估肺高血压患者右心室功能的比较

    Institute of Scientific and Technical Information of China (English)

    王臻臻; 杨振文; 万征; 于铁链; 贾莉莉; 杜鑫; 黄灿亮

    2014-01-01

    目的 比较经胸超声心动图(TTE)评价肺高血压(PH)患者右心室功能的各指标与心脏核磁共振成像技术(CMR)测得的右心室射血分数(RVEF)及6 min步行距离(6MWD)的相关性.方法 入选天津医科大学总医院心血管内科2011年3月至2013年3月住院的Ⅰ类和Ⅳ类PH患者40例.入院后行右心导管(RHC)检查,确诊患者在病情稳定及治疗无变化1周内行CMR、TTE、6MWD试验.分别对CMR、TTE、6MWD指标进行相关性分析,并对TTE检测的各指标与CMR获得的RVEF(RVEF-CMR)的相关系数由大到小进行排序.结果 TTE评价右心室功能的指标中,游离壁三尖瓣环收缩期纵向收缩最大速度(S')、游离壁三尖瓣环收缩期峰值位移(TAPSE)、右心室面积变化分数(FAC)、游离壁三尖瓣环等容收缩期加速度(IVA)、心肌做功指数(MPI)与RVEF-CMR均存在相关性,相关系数依次是r =0.69(P <0.001)、r=0.65(P <0.001)、r=0.62(P <0.001)、r=0.43(P =0.006)和r=-0.38(P <0.05).S '、TAPSE、FAC、IVA、MPI与6MWD无相关性.RVEF-CMR与6MWD无相关性.最准确指示RVEF-CMR≤20%的指标是S'<8.79 cm/s,ROC曲线下面积0.92(95% CI:0.72 ~0.84),敏感度0.91,特异度0.80.结论 S'与RVEF相关性最强,S '<8.79 cm/s能准确指示出RVEF≤20%的患者.RVEF-CMR、S '、TAPSE与6MWD均无相关性.%Objective To explore the association between transthoracic echocardiography (TFE) derived right ventricular (RV) function parameters with cardiovascular magnetic resonance imaging (CMR)derived RV ejection fraction (RVEF) and 6 minute walk distance (6MWD) in pulmonary hypertension (PH) patients.Methods A total of 40 PH patients (37 pulmonary artery hypertension (PAH) and 3 chronic thromboembolic pulmonary hypertension (CTEPH)) hospitalized in our department between March 2011 and March 2013 were enrolled in this study.PH diagnosis was established by right heart catheterization and TTE,CMR and 6MWT were performed within one week post TTE

  5. Assessing Strategies for Heart Failure with Preserved Ejection Fraction at the Outpatient Clinic

    Directory of Open Access Journals (Sweden)

    Antonio José Lagoeiro Jorge

    2014-09-01

    Full Text Available Background: Heart failure with preserved ejection fraction (HFPEF is the most common form of heart failure (HF, its diagnosis being a challenge to the outpatient clinic practice. Objective: To describe and compare two strategies derived from algorithms of the European Society of Cardiology Diastology Guidelines for the diagnosis of HFPEF. Methods: Cross-sectional study with 166 consecutive ambulatory patients (67.9±11.7 years; 72% of women. The strategies to confirm HFPEF were established according to the European Society of Cardiology Diastology Guidelines criteria. In strategy 1 (S1, tissue Doppler echocardiography (TDE and electrocardiography (ECG were used; in strategy 2 (S2, B-type natriuretic peptide (BNP measurement was included. Results: In S1, patients were divided into groups based on the E/E'ratio as follows: GI, E/E'> 15 (n = 16; 9%; GII, E/E'8 to 15 (n = 79; 48%; and GIII, E/E' 122 for women and > 149 g/m2 for men] and ECG (atrial fibrillation parameters were assessed, confirming HFPEF in 33 more patients, adding up to 49 (29%. In S2, patients were divided into three groups based on BNP levels. GI (BNP > 200 pg/mL consisted of 12 patients, HFPEF being confirmed in all of them. GII (BNP ranging from 100 to 200 pg/mL consisted of 20 patients with LAVI > 29 mL/m2, or LVMI ≥ 96 g/m2 for women or ≥ 116 g/m2 for men, or E/E'≥ 8 or atrial fibrillation on ECG, and the diagnosis of HFPEF was confirmed in 15. GIII (BNP < 100 pg/mL consisted of 134 patients, 26 of whom had the diagnosis of HFPEF confirmed when GII parameters were used. Measuring BNP levels in S2 identified 4 more patients (8% with HFPEF as compared with those identified in S1. Conclusion: The association of BNP measurement and TDE data is better than the isolated use of those parameters. BNP can be useful in identifying patients whose diagnosis of HF had been previously excluded based only on TDE findings.

  6. Effect of Nebivolol on MIBG Parameters and Exercise in Heart Failure with Normal Ejection Fraction

    Energy Technology Data Exchange (ETDEWEB)

    Messias, Leandro Rocha, E-mail: lmessias@cardiol.br; Ferreira, Aryanne Guimarães; Miranda, Sandra Marina Ribeiro de; Teixeira, José Antônio Caldas [Universidade Federal Fluminense, Rio de Janeiro, RJ (Brazil); Azevedo, Jader Cunha de [Universidade Federal Fluminense, Rio de Janeiro, RJ (Brazil); Hospital Procardíaco, Rio de Janeiro, RJ (Brazil); Messias, Ana Carolina Nader Vasconcelos [Hospital Federal dos Servidores do Estado do Rio de Janeiro, Rio de Janeiro, RJ (Brazil); Maróstica, Elisabeth [Universidade Federal Fluminense, Rio de Janeiro, RJ (Brazil); Mesquita, Claudio Tinoco [Universidade Federal Fluminense, Rio de Janeiro, RJ (Brazil); Hospital Procardíaco, Rio de Janeiro, RJ (Brazil)

    2016-05-15

    More than 50% of the patients with heart failure have normal ejection fraction (HFNEF). Iodine-123 metaiodobenzylguanidine (123I-MIBG) scintigraphy and cardiopulmonary exercise test (CPET) are prognostic markers in HFNEF. Nebivolol is a beta-blocker with vasodilating properties. To evaluate the impact of nebivolol therapy on CPET and123I-MIBG scintigraphic parameters in patients with HFNEF. Twenty-five patients underwent 123I-MIBG scintigraphy to determine the washout rate and early and late heart-to-mediastinum ratios. During the CPET, we analyzed the systolic blood pressure (SBP) response, heart rate (HR) during effort and recovery (HRR), and oxygen uptake (VO{sub 2}). After the initial evaluation, we divided our cohort into control and intervention groups. We then started nebivolol and repeated the tests after 3 months. After treatment, the intervention group showed improvement in rest SBP (149 mmHg [143.5-171 mmHg] versus 135 mmHg [125-151 mmHg, p = 0.016]), rest HR (78 bpm [65.5-84 bpm] versus 64.5 bpm [57.5-75.5 bpm, p = 0.028]), peak SBP (235 mmHg [216.5-249 mmHg] versus 198 mmHg [191-220.5 mmHg], p = 0.001), peak HR (124.5 bpm [115-142 bpm] versus 115 bpm [103.7-124 bpm], p= 0.043), HRR on the 1st minute (6.5 bpm [4.75-12.75 bpm] versus 14.5 bpm [6.7-22 bpm], p = 0.025) and HRR on the 2nd minute (15.5 bpm [13-21.75 bpm] versus 23.5 bpm [16-31.7 bpm], p = 0.005), but no change in peak VO{sub 2} and 123I-MIBG scintigraphic parameters. Despite a better control in SBP, HR during rest and exercise, and improvement in HRR, nebivolol failed to show a positive effect on peak VO2 and 123I-MIBG scintigraphic parameters. The lack of effect on adrenergic activity may be the cause of the lack of effect on functional capacity.

  7. Pre-chemotherapy values for left and right ventricular volumes and ejection fraction by gated tomographic radionuclide angiography using a cadmium-zinc-telluride detector gamma camera

    DEFF Research Database (Denmark)

    Haarmark, Christian; Haase, Christine; Jensen, Maria Maj

    2016-01-01

    BACKGROUND: Estimation of left ventricular ejection fraction (LVEF) using equilibrium radionuclide angiography is an established method for assessment of left ventricular function. The purpose of this study was to establish normative data on left and right ventricular volumes and ejection fractio...

  8. Predicting Heart Failure With Preserved and Reduced Ejection Fraction : The International Collaboration on Heart Failure Subtypes

    NARCIS (Netherlands)

    Ho, Jennifer E; Enserro, Danielle; Brouwers, Frank P; Kizer, Jorge R; Shah, Sanjiv J; Psaty, Bruce M; Bartz, Traci M; Santhanakrishnan, Rajalakshmi; Lee, Douglas S; Chan, Cheeling; Liu, Kiang; Blaha, Michael J; Hillege, Hans L; van der Harst, Pim; van Gilst, Wiek H; Kop, Willem J; Gansevoort, Ron T; Vasan, Ramachandran S; Gardin, Julius M; Levy, Daniel; Gottdiener, John S; de Boer, Rudolf A; Larson, Martin G

    2016-01-01

    BACKGROUND: Heart failure (HF) is a prevalent and deadly disease, and preventive strategies focused on at-risk individuals are needed. Current HF prediction models have not examined HF subtypes. We sought to develop and validate risk prediction models for HF with preserved and reduced ejection fract

  9. Predicting Heart Failure With Preserved and Reduced Ejection Fraction : The International Collaboration on Heart Failure Subtypes

    NARCIS (Netherlands)

    Ho, Jennifer E.; Enserro, Danielle; Brouwers, Frank P.; Kizer, Jorge R.; Shah, Sanjiv J.; Psaty, Bruce M.; Bartz, Traci M.; Santhanakrishnan, Rajalakshmi; Lee, Douglas S.; Chan, Cheeling; Liu, Kiang; Blaha, Michael J.; Hillege, Hans L.; van der Harst, Pim; van Gilst, Wiek H.; Kop, Willem J.; Gansevoort, Ron T.; Vasan, Ramachandran S.; Gardin, Julius M.; Levy, Daniel; Gottdiener, John S.; de Boer, Rudolf A.; Larson, Martin G.

    2016-01-01

    Background-Heart failure (HF) is a prevalent and deadly disease, and preventive strategies focused on at-risk individuals are needed. Current HF prediction models have not examined HF subtypes. We sought to develop and validate risk prediction models for HF with preserved and reduced ejection fracti

  10. Prediction of all-cause mortality and heart failure admissions from global left ventricular longitudinal strain in patients with acute myocardial infarction and preserved left ventricular ejection fraction

    DEFF Research Database (Denmark)

    Ersbøll, Mads; Valeur, Nana; Mogensen, Ulrik Madvig;

    2013-01-01

    This study sought to test the hypothesis that semiautomated calculation of left ventricular global longitudinal strain (GLS) can identify high-risk subjects among patients with myocardial infarctions (MIs) with left ventricular ejection fractions (LVEFs) >40%....

  11. Repaired tetralogy of Fallot with coexisting unrepaired partial anomalous pulmonary venous connection is associated with diminished right ventricular ejection fraction and more severe right ventricular dilation

    Energy Technology Data Exchange (ETDEWEB)

    Chan, Sherwin S. [Children' s Mercy Hospital and Clinics, Department of Radiology, Kansas City, MO (United States); Whitehead, Kevin K.; Kim, Timothy S.; Fu, Gregory L.; Fogel, Mark A.; Harris, Matthew A. [Children' s Hospital of Philadelphia, Department of Cardiology, Philadelphia, PA (United States); Keller, Marc S. [Children' s Hospital of Philadelphia, Department of Radiology, Philadelphia, PA (United States)

    2015-09-15

    There is an established association between tetralogy of Fallot and partial anomalous pulmonary venous connections. This association is important because surgically repaired tetralogy patients have increased risk of right heart failure. We hypothesize that partial anomalous venous connections increase right ventricular volumes and worsen right ventricular failure. We reviewed cardiac MRI exams performed at a tertiary pediatric hospital from January 2005 to January 2014. We identified patients with repaired tetralogy and unrepaired partial anomalous pulmonary venous connection. We used age- and gender-matched repaired tetralogy patients without partial anomalous pulmonary venous connection as controls. We analyzed the MRI results and surgical course and performed comparative statistics to identify group differences. There were eight patients with repaired tetralogy and unrepaired partial anomalous pulmonary venous connection and 16 controls. In all cases, the partial anomalous pulmonary venous connection was not detected on preoperative echocardiography. There were no significant differences in surgical course and body surface area between the two groups. Repaired tetralogy patients with unrepaired partial anomalous pulmonary venous connection showed significantly higher indexed right ventricular end diastolic volume (149 ± 33 mL/m{sup 2} vs. 118 ± 30 mL/m{sup 2}), right ventricle to left ventricle size ratios (3.1 ± 1.3 vs. 1.9 ± 0.5) and a higher incidence of reduced right ventricular ejection fraction compared to controls (3/8 vs. 0/16). Repaired tetralogy of Fallot with unrepaired partial anomalous pulmonary venous connection is associated with reduced right ventricular ejection fraction and more significant right ventricular dilation. (orig.)

  12. Prognostic usefulness of insulin-like growth factor-binding protein 7 in heart failure with reduced ejection fraction: a novel biomarker of myocardial diastolic function?

    Science.gov (United States)

    Gandhi, Parul U; Gaggin, Hanna K; Sheftel, Alex D; Belcher, Arianna M; Weiner, Rory B; Baggish, Aaron L; Motiwala, Shweta R; Liu, Peter P; Januzzi, James L

    2014-11-15

    Insulin-like growth factor-binding protein 7 (IGFBP7) is a biomarker that has recently been associated with heart failure and cardiac hypertrophy. The aim of this study was to examine IGFBP7 relative to echocardiographic abnormalities reflecting diastolic dysfunction. One hundred twenty-four patients with ambulatory heart failure with reduced ejection fraction and baseline detailed 2-dimensional echocardiograms were followed for a mean of 10 months. IGFBP7 was measured serially at each office visit; 108 patients underwent follow-up echocardiography. Echocardiographic parameters of diastolic function were compared at baseline and over time. IGFBP7 concentrations were not linked to left ventricular size or systolic function. In contrast, those with elevated baseline IGFBP7 concentrations were more likely to have abnormalities of parameters describing diastolic function, such as higher left atrial volume index, transmitral E/A ratio, E/E' ratio, and right ventricular systolic pressure. IGFBP7 was correlated with left atrial volume index (ρ = 0.237, p = 0.008), transmitral E/A ratio (ρ = 0.304, p = 0.001), E/E' ratio (ρ = 0.257, p = 0.005), and right ventricular systolic pressure (ρ = 0.316, p = 0.001). Furthermore, each was found to be independently predictive of IGFBP7 in adjusted analysis. In subjects with baseline and final echocardiograms, more time spent with elevated IGFBP7 concentrations in serial measurement was associated with worsening diastolic function and increasing left atrial volume index or right ventricular systolic pressure. IGFBP7 concentrations were predictive of an increased risk for cardiovascular events independent of echocardiographic measures of diastolic function (p = 0.006). In conclusion, IGFBP7 is a novel prognostic biomarker for heart failure with reduced ejection fraction and shows significant links to the presence and severity of echocardiographic parameters of abnormal diastolic function.

  13. Bleeding Risk and Antithrombotic Strategy in Patients with Sinus Rhythm Heart Failure with Reduced Ejection Fraction Treated with Warfarin or Aspirin

    Science.gov (United States)

    Ye, Siqin; Cheng, Bin; Lip, Gregory Y. H.; Buchsbaum, Richard; Sacco, Ralph L.; Levin, Bruce; Di Tullio, Marco R.; Qian, Min; Mann, Douglas L.; Pullicino, Patrick M.; Freudenberger, Ronald S.; Teerlink, John R.; Mohr, J.P.; Graham, Susan; Labovitz, Arthur J.; Estol, Conrado J.; Lok, Dirk J.; Ponikowski, Piotr; Anker, Stefan D.; Thompson, John L.P.; Homma, Shunichi

    2015-01-01

    We sought to assess the performance of existing bleeding risk scores, such as HAS-BLED or OBRI, in patients with heart failure with reduced ejection fraction (HFrEF) in sinus rhythm (SR) treated with warfarin or aspirin. We calculated HAS-BLED and OBRI risk scores for 2,305 patients with HFrEF in SR enrolled in the Warfarin versus Aspirin in Reduced Cardiac Ejection Fraction (WARCEF) trial. Proportional hazards models were used to test whether each score predicted major bleeding, and comparison of different risk scores was performed using Harell’s c-statistic and net-reclassification improvement (NRI) index. For the warfarin arm, both scores predicted bleeding risk, with OBRI having significantly higher c-statistic (0.72 vs 0.61; p=0.03) compared to HAS-BLED, though the NRI for comparing OBRI to HAS-BLED was not significant (0.32, 95% CI - 0.18-0.37). Performance of the OBRI and HAS-BLED risk scores were similar for the aspirin arm. For participants with OBRI score of 0 to 1, warfarin compared with aspirin reduced ischemic stroke (HR 0.51, 95% CI 0.26-0.98, p=0.042) without significantly increasing major bleeding (HR 1.24, 95% CI 0.66-2.30, p=0.51). For those with OBRI score of ≥2, there was a trend for reduced ischemic stroke with warfarin compared to aspirin (HR 0.56, 95% CI 0.27-1.15, p=0.12), but major bleeding was increased (HR 4.04, 95% CI 1.99-8.22, p<0.001). In conclusion, existing bleeding risk scores can identify bleeding risk in HFrEF patients in SR, and could be tested for potentially identifying patients with a favorable risk / benefit profile for antithrombotic therapy with warfarin. PMID:26189039

  14. Relationship of serum sodium concentration to mortality in a wide spectrum of heart failure patients with preserved and with reduced ejection fraction

    DEFF Research Database (Denmark)

    Rusinaru, Dan; Tribouilloy, Christophe; Berry, Colin

    2012-01-01

    Hyponatraemia has been associated with reduced survival in patients with heart failure and reduced ejection fraction (HF-REF). The relationship between serum sodium and outcome is unclear in heart failure with preserved (≥ 50%) ejection fraction (HF-PEF). Therefore, we used a large individual...... patient data meta-analysis to study the risk of death associated with hyponatraemia in HF-REF and in HF-PEF....

  15. TRANSURETHRAL RESECTION OF PROSTRATE IN DILATED CARDIOMYOPATHY PATIENT WITH LOW EJECTION FRACTION

    Directory of Open Access Journals (Sweden)

    Prabhavathi

    2014-06-01

    Full Text Available Dilated cardiomyopathy (DCM patient undergoing non-cardiac surgery poses a challenge for the anesthesiologist to manage it efficiently. DCM is usually accompanied by progressive congestive cardiac failure (CCF and life threatening arrhythmias. The anesthesiologist must have the idea of its haemodynamics, diagnostic evaluations, treatment modalities and more so regarding various drug interactions during anesthesia. We managed this case with combined low dose spinal epidural anesthesia with dexmeditomedine as additive.

  16. Speckle tracking determination of mitral tissue annular displacement: comparison with strain and ejection fraction, and association with outcomes in haemodialysis patients.

    Science.gov (United States)

    Chiu, Diana Y Y; Abidin, Nik; Hughes, John; Sinha, Smeeta; Kalra, Philip A; Green, Darren

    2016-10-01

    Abnormal Global longitudinal strain (GLS) and reduced left ventricular ejection fraction (LVEF) are established poor prognostic risk factors in haemodialysis patients. Tissue motion annular displacement of mitral valve annulus (TMAD), determined by speckle tracking echocardiography (STE), can be performed rapidly and is an indicator of systolic dysfunction, but has been less well explored. This study aims to compare TMAD with GLS and LVEF and its association with outcomes in haemodialysis patients. 198 haemodialysis patients (median age 64.2 years, 69 % men) had 2D echocardiography, with STE determined GLS and TMAD. Bland-Altman analysis and linear regression assessed relationship between GLS, LVEF and TMAD. Cox regression analysis investigated association of TMAD with mortality and cardiac events. TMAD had low inter- and intra-observer variability with small biases and narrow limits of agreement (LOA) (bias of -0.01 ± 1.32 (95 % LOA was -2.60 to 2.58) and -0.07 ± 1.27 (95 % LOA -2.55 to 2.41) respectively). There was a moderate negative correlation between GLS and LVEF (r = -0.383, p < 0.001) and a weak positive correlation between TMAD and LVEF (r = 0.248, p < 0.001). There was strong negative correlation of TMAD with GLS (r = -0.614, p < 0.001). In a multivariable Cox regression analysis, TMAD was not associated with mortality (HR 1.04, 95 % CI 0.91-1.19), cardiac death (HR 1.03, 95 % CI 0.80-1.32) or cardiac events (HR 0.91, 95 % CI 0.80-1.02). TMAD is a quick and reproducible alternative to GLS which may be very useful in cardiovascular risk assessment, but does not have the same prognostic value in HD patients as GLS.

  17. Association of serum calcium and heart failure with preserved ejection fraction in patients with type 2 diabetes

    OpenAIRE

    Li, Junfeng; Wu, Nan; Dai, Wenling; Jiang, Liu; Li, Yintao; Li, Shibao; WEN, ZHONGYUAN

    2016-01-01

    Background Type 2 diabetes mellitus (T2DM) is a recognized trigger factor for heart failure with preserved ejection fraction (HFpEF). Recent studies show that higher serum calcium level is associated with greater risk of both T2DM and heart failure. We speculate that increased serum calcium is related to HFpEF prevalence in patients with T2DM. Methods In this cross-sectional echocardiographic study, 807 normocalcemia and normophosphatemia patients with T2DM participated, of whom 106 had HFpEF...

  18. Non-invasive measurement of stroke volume and left ventricular ejection fraction. Radionuclide cardiography compared with left ventricular cardioangiography

    DEFF Research Database (Denmark)

    Kelbaek, H; Svendsen, Jesper Hastrup; Aldershvile, J;

    2011-01-01

    The stroke volume (SV) was determined by first passage radionuclide cardiography and the left ventricular ejection fraction (LVEF) by multigated radionuclide cardiography in 20 patients with ischemic heart disease. The results were evaluated against those obtained by the invasive dye dilution...... or thermodilution and left ventricular cardioangiographic techniques. In a paired comparison the mean difference between the invasive and radionuclide SV was -1 ml (SED 3.1) with a correlation coefficient of 0.83 (p less than 0.01). Radionuclide LVEF values also correlated well with cardioangiographic measurements...

  19. Circulating levels of tumor necrosis factor-alpha receptor 2 are increased in heart failure with preserved ejection fraction relative to heart failure with reduced ejection fraction: evidence for a divergence in pathophysiology.

    Directory of Open Access Journals (Sweden)

    Brendan N Putko

    Full Text Available BACKGROUND: Various pathways have been implicated in the pathogenesis of heart failure (HF with preserved ejection fraction (HFPEF. Inflammation in response to comorbid conditions, such as hypertension and diabetes, may play a proportionally larger role in HFPEF as compared to HF with reduced ejection fraction (HFREF. METHODS AND RESULTS: This study investigated inflammation mediated by the tumor necrosis factor-alpha (TNFα axis in community-based cohorts of HFPEF patients (n = 100, HFREF patients (n = 100 and healthy controls (n = 50. Enzyme-linked immunosorbent assays were used to investigate levels of TNFα, its two receptors (TNFR1 and TNFR2, and a non-TNFα cytokine, interleukin-6 (IL-6, in plasma derived from peripheral blood samples. Plasma levels of TNFα and TNFR1 were significantly elevated in HFPEF relative to controls, while levels of TNFR2 were significantly higher in HFPEF than both controls and HFREF. TNFα, TNFR1 and TNFR2 were each significantly associated with at least two of the following: age, estimated glomerular filtration rate, hypertension, diabetes, smoking, peripheral vascular disease or history of atrial fibrillation. TNFR2 levels were also significantly associated with increasing grade of diastolic dysfunction and severity of symptoms in HFPEF. CONCLUSIONS: Inflammation mediated through TNFα and its receptors, TNFR1 and TNFR2, may represent an important component of a comorbidity-induced inflammatory response that partially drives the pathophysiology of HFPEF.

  20. Advances on treating and diagnosing heart failure with preserved ejection fraction%射血分数保留心力衰竭诊疗进展

    Institute of Scientific and Technical Information of China (English)

    高淑贤; 贾辛未; 赵文萍

    2016-01-01

    Heart failure( HF) with preserved ejection fraction ( HFPEF) is a clinical syndrome of exercise intol-erance and/or congestion,in the presence of a left ventricular(LV) ejection fraction within the normal limits(i. e.LVEF>50%) .Determining the presence of impaired LV relaxation and/or filling ( diastolic dysfunction ) in HFPEF is needed to pragmatically to distinguish it from other cardiac and non-cardiac conditions where symptoms are not due to HF .There are multiple mechanisms for diastolic dysfunction ranging from structural abnormalities to functional derangements in HFPEF yet tailored therapies are lacking .Treatments proven effective in HF with systolic dysfunction have failed to show significant benefit in patients with HFPEF ,which prognosis remains poor . This review will discuss the HFPEF .%射血分数保留心力衰竭( HFPEF)是一种运动耐受减低和(或)组织充血为特征的一种临床综合征,而其左心室射血分数在正常范围内(例如LVEF>50%)。 HFPEF的诊断比射血分数减少心力衰竭( HFREF)的诊断更具挑战性,因为它需要排除大量其他潜在的提示心力衰竭症状的心源性及非心源性的诊断。舒张功能障碍由多种机制引起,包括心脏结构异常及功能异常,但个体化治疗仍缺乏。随着多年临床治疗发展, HFREF患者的获益明显提高,但是HFPEF患者的患病率及病死率却没有明显改变。

  1. Changes in left ventricular systolic function in patients with chronic heart failure with preserved ejection fraction and cardiorenal anemic syndrome

    Directory of Open Access Journals (Sweden)

    Vasylenko V.A.

    2015-09-01

    Full Text Available The feature of chronic heart failure (CHF in elderly people is increasing incidence of heart failure with preserved left ventricular ejection fraction (LVEF which is associated with age. Such patients account for almost half of the total number of patients with heart failure. Cardiorenal syndrome (CRS is associated with an increased risk of mortality in patients with CHF. The impact of CRS on the structural and functional condition of the heart in these patients is studied insufficiently. The study involved 103 patients with CHF II-IV NYHA with preserved LVEF (>45% and CRS (hemoglobin <120 g/l and fractional shortening size.

  2. Changing the treatment of heart failure with reduced ejection fraction: clinical use of sacubitril-valsartan combination

    Science.gov (United States)

    Kaplinsky, Edgardo

    2016-01-01

    Despite significant therapeutic advances, patients with chronic heart failure (HF) remain at high risk of morbidity and mortality. Sacubitril valsartan (previously known as LCZ696) is a new oral agent approved for the treatment of symptomatic chronic heart failure in adults with reduced ejection fraction. It is described as the first in class angiotensin receptor neprilysin inhibitor (ARNI) since it incorporates the neprilysin inhibitor, sacubitril and the angiotensin II receptor antagonist, valsartan. Neprilysin is an endopeptidase that breaks down several vasoactive peptides including natriuretic peptides (NPs), bradykinin, endothelin and angiotensin II (Ang-II). Therefore, a natural consequence of its inhibition is an increase of plasmatic levels of both, NPs and Ang-II (with opposite biological actions). So, a combined inhibition of these both systems (Sacubitril / valsartan) may enhance the benefits of NPs effects in HF (natriuresis, diuresis, etc) while Ang-II receptor is inhibited (reducing vasoconstriction and aldosterone release). In a large clinical trial (PARADIGM-HF with 8442 patients), this new agent was found to significantly reduce cardiovascular and all cause mortality as well as hospitalizations due to HF (compared to enalapril). This manuscript reviews clinical evidence for sacubitril valsartan, dosing and cautions, future directions and its considered place in the therapy of HF with reduced ejection fraction. PMID:28133468

  3. Comparison of two radionuclide ejection-fraction techniques with contrast angiography in ischemic heart disease and valvular heart disease

    Energy Technology Data Exchange (ETDEWEB)

    Hassan, I.M.; Abdel-Dayem, H.M.; Mohammed, M.M.J.; Simo, M.; Yousef, A.M.; Badruddosa, M.; Mahmood, A.R.; Sayed, M.E.

    1986-04-01

    First-pass radionuclide angiography (FPRA) in the 30/sup 0/ right anterior oblique and equilibrium gated radionuclide angiography (EGNA) in the 45/sup 0/ left anterior oblique were used for quantitative measurements of left ventricular ejection fraction (LVEF). Equipment used was a 400T gamma-camera interfaced with a Simis III Informatek computer. The results were compared with contrast angiography (CA). The aim of this study was to determine the sensitivity of both radionuclide techniques. The present data are based on 65 patients in whom CA and EGNA were performed. In 47 patients both FPRA and EGNA were performed. Results suggested that in ischemic heart disease (IHD) and valvular heart disease (VHD) the EGNA technique is well correlated with CA (r=0.9 and 0.73, respectively). FPRA correlated well only with CA in IHD (r=0.86), but not in VHD (r=0.18). This study indicates that both FPRA and EGNA are sensitive, noninvasive techniques for measuring ejection fraction in IHD, while in VHD, EGNA is more sensitive technique than FPRA.

  4. Time-effectiveness, observer-dependence, and accuracy of measurements of left ventricular ejection fraction using 4-channel MDCT

    Energy Technology Data Exchange (ETDEWEB)

    Boehm, T.; Willmann, J.K.; Desbiolles, L.M.; Marincek, B.; Wildermuth, S. [Dept. of Radiology, Kantonsspital, Chur (Switzerland); Alkadhi, H. [Dept. Medical Radiology, Inst. of Diagnostic Radiology, Univ. Hospital, Zurich (Switzerland); Roffi, M. [Dept. of Cardiology, Univ. Hospital, Zurich (Switzerland)

    2004-04-01

    Purpose: To evaluate the time-effectiveness, inter-observer variance, and accuracy of left ventricular ejection fraction (EF) measurements using retrospectively ECG-gated four-channel multi-detector row CT (MDCT) angiography in comparison with biplane cine-ventriculography. Materials and Methods: Twenty consecutive patients underwent retrospectively ECG-gated MDCT angiography and conventional coronary angiography with biplane ventriculography. Raw MDCT data were reconstructed at 0%-90% of the cardiac cycle in increments of 10%. Ten geometrically identical multiplanar reformations parallel to the short axis of the heart were reconstructed in each patient. Three blinded readers segmented the left ventricle in the end-systolic and end-diastolic phase using standardized window settings in order to determine the EF. The EF was measured with biplane cine-ventriculography by two blinded readers and was compared with MDCT. The time needed for post-processing was recorded and the inter-observer agreement for both imaging techniques was assessed. Results: Mean post-processing time was 63{+-}3 min per patient for MDCT and 5.5{+-}1.2 min for ventriculography. MDCT and ventriculography showed a good correlation (r=0.83, p<0.0001) for measurement of the EF. Mean errors of EF measurements for the three MDCT readers compared with the mean of the ventriculography were -6.3{+-}6.6%, -4.7{+-}7.1% and -4.6{+-}5.7%, respectively. The mean differences between the three readers assessing MDCT were -1.6{+-}3.2% (reader 1 versus 2, r=0.96), -1.6{+-}5.6% (1 versus 3, r=0.95) and -0.011{+-}2.9% (2 versus 3, r=0.97, p<0.0001). The mean differences between the two readers assessing ventriculography was 0.32{+-}5.1% (r=0.88, p<0.0001). (orig.) [German] Ziel: Beurteilung der Nachverarbeitungszeit, Messgenauigkeit und Untersucherabhaengigkeit bei der Bestimmung der linksventrikulaeren Ejektionsfraktion (EF) mit der retrospektiv EKG-synchronisierten Multidetektor-CT-(MDCT-)Angiographie im

  5. Ranolazine preserves and improves left ventricular ejection fraction and autonomic measures when added to guideline-driven therapy in chronic heart failure

    Directory of Open Access Journals (Sweden)

    Murray, Gary

    2014-12-01

    Full Text Available Background Ranolazine (RAN reduces cardiac sodium channel 1.5’s late sodium current in congestive heart failure (CHF, reducing myocardial calcium overload, potentially improving left ventricular (LV function. RAN blocks neuronal sodium channel 1.7, potentially altering parasympathetic and sympathetic (P&S activity. The effects of RAN on LV ejection fraction (LVEF and P&S function in CHF were studied. Methods Matched CHF patients were given open-label RAN (1000 mg po-bid added to guideline-driven therapy (RANCHF, 41 systolic, 13 diastolic or no adjuvant therapy (control, NORANCHF, 43 systolic, 12 diastolic. Echocardiographic LVEF and P&S measures were obtained at baseline and follow-up (mean 23.7 months. Results LVEF increased in 70% of RANCHF patients, an average of 11.3 units. Mean LVEF remained unchanged in NORANCHF patients. P&S measures indicated cardiovascular autonomic neuropathy (P≤0.1 bpm2 in 20% of NORANCHF patients at baseline and in 29% at follow-up (increasing in both groups. At baseline, 28% of patients had high sympathovagal balance (SB, RAN normalized SB over 50% of these; in contrast, the NORANCHF group had a 20% increase in patients with high SB. Conclusions RAN preserves or improves LVEF and decreases high SB in CHF.

  6. Effects of Endurance Exercise Training and Crataegus Extract WS® 1442 in Patients with Heart Failure with Preserved Ejection Fraction – A Randomized Controlled Trial

    Directory of Open Access Journals (Sweden)

    Sascha Härtel

    2014-09-01

    Full Text Available Impaired exercise capacity is the core symptom of heart failure with preserved ejection fraction (HFpEF. We assessed effects of exercise training and Crataegus extract WS 1442 in HFpEF and aimed to identify mechanisms of action in an exploratory trial (German Clinical Trials Register DRKS00000259. 140 sedentary HFpEF NYHA II patients on standard treatment received eight weeks of aerobic endurance training and half were randomized to WS 1442 900 mg/day. Symptoms, 2 km walking time (T2km, parameters of exercise tolerance, cardiac and vascular function, muscular efficiency and skeletal muscular haemoglobin oxygen saturation (SO2 measured during a treadmill protocol were captured at baseline and after eight weeks. Adverse events were recorded during the trial. Mechanisms of action were explored by correlation and path analyses of changes. Symptoms and exercise capacity improved with training, but correlations between improvements were low and path models were rejected. SO2 increased, decreased or undulated with increasing exercise intensity in individual patients and was not altered by training. WS 1442 improved T2km (-12.7% vs. -8.4%, p = 0.019, tended to improve symptoms and to pronounce SO2-decrease with increasing exercise, an indicator of oxygen utilisation. Endurance training and WS 1442 were safe and well tolerated in combination with standard drug treatment.

  7. Prognostic implications of post-stress ejection fraction decrease detected by gated SPECT in the absence of stress-induced perfusion abnormalities

    Energy Technology Data Exchange (ETDEWEB)

    Dona, Manjola; Massi, Lucia; Settimo, Leonardo; Bartolini, Matteo; Gianni, Gianluca; Pupi, Alberto; Sciagra, Roberto [University of Florence, Nuclear Medicine Unit, Department of Clinical Physiopathology, Florence (Italy)

    2011-03-15

    The prognostic meaning of a post-stress ejection fraction (EF) decrease detected by perfusion gated SPECT is still unclear. We therefore followed up patients with post-stress EF decrease in the absence of stress-induced perfusion abnormalities. We prospectively enrolled 57 consecutive patients with post-stress EF drop {>=} 5 EF units and summed difference score (SDS) {<=} 1. They were followed up for more than 1 year and their outcome was compared with a group of sex- and age-matched controls with the same SDS but without EF decrease. During follow-up there were 13 events (1 cardiac death, 1 non-fatal myocardial infarction, 1 congestive heart failure and 10 late revascularizations). In the control group we registered six events. There was a significant difference (p < 0.0001) between the event-free survival curves of the two groups. The event rate of patients with post-stress EF decrease {>=} 5 EF units is relatively high and is significantly worse than that of a control group of patients with similarly normal SDS but without EF changes. Therefore, a post-stress EF decrease without stress-induced perfusion abnormalities should be cautiously interpreted. (orig.)

  8. Serum Soluble Urokinase-Type Plasminogen Activator Receptor Is Associated with Low Left Ventricular Ejection Fraction and Elevated Plasma Brain-Type Natriuretic Peptide Level

    Science.gov (United States)

    Fujita, Shu-ichi; Tanaka, Suguru; Maeda, Daichi; Morita, Hideaki; Fujisaka, Tomohiro; Takeda, Yoshihiro; Ito, Takahide; Ishizaka, Nobukazu

    2017-01-01

    Background Recent studies have suggested that soluble urokinase plasminogen activator receptor (suPAR), a biomarker of subclinical levels of inflammation, is significantly correlated with cardiovascular events. Purpose We investigated the association between suPAR and left ventricular ejection fraction (LVEF), left ventricular mass index (LVMI), and plasma B-type natriuretic peptide (BNP) among cardiac inpatients. Methods and Results In total, 242 patients (mean age 71.3 ± 9.8 years; 70 women) admitted to the cardiology department were enrolled in the study. suPAR was significantly correlated with LVEF (R = -0.24, P 3236 pg/mL) was associated with low LVEF ( 300 pg/mL) with an odds ratio of 3.84 (95% confidence interval [CI], 1.22–12.1) and 5.36 (95% CI, 1.32–21.8), respectively, after adjusting for age, sex, log-transformed estimated glomerular filtration rate (log(eGFR)), C-reactive protein, and diuretic use. The association between suPAR and LVMI was not statistically significant. In multivariate receiver operating characteristic analysis, addition of log(suPAR) to the combination of age, sex, log(eGFR) and CRP incrementally improved the prediction of low LVEF (area under the curve [AUC], 0.827 to 0.852, P = 0.046) and BNP ≥ 300 pg/mL (AUC, 0.869 to 0.906; P = 0.029). Conclusions suPAR was associated with low LVEF and elevated BNP, but not with left ventricular hypertrophy, independent of CRP, renal function, and diuretic use among cardiac inpatients who were not undergoing chronic hemodialysis. PMID:28135310

  9. Increased left ventricular ejection fraction after a meal: potential source of error in performance of radionuclide angiography

    Energy Technology Data Exchange (ETDEWEB)

    Brown, J.M.; White, C.J.; Sobol, S.M.; Lull, R.J.

    1983-06-01

    The effect of a standardized meal on left ventricular (LV) ejection fraction (EF) was determined by equilibrium radionuclide angiography in 16 patients with stable congestive heart failure but without pulmonary or valvular heart disease. LVEF was determined in the fasting state and 15, 30, and 45 minutes after a meal. Patients with moderately depressed fasting LVEF (30 to 50%), Group I, had a mean increase of 6.9 +/- 2.9% (p less than 0.005) in the LVEF at 45 minutes after the meal. Patients with severely depressed fasting LVEF (less than 30%), Group II, had no change after the meal. It is concluded that significant increases in LVEF may occur after meals in patients with moderate but not severe left ventricular dysfunction. Equilibrium radionuclide angiography studies that are not standardized for patients' mealtimes may introduce an important unmeasured variable that will affect the validity of data in serial studies of left ventricular function.

  10. Anaesthetic Management of Renal Transplant Surgery in Patients of Dilated Cardiomyopathy with Ejection Fraction Less Than 40%

    Directory of Open Access Journals (Sweden)

    Divya Srivastava

    2014-01-01

    Full Text Available Cardiovascular disease (CVD is an important comorbidity of chronic kidney disease, and reducing cardiovascular events in this population is an important goal for the clinicians who care for chronic kidney disease patients. The high risk for CVD in transplant recipients is in part explained by the high prevalence of conventional CVD risk factors (e.g., diabetes, hypertension, and dyslipidemia in this patient population. Current transplant success allows recipients with previous contraindications to transplant to have access to this procedure with more frequency and safety. Herein we provide a series of eight patients with dilated cardiomyopathy with poor ejection fraction posted for live donor renal transplantation which was successfully performed under regional anesthesia with sedation.

  11. Diastolic function is associated with quality of life and exercise capacity in stable heart failure patients with reduced ejection fraction

    Directory of Open Access Journals (Sweden)

    M.F. Bussoni

    2013-09-01

    Full Text Available Exercise capacity and quality of life (QOL are important outcome predictors in patients with systolic heart failure (HF, independent of left ventricular (LV ejection fraction (LVEF. LV diastolic function has been shown to be a better predictor of aerobic exercise capacity in patients with systolic dysfunction and a New York Heart Association (NYHA classification ≥II. We hypothesized that the currently used index of diastolic function E/e' is associated with exercise capacity and QOL, even in optimally treated HF patients with reduced LVEF. This prospective study included 44 consecutive patients aged 55±11 years (27 men and 17 women, with LVEF<0.50 and NYHA functional class I-III, receiving optimal pharmacological treatment and in a stable clinical condition, as shown by the absence of dyspnea exacerbation for at least 3 months. All patients had conventional transthoracic echocardiography and answered the Minnesota Living with HF Questionnaire, followed by the 6-min walk test (6MWT. In a multivariable model with 6MWT as the dependent variable, age and E/e' explained 27% of the walked distance in 6MWT (P=0.002; multivariate regression analysis. No association was found between walk distance and LVEF or mitral annulus systolic velocity. Only normalized left atrium volume, a sensitive index of diastolic function, was associated with decreased QOL. Despite the small number of patients included, this study offers evidence that diastolic function is associated with physical capacity and QOL and should be considered along with ejection fraction in patients with compensated systolic HF.

  12. Bleeding Risk and Antithrombotic Strategy in Patients With Sinus Rhythm and Heart Failure With Reduced Ejection Fraction Treated With Warfarin or Aspirin.

    Science.gov (United States)

    Ye, Siqin; Cheng, Bin; Lip, Gregory Y H; Buchsbaum, Richard; Sacco, Ralph L; Levin, Bruce; Di Tullio, Marco R; Qian, Min; Mann, Douglas L; Pullicino, Patrick M; Freudenberger, Ronald S; Teerlink, John R; Mohr, J P; Graham, Susan; Labovitz, Arthur J; Estol, Conrado J; Lok, Dirk J; Ponikowski, Piotr; Anker, Stefan D; Thompson, John L P; Homma, Shunichi

    2015-09-15

    We sought to assess the performance of existing bleeding risk scores, such as the Hypertension, Abnormal Renal/Liver Function, Stroke, Bleeding History or Predisposition, Labile INR, Elderly, Drugs/Alcohol Concomitantly (HAS-BLED) score or the Outpatient Bleeding Risk Index (OBRI), in patients with heart failure with reduced ejection fraction (HFrEF) in sinus rhythm (SR) treated with warfarin or aspirin. We calculated HAS-BLED and OBRI risk scores for 2,305 patients with HFrEF in SR enrolled in the Warfarin versus Aspirin in Reduced Cardiac Ejection Fraction trial. Proportional hazards models were used to test whether each score predicted major bleeding, and comparison of different risk scores was performed using Harell C-statistic and net reclassification improvement index. For the warfarin arm, both scores predicted bleeding risk, with OBRI having significantly greater C-statistic (0.72 vs 0.61; p = 0.03) compared to HAS-BLED, although the net reclassification improvement for comparing OBRI to HAS-BLED was not significant (0.32, 95% confidence interval [CI] -0.18 to 0.37). Performance of the OBRI and HAS-BLED risk scores was similar for the aspirin arm. For participants with OBRI scores of 0 to 1, warfarin compared with aspirin reduced ischemic stroke (hazard ratio [HR] 0.51, 95% CI 0.26 to 0.98, p = 0.042) without significantly increasing major bleeding (HR 1.24, 95% CI 0.66 to 2.30, p = 0.51). For those with OBRI score of ≥2, there was a trend for reduced ischemic stroke with warfarin compared to aspirin (HR 0.56, 95% CI 0.27 to 1.15, p = 0.12), but major bleeding was increased (HR 4.04, 95% CI 1.99 to 8.22, p <0.001). In conclusion, existing bleeding risk scores can identify bleeding risk in patients with HFrEF in SR and could be tested for potentially identifying patients with a favorable risk/benefit profile for antithrombotic therapy with warfarin.

  13. Cardiac manifestations of myotonic dystrophy type 1

    DEFF Research Database (Denmark)

    Petri, Helle; Vissing, John; Witting, Nanna;

    2012-01-01

    To estimate the degree of cardiac involvement regarding left ventricular ejection fraction, conduction abnormalities, arrhythmia, risk of sudden cardiac death (SCD) and the associations between cardiac involvement and cytosine-thymine-guanine (CTG)-repeat, neuromuscular involvement, age and gende...... in patients with myotonic dystrophy type 1 (MD1)....

  14. Forward ejection fraction: a new index of left ventricular function in mitral regurgitation.

    Science.gov (United States)

    Clancy, K F; Hakki, A H; Iskandrian, A S; Hadjimiltiades, S; Mundth, E D; Hakki, A H; Bemis, C E; Nestico, P F; DePace, N L; Segal, B L

    1985-09-01

    Previous studies have shown that a normal LVEF is not a reliable index of LV function in MR. We hypothesized that the forward EF, which is the forward stroke volume (measured by Fick or thermodilution) divided by end-diastolic volume (measured by contrast ventriculography) may be a useful index of LV function, since it represents LV emptying into the aorta. This index was examined in 54 patients with chronic MR who had normal EF (greater than or equal to 50%). There were significant correlations between the forward EF and the end-diastolic volume index (r = -0.69, p less than 0.001), end-systolic volume index (r = -0.64, p less than 0.001), cardiac index (r = 0.43, p less than 0.01), and the ratio of systolic pressure-to-end-systolic volume (r = 0.65, p less than 0.001). Patients were divided into two groups according to the forward EF: group I (n = 34) had forward EF less than or equal to 35%; and group II (n = 20) had forward EF greater than 35%. Of the 32 patients who subsequently underwent mitral valve replacement, 24 patients were in group I and eight patients were in group II. At a mean follow-up of 35 months, four patients died; all of them were in group I. Improvement in functional class occurred in 75% of surgical survivors (80% in group I and 63% in group II, p = NS). These preliminary data suggest that forward EF may be a useful index of LV performance in patients with MR who have normal EF.

  15. Relationship between angina pectoris and outcomes in patients with heart failure and reduced ejection fraction : an analysis of the Controlled Rosuvastatin Multinational Trial in Heart Failure (CORONA)

    NARCIS (Netherlands)

    Badar, Athar A.; Perez-Moreno, Ana Cristina; Jhund, Pardeep S.; Wong, Chih M.; Hawkins, Nathaniel M.; Cleland, John G. F.; van Veldhuisen, Dirk J.; Wikstrand, John; Kjekshus, John; Wedel, Hans; Watkins, Stuart; Gardner, Roy S.; Petrie, Mark C.; McMurray, John J. V.

    2014-01-01

    Aim Angina pectoris is common in patients with heart failure and reduced ejection fraction (HF-REF) but its relationship with outcomes has not been well defined. This relationship was investigated further in a retrospective analysis of the Controlled Rosuvastatin Multinational Trial in Heart Failure

  16. Challenging aspects of treatment strategies in heart failure with preserved ejection fraction: “Why did recent clinical trials fail?”

    Institute of Scientific and Technical Information of China (English)

    Peter; Moritz; Becher; Nina; Fluschnik; Stefan; Blankenberg; Dirk; Westermann

    2015-01-01

    Heart failure(HF) is the leading cause of hospitalization among older adults and the prevalence is growing with the aging populations in the Western countries. Epidemiologic reports suggest that approximately 50% of patients who have signs or symptoms of HF have preserved left ventricular ejection fraction. This HF type predominantly affects women and the elderly with other co-morbidities, such as diabetes, hypertension, and overt volume status. Most of the current treatment strategies are based on morbidity benefits such as quality of life and reduction of clinical HF symptoms. Treatment of patients with HF with preserved ejection fraction displayed disappointing results from several large randomized controlled trials. The heterogeneity of HF with preserved ejection fraction, understood as complex syndrome, seems to be one of the primary reasons. Here, we present an overview of the current management strategies with available evidence and new therapeutic approach from drugs currently in clinical trials, which target diastolic dysfunction, chronotropic incompetence, and risk factor management. We provide an outline and interpretation of recent clinical trials that failed to improve outcome and survival in patients with HF with preserved ejection fraction.

  17. Importance of combined left atrial size and estimated pulmonary pressure for clinical outcome in patients presenting with heart failure with preserved ejection fraction

    DEFF Research Database (Denmark)

    Donal, Erwan; Lund, Lars H; Oger, Emmanuel

    2017-01-01

    Aims: Heart failure with preserved ejection fraction (HFpEF) is a complex syndrome with various phenotypes and outcomes. The prognostic relevance of echocardiography and the E/e' ratio has previously been reported. We sought to study in addition, the value of estimated pulmonary pressure and left...

  18. Effect of Vericiguat, a Soluble Guanylate Cyclase Stimulator, on Natriuretic Peptide Levels in Patients With Worsening Chronic Heart Failure and Reduced Ejection Fraction

    DEFF Research Database (Denmark)

    Gheorghiade, Mihai; Greene, Stephen J; Butler, Javed;

    2015-01-01

    IMPORTANCE: Worsening chronic heart failure (HF) is a major public health problem. OBJECTIVE: To determine the optimal dose and tolerability of vericiguat, a soluble guanylate cyclase stimulator, in patients with worsening chronic HF and reduced left ventricular ejection fraction (LVEF). DESIGN, ...

  19. One-Year Outcomes After Transcatheter Insertion of an Interatrial Shunt Device for the Management of Heart Failure With Preserved Ejection Fraction

    NARCIS (Netherlands)

    Kaye, David M.; Hasenfuss, Gerd; Neuzil, Petr; Post, Martijn C.; Doughty, Robert; Trochu, Jean-Noel; Kolodziej, Adam; Westenfeld, Ralf; Penicka, Martin; Rosenberg, Mark; Walton, Antony; Muller, David; Walters, Darren; Hausleiter, Jorg; Raake, Philip; Petrie, Mark C.; Bergmann, Martin; Jondeau, Guillaume; Feldman, Ted; van Veldhuisen, Dirk J.; Ponikowski, Piotr; Silvestry, Frank E.; Burkhoff, Dan; Hayward, Christopher

    2016-01-01

    Background-Heart failure with preserved ejection fraction has a complex pathophysiology and remains a therapeutic challenge. Elevated left atrial pressure, particularly during exercise, is a key contributor to morbidity and mortality. Preliminary analyses have demonstrated that a novel interatrial s

  20. Clinical characteristics, left and right ventricular ejection fraction, and long-term prognosis in patients with non-insulin-dependent diabetes surviving an acute myocardial infarction

    DEFF Research Database (Denmark)

    Melchior, T; Gadsbøll, N; Hildebrandt, P;

    1996-01-01

    (with diabetes: median 46% vs without diabetes: median 43%; p = 0.89). Median right ventricular ejection fraction (62%) was within normal limits in both groups and did not differ statistically. Survival data were obtained for all patients. The 5-year mortality was increased in patients with diabetes...

  1. A mismatch index based on the difference between measured left ventricular ejection fraction and that estimated by infarct size at three months following reperfused acute myocardial infarction

    DEFF Research Database (Denmark)

    Carlsen, Esben A; Bang, Lia E; Lønborg, Jacob;

    2014-01-01

    BACKGROUND AND AIM: The reduction of left ventricular ejection fraction (LVEF) following ST-segment elevation myocardial infarction (STEMI) is a result of infarcted myocardium and may involve dysfunctional but viable myocardium. An index that may quantitatively determine whether LVEF is reduced b...

  2. Agreement of left ventricular ejection fraction and volumes between adenosine stress TL-201 gated SPECT and echocardiography

    Energy Technology Data Exchange (ETDEWEB)

    Pai, M. S. [College of Medicine, Univ. of Ewha, Seoul (Korea, Republic of); Moon, D. H.; Kim, H. M.; Yang, Y. J.; Kang, D. H. [Asan Medical Center, Seoul (Korea, Republic of)

    2003-07-01

    Electrocardiogram-gated TI-201 SPECT measurements of left ventricular ejection fraction (EF), end-diastolic volume (EDV), and end-systolic volume (ESV) have shown high correlation with conventional methods. However, how much these parameters measured by TI-201 gated SPECT differ from those by echocardiography has not been assessed. Adenosine stress (Ad-G) and redistribution TI-201 gated SPECT (Re-G) and resting echocardiography were conducted in 337 patients (184 male, 153 female). EDV, ESV and LVEF measured by QGS software were compared with the results by echocardiography. Patients with arrhythmia (atrial fibrillation or frequent premature contractions) or evidence of fixed or reversible perfusion defects on TI-201 SPECT were excluded. EF, EDV and ESV measured by Ad-G (63.3{+-}9.8,73.8{+-}30.2,29.1{+-}20.1) and Re-G (65.2{+-}11.6,69.1{+-}30.1,26.5{+-}20.3) correlated well with those by Echo (61.4{+-}7.9,78.3{+-}2.7, 30.7{+-} 17.5 ; r of Ad-G=0.547, 0.850, 0.827, p<0.001 ; r of Re-G=0.585, 0.838, 0.819, p<0.001). However the difference (mean, SD, SEE of Echo - gated SPECT) was statistically significant (EF: Ad-G=1.71, 8.92, 0.48, Re-G=3.59, 10.39, 0.56, p<0.001 ; EDV: Ad-G=4.75, 16.21, 0.88, Re-G=9.53, 16.77, 0.91, p<0.001 ; ESV: Ad-G=1.75, 11.35, 0.61, p<0.05, Re-G=4.29, 11.7, 0.63, p<0.001). Bland-Altman plots showed that the difference of EDV and ESV did not vary in any systematic way over the range of measurement, whereas the difference of EF increased with increasing average EF by Echo and gated-SPECT. The difference of EF, EDV, and ESV between Ad-G and Echo was significantly smaller than those between Re-G and Echo (p<0.001). Gated TI-201 SPECT underestimates EDV and ESV over a wide range of volume. As a result, EF by gated TI-201 SPECT is overestimated especially in patients with small LV volume. Ad-G is preferable to Re-G in assessing left ventricular ejection fraction and volume in place of Echo because of smaller bias.

  3. Impact of Exhaled Breath Acetone in the Prognosis of Patients with Heart Failure with Reduced Ejection Fraction (HFrEF). One Year of Clinical Follow-up

    Science.gov (United States)

    Saldiva, Paulo H. N.; Mangini, Sandrigo; Issa, Victor S.; Ayub-Ferreira, Silvia M.; Bocchi, Edimar A.

    2016-01-01

    Background The identification of new biomarkers of heart failure (HF) could help in its treatment. Previously, our group studied 89 patients with HF and showed that exhaled breath acetone (EBA) is a new noninvasive biomarker of HF diagnosis. However, there is no data about the relevance of EBA as a biomarker of prognosis. Objectives To evaluate whether EBA could give prognostic information in patients with heart failure with reduced ejection fraction (HFrEF). Methods After breath collection and analysis by gas chromatography-mass spectrometry and by spectrophotometry, the 89 patients referred before were followed by one year. Study physicians, blind to the results of cardiac biomarker testing, ascertained vital status of each study participant at 12 months. Results The composite endpoint death and heart transplantation (HT) were observed in 35 patients (39.3%): 29 patients (32.6%) died and 6 (6.7%) were submitted to HT within 12 months after study enrollment. High levels of EBA (≥3.7μg/L, 50th percentile) were associated with a progressively worse prognosis in 12-month follow-up (log-rank = 11.06, p = 0.001). Concentrations of EBA above 3.7μg/L increased the risk of death or HT in 3.26 times (HR = 3.26, 95%CI = 1.56–6.80, p = 0.002) within 12 months. In a multivariable cox regression model, the independent predictors of all-cause mortality were systolic blood pressure, respiratory rate and EBA levels. Conclusions High EBA levels could be associated to poor prognosis in HFrEF patients. PMID:28030609

  4. Association between circulating fibroblast growth factor 23, α-Klotho, and the left ventricular ejection fraction and left ventricular mass in cardiology inpatients.

    Directory of Open Access Journals (Sweden)

    Kensaku Shibata

    Full Text Available BACKGROUND: Fibroblast growth factor 23 (FGF23, with its co-receptor Klotho, plays a crucial role in phosphate metabolism. Several recent studies suggested that circulating FGF23 and α-Klotho concentrations might be related to cardiovascular abnormalities in patients with advanced renal failure. PURPOSE: Using data from 100 cardiology inpatients who were not undergoing chronic hemodialysis, the association of circulating levels of FGF23, α-Klotho, and other calcium-phosphate metabolism-related parameters with the left ventricular ejection fraction (LVEF and left ventricular mass (LVM was analyzed. METHODS AND RESULTS: LVEF was measured using the modified Simpson method for apical 4-chamber LV images and the LVM index (LVMI was calculated by dividing the LVM by body surface area. Univariate analysis showed that log transformed FGF23, but not that of α-Klotho, was significantly associated with LVEF and LVMI with a standardized beta of -0.35 (P<0.001 and 0.26 (P<0.05, respectively. After adjusting for age, sex, estimated glomerular filtration rate, and serum concentrations of intact parathyroid hormone, and 25-hydroxyvitamin D as covariates into the statistical model, log-transformed FGF23 was found to be a statistically positive predictor for decreased left ventricular function and left ventricular hypertrophy. CONCLUSIONS: In cardiology department inpatients, circulating FGF23 concentrations were found to be associated with the left ventricular mass and LVEF independent of renal function and other calcium-phosphate metabolism-related parameters. Whether modulation of circulating FGF23 levels would improve cardiac outcome in such a high risk population awaits further investigation.

  5. Changes in Follow-up Left Ventricular Ejection Fraction Associated with Outcomes in Primary Prevention ICD and CRT-D Recipients

    Science.gov (United States)

    Zhang, Yiyi; Guallar, Eliseo; Blasco-Colmenares, Elena; Butcher, Barbara; Norgard, Sanaz; Nauffal, Victor; Marine, Joseph E.; Eldadah, Zayd; Dickfeld, Timm; Ellenbogen, Kenneth A.; Tomaselli, Gordon F.; Cheng, Alan

    2015-01-01

    BACKGROUND Heart failure patients with primary prevention implantable cardioverter-defibrillators (ICD) may experience an improvement in left ventricular ejection fraction (LVEF) over time. However, it is unclear how LVEF improvement affects subsequent risk for mortality and sudden cardiac death (SCD). OBJECTIVES We sought to assess changes in LVEF after ICD implantation and the implication of these changes on subsequent mortality and ICD shocks. METHODS We conducted a prospective cohort study of 538 patients with repeated LVEF assessments after ICD implantation for primary prevention of SCD. The primary endpoint was appropriate ICD shock, defined as a shock for ventricular tachyarrhythmias. The secondary endpoint was all-cause mortality. RESULTS Over a mean follow-up of 4.9 years, LVEF decreased in 13.0%, improved in 40.0%, and was unchanged in 47.0% of the patients. In the multivariate Cox models comparing patients with an improved LVEF to those with an unchanged LVEF, the hazard ratios were 0.33 (95% confidence interval [CI]: 0.18 to 0.59) for mortality and 0.29 (95% CI: 0.11 to 0.78) for appropriate shock, respectively. During follow-up, 25% of patients showed an improvement in LVEF to >35% and their risk of appropriate shock decreased but was not eliminated. CONCLUSION Among primary prevention ICD patients, 40.0% had an improved LVEF during follow-up and 25% had LVEF improved to >35%. Changes in LVEF were inversely associated with all-cause mortality and appropriate shock for ventricular tachyarrhythmia. In patients whose follow-up LVEF improved to >35%, the risk of an appropriate shock remained but was markedly decreased. PMID:26227190

  6. Rhythm changes and the function of the left ventricle: analysis of effects on the left ventricular ejection fraction

    Directory of Open Access Journals (Sweden)

    Ferati Fatmir

    2013-03-01

    Full Text Available The purpose of the case report is the analysis of the effects of rhythm changes on ejection fraction (EF of the left ventricle (LV, which can be determined by transthoracal echocardiography. For this purpose, we have analyzed five patients with different rhythm changes. From three of them the conversion was spontaneous, one patient was converted with DC shock of ICD, and the other patient was converted medicamentosly.While analyzing the hemodynamic changes of the heart rhythm, one can see the need and the urgency for converting some of these changes — based on the effects that rhythm changes have in the hemodynamic function of the heart. According to the data, some of hemodynamic changes of the LV are almost minimal, like in the paroxysmal supraventicular tachycardia (PSVT, while the changes are enhanced in the atrial fibrillation (AF with an uncontrolled ventricular rhythm, and especially in the ventricular tachycardia (VT. This indicates the need for a fast conversion of the rhythm in VT and with a DC shock when required. Also in the cases of AF, in cases of inability of conversion of the rhythm in a sinus rhythm, control of the heart rate gives an important hemodynamic effect that can be seen from echocardiographic parameters

  7. Increased Left Ventricular Stiffness Impairs Exercise Capacity in Patients with Heart Failure Symptoms Despite Normal Left Ventricular Ejection Fraction

    Directory of Open Access Journals (Sweden)

    David Sinning

    2011-01-01

    Full Text Available Aims. Several mechanisms can be involved in the development of exercise intolerance in patients with heart failure despite normal left ventricular ejection fraction (HFNEF and may include impairment of left ventricular (LV stiffness. We therefore investigated the influence of LV stiffness, determined by pressure-volume loop analysis obtained by conductance catheterization, on exercise capacity in HFNEF. Methods and Results. 27 HFNEF patients who showed LV diastolic dysfunction in pressure-volume (PV loop analysis performed symptom-limited cardiopulmonary exercise testing (CPET and were compared with 12 patients who did not show diastolic dysfunction in PV loop analysis. HFNEF patients revealed a lower peak performance (=.046, breathing reserve (=.006, and ventilation equivalent for carbon dioxide production at rest (=.002. LV stiffness correlated with peak oxygen uptake (=−0.636, <.001, peak oxygen uptake at ventilatory threshold (=−0.500, =.009, and ventilation equivalent for carbon dioxide production at ventilatory threshold (=0.529, =.005. Conclusions. CPET parameters such as peak oxygen uptake, peak oxygen uptake at ventilatory threshold, and ventilation equivalent for carbon dioxide production at ventilatory threshold correlate with LV stiffness. Increased LV stiffness impairs exercise capacity in HFNEF.

  8. A systematic review concerning the relation between the sympathetic nervous system and heart failure with preserved left ventricular ejection fraction.

    Directory of Open Access Journals (Sweden)

    Willemien L Verloop

    Full Text Available Heart failure with preserved left ventricular ejection fraction (HFPEF affects about half of all patients diagnosed with heart failure. The pathophysiological aspect of this complex disease state has been extensively explored, yet it is still not fully understood. Since the sympathetic nervous system is related to the development of systolic HF, we hypothesized that an increased sympathetic nerve activation (SNA is also related to the development of HFPEF. This review summarizes the available literature regarding the relation between HFPEF and SNA.Electronic databases and reference lists through April 2014 were searched resulting in 7722 unique articles. Three authors independently evaluated citation titles and abstracts, resulting in 77 articles reporting about the role of the sympathetic nervous system and HFPEF. Of these 77 articles, 15 were included for critical appraisal: 6 animal and 9 human studies. Based on the critical appraisal, we selected 9 articles (3 animal, 6 human for further analysis. In all the animal studies, isoproterenol was administered to mimic an increased sympathetic activity. In human studies, different modalities for assessment of sympathetic activity were used. The studies selected for further evaluation reported a clear relation between HFPEF and SNA.Current literature confirms a relation between increased SNA and HFPEF. However, current literature is not able to distinguish whether enhanced SNA results in HFPEF, or HFPEF results in enhanced SNA. The most likely setting is a vicious circle in which HFPEF and SNA sustain each other.

  9. Prevalence and Risk Factors of Heart Failure with Preserved Ejection Fraction: A Population-Based Study in Northeast China

    Directory of Open Access Journals (Sweden)

    Liang Guo

    2016-07-01

    Full Text Available Background: Heart failure with preserved ejection fraction (HFpEF has attracted increasing attention worldwide. We aimed to estimate the prevalence of HFpEF and analyze its correlates in a sample of residents of northeast China; Methods: A population-based study of 2230 participants ≥35 years old was conducted in rural areas of Liaoning Province from January 2012 through August 2013. Information about lifestyle and other potential risk factors was obtained. HFpEF was diagnosed according to the recommendations of European Society of Cardiology; Results: The overall prevalence of HFpEF was 3.5% (1.8% in men and 4.9% in women. The prevalence of HFpEF increased with age in both genders and was greater in women than in men for every age group. Multivariable logistic regression analysis found that female gender (OR, 3.575; 95% CI, 1.761–7.256, hypertension (OR, 3.711; 95% CI, 2.064–6.674, and history of heart disease (2.086; 95% CI, 1.243–3.498 were associated factors for prevalent HFpEF; Conclusions: In a general population from rural northeast China, we found that female gender, hypertension, and history of heart disease were risk factors for prevalent HFpEF.

  10. A pilot study of angiogenin in heart failure with preserved ejection fraction: a novel potential biomarker for diagnosis and prognosis?

    Science.gov (United States)

    Jiang, Hong; Zhang, Lei; Yu, Ying; Liu, Ming; Jin, Xuejuan; Zhang, Peipei; Yu, Peng; Zhang, Shuning; Zhu, Hongmin; Chen, Ruizhen; Zou, Yunzeng; Ge, Junbo

    2014-11-01

    Characteristics of heart failure with preserved ejection fraction (HFPEF) have not yet been fully understood. The objectives of this pilot study are to detect protein expression profile in the sera of HFPEF patients, and to identify potential biomarkers for the disease. Five hundred and seven proteins were detected in the sera of healthy volunteers and patients with either HFPEF or hypertension using antibody microarrays (three in each group). The results showed that the serum concentrations of 17 proteins (e.g. angiogenin, activin A and artemin) differed considerably between HFPEF and non-HFPEF patients (hypertensive patients and healthy controls), while a protein expression pattern distinct from that in non-HFPEF patients was associated with HFPEF patients. The up-regulation of angiogenin in both HFPEF patients with LVEF ≥50% (P = 0.004) and a subset of HFPEF patients with LVEF = 41-49% (P HFPEF patients and 16 healthy controls. Meanwhile, angiogenin distinguished HFPEF patients from controls with a mean area under the receiver operating characteristic curve of 0.88 (P HFPEF patients were positively correlated with Lg(N-terminal pro-B-type natriuretic peptide, NT-proBNP) (P HFPEF.

  11. Spectral transfer function analysis of respiratory hemodynamic fluctuations predicts end-diastolic stiffness in preserved ejection fraction heart failure.

    Science.gov (United States)

    Abdellatif, Mahmoud; Leite, Sara; Alaa, Mohamed; Oliveira-Pinto, José; Tavares-Silva, Marta; Fontoura, Dulce; Falcão-Pires, Inês; Leite-Moreira, Adelino F; Lourenço, André P

    2016-01-01

    Preserved ejection fraction heart failure (HFpEF) diagnosis remains controversial, and invasive left ventricular (LV) hemodynamic evaluation and/or exercise testing is advocated by many. The stiffer HFpEF myocardium may show impaired stroke volume (SV) variation induced by fluctuating LV filling pressure during ventilation. Our aim was to investigate spectral transfer function (STF) gain from end-diastolic pressure (EDP) to indexed SV (SVi) in experimental HFpEF. Eighteen-week-old Wistar-Kyoto (WKY) and ZSF1 lean (ZSF1 Ln) and obese rats (ZSF1 Ob) randomly underwent LV open-chest (OC, n = 8 each group) or closed-chest hemodynamic evaluation (CC, n = 6 each group) under halogenate anesthesia and positive-pressure ventilation at constant inspiratory pressure. Beat-to-beat fluctuations in hemodynamic parameters during ventilation were assessed by STF. End-diastolic stiffness (βi) and end-systolic elastance (Eesi) for indexed volumes were obtained by inferior vena cava occlusion in OC (multibeat) or single-beat method estimates in CC. ZSF1 Ob showed higher EDP spectrum (P heart catheterization-derived EDP surrogates to noninvasively determined SV as screening/diagnostic tool to assess myocardial stiffness in HFpEF.

  12. Systolic Longitudinal Function of the Left Ventricle Assessed by Speckle Tracking in Heart Failure Patients with Preserved Ejection Fraction

    Science.gov (United States)

    Toufan, Mehrnoush; Mohammadzadeh Gharebaghi, Saeed; Pourafkari, Leili; Delir Abdolahinia, Elham

    2015-01-01

    Background: Echocardiographic evaluations of the longitudinal axis of the left ventricular (LV) function have been used in the diagnosis and assessment of heart failure with normal ejection fraction (HFNEF). The evaluation of the global and segmental peak systolic longitudinal strains (PSLSs) by two-dimensional speckle tracking echocardiography (STE) may correlate with conventional echocardiography findings. We aimed to use STE to evaluate the longitudinal function of the LV in patients with HFNEF. Methods: In this study, 126 patients with HFNEF and diastolic dysfunction and 60 normal subjects on conventional echocardiography underwent STE evaluations, including LV end-diastolic and end-systolic dimensions; interventricular septal thickness; posterior wall thickness; LV volume; LV ejection fraction; left atrial volume index; early diastolic peak flow velocity (𝐸); late diastolic peak flow velocity (𝐴); 𝐸/𝐴 ratio; deceleration time of 𝐸; early diastolic myocardial velocity (e′); late diastolic myocardial velocity (A′); systolic myocardial velocity (S); and global, basal, mid, and apical PSLSs. The correlations between these methods were assessed. Results: The mean age was 57.50 ± 10.07 years in the HFNEF patients and 54.90 ± 7.17 years in the control group. The HFNEF group comprised 69.8% males and 30.2% females, and the normal group consisted of 70% males and 30% females. The global, basal, mid, and apical PSLSs were significantly lower in the HFNEF group (p value < 0.001 for all). There was a significant positive correlation between the global PSLS and the septal e' (p value < 0.001). There was a negative correlation between the global PSLS and the E/e' ratio (p value = 0.001). There was a significant negative correlation between the E/e' ratio and the mid PSLS (p value = 0.002) and the basal PSLS (p value = 0.001). There was a weak positive correlation between the septal e' and the mid PSLS (p value = 0.001) and the

  13. Effect of mental stress on left ventricular ejection fraction and its relationship to the severity of coronary artery disease

    Energy Technology Data Exchange (ETDEWEB)

    Kuroda, Toru; Kuwabara, Yoichi; Watanabe, Satoshi; Nakaya, Jiro; Hasegawa, R.; Shikama, Takeshi; Matsuno, Kouki; Mikami, Yuji; Fujii, Kiyotaka; Saito, Toshihiro; Masuda, Yoshiaki [Dept. of Internal Medicine, Chiba Univ. (Japan)

    2000-12-01

    To evaluate the relationship between the mental stress-induced decrease in left ventricular ejection fraction (LVEF) and the severity of exercise-induced ischaemia, 20 patients with stable coronary artery disease (CAD) underwent radionuclide ventriculography during mental stress testing and stress myocardial perfusion single-photon emission tomography (SPET). We also examined whether changes in haemodynamic and neurohormonal parameters are related to changes in LVEF during mental stress. The LVEF decreased from 54.8%{+-}17.7% to 49.8%{+-}16.2% with mental stress (P<0.0005). Ten of the 20 patients (50.0%) had a {>=}5% decrease in LVEF. The remaining ten patients had no or a <5% decrease in LVEF. There was a significant correlation between the change in LVEF during mental stress and the size of the reversible defect on stress myocardial perfusion SPET (r=-0.80, P<0.0005), with close regional correspondence (75% identical). This correlation was less strong in the 12 patients with a total defect score at rest of <10 (r=-0.69, P=0.014) than in the eight patients with a total defect score at rest of {>=}10 (r=-0.94, P=0.001). The changes in blood pressure and heart rate were not significantly correlated with the change in LVEF, but the percent change in adrenaline concentration correlated with the change in LVEF. It is suggested that mental stress impairs systolic function by inducing transient myocardial ischaemia. The effect of neurohormonal responses during mental stress on LV systolic function may also be important in patients with CAD. (orig.)

  14. Echocardiography and invasive hemodynamics during stress testing for diagnosis of heart failure with preserved ejection fraction: an experimental study.

    Science.gov (United States)

    Leite, Sara; Oliveira-Pinto, José; Tavares-Silva, Marta; Abdellatif, Mahmoud; Fontoura, Dulce; Falcão-Pires, Inês; Leite-Moreira, Adelino F; Lourenço, André P

    2015-06-15

    Inclusion of exercise testing in diagnostic guidelines for heart failure with preserved ejection fraction (HFpEF) has been advocated, but the target population, technical challenges, and underlying pathophysiological complexity raise difficulties to implementation. Hemodynamic stress tests may be feasible alternatives. Our aim was to test Trendelenburg positioning, phenylephrine, and dobutamine in the ZSF1 obese rat model to find echocardiographic surrogates for end-diastolic pressure (EDP) elevation and HFpEF. Seventeen-week-old Wistar-Kyoto, ZSF1 lean, and obese rats (n = 7 each) randomly and sequentially underwent (crossover) Trendelenburg (30°), 5 μg·Kg(-1)·min(-1) dobutamine, and 7.5 μg·Kg(-1)·min(-1) phenylephrine with simultaneous left ventricular (LV) pressure-volume loop and echocardiography evaluation under halogenate anesthesia. Effort testing with maximum O2 consumption (V̇o 2 max) determination was performed 1 wk later. Obese ZSF1 showed lower effort tolerance and V̇o 2 max along with higher resting EDP. Both Trendelenburg and phenylephrine increased EDP, whereas dobutamine decreased it. Significant correlations were found between EDP and 1) peak early filling Doppler velocity of transmitral flow (E) to corresponding myocardial tissue Doppler velocity (E') ratio, 2) E to E-wave deceleration time (E/DT) ratio, and 3) left atrial area (LAA). Diagnostic efficiency of E/DT*LAA by receiver-operating characteristic curve analysis for elevation of EDP above a cut-off of 13 mmHg during hemodynamic stress was high (area under curve, AUC = 0.95) but not higher than that of E/E' (AUC = 0.77, P = 0.15). Results in ZSF1 obese rats suggest that noninvasive echocardiography after hemodynamic stress induced by phenylephrine or Trendelenburg can enhance diagnosis of stable HFpEF and constitute an alternative to effort testing.

  15. Prognostic significance of tPA/PAI-1 complex in patients with heart failure and preserved ejection fraction.

    Science.gov (United States)

    Winter, Max-Paul; Kleber, Marcus E; Koller, Lorenz; Sulzgruber, Patrick; Scharnagl, Hubert; Delgado, Graciela; Goliasch, Georg; März, Winfried; Niessner, Alexander

    2017-02-28

    Heart failure with preserved ejection fraction (HFpEF) represents a major epidemic, clinical and public health problem with rising patient numbers every year. Traditional markers for heart failure have been shown to be of limited sensitivity in patients with HFpEF, as those do not reflect pathophysiology of the disease properly. Dysregulation of haemostasis is thought to be central for the initiation and progression of HFpEF. For this reason, we aimed to assess markers of fibrinolytic activity as potential biomarkers for risk assessment in patients with HFpEF. We evaluated blood coagulation parameters in 370 patients with HFpEF included in the LUdwigshafen Risk and Cardiovascular Health (LURIC) study. Within an observation period of 9.7 years, 40 percent of these patients died from any cause. tPA/PAI-1 complex significantly predicted all-cause mortality with a hazard ratio (HR) of 1.24 (95 % confidence interval [CI] 1.04-1.47) per increase of 1 SD and cardiovascular mortality with a HR 1.26 (95 % CI 1.02-1.56) per increase of 1 SD. Both associations remained significant after adjustment for cardiovascular risk factors, N-terminal pro-B-type natriuretic peptide (NT-proBNP) and frequent HFpEF- related comorbidities. Importantly, tPA/PAI-1 complex had additional prognostic value above and beyond NT-proBNP as indicated by integrated discrimination improvement (0.0157, p=0.017). In conclusion, the concentration of tPA/PAI-1 complex is an independent predictor of mortality from all causes and from cardiovascular causes in patients with HFpEF. The concomitant measurement of tPA/PAI-1 complex might be useful in clinical practice to add prognostic value to traditional markers of heart failure.

  16. Causes and predictors of hospital readmissions in patients older than 65 years hospitalized for heart failure with preserved left ventricular ejection fraction in western Romania

    Directory of Open Access Journals (Sweden)

    Mavrea AM

    2015-06-01

    -terminal-pro-brain natriuretic peptide >477 pg/mL (P<0.02 in the elderly group, while in the nonelderly group, the independent predictors of this outcome were a New York Heart Association functional class of IV at initial hospitalization (P<0.04, as well as plasma levels of brain natriuretic peptide >390 pg/mL (P=0.03 and tumor necrosis factor (TNF-α >7.1 pg/mL (P<0.001. Readmissions due to noncardiovascular causes were independently predicted by plasma levels of TNF-α >10 pg/mL in the elderly (P=0.003 and of interleukin (IL-6 >1.9 pg/mL in the nonelderly (P<0.04.Conclusion: We conclude that in HFpEF patients aged ≥65 years, the main cause of rehospitalization during the 1-year follow-up was HF aggravation. The risk of this outcome was independently predicted by increased levels of cardiac peptides, while the risk of noncardiovascular readmissions was predicted by increased levels of inflammatory biomarkers. Increased TNF-a levels predicted both cardiovascular and noncardiovascular readmissions, while increased levels of high-sensitivity C-reactive protein did not predict any of these outcomes in our study.Keywords: elderly, heart failure with preserved left ventricular ejection fraction, hospital readmissions

  17. Decreased plasma IL-35 levels are related to the left ventricular ejection fraction in coronary artery diseases.

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    Yingzhong Lin

    Full Text Available BACKGROUND: Accumulating evidence shows that the novel anti-inflammatory cytokine IL-35 can efficiently suppress effector T cell activity and alter the progression of inflammatory and autoimmune diseases. The two subunits of IL-35, EBI3 and p35, are strongly expressed in human advanced plaque, suggesting a potential role of IL-35 in atherosclerosis and coronary artery disease (CAD. However, the plasma levels of IL-35 in patients with CAD have yet to be investigated. METHODS: Plasma IL-35, IL-10, TGF-β1, IL-12 and IL-27 levels were measured using an ELISA in 43 stable angina pectoris (SAP patients, 62 unstable angina pectoris (UAP patients, 56 acute myocardial infarction (AMI patients and 47 chest pain syndrome patients as a control group. RESULTS: The results showed that plasma IL-35 levels were significantly decreased in the SAP group (90.74±34.22 pg/ml, the UAP group (72.20±26.63 pg/ml, and the AMI group (50.21±24.69 pg/ml compared with chest pain syndrome group (115.06±32.27 pg/ml. Similar results were also demonstrated with IL-10 and TGF-β1. Plasma IL-12 and IL-27 levels were significantly increased in the UAP group (349.72±85.22 pg/ml, 101.75±51.42 pg/ml, respectively and the AMI group (318.05±86.82 pg/ml, 148.88±68.45 pg/ml, respectively compared with chest pain syndrome group (138.68±34.37 pg/ml, 63.60±22.75 pg/ml, respectively and the SAP group (153.84±53.86 pg/ml, 70.84±38.77 pg/ml, respectively. Furthermore, lower IL-35 levels were moderately positively correlated with left ventricular ejection fraction (LVEF in CAD patients (R = 0.416, P<0.01, whereas higher IL-27 levels were weakly negatively correlated with LVEF in CAD patients(R = -0.205, P<0.01. CONCLUSIONS: The results of the present study show that circulating IL-35 is a potentially novel biomarker for coronary artery disease. Regulating the expression of IL-35 also provides a new possible target for the treatment of atherosclerosis and CAD.

  18. Diagnosis of heart failure with preserved ejection fraction: improved accuracy with the use of markers of collagen turnover.

    LENUS (Irish Health Repository)

    Martos, Ramon

    2012-02-01

    AIMS: Heart failure with preserved ejection fraction (HF-PEF) can be difficult to diagnose in clinical practice. Myocardial fibrosis is a major determinant of diastolic dysfunction (DD), potentially contributing to the progression of HF-PEF. The aim of this study was to analyse whether serological markers of collagen turnover may predict HF-PEF and DD. METHODS AND RESULTS: We included 85 Caucasian treated hypertensive patients (DD n=65; both DD and HF-PEF n=32). Serum carboxy (PICP), amino (PINP), and carboxytelo (CITP) peptides of procollagen type I, amino (PIIINP) peptide of procollagen type III, matrix metalloproteinases (MMP-1, MMP-2, and MMP-9), and tissue inhibitor of MMP levels were assayed. Using receiver operating characteristic curve analysis, MMP-2 (AUC=0.91; 95% CI: 0.84, 0.98), CITP (0.83; 0.72, 0.92), PICP (0.82; 0.72, 0.92), B-type natriuretic peptide (BNP) (0.82; 0.73, 0.91), MMP-9 (0.79; 0.68, 0.89), and PIIINP (0.78; 0.66, 0.89) levels were significant predictors of HF-PEF (P<0.01 for all). Carboxytelo peptides of procollagen type I (AUC=0.74; 95% CI: 0.62, 0.86), MMP-2 (0.73; 0.62, 0.84), PIIINP (0.73; 0.60, 0.85), BNP (0.69; 0.55, 0.83) and PICP (0.66; 0.54, 0.78) levels were significant predictors of DD (P<0.05 for all). A cutoff of 1585 ng\\/mL for MMP-2 provided 91% sensitivity and 76% specificity for predicting HF-PEF and combinations of biomarkers could be used to adjust either sensitivity or specificity. CONCLUSION: Markers of collagen turnover identify patients with HF-PEF and DD. Matrix metalloproteinase 2 may be more useful than BNP in the identification of HF-PEF. This suggests that these new biochemical tools may assist in identifying patients with these diagnostically challenging conditions.

  19. Risk factors for mortality after coronary artery bypass grafting in patients with low left ventricular ejection fraction

    Institute of Scientific and Technical Information of China (English)

    WANG Jin; XIAO Feng; REN Jian; LI Yan; ZHANG Ming-li

    2007-01-01

    Background We managed to assess and confirm the risk factors for mortality after coronary artery bypass grafting (CABG) operations so as to map out the proper guidance of surgical strategy especially in patients with low left ventricular ejection fraction (LVEF) in domestic polyclinic like ours.Methods Five hundred and forty-eight consecutive patients underwent CABG from December 1999 through August 2005 were analyzed retrospectively. Eighty-nine cases had an LVEF of 40% or less. All together twenty-two candidate factors were evaluated for their association with perioperative death using univariate and multivariate stepwise Logistic analysis.Results When data from all the patients who had undergone CABG were taken into account, LVEF, left ventricular end diastolic diameter (LVEDD), mitral regurgitation, aneurysm of the heart wall, mitral repair/replacement, resection of aneurysm, concomitant aortic valve replacement, and perioperative intra-aortic balloon counter-pulsation (IABP), left ventricular assist device (LVAD) and cardiopulmonary bypass (CPB) all showed an association with perioperative death in univariate analysis, while an LVEF of >40%, on the other hand, appeared to be a protective factor. In multivariate analysis, moderate to severe mitral regurgitation, aneurysm of the heart wall, repair of septal perforation and aortic regurgitation were proved to be risk factors. When the analysis was restricted to patients with an LVEF of 40% or less,such variables as age, LVEDD, mitral regurgitation, mitral repair/replacement, IABP, and CPB were qualified as risk factors in a univariate analysis. Age, moderate mitral regurgitation, aneurysm of the heart wall, CPB, left main coronary artery disease and female were associated with perioperative death in a multivariate logistic regression analysis.Conclusions Concerning the prognosis, patients who undergo CABG would have different risk factors when data from all the enrolled patients or data from patients with LVEF

  20. Worsening renal function and outcome in heart failure patients with reduced and preserved ejection fraction and the impact of angiotensin receptor blocker treatment : data from the CHARM-study programme

    NARCIS (Netherlands)

    Damman, Kevin; Solomon, Scott D.; Pfeffer, Marc A.; Swedberg, Karl; Yusuf, Salim; Young, James B.; Rouleau, Jean L.; Granger, Christopher B.; McMurray, John J. V.

    2016-01-01

    Aims We investigated the association between worsening renal function (WRF) that occurs during renin-angiotensin-aldosterone system inhibition initation and outcome in heart failure (HF) patients with preserved ejection fraction (HFPEF) and compared this with HF patients with reduced ejection fracti

  1. Prognostic value of plasma catecholamines, plasma renin activity, and plasma atrial natriuretic peptide at rest and during exercise in congestive heart failure: comparison with clinical evaluation, ejection fraction, and exercise capacity

    DEFF Research Database (Denmark)

    Madsen, B K; Keller, N; Christiansen, E;

    1995-01-01

    carried significant, independent prognostic information in a multivariate analysis: left ventricular ejection fraction (P = .03), plasma noradrenaline at rest (P = .009), New York Heart Association class III + IV (P = .005), increase in heart rate during exercise

  2. Left ventricular markers of global dyssynchrony predict limited exercise capacity in heart failure, but not in patients with preserved ejection fraction

    Directory of Open Access Journals (Sweden)

    Bajraktari Gani

    2012-09-01

    Full Text Available Abstract Background The aim of this study was to prospectively examine echocardiographic parameters that correlate and predict functional capacity assessed by 6 min walk test (6-MWT in patients with heart failure (HF, irrespective of ejection fraction (EF. Methods In 147 HF patients (mean age 61 ± 11 years, 50.3% male, a 6-MWT and an echo-Doppler study were performed in the same day. Global LV dyssynchrony was indirectly assessed by total isovolumic time - t-IVT [in s/min; calculated as: 60 – (total ejection time + total filling time], and Tei index (t-IVT/ejection time. Patients were divided into two groups based on the 6-MWT distance (Group I: ≤300 m and Group II: >300 m, and also in two groups according to EF (Group A: LVEF ≥ 45% and Group B: LVEF  Results In the cohort of patients as a whole, the 6-MWT correlated with t-IVT (r = −0.49, p  Conclusion In patients with HF, the limited exercise capacity, assessed by 6-MWT, is related mostly to severity of global LV dyssynchrony, more than EF or raised filling pressures. The lack of exercise predictors in HFpEF reflects its multifactorial pathophysiology.

  3. Functional Relevance of Coronary Artery Disease by Cardiac Magnetic Resonance and Cardiac Computed Tomography: Myocardial Perfusion and Fractional Flow Reserve

    Directory of Open Access Journals (Sweden)

    Gianluca Pontone

    2015-01-01

    Full Text Available Coronary artery disease (CAD is one of the leading causes of morbidity and mortality and it is responsible for an increasing resource burden. The identification of patients at high risk for adverse events is crucial to select those who will receive the greatest benefit from revascularization. To this aim, several non-invasive functional imaging modalities are usually used as gatekeeper to invasive coronary angiography, but the diagnostic yield of elective invasive coronary angiography remains unfortunately low. Stress myocardial perfusion imaging by cardiac magnetic resonance (stress-CMR has emerged as an accurate technique for diagnosis and prognostic stratification of the patients with known or suspected CAD thanks to high spatial and temporal resolution, absence of ionizing radiation, and the multiparametric value including the assessment of cardiac anatomy, function, and viability. On the other side, cardiac computed tomography (CCT has emerged as unique technique providing coronary arteries anatomy and more recently, due to the introduction of stress-CCT and noninvasive fractional flow reserve (FFR-CT, functional relevance of CAD in a single shot scan. The current review evaluates the technical aspects and clinical experience of stress-CMR and CCT in the evaluation of functional relevance of CAD discussing the strength and weakness of each approach.

  4. Relationship between the level of NT-proBNP and left ventricular diastolic function in chronic heart failure patients with preserved ejection fraction

    Institute of Scientific and Technical Information of China (English)

    Zhu Youfeng; Li Kong; Wei Jianrui; Yin Haiyan; Zhang Rui

    2014-01-01

    Objective To investigate the relationship between n-terminal pro-brain natriuretic peptide (NT-proBNP) level and echocardiographic parameter in patients with chronic heart failure with preserved ejection fraction (HFPEF) and evaluate the correlation,specificity and sensitivity on these indices.Methods Sixty-six symptomatic patients with isolated diastolic dysfunction and preserved left ventricular ejection fraction (LVEF) (≥ 50%) and forty-three people with normal left ventricular (LV) function were examined by conventional echocardiography,tissue Doppler imaging (TDI).Plasma NT-proBNP levels were determined simultaneously.Results Compared with control group,NT-proBNP,E/Em,LVMI were significantly higher in HFPEF (P < 0.01); NT-proBNP was significantly correlated with E/Em (correlation coefficient r =0.576).Conclusion NT-proBNP,E/Em,LVMI were significant markers for reflecting left ventricular diastolic function and good tools for diagnosing HFPEF.NT-proBNP had a significant negative predictive value (92.7%) when NT-proBNP < 90 pg/ml.

  5. High coronary artery calcium score affects clinical outcome despite normal stress myocardial perfusion imaging and normal left ventricular ejection fraction

    DEFF Research Database (Denmark)

    Madsen, Claus Juul; Andersen, Kim F; Zerahn, Bo

    2013-01-01

    Normal myocardial perfusion imaging (MPI) indicates a low risk for cardiac death and new ischaemic events. However, the impact of normal MPI combined with a high coronary artery calcium score (CACS) is not clear. The aims of this study were to evaluate the risk of severely elevated CACS...

  6. Comparative Analysis of Different Ejection Fraction in Patients With Chronic Heart Failure%不同射血分数的慢性心衰患者临床对比分析

    Institute of Scientific and Technical Information of China (English)

    邱明华

    2015-01-01

    目的:探讨不同射血分数对慢性心衰患者的影响。方法依据左室射血分数值(50%)分为保留正常射血分数的心力衰竭(HFPEF)组和射血分数减损的心力衰竭(HFDEF)组,随访评价临床表现及生存情况等。结果 HFPEF组比较,HFDEF组患者临床症状更重,死亡率更高,具有统计学意义。结论射血分数减损是慢性心力衰竭的独立危险因素。%Objective Explore the effect of different ejection fraction in patients with chronic heart failure.Methods Value of left ventricular ejection fraction (50%) as a standard grouping. Each of the two groups was keeping the heart failurewith normal ejection fraction (HFPEF) and ejection fraction in derogationof congestive heart failure (HFDEF) group. Evaluation of clinical performance andsurvival, and so on.ResultsCompared with HFPEF group, HFDEF set of clinical symptoms in patients with more severe and mortality was more higher,Statistically signiifcant.Conclusion Ejection fraction derogations was independent risk factors for chronicheart failure.

  7. Sildenafil and diastolic dysfunction after acute myocardial infarction in patients with preserved ejection fraction: the Sildenafil and Diastolic Dysfunction After Acute Myocardial Infarction (SIDAMI) trial

    DEFF Research Database (Denmark)

    Andersen, Mads Jønsson; Ersboll, M; Axelsson, Anders

    2013-01-01

    BACKGROUND: Diastolic dysfunction is frequently seen after myocardial infarction and is characterized by a disproportionate increase in filling pressure during exercise to maintain stroke volume. We hypothesized that sildenafil would reduce filling pressure during exercise in patients...... with diastolic dysfunction after myocardial infarction. METHODS AND RESULTS: Seventy patients with diastolic dysfunction and near normal left ventricular ejection fraction on echocardiography were randomly assigned sildenafil 40 mg thrice daily or matching placebo for 9 weeks. Before randomization and after 9...... but was unchanged in the placebo group. CONCLUSIONS: Sildenafil did not decrease filling pressure at rest or during exercise in post-myocardial infarction patients with diastolic dysfunction. However, there were effects on secondary end points, which require further studies....

  8. Transcatheter treatment of heart failure with preserved or mildly reduced ejection fraction using a novel interatrial implant to lower left atrial pressure

    DEFF Research Database (Denmark)

    Søndergaard, Lars; Reddy, Vivek; Kaye, David

    2014-01-01

    BACKGROUND: Heart failure with preserved or mildly reduced ejection fraction (HFpEF) is common and, to date, therapeutic options are limited. Increased left atrial pressure is a key contributor to the symptoms associated with HFpEF, particularly during physical activity. We report the 30-day...... patients, one class in five patients, and worsened by one class in one patient. No patient developed pulmonary hypertension. Two serious adverse events occurred; heart failure re-hospitalization, and implant malposition successfully treated with a new device. CONCLUSION: Contemporary management of HFpEF......Hg (exercise); and ≥1 hospitalization for heart failure within the past 12 months, or persistent NYHA class III/IV for at least 3 months. Mean age, LVEF, and NYHA class were 70 ± 12 years, 57 ± 9%, and 3.2 ± 0.4, respectively. Most patients had significant co-morbidities. The interatrial septal device (IASD...

  9. Effect of Phosphodiesterase-5 Inhibition on Exercise Capacity and Clinical Status in Heart Failure with Preserved Ejection Fraction: A Randomized Clinical Trial

    Science.gov (United States)

    Redfield, Margaret M; Chen, Horng H; Borlaug, Barry A; Semigran, Marc J.; Lee, Kerry L.; Lewis, Gregory; LeWinter, Martin M.; Rouleau, Jean L.; Bull, David A.; Mann, Douglas L.; Deswal, Anita; Stevenson, Lynne W.; Givertz, Michael M.; Ofili, Elizabeth O.; O’Connor, Christopher M.; Felker, G. Michael; Goldsmith, Steven R.; Bart, Bradley A.; McNulty, Steven E; Ibarra, Jenny C.; Lin, Grace; Oh, Jae K.; Patel, Manesh R.; Kim, Raymond J.; Tracy, Russell P.; Velazquez, Eric J.; Anstrom, Kevin J.; Hernandez, Adrian F.; Mascette, Alice M.; Braunwald, Eugene

    2013-01-01

    Importance Studies in experimental and human heart failure suggest that phosphodiesterase type-5 inhibitors may enhance cardiovascular function, and thus, exercise capacity in heart failure with preserved ejection fraction. Objective To determine the effect of the phosphodiesterase type-5 inhibitor, sildenafil, in comparison to placebo on exercise capacity and clinical status in heart failure with preserved ejection fraction. Design, setting, and patients Multicenter, double-blind, placebo-controlled, parallel design, randomized clinical trial of 216 stable outpatients with heart failure, ejection fraction ≥ 50%, elevated N-terminal pro-brain natriuretic peptide or elevated invasively-measured filling pressures, and reduced exercise capacity. Participants were randomized from October 2008 through February 2012 at 26 centers in the United States and Canada. Intervention Sildenafil (n=113) or placebo (n=103) administered orally at 20 mg three times daily for 12 weeks followed by 60 mg three times daily for 12 weeks. Main outcome measures Primary endpoint was change in peak oxygen consumption after 24 weeks of therapy. Secondary endpoints included change in six-minute walk distance and a three tier hierarchical composite clinical status score where patients were ranked (range 1-N) based on time to death, time to cardiovascular or cardiorenal hospitalization and change in quality of life for participants alive without cardiovascular or cardiorenal hospitalization at 24 weeks. Results Median age was 69 years and 48% of patients were female. At baseline, median peak oxygen consumption (11.7 ml/kg/min) and six-minute walk distance (308 meters) were reduced and median E/e′ (16), left atrial volume index (44 ml/m2) and pulmonary artery systolic pressure (41 mmHg) were consistent with chronically-elevated left ventricular filling pressures. At 24 weeks, median (interquartile range) changes in peak oxygen consumption (ml/kg/min) in patients who received placebo [−0

  10. 射血分数保留型心力衰竭的研究进展%Research Progress of Heart Failure with Preserved Ejection Fraction

    Institute of Scientific and Technical Information of China (English)

    董海翠(综述); 汪祥海(审校)

    2016-01-01

    Heart failure with preserved ejection fraction(HFpEF) is one of the most challenging clinical syndromes ,and has been the main form of heart failure.Importantly,its morbidity and mortality were comparative with the heart failure with reduced ejection fraction ,so HFpEF is greatly in need of the systematic research on its clinical feature ,pathophysiology ,and more.However,there is still no clear and con-sistent conclusion .Here we reviewed the research progress of HFpEF in terms of the clinical feature ,pathophysiology ,diagnosis ,and treatment in recent years ,which will be beneficial to the clinical diagnosis and treatment of HFpEF for the clinician .%射血分数保留型心力衰竭是最具挑战性的临床综合征之一,并逐渐在心力衰竭中占主导地位,其发病率和病死率已与射血分数减少型心力衰竭相当,因此,急需对其临床特点与发病机理等进行系统的研究。然而,目前有关的研究仍无明确且统一的结论。在此,对近几年射血分数保留型心力衰竭的临床特征、病理生理机制、诊断以及治疗方法进行综述,将有助于临床医生对射血分数保留型心力衰竭的诊断与治疗。

  11. Determinants of the response of left ventricular ejection fraction to vasodilator stress in electrocardiographically gated {sup 82}rubidium myocardial perfusion PET

    Energy Technology Data Exchange (ETDEWEB)

    Brown, Tracy L.Y.; Merrill, Jennifer; Bengel, Frank M. [Johns Hopkins University, Department of Radiology and Radiological Sciences, Division of Nuclear Medicine, Baltimore, MD (United States); Volokh, Lana [GE Healthcare, Haifa (Israel)

    2008-02-15

    Myocardial perfusion imaging with {sup 82}Rb PET allows for ECG-gated studies to be obtained early after radiotracer injection, capturing ventricular function close to peak pharmacologic action of dipyridamole. This is different from gated SPECT and may potentially provide additional diagnostic information. We sought to identify potential correlates of the PET-derived ejection fraction response to vasodilator stress. One hundred ten consecutive patients undergoing {sup 82}Rb PET myocardial perfusion imaging during evaluation for coronary artery disease were included. Using a GE Discovery STRx PET-CT scanner, ECG-gated images (eight bins) were obtained at rest and 4 min after dipyridamole infusion, 90 s after infusion of 1,480-2,220 MBq of {sup 82}Rb. Summed rest, stress, and difference scores (SRS, SSS, and SDS) were determined using a five-point scoring system and 20-segment model. Ejection fraction was calculated using automated QGS software. Significant reversibility (SDS {>=} 4) was found in 23 patients (21%). Mean LVEF in all patients was 47 {+-} 13% at rest and 53 {+-} 13% during dipyridamole. LVEF increased in 89 patients, and decreased in 17 patients during vasodilation. The change in LVEF was inversely correlated with SDS (r = -0.26; p = 0.007). Additionally, it was inversely correlated with resting LVEF (r = -0.20; p = 0.03) and SSS (r = -0.25; p = 0.009). No significant correlations were observed with SRS, heart rate, blood pressure, age, hypertension, hypercholesterolemia, or pretest likelihood of disease. At multivariate regression analysis, SDS was an independent predictor of the change in LVEF. Gated {sup 82}Rb PET during pharmacologic stress allows for assessment of the functional response to vasodilation. The magnitude of LVEF increase is determined by stress perfusion/reversible perfusion defects. Functional response to hyperemia may thus be incorporated in future evaluations of diagnostic and prognostic algorithms based on {sup 82}Rb PET. (orig.)

  12. Value of left ventricular regional ejection fraction determined by real-time three-dimensional echocardiography in diagnosis of aneurysm: compared with left ventriculography

    Institute of Scientific and Technical Information of China (English)

    LI Xiu-chang; YAN Cheng-jun; YAO Gui-hua; ZHANG Mei; LI Ji-fu; ZHANG Yun

    2009-01-01

    Background Regional ejection fraction (EF_R) measured by real-time three-dimensional echocardiography (RT-3DE)provides a novel method for quantifying left-ventricular (LV) regional systolic function. We aimed to explore the diagnostic value of regional ejection fraction (EFR) derived from RT-3DE in detecting LV aneurysms in patients with myocardial infarction. Methods Thirty-eight patients with myocardial infarction were prospectively enrolled and underwent electrocardiography (ECG), two-dimensional echocardiography (2-DE), RT-3DE and left ventriculography (LVG).Subjects with a negative EFR in at least one segment on RT-3DE were considered as having a ventricular aneurysm. We compared the sensitivity, specificity, Youden's index, and positive and negative predictive values of ECG, 2-DE and RT-3DE in determining LV aneurysm with detection by LVG.Results On LVG an LV aneurysm was diagnosed in 16 (42.1%) patients. The sensitivity and specificity were 62.5% and 86.4% for ECG, 81.2% and 95.4% for 2-DE, and 100.0% and 90.9% for RT-3DE in diagnosing LV aneurysm. Youden's indexes for ECG, 2-DE and RT-3DE were 0.49, 0.77 and 0.91, respectively. Positive and negative predictive values were 76.9% and 76.0% for ECG, 92.9% and 87.5% for 2-DE, and 88.9% and 100.0% for RT-3DE. Conclusions RT-3DE-derived EFR provides a novel, reliable index in the diagnosis of LV aneurysm and has excellent sensitivity and specificity.

  13. Optimising the dichotomy limit for left ventricular ejection fraction in selecting patients for defibrillator therapy after myocardial infarction

    DEFF Research Database (Denmark)

    Yap, Yee Guan; Duong, Trinh; Bland, J Martin;

    2007-01-01

    of MI. METHODS AND RESULTS: Data from the placebo arms of four randomised trials were pooled to create a cohort of 2828 patients (2206 men, mean (SD) age 65 (11) years) with reduced left ventricular function after MI. The median LVEF was 33% (range 6-40%). LVEF significantly predicted mortality. Each 10......% to death in 2 years. At an LVEF of 16-20%, more patients are likely to die from arrhythmic than non-arrhythmic cardiac deaths, whereas in those...... with LVEF deaths were non-arrhythmic. However, the total number of deaths substantially decreased with lower LVEF. CONCLUSION: A trade-off exists between the sensitivity and positive predictive accuracy across a range of LVEF, and no single dichotomy limit is completely satisfactory...

  14. Left ventricular ejection fraction normalization in cardiac resynchronization therapy and risk of ventricular arrhythmias and clinical outcomes

    DEFF Research Database (Denmark)

    Ruwald, Martin H; Solomon, Scott D; Foster, Elyse

    2014-01-01

    within 2.2 years of follow-up. Risk of inappropriate ICD therapy is still present, and these patients could be considered for downgrade from CRT-defibrillator to CRT-pacemaker at the time of battery depletion if no VTAs have occurred. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique...

  15. Impact of early, late, and no ST-segment resolution measured by continuous ST Holter monitoring on left ventricular ejection fraction and infarct size as determined by cardiovascular magnetic resonance imaging

    NARCIS (Netherlands)

    J.D.E. Haeck; N.J.W. Verouden; W.J. Kuijt; K.T. Koch; M. Majidi; A. Hirsch; J.G.P. Tijssen; M.W. Krucoff; R.J. de Winter

    2011-01-01

    Background: The goal of this study is to determine the predictive value of ST-segment resolution (STR) early after percutaneous coronary intervention (PCI), late STR, and no STR for left ventricular ejection fraction (LVEF) and infarct size (IS) by cardiovascular magnetic resonance (CMR) at follow-u

  16. Cardiovascular effects of hemoglobin response in patients receiving epoetin alfa and oral iron in heart failure with a preserved ejection fraction

    Institute of Scientific and Technical Information of China (English)

    Sirish Vullaganti; Jeff Goldsmith; Sergio Teruya; Julissa Alvarez; Stephen Helmke; Mathew S.Maurer

    2014-01-01

    Background Previous data from a recently conducted prospective, single blind randomized clinical trial among community dwelling older patients with heart failure with a preserved ejection fraction (HFPEF) and anemia randomized to treatment with epoetin alfa (erythro-poiesis-stimulating agents, ESA) vs. placebo did not demonstrate significant benefits of therapy regarding left ventricular (LV) structure, functional capacity, or quality of life (QOL). However, several patients randomized to the treatment arm were non-responders with a subop-timal increase in hemoglobin. All patients in the trial also received oral ferrous gluconate, which could have contributed to increases in he-moglobin observed in those receiving placebo. Accordingly, we performed an analysis separating patients into responders vs. non-responders in order to determine if measured improvement in anemia would have any effect on clinical endpoints. Methods A total of 56 patients (age 77 ± 11 years, 68%female) were recruited who had anemia defined as a hemoglobin of≤12 g/dL (average, 10.4 ± 1 g/dL) with HFPEF defined as having NHANES-CHF (National Health And Nutrition Examination Survey:Congestive Heart Failure) criteria score of≥3 and an ejection fraction of>40%(average EF=63%±15%). Patients were randomly allocated to receive either ESA and ferrous gluconate or ferrous gluconate only. In this analysis, a responder was defined as a patient with an increase of 1 g/dL in the first 4 weeks of the trial. Re-sults Nineteen subjects were classified as responders compared to 33 non-responders. While the average hemoglobin increased signifi-cantly at the end of 6 months for responders (1.8 ± 0.3 vs. 0.8 ± 0.2 g/dL, P = 0.004), 50% of the subjects assigned to ESA were non-responders. Left ventricular function including ejection fraction (P=0.32) and end diastolic volume (P=0.59) was unchanged in res-ponders compared to non-responders. Responders also showed no significant improvements in New York

  17. Impact of Race, Ethnicity, and Multimodality Biomarkers on the Incidence of New-Onset Heart Failure With Preserved Ejection Fraction (from the Multi-Ethnic Study of Atherosclerosis).

    Science.gov (United States)

    Silverman, Michael G; Patel, Birju; Blankstein, Ron; Lima, Joao A C; Blumenthal, Roger S; Nasir, Khurram; Blaha, Michael J

    2016-05-01

    Heart failure with preserved ejection fraction (HFpEF) is a prevalent condition with no established prevention or treatment strategies. Furthermore, the pathophysiology and predisposing risk factors for HFpEF are incompletely understood. Therefore, we sought to characterize the incidence and determinants of HFpEF in the Multi-Ethnic Study of Atherosclerosis (MESA). Our study included 6,781 MESA participants (White, Black, Chinese, and Hispanic men and women age 45 to 84 years, free of baseline cardiovascular disease). The primary end point was time to diagnosis of HFpEF (left ventricular ejection fraction ≥45%). Multivariable adjusted hazard ratios (HRs) with 95% confidence intervals were calculated to identify predictors of HFpEF. Over median follow-up of 11.2 years (10.6 to 11.7), 111 subjects developed HFpEF (cumulative incidence 1.7%). Incidence rates were similar across all races/ethnicities. Age (HR 2.3 [1.7 to 3.0]), hypertension (HR 1.8 [1.1 to 2.9]), diabetes (HR 2.3 [1.5 to 3.7]), body mass index (HR 1.4 [1.1 to 1.7]), left ventricular hypertrophy by electrocardiography (HR 4.3 [1.7 to 11.0]), interim myocardial infarction (HR 4.8 [2.7 to 8.6]), elevated N-terminal of the prohormone brain natriuretic peptide (HR 2.4 [1.5 to 4.0]), detectable troponin T (HR 4.5 [1.9 to 10.9]), and left ventricular mass index by magnetic resonance imaging (MRI; 1.3 [1.0 to 1.6]) were significant predictors of incident HFpEF. Worsening renal function, inflammatory markers, and coronary artery calcium were significant univariate but not multivariate predictors of HFpEF. Gender was neither a univariate nor multivariate predictor of HFpEF. In conclusion, we demonstrate several risk factors and biomarkers associated with incident HFpEF that were consistent across different racial/ethnic groups and may represent potential therapeutic targets for the prevention and treatment of HFpEF.

  18. Prevalence of symptomatic heart failure with reduced and with normal ejection fraction in an elderly general population-the CARLA study.

    Directory of Open Access Journals (Sweden)

    Daniel Tiller

    Full Text Available BACKGROUND/OBJECTIVES: Chronic heart failure (CHF is one of the most important public health concerns in the industrialized world having increasing incidence and prevalence. Although there are several studies describing the prevalence of heart failure with reduced ejection fraction (HFREF and heart failure with normal ejection fraction (HFNEF in selected populations, there are few data regarding the prevalence and the determinants of symptomatic heart failure in the general population. METHODS: Cross-sectional data of a population-based German sample (1,779 subjects aged 45-83 years were analyzed to determine the prevalence and determinants of chronic SHF and HFNEF defined according to the European Society of Cardiology using symptoms, echocardiography and serum NT-proBNP. Prevalence was age-standardized to the German population as of December 31st, 2005. RESULTS: The overall age-standardized prevalence of symptomatic CHF was 7.7% (95%CI 6.0-9.8 for men and 9.0% (95%CI 7.0-11.5 for women. The prevalence of CHF strongly increased with age from 3.0% among 45-54- year-old subjects to 22.0% among 75-83- year-old subjects. Symptomatic HFREF could be shown in 48% (n = 78, symptomatic HFNEF in 52% (n = 85 of subjects with CHF. The age-standardized prevalence of HFREF was 3.8 % (95%CI 2.4-5.8 for women and 4.6 % (95%CI 3.6-6.3 for men. The age-standardized prevalence of HFNEF for women and men was 5.1 % (95%CI 3.8-7.0 and 3.0 % (95%CI 2.1-4.5, respectively. Persons with CHF were more likely to have hypertension (PR = 3.4; 95%CI 1.6-7.3 or to have had a previous myocardial infarction (PR = 2.5, 95%CI 1.8-3.5. CONCLUSION: The prevalence of symptomatic CHF appears high in this population compared with other studies. While more women were affected by HFNEF than men, more male subjects suffered from HFREF. The high prevalence of symptomatic CHF seems likely to be mainly due to the high prevalence of cardiovascular risk factors in this population.

  19. A framework of whole heart extracellular volume fraction estimation for low dose cardiac CT images

    Science.gov (United States)

    Chen, Xinjian; Summers, Ronald M.; Nacif, Marcelo Souto; Liu, Songtao; Bluemke, David A.; Yao, Jianhua

    2012-02-01

    Cardiac magnetic resonance imaging (CMRI) has been well validated and allows quantification of myocardial fibrosis in comparison to overall mass of the myocardium. Unfortunately, CMRI is relatively expensive and is contraindicated in patients with intracardiac devices. Cardiac CT (CCT) is widely available and has been validated for detection of scar and myocardial stress/rest perfusion. In this paper, we sought to evaluate the potential of low dose CCT for the measurement of myocardial whole heart extracellular volume (ECV) fraction. A novel framework was proposed for CCT whole heart ECV estimation, which consists of three main steps. First, a shape constrained graph cut (GC) method was proposed for myocardium and blood pool segmentation for post-contrast image. Second, the symmetric Demons deformable registrations method was applied to register pre-contrast to post-contrast images. Finally, the whole heart ECV value was computed. The proposed method was tested on 7 clinical low dose CCT datasets with pre-contrast and post-contrast images. The preliminary results demonstrated the feasibility and efficiency of the proposed method.

  20. Inspiratory Muscle Training and Functional Electrical Stimulation for Treatment of Heart Failure With Preserved Ejection Fraction: Rationale and Study Design of a Prospective Randomized Controlled Trial.

    Science.gov (United States)

    Palau, Patricia; Domínguez, Eloy; López, Laura; Heredia, Raquel; González, Jessika; Ramón, Jose María; Serra, Pilar; Santas, Enrique; Bodi, Vicente; Sanchis, Juan; Chorro, Francisco J; Núñez, Julio

    2016-08-01

    Heart failure with preserved ejection fraction (HFpEF) has become the most prevalent form of heart failure in developed countries. Regrettably, there is no evidence-based effective therapy for HFpEF. We seek to evaluate whether inspiratory muscle training, functional electrical stimulation, or a combination of both can improve exercise capacity as well as left ventricular diastolic function, biomarker profile, quality of life (QoL), and prognosis in patients with HFpEF. A total of 60 stable symptomatic patients with HFpEF (New York Heart Association class II-III/IV) will be randomized (1:1:1:1) to receive a 12-week program of inspiratory muscle training, functional electrical stimulation, a combination of both, or standard care alone. The primary endpoint of the study is change in peak exercise oxygen uptake; secondary endpoints are changes in QoL, echocardiogram parameters, and prognostic biomarkers. As of March 21, 2016, thirty patients have been enrolled. Searching for novel therapies that improve QoL and autonomy in the elderly with HFpEF has become a health care priority. We believe that this study will add important knowledge about the potential utility of 2 simple and feasible physical interventions for the treatment of advanced HFpEF.

  1. Global and regional left ventricular strain indices in post-myocardial infarction patients with ventricular arrhythmias and moderately abnormal ejection fraction.

    Science.gov (United States)

    Nguyen, Bich Lien; Capotosto, Lidia; Persi, Alessandro; Placanica, Attilio; Rafique, Asim; Piccirillo, Gianfranco; Gaudio, Carlo; Gang, Eli S; Siegel, Robert J; Vitarelli, Antonio

    2015-02-01

    The aim of the study described here was to compare myocardial strains in ischemic heart patients with and without sustained ventricular tachycardia (VT) and moderately abnormal left ventricular ejection fraction (LVEF) to investigate which index could better predict VT on the basis of the analysis of global and regional left ventricular (LV) dysfunction. We studied 467 patients with previous myocardial infarction and LVEF >35%. Fifty-one patients had documented VT, and 416 patients presented with no VT. LV volumes and score index were obtained by 2-D echocardiography. Longitudinal, radial and circumferential strains were determined. Strains of the infarct, border and remote zones were also obtained. There were no differences in standard LV 2-D parameters between patients with and those without VT. Receiver operating characteristic values were -12.7% for global longitudinal strain (area under the curve [AUC] = 0.72), -4.8% for posterior-inferior wall circumferential strain (AUC = 0.80), 61 ms for LV mechanical dispersion (AUC = 0.84), -10.1% for longitudinal strain of the border zone (AUC = 0.86) and -9.2% for circumferential strain of the border zone (AUC = 0.89). In patients with previous myocardial infarction and moderately abnormal LVEF, peri-infarct circumferential strain was the strongest predictor of documented ventricular arrhythmias among all strain quantitative indices. Additionally, strain values from posterior-inferior wall infarctions had a higher association with arrhythmic events compared with global strain.

  2. Defining the real-world reproducibility of visual grading of left ventricular function and visual estimation of left ventricular ejection fraction: impact of image quality, experience and accreditation.

    Science.gov (United States)

    Cole, Graham D; Dhutia, Niti M; Shun-Shin, Matthew J; Willson, Keith; Harrison, James; Raphael, Claire E; Zolgharni, Massoud; Mayet, Jamil; Francis, Darrel P

    2015-10-01

    Left ventricular function can be evaluated by qualitative grading and by eyeball estimation of ejection fraction (EF). We sought to define the reproducibility of these techniques, and how they are affected by image quality, experience and accreditation. Twenty apical four-chamber echocardiographic cine loops (Online Resource 1-20) of varying image quality and left ventricular function were anonymized and presented to 35 operators. Operators were asked to provide (1) a one-phrase grading of global systolic function (2) an "eyeball" EF estimate and (3) an image quality rating on a 0-100 visual analogue scale. Each observer viewed every loop twice unknowingly, a total of 1400 viewings. When grading LV function into five categories, an operator's chance of agreement with another operator was 50% and with themself on blinded re-presentation was 68%. Blinded eyeball LVEF re-estimates by the same operator had standard deviation (SD) of difference of 7.6 EF units, with the SD across operators averaging 8.3 EF units. Image quality, defined as the average of all operators' assessments, correlated with EF estimate variability (r = -0.616, p visual grading agreement (r = 0.58, p visual grading of LV function and LVEF estimation is dependent on image quality, but individuals cannot themselves identify when poor image quality is disrupting their LV function estimate. Clinicians should not assume that patients changing in grade or in visually estimated EF have had a genuine clinical change.

  3. Changes in Cardiopulmonary Reserve and Peripheral Arterial Function Concomitantly with Subclinical Inflammation and Oxidative Stress in Patients with Heart Failure with Preserved Ejection Fraction

    Directory of Open Access Journals (Sweden)

    Damien Vitiello

    2014-01-01

    Full Text Available Background. Changes in cardiopulmonary reserve and biomarkers related to wall stress, inflammation, and oxidative stress concomitantly with the evaluation of peripheral arterial blood flow have not been investigated in patients with heart failure with preserved ejection fraction (HFpEF compared with healthy subjects (CTL. Methods and Results. Eighteen HFpEF patients and 14 CTL were recruited. Plasma levels of inflammatory and oxidative stress biomarkers were measured at rest. Brain natriuretic peptide (BNP was measured at rest and peak exercise. Cardiopulmonary reserve was assessed using an exercise protocol with gas exchange analyses. Peripheral arterial blood flow was determined by strain gauge plethysmography. Peak VO2 (12.0±0.4 versus 19.1±1.1 mL/min/kg, P<0.001 and oxygen uptake efficiency slope (1.55±0.12 versus 2.06±0.14, P<0.05 were significantly decreased in HFpEF patients compared with CTL. BNP at rest and following stress, C-reactive-protein, interleukin-6, and TBARS were significantly elevated in HFpEF. Both basal and posthyperemic arterial blood flow were not significantly different between the HFpEF patients and CTL. Conclusions. HFpEF exhibits a severe reduction in cardiopulmonary reserve and oxygen uptake efficiency concomitantly with an elevation in a broad spectrum of biomarkers confirming an inflammatory and prooxidative status in patients with HFpEF.

  4. In situ expression of Bcl-2 in pulmonary artery endothelial cells associates with pulmonary arterial hypertension relative to heart failure with preserved ejection fraction

    Science.gov (United States)

    Benza, Raymond L.; Williams, Gretchen; Wu, Changgong; Shields, Kelly J.; Raina, Amresh; Murali, Srinivas

    2016-01-01

    Abstract We have previously reported that pulmonary artery endothelial cells (PAECs) can be harvested from the tips of discarded Swan-Ganz catheters after right heart catheterization (RHC). In this study, we tested the hypothesis that the existence of an antiapoptotic phenotype in PAECs obtained during RHC is a distinctive feature of pulmonary arterial hypertension (PAH; World Health Organization group 1) and might be used to differentiate PAH from other etiologies of pulmonary hypertension. Specifically, we developed a flow cytometry-based measure of Bcl-2 activity, referred to as the normalized endothelial Bcl-2 index (NEBI). We report that higher NEBI values are associated with PAH to the exclusion of heart failure with preserved ejection fraction (HFpEF) and that this simple diagnostic measurement is capable of differentiating PAH from HFpEF without presenting addition risk to the patient. If validated in a larger, multicenter study, the NEBI has the potential to assist physicians in the selection of appropriate therapeutic interventions in the common and dangerous scenario wherein patients present a clinical and hemodynamic phenotype that makes it difficult to confidently differentiate between PAH and HFpEF. PMID:28090298

  5. High sensitive troponin T and heart fatty acid binding protein: Novel biomarker in heart failure with normal ejection fraction?: A cross-sectional study

    Directory of Open Access Journals (Sweden)

    Barroso Michael

    2011-07-01

    Full Text Available Abstract Background High sensitive troponin T (hsTnT and heart fatty acid binding protein (hFABP are both markers of myocardial injury and predict adverse outcome in patients with systolic heart failure (SHF. We tested whether hsTnT and hFABP plasma levels are elevated in patients with heart failure with normal ejection fraction (HFnEF. Methods We analyzed hsTnT, hFABP and N-terminal brain natriuretic peptide in 130 patients comprising 49 HFnEF patients, 51 patients with asymptomatic left ventricular diastolic dysfunction (LVDD, and 30 controls with normal diastolic function. Patients were classified to have HFnEF when the diagnostic criteria as recommended by the European Society of Cardiology were met. Results Levels of hs TnT and hFABP were significantly higher in patients with asymptomatic LVDD and HFnEF (both p Conclusion In HFnEF patients, hsTnT and hFABP are elevated independent of coronary artery disease, suggesting that ongoing myocardial damage plays a critical role in the pathophysiology. A combination of biomarkers and echocardiographic parameters might improve diagnostic accuracy and risk stratification of patients with HFnEF.

  6. Prediction of Changes in Left Ventricular Ejection Fraction after Off-Pump Coronary Artery Bypass Grafting Surgery by Myocardial Perfusion Single-Photon Emission Computed Tomography

    Directory of Open Access Journals (Sweden)

    Maryam Mirzaie

    2015-09-01

    Full Text Available Introduction: Left ventricular ejection fraction (LVEF is considered to be the single most important prognostic factor in patients with previous myocardial infarction. LVEF is not improved in all patients after coronary artery bypass grafting (CABG. This study aimed to assess the possibility of prediction of LVEF changes after CABG using myocardial perfusion gated signle photon emission computed tomography (GSPECT. Materials and Methods: Overall, 48 patients with mean LVEF of 30.2% (±4.7 underwent Echocardiography and GSPECT after injection of Tc-99m-MIBI at rest. Myocardial uptake was evaluated in 17 myocardial segments and was compared with age and gender matched normal data pool. The risks and benefits of CABG were explained to the patients and 16 cases (15 male and 1 female with the mean age of 61.1 years (±10.8 accepted to undergo off-pump CABG. All the patients were followed-up for at least six months and echocardiography and GSPECT were repeated at the end of follow up. Results: The mean LVEF was increased from of 31.1% (±3.5 to 34.5% (±3.6 after surgery (P

  7. Structural and functional changes in the heart and clinical features of heart failure with preserved left ventricular ejection fraction in patients after myocardial infarction, comorbided with arterial hypertension

    Directory of Open Access Journals (Sweden)

    V. D. Syvolap

    2013-12-01

    Full Text Available Recently, much attention was paid to left ventricular diastolic dysfunction and its role in the occurrence of chronic heart failure. In patients after myocardial infarction, diastolic dysfunction often precedes systolic dysfunction and predicts prognosis. In patients after myocardial infarction, diastolic dysfunction is caused by a violation of early diastolic relaxation in the area of increasing stiffness. Diastolic dysfunction is formed by hypertrophy, fibrosis, myocardial ischemia and arterial hypertension. Given the important role of diastolic dysfunction in the formation of heart failure in postinfarction patients with concomitant arterial hypertension, the mechanisms of its impact on clinical features and structural-functional changes of the heart is an actual problem. Objective: To determine the structural and functional changes in the heart and clinical features of heart failure with preserved left ventricular ejection fraction in patients after myocardial infarction with concomitant arterial hypertension. Materials and methods: In 91 patients with post-infarction cardiosclerosis and preserved left ventricular ejection fraction (EF > 45 % with arterial hypertension were investigated structural and functional changes in the heart and clinical features of heart failure by assessing clinical status and ultrasound of the heart. Prescription myocardial infarction ranged from 2 months to 3 years. Patients were divided into 3 groups. The first group included 50 patients with diastolic dysfunction and symptoms of heart failure (mean age 64,1 ± 1,2 years. In the second group were 31 patients with diastolic dysfunction without heart failure symptoms (mean age 59,5 ± 1,6 years. The third group consisted of 10 patients without diastolic dysfunction and manifestations of heart failure (mean age 57 ± 2,8 years. Results and discussion: 10% patients with postinfarction cardiosclerosis and concomitant hypertension with diastolic heart failure had NYHA

  8. Left Ventricular Global Longitudinal Strain (GLS Is a Superior Predictor of All-Cause and Cardiovascular Mortality When Compared to Ejection Fraction in Advanced Chronic Kidney Disease.

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    Rathika Krishnasamy

    Full Text Available Echocardiographic global longitudinal strain (GLS is increasingly recognised as a more effective technique than conventional ejection fraction (EF in detecting subtle changes in left ventricular (LV function. This study investigated the prognostic value of GLS over EF in patients with advanced Chronic Kidney Disease (CKD.The study included 183 patients (57% male, 63% on dialysis with CKD stage 4, 5 and 5Dialysis (D. 112 (61% of patients died in a follow up of 7.8 ± 4.4 years and 41% of deaths were due to cardiovascular (CV disease. GLS was calculated using 2-dimensional speckle tracking and EF was measured using Simpson's biplane method. Cox proportional hazard models were used to assess the association of measures of LV function and all- cause and CV mortality.The mean GLS at baseline was -13.6 ± 4.3% and EF was 45 ± 11%. GLS was a significant predictor of all-cause [Hazard Ratio (HR 1.09 95%; Confidence Interval (CI 1.02-1.16; p = 0.01] and CV mortality (HR 1.16 95%; CI 1.04-1.30; p = 0.008 following adjustment for relevant clinical variables including LV mass index (LVMI and EF. GLS also had greater predictive power for both all- cause and CV mortality compared to EF. Impaired GLS (>-16% was associated with a 5.6-fold increased unadjusted risk of CV mortality in patients with preserved EF.In this cohort of patients with advanced CKD, GLS is a more sensitive predictor of overall and CV mortality compared to EF. Studies of larger populations in CKD are required to confirm that GLS provides additive prognostic value in patients with preserved EF.

  9. Guideline-Directed Medication Use in Patients With Heart Failure With Reduced Ejection Fraction in India: American College of Cardiology's PINNACLE India Quality Improvement Program.

    Science.gov (United States)

    Pokharel, Yashashwi; Wei, Jessica; Hira, Ravi S; Kalra, Ankur; Shore, Supriya; Kerkar, Prafulla G; Kumar, Ganesh; Risch, Samantha; Vicera, Veronique; Oetgen, William J; Deswal, Anita; Turakhia, Mintu P; Glusenkamp, Nathan; Virani, Salim S

    2016-03-01

    Little is known about the use of guideline-directed medical therapy (GDMT) in outpatients with heart failure with reduced left ventricular ejection fraction (HFrEF; ≤40%) in India. Our objective was to understand the use of GDMT in outpatients with HFrEF in India. The Practice Innovation And Clinical Excellence (PINNACLE) India Quality Improvement Program (PIQIP) is a registry for cardiovascular quality improvement in India supported by the American College of Cardiology Foundation. Between January 2008 and September 2014, we evaluated documentation of use of angiotensin-converting enzyme inhibitors (ACEIs)/angiotensin receptor blockers (ARBs) and β-blockers, or both, among outpatients with HFrEF seeking care in 10 centers enrolled in the PIQIP registry. Among 75 639 patients in the PIQIP registry, 34 995 had EF reported, and 15 870 had an EF ≤40%. The mean age was 56 years; 23% were female. Hypertension, diabetes, coronary artery disease, and myocardial infarction were present in 37%, 23%, 27%, and 17%, respectively. Use of ACEIs/ARBs, β-blockers, and both were documented in 33.5%, 34.9%, and 29.6% of patients, respectively. The documentation of GDMT was higher in men, in patients age ≥65 years, and in those with presence of hypertension, diabetes, or coronary artery disease. Documentation of GDMT gradually increased over the study period. Among patients enrolled in the PIQIP registry, about two-thirds of patients with EF ≤40% did not have documented receipt of GDMT. This study is an initial step toward improving adherence to GDMT in India and highlights the feasibility of examining quality of care in HFrEF in a resource-limited setting.

  10. Hormone therapy with tamoxifen reduces plasma levels of NT-B-type natriuretic peptide but does not change ventricular ejection fraction after chemotherapy in women with breast cancer

    Directory of Open Access Journals (Sweden)

    F.B. Silva

    2015-02-01

    Full Text Available The objective of this study was to evaluate the effect of tamoxifen on the plasma concentration of NT-pro-B-type natriuretic peptide (NT-proBNP in women undergoing chemotherapy for breast cancer and to correlate changes in NT-proBNP with the left ventricular ejection fraction (LVEF. Over a period of 12 months, we followed 60 women with a diagnosis of breast cancer. The patients were separated into a group that received only chemotherapy (n=23, a group that received chemotherapy + tamoxifen (n=21, and a group that received only tamoxifen (n=16. Plasma levels of NT-proBNP were assessed at 0 (T0, 6 (T6, and 12 (T12 months of treatment, and echocardiography data were assessed at T0 and T12. Plasma NT-proBNP levels were increased in the chemotherapy-only group at T6 and T12, whereas elevated NT-proBNP levels were only found at T6 in the chemotherapy + tamoxifen group. At T12, the chemotherapy + tamoxifen group exhibited a significant reduction in the peptide to levels similar to the group that received tamoxifen alone. The chemotherapy-only group exhibited a significant decrease in LVEF at T12, whereas the chemotherapy + tamoxifen and tamoxifen-only groups maintained levels similar to those at the beginning of treatment. Treatment with tamoxifen for 6 months after chemotherapy significantly reduced the plasma levels of NT-proBNP and did not change LVEF in women with breast cancer.

  11. Low-sodium dietary approaches to stop hypertension diet reduces blood pressure, arterial stiffness, and oxidative stress in hypertensive heart failure with preserved ejection fraction.

    Science.gov (United States)

    Hummel, Scott L; Seymour, E Mitchell; Brook, Robert D; Kolias, Theodore J; Sheth, Samar S; Rosenblum, Hannah R; Wells, Joanna M; Weder, Alan B

    2012-11-01

    Recent studies suggest that oxidative stress and vascular dysfunction contribute to heart failure with preserved ejection fraction (HFPEF). In salt-sensitive HFPEF animal models, diets low in sodium and high in potassium, calcium, magnesium, and antioxidants attenuate oxidative stress and cardiovascular damage. We hypothesized that the sodium-restricted Dietary Approaches to Stop Hypertension diet (DASH/SRD) would have similar effects in human hypertensive HFPEF. Thirteen patients with treated hypertension and compensated HFPEF consumed the DASH/SRD for 21 days (all food/most beverages provided). The DASH/SRD reduced clinic systolic (155-138 mm Hg; P=0.02) and diastolic blood pressure (79-72 mm Hg; P=0.04), 24-hour ambulatory systolic (130-123 mm Hg; P=0.02) and diastolic blood pressure (67-62 mm Hg; P=0.02), and carotid-femoral pulse wave velocity (12.4-11.0 m/s; P=0.03). Urinary F2-isoprostanes decreased by 31% (209-144 pmol/mmol Cr; P=0.02) despite increased urinary aldosterone excretion. The reduction in urinary F2-isoprostanes closely correlated with the reduction in urinary sodium excretion on the DASH/SRD. In this cohort of HFPEF patients with treated hypertension, the DASH/SRD reduced systemic blood pressure, arterial stiffness, and oxidative stress. These findings are characteristic of salt-sensitive hypertension, a phenotype present in many HFPEF animal models and suggest shared pathophysiological mechanisms linking these 2 conditions. Further dietary modification studies could provide insights into the development and progression of hypertensive HFPEF.

  12. Right ventricular ejection fraction during exercise in normal subjects and in coronary artery disease patients: assessment by multiple-gated equilibrium scintigraphy

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    Maddahi, J.; Berman, D.S.; Matsuoka, D.T.; Waxman, A.D.; Forrester, J.S.; Swan, H.J.C.

    1980-07-01

    The response of right ventricular ejection fraction (RVEF) during exercise and its relationship to the location and extent of coronary artery disease are not fully understood. We have recently developed and validated a new method for scintigraphic evaluation of RVEF using rapid multiple-gated equilibrium scintigraphy and multiple right ventricular regions of interest. The technique has been applied during upright bicycle exercise in 10 normal subjects and 20 patients with coronary artery disease. Resting RVEF was not significantly different between the groups (0.49 +- 0.04 vs 0.47 +- 0.09, respectively, mean +- SD). In all 10 normal subjects RVEF rose (0.49 +- 0.04 to 0.66 +- 0.08, p < 0.01) at peak exercise. At peak exercise in coronary artery disease patients, the group RVEF remained unchanged (0.47 +- 0.09 to 0.50 +- 0.11, p = NS), but the individual responses varied. In the coronary artery disease patients, the relationship between RVEF response to exercise and exercise left ventricular function, septal motion and right coronary artery stenosis were studied. Significant statistical association was found only between exercise RVEF and right coronary artery stenosis. RVEF rose during exercise in seven of seven patients without right coronary artery stenosis (0.42 +- 0.06 to 0.58 +- 0.08, p = 0.001) and was unchanged or fell in 12 of 13 patients with right coronary artery stenosis (0.50 +- 0.09 to 0.45 +- 0.10, p = NS). We conclude that (1) in normal subjects RVEF increases during upright exercise and (2) although RVEF at rest is not necessarily affected by coronary artery disease, failure of RVEF to increase during exercise, in the absence of chronic obstructive pulmonary disease or valvular heart disease, may be related to the presence of significant right coronary artery stenosis.

  13. Diastolic function of the left ventricle in patients with cardiomyopathy and low ejection fraction: the role of torsion in left bundle branch block

    Directory of Open Access Journals (Sweden)

    E. N. Pavlyukova

    2016-01-01

    Full Text Available Influence of left bundle branch block (LBBB on left ventricle (LV diastolic function and mechanisms of LV torsion remains underestimated.Aim. To study the relationship of LV diastolic function and LV torsion in patients with cardiomyopathy and LBBB in comparison with patients with cardiomyopathy and normal intraventricular conduction.Material and methods. Patients with cardiomyopathy (n=74 and LV ejection fraction <40% were included into the study and divided in two groups with narrow QRS complex and LBBB (the mean QRS duration = 153 ms. Echocardiography was performed in all patients with hemodynamic indices detection, and myocardium strain and torsion estimation.Results. The patients with LBBB showed less twisting, than patients without LBBB (3.24±3.35° and 5.87±3.83°, respectively, p=0.013914, but significant diastolic function differences between groups were absent. Despite the lack of difference in heart remodeling indices, subgroup of patients with LV rigid body rotation showed significantly less LV twisting and changes in pulmonary vein flow related to LV high end diastolic pressure. In the rigid body rotation group systolic left atrial filling fraction was 32.3±8.07%, whereas in the group with a physiological counter-rotation - 53.1±10.1% (p=0.000226. Potential reason of these findings was interventricular dyssynchrony. Deviation of time interval to peak myocardial systolic velocity between opposite basal segments in group with LBBB and anomalous LV rotation was more (63.3±35.1 ms than this in group with LBBB and physiological LV rotation (8.0±17.9 mc, p=0.015922. This finding suggests that LV rigid body rotation in patients with LBBB may reflect a more pronounced mechanical dyssynchrony.Conclusion. LBBB has complex negative influence on process of LV electric activation and contraction which results in deterioration of LV twisting, mechanical dyssynchrony and deterioration of diastolic function. In disorders of intraventricular

  14. A framework of whole heart extracellular volume fraction estimation for low-dose cardiac CT images.

    Science.gov (United States)

    Chen, Xinjian; Nacif, Marcelo S; Liu, Songtao; Sibley, Christopher; Summers, Ronald M; Bluemke, David A; Yao, Jianhua

    2012-09-01

    Cardiac CT (CCT) is widely available and has been validated for the detection of focal myocardial scar using a delayed enhancement technique in this paper. CCT, however, has not been previously evaluated for quantification of diffuse myocardial fibrosis. In our investigation, we sought to evaluate the potential of low-dose CCT for the measurement of myocardial whole heart extracellular volume (ECV) fraction. ECV is altered under conditions of increased myocardial fibrosis. A framework consisting of three main steps was proposed for CCT whole heart ECV estimation. First, a shape-constrained graph cut (GC) method was proposed for myocardium and blood pool segmentation on postcontrast image. Second, the symmetric demons deformable registration method was applied to register precontrast to postcontrast images. So the correspondences between the voxels from precontrast to postcontrast images were established. Finally, the whole heart ECV value was computed. The proposed method was tested on 20 clinical low-dose CCT datasets with precontrast and postcontrast images. The preliminary results demonstrated the feasibility and efficiency of the proposed method.

  15. Comparison of 5-Year Outcomes After Coronary Artery Bypass Grafting in Heart Failure Patients With Versus Without Preserved Left Ventricular Ejection Fraction (from the CREDO-Kyoto CABG Registry Cohort-2).

    Science.gov (United States)

    Marui, Akira; Nishiwaki, Noboru; Komiya, Tatsuhiko; Hanyu, Michiya; Tanaka, Shiro; Kimura, Takeshi; Sakata, Ryuzo

    2015-08-15

    Heart failure (HF) with reduced left ventricular (LV) ejection fraction (HFrEF) is regarded as an independent risk factor for poor outcomes after coronary artery bypass grafting (CABG). However, the impact of HF with preserved EF (HFpEF) still has been unclear. We identified 1,877 patients who received isolated CABG of 15,939 patients who underwent first coronary revascularization enrolled in the CREDO-Kyoto (Coronary REvascularization Demonstrating Outcome Study in Kyoto) Registry Cohort-2. Of them, 1,489 patients had normal LV function (LVEF >50% without a history of HF; Normal group), 236 had HFrEF (LVEF ≤50% with HF), and 152 had HFpEF (LVEF >50% with HF). Preoperative LVEF was the lowest in the HFrEF group (62 ± 12%, 36 ± 9%, and 61 ± 7% for the Normal, HFrEF, and HFpEF groups, respectively; p HFpEF group (14%, 27%, and 32%, respectively; p HFpEF group was greater than the Normal group (hazard ratio [HR] 1.42; 95% confidence interval [CI] 1.02 to 1.97; p = 0.04). The risk of all-cause death was not different between the HFpEF and the HFrEF groups (HR 0.88; 95% CI 0.61 to 1.29; p = 0.52). In addition, the risks of cardiac death and sudden death in the HFpEF group were greater than the Normal group (HR 2.14, 95% CI 1.32 to 3.49, p = 0.002; and HR 3.60, 95% CI 1.55 to 8.36, p = 0.003, respectively), and the risks of those end points were not different between the HFrEF and the HFpEF groups. Despite low 30-day mortality rate after CABG in patients with HFpEF, HFpEF was associated with high risks of long-term death and cardiovascular events. Patients with HFpEF, as well as HFrEF, should be carefully operated and followed up.

  16. Do optimal prognostic thresholds in continuous physiological variables really exist? Analysis of origin of apparent thresholds, with systematic review for peak oxygen consumption, ejection fraction and BNP.

    Directory of Open Access Journals (Sweden)

    Alberto Giannoni

    Full Text Available BACKGROUND: Clinicians are sometimes advised to make decisions using thresholds in measured variables, derived from prognostic studies. OBJECTIVES: We studied why there are conflicting apparently-optimal prognostic thresholds, for example in exercise peak oxygen uptake (pVO2, ejection fraction (EF, and Brain Natriuretic Peptide (BNP in heart failure (HF. DATA SOURCES AND ELIGIBILITY CRITERIA: Studies testing pVO2, EF or BNP prognostic thresholds in heart failure, published between 1990 and 2010, listed on Pubmed. METHODS: First, we examined studies testing pVO2, EF or BNP prognostic thresholds. Second, we created repeated simulations of 1500 patients to identify whether an apparently-optimal prognostic threshold indicates step change in risk. RESULTS: 33 studies (8946 patients tested a pVO2 threshold. 18 found it prognostically significant: the actual reported threshold ranged widely (10-18 ml/kg/min but was overwhelmingly controlled by the individual study population's mean pVO2 (r = 0.86, p<0.00001. In contrast, the 15 negative publications were testing thresholds 199% further from their means (p = 0.0001. Likewise, of 35 EF studies (10220 patients, the thresholds in the 22 positive reports were strongly determined by study means (r = 0.90, p<0.0001. Similarly, in the 19 positives of 20 BNP studies (9725 patients: r = 0.86 (p<0.0001. Second, survival simulations always discovered a "most significant" threshold, even when there was definitely no step change in mortality. With linear increase in risk, the apparently-optimal threshold was always near the sample mean (r = 0.99, p<0.001. LIMITATIONS: This study cannot report the best threshold for any of these variables; instead it explains how common clinical research procedures routinely produce false thresholds. KEY FINDINGS: First, shifting (and/or disappearance of an apparently-optimal prognostic threshold is strongly determined by studies' average pVO2, EF or BNP. Second

  17. Clinical outcome of high-risk patients with severe aortic stenosis and reduced left ventricular ejection fraction undergoing medical treatment or TAVI.

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    Thomas Pilgrim

    Full Text Available INTRODUCTION: Reduced left ventricular function in patients with severe symptomatic valvular aortic stenosis is associated with impaired clinical outcome in patients undergoing surgical aortic valve replacement (SAVR. Transcatheter Aortic Valve Implantation (TAVI has been shown non-inferior to SAVR in high-risk patients with respect to mortality and may result in faster left ventricular recovery. METHODS: We investigated clinical outcomes of high-risk patients with severe aortic stenosis undergoing medical treatment (n = 71 or TAVI (n = 256 stratified by left ventricular ejection fraction (LVEF in a prospective single center registry. RESULTS: Twenty-five patients (35% among the medical cohort were found to have an LVEF≤30% (mean 26.7±4.1% and 37 patients (14% among the TAVI patients (mean 25.2±4.4%. Estimated peri-interventional risk as assessed by logistic EuroSCORE was significantly higher in patients with severely impaired LVEF as compared to patients with LVEF>30% (medical/TAVI 38.5±13.8%/40.6±16.4% versus medical/TAVI 22.5±10.8%/22.1±12.8%, p <0.001. In patients undergoing TAVI, there was no significant difference in the combined endpoint of death, myocardial infarction, major stroke, life-threatening bleeding, major access-site complications, valvular re-intervention, or renal failure at 30 days between the two groups (21.0% versus 27.0%, p = 0.40. After TAVI, patients with LVEF≤30% experienced a rapid improvement in LVEF (from 25±4% to 34±10% at discharge, p = 0.002 associated with improved NYHA functional class at 30 days (decrease ≥1 NYHA class in 95%. During long-term follow-up no difference in survival was observed in patients undergoing TAVI irrespective of baseline LVEF (p = 0.29, whereas there was a significantly higher mortality in medically treated patients with severely reduced LVEF (log rank p = 0.001. CONCLUSION: TAVI in patients with severely reduced left ventricular function may be

  18. High-intensity interval training vs. moderate-intensity continuous exercise training in heart failure with preserved ejection fraction: a pilot study.

    Science.gov (United States)

    Angadi, Siddhartha S; Mookadam, Farouk; Lee, Chong D; Tucker, Wesley J; Haykowsky, Mark J; Gaesser, Glenn A

    2015-09-15

    Heart failure with preserved ejection fraction (HFpEF) is a major cause of morbidity and mortality. Exercise training is an established adjuvant therapy in heart failure; however, the effects of high-intensity interval training (HIIT) in HFpEF are unknown. We compared the effects of HIIT vs. moderate-intensity aerobic continuous training (MI-ACT) on peak oxygen uptake (V̇o₂peak), left ventricular diastolic dysfunction, and endothelial function in patients with HFpEF. Nineteen patients with HFpEF (age 70 ± 8.3 yr) were randomized to either HIIT (4 × 4 min at 85-90% peak heart rate, with 3 min active recovery) or MI-ACT (30 min at 70% peak heart rate). Fifteen patients completed exercise training (HIIT: n = 9; MI-ACT: n = 6). Patients trained 3 days/wk for 4 wk. Before and after training patients underwent a treadmill test for V̇o₂peak determination, 2D-echocardiography for assessment of left ventricular diastolic dysfunction, and brachial artery flow-mediated dilation (FMD) for assessment of endothelial function. HIIT improved V̇o₂peak (pre = 19.2 ± 5.2 ml·kg(-1)·min(-1); post = 21.0 ± 5.2 ml·kg(-1)·min(-1); P = 0.04) and left ventricular diastolic dysfunction grade (pre = 2.1 ± 0.3; post = 1.3 ± 0.7; P = 0.02), but FMD was unchanged (pre = 6.9 ± 3.7%; post = 7.0 ± 4.2%). No changes were observed following MI-ACT. A trend for reduced left atrial volume index was observed following HIIT compared with MI-ACT (-3.3 ± 6.6 vs. +5.8 ± 10.7 ml/m(2); P = 0.06). In HFpEF patients 4 wk of HIIT significantly improved V̇o₂peak and left ventricular diastolic dysfunction. HIIT may provide a more robust stimulus than MI-ACT for early exercise training adaptations in HFpEF.

  19. Cardiac function after chemoradiation for esophageal cancer : comparison of heart dose-volume histogram parameters to multiple gated acquisition scan changes

    NARCIS (Netherlands)

    Tripp, P; Malhotra, H K; Javle, M; Shaukat, A; Russo, R; de Boer, Sietse; Podgorsak, M; Nava, H; Yang, G Y

    2005-01-01

    In this paper we determine if preoperative chemoradiation for locally advanced esophageal cancer leads to changes in cardiac ejection fraction. This is a retrospective review of 20 patients treated at our institution for esophageal cancer between 2000 and 2002. Multiple gated acquisition cardiac sca

  20. Predictors of low cardiac output in decompensated severe heart failure

    Directory of Open Access Journals (Sweden)

    Marcelo Eidi Ochiai

    2011-01-01

    Full Text Available OBJECTIVE: To identify predictors of low cardiac output and mortality in decompensated heart failure. INTRODUCTION: Introduction: Patients with decompensated heart failure have a high mortality rate, especially those patients with low cardiac output. However, this clinical presentation is uncommon, and its management is controversial. METHODS: We studied a cohort of 452 patients hospitalized with decompensated heart failure with an ejection fraction of 60 years, and 64.6% were men. Low cardiac output was present in 281 (63% patients on admission. Chagas disease was the cause of heart failure in 92 (20.4% patients who had higher B type natriuretic peptide levels (1,978.38 vs. 1,697.64 pg/mL; P = 0.015. Predictors of low cardiac output were Chagas disease (RR: 3.655, P<0.001, lower ejection fraction (RR: 2.414, P<0.001, hyponatremia (RR: 1.618, P = 0.036, and renal dysfunction (RR: 1.916, P = 0.007. Elderly patients were inversely associated with low cardiac output (RR: 0.436, P = 0.001. Predictors of mortality were Chagas disease (RR: 2.286, P<0.001, ischemic etiology (RR: 1.449, P = 0.035, and low cardiac output (RR: 1.419, P = 0.047. CONCLUSIONS: In severe decompensated heart failure, predictors of low cardiac output are Chagas disease, lower ejection fraction, hyponatremia, and renal dysfunction. Additionally, Chagas disease patients have higher B type natriuretic peptide levels and a worse prognosis independent of lower ejection fraction.

  1. 铁缺乏与左室射血分数保留性心力衰竭的关系%The correlation between iron deficiency and heart failure with preserved left ventricular ejection fraction

    Institute of Scientific and Technical Information of China (English)

    黄南清; 郑学鸥

    2016-01-01

    Objective To study the correlation between iron deficiency and heart failure with preserved left ventricular ejection fraction (HFpEF).Methods 179 HFpEF patients were enrolled. Ferritin, transferrin saturation, soluble transferrin receptor index and cardiac function index were tested. Participants were divided into iron deficiency group (n=61) and non-iron-deficiency group (n=118) based on the level of ferritin or transferrin saturation. The correlation between iron deficiency and HFpEF were studied.Results The difference of left atrium diameter (LAD) [(48.76±9.67)mmvs. (42.89±8.55)mm], ratio of early peak (E) to late peak (A) of mitral flow velocities (E/A) in cardiac ultrasound test [(1.14±0.35vs.(0.93±0.29)], N-terminal pro brain natriuretic peptide [NT-proBNP,(1903.14±123.27)pg/mlvs. (1601.23±115.93)pg/ml], 6-min-walk-test [6MWT, (351.71±74.27)mvs. (389.96±79.31)m], and NYHA heart function classification between two groups were statistically significant (P<0.05). There was a correlation between level of ferritin, transferrin saturation and soluble transferrin receptor index with LAD, E/A, NT-proBNP and 6MWT. The level of ferritin, transferrin saturation and soluble transferrin receptor index among different cardiac function classification were significantly different (P<0.05). Along with cardiac function classification increasing, level of ferritin and transferrin saturation was decreased, while soluble transferrin receptor index increased.Conclusion There is correlation between iron deficiency and HFpEF, it is necessary to screening iron deficiency in heart failure patients.%目的:探讨铁缺乏与左室射血分数保留性心力衰竭(HFpEF)的相关性。方法入选179例HFpEF患者作为研究对象,检测患者的铁蛋白、转铁蛋白饱和度及可溶性转铁蛋白受体指数及心功能。根据血清铁蛋白或者转铁蛋白饱和度水平,将179例HFpEF患者分为铁缺乏组(n=61)和非铁缺乏组(n=118),探

  2. Cardiac function after chemoradiation for esophageal cancer: comparison of heart dose-volume histogram parameters to multiple gated acquisition scan changes.

    Science.gov (United States)

    Tripp, P; Malhotra, H K; Javle, M; Shaukat, A; Russo, R; De Boer, S; Podgorsak, M; Nava, H; Yang, G Y

    2005-01-01

    In this paper we determine if preoperative chemoradiation for locally advanced esophageal cancer leads to changes in cardiac ejection fraction. This is a retrospective review of 20 patients treated at our institution for esophageal cancer between 2000 and 2002. Multiple gated acquisition cardiac scans were obtained before and after platinum-based chemoradiation (50.4 Gy). Dose-volume histograms for heart, left ventricle and left anterior descending artery were analyzed. Outcomes assessed included pre- and postchemoradiation ejection fraction ratio and percentage change in ejection fraction postchemoradiation. A statistically significant difference was found between median prechemoradiation ejection fraction (59%) and postchemoradiation ejection fraction (54%) (P = 0.01), but the magnitude of the difference was not clinically significant. Median percentage volume of heart receiving more than 20, 30 and 40 Gy were 61.5%, 58.5% and 53.5%, respectively. Our data showed a clinically insignificant decline in ejection fraction following chemoradiation for esophageal cancer. We did not observe statistically or clinically significant associations between radiation dose to heart, left ventricle or left anterior descending artery and postchemoradiation ejection fraction.

  3. Butanolic fraction of Moringa oleifera Lam. (Moringaceae) attenuates isoprotrenol induced cardiac necrosis and oxidative stress in rats: an EPR study

    OpenAIRE

    Panda, Sunanda

    2015-01-01

    The preventive effect of Moringa oleifera polyphenolic fraction (MOPF) on cardiac damage was evaluated in isoproterenol (ISO) induced cardiotoxicity model of Wistar rats. Male rats in different groups were treated with MOPF orally at the dose of 50, 100 and 150 mg/kg/day for 28 days and were subsequently administered (s.c.) with ISO (85 mg/kg body weight) for the last two days. At the end of the experiment levels of serum troponin-T, creatine kinase-MB, lactate dehydrogenase, content of malon...

  4. Influence of ST-segment recovery on infarct size and ejection fraction in patients with ST-segment elevation myocardial infarction receiving primary percutaneous coronary intervention

    DEFF Research Database (Denmark)

    Hallén, Jonas; Ripa, Maria Sejersten; Johanson, Per;

    2010-01-01

    In patients with ST-segment elevation myocardial infarction treated with fibrinolytics, electrocardiogram-derived measures of ST-segment recovery guide therapy decisions and predict infarct size. The comprehension of these relationships in patients undergoing mechanical reperfusion is limited. We...... studied 144 patients treated with primary percutaneous coronary intervention. We aimed to define the association between infarct size as determined by cardiac magnetic resonance imaging and different metrics of ST-segment recovery. Electrocardiograms were assessed at baseline and 90 minutes after primary.......781). In conclusion, an electrocardiogram obtained early after primary percutaneous coronary intervention analyzed by a simple algorithm provided prognostic information on the final infarct size and cardiac function....

  5. The impact of hypertension as a road to heart failure with preserved ejection fraction: diagnostic value of two-dimensional speckle tracking echocardiography for the early impairment of left atrial-left ventricular-arterial coupling.

    Science.gov (United States)

    Oki, Takashi; Miyoshi, Hirokazu; Oishi, Yoshifumi; Mizuguchi, Yukio; Ara, Nusrat; Iuchi, Arata

    2014-01-01

    Heart failure with preserved ejection fraction (HFPEF) is a syndrome that frequently occurs in older people and patients with cardiovascular risk factors, particularly hypertension. This syndrome is not a specific disease process, whereas is associated with high morbidity and mortality in patients with heart failure with reduced ejection fraction (HFREF) as well. Therefore, a "one size fits all" diagnosis strategy is unlikely to operate for patients with HFPEF. Assessment of left atrial (LA)-left ventricular (LV)-arterial coupling seems to have a clinical impact on hypertensive patients, because HF signs and symptoms have been found to be significantly related to inappropriate LA-LV interaction during diastole and LV-arterial interaction during systole. Two-dimensional speckle tracking echocardiography (2DSTE) is a new tool that may have a role in earlier detecting the impaired LA, LV, and arterial function in asymptomatic patients. This review explored the impact of LA-LV-arterial coupling in understanding the pathophysiology of hypertension as a road to HFPEF, and the possibilities of clinical application by using 2DSTE.

  6. 左室射血分数正常的心力衰竭患者诊治进展%Progress of diagnosis and management of heart failure with preserved left ventricular ejection fraction

    Institute of Scientific and Technical Information of China (English)

    薛增明; 马长生

    2012-01-01

    Heart failure with preserved left ventricular ejection fraction is more common in older women. The incentives are diabetes, hypertension, ischemic heart disease, and the mechanism are left ventricular relaxation impaired and diastolic stiffness increase. Signs and symptoms of heart failure, left ventricular ejection fraction ≥ 50% and no valve abnormalities in ultrasound are all necessary for its diagnosis. Treatment is mainly againsted primary diseases.%左室射血分数正常的心力衰竭(HFPEF)老年女性更常见.基础病因多为糖尿病、高血压、缺血性心脏病.机制为左室松弛受损和舒张期僵硬度增加.诊断包括有心力衰竭的症状和体征,左室射血分数≥50%,超声检查无心瓣膜异常.治疗针对原发病为主.

  7. Improved hepatic arterial fraction estimation using cardiac output correction of arterial input functions for liver DCE MRI

    Science.gov (United States)

    Chouhan, Manil D.; Bainbridge, Alan; Atkinson, David; Punwani, Shonit; Mookerjee, Rajeshwar P.; Lythgoe, Mark F.; Taylor, Stuart A.

    2017-02-01

    Liver dynamic contrast enhanced (DCE) MRI pharmacokinetic modelling could be useful in the assessment of diffuse liver disease and focal liver lesions, but is compromised by errors in arterial input function (AIF) sampling. In this study, we apply cardiac output correction to arterial input functions (AIFs) for liver DCE MRI and investigate the effect on dual-input single compartment hepatic perfusion parameter estimation and reproducibility. Thirteen healthy volunteers (28.7  ±  1.94 years, seven males) underwent liver DCE MRI and cardiac output measurement using aortic root phase contrast MRI (PCMRI), with reproducibility (n  =  9) measured at 7 d. Cardiac output AIF correction was undertaken by constraining the first pass AIF enhancement curve using the indicator-dilution principle. Hepatic perfusion parameters with and without cardiac output AIF correction were compared and 7 d reproducibility assessed. Differences between cardiac output corrected and uncorrected liver DCE MRI portal venous (PV) perfusion (p  =  0.066), total liver blood flow (TLBF) (p  =  0.101), hepatic arterial (HA) fraction (p  =  0.895), mean transit time (MTT) (p  =  0.646), distribution volume (DV) (p  =  0.890) were not significantly different. Seven day corrected HA fraction reproducibility was improved (mean difference 0.3%, Bland–Altman 95% limits-of-agreement (BA95%LoA)  ±27.9%, coefficient of variation (CoV) 61.4% versus 9.3%, ±35.5%, 81.7% respectively without correction). Seven day uncorrected PV perfusion was also improved (mean difference 9.3 ml min‑1/100 g, BA95%LoA  ±506.1 ml min‑1/100 g, CoV 64.1% versus 0.9 ml min‑1/100 g, ±562.8 ml min‑1/100 g, 65.1% respectively with correction) as was uncorrected TLBF (mean difference 43.8 ml min‑1/100 g, BA95%LoA  ±586.7 ml min‑1/ 100 g, CoV 58.3% versus 13.3 ml min‑1/100 g, ±661.5 ml min‑1/100 g, 60

  8. Reduced Right Ventricular Function Predicts Long-Term Cardiac Re-Hospitalization after Cardiac Surgery.

    Directory of Open Access Journals (Sweden)

    Leela K Lella

    Full Text Available The significance of right ventricular ejection fraction (RVEF, independent of left ventricular ejection fraction (LVEF, following isolated coronary artery bypass grafting (CABG and valve procedures remains unknown. The aim of this study is to examine the significance of abnormal RVEF by cardiac magnetic resonance (CMR, independent of LVEF in predicting outcomes of patients undergoing isolated CABG and valve surgery.From 2007 to 2009, 109 consecutive patients (mean age, 66 years; 38% female were referred for pre-operative CMR. Abnormal RVEF and LVEF were considered 30 days outcomes included, cardiac re-hospitalization, worsening congestive heart failure and mortality. Mean clinical follow up was 14 months.Forty-eight patients had reduced RVEF (mean 25% and 61 patients had normal RVEF (mean 50% (p<0.001. Fifty-four patients had reduced LVEF (mean 30% and 55 patients had normal LVEF (mean 59% (p<0.001. Patients with reduced RVEF had a higher incidence of long-term cardiac re-hospitalization vs. patients with normal RVEF (31% vs.13%, p<0.05. Abnormal RVEF was a predictor for long-term cardiac re-hospitalization (HR 3.01 [CI 1.5-7.9], p<0.03. Reduced LVEF did not influence long-term cardiac re-hospitalization.Abnormal RVEF is a stronger predictor for long-term cardiac re-hospitalization than abnormal LVEF in patients undergoing isolated CABG and valve procedures.

  9. Assessment of Rho-kinase inhibitor in heart failure with preserved left ventricular ejection fraction patients%Rho激酶抑制剂短期治疗射血分数保留性心衰疗效评估

    Institute of Scientific and Technical Information of China (English)

    张伟; 马小川; 高智耀; 王芳; 张涛

    2011-01-01

    preserved ejection fraction( HFPEF) patients in short term. Methods The study involved 80 subjects diagnosed with HFPEF,age arranged from 45 to 65 years. Randomly divided into two group:37 subjects assigned into group A,as control group received simple traditional anti-heart failure optima] medical therapy;43 subjects assigned into group B, as experimental group not only received traditional optimal medical therapy but also fasudil therapy. All serum BNP values of patients were tested in 24 hours,2 weeks after admission,respectively. Echocar-diography parameters such as left ventricular the maximum rate of pressure drop ( -dp/dtmax) , and calculated the time constant of left ventricular pressure fall( T) of all patients,all data were measured in 48 hours,2 weeks after admission, respectively. Followed-up and recorded the NYHA classification 2 weeks after admission, discharged 4 weeks and 6 weeks,respectively. Results The NYHA classification of patients in both groups were significantly improved(x2= 7. 318,P=0. 026) after 2 weeks treatment;Discharged 4 weeks,on the basis of improvement both groups,the NYHA class of experimental group were improved more significantly (x2 = 6. 036,P =0. 014) ;Followed up for 6 weeks, although both groups cardiac function improved, However, compared between the group A and group B, (x2 = 0. 409 ,P = 0. 522) , no significant difference obtained. Serum BNP concentrations was measured 2 weeks after admission, comparison between two groups[ (283.41 ±34.69)pg/mL vs (263.65 ±49. 11 )pg/mL,P =0.039] .statistical difference significantly. However,-dp/dtMax data comparison between the groups after 2 weeks treatment, that was[ ( 1 259. 50 ± 198. 31 )mmHg/s vs( 1341. 20 ± 178. 79 ) mmHg/s, P = 0. 056 ], there were no statistically significant differences. T values of patients was compared between groups 2 weeks after admission, [ (55. 16 ±8. 99) ms vs(47. 47 ±7. 27)ms, P <0. 05 J , there was statistically significant difference. Conclusion Both

  10. Myocardial Extracellular Volume Fraction with Dual-Energy Equilibrium Contrast-enhanced Cardiac CT in Nonischemic Cardiomyopathy: A Prospective Comparison with Cardiac MR Imaging.

    Science.gov (United States)

    Lee, Hye-Jeong; Im, Dong Jin; Youn, Jong-Chan; Chang, Suyon; Suh, Young Joo; Hong, Yoo Jin; Kim, Young Jin; Hur, Jin; Choi, Byoung Wook

    2016-07-01

    Purpose To evaluate the feasibility of equilibrium contrast material-enhanced dual-energy cardiac computed tomography (CT) to determine extracellular volume fraction (ECV) in nonischemic cardiomyopathy (CMP) compared with magnetic resonance (MR) imaging. Materials and Methods This study was approved by the institutional review board; informed consent was obtained. Seven healthy subjects and 23 patients (six with hypertrophic CMP, nine with dilated CMP, four with amyloidosis, and four with sarcoidosis) (mean age ± standard deviation, 57.33 years ± 14.82; 19 male participants [63.3%]) were prospectively enrolled. Twelve minutes after contrast material injection (1.8 mL/kg at 3 mL/sec), dual-energy cardiac CT was performed. ECV was measured by two observers independently. Hematocrit levels were compared between healthy subjects and patients with the Mann-Whitney U test. In per-subject analysis, interobserver agreement for CT was assessed with the intraclass correlation coefficient (ICC), and intertest agreement between MR imaging and CT was assessed with Bland-Altman analysis. In per-segment analysis, Student t tests in the linear mixed model were used to compare ECV on CT images between healthy subjects and patients. Results Hematocrit level was 43.44% ± 1.80 for healthy subjects and 41.23% ± 5.61 for patients with MR imaging (P = .16) and 43.50% ± 1.92 for healthy subjects and 41.35% ± 5.92 for patients with CT (P = .15). For observer 1 in per-subject analysis, ECV was 34.18% ± 8.98 for MR imaging and 34.48% ± 8.97 for CT. For observer 2, myocardial ECV was 34.42% ± 9.03 for MR imaging and 33.98% ± 9.05 for CT. Interobserver agreement for ECV at CT was excellent (ICC = 0.987). Bland-Altman analysis between MR imaging and CT showed a small bias (-0.06%), with 95% limits of agreement of -1.19 and 1.79. Compared with healthy subjects, patients with hypertrophic CMP, dilated CMP, amyloidosis, and sarcoidosis had significantly higher myocardial ECV at dual

  11. Fluorescent magnetic iron oxide nanoparticles for cardiac precursor cell selection from stromal vascular fraction and optimization for magnetic resonance imaging

    Directory of Open Access Journals (Sweden)

    Verma VK

    2015-01-01

    Full Text Available Vinod Kumar Verma,1 Suguna Ratnakar Kamaraju,1 Ravindranath Kancherla,1 Lakshmi K Kona,1 Syed Sultan Beevi,1 Tanya Debnath,1 Shalini P Usha,1 Rammohan Vadapalli,2 Ali Syed Arbab,3 Lakshmi Kiran Chelluri11Department of Transplant Biology, Immunology and Stem Cell Laboratory, Global Hospitals, 2Department of Imageology, Vijaya Radiology Centre, Hyderabad, India; 3Department of Biochemistry and Molecular Biology, Georgia Regents University, Augusta, GA, USAAbstract: Fluorescent magnetic iron oxide nanoparticles have been used to label cells for imaging as well as for therapeutic purposes. The purpose of this study was to modify the approach to develop a nanoprobe for cell selection and imaging with a direct therapeutic translational focus. The approach involves physical coincubation and adsorption of superparamagnetic iron oxide nanoparticle-polyethylene glycol (SPION-PEG complexes with a monoclonal antibody (mAb or a set of antibodies. Flow cytometry, confocal laser scanning microscopy, transmission electron microscopy, iron staining, and magnetic resonance imaging were used to assess cell viability, function, and labeling efficiency. This process has been validated by selecting adipose tissue-derived cardiac progenitor cells from the stromal vascular fraction using signal regulatory protein alpha (SIRPA/kinase domain receptor (KDR mAbs. These markers were chosen because of their sustained expression during cardiomyocyte differentiation. Sorting of cells positive for SIRPA and KDR allowed the enrichment of cardiac progenitors with 90% troponin-I positivity in differentiation cultures. SPION labeled cardiac progenitor cells (1×105 cells was mixed with gel and used for 3T magnetic resonance imaging at a concentration, as low as 12.5 µg of iron. The toxicity assays, at cellular and molecular levels, did not show any detrimental effects of SPION. Our study has the potential to achieve moderate to high specific cell selection for the dual purpose of

  12. Plasma soluble urokinase plasminogen activator receptor (suPAR) level is associated with myocardial impairment assessed with advanced echocardiography in Type 1 Diabetes Patients with normal ejection fraction and without known heart disease or end stage renal disease

    DEFF Research Database (Denmark)

    Theilade, Simone; Rossing, Peter; Eugen-Olsen, Jesper;

    2016-01-01

    PAR is associated with early myocardial impairment assessed with advanced echocardiographic methods. Methods In an observational study on 318 type 1 diabetes patients without known heart disease and with normal left ventricular ejection fraction (LVEF) (biplane LVEF >45%), we performed conventional, tissue Doppler...... was: 58±5%. suPAR levels were not associated with LVEF (p = 0.11). In adjusted models, higher suPAR levels were independently associated with both impaired systolic function assessed with global longitudinal strain (GLS) and tissue velocity s', and with impaired diastolic measures a' and e'/a' (all p...... ≤ 0.034). In multivariable analysis including cardiovascular riskfactors and both systolic and diastolic measures (GLS and e'/a') both remained independently associated with suPAR levels (p ≤ 0.012). Conclusions In type 1 diabetes patients with normal LVEF and without known heart disease, su...

  13. Analysis of circumferential and longitudinal left ventricular systolic function in patients with non-ischemic chronic heart failure and preserved ejection fraction (from the CARRY-IN-HFpEF study).

    Science.gov (United States)

    Cioffi, Giovanni; Senni, Michele; Tarantini, Luigi; Faggiano, Pompilio; Rossi, Andrea; Stefenelli, Carlo; Russo, Tiziano Edoardo; Alessandro, Selmi; Furlanello, Francesco; de Simone, Giovanni

    2012-02-01

    Heart failure with preserved left ventricular ejection fraction (HFpEF) is implicitly attributed to diastolic dysfunction, often recognized in elderly patients with hypertension, diabetes, and renal dysfunction. In these patients, left ventricular circumferential and longitudinal shortening is often impaired despite normal ejection fraction. The aim of this prospective study was to analyze circumferential and longitudinal shortening and their relations in patients with nonischemic HFpEF. Stress-corrected midwall shortening (sc-MS) and mitral annular peak systolic velocity (S') were measured in 60 patients (mean age 73 ± 13 years) with chronic nonischemic HFpEF in stable New York Heart Association functional class II or III and compared to the values in 120 healthy controls and 120 patients with hypertension without HFpEF. Sc-MS was classified as low if HFpEF, 27% of patients with hypertension, and 2% of controls; isolated low S' was detected in 11% of patients with HFpEF, 7% of patients with hypertension, and 5% of controls; and combined low sc-MS and low S' was detected in 26% of patients with HFpEF, 9% of patients with hypertension, and 5% of controls (HFpEF vs others, all p values HFpEF. The relation between sc-MS and S' was nonlinear (cubic). Changes in S' within normal values corresponded to negligible variations in sc-MS, whereas the progressive decrease below 8.5 cm/s was associated with substantial decrease in sc-MS. In conclusion, circumferential and/or longitudinal systolic dysfunction is present in most patients with HFpEF. Circumferential shortening normalized by wall stress identifies more patients with concealed left ventricular systolic dysfunction than longitudinal shortening.

  14. Ejection Tower Lab

    Data.gov (United States)

    Federal Laboratory Consortium — The Ejection Tower Facility's mission is to test and evaluate new ejection seat technology being researched and developed for future defense forces. The captive and...

  15. Gated blood-pool studies of cardiac function in the rat and marmoset

    Energy Technology Data Exchange (ETDEWEB)

    McIntosh, G.H.; Barnden, L.R.; Buttfield, I.H.; Charnock, J.S.

    1983-08-01

    To develop a sensitive, relatively noninvasive method for monitoring cardiac function in small laboratory animals, equilibrium gated blood-pool imaging (with Tc-99m RBC) was adapted for use in an inbred strain of laboratory rats of 400-470 g body weight and in marmosets of 320-400 g body weight. A 2-mm pinhole collimator was fitted to the gamma camera to produce a distinct image of the left ventricle following intravenous injection of 5 mCi of pertechnetate. Reproducible and consistent data for heart rate, left-ventricular ejection fraction, and peak ejection rate were obtained from studies on 13 male rats and five marmosets maintained on constant diets. An intravenous injection of 0.4 microgram of isoprenaline led to predictable increases in heart rate, left-ventricular ejection fraction, and peak ejection rate, and provided evidence of the sensitivity of the method in monitoring heart function in small laboratory animals.

  16. Gated blood-pool studies of cardiac function in the rat and marmoset

    Energy Technology Data Exchange (ETDEWEB)

    McIntosh, G.H. (CSIRO, Adelaide, South Australia); Barnden, L.R.; Buttfield, I.H.; Charnock, J.S.

    1983-08-01

    To develop a sensitive, relatively noninvasive method for monitoring cardiac function in small laboratory animals, equilibrium gated blood-pool imaging (with Tc-99m RBC) was adapted for use in an inbred strain of laboratory rats of 400 to 470 g body weight and in marmosets of 320 to 400 g body weight. A 2-mm pinhole collimator was fitted to the gamma camera to produce a distinct image of the left ventricle following intravenous injection of 5 mCi of pertechnetate. Reproducible and consistent data for heart rate, left-ventricular ejection fraction, and peak ejection rate were obtained from studies on 13 male rats and five marmosets maintained on constant diets. An intravenous injection of 0.4 ..mu..g of isoprenaline led to predictable increases in heart rate, left-ventricular ejection fraction, and peak ejection rate, and provided evidence of the sensitivity of the method in monitoring heart function in small laboratory animals.

  17. Noninvasive cardiac risk stratification of diabetic and nondiabetic uremic renal allograft candidates using dipyridamole-thallium-201 imaging and radionuclide ventriculography

    Energy Technology Data Exchange (ETDEWEB)

    Brown, K.A.; Rimmer, J.; Haisch, C. (Univ. of Vermont College of Medicine, Burlington (USA))

    1989-11-01

    The ability of noninvasive risk stratification using dipyridamole-thallium-201 (Tl-201) imaging and radionuclide ventriculography to predict perioperative and long-term cardiac events (myocardial infarction or cardiac death) was evaluated in 36 uremic diabetic and 29 nondiabetic candidates for renal allograft surgery. Of the 35 patients who underwent renal allograft surgery 8 +/- 7 months after the study, none had transient Tl-201 defects (although 13 had depressed left ventricular ejection fraction) and none developed perioperative cardiac events. During a mean follow-up of 23 +/- 11 months, 6 (9%) patients developed cardiac events. Logistic regression analysis was used to compare the predictive value of clinical data (including age, sex, diabetes, chest pain history, allograft recipient) and radionuclide data. Presence of transient Tl-201 defect and left ventricular ejection fraction were the only significant predictors of future cardiac events (p less than 0.01). No other patient variables, including diabetes or receiving a renal allograft, had either univariate or multivariate predictive value. All 3 patients with transient Tl-201 defects had cardiac events compared with only 3 of 62 (5%) patients without transient Tl-201 defect (p less than 0.0001). Mean left ventricular ejection fraction was lower in patients with cardiac events (44 +/- 13%) compared with patients without cardiac events (57 +/- 9%, p less than 0.005). Overall, 5 of 6 patients with cardiac events had either transient Tl-201 defects or depressed left ventricular ejection fraction. Dipyridamole-Tl-201 imaging and radionuclide ventriculography may be helpful in identifying uremic candidates for renal allograft surgery who are at low risk for perioperative and long-term cardiac events.

  18. Study in clinical data from heart failure patients with preserved and reduced ejection fraction%射血分数保留和射血分数降低心衰患者临床资料分析

    Institute of Scientific and Technical Information of China (English)

    刘士立; 赵丽; 苗利辉

    2016-01-01

    目的 分析射血分数保留的心衰(heart failure with preserved ejection fraction,HFPEF)与射血分数降低的心衰(heart failure with reduced ejection fraction,HFREF)患者的临床资料,并探讨两种类型心衰的差异及鉴别诊断指标.方法 回顾总结复兴医院急诊科2013年8月至2015年7月收治的心衰患者443例.根据射血分数(left ventricular ejection fraction,LVEF)将443例患者分为两组,HFPEF组(n =350)及HFREF组(n=93),比较两组患者一般情况、入院后24h实验室检测指标,以及超声心动图检查指标,并用Logistic多因素回归分析影响心衰类型的因素,建立多变量观察值的受试者工作特征曲线(ROC曲线),分析多变量联合鉴别两种不同类型心衰的敏感度和特异度.结果 HFPEF组患者年龄、女性所占比例、合并有慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)比例、超敏C反应蛋白(high sensitivity C-reactive protein,hs-CRP)显著高于HFREF组(P<0.01),HFREF组患者男性所占比例、合并冠心病比例、B型钠尿肽(brain natriuretic peptide,BNP)、肌钙蛋白T(troponin T,TnT)、尿素氮(urea nitrogen,BUN)、尿酸(nric acid,UA)、糖化血红蛋白(glycosylated hemoglobin,HbA1c)高于HFPEF组(P<0.01或P<0.05);应用Logistic回归分析影响心衰类型的因素,联合性别、hs-CRP、BNP、BUN、UA、HbA1c作出预测HFREF概率的ROC曲线,ROC曲线下面积(AUC)为0.878,灵敏度为84.9%,特异度为77.7%.结论 联合性别及入院24 h hs-CRP、BNP、BUN、UA、HbA1c可能对心衰类型的鉴别诊断有参考价值.%Objective To analyze the difference in clinical characteristics and differential diagnostic indicators between heart failure patients with preserved ejection fraction (HFPEF) and those with reduced ejection fraction (HFREF).Methods A total of 443 patients with heart failure admitted in our department from Aug 2013 to Ju12015 were retrospectively analyzed.According to the different values

  19. Cardiac troponin assays in the management of heart failure.

    Science.gov (United States)

    Torre, Matthew; Jarolim, Petr

    2015-02-20

    Cardiac troponins I and T are established biomarkers of cardiac injury. Testing for either of these two cardiac troponins has long been an essential component of the diagnosis of acute myocardial infarction. In addition, cardiac troponin concentrations after acute myocardial infarction predict future adverse events including development of ischemic heart failure and chronic elevations of cardiac troponin correlate with heart failure severity. These predictions and correlations are particularly obvious when cardiac troponin concentrations are measured using the new high sensitivity cardiac troponin assays. Thus, a growing body of literature suggests that cardiac troponin testing may have important clinical implications for heart failure patients with reduced or preserved ejection fraction. In this review, we explore the prognostic utility of measuring cardiac troponin concentrations in patients with acute or chronic heart failure and in populations at risk of developing heart failure and the relationship between cardiac troponin levels and disease severity. We also summarize the ongoing debates and research on whether serial monitoring of cardiac troponin levels may become a useful tool for guiding therapeutic interventions in patients with heart failure.

  20. Evaluación ecocardiográfica de la función sistólica en el caballo: Parte 1. Valores de referencia para el porcentaje de acortamiento fraccional y fracción de eyección Echocardiographic evaluation of the systolic function in the horse: Referene values for fractional shortening and ejection fraction

    Directory of Open Access Journals (Sweden)

    C.H. LIGHTOWLER

    2000-01-01

    Full Text Available Los autores presentan los valores del P.A.F. y la F.E. del ventrículo izquierdo obtenidos de 48 caballos mestizos, no entrenados, con pesos entre 330 y 550 kilos y edades que oscilaron entre 2 y 17 años. Para el P.A.F. el valor medio obtenido fue de 39,4% ± 5,5 y el c.v. de 13,9%, con valores extremos entre 48 y 27. Respecto de la F.E. el valor medio fue de 67,2% ± 7,3 y un c. v. de 10,9% con extremos entre 80,2 y 50,4. Se realizó la comparación de los valores medios obtenidos con los publicados por otros investigadores, no observándose diferencias significativas para el P.A.F. y la F.E con ninguno de los valores investigados, salvo con los publicados por Lescure y Tamsali, (1984The authors present the values of the percentage of fractional shortening and ejection fraction of the left ventricle in horses obtained by echocardiographic evaluation. Forty eight untrained crossbred horses were evaluated, weighing between 330 and 550 kg and ages ranging between 2 and 17 years old. The mean value for the percentage of fractional shortening was 39.38% ± 5.47 with a variation coefficient of 13. 88%, with limit values between 48 and 27. Regarding the ejection fraction, the mean value was 67.2%± 7.33 and a variation coefficient of 10.9% with limits between 80.2 and 50.4. No differences between our indexes mean values and those reported by other investigators were observed, except with those published by Lescure and Tamsali, 1984

  1. Reduced global longitudinal strain in association to increased left ventricular mass in patients with aortic valve stenosis and normal ejection fraction: a hybrid study combining echocardiography and magnetic resonance imaging

    Directory of Open Access Journals (Sweden)

    Scheffold Thomas

    2010-07-01

    Full Text Available Abstract Background Increased muscle mass index of the left ventricle (LVMi is an independent predictor for the development of symptoms in patients with asymptomatic aortic stenosis (AS. While the onset of clinical symptoms and left ventricular systolic dysfunction determines a poor prognosis, the standard echocardiographic evaluation of LV dysfunction, only based on measurements of the LV ejection fraction (EF, may be insufficient for an early assessment of imminent heart failure. Contrary, 2-dimensional speckle tracking (2DS seems to be superior in detecting subtle changes in myocardial function. The aim of the study was to assess these LV function deteriorations with global longitudinal strain (GLS analysis and the relations to LVMi in patients with AS and normal EF. Methods 50 patients with moderate to severe AS and 31 controls were enrolled. All patients underwent echocardiography, including 2DS imaging. LVMi measures were performed with magnetic resonance imaging in 38 patients with AS and indexed for body surface area. Results The total group of patients with AST showed a GLS of -15,2 ± 3,6% while the control group reached -19,5 ± 2,7% (p Conclusions In conclusion, increased LVMi is reflected in abnormalities of GLS and the proportion of GLS impairment depends on the extent of LV hypertrophy. Therefore, simultaneous measurement of LVMi and GLS might be useful to identify patients at high risk for transition into heart failure who would benefit from aortic valve replacement irrespectively of LV EF.

  2. 左心室射血分数保留心力衰竭的诊断治疗现状%Present Situation of Diagnosis and Treatment of Left Ventricular Ejec-tion Fraction Heart Failure Reservations

    Institute of Scientific and Technical Information of China (English)

    阳育昌

    2014-01-01

    Along with population aging society’s arrival in our country, incidence rate of left ventricular ejection fraction and coronary heart disease, hypertension, heart failure (HFPEF) retention was rising, which clinical medical workers should pay close attention to. This paper describes the methods of clini-cal diagnosis, treatment of HF ̄PEF in recent years, in order to provide a useful reference for clinicians accurately judge to the patients and take timely and effective treatment.%随着我国人口老龄化社会的到来,冠状动脉粥样硬化性心脏病、高血压等相关的左心室射血分数保留心力衰竭(HFPEF)的发病率不断提升,对此临床医学工作者应该密切关注。本文综述了近几年来临床诊断、治疗HF-PEF的方法,以期为临床医生准确判断病人病情,及时采取有效的治疗方法提供有益参考。

  3. Predictors for severe cardiac complications after hematopoietic stem cell transplantation.

    Science.gov (United States)

    Sakata-Yanagimoto, M; Kanda, Y; Nakagawa, M; Asano-Mori, Y; Kandabashi, K; Izutsu, K; Imai, Y; Hangaishi, A; Kurokawa, M; Tsujino, S; Ogawa, S; Chiba, S; Motokura, T; Hirai, H

    2004-05-01

    The value of pre-transplant factors for predicting the development of cardiac complications after transplantation has been inconsistent among studies. We analyzed the impact of pre-transplant factors on the incidence of severe cardiac complications in 164 hematopoietic stem cell transplant recipients. We identified eight patients (4.8%) who experienced grade III or IV cardiac complications according to the Bearman criteria. Seven died of cardiac causes a median of 3 days after the onset of cardiac complications. On univariate analysis, both the cumulative dose of anthracyclines and the use of anthracyclines within 60 days before transplantation affected the incidence of severe cardiac complications (P=0.0091 and 0.011). The dissociation of heart rate and body temperature, which reflects "relative tachycardia", was also associated with a higher incidence of cardiac complications (P=0.024). None of the variables obtained by electrocardiography or echocardiography were useful for predicting cardiac complications after transplantation, although the statistical power might not be sufficient to detect the usefulness of ejection fraction. On a multivariate analysis, the cumulative dose of anthracyclines was the only independent significant risk factor for severe cardiac complications. We conclude that the cumulative dose of anthracyclines is the most potent predictor of cardiac complications and the administration of anthracyclines should be avoided within two months before transplantation.

  4. Radionuclide assessment of left ventricular function following cardiac surgery

    Energy Technology Data Exchange (ETDEWEB)

    Howe, W.R.; Jones, R.H.; Sabiston, D.C. Jr.

    1976-01-01

    Use of a high count-rate gamma scintillation camera permits the noninvasive assessment of left ventricular function by nuclear angiocardiography. Counts recorded from the region of the left ventricle at 50- or 100-msec intervals during the first transit of an intravenously administered bolus of radioisotope produce a high-fidelity indicator-dilution curve. Count fluctuations reflect left ventricular volume changes during the cardiac cycle and permit measurement of dv/dt, ejection fraction, mean transit time, and wall motion of this chamber. The present study evaluates (1) the accuracy of this technique compared to standard biplane cineangiography and (2) its usefulness in evaluating patients after cardiac surgery.

  5. Predictive value of local and core laboratory echocardiographic assessment of cardiac function in patients with chronic stable angina: The ACTION study

    NARCIS (Netherlands)

    A.M. Dart (Anthony); J.E. Otterstad (Jan Erik); B.A. Kirwan (Bridget Anne); J.D. Parker (John); S. de Brouwer (Sophie); P. Poole-Wilson (Philip); J. Lubsen (Jacobus)

    2007-01-01

    textabstractAims: To evaluate the relationship between echocardiographic cardiac function and outcome in patients with stable symptomatic angina. Methods: Baseline echo left ventricular ejection fraction and volume data measured in a central laboratory was available for 7016 patients (92% of the tot

  6. 40 Cases of Misdiagnosis of Aged Patients with Heart Failure Left Ventricular Ejection Fraction Retained%老年左心室射血分数保留的心力衰竭40例误诊分析

    Institute of Scientific and Technical Information of China (English)

    董英男; 钟九华; 贺菲; 王连馥

    2011-01-01

    Objective To discuss the reason of misdiagnose of seniors' left vertricle heart failure with preserved ejection fraction( HFPEF ). Methods 40 cases of misdiagnosed senior HFPEF patients in our hospital were collected, their basic pathogen clinical behaviors and misdiagnosed situations were analyzed.Results 65.0% patients of HFPEF were misdiagnosed as respiratory system disease. 17.5% patients of HFPEF were misdiagnosed as cerebrovascalar disease. 15.0% patients of HFPEF were misdiagnosed as psychological system disease. 15.0% patients of HFPEF were misdiagnosed as digestive system disease. Conclusion Occult disease in patients aged HFNEF. Often to cover up because of the coexistence of various diseases of heart failure symptoms. Therefore, clinicians should be vigilant to avoid misdiagnosis.%目的探讨老年左心室射血分数保留的心力衰竭(HFPEF)误诊原因.方法收集我科住院老年HFPEF的误诊病例40例,对其基础病因、临床表现及误诊情况进行临床分析.结果本组老年HFPEF中有26例(65.0%)的患者被误诊为呼吸系统疾病,7例(17.5%)患者被误诊为脑血管疾病,6例(15.0%)患者被误诊为精神系统疾病,6例(15.0%)患者被误诊为消化系统疾病.结论老年HFPEF患者病情隐匿.常因多种疾病并存而掩盖心力衰竭症状.故临床医师应提高警惕,避免误诊误治.

  7. Serum levels of NT- pro ANP, BNP, NT-pro BNP and function of the left atrium in patients with heart failure and preserved ejection fraction after myocardial infarction

    Science.gov (United States)

    Shurupov, V.; Suslova, T.; Ryabov, V.

    2015-11-01

    The objective of our study was to evaluate the levels of natriuretic peptides in patients (pts) with heart failure with preserved ejection fraction (HFpEF) in 12 month after ST elevation myocardial infarction (STEMI) with a focus on the function of left atrium (LA) and left ventricular (LV) filling pressure. 55 pts were included in the study. 6-minute walk test was performed. Echo exam was performed by the diagnostic system VIVID 7. BNP in whole blood was determined using the Triage ® Meter BNP test. The serum levels of NT-pro BNP, NT-pro ANP («Biomedica», Austria) were determined in blood samples by enzyme-linked immune-sorbent assay (ELISA). LA volume index were differences (16.03±3.39 ml/m2; 25.36±8.26 ml/m2; 29.41±9.46 ml/m2 accordingly I, II, III class) depending on severity of HF. Well as E/E' ratio were differences (7.5±1.4; 9.8±5.1; 13.5±7.6 accordingly I, II, III class) depending on severity of HF. The LA volume index correlated with levels of NT-pro ANP (R=0.29; p=0.04), levels of NT-pro BNP (R=0.37; p=0.01), levels of BNP (R=0.51; p=0.0001). The LV filling pressure correlated with levels of NT-pro ANP (R=0.45; p=0.002), levels of NT-pro BNP (R=0.49; p=0.001), levels of BNP (R=0.37; p=0.01).

  8. Change in right ventricular function during off-pump coronary artery bypass graft surgery in patients with different ejection fraction%不同射血分数患者非体外循环冠状动脉旁路移植术中右心功能变化

    Institute of Scientific and Technical Information of China (English)

    王长卿

    2012-01-01

    Objective To study the right ventricular (RV) function during off-pump coronary artery bypass graft COPCABG) surgery in patients with different ejection fraction(EF). Methods Fifty ASA E or DI patienis scheduled for OPCABG were randomly divided into two groups,group EF≥50% (n = 30), group EF≤35% (n = 20). A thermodilution pulmonary artery catheter was inserted after anesthesia induction. The values of CVP, mean pulmonary arterial pressure CMPAP), pulmonary arterial wedge pressure (PAWP), cardiac output index (CD, right ventricular ejection fraction (RVEF) and right ventricular end-diastolic volume index (RVEDVI) were measured at the points of immediate epicardium opening (baseline), 5 nun after the heart was positioned for each coronary anastomosis (Included left anterior descending( LAD) artery, left circumflex (LCX) artery, posterior descending artery (PDA)) and after the sternum closing. Results CVP. MPAP and PAWP increased during anastomoses of each coronary artery(P<0. 05). During anastomosis of the LCX artery and PDA, Cl and RVEF in both groups were significantly reduced(P<0. 05), RVEDVI in group EF≥50% decreased and increased in group EF≤35%(P<0. 05). Compared with group EF≤35%, RVEF in group EF≥50% increased significantly during anastomoses of LCX and PDA and after sternum closing, RVEDVI decreased during anastomoses of LCX and PDA(P<0. 05). Qmdusion The displacement of beating heart for positioning during anastomosis of the graft to I.CX artery and PDA caused significant derangement of RV function. The change of RV function was different in patients with different EF.%目的 研究不同射血分数患者非体外循环冠状动脉旁路移植术(OPCABG)术中右心功能变化规律.方法 选择50例择期行OPCABG的患者,ASAⅡ或Ⅲ级,其中EF≥50%组30例,EF≤35%组20例,麻醉诱导后放置肺动脉导管,分别记录开心包后(基础值)、前降支(LAD)搭桥、回旋支(LCX)搭桥、后降

  9. Exercise-induced cardiac fatigue in low handicap polo horses

    Directory of Open Access Journals (Sweden)

    CAO Bello

    2014-01-01

    Full Text Available Physical exercise leads to several changes in the cardiovascular system of horses and may induce abnormalities that are not observed at rest. Little is known about the cardiac effects of intense physical exercise performed by horses in polo competitions. This study aimed at identifying if exercise-induced cardiac fatigue is observed in healthy polo ponies. We examined 25 equine athletes before and after a training match. The results demonstrated post-exercise electrocardiographic alteration such as cardiac arrhythmia, QTc prolongation, abnormal T waves and ST-segment elevation. The post-exercise echocardiogram showed interventricular septum and left ventricle free wall thickness reduction, systolic volume decreased and ejection fraction decreased. These results suggest that polo causes exercise-induced cardiac fatigue. It was not possible to establish accurately the etiology of this abnormality, nor its long-term consequences.

  10. CFD Simulations of Vibration Induced Droplet Ejection.

    Science.gov (United States)

    James, Ashley; Smith, Marc K.; Glezer, Ari

    1998-11-01

    Vibration-induced droplet ejection is a process that occurs when a liquid droplet is placed on a vibrating membrane. Above a critical value of the excitation amplitude, Faraday waves form on the surface of the drop. As the amplitude is increased secondary drops are ejected from the wave crests. A Navier-Stokes solver designed to simulate the transient fluid mechanics of the process is presented. The solver is based on a MAC method on a staggered grid. A volume of fluid method is implemented to track the free surface. The volume fraction is advected via a second-order, unsplit method that minimizes numerical diffusion of the interface. Surface tension is incorporated as a continuum surface force. This work is intended to provide a comprehensive description of the fluid dynamics involved in vibration-induced droplet ejection, with the aim of understanding the mechanism behind the ejection process. The evolution of the interface through droplet ejection will be simulated. The dependence of the ejection process on the driving parameters will be evaluated and the resonance characteristics of the drop will be determined. The results of the computations will be compared with experimental results.

  11. The E-wave deceleration rate E/DT outperforms the tissue Doppler-derived index E/e' in characterizing lung remodeling in heart failure with preserved ejection fraction.

    Directory of Open Access Journals (Sweden)

    T Dung Nguyen

    Full Text Available BACKGROUND: Diastolic dysfunction in heart failure with preserved ejection fraction (HFpEF may result in pulmonary congestion and lung remodeling. We evaluated the usefulness of major diastolic echocardiographic parameters and of the deceleration rate of early transmitral diastolic velocity (E/DT in predicting lung remodeling in a rat model of HFpEF. METHODS AND RESULTS: Rats underwent aortic banding (AoB to induce pressure overload (PO. Left ventricular hypertrophy fully developed 2 weeks after AoB. At 4 and 6 weeks, the lung weight-to-body weight ratio (LW/BW, a sensitive marker for pulmonary congestion and remodeling, dramatically increased despite preserved fractional shortening, indicating the presence of HFpEF. The time course of LW/BW was well reflected by E/DT, by the ratio of early to late transmitral diastolic velocity (E/A and the deceleration time of E (DT, but not by the ratio of transmitral to mitral annular early diastolic velocity (E/e'. In agreement, the best correlation with LW/BW was found for E/DT (r = 0.76; p<0.0001, followed by E/A (r = 0.69; p<0.0001, DT (r = -0.62; p<0.0001 and finally E/e' (r = 0.51; p<0.001. Furthermore, analysis of receiver-operating characteristic curves for the prediction of increased LW/BW revealed excellent area under the curve values for E/DT (AUC = 0.98 and DT (AUC = 0.95, which are significantly higher than that of E/e' (AUC = 0.82. In a second approach, we also found that the new parameter E/DT correlated well with right ventricular weight index and echocardiographic measures of right ventricular systolic function. CONCLUSIONS: The novel parameter E/DT outperforms the tissue Doppler index E/e' in detecting and monitoring lung remodeling induced by pressure overload. The results may provide a handy tool to point towards secondary lung disease in HFpEF and warrant further clinical investigations.

  12. Black Hole Induced Ejections

    OpenAIRE

    Pelletier, G.

    2004-01-01

    Black Holes generate a particular kind of environments dominated by an accretion flow which concentrates a magnetic field. The interplay of gravity and magnetism creates this paradoxical situation where relativistic ejection is allowed and consequently high energy phenomena take place. Therefore Black Holes, which are very likely at the origin of powerfull astrophysical phenomena such as AGNs, micro- quasars and GRBs where relativistic ejections are observed, are at the heart of high energy a...

  13. 预防应用主动脉内球囊反搏在低射血分数患者非体外循环冠状动脉旁路移植术的临床研究%Prophylactic application of intra-aortic balloon pump for low ejection fraction patients before off-pump coronary artery bypass grafting

    Institute of Scientific and Technical Information of China (English)

    屈云飞; 孙晓宁; 张红强; 赖登祥; 张俭荣; 周素明

    2015-01-01

    目的:分析预防应用主动脉内球囊反搏(intra-aortic balloon pump,IABP)对术前低射血分数(EF值0.05);住院期间病死率试验组明显低于对照组(P0.05)。结论:术前低EF值冠心病预防性应用IABP是安全有效的,能够改善心功能,减少术后心梗、低心排、肾功能不全等严重并发症的发生,从而降低围术期病死率,提高低术前EF值病人OPCAB的手术疗效。%Objective:To analyze clinical and prognosis effect of intra-aortic balloon pump (IABP) application for low ejection fraction (ejection fraction0.05). In-hospital mortality of the IABP group was significantly lower than that of the control group. hTe differences of survival rate were not statistically signiifcant for 1 and 5 years atfer surgery between two groups (P>0.05). Conclusion:Preoperative prophylactic IABP application can not only significantly ameliorate patient heart function and reduce perioperative morbidity and mortality, but also considerably reduce surgical risk and improve surgical effect of low ejection fraction patients undergoing OPCAB.

  14. Left atrial dysfunction in type 2 diabetes mellitus: insights from cardiac MRI

    Energy Technology Data Exchange (ETDEWEB)

    Graca, Bruno; Donato, Paulo; Caseiro-Alves, Filipe [University of Coimbra, Faculty of Medicine, Coimbra (Portugal); Coimbra' s Hospital Centre and University, Medical Imaging Department, Coimbra (Portugal); Joao Ferreira, Maria [University of Coimbra, Faculty of Medicine, Coimbra (Portugal); Coimbra' s Hospital Centre and University, Cardiology Department, Coimbra (Portugal); Gomes, Leonor [University of Coimbra, Faculty of Medicine, Coimbra (Portugal); Coimbra' s Hospital Centre and University, Endocrinology Department, Coimbra (Portugal); Castelo-Branco, Miguel [University of Coimbra, Faculty of Medicine, Coimbra (Portugal)

    2014-11-15

    The left atrium (LA) modulates left ventricular filling through reservoir, conduit and booster pump functions. Only limited data exist on LA involvement in type 2 diabetes mellitus (DM2). This study sought to assess LA function in asymptomatic DM2 with cardiac MRI. We hypothesized that cardiac MRI can detect LA dysfunction in asymptomatic DM2. Forty-five patients with asymptomatic DM2 and 24 normoglycaemic controls were studied. MRI cine imaging was performed to measure LA maximal and minimal volumes. A flow-sensitive phase-contrast gradient-echo sequence was used for flow measurements perpendicular to the orifice of the mitral valve, to quantify active LA stroke volume. LA total, passive and active emptying volumes and fractions were calculated. LA reservoir function, namely LA total ejection fraction, was significantly greater in controls compared to patients with DM2 (62.2 ± 5.2 vs 57.0 ± 7.6 %, P = 0.004). LA passive ejection fraction was also greater in the controls (26.2 ± 9.5 vs 16.1 ± 11.0 %, P < 0.001). Regarding parameters of LA booster pump function, LA active ejection fraction was not significantly different between groups. DM2 was demonstrated to be an independent determinant of LA function. Cardiac MRI enables the detection of LA dysfunction in asymptomatic DM2, characterized by a reduction in LA reservoir and conduit functions. (orig.)

  15. Determination of differences in the left ventricular ejection fraction (LVEF) by radionuclides and echocardiography pre and post treatment with anthracycline in pediatric patients with oncology diagnostic of the La Raza Medical Center; Determinacion de diferencias en la fraccion de eyeccion del ventriculo izquierdo (FEVI) por radionuclidos y ecocardiografia pre y post tratamiento con antraciclinas en pacientes pediatricos con diagnostico oncologico del Centro Medico La Raza

    Energy Technology Data Exchange (ETDEWEB)

    Veras R, H

    2003-07-01

    The objective of this work was to correlate the left ventricular ejection fraction determine by radionuclide angiocardiography and echocardiography in pediatric patients under anthracycline treatment. Material and methods: 41 patients were studied with range age from 3 to 14 years, with oncology diagnostic that were treated with anthracycline. Radionuclide angiocardiography and echocardiography were performed before an after anthracycline administration to determine the changes in the Ieft ventricular ejection fraction. Results: Anthracycline treatment caused no changes in the electrocardiography, echocardiogram and radionuclide angiocardiography. Conclusions: In our study anthracycline treatment caused no changes in the electrocardiography, echocardiography and both radionuclide angiocardiography techniques, first-pass and equilibrium. A high correlation was obtaining when left ventricular ejection fraction is compared between radionuclide angiocardiography and echocardiogram. (Author)

  16. Changes in ejection fraction and subtypes of neural peptide Y receptor in rats with myocardial hypertrophy induced by abdominal aortic constriction%腹主动脉狭窄致大鼠左室肥大后心脏射血功能及神经肽Y受体亚型变化

    Institute of Scientific and Technical Information of China (English)

    董颀; 戴文军; 赵路宁; 杨春涛; 陈爱兰; 陈敏生

    2012-01-01

    Objective; To assess the changes in left ventricular ejection fraction and neural peptide Y (NPY ) receptor subtypes ( Y1 , Y2, Y4 and Y5 ) in pressure-overload rats with myocardial hypertrophy. Methods: Pressure-overload cardiac hypertrophy model was established by abdominal aortic constriction (AAC) in rats for assessment of the weight of the heart and left ventricle. Left ventricular hemodynamics was measured by common carotid artery catheterization. IE33 echocardiography was employed to determine the thickness of vascular wall, inner caliber, volume and ejection functions of the left ventricle. The mRNA expression of NPY receptor subtypes in left ventricular tissue homogenates was detected by means of quantitative polymerase chain reaction. Results: Compare to sham group, the AAC rats yielded considerably increased ratio of heart weight to body weight and that of left ventricular weight to right ventricular weight ( both P < 0. 05). This was in line with the increased left ventricular systolic pressure (LVSP) , maximum rising rate of isovolumic systolic pressure ( + dsp / dtn]m ) and maximum reducing rate of diastolic pressure (-ddp/dtmas ) (all P < 0. 05). The M-mode echocardiography suggested that the interventricular septum diastole ( IVSD) , interventricular septum systole (IVSS) , left ventricular posterior wall diastole (LVPWD) and left ventricular posterior wall systole (LVPWS) were significantly increased in AAC rats compared with sham group (all P < 0. 05). The left ventricular mass calculated by ultrasonography was highly correlated with the measured values ( r = 0. 997 ). AAC rats were featured by reduced cardiac output by 55% compared with sham group (P < 0. 01 ). Additionally, the mRNA expression of Y1, Y2, Y4, and Y5 myocardial receptors in AAC rats was markedly attenuated compared with sham group (all P<0.05). Conclusion: Pressure overload results in significant cardiac hypertrophy, enhanced left ventricular systolic and diastolic capacity yet

  17. Age, estimated glomerular filtration rate and ejection fraction score predicts contrast-induced acute kidney injury in patients with diabetes and chronic kidney disease: insight from the TRACK-D study

    Institute of Scientific and Technical Information of China (English)

    Li Jing; Li Yi; Wang Xiaozeng; Yang Shuguang; Gao Chuanyu; Zhang Zheng; Yang Chengming

    2014-01-01

    Background The occurrence of contrast induced acute kidney injury (CIAKI) has a pronounced impact on morbidity and mortality.The aim of the present study was to appraise the diagnostic efficacy of age,estimated glomerular filtration rate (eGFR) and ejection fraction (AGEF) score (age/EF(%)+1 (if eGFR was <60 ml·min-1·1.73 m2)) as an predictor of CIAKI in patients with diabetes mellitus (DM) and concomitant chronic kidney disease (CKD).Methods The AGEF score was calculated for 2 998 patients with type 2 DM and concomitant CKD who had undergone coronary/peripheral arterial angiography.CIAKI was defined as an increase in sCr concentration of 0.5 mg/dl (44.2 mmol/L) or 25% above baseline at 72 hours after exposure to the contrast medium.Post hoc analysis was performed by stratifying the rate of CIAKI according to AGEF score tertiles.The diagnostic efficacy of the AGEF score for predicting CIAKI was evaluated with receiver operating characteristic (ROC) analysis.Results The AGEF score ranged from 0.49 to 3.09.The AGEF score tertiles were defined as follows:AGEFlow ≤0.92 (n=1 006); 0.92 <AGEFmid ≤1.16 (n=1 000),and ACEFhigh >1.16 (n=992).The incidence of CIAKI was significantly different in patients with low,middle and high AGEF scores (AGEFlow=1.1%,AGEFmid=2.3% and AGEFhigh=5.8%,P <0.001).By multivariate analysis,AGEF score was an independent predictor of CIAKI (odds ratio=4.96,95% CI:2.32-10.58,P <0.01).ROC analysis showed that the area under the curve was 0.70 (95% CI:0.648-0.753,P <0.001).Conclusion The AGEF score is effective for stratifying risk of CIAKI in patients with DM and CKD undergoing coronary/peripheral arterial angiography.

  18. 心房纤颤对左心室射血分数正常的心力衰竭患者的影响%The impact of atrial fibrillation in heart failure patients with preserved left lentricular ejection fraction

    Institute of Scientific and Technical Information of China (English)

    魏芳; 李晓艳

    2011-01-01

    目的 分析心房纤颤在左心室射血分数正常的心力衰竭(HFPEF)患者中的比例及其临床特征.方法 选取HFPEF患者86例.依照是否存在心房纤颤病史或入院时心电图检查是否存在心房纤颤分为房颤组、非房颤组,并比较两组的特征.结果 HFPEF患者心房纤颤的发生率为34.9%.房颤组平均年龄高于非房颤组[(71.6±8.97)岁与(62.71±17.79)岁].多元线性回归分析表明室间隔厚度、肾功能不全和感染性疾病依次与血浆氨基末端脑钠肽前体水平相关.心房纤颤与左房内径相关性较好.结论 心房纤颤是HFPEF患者常见的心律失常,左心房容积增大是房颤的主要临床特征.心房纤颤可能是HFPEF重要发病机制之一.%Objective Analyse the ratio and characteristics of atrial fibrillation in heart failure patients with preserved left ventricular ejection fraction (HFPEF).Methods 86 HFPEF patients were enrolled.Catalogue patients into two groups by atrial fibrillation history or admission electrocardiography results :with atrial fibrillation, without atrial fibrillation.Result The ratio of atrial fibrillation in HFPEF patients was 34.9%.The patients with atrial fibrillation were averagely older than the patients without atrial fibrillation(71.6 ± 8.97 vs 62.71 ± 17.79 ,P < 0.05 ).The multiple linear regression result indicated that interventricular septum(IVS) ,renal dysfunction and infection disease correlated with plasma NTproBNP level by turns.Atrial fibrillation correlated to left atrial dimension (LAD) ( P < 0.05 ).Conclusion Atrial fibrillation is a common arrythmia in HFPEF patients.The enlargement of left atrial dimension is the primary characteristic of the group with atrial fibrillation.Atrial fibrillation could be one of the pathogenesis to HFPEF.

  19. Mechanisms, diagnoses and therapies of heart failure with preserved ejection fraction%慢性射血分数保留心力衰竭的发病机制与诊治

    Institute of Scientific and Technical Information of China (English)

    赵鹏; 李玉明

    2015-01-01

    Heart failure with left ventricular ejection fraction is not common, which is named HF with preserved EF (HF-pEF), is increasingly predominant form of HF in the real world. Its morbidity and mortality are equal with HF with reduced EF (HF-rEF) and it remains the most challenging of clinical syndromes for the practicing clinician, with a multitude of proposed mechanisms involving the heart and other organs and complex interplay with common comorbidities. As the list of failed treatments continues to grow, HF-pEF clearly represents a major unmet medical need. In this article, we provide an overview of HF-pEF for both the clinical and basic research, which includes a brief examination of its evolving epidemiology, a summary of proposed mechanisms, the diagnostic criteria, a review of our valiant but unsuccessful prior efforts to develop an effective therapy and a discussion of newer potential approaches.%左心室射血分数保留的心力衰竭(HF-pEF)在临床中较常见,处理此类心力衰竭对临床医生是一个挑战。HF-pEF的发病率和死亡率与左心室射血分数降低的心力衰竭(HF-rEF)相同,且发病机制更加复杂,既有心脏本身也有其他脏器的异常,同时还存在多种并发症间的相互作用影响。现有治疗心力衰竭的多数药物对于HFpEF无效,因此这类患者应该受到更多的关注。本文基于临床实践和基础研究,总结了HFpEF的流行病学特点、发病机制、诊断标准、医学上曾经尝试过的治疗方法,并对未来治疗本病的新手段进行讨论。

  20. [Effects of temporary dual-chamber cardiac pacing in refractory cardiac failure].

    Science.gov (United States)

    Scanu, P; Lecluse, E; Michel, L; Bureau, G; Saloux, E; Cleron, S; Valette, B; Grollier, G; Potier, J C; Foucault, J P

    1996-12-01

    The authors studied 18 patients (15 men, 3 women) with an average age of 67 +/- 8 years with refractory cardiac failure. In order to determine the potential of pacing to raise cardiac output in severe cardiac failure. The average ejection fraction was 26 +/- 6.5%. All patients were in sinus rhythm:resting cardiac output was 3.35 l/min. Two temporary pacing catheters were positioned in the right atrium and at the apex of the right ventricle for dual-chamber mode pacing triggered by the spontaneous P waves. Changes in cardiac output were measured by Doppler echocardiography at different values of atrioventricular delay. Patients were considered to be responders if their cardiac outputs rose by 15%. In 7 patients meeting this criterion, the average increase in cardiac output was 27% (2.99 +/- 0.7 to 3.81 +/- 0.86 l/mn; p < 0.01); all had dilated cardiomyopathies with left bundle branch block and the optimal AV delay was 103 +/- 21 ms (80-140 ms); the duration of diastolic filling increased from 212 +/- 98 to 292 +/- 116 ms (p = 0.02). In the non-responding group (11 patients with an increase of cardiac output of only 3.6 +/- 0.09 to 3.9 +/- 0.92 l/mn; p < 0.01), the underlying disease process was mainly ischaemic. Two predictive factors of efficacy of dual-chamber pacing were identified: a short ventricular filling period (29 +/- 8% of the RR interval in the responders vs 44 +/- 9% in the non-responders; p < 0.01) and the presence of 1st degree atrioventricular block. Dual-chamber pacing could be a valuable method of increasing resting cardiac outputs in a selected group of patients with severe, refractory, cardiac failure.

  1. Pectoral nerves (PECS) and intercostal nerve block for cardiac resynchronization therapy device implantation

    OpenAIRE

    Fujiwara, Atsushi; Komasawa, Nobuyasu; Minami, Toshiaki

    2014-01-01

    A 71-year-old man was scheduled to undergo cardiac resynchronization therapy device (CRTD) implantation. He was combined with severe chronic heart failure due to ischemic heart disease. NYHA class was 3 to 4 and electrocardiogram showed non-sustained ventricular. Ejection fraction was about 20% revealed by transthoracic echocardiogram. He was also on several anticoagulation medications. We planned to implant the device under the greater pectoral muscle. As general anesthesia was considered ri...

  2. 不同心功能状态对接受血运重建治疗冠心病患者预后的影响%Comparison of outcome in patients with impaired left ventricular ejection fractions having revascularization

    Institute of Scientific and Technical Information of China (English)

    金彦彦; 马长生; 康俊萍; 聂绍平; 张崟; 吕强; 刘晓惠; 吴学思; 胡荣

    2011-01-01

    目的 探究LVEF >40%伴心衰的冠心病患者接受血运重建治疗的近期及远期预后.方法 连续入选2003年7月1日至2005年9月30日在北京安贞医院接受经皮冠脉介入治疗(PCI)或冠脉旁路移植术(CABG)的3286例患者.至少随访1年,平均随访时间18个月.按照左室射血分数(LVEF)和有无充血性心力衰竭分为:A组LVEF> 40%并无心衰者(2022例)、B组LVEF> 40%伴心力衰竭者(1070例)、C组LVEF≤40%(194例).比较各组患者间的临床特征、院内、长期死亡及主要不良心脑血管事件(MACCE)的发生率.结果 67.1%患者接受PCI治疗,32.9%患者接受CABG治疗,A组患者接受PCI治疗的比例最高.LVEF> 40%的冠心病患者中伴有心衰的患者并不少见,占34.6%.LVEF≤40%组患者院内死亡率、长期死亡率明显高于其他两组患者.LVEF> 40%伴心衰者组患者院内死亡率、长期死亡率明显高于LVEF> 40%并无心衰者组患者.COX多因素回归分析结果显示,除LVEF≤40%组患者死亡风险是LVEF> 40%并无心衰组患者的2.3倍(HR2.324,95%CI0.982 ~5.728),LVEF> 40%伴心衰组患者死亡率是LVEF> 40%无心衰组患者的1.3倍(HR.275,95%CI0.792 ~2.053).结论 LVEF>40%的冠心病患者中伴有心衰的患者并不少见死亡率高,是LVEF> 40%无心衰组患者的1.3倍.%Objective To investigate short-term and long-term effect of revascularization on the patients with impaired left ventricular ejection fraction and congestive heart failure. Methods The study is a retrospective study in a single center including 3286 patiens with CAD receiving PCI or CABG from July 2003 to September 2005 at Beijing Anzhen Hospital. The patients were divided into 3 groups by left ventricular ejection fraction (LVEF) and congestive heart failure (CHF) including: patients with LVEF > 40% without CHF symptans (Group A, n=2022) , patients with LVEF >40% and CHF (Group B, n = 1070), patients with

  3. Comparison of echocardiographic (US volumetry with cardiac magnetic resonance (CMR imaging in transfusion dependent thalassemia major (TM

    Directory of Open Access Journals (Sweden)

    Gotsis Efstathios

    2007-07-01

    Full Text Available Abstract Background Despite advances in survival in patients with thalassemia major (TM the most common cause of death is cardiac disease. Regular cardiac follow-up is imperative in order to identify and reverse pathology. Cardiac Magnetic Resonance (CMR and Echocardiography (US are applied in parallel to TM patients for cardiac evaluation and ongoing monitoring. A comparison between mutual features would be useful in order to assess the accuracy and reliability of the two methods, with a particular focus on routine US application. TM's special attributes offer an excellent opportunity for cardiac imaging research that has universal general purpose applications. Methods 135 TM patients underwent US (Teichholz's M-mode formula – rapidly accessible means of measuring volumes and ejection fraction and CMR volumetry. Paired-samples t-test, Passing & Badlock regression and Bland & Altman plot were used while comparing the common parameters between the CMR and the US. Results We found that the US volumes were underestimated, especially the end-diastolic volume (p Conclusion In cases where cardiac wall movement abnormalities are absent, the US Teichholz's M-mode formula for volume measurements, though less sophisticated in comparison to the high resolution CMR technique, offers an adequate ejection fraction estimation for routine use, especially when monitoring gross alterations in cardiac function over time, and is easy to perform.

  4. Pre-ejection period by radial artery tonometry supplements echo doppler findings during biventricular pacemaker optimization

    Directory of Open Access Journals (Sweden)

    Qamruddin Salima

    2011-07-01

    Full Text Available Abstract Background Biventricular (Biv pacemaker echo optimization has been shown to improve cardiac output however is not routinely used due to its complexity. We investigated the role of a simple method involving computerized pre-ejection time (PEP assessment by radial artery tonometry in guiding Biv pacemaker optimization. Methods Blinded echo and radial artery tonometry were performed simultaneously in 37 patients, age 69.1 ± 12.8 years, left ventricular (LV ejection fraction (EF 33 ± 10%, during Biv pacemaker optimization. Effect of optimization on echo derived velocity time integral (VTI, ejection time (ET, myocardial performance index (MPI, radial artery tonometry derived PEP and echo-radial artery tonometry derived PEP/VTI and PEP/ET indices was evaluated. Results Significant improvement post optimization was achieved in LV ET (286.9 ± 37.3 to 299 ± 34.6 ms, p Conclusion An acute shortening of PEP by radial artery tonometry occurs post Biv pacemaker optimization and correlates with improvement in hemodynamics by echo Doppler and may provide a cost-efficient approach to assist with Biv pacemaker echo optimization.

  5. ACUTE RENAL FAILURE AFTER CARDIAC SURGERY

    Directory of Open Access Journals (Sweden)

    N Safai

    2008-08-01

    Full Text Available "nAcute renal failure (ARF following cardiac surgery occurs in 1 to 10% of patients. Patients who develop ARF have higher rates of mortality. This study was undertaken to estimate the role of perioperative variables in predicting of post cardiac surgery ARF. We studied a cohort of 398 adult patients who underwent cardiac surgery at our institution from February 2004 to February 2006. Adult patients who were scheduled for cardiac valvular surgery, coronary artery bypass grafting (CABG or both, with or without cardiopulmonary bypass (CPB were included. Exclusion criteria were death within two days of operation (n= 8, incomplete patient data, and preexisting renal dysfunction and dialysis requirement or a baseline serum creatinine > 4 mg/dl. Age, sex, left ventricular ejection fraction, diabetes, preoperative, presence of proteinuria (on dipstick, type of surgery, use of CPB and duration of surgery were recorded. A logistic regression analysis was performed to assess independent contribution of variables in the risk of ARF. A binary logistic regression revealed age was an independent predictor of ARF (P < 0.05. When both all variables were included in a multinominal logistic regression model, preoperative proteinuria independently predicted ARF (Odds ratio= 3.91, 95% CI: 1.55-9.91, P = 0.004. Our results revealed that special considerations should be given to elderly and patients with proteinuria when managing post cardiac surgery ARF.

  6. Endothelial Function as a Possible Significant Determinant of Cardiac Function during Exercise in Patients with Structural Heart Disease

    Directory of Open Access Journals (Sweden)

    Bonpei Takase

    2009-01-01

    Full Text Available This study was investigated the role that endothelial function and systemic vascular resistance (SVR play in determining cardiac function reserve during exercise by a new ambulatory radionuclide monitoring system (VEST in patients with heart disease. The study population consisted of 32 patients. The patients had cardiopulmonary stress testing using the treadmill Ramp protocol and the VEST. The anaerobic threshold (AT was autodetermined using the V-slope method. The SVR was calculated by determining the mean blood pressure/cardiac output. Flow-mediated vasodilation (FMD was measured in the brachial artery to evaluate endotheilial function. FMD and the percent change f'rom rest to AT in SVR correlated with those from rest to AT in ejection fraction and peak ejection ratio by VEST, respectively. Our findings suggest that FMD in the brachial artery and the SVR determined by VEST in patients with heart disease can possibly reflect cardiac function reserve during aerobic exercise.

  7. 阿托伐他汀对射血分数保留的心衰临床治疗研究%Effects of atorvastatin on heart failure with preserved ejection fraction

    Institute of Scientific and Technical Information of China (English)

    郭文玉; 徐验; 杨碧芳

    2012-01-01

    ObjeCtive To explore the effects of statins on heart failure with preserved ejection fraction. Methods 70 patients were randomly divided into 2 groups: atorvastatin group (35 caes and given atorvastatin 20mg/d + conventional treatment), and control group (35 cases only given conventional treatment) . E/E 'ratio, E/A ratio ,E peak deceleration time (DT), left ventricular mass index (LVMI), left atrioventricular volume index (LAVI) , and check NT-proBNP,hs-CRP were measured before treatment, a month , three months and 12 months after treatment Results Significantl improvement in echocardiography index was noticed (P 0.05). Treated after 12months 6 MWT of atorvastatin group is significantly higher than control group (463 ± 57 vs 411 ± 59 P < 0 05), E/E ' ratio also showed a significantly improvement than control group (8.0 ±2.8 vs 10.8 ±3.0 P < 0 05), hs-CRP of atorvastatin group improved 3 months after treatment.and it improved much significantly 12 months after treatment compared with control group (3.02 ± 0.43 vs 4.73 ± 0.68 P < 0 05),.ConclUSion Atorvastatin can improves left ventricular diastolic function in patients with HFPEF, relieve their clinical symptoms, maybe can improve prognosis.%目的 探讨阿托伐他汀治疗射血分数保留的心衰(HFPEF)患者的有效性及安全性.方法 将70例HFPEF患者,随机分为阿托伐他汀组35例(阿托伐他汀20mg/d+基础治疗)、对照组35例(仅予基础治疗),分别于治疗前、治疗后1个月、3个月及12个月时测量E/E’比值、E/A比值、E峰减速时间(DT)、左室质量指数(LVMI)、左房容积指数(LAVI),同时检测血浆N末端脑利纳肽前体(NT-proBNP)、高敏C反应蛋白(hs-CRP)、测定6min步行距离(6MWT).结果 治疗3月时,2组超声指标较治疗前有明显改善(P<0 05),但此时2组间比较差异无统计学意义(P>0.05).治疗12月时,阿托伐他汀组与对照组比较6MWT有显著提高(463±57vs411±59,P<0.05),体现左室舒张功能的超

  8. Risk factors for heart failure with preserved ejection fraction in the elderly%老年射血分数保留心力衰竭患者危险因素分析

    Institute of Scientific and Technical Information of China (English)

    黄樱硕; 张健; 王丹; 白丽; 杨旭; 黄蔚; 李敏; 孙颖

    2014-01-01

    Objective To determine the risk factors for heart failure with preserved ejection fraction (HFpEF) in the elderly by retrospectively analyzing their clinical features and echocardiographic parameters of HFpEF patients and comparing with those of non-heart failure patients with asymptomatic diastolic dysfunction. Methods A total of 234 consecutive patients (≥60 years old) admitted in our department from December 2011 to December 2012 were enrolled in this study. They were divided into asymptomatic left ventricular diastolic dysfunction group (ADD group, n=104) and HFpEF group (n=130). Risk factors of HFpEF were analyzed by logistic regression. Results Compared with ADD group, the patients in HFpEF group were older and had a lower estimated glomerular filtration rate (eGFR) (P<0.05). Logistic regression analysis indicated that coronary artery disease(CAD), hypertension, and chronic obstructive pulmonary disease (COPD) were independent risk factors of HFpEF (P=0.001, 0.031, 0.003, respectively). Conclusion CAD, hypertension and COPD are associated with HFpEF in this cohort.%目的:回顾性分析老年射血分数保留心力衰竭(HFpEF)患者的临床及超声心动图参数,与无症状舒张功能不全的非心衰患者比较,明确HFpEF的危险因素。方法入选2011年12月至2012年12月在首都医科大学附属北京友谊医院医疗保健中心心血管内科就诊的234例患者(年龄≥60岁),分为无症状舒张功能不全组(ADD组)104例和射血分数保留心力衰竭组(HFpEF组)130例。通过回归分析明确HFpEF的独立危险因素。结果与ADD组相比,HFpEF患者的平均年龄较大,估测的肾小球滤过率较低。logistic回归分析表明冠心病、高血压和慢性阻塞性肺疾病(COPD)是HFpEF的独立危险因素(P=0.001,0.031,0.003)。结论老年患者中,冠心病、高血压和COPD与HFpEF相关。

  9. 中西医对射血分数保留心力衰竭(HFpEF)研究简况%Overview of Chinese Medicine and Western Medicine on Heart Dailure with Preserved Ejection Fraction(HFpEF)

    Institute of Scientific and Technical Information of China (English)

    涂明玉; 郑峰

    2014-01-01

    左心室射血分数保留的心力衰竭(Heart failure with preserved ejection fraction,HFpEF)是指临床具有心力衰竭(Heart Failure,HF)症状或体征,且左心室射血分数(LVEF) ≥50%的一种综合征,是射血分数保留的心血管疾病患者的共同终末归路,西医诊断标准可简单归纳为“1+1+1”诊断模式,常见于老年患者,女性多见,且大多有高血压病、糖尿病、冠心痛、房颤等基础病,因此这类疾患常成为搭往HFpEF的桥梁.根据HFpEF临床表现,可将其归属于“心悸”、“怔忡”、“水肿”、“胸痹”等范畴,任继学最早用“心衰”来命名,张伯礼、薛博瑜首次将“心衰病”作为一种独立的病证加入心系疾病中;以心气虚为始动因素,多见于气阴两虚,并常兼见瘀血、水饮和痰浊等,心功能多处于Ⅰ~Ⅲ级,多见于潜证、轻度和中度心衰病.西医无特异性手段,对症治疗为主;中医按心气虚、气阴两虚等治疗,生脉散、炙甘草汤等.中西医的治疗目标已不仅仅满足于改善症状,提高生活质量,而是从心脏的结构、功能、细胞生物学等更深层次进行治疗.心室重构是潜证心衰病的内在因素,与瘀血密切相关,且阴虚灼伤阴液可致瘀、阴虚无气而无力推动血液在脉管中正常运行,治疗要以益气养阴为主,佐以活血化瘀、化痰祛湿,从改善衰竭心脏病理变化的角度来寻求一个更具有修复性的长远策略.

  10. Sudden cardiac death and mitral and aortic valve disease

    Directory of Open Access Journals (Sweden)

    Bockeria O.L.

    2013-09-01

    Independent determinants of sudden death were left ventricular ejection fraction and atrial fibrillation. The main cause of death in patients with mitral valve stenosis is a thromboembolism from the left heart chambers to systemic circulation, and the risk of the latter increases with atrial fibrillation. There is no sudden cardiac death in mitral valve stenosis. The absence of left ventricular remodeling in mitral valve stenosis probably explains this finding. Onset of symptoms and signs of left ventricular dysfunction are the main predictors of sudden death and are indications for surgery. It should be emphasized that the database of sudden cardiac death in patients with valvular heart disease is very limited compared to patients with coronary heart disease and cardiomyopathies. Some issues related to predictors and mechanisms of SCD are currently poorly understood, therefore prevention of sudden cardiac death is difficult, especially in asymptomatic patients.

  11. Use of nitric oxide in thoracic surgery for a high risk cardiac patient

    Directory of Open Access Journals (Sweden)

    Vishal Garg

    2014-01-01

    Full Text Available Nitric oxide (NO is a selective pulmonary vasodilator especially in the presence of pulmonary artery hypertension. With right ventricle (RV dysfunction, inhaled NO may increase RV ejection fraction and cardiac output. The main advantage of NO over intravenous therapy is its inability to decrease systemic pressure thereby maintaining the coronary perfusion pressure and the myocardial perfusion. In this case report, we discuss the use of NO in a routine thoracic surgery patient suffering with severe left ventricular dysfunction and a potential candidate for a very high cardiac risk.

  12. Peripartum cardiomyopathy: postpartum decompensation and use of non-invasive cardiac output monitoring.

    Science.gov (United States)

    Lorello, G; Cubillos, J; McDonald, M; Balki, M

    2014-02-01

    The utility of a non-invasive cardiac output monitor (NICOM™) in guiding the peripartum management and identification of postpartum complications in a patient with severe peripartum cardiomyopathy is reported. A 31-year-old nulliparous woman at 35 weeks of gestation presented with a three-week history of worsening dyspnea and progressive functional deterioration. A transthoracic echocardiogram showed severe left ventricular systolic dysfunction with an ejection fraction peripartum cardiomyopathy. We suggest that use of NICOM™ be extended into the postpartum period to detect signs of cardiac decompensation in such patients.

  13. Black Hole Induced Ejections

    CERN Document Server

    Pelletier, G

    2004-01-01

    Black Holes generate a particular kind of environments dominated by an accretion flow which concentrates a magnetic field. The interplay of gravity and magnetism creates this paradoxical situation where relativistic ejection is allowed and consequently high energy phenomena take place. Therefore Black Holes, which are very likely at the origin of powerfull astrophysical phenomena such as AGNs, micro- quasars and GRBs where relativistic ejections are observed, are at the heart of high energy astrophysics. The combination of General Relativity and Magneto-HydroDynamics (MHD) makes theory difficult; however great pionneers opened beautiful tracks in the seventies and left important problems to be solved for the next decades. These lectures will present the status of these issues. They have a tutorial aspect together with critical review aspect and contain also some new issues. Most of these lectures has been presented at the "School on Black Hole in the Universe" at Cargese, in May 2003.

  14. Coronal Mass Ejections

    CERN Document Server

    Kunow, H; Linker, J. A; Schwenn, R; Steiger, R

    2006-01-01

    It is well known that the Sun gravitationally controls the orbits of planets and minor bodies. Much less known, however, is the domain of plasma fields and charged particles in which the Sun governs a heliosphere out to a distance of about 15 billion kilometers. What forces activates the Sun to maintain this power? Coronal Mass Ejections (CMEs) and their descendants are the troops serving the Sun during high solar activity periods. This volume offers a comprehensive and integrated overview of our present knowledge and understanding of Coronal Mass Ejections (CMEs) and their descendants, Interplanetary CMEs (ICMEs). It results from a series of workshops held between 2000 and 2004. An international team of about sixty experimenters involved e.g. in the SOHO, ULYSSES, VOYAGER, PIONEER, HELIOS, WIND, IMP, and ACE missions, ground observers, and theoreticians worked jointly on interpreting the observations and developing new models for CME initiations, development, and interplanetary propagation. The book provides...

  15. Coronal Mass Ejections

    Science.gov (United States)

    Crooker, Nancy; Joselyn, Jo Ann; Feynman, Joan

    The early 1970's can be said to mark the beginning of The Enlightenment in the history of the Space Age, literally as well as by analogy to European history. Instruments blinded by Earth's atmosphere were lifted above and, for the first time, saw clearly and continuously the ethereal white light and sparkling x-rays from the solar corona. From these two bands of the light spectrum came images of coronal mass ejections and coronal holes, respectively. But whereas coronal holes were immediately identified as the source of high-speed solar wind streams, at first coronal mass ejections were greeted only by a sense of wonder. It took years of research to identify their signatures in the solar wind before the fastest ones could be identified with the well-known shock disturbances that cause the most violent space storms.

  16. Diagnostic performance of cardiac imaging methods to diagnose ischaemia-causing coronary artery disease when directly compared with fractional flow reserve as a reference standard

    DEFF Research Database (Denmark)

    Danad, Ibrahim; Szymonifka, Jackie; Twisk, Jos W R

    2016-01-01

    ), and cardiac magnetic resonance (MRI) imaging when directly compared with an FFR reference standard. METHOD AND RESULTS: PubMed and Web of Knowledge were searched for investigations published between 1 January 2002 and 28 February 2015. Studies performing FFR in at least 75% of coronary vessels......AIMS: The aim of this study was to determine the diagnostic performance of single-photon emission computed tomography (SPECT), stress echocardiography (SE), invasive coronary angiography (ICA), coronary computed tomography angiography (CCTA), fractional flow reserve (FFR) derived from CCTA (FFRCT...... for the diagnosis of ischaemic coronary artery disease (CAD) were included. Twenty-three articles reporting on 3788 patients and 5323 vessels were identified. Meta-analysis was performed for pooled sensitivity, specificity, likelihood ratios (LR), diagnostic odds ratio, and summary receiver operating characteristic...

  17. Butanolic fraction of Moringa oleifera Lam. (Moringaceae) attenuates isoprotrenol-induced cardiac necrosis and oxidative stress in rats: an EPR study.

    Science.gov (United States)

    Panda, Sunanda

    2015-01-01

    The preventive effect of Moringa oleifera polyphenolic fraction (MOPF) on cardiac damage was evaluated in isoproterenol (ISO) induced cardiotoxicity model of Wistar rats. Male rats in different groups were treated with MOPF orally at the dose of 50, 100 and 150 mg/kg/day for 28 days and were subsequently administered (s.c.) with ISO (85 mg/kg body weight) for the last two days. At the end of the experiment levels of serum troponin-T, creatine kinase-MB, lactate dehydrogenase, content of malondialdehyde (MDA), activities/levels of different cellular antioxidants were estimated in control and experimental groups. Additionally, scavenging potential to the hydroxyl radical of the fraction was measured by electron paramagnetic resonance (EPR). ISO administered rats showed significant increase in the levels of serum troponin-I, creatine kinase, lactate dehydrogenase, and heart tissue MDA content. Furthermore, marked reduction in the activities of antioxidants such as superoxide dismutase, catalase, glutathione peroxidase and reduced glutathione levels were observed. EPR study showed an increase in signal intensity in ISO-induced rats. Triphenyl tetrazolium chloride (TTC) staining of heart section revealed a marked increase in infarcted area in ISO-induced rats. Histological features of the heart also indicated a disruption in the structure of cardiac myofibrils in these animals. MOPF (100 mg/kg body weight) pretreatment prevented all these adverse effects of ISO. Present results show that the rich polyphenolic content of Moringa oleifera significantly reduced the myocardial damage and decreased the oxidative stress, possibly through hydroxyl radical scavenging activity as evidenced from the EPR spectra.

  18. Level of complement activity predicts cardiac dysfunction after acute myocardial infarction treated with primary percutaneous coronary intervention

    DEFF Research Database (Denmark)

    2009-01-01

    BACKGROUND: The positive effect of reperfusion after ST-elevation myocardial infarction (STEMI) can be reduced by ischemic/reperfusion (I/R) injury.Mannose-binding-lectin (MBL) and soluble C5b-9 (membrane-attack-complex) are involved in complement-driven cell lysis and may play a role in human...... descending coronary artery who were successfully treated with pPCI. Cardiac dysfunction was defined as left ventricular ejection fraction LVEF or = 35%. After adjustment...

  19. Echocardiographic evaluation of cardiac dyssynchrony in patients with congestive heart failure.

    Science.gov (United States)

    Qin, Chuan; Zhang, Li; Zhang, Zi-Ming; Wang, Bin; Ye, Zhou; Wang, Yong; Nanda, Navin C; Xie, Ming-Xing

    2016-06-01

    The present study investigated the application of echocardiography to evaluation of cardiac dyssynchrony in patients with congestive heart failure (CHF). A total of 348 consecutive CHF patients who were admitted for cardiac resynchronization (CRT) and presented with low ejection fraction (EF) and wide QRS duration were enrolled in this study, along with 388 healthy individuals. Dyssynchrony was assessed based on filling time ratio (FT/RR), left ventricular pre-ejection delay (PED), interventricular mechanical delay (IVMD), longitudinal opposing wall delay (LOWD) and radial septal to posterior wall delay (RSPWD). Response to CRT was defined as a ≥15% increase in EF. The results showed that FT/RR was decreased while PED, IVMD, LOWD and RSPWD were increased in the CHF group compared with the control group (Pcardiac dyssynchrony in patients with CHF.

  20. Changes of Renal Function in Elderly Patients with Heart Failure but Normal Ejection Fraction and Its Clinical Significance%射血分数正常的心力衰竭老年患者的肾功能改变及其临床意义

    Institute of Scientific and Technical Information of China (English)

    问文敏; 孙光; 张潇怡; 林杰

    2015-01-01

    Objective To observe the changes of renal function in elderly patients with heart failure but normal ejection fraction,and explore its clinical significance. Methods A total of 145 cases diagnosed as coronary artery disease from Department of Geriatric Cardiology in The First Affili⁃ated Hospital of China Medical University were enrolled in the study. All of the cases were divided into HFPEF group(65 cases)and non HFPEF group(80 cases). All patients underwent cardiac ultrasound,BNP and renal function examination,and the glomerular filtration rate(GFR)was cal⁃culated. Results The average age of patients in HFPEF group was significantly higher than non HFPEF group(P<0.001),and the incidence of hypertension,diabetes,coronary heart disease,atrial fibrillation,or concomitant incidence of two or more kinds of these disease in HFPEF group was significantly higher than non HFPEF group(P1=0.046,P2<0.001,P3=0.002,P4=0.021,P5<0.001);the GFR of two groups of patients were lower than normal level,but the GFR of HFPEF group was significantly lower than non HFPEF group(P=0.046);E/Em was significantly higher (P<0.001),Em was significantly lower(P=0.002),left atrial diameter was significantly higher(P<0.001),LVEF was significantly lower(P=0.012),BNP values were significantly higher(P=0.001)in HFPEF group than in the non⁃HFPEF group;There were significant linear correlation between GFR and E/Em(r=-0.428,P=0.001),GFR and the BNP(r=-0.435,P=0.001),E/Em and BNP(r=0.392,P=0.002)in HFPEF group. Conclusion Elderly patients with heart failure but normal ejection fraction were older,and more of them were complicated with hyperten⁃sion,diabetes,coronary heart disease,atrial fibrillation,or concurrency of these diseases. Glomerular filtration rate was significantly decreased in el⁃derly patients with HFPEF,which has a significant correlation with diastolic function parameters.%目的:观察射血分数正常的心力衰竭(HFPEF)老年患者的肾功能指标及

  1. [Biventricular resynchronization in the management of severe cardiac insufficiency].

    Science.gov (United States)

    Chine, Samira; Kammoun, Ikram; Ben Halima, Afef; Lefi, Abdelatif; Chaabène, Olfa; Zouaoui, Walid; Essmatt, Wajih; Marrakchi, Sonia; Gargouri, Sami; Keskes, Hend; Kachboura, Salem

    2004-01-01

    Heart failure is a major problem of public health, it represents a frequent status among patients with heart disease, and its implications in term of mortality and cost are high. Non Pharmacological treatment of heart failure most commonly designed as cardiac resynchronization therapy (CRT) has demonstrate efficacy to improve functional class, exertion capacity, left ventricular ejection fraction, reduction of mitral regurgitation, and probably mortality at midterm. The most recent studies emphasize on the role of implantable cardioverter defibrillate or (ICD) combined with CRT to reduce mortality. More trials are needed to valid this concept.

  2. Traditional Chinese Medicine in the Treatment of Heart Failure with Normal Ejection Fraction:A Systematic Review%加载中药干预射血分数正常心力衰竭的系统评价

    Institute of Scientific and Technical Information of China (English)

    平伟; 赵志强; 侯欣颖; 王贤良; 侯雅竹; 毛静远

    2016-01-01

    Objective To evaluate the efficacy and safety of traditional Chinese medicine(TCM)for heart failure with normal ejection fraction(HFNEF).Methods Electronic literature of CNKI,VIP,WanFang,China biological medical (CBM)literature,Pubmed,EM-Base,Cochrane Library were searched until October,2015.Randomized control ed trails (RCTs)compared combined TCM with west-ern medicine in patients with HFPEF or DHF were eligible for inclusion.The analysis was performed with the software of Rev Man 5.3. Quality was assessed by using the Cochrane risk of bias tool .Results Nine RCTs,total y 636 patients with HFNEF were identified.Com-pared with the control group,the distances of the 6 minute walk test (6MWT)were increased [MD=1.24,95% CI (0.98,1.51),P<0.001],the values of N terminal pro B type natriuretic peptide (NT proBNP)reduced [MD=-135.97,95% CI (-164.60,-107.33),P<0.001],the E value reduced [MD=10.36,95% CI (6.81,13.92),P<0.001),the A value improved [MD=-6.28, 95% CI (-10.82,-1.75),P=0.007],the E/A value reduced [MD=0.30,95% CI (0.23,0.38),P<0.001]in the combination group.The efficiency was improved [RR= 1.29,95% CI (1.15,1.44),P<0.001].The clinical y significant efficiency was improved [RR=1.61,95% CI (1.19,2.19),P=0.002].No obvious adverse reactions and hepatic and renal impairment was reported during these trails.Conclusion Compared with the western medicine treatment,additional TCM for HFNEF was safe and effective.It could increase the distance of the 6MWT,reduce the values of NT pro BNP,the value of E ,the value E/A and the A value,improve the clinical efficacy.%目的:系统评价在西药常规治疗基础上加载中药治疗射血分数正常心力衰竭的有效性和安全性。方法从建库起至2015年10月,检索中国期刊全文数据库(CNKI)、中国科技期刊全文数据库(VIP)、万方期刊数据库(WANFANG)、中国生物医学文献数据库(CBM)、PubMed、EMBase、Cochrane Library,纳入以射血分数正常/保留的心力衰竭或舒张性心

  3. Acetaminophen protects against iron-induced cardiac damage in gerbils.

    Science.gov (United States)

    Walker, Ernest M; Epling, Christopher P; Parris, Cordel; Cansino, Silvestre; Ghosh, Protip; Desai, Devashish H; Morrison, Ryan G; Wright, Gary L; Wehner, Paulette; Mangiarua, Elsa I; Walker, Sandra M; Blough, Eric R

    2007-01-01

    There are few effective agents that safely remove excess iron from iron-overloaded individuals. Our goal was to evaluate the iron-removing effectiveness of acetaminophen given ip or orally in the gerbil iron-overload model. Male gerbils were divided into 5 groups: saline controls, iron-overloaded controls, iron-overloaded treated with ip acetaminophen, iron-overloaded treated with oral acetaminophen, and iron-overloaded treated with ipdeferoxamine. Iron dextran was injected iptwice/wk for 8 wk. Acetaminophen and deferoxamine treatments were given on Mondays, Wednesdays, and Fridays during the same 8 wk and continued for 4 wk after completion of iron-overloading. Echocardiograms were performed after completion of the iron-overloading and drug treatments. Liver and cardiac iron contents were determined by inductively coupled plasma atomic emission spectrometry (ICP-AES). Iron-overloaded controls had 232-fold and 16-fold increases in liver and cardiac iron content, respectively, compared to saline controls. In iron-overloaded controls, echocardiography showed cardiac hypertrophy, right and left ventricular distension, significant reduction in left ventricular ejection fraction (-22%), and fractional shortening (-31%) during systole. Treatments with acetaminophen (ip or oral) or deferoxamine (ip) were equally effective in reducing cardiac iron content and in preventing cardiac structural and functional changes. Both agents also significantly reduced excess hepatic iron content, although acetaminophen was less effective than deferoxamine. The results suggest that acetaminophen may be useful for treatment of iron-induced pathology.

  4. Distinct Endothelial Cell Responses in the Heart and Kidney Microvasculature Characterize the Progression of Heart Failure With Preserved Ejection Fraction in the Obese ZSF1 Rat With Cardiorenal Metabolic Syndrome

    NARCIS (Netherlands)

    Van Dijk, Christian G M; Oosterhuis, Nynke R.; Xu, Yan Juan; Brandt, Maarten; Paulus, Walter J.; Van Heerebeek, Loek; Duncker, Dirk J.; Verhaar, Marianne C.; Fontoura, Dulce; Lourenço, André P.; Leite-Moreira, Adelino F.; Falcão-Pires, Inês; Joles, Jaap A.; Cheng, Caroline

    2016-01-01

    BACKGROUND: The combination of cardiac and renal disease driven by metabolic risk factors, referred to as cardiorenal metabolic syndrome (CRMS), is increasingly recognized as a critical pathological entity. The contribution of (micro)vascular injury to CRMS is considered to be substantial. However,

  5. Comparison of outcome in patients with percutaneous coronary intervention in different left ventricular ejection fractions%不同左室射血分数等级冠心病患者接受冠状动脉介入治疗的预后分析

    Institute of Scientific and Technical Information of China (English)

    金彦彦; 马长生; 康俊萍; 聂绍平; 张崟; 吕强; 刘晓惠; 胡荣

    2012-01-01

    目的:探讨不同心功能状态的冠心病患者接受冠状动脉介入(PCI)治疗的预后情况.方法:连续入选接受PCI治疗的2 234例患者,至少随访1年以上.按照LVEF分为:A组,LVEF≤40%(106例);B组,LVEF 41%~49% (205例);C组,LVEF≥50%(1 923例).比较各组院内、长期死亡及主要不良心脑血管事件(MACCE)的发生率.结果:A、B、C组院内死亡率分别为2.8%、0.5%、0.2%,P<0.01;长期死亡率分别为5.7%、4.4%、1.6%,P<0.01.A、B、C组院内MACCE率为5.7%、2.0%、1.0%,P<0.01;长期MACCE率为18.8%、11.6%、11.7%,P<0.05.COX多因素回归示:A组患者长期死亡风险是C组患者的3.646倍(RR 3.646,95%CI 1.517~8.762);B组患者长期死亡风险是C组患者的2.184倍(RR 2.184,95%CI 1.321~5.684).结论:LVEF≤40%患者院内及长期死亡率和MACCE发生率仍明显高于LVEF> 41%患者.%Objective:To investigate short-term and long-term prognosis of the patients with different states of cardiac function after receiving PCI. Method:The study was the retrospective registered study in the single center, including 2 234 patients received PCI. All patients were divided into 3 groups by left ventricular ejection fraction (LVEF): Agroup, LVEF≤40% (n=106); B group, LVEF 41% to 49% (n = 205); C group, LVEF≥50% (n = 1 923). The time of follow-up was more than one year. The mortality and the MACCE were compared among 3 groups. Result:The in-hospital mortality in A, B, C group were 2.8%, 0.5%, 0.2%, respectively, P41%.

  6. 芪苈强心胶囊治疗射血分数保留的心力衰竭疗效的 Meta 分析%Meta-analysis of the effect of Qiliqiangxin capsules for patients with heart failure and preserved ejection fraction

    Institute of Scientific and Technical Information of China (English)

    许强; 刘宏军; 刘学会

    2015-01-01

    目的:系统评价芪苈强心胶囊治疗射血分数保留的心力衰竭(HFpEF)的疗效。方法系统检索中国知网、万方医学网和维普等数据库检索时间为自建库至2015年3月1日,收集芪苈强心胶囊治疗HFpEF的随机对照试验( RCT)。采用RevMan 5.2.0软件进行统计分析。结果共纳入10篇文献患者829例。 Meta分析结果:在常规治疗基础上,加用芪苈强心胶囊有助于进一步改善心功能(RR=1.41,95%CI 1.15~1.71, P <0.01)和E/A值(WMD=0.14,95%CI 0.07~0.21, P <0.01),提高6 min步行距离(WMD=67.40,95%CI 2.17~132.63, P =0.04),降低脑钠肽(WMD=-93.46,95%CI -121.98~-64.93, P <0.01)和氨基末端脑钠肽前体(WMD=-543.45,95%CI -924.25~-162.65, P <0.01)水平。结论芪苈强心胶囊治疗HFpEF疗效好,安全性高,值得临床推广。%Objective To systemic evaluate the effect of Qiliqiangxin capsules in the treatment of heart failure with preserved ejection fraction (HFpEF).Methods Systemic retrieval CNKI, Wanfang medicine and VIP database from data-base self-building to March 1, 2015, collected randomized controlled trials (RCT) of Qiliqiangxin capsules in the treatment of HFpEF.Statistical analysis were performed using 5.2.0 RevMan software.Results A total of 10 articles (829 cases) were included.Meta-analysis showed that, on the basis of routine treatment, the Qiliqiangxin capsules can help to further improve the cardiac function (RR=1.41, 95%CI 1.15 to 1.71, P <0.01), E/a value (WMD=0.14, 95% CI 0.07 to 0.21, P <0.01), and 6 min walking distance (WMD=67.40, 95%CI 2.17 to 132.63, P =0.04), also reduced the brain natri-uretic peptide (WMD=-93.46, 95%CI -121.98 to -64.93, P <0.01) and N-terminal pro brain natriuretic peptide (WMD=-543.45, 95%CI -924.25 to -162.65, P <0.01) level.Conclusion Qiliqiangxin capsules has good cura

  7. Action as ejection.

    Science.gov (United States)

    Franco, Daisy

    2006-01-01

    The systematic analysis of acting-out episodes can be used in assessing analytic progress. Variables to be considered are the nature of the wish, the type of defense, and the degree of concreteness (versus symbolization) of the mental processes used in attempting actualization (as distinct from the resort to action). Two acting-out episodes of a borderline patient who acted out as a character trait, both occurring outside the analytic setting, are presented as illustrations. In the first one, occurring relatively early in the analysis, when split-off negative and positive self-images had to be rigidly maintained, ejection of the negative self-image was actualized via the regressive use of a symbolic equation and the mechanism of displacement, obliterating the distinction between an internal feeling and an external thing that here was literally thrown out. The later episode, occurring after the split was healed and within the context of a frustrating heterosexual involvement, contained an acted-out allusion to identification and competition with the mother. As in a dream, via associations, an unconscious wish for oedipal victory was revealed. Whereas in the first episode the goal of ejection was central, with splitting and denial the underlying defenses, it was absent from the second, in which an attempt was made to actualize a repressed infantile wish and made greater use of symbolization. It is concluded that acting-out episodes at different periods of the analysis, when systematically analyzed, can serve in assessing a patient's progress.

  8. Characterisation of peripartum cardiomyopathy by cardiac magnetic resonance imaging

    Energy Technology Data Exchange (ETDEWEB)

    Mouquet, Frederic; Groote, Pascal de; Bouabdallaoui, Nadia; Dagorn, Joel; Lamblin, Nicolas; Bauters, Christophe [Pole de Cardiologie et Maladies Vasculaires, CHRU Lille et Universite Lille 2, Lille Cedex (France); Lions, Christophe; Willoteaux, Serge; Beregi, Jean Paul [Radiologie et Imagerie Cardiovasculaire, CHRU Lille et Universite Lille 2, Lille Cedex (France); Deruelle, Philippe [Gynecologie-Maternite, CHRU Lille et Universite Lille 2, Lille Cedex (France)

    2008-12-15

    Peripartum cardiomyopathy (PPCM) is a rare cause of heart failure. Only half of the patients recover normal cardiac function. We assessed the usefulness of magnetic resonance imaging (MRI) and late enhancement imaging to detect myocardial fibrosis in order to predict cardiac function recovery in patients with peripartum cardiomyopathy. Among a consecutive series of 1,037 patients referred for heart failure treatment or prognostic evaluation between 1999 and 2006, eight women had confirmed PPCM. They all underwent echocardiography and cardiac MRI for assessment of left ventricular anatomy, systolic function and detection of myocardial fibrosis through late enhancement imaging. Mean ({+-} SD) baseline left ventricular ejection fraction (LVEF) was 28 {+-} 4%. After a follow-up of 50 {+-} 9 months, half the patients recovered normal cardiac function (LVEF = 58 {+-} 4%) and four did not (LVEF = 35 {+-} 6%). None of the eight patients exhibited abnormal myocardial late enhancement. No difference in MRI characteristics was observed between the two groups. Patients with PPCM do not exhibit a specific cardiac MRI pattern and particularly no myocardial late enhancement. It suggests that myocardial fibrosis does not play a major role in the limitation of cardiac function recovery after PPCM. (orig.)

  9. Ventricular function following coronary artery bypass grafting: comparison between Gated SPECT and cardiac magnetic resonance imaging

    Energy Technology Data Exchange (ETDEWEB)

    Mesquita, Claudio Tinoco [Hospital Pro-Cardiaco, Rio de Janeiro, RJ (Brazil). Servico de Medicina Nuclear; Instituto Nacional de Cardiologia, Rio de Janeiro, RJ (Brazil); Pessoa, Maria Carolina Pinheiro [Pro-Echo Hospital Samaritano, Rio de Janeiro, RJ (Brazil); Vasconcelos, Paulo Pontes [Centro de Diagnostico por Imagens (CDPI), Rio de Janeiro, RJ (Brazil); Oliveira Junior, Amarino Carvalho [Hospital Pro-Cardiaco, Rio de Janeiro, RJ (Brazil). Servico de Radiologia; Dohmann, Hans Fernando Rocha [Hospital Pro-Cardiaco, Rio de Janeiro, RJ (Brazil). Servico de Radiologia; Instituto Nacional de Cardiologia, Rio de Janeiro, RJ (Brazil); Reis, Adair Gomes dos [Nuclear Diagnosticos, SP (Brazil); Fonseca, Lea Mirian Barbosa da [Pro-Echo Hospital Samaritano, Rio de Janeiro, RJ (Brazil); Universidade Federal do Rio de Janeiro (UFRJ), RJ (Brazil)

    2009-04-15

    Background: The assessment of left ventricular function may be impaired by the abnormal interventricular septal motion frequently found after coronary artery bypass grafting (CABG). Studies on the validation of gated SPECT as a tool for the assessment of left ventricular function in this patient group are scarce. Objective: We investigated the agreement and correlation between left ventricular ejection fraction (LVEF), end-diastolic volume (EDV), and end-systolic volume (ESV) as obtained using electrocardiogram-gated myocardial perfusion scintigraphy (gated SPECT) and cardiac magnetic resonance imaging in 20 patients undergoing coronary artery bypass grafting. Methods: Correlation was measured using Spearman's correlation coefficient ({rho}). Agreement was assessed using Bland-Altman analysis. Results: A good correlation was found between gated SPECT and cardiac magnetic resonance imaging in patients after CABG with regard to left ventricular ejection fraction ({rho} = 0.85; p =0.0001), moderate correlation for end-diastolic volume ({rho} = 0.51; p = 0.02), and non-significant correlation for end-diastolic volume ({rho} = 0.13; p = 0.5). Agreement ranges for LVEF, ESV and EDV were: -20% to 12%; -38 to 54 ml and; -96 to 100 ml, respectively. Conclusion: A reliable correlation was found for left ventricular ejection fraction as obtained by gated SPECT and magnetic resonance imaging in patients undergoing CABG. For ventricular volumes, however, the correlation is not adequate. (author)

  10. Pheochromocytoma-induced atrial tachycardia leading to cardiogenic shock and cardiac arrest: resolution with atrioventricular node ablation and pacemaker placement.

    Science.gov (United States)

    Shawa, Hassan; Bajaj, Mandeep; Cunningham, Glenn R

    2014-12-01

    Pheochromocytoma should be considered in young patients who have acute cardiac decompensation, even if they have no history of hypertension. Atrioventricular node ablation and pacemaker placement should be considered for stabilizing pheochromocytoma patients with cardiogenic shock due to atrial tachyarrhythmias. A 38-year-old black woman presented with cardiogenic shock (left ventricular ejection fraction, cardiogenic shock and cardiac arrest unresolved by the placement of 2 different ventricular assist devices, but that was completely reversed by radiofrequency ablation of the atrioventricular node and the placement of a temporary pacemaker. We present the patient's clinical, laboratory, and imaging findings, and we review the relevant literature.

  11. Assessment of blood N-terminal pro-brain natriuretic peptide levels in patients with heart failure with preserved ejection fraction%射血分数正常的心力衰竭患者全血N-末端脑钠肽前体浓度变化

    Institute of Scientific and Technical Information of China (English)

    陈广胜; 徐崇利; 张郁青; 林涛

    2012-01-01

    Objectives To assess ihe changes of blood N-terminal pro-brain natriuretic peptide (NT-pro-BNP) levels in patients with heart failure with preserved ejection fraction (HFPEF). Methods Totally 78 patients with cardiovascular diseases were classified into three groups: 22 cases with normal heart function, 33 cases with HFPEF and 23 cases with heart failure with reduced ejection fraction (HFREF). Blood NT-pro-BNP levels were measured and echoeardiograms were performed in all patients. Results Blood NT-pro-BNP levels in patients with HFPEF were significantly higher than those in patients with normal heart function [(1 424+996 )pg/mL vs. (167+ 117 )pg/mL,P<0.01 ] and significantly lower than those in patients with HFREF [(1 424±996)mg/L vs. (5 910±2828)mg/L,P<0.01 ]. For heart failure patients, blood NT-pro-BNP levels were negatively correlated with ejection fraction (r=—0.72,P<0.01 ), positively correlated with left atrial diameter (r=0.34,-P<0.05), left end-diastolic ventricular diameter (r=0.61 ,P<0.05) , left end-systolic ventricular diameter (r=0.62,P<0.05) and E/A ratio (r=0.40, P<0.05). Conclusions Compared with that of HFREF, HFPEF is associated with a less elevated level of NT-pro-BNP.%目的 评估射血分数正常的心力衰竭(心衰)患者全血N-末端脑钠肽前休(N-terminal pro-brain natriureticpeptide,NT-pro-BNP)浓度的变化.方法 入选78例心脏病患者分为3组:心功能正常组22例,射血分数正常心衰(heart failure with preserved ejection fretion,HFPEF)组33例,射血分数减低心衰(heart failure with reduced ejection fraction,HFREF)组23例.测定患者的全血NT-pro-BNP浓度并进行超声心动图检查.结果 HFPEF组患者全血NT-proBNP浓度高于心功能正常组[(1 424±996)pg/mL vs.(167±117) pg/mL,P<0.01],低于HFREF组[(1 424±996)mg/L vs.(5 910±2 828)mg/L,P<0.01],差异有统计学意义.心衰患者全血NT-proBNP浓度与射血分数呈负相关(r=-0.72,P<0.01),与左心房内径(r=0.34,P<0.05)

  12. Cardiac arrhythmias induced by chloral hydrate in rhesus monkeys.

    Science.gov (United States)

    Han, Pengfei; Song, Haibo; Yang, Pingliang; Xie, Huiqi; Kang, Y James

    2011-06-01

    Chloral hydrate has been long used as a safe sedative and hypnotic drug in humans. However, reports on its cardiovascular adverse effects have been published from time to time. The present study was undertaken to use Rhesus monkeys as a model to define the dose regiment of chloral hydrate at which cardiac arrhythmias can be induced and the consequences of the cardiac events. Male Rhesus monkeys of 2-3 years old were intravenously infused with chloral hydrate starting at 50 mg/kg with an increasing increment of 25 mg/kg until the occurrence of cardiac arrhythmias. In addition, a traditional up-and-down dosing procedure was applied to define a single dose level at which cardiac arrhythmias can be induced. The data obtained showed that when the sequentially escaladed dose reached 125 mg/kg, cardiac arrhythmias occurred in all monkeys tested. The single effective dose to cause cardiac arrhythmias calculated from the crossover analysis was 143 ± 4 mg/kg. This value would be equivalent to 68.6 ± 1.9 mg/kg for children and 46.4 ± 1.3 mg/kg for adults in humans. Under either multiple or single dose condition, cardiac arrhythmias did not occur before 40 min after the onset of anesthesia induced by chloral hydrate. Cardiac arrhythmias were recovered without help at the end of the anesthesia in most cases, but also continued after the regain of consciousness in some cases. The cardiac arrhythmias were accompanied with compromised cardiac function including suppressed fractional shortening and ejection fraction. This study thus suggests that cautions need to be taken when chloral hydrate is used above certain levels and beyond a certain period of anesthesia, and cardiac arrhythmias induced by chloral hydrate need to be closely monitored because compromised cardiac function may occur simultaneously. In addition, patients with cardiac arrhythmias induced by chloral hydrate should be monitored even after they are recovered from the anesthesia.

  13. Right and left ventricular cardiac function in a developed world population with human immunodeficiency virus studied with radionuclide ventriculography

    DEFF Research Database (Denmark)

    Lebech, Anne-Mette; Gerstoft, Jan; Hesse, Birger

    2004-01-01

    BACKGROUND: Cardiac dysfunction has been reported in a substantial part of patients infected with the human immunodeficiency virus (HIV). However, most studies are from a time before the introduction of highly active antiretroviral treatment (HAART), which has significantly reduced HIV-associated......BACKGROUND: Cardiac dysfunction has been reported in a substantial part of patients infected with the human immunodeficiency virus (HIV). However, most studies are from a time before the introduction of highly active antiretroviral treatment (HAART), which has significantly reduced HIV......-associated morbidity and mortality rates. Accordingly, the prevalence of HIV-associated cardiac dysfunction may also have changed. The aim of the study was to establish the prevalence of right- and left-sided cardiac dysfunction in a Danish HIV population, most of whom were undergoing HAART, with radionuclide...... ventricular ejection fraction and 6 (7%) had a reduced right ventricle ejection fraction (0.35-0.42) compared with reference values from the age- and sex-matched reference population. Patients with HIV and reduced cardiac function did not differ in the duration of HIV, CD4 count, CD4 nadir, or HIV RNA load...

  14. Early association of electrocardiogram alteration with infarct size and cardiac function after myocardial infarction

    Institute of Scientific and Technical Information of China (English)

    陶则伟; 黄元伟; 夏强; 傅军; 赵志宏; 陆贤; BRUCEI.C.

    2004-01-01

    Objective:Myocardial infarction (MI) is the main cause of heart failure, but the relationship between the extent of MI and cardiac function has not been clearly determined.The present study was undertaken to investigate early changes in the electrocardiogram associated with infarct size and cardiac function after MI. Methods: MI was induced by ligating the left anterior descending coronary artery in rats. Electrocardiograms, echocardiographs and hemodynamic parameters were assessed and myocardial infarct size was measured from mid-transverse sections stained with Masson's trichrome. Results:The sum of pathological Q wave amplitudes was strongly correlated with myocardial infarct size (r=0.920, P<0.0001), left ventricular ejection fraction (r=-0.868, P<0.0001) and left ventricular end diastolic pressure (r=0.835, P<0.0004).Furthermore, there was close relationship between MI size and cardiac function as assessed by left ventricular ejection fraction (r=-0.913, P<0.0001) and left ventricular end diastolic pressure (r=0.893, P<0.0001).Conclusion: The sum of pathological Q wave amplitudes after MI can be used to estimate the extent of MI as well as cardiac function.

  15. Magnetic resonance imaging assessment of cardiac dysfunction in δ-sarcoglycan null mice.

    Science.gov (United States)

    Wansapura, Janaka P; Millay, Douglas P; Dunn, R Scott; Molkentin, Jeffery D; Benson, D Woodrow

    2011-01-01

    Delta-sarcoglycan (δ-sarcoglycan) null, Scgd(-/-), mice develop cardiac and skeletal muscle histopathological alterations similar to those in humans with limb-girdle muscular dystrophy. The objective of this study was to assess the feasibility of using MRI to investigate cardiac dysfunction in Scgd(-/-) mice. Cardiac MRI of 8 month old Scgd(-/-) and wild type (WT) mice was performed. Compared to WT, Scgd(-/-) mice had significantly lower LV ejection fraction (44±5% vs. 66±4%, p=0.014), lower RV ejection fraction (25±2% vs. 51±3%, p<0.001) lower myocardial circumferential strain, (15.0±0.3% vs. 16.9±0.3%, p=0.007) and RV dilatation (54±3 μL vs. 40±3 μL, p=0.007). The regional circumferential strain also demonstrated significant temporal dyssynchrony between opposing regions of the Scgd(-/-) LV. Our results demonstrate severe cardiac dysfunction in Scgd(-/-) mice at 8 months. The study identifies a set of non-invasive markers that could be used to study efficacy of novel therapeutic agents in dystrophic mice.

  16. Early association of electrocardiogram alteration with infarct size and cardiac function after myocardial infarction

    Institute of Scientific and Technical Information of China (English)

    TAO Ze-wei (陶则伟); HUANG Yuan-wei (黄元伟); XIA Qiang (夏强); FU Jun (傅军); ZHAO Zhi-hong (赵志宏); LU Xian (陆贤); BRUCE I.C.

    2004-01-01

    Objective: Myocardial infarction (MI) is the main cause of heart failure, but the relationship between the extent of MI and cardiac function has not been clearly determined. The present study was undertaken to investigate early changes in the electrocardiogram associated with infarct size and cardiac function after MI. Methods: MI was induced by ligating the left anterior descending coronary artery in rats. Electrocardiograms, echocardiographs and hemodynamic parameters were assessed and myocardial infarct size was measured from mid-transverse sections stained with Masson's trichrome. Results: The sum of pathological Q wave amplitudes was strongly correlated with myocardial infarct size (r = 0.920, P < 0.0001), left ventricular ejection fraction (r = (0.868, P < 0.0001) and left ventricular end diastolic pressure (r = 0.835, P < 0.0004). Furthermore, there was close relationship between MI size and cardiac function as assessed by left ventricular ejection fraction (r = (0.913, P < 0.0001) and left ventricular end diastolic pressure (r = 0.893, P < 0.0001). Conclusion: The sum of pathological Q wave amplitudes after MI can be used to estimate the extent of MI as well as cardiac function.

  17. 组织多普勒成像对射血分数正常的心衰患者左心功能评价%Evaluation of Left Ventricular Function by Tissue Doppler Imaging in Patients of Heart Failure with Normal Ejection Fraction

    Institute of Scientific and Technical Information of China (English)

    杨洁梅; 赵进军; 修春红; 沈景霞; 刘慧; 薛凤华

    2012-01-01

    Objective: To evaluate the variation of left ventricular function in the patients of heart failure with normal ejection fraction by Tissue doppler imaging. Methods: 30 healthy individuals(Group I), 30 patients of heart failure with EF>50% (Group II) a-nd 30 patients with EF50%, DSp and IVRTp had the biggest area under ROC curve respectively in the five sites. Conclusions: The patients of heart failure with normal ejection fraction have systolic dysfunction in left ventricular long-axis. DSm and Tem are effective parameters to diagnose left ventricular function in the patients of heart failure with EF>50%. DSp and Tep are the optimal sites for assessing left ventricular function in the patients of heart failure with normal ejection fraction.%目的:探讨组织多普勒成像(TDI)技术评价射血分数正常的心衰患者左室长轴功能特点.方法:选取30名健康人(Ⅰ组)、EF> 50%的心衰患者30名(Ⅱ组)和EF<50%的心衰患者30名(Ⅲ组)作为研究对象,采用TDI在二尖瓣环室间隔(ivs)、侧壁(1)、前壁(a)、后壁(p)、下壁(d)测量其Sm、DSm、IVCTm、TSm、Em、Am、IVRTm、TEm等指标.结果:Ⅰ组、Ⅱ组、Ⅲ组DSm、Sm逐渐减低,(P<0.05);而ⅣVCTm、TSm逐渐升高(P<0.05);ⅣVRTm、TEm在Ⅰ组、Ⅲ组、Ⅱ组逐渐升高(P<0.05);DSm及TEm在诊断EF>50%心衰患者心功能的指标中ROC曲线下面积最大,同样DSp及TEp在五个位点中ROC曲线下面积最大.结论:射血分数正常的心衰患者存在收缩减低;DSm及TEm是诊断EF>50%心衰患者心功能比较有效的指标;后壁是诊断的最佳位点.

  18. Prognostic value of sympathetic innervation and cardiac asynchrony in dilated cardiomyopathy

    Energy Technology Data Exchange (ETDEWEB)

    Manrique, Alain; Hitzel, Anne; Vera, Pierre [Rouen University Hospital - Henri Becquerel Center, Nuclear Medicine, Rouen (France); Bernard, Mathieu; Bauer, Fabrice [Rouen University Hospital, Cardiology, Rouen (France); Menard, Jean-Francois [Rouen University Hospital, Biostatistics, Rouen (France); Sabatier, Remi [Caen University Hospital, Cardiology, Caen (France); Jacobson, Arnold [GE Healthcare, Princeton, NJ (United States); Agostini, Denis [Caen University Hospital, Nuclear Medicine, Caen (France)

    2008-11-15

    The purpose of the study is to examine prognostic values of cardiac I-123 metaiodobenzylguanidine (MIBG) uptake and cardiac dyssynchrony in patients with dilated cardiomyopathy (DCM). Ninety-four patients with non-ischemic DCM underwent I-123 MIBG imaging for assessing cardiac sympathetic innervation and equilibrium radionuclide angiography. Mean phase angles and SD of the phase histogram were computed for both right ventricular (RV) and left ventricular (LV). Phase measures of interventricular (RV-LV) and intraventricular (SD-RV and SD-LV) asynchrony were computed. Most patients were receiving beta-blockers (89%) and angiotensin-converting enzyme inhibitors (88%). One patient (1%) was lost to follow-up, six had cardiac death (6.4%), eight had heart transplantation (8.6%), and seven had unplanned hospitalization for heart failure (7.5%; mean follow-up: 37 {+-} 16 months). Patients with poor clinical outcome were older, had higher The New York Heart Association functional class, impaired right ventricular ejection fraction and left ventricular ejection fraction, and impaired cardiac I-123 MIBG uptake. On multivariate analysis, I-123 MIBG heart-to-mediastinum (H/M) uptake ratio <1.6 was the only predictor of both primary (cardiac death or heart transplantation, RR = 7.02, p < 0.01) and secondary (cardiac death, heart transplantation, or recurrent heart failure, RR = 8.10, p = 0.0008) end points. In patients receiving modern medical therapy involving beta-blockers, I-123 MIBG uptake, but not intra-LV asynchrony, was predictive of clinical outcome. The impact of beta-blockers on the prognostic value of ventricular asynchrony remains to be clarified. (orig.)

  19. Cardiac size of high-volume resistance trained female athletes: shaping the body but not the heart.

    Science.gov (United States)

    Venckunas, T; Simonavicius, J; Marcinkeviciene, J E

    2016-03-01

    Introduction Exercise training, besides many health benefits, may result in cardiac remodelling which is dependent on the type and amount of exercise performed. It is not clear, however, whether significant adaptation in cardiac structure is possible in females undergoing resistance type of exercise training. Rigorous high volume training of most muscle groups emphasising resistance exercises are being undertaken by athletes of some aesthetic sports such as female fitness (light bodybuilding). The impact of this type of training on cardiac adaptation has not been investigated until now. The aim of the current study was to disclose the effect of high volume resistance training on cardiac structure and function. Methods 11 top-level female fitness athletes and 20 sedentary age-matched controls were recruited to undergo two-dimensional echocardiography. Results Cardiac structure did not differ between elite female fitness athletes and controls (p > 0.05), and fitness athletes had a tendency for a smaller (p = 0.07) left ventricular (LV) mass indexed to lean body mass. Doppler diastolic function index (E/A ratio) and LV ejection fraction were similar between the groups (p > 0.05). Conclusions Elite female fitness athletes have normal cardiac size and function that do not differ from matched sedentary controls. Consequently, as high volume resistance training has no easily observable effect on adaptation of cardiac structure, when cardiac hypertrophy is present in young resistance-trained lean female, other reasons such as inherited cardiac disease are to be considered carefully.

  20. Nuclear cardiac imaging for the diagnosis and management of heart failure: what can be learned from recent guidelines?

    Science.gov (United States)

    Vervloet, Delphine M; DE Sutter, Johan

    2016-01-20

    The aim of this review is to provide the clinical cardiologist and nuclear medicine specialist a brief overview of the currently accepted clinical use of cardiac nuclear imaging for the diagnosis and management of patients with heart failure based on recent (2012-2015) European Society of Cardiology (ESC) guidelines. We used the most recent ESC guidelines on heart failure, management of stable coronary artery disease, cardiac pacing, myocardial revascularisation, non-cardiac surgery and ventricular arrhythmias and sudden death. Nowadays cardiac nuclear imaging is useful in almost every step in heart failure from diagnostics to treatment. In first diagnosis of heart failure radionuclide imaging can provide information on ventricular function and volumes and nuclear imaging techniques provide accurate and reproducible left ventricular function assessment. In work out of the aetiology of the heart failure CMR, SPECT and PET imaging can demonstrate presence of inducible ischemia and myocardial viability. For prognostic information MIBG might be promising in the future. In treatment planning cardiac nuclear imaging is important to evaluate new angina and to assess accurate left ventricular ejection fraction before cardiac resynchronization therapy. Imaging stress testing is useful in the preoperative evaluation for non-cardiac surgery of heart failure patients. There is until now no recommended place for cardiac nuclear imaging in the follow-up of heart failure patients or prior to the initiation of cardiac rehabilitation.

  1. EANM/ESC guidelines for radionuclide imaging of cardiac function

    DEFF Research Database (Denmark)

    Hesse, B.; Lindhardt, T.B.; Acampa, W.;

    2008-01-01

    radionuclide ventriculography, gated myocardial perfusion scintigraphy, gated PET, and studies with non-imaging devices for the evaluation of cardiac function. The items covered are presented in 11 sections: clinical indications, radiopharmaceuticals and dosimetry, study acquisition, RV EF, LV EF, LV volumes......Radionuclide imaging of cardiac function represents a number of well-validated techniques for accurate determination of right (RV) and left ventricular (LV) ejection fraction (EF) and LV volumes. These first European guidelines give recommendations for how and when to use first-pass and equilibrium......, LV regional function, LV diastolic function, reports and image display and reference values from the literature of RVEF, LVEF and LV volumes. If specific recommendations given cannot be based on evidence from original, scientific studies, referral is given to "prevailing or general consensus...

  2. Cardiac Implantable Electronic Device Infection: From an Infection Prevention Perspective

    Science.gov (United States)

    Sastry, Sangeeta; Rahman, Riaz; Yassin, Mohamed H.

    2015-01-01

    A cardiac implantable electronic device (CIED) is indicated for patients with severely reduced ejection fraction or with life-threatening cardiac arrhythmias. Infection related to a CIED is one of the most feared complications of this life-saving device. The rate of CIED infection has been estimated to be between 2 and 25; though evidence shows that this rate continues to rise with increasing expenditure to the patient as well as healthcare systems. Multiple risk factors have been attributed to the increased rates of CIED infection and host comorbidities as well as procedure related risks. Infection prevention efforts are being developed as defined bundles in numerous hospitals around the country given the increased morbidity and mortality from CIED related infections. This paper aims at reviewing the various infection prevention measures employed at hospitals and also highlights the areas that have relatively less established evidence for efficacy. PMID:26550494

  3. MR image analysis: Longitudinal cardiac motion influences left ventricular measurements

    Energy Technology Data Exchange (ETDEWEB)

    Berkovic, Patrick [University Hospital Antwerp, Department of Cardiology (Belgium)], E-mail: pberko17@hotmail.com; Hemmink, Maarten [University Hospital Antwerp, Department of Cardiology (Belgium)], E-mail: maartenhemmink@gmail.com; Parizel, Paul M. [University Hospital Antwerp, Department of Radiology (Belgium)], E-mail: paul.parizel@uza.be; Vrints, Christiaan J. [University Hospital Antwerp, Department of Cardiology (Belgium)], E-mail: chris.vrints@uza.be; Paelinck, Bernard P. [University Hospital Antwerp, Department of Cardiology (Belgium)], E-mail: Bernard.paelinck@uza.be

    2010-02-15

    Background: Software for the analysis of left ventricular (LV) volumes and mass using border detection in short-axis images only, is hampered by through-plane cardiac motion. Therefore we aimed to evaluate software that involves longitudinal cardiac motion. Methods: Twenty-three consecutive patients underwent 1.5-Tesla cine magnetic resonance (MR) imaging of the entire heart in the long-axis and short-axis orientation with breath-hold steady-state free precession imaging. Offline analysis was performed using software that uses short-axis images (Medis MASS) and software that includes two-chamber and four-chamber images to involve longitudinal LV expansion and shortening (CAAS-MRV). Intraobserver and interobserver reproducibility was assessed by using Bland-Altman analysis. Results: Compared with MASS software, CAAS-MRV resulted in significantly smaller end-diastolic (156 {+-} 48 ml versus 167 {+-} 52 ml, p = 0.001) and end-systolic LV volumes (79 {+-} 48 ml versus 94 {+-} 52 ml, p < 0.001). In addition, CAAS-MRV resulted in higher LV ejection fraction (52 {+-} 14% versus 46 {+-} 13%, p < 0.001) and calculated LV mass (154 {+-} 52 g versus 142 {+-} 52 g, p = 0.004). Intraobserver and interobserver limits of agreement were similar for both methods. Conclusion: MR analysis of LV volumes and mass involving long-axis LV motion is a highly reproducible method, resulting in smaller LV volumes, higher ejection fraction and calculated LV mass.

  4. Cardiac Sympathetic Hyperactivity after Chemotherapy: Early Sign of Cardiotoxicity?

    Energy Technology Data Exchange (ETDEWEB)

    Guimarães, Sarita Lígia Pessoa de Melo Machado [Pós-Graduação em Ciências da Saúde da Universidade Federal de Pernambuco (PGCS-UFPE), Recife, PE (Brazil); Hospital Agamenon Magalhães (HAM), Recife, PE (Brazil); Brandão, Simone Cristina Soares, E-mail: simonecordis@yahoo.com.br [Pós-Graduação em Ciências da Saúde da Universidade Federal de Pernambuco (PGCS-UFPE), Recife, PE (Brazil); Andrade, Luciana Raposo [Hospital Santa Joana, Recife, PE (Brazil); Maia, Rafael José Coelho [Pós-Graduação em Ciências da Saúde da Universidade Federal de Pernambuco (PGCS-UFPE), Recife, PE (Brazil); Hospital Agamenon Magalhães (HAM), Recife, PE (Brazil); Markman Filho, Brivaldo [Pós-Graduação em Ciências da Saúde da Universidade Federal de Pernambuco (PGCS-UFPE), Recife, PE (Brazil)

    2015-09-15

    Chemotherapy with anthracyclines and trastuzumab can cause cardiotoxicity. Alteration of cardiac adrenergic function assessed by metaiodobenzylguanidine labeled with iodine-123 ({sup 123}I-mIBG) seems to precede the drop in left ventricular ejection fraction. To evaluate and to compare the presence of cardiovascular abnormalities among patients with breast cancer undergoing chemotherapy with anthracyclines and trastuzumab, and only with anthracycline. Patients with breast cancer were analyzed clinical, laboratory, electrocardiographic and echocardiographic and cardiac sympathetic activity. In scintigraphic images, the ratio of {sup 123}I-mIBG uptake between the heart and mediastinum, and the washout rate were calculated. The variables were compared between patients who received anthracyclines and trastuzumab (Group 1) and only anthracyclines (Group 2). Twenty patients, with mean age 57 ± 14 years, were studied. The mean left ventricular ejection fraction by echocardiography was 67.8 ± 4.0%. Mean washout rate was 28.39 ± 9.23% and the ratio of {sup 123}I-mIBG uptake between the heart and mediastinum was 2.07 ± 0.28. Of the patients, 82% showed an increased in washout rate, and the ratio of {sup 123}I-mIBG uptake between the heart and mediastinum decreased in 25%. Concerning the groups, the mean washout rate of Group 1 was 32.68 ± 9.30% and of Group 2 was 24.56 ± 7.72% (p = 0,06). The ratio of {sup 123}I-mIBG uptake between the heart and mediastinum was normal in all patients in Group 2, however, the Group 1, showed 50% the ratio of {sup 123}I-mIBG uptake between the heart and mediastinum ≤ 1.8 (p = 0.02). In women with breast cancer undergoing chemotherapy, assessment of cardiac sympathetic activity with {sup 123}I-mIBG appears to be an early marker of cardiotoxicity. The combination of chemotherapy showed higher risk of cardiac adrenergic hyperactivity.

  5. Loss of Bmx nonreceptor tyrosine kinase prevents pressure overload-induced cardiac hypertrophy.

    Science.gov (United States)

    Mitchell-Jordan, Scherise A; Holopainen, Tanja; Ren, Shuxun; Wang, Sujing; Warburton, Sarah; Zhang, Michael J; Alitalo, Kari; Wang, Yibin; Vondriska, Thomas M

    2008-12-05

    Bmx nonreceptor tyrosine kinase has an established role in endothelial and lymphocyte signaling; however, its role in the heart is unknown. To determine whether Bmx participates in cardiac growth, we subjected mice deficient in the molecule (Bmx knockout mice) to transverse aortic constriction (TAC). In comparison with wild-type mice, which progressively developed massive hypertrophy following TAC, Bmx knockout mice were resistant to TAC-induced cardiac growth at the organ and cell level. Loss of Bmx preserved cardiac ejection fraction and decreased mortality following TAC. These findings are the first to demonstrate a necessary role for the Tec family of tyrosine kinases in the heart and reveal a novel regulator (Bmx) of pressure overload-induced hypertrophic growth.

  6. Quantification of myocardial iron deficiency in nonischemic heart failure by cardiac T2* magnetic resonance imaging.

    Science.gov (United States)

    Nagao, Michinobu; Matsuo, Yoshio; Kamitani, Takeshi; Yonezawa, Masato; Yamasaki, Yuzo; Kawanami, Satoshi; Abe, Kohtaro; Mukai, Yasushi; Higo, Taiki; Yabuuchi, Hidetake; Takemura, Atsushi; Yoshiura, Takashi; Sunagawa, Kenji; Honda, Hiroshi

    2014-03-15

    The aim of this study was to use T2* cardiac magnetic resonance (CMR) imaging to quantify myocardial iron content in patients with heart failure (HF) and to investigate the relation between iron content, cardiac function, and the cause of HF. CMR data were analyzed from 167 patients with nonischemic and 31 with ischemic HF and 50 patients with normal ventricular function. Short-axis T2* imaging was accomplished using 3-T scanner and multiecho gradient-echo sequence. Myocardial T2* value (M-T2*) was calculated by fitting the signal intensity data for the mid-left ventricular (LV) septum to a decay curve. Patients with nonischemic HF were categorized into patients with LV ejection fraction (LVEF) iron deficiency and nonischemic HF. M-T2* is a biomarker that can predict adverse cardiac function in patients with nonischemic HF.

  7. Evaluation of cardiac structures and function in hypertrophic cardiomyopathy with magnetic resonance imaging

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    Objective:To assess the capability of magnetic resonance imaging(MRI)in evaluating the cardiac structures and function in the hypertrophic cardiomyopathy(HCM).Methods:Fourteen healthy volunteers and eighteen cases with HCM verified by history,clinical presentation,electrocardiogram and echocardiography(ECG)were performed with MRI.The myocardial thickness of interventricular septum at the basal segment and that of posterolateral free wall of the left ventricle(LV)were measured.Some indexes for evaluating cardiac function were measured using ARGUS auto-quantitative program.Resuits:The myocardial thickness of septum at the basal segment had significant difference between the HCM patients and the healthy volunteers.There was no significant difference between MRI and ECG in examining end-diastolic volume,ejection fraction of the LV.Conclusion:MRI can fully provide more information on the abnormalities of cardiac anatomy and function;thus,it is of great value in clinical application.

  8. Divine Love and Deep Connections: A Long-Term Followup of Patients Surviving Cardiac Surgery

    Directory of Open Access Journals (Sweden)

    Amy L. Ai

    2011-01-01

    Full Text Available We examined experiencing divine love as an indicator of affective spiritual growth in a prospective cohort of 200 patients surviving cardiac surgery. These patients previously completed two-wave preoperative interviews when standardized cardiac surgery data were also collected. The information included left ventricular ejection fraction, New York Heart Association Classification, baseline health (physical and mental, optimism, hope, religiousness, prayer coping, religious/spiritual coping, and demographics. We then measured divine love at 900 days postoperatively. Hierarchical linear regression indicated the direct effect of positive religious coping on experiences of divine love, controlling for other key variables. Postoperatively perceived spiritual support was entered at the final step as an explanatory factor, which appeared to mediate the coping effect. None of the other faith factors predicted divine love. Further research regarding divine love and spiritual support may eventually guide clinical attempts to support patients' spiritual growth as an independently relevant outcome of cardiac surgery.

  9. Cardiac retransplantation is an efficacious therapy for primary cardiac allograft failure

    Directory of Open Access Journals (Sweden)

    Acker Michael A

    2008-05-01

    Full Text Available Abstract Background Although orthotopic heart transplantation has been an effective treatment for end-stage heart failure, the incidence of allograft failure has increased, necessitating treatment options. Cardiac retransplantation remains the only viable long-term solution for end-stage cardiac allograft failure. Given the limited number of available donor hearts, the long term results of this treatment option need to be evaluated. Methods 709 heart transplants were performed over a 20 year period at our institution. Repeat cardiac transplantation was performed in 15 patients (2.1%. A retrospective analysis was performed to determine the efficacy of cardiac retransplantation. Variables investigated included: 1 yr and 5 yr survival, length of hospitalization, post-operative complications, allograft failure, recipient and donor demographics, renal function, allograft ischemic time, UNOS listing status, blood group, allograft rejection, and hemodynamic function. Results Etiology of primary graft failure included transplant arteriopathy (n = 10, acute rejection (n = 3, hyperacute rejection (n = 1, and a post-transplant diagnosis of metastatic melanoma in the donor (n = 1. Mean age at retransplantation was 45.5 ± 9.7 years. 1 and 5 year survival for retransplantation were 86.6% and 71.4% respectively, as compared to 90.9% and 79.1% for primary transplantation. Mean ejection fraction was 67.3 ± 12.2% at a mean follow-up of 32.6 ± 18.5 mos post-retransplant; follow-up biopsy demonstrated either ISHLT grade 1A or 0 rejection (77.5 ± 95.7 mos post-transplant. Conclusion Cardiac retransplantation is an efficacious treatment strategy for cardiac allograft failure.

  10. Longitudinal monitoring of cardiac siderosis using cardiovascular magnetic resonance T2* in patients with thalassemia major on various chelation regimens: a 6-year study.

    Science.gov (United States)

    Ambati, Srikanth R; Randolph, Rachel E; Mennitt, Kevin; Kleinert, Dorothy A; Weinsaft, Jonathan W; Giardina, Patricia J

    2013-08-01

    Cardiovascular magnetic resonance (CMR) and hepatic magnetic resonance imaging (MRI) have become reliable noninvasive tools to monitor iron excess in thalassemia major (TM) patients. However, long-term studies are lacking. We reviewed CMR and hepatic MRI T2* imaging on 54 TM patients who had three or more annual measurements. They were managed on various chelation regimens. Patients were grouped according to their degree of cardiac siderosis: severe (T2*, cardiac siderosis (T2*, >20 msec). We looked at the change in cardiac T2*, liver iron concentration (LIC) and left ventricular ejection fraction (LVEF) at years 3 and 5. In patients with severe cardiac siderosis, cardiac T2* (mean ± SD) improved from 6.9 ± 1.6 at baseline to 13.6 ± 10.0 by year 5, mean ΔT2* = 6.7 (P = 0.04). Change in cardiac T2* at year 3 was not significant in the severe group. Patients with mild to moderate cardiac siderosis had mean cardiac T2* of 14.6 ± 2.9 at baseline which improved to 26.3 ± 9.5 by year 3, mean ΔT2* =  1.7 (P = 0.01). At baseline, median LICs (mg/g dry weight) in patients with severe, mild-moderate, and no cardiac siderosis were 3.6, 2.8, and 3.3, whereas LVEFs (mean ± SD) (%) were 56.3 ± 10.1, 60 ± 5, and 66 ± 7.6, respectively. No significant correlation was noted between Δ cardiac T2* and Δ LIC, Δ cardiac T2*, and Δ LVEF at years 3 and 5. Throughout the observation period, patients with no cardiac siderosis maintained their cardiac T2* above 20 msec. The majority of patients with cardiac siderosis improve cardiac T2* over time with optimal chelation.

  11. Coronal Mass Ejections: Observations

    Directory of Open Access Journals (Sweden)

    David F. Webb

    2012-06-01

    Full Text Available Solar eruptive phenomena embrace a variety of eruptions, including flares, solar energetic particles, and radio bursts. Since the vast majority of these are associated with the eruption, development, and evolution of coronal mass ejections (CMEs, we focus on CME observations in this review. CMEs are a key aspect of coronal and interplanetary dynamics. They inject large quantities of mass and magnetic flux into the heliosphere, causing major transient disturbances. CMEs can drive interplanetary shocks, a key source of solar energetic particles and are known to be the major contributor to severe space weather at the Earth. Studies over the past decade using the data sets from (among others the SOHO, TRACE, Wind, ACE, STEREO, and SDO spacecraft, along with ground-based instruments, have improved our knowledge of the origins and development of CMEs at the Sun and how they contribute to space weather at Earth. SOHO, launched in 1995, has provided us with almost continuous coverage of the solar corona over more than a complete solar cycle, and the heliospheric imagers SMEI (2003 – 2011 and the HIs (operating since early 2007 have provided us with the capability to image and track CMEs continually across the inner heliosphere. We review some key coronal properties of CMEs, their source regions and their propagation through the solar wind. The LASCO coronagraphs routinely observe CMEs launched along the Sun-Earth line as halo-like brightenings. STEREO also permits observing Earth-directed CMEs from three different viewpoints of increasing azimuthal separation, thereby enabling the estimation of their three-dimensional properties. These are important not only for space weather prediction purposes, but also for understanding the development and internal structure of CMEs since we view their source regions on the solar disk and can measure their in-situ characteristics along their axes. Included in our discussion of the recent developments in CME

  12. Impact of patient's age and disease duration on cardiac performance in acromegaly: a radionuclide angiography study.

    Science.gov (United States)

    Colao, A; Cuocolo, A; Marzullo, P; Nicolai, E; Ferone, D; Della Morte, A M; Petretta, M; Salvatore, M; Lombardi, G

    1999-05-01

    The aim of this study was to evaluate the impact of age and disease duration on cardiac performance in acromegaly. To address these issues, the left ventricular function at rest and during physical exercise was assessed by equilibrium radionuclide angiography in 40 rigorously selected patients with active acromegaly but without evidence of other complications able to affect heart function and in 32 healthy controls. Patients and controls were divided in two groups, on the basis of age below and above 40 yr. Circulating GH and insulin-like growth factor-I levels were significantly increased in patients, compared with controls, but were similar in the two groups of patients. At peak exercise, the systolic blood pressure was significantly higher in elderly patients (P 50%) in all but 2 patients and in all controls. The left ventricular ejection fraction at peak exercise was significantly decreased in elderly, compared with young, patients (P < 0.01) and in age-matched controls (P < 0.001). A normal response of the left ventricular ejection fraction to exercise was found in 12 of 40 patients (30%) and in 28 of 32 controls (87.5%) (chi2, 5.764; P < 0.01). Exercise-induced changes in left ventricular ejection fraction were significantly decreased in young (+5.2 +/- 4.4% vs. +21.3 +/- 3.4%, P < 0.005) and elderly patients (-10.2 +/- 2.8% vs. +13.7 +/- 2.7%, P < 0.0001), as compared with age-matched controls. The peak rate of left ventricular filling was significantly higher in young, than in elderly, patients whether peak filling rate was normalized to end-diastolic volume (P < 0.001), or stroke volume (P < 0.0001), or expressed as the ratio of peak filling rate to peak ejection rate (P < 0.001). The peak rate of left ventricular filling was significantly decreased in elderly patients, compared with young patients and age-matched controls, whether peak filling rate was normalized to end-diastolic volume (P < 0.01), or stroke volume (P < 0.005), or expressed as the ratio

  13. Assessment of cardiac function by magnetic resonance imaging: segmented versus real time steady-state free precession sequences

    Energy Technology Data Exchange (ETDEWEB)

    Bezerra, Leonardo Bernardo [Rio Grande do Norte Univ., Natal, RN (Brazil)]. E-mail: warrenhellwind@yahoo.com.br; Marchiori, Edson; Pontes, Paulo V. [Universidade Federal Fluminense, Niteroi, RJ (Brazil). Dept. de Radiologia

    2006-09-15

    Objective: to compare ventricular systolic parameters on segmented and real-time steady-state free precession cine-MRI sequences and ECG-gated MRI in patients presenting or not with cardiac arrhythmias. Materials and methods: ejection fraction and end-diastolic/end-systolic volumes have been compared in 31 patients, 11 presenting with cardiac arrhythmias, and 20 with regular sinus rhythm, using ECG-gated segmented and real-time sequences. The statistical analysis was performed using Pearson's correlation and Bland-Altman agreement plot, with p < 0.01. Results: real-time acquisitions demonstrated endocardial borders blurring effects, but both sequences presented a clear, positive correlation: ejection fraction r = 0.94; end-diastolic volume r = 0.93 and end-systolic volume r 0.98. The assessment of 11 patients with arrhythmias has not demonstrated a statistically significant difference, despite the lower blood pool-myocardial contrast ratio. Conclusion: real-time sequences may be utilized for cardiac function assessment, regardless the patient's cardiac rhythm. (author)

  14. Evaluation of cardiac function in patients with Duchenne's muscular dystrophy by single photon emission computed tomography (SPECT)

    Energy Technology Data Exchange (ETDEWEB)

    Tamura, Takuhisa; Motomura, Masakatsu; Kanazawa, Hajime; Shibuya, Noritoshi (Kawatana Byoin National Sanatorium, Nagasaki (Japan))

    1989-06-01

    The extent of myocardial ischemia was evaluated in 20 patients with Duchenne's muscular dystrophy (DMD) by using Bull's eye method of thallium-201 myocardial SPECT. It was examined in relation to skeletal muscle involvement, age, left ventricular (LV) ejection fraction and ventricular premature contractions (VPCs). Myocardial ischemia was detected in all of patients with DMD. Ischemic lesion was mostly detected in the apical side of the LV lateral wall and interventricular septum, while the extent of myocardial ischemia had no correlations with either the stage of functional disability of skeletal muscle or age. The more ischemic ratio was higher, the more LV ejection fraction decreased. The total number of VPCs was relatively small and it did not have any relation to myocardial ischemic ratio. These results suggest that younger DMD patients having extensive myocardial ischemia and/or ventricular tachycardia will have a high risk of cardiac death. (author).

  15. Study of heart rate recovery and chronotropic response in heart failure patients with preserved ejection fraction%左室射血分数保留的心力衰竭患者心脏变时性及心率恢复研究

    Institute of Scientific and Technical Information of China (English)

    李江华; 刘启云; 韩军丽; 高虹; 董少红

    2015-01-01

    Objective To investigate the changes in Heart Rate Recovery (HRR) and Chronotropic Response (CR) after maximal exercise treadmill testing in heart failure patients with preserved ejection fraction (HFPEF) and its significance.Methods 46 patients with HFPEF and 28 normal subjects were enrolled.All patients and the control group were submitted color Doppler echocardiography, evaluated the main index of left ventricular diastolic function.Treadmill exercise testing was performed in all of them.Heart Rate (HR) was measured at rest, at maximum exercise and at 1,2,and 3 minutes into recovery, percentage of HR reserve, percentage of peak HR and HR recovery 1,2,3 -minute after exercise were calculated.Results HFPEF group compared with the normal control group,late diastolic mitral flow velocity peak (A peak),early diastolic mitral flow velocity and mitral annulus peak early diastolic peak velocity spectrum (E peak/Em), isovolumic relaxation time (IVRT) increased (0.93 ±0.13 vs 0.68 ±0.12, 9.68 ±1.89 vs 7.17 ±1.33, 89.65 ±16.90 vs 77.04 ± 7.53), the differences were statistically significant (P <0.01).And the diastole early and late diastolic peak ratio (E peak/A), early diastolic mitral annular motion spectrum peak velocity (Em), early diastolic mitral annulus annulus peak velocity spectrum and late diastolic peak velocity of mitral spectrum (Em/Am) decreased (0.89 ±0.13vs 1.20 ±0.15, 8.69 ±1.3 vs 11.53 ±1.88, 0.86 ±0.31 vs 1.23 ±0.37), the differences were statistically significant (P <0.01).Peak heart rate and heart rate reserve decreased significantly in HFPEF group.CR functions significantly decreased; Heart rate recovery significantly reduced at the first 3 min after exercise stop in HFPEF group.MetS of HFPEF group was lower than that in control group ( P <0.01).Conclusions Patients with HFPEF have impaired HHR and CR, these patients could have early abnormal modulation of cardiac autonomic activity.%目的:探讨左室射血分数保留的心力衰竭

  16. 血管紧张素转换酶基因导向治疗原发性高血压及左心室射血分数保留的心力衰竭临床疗效研究%Clinical efficacy for angiotensin-converting enzyme gene directed therapy for essential hypertension and heart failure with preserved ejection fraction

    Institute of Scientific and Technical Information of China (English)

    王慧; 王薇; 陈伟达; 王俏; 张磊艺

    2016-01-01

    目的:探讨经血管紧张素转换酶(ACE)基因导向治疗原发性高血压及左心室射血分数保留的心力衰竭(HFpEF)的临床疗效及意义。方法随机选取2014年10月至2015年7月在佳木斯大学附属第一医院心内一科住院的原发性高血压并HFpEF患者90例,年龄55~80岁,平均(67.51±7.34)岁,其中男性36例、女性54例,按ACE基因型检测结果分为A组(DD型)19例、B组(ID型)38例、C组(II型)33例三组。所有患者均在入院24 h内行ACE基因型检测、血压测量及超声心动图检查,给予贝那普利10 mg/d每日清晨空腹口服,疗程3个月。3个月后复查血压及超声心动图。分别比较治疗前后各组内及治疗后各组间的临床指标。结果各组治疗前后二尖瓣口舒张早期E波的峰值流速与舒张晚期A波的峰值流速比值(E/A)、6 min步行试验(6MWT)均明显增加,二尖瓣口舒张早期 E 波的峰值流速与二尖瓣环运动的峰值速度比值(E/E’)、等容舒张时间(IVRT)、E波减速时间(DT)、收缩压(SBP)、舒张压(DBP)均明显减低;治疗后各组间比较:A组E/A、6MWT增加幅度大于B组,E/E'、IVRT、DT、SBP、DBP降低幅度大于B组;B组E/A、6MWT增加幅度大于C组,E/E'、IVRT、DT、SBP、DBP降低幅度大于C组。结论原发性高血压并HFpEF患者依据ACE基因型不同给予血管紧张素转换酶抑制剂(ACEI)类药物在改善心脏舒张功能及血压方面,DD型最优、ID型次之、II型较差,是一种基因导向的个体化治疗方案,对临床科学合理用药有重要意义。%ObjectiveTo investigate the clinical efficacy and significance of angiotensin- converting enzyme (ACE) gene-directed therapy in the essential hypertension and heart failure with preserved ejection fraction (HFpEF).Methods90 patients were randomly selected in the First Affiliated Hospital of Jiamusi University from October 2014

  17. Hyperbaric oxygen on left ventricular ejection fraction preserved by the influence of left ventricular remodeling in patients with heart failure%高压氧对左室射血分数保留的心力衰竭患者左室重构的影响

    Institute of Scientific and Technical Information of China (English)

    李继锋; 林炳钦; 林宝珠; 蔡建生; 彭志坚; 许锦叶

    2014-01-01

    目的:观察高压氧对左室射血分数保留的心力衰竭(HFpEF)患者左室重构的影响。方法:将110例HFpEF患者随机分为两组,对照组55例应用常规抗心衰药物治疗,治疗组在常规药物治疗基础上加用高压氧治疗,应用彩色多普勒超声检测治疗前及治疗后3个月左心室结构各项指标。结果:两组治疗后,左室结构各项指标(左室舒张末期内径、室间隔舒张末期厚度、左室后壁舒张末期厚度、左室心肌重量指数)均明显下降(P<0.01),治疗组与对照组比较差异有统计学意义(P<0.05)。随访3个月,治疗组发生复合心血管事件较对照组减少且差异有显著性(P<0.05)。结论:高压氧治疗能显著改善HFpEF患者左室舒张和收缩功能,逆转左室重构,并可减少心血管事件的发生。%Objective To study hyperbaric oxygen on left ventricular ejection fraction preserved by the influence of left ventricular remodeling in patients with heart failure. Methods A total of 110 patients with heart failure and normal ejection fraction were randomly allocated into the control group (n=55) and the HBO group (n=55). The control group were given the routine therapy, the HBO group were treated with hyperbaric oxygen on the basis of conventional drug. The application of color doppler ultrasound before and after treatment for 3 months left ventricular structure indicators. Results Left ventricular structure indicators were significantly decreased (LVDd、IVSD、LVPWD、LVMI)(P<0.01). Compared with the control group the difference was statistically significant (P<0.05). Follow-up of 3 months, The treatment group composite cardiovascular events was fewer than the control group and had significant difference (P<0.05). Conclusion Hyperbaric oxygen therapy can significantly improve left ventricular ejection fraction preserved by heart failure of left ventricular diastolic and systolic function and

  18. GDF-15在左心室射血分数正常心力衰竭患者诊疗中的应用价值%Significance of serum GDF-15 in the diagnosis and prognostic prediction of heart failure with preserved ejection fraction

    Institute of Scientific and Technical Information of China (English)

    张月琴; 林玎; 谢晓林

    2015-01-01

    Objective To explore the value of serum growth differentiation factor- 15 (GDF- 15) in the diagnosis and prognostic prediction of heart failure (HF) with preserved ejection fraction (HF- PEF). Methods 62 patients with HFPEF, 68 patients with HF and a reduced ejection fraction (HF- REF) and 40 healthy subjects were enrolled. Serum GDF- 15 and NT- proBNP concentration, left ventricular ejection fraction, left ventricular end diastolic dimension were measured. HF- PEF and HF- REF patients received conventional treatment and were followed up for 2 years. Results Serum GDF- 15 in HF- PEF patients was significantly higher than that in healthy subjects (P<0.01) and lower than that in HF- REF patients (P<0.01). The area under the receiver operating characteristic curve (AUC) for diagnosis of HFPEF was 0.814 for GDF- 15, significantly higher than 0.764 for NT- proBNP(P<0.05). AUC of GDF- 15 combined with NT- proBNP was 0.829, higher than either one alone (P<0.05). AUC for prediction of HF- related adverse events was 0.825 for GDF- 15 and 0.805 for NT- proBNP, which was 0.832 for GDF- 15 combined NT- proBNP and significantly higher than either of them (P<0.05). Conclusion Serum GDF- 15 is helpful in the diagnosis and prognostic prediction of HF- PEF, especial y when combined with NT- proBNP.%目的:探讨血清生长分子因子-15(GDF-15)在左心室射血分数(LVEF)正常心力衰竭(HF- PEF)患者诊断和预后预测中的意义。方法选择HF- PEF患者62例(HF- PEF组),LVEF减低心力衰竭68例(HF- REF组),健康者40例,测定血清GDF-15、NT- proBNP水平、LVEF和左心室舒张末期内径;HF- PEF、HF- REF组给予常规治疗并随访2年,记录心力衰竭相关不良事件。结果 HF- PEF组血清GDF-15水平高于对照组,低于HF- REF组,差异均有统计学意义(均P<0.01)。血清GDF-15和NT- proBNP诊断HF- PEF的ROC曲线下面积(AUC)分别为0.814和0.764,差异有统计学意义(P<0.05)

  19. Coronal Mass Ejections An Introduction

    CERN Document Server

    Howard, Timothy

    2011-01-01

    In times of growing technological sophistication and of our dependence on electronic technology, we are all affected by space weather. In its most extreme form, space weather can disrupt communications, damage and destroy spacecraft and power stations, and increase radiation exposure to astronauts and airline passengers. Major space weather events, called geomagnetic storms, are large disruptions in the Earth’s magnetic field brought about by the arrival of enormous magnetized plasma clouds from the Sun. Coronal mass ejections (CMEs) contain billions of tons of plasma and hurtle through space at speeds of several million miles per hour. Understanding coronal mass ejections and their impact on the Earth is of great interest to both the scientific and technological communities. This book provides an introduction to coronal mass ejections, including a history of their observation and scientific revelations, instruments and theory behind their detection and measurement, and the status quo of theories describing...

  20. Systolic versus diastolic cardiac function variables during epirubicin treatment for breast cancer

    DEFF Research Database (Denmark)

    Appel, Jon Michael; Jensen, Benny Vittrup; Nielsen, Dorthe L.;

    2010-01-01

    Anthracyclines are important in the treatment of numerous malignant diseases but the use is limited by a risk of heart failure (CHF). LVEF (left ventricular ejection fraction) measurements by radionuclide ventriculography with multiple gated acquisition (MUGA) is often used for cardiac monitoring....... However, diastolic variables have been proposed as sensitive supplements. It was hypothesized that a change in diastolic filling variables measured by MUGA could identify individuals after epirubicin treatment (ET) in risk of developing heart failure. A retrospective analysis of registered raw data...

  1. Systolic versus diastolic cardiac function variables during epirubicin treatment for breast cancer

    DEFF Research Database (Denmark)

    Appel, Jon Michael; Jensen, Benny V; Nielsen, Dorthe L.;

    2010-01-01

    Anthracyclines are important in the treatment of numerous malignant diseases but the use is limited by a risk of heart failure (CHF). LVEF (left ventricular ejection fraction) measurements by radionuclide ventriculography with multiple gated acquisition (MUGA) is often used for cardiac monitoring....... Individuals completing high-dose ET for breast cancer were selected from a 2-year period. All had MUGA-scans performed prior to and after ET and were observed clinically for late development of CHF. Eleven of 34 individuals developed CHF. A significant LVEF-reduction was recorded after ET with only minor...

  2. Quantitative analysis of cardiac function: Comparison of electrocardiogram dual gated single photon emission tomography, planar radionuclide ventriculogram and contrast ventriculography in the determination of LV volume and ejection fraction

    Energy Technology Data Exchange (ETDEWEB)

    Ziada, G.; Abdel-Dayem, H.M.; Higazy, E.; Mohamed, M.M.; Bahar, R.; Hayat, N.; Yousof, A.M.

    1987-03-01

    A dual gated tomography (DGT) program for end systolic and end diastolic acquisition and subsequent processing for calculation of LVEF, end diastolic and end systolic volumes (EDV, ESV) has been evaluated in 20 healthy volunteers (25 years-40 years) and 45 patients (25 years-60 years): 20 with ischaemic heart disease and 25 with valvular heart disease (VHD). All had biplane multigated blood pool (MUGA) studies in the 40/sup 0/ LAO projection using in vivo /sup 99m/Tc-R BCs, immediately followed by DG. The results in the patients group were correlated with contrast ventriculography (CV). In the volunteer group, the normal values for LVEF, EDV and ESV measured with DGT were found to be 63%+10%, 91 ml + 6 ml and 30 ml + 6ml and r value for the LVEF=0.91 compared with MUGA. In the IHD group, r values compared with CV were 0.915 and 0.97 for the EDV and ESV and 0.934 for the LVEF. Compared with the MUGA, the r value for LVEF was 0.883. In the VHD group, r values were 0.98 for both the EDV and ESV and 0.948 for the LVEF (P<0.002) compared with CV and 0.789 for the LVEF compared with the MUGA. We feel that DGT is an accurate and reproducible technique for LV function measurements.

  3. The Effects of Six-minute Walking Exercise on Exercise Tolerance of Heart Failure with Preserved Ejection Fraction%6分钟步行运动训练对射血分数保留的心力衰竭患者运动耐力的影响

    Institute of Scientific and Technical Information of China (English)

    任春琦; 张盼; 赵春勇; 赵慧慧

    2014-01-01

    目的:探讨6 min步行运动训练对射血分数保留的心力衰竭患者运动耐力的影响。方法:采用随机法将50例射血分数保留(LVEF≥50%)的心力衰竭患者分为训练组及对照组,每组25例。两组患者均给予常规药物治疗,训练组在上述治疗基础上每日辅以6 min步行运动训练。6个月后观察两组患者治疗前、后6 min步行距离变化情况。结果:经6个月治疗后,训练组6 min步行距离提高幅度显著优于对照组(P<0.05)。结论:6 min步行运动训练能显著改善射血分数保留心力衰竭患者的运动耐力,有益于提高生活质量。%Objective:To investigate the effects of 6-minutes of walking exercise(6-MWE) on the exercise tolerance of heart failure patients with preserved ejection fraction(HFpEF).Method:Fifty heart failure patients with preserved ejection fraction(LVEF≥50%) were randomly divided into an exercise training group and a control group with 25 cases in each.Each group was treated with routine drug.The exercise training group was treated with the same drugs plus 6-MWE.Before and after the six-month period of treatment,their 6-minute walk distance(6-MWD) was measured.Result:The 6-MWD of the experimental group improved significantly more than control group after 6 months(P<0.05).Conclusion:6-MWE can significantly improve the exercise tolerance of HFpEFs,and improve their quality of life.

  4. Cardiac structure and function during ageing in energetically compromised Guanidinoacetate N-methyltransferase (GAMT-knockout mice – a one year longitudinal MRI study

    Directory of Open Access Journals (Sweden)

    Clarke Kieran

    2008-02-01

    Full Text Available Abstract Background High-resolution magnetic resonance imaging (cine-MRI is well suited for determining global cardiac function longitudinally in genetically or surgically manipulated mice, but in practice it is seldom used to its full potential. In this study, male and female guanidinoacetate N-methyltransferase (GAMT knockout, and wild type littermate mice were subjected to a longitudinal cine-MRI study at four time points over the course of one year. GAMT is an essential enzyme in creatine biosynthesis, such that GAMT deficient mice are entirely creatine-free. Since creatine plays an important role in the buffering and transfer of high-energy phosphate bonds in the heart, it was hypothesized that lack of creatine would be detrimental for resting cardiac performance during ageing. Methods Measurements of cardiac structure (left ventricular mass and volumes and function (ejection fraction, stroke volume, cardiac output were obtained using high-resolution cine-MRI at 9.4 T under isoflurane anaesthesia. Results There were no physiologically significant differences in cardiac function between wild type and GAMT knockout mice at any time point for male or female groups, or for both combined (for example ejection fraction: 6 weeks (KO vs. WT: 70 ± 6% vs. 65 ± 7%; 4 months: 70 ± 6% vs. 62 ± 8%; 8 months: 62 ± 11% vs. 62 ± 6%; 12 months: 61 ± 7% vs. 59 ± 11%, respectively. Conclusion These findings suggest the presence of comprehensive adaptations in the knockout mice that can compensate for a lack of creatine. Furthermore, this study clearly demonstrates the power of cine-MRI for accurate non-invasive, serial cardiac measurements. Cardiac growth curves could easily be defined for each group, in the same set of animals for all time points, providing improved statistical power, and substantially reducing the number of mice required to conduct such a study. This technique should be eminently useful for following changes of cardiac structure and

  5. Berberine attenuates adverse left ventricular remodeling and cardiac dysfunction after acute myocardial infarction in rats: role of autophagy.

    Science.gov (United States)

    Zhang, Yao-Jun; Yang, Shao-Hua; Li, Ming-Hui; Iqbal, Javaid; Bourantas, Christos V; Mi, Qiong-Yu; Yu, Yi-Hui; Li, Jing-Jing; Zhao, Shu-Li; Tian, Nai-Liang; Chen, Shao-Liang

    2014-12-01

    The present study aimed to test the hypothesis that berberine, a plant-derived anti-oxidant, attenuates adverse left ventricular remodelling and improves cardiac function in a rat model of myocardial infarction (MI). Furthermore, the potential mechanisms that mediated the cardioprotective actions of berberine, in particular the effect on autophagy, were also investigated. Acute MI was induced by ligating the left anterior descending coronary artery of Sprague-Dawley rats. Cardiac function was assessed by transthoracic echocardiography. The protein activity/levels of autophagy related to signalling pathways (e.g. LC-3B, Beclin-1) were measured in myocardial tissue by immunohistochemical staining and western blot. Four weeks after MI, berberine significantly prevented cardiac dysfunction and adverse cardiac remodelling. MI rats treated with low dose berberine (10 mg/kg per day) showed higher left ventricular ejection fraction and fractional shortening than those treated with high-dose berberine (50 mg/kg per day). Both doses reduced interstitial fibrosis and post-MI adverse cardiac remodelling. The cardioprotective action of berberine was associated with increased LC-3B II and Beclin-1 expressions. Furthermore, cardioprotection with berberine was potentially related to p38 MAPK inhibition and phospho-Akt activation. The present in vivo study showed that berberine is effective in promoting autophagy, and subsequently attenuating left ventricular remodelling and cardiac dysfunction after MI. The potential underlying mechanism is augmentation of autophagy through inhibition of p38 MAPK and activation of phospho-Akt signalling pathways.

  6. Behavior of cardiac variables in animals exposed to cigarette smoke

    Directory of Open Access Journals (Sweden)

    Sergio Alberto Rupp de Paiva

    2003-09-01

    Full Text Available OBJECTIVE: To assess the behavior of cardiac variables in animals exposed to cigarette smoke. METHODS: Two groups of Wistar rats were studied as follows: control group (C, comprising 28 animals; and smoking group (S, comprising 23 animals exposed to cigarette smoke for 30 days. Left ventricular cardiac function was assessed in vivo with transthoracic echocardiography, and myocardial performance was analyzed in vitro in preparations of isolated left ventricular papillary muscle. The cardiac muscle was assessed in isometric contractions with an extracellular calcium concentration of 2.5 mmol/L. RESULTS: No statistical difference was observed in the values of the body variables of the rats and in the mechanical data obtained from the papillary muscle between the control and smoking groups. The values of left ventricular systolic diameter were significantly greater in the smoking animals than in the control animals (C= 3.39 ± 0.4 mm and S= 3.71 ± 0.51 mm, P=0.02. A significant reduction was observed in systolic shortening fraction (C= 56.7 ± 4.2% and S= 53.5 ± 5.3%, P=0.02 and in ejection fraction (C= 0.92 ± 0.02 and S= 0.89 ± 0.04, P=0.01. CONCLUSION: The rats exposed to cigarette smoke had a reduction in left ventricular systolic function, although their myocardial function was preserved.

  7. AVE 0991 attenuates cardiac hypertrophy through reducing oxidative stress.

    Science.gov (United States)

    Ma, Yuedong; Huang, Huiling; Jiang, Jingzhou; Wu, Lingling; Lin, Chunxi; Tang, Anli; Dai, Gang; He, Jiangui; Chen, Yili

    2016-06-10

    AVE 0991, the nonpeptide angiotensin-(1-7) (Ang-(1-7)) analog, is recognized as having beneficial cardiovascular effects. However, the mechanisms have not been fully elucidated. This study was designed to investigate the effects of AVE 0991 on cardiac hypertrophy and the mechanisms involved. Mice were underwent aortic banding to induce cardiac hypertrophy followed by the administration of AVE 0991 (20 mg kg·day (-1)) for 4 weeks. It was shown that AVE 0991 reduced left ventricular hypertrophy and improved heart function, characterized by decreases in left ventricular weight and left ventricular end-diastolic diameter, and increases in ejection fraction. Moreover, AVE 0991 significantly down-regulated mean myocyte diameter and attenuate the gene expression of the hypertrophic markers. Furthermore, AVE 0991 inhibited the expression of NOX 2 and NOX 4, meaning that AVE 0991 reduced oxidative stress of cardiac hypertrophy mice. Our data showed that AVE 0991 treatment could attenuate cardiac hypertrophy and improve heart function, which may be due to reduce oxidative stress.

  8. Electrocardiography as the First Step for the Further Examination of Cardiac Involvement in Myasthenia Gravis

    Directory of Open Access Journals (Sweden)

    Takao Kato

    2016-01-01

    Full Text Available Introduction. Cardiac involvement of myasthenia gravis (MG accompanies a poor prognosis. In the present study, we aimed to investigate the relationship between ECG abnormality and cardiac involvement. Methods. Of 178 patients diagnosed with MG between 2001 and 2013 at our hospital, we retrospectively analyzed consecutive 58 patients who underwent both ECG and echocardiography and without underlying cardiovascular disease. ECG abnormalities were defined by computer-assigned Minnesota-codes. Cardiac damage was defined as either (1 ejection fraction (EF 8 on echocardiography. Results. Thirty-three patients (56.8% had ECG abnormality. An elevated E/e′ was observed in patients with ECG abnormality compared to those without ECG abnormality (11.2±3.2, 8.7±2.2, resp., p=0.03. Among patients with ECG abnormality, 14 of 15 patients showed cardiac damage. Among patients without ECG abnormality, 6 of 33 patients showed cardiac damage (p=0.003. Reduced EF was observed in five patients (8.6% with ECG abnormality and none in patients without ECG abnormality. Conclusions. ECG may aid as the first step for the further examination of cardiac damage in patients with MG.

  9. In vivo MRI characterization of progressive cardiac dysfunction in the mdx mouse model of muscular dystrophy.

    Directory of Open Access Journals (Sweden)

    Daniel J Stuckey

    Full Text Available AIMS: The mdx mouse has proven to be useful in understanding the cardiomyopathy that frequently occurs in muscular dystrophy patients. Here we employed a comprehensive array of clinically relevant in vivo MRI techniques to identify early markers of cardiac dysfunction and follow disease progression in the hearts of mdx mice. METHODS AND RESULTS: Serial measurements of cardiac morphology and function were made in the same group of mdx mice and controls (housed in a non-SPF facility using MRI at 1, 3, 6, 9 and 12 months after birth. Left ventricular (LV and right ventricular (RV systolic and diastolic function, response to dobutamine stress and myocardial fibrosis were assessed. RV dysfunction preceded LV dysfunction, with RV end systolic volumes increased and RV ejection fractions reduced at 3 months of age. LV ejection fractions were reduced at 12 months, compared with controls. An abnormal response to dobutamine stress was identified in the RV of mdx mice as early as 1 month. Late-gadolinium-enhanced MRI identified increased levels of myocardial fibrosis in 6, 9 and 12-month-old mdx mice, the extent of fibrosis correlating with the degree of cardiac remodeling and hypertrophy. CONCLUSIONS: MRI could identify cardiac abnormalities in the RV of mdx mice as young as 1 month, and detected myocardial fibrosis at 6 months. We believe these to be the earliest MRI measurements of cardiac function reported for any mice, and the first use of late-gadolinium-enhancement in a mouse model of congenital cardiomyopathy. These techniques offer a sensitive and clinically relevant in vivo method for assessment of cardiomyopathy caused by muscular dystrophy and other diseases.

  10. 美托洛尔缓释片治疗左室射血分数保留的心力衰竭的疗效观察%Metoprolol extended-release tablets in treatment of heart failure with preserved ejection fraction

    Institute of Scientific and Technical Information of China (English)

    谢赟; 蒋金法

    2012-01-01

    Objective To evaluate the efficacy of metoprolol extended-release tablets in treatment of heart failure with preserved ejection fraction (HFpEF). Methods One hundred and thirty three patients with HFpEF were randomly assigned to receive conventional therapy and metoprolol extended-release tablets (metoprolol group, n = 69) or receive conventional therapy only ( control group, n = 64). The blood pressure, heart rate, left ventricular diastolic function were compared between the two groups. The metoprolol group was further divided into low-dosage treated group[ (47. 5 ±10) mg/d, n =40] and high-dosage group [ (95 ±20) mg/d, n - 29 ]. Results Left ventricular ejection fraction (LVEF) , left ventricular end diastolic diameter(LVEDD), blood pressure, heart rate and N-terminal pro-brain natriuretic peptide ( NT-pro-BNP) levels were improved significantly 12 months after treatment in the metoprolol group, there were significantly differences between metoprolol and control groups(P < 0. 05, P < 0. 01). The isovolumic relaxation time (IVRT) , early left ventricular filling velocity(E), velocity of left ventricular filling contributed by atrial contraction (A) , E/A and left atrial diameter( LAD) after treatment were better than those before treatments ( P < 0. 01), and also better than those in control group (P <0.01). Compared to those in low-dosage group,heart rate and plasma NTproBNP concentration in high-dosage group were significantly improved (P < 0. 01). Conclusion Metoprolol extended-release tablets can improve the heart diastolic function in patients with HFpEF; and high-dosage metoprolol may inhibit the over-activation of neural hormones and further improves biological efficacy.%目的 观察美托洛尔缓释片对左室射血分数保留的心力衰竭(heart failure with preserved ejection fraction,HFpEF)患者心功能的改善作用.方法 入选HFpEF患者133例,随机分成美托洛尔缓释片治疗组69例及对照组64例,两组患者均给予抗心力

  11. Apocynin improving cardiac remodeling in chronic renal failure disease is associated with up-regulation of epoxyeicosatrienoic acids.

    Science.gov (United States)

    Zhang, Kun; Liu, Yu; Liu, Xiaoqiang; Chen, Jie; Cai, Qingqing; Wang, Jingfeng; Huang, Hui

    2015-09-22

    Cardiac remodeling is one of the most common cardiac abnormalities and associated with a high mortality in chronic renal failure (CRF) patients. Apocynin, a nicotinamide-adenine dinucleotide phosphate (NADPH) oxidase inhibitor, has been showed cardio-protective effects. However, whether apocynin can improve cardiac remodeling in CRF and what is the underlying mechanism are unclear. In the present study, we enrolled 94 participants. In addition, we used 5/6 nephrectomized rats to mimic cardiac remodeling in CRF. Serum levels of epoxyeicosatrienoic acids (EETs) and its mainly metabolic enzyme-soluble epoxide hydrolase (sEH) were measured. The results showed that the serum levels of EETs were significantly decreased in renocardiac syndrome participants (P < 0.05). In 5/6 nephrectomized CRF model, the ratio of left ventricular weight / body weight, left ventricular posterior wall thickness, and cardiac interstitial fibrosis were significantly increased while ejection fraction significantly decreased (P < 0.05). All these effects could partly be reversed by apocynin. Meanwhile, we found during the process of cardiac remodeling in CRF, apocynin significantly increased the reduced serum levels of EETs and decreased the mRNA and protein expressions of sEH in the heart (P < 0.05). Our findings indicated that the protective effect of apocynin on cardiac remodeling in CRF was associated with the up-regulation of EETs. EETs may be a new mediator for the injury of kidney-heart interactions.

  12. Pacemaker optimization guided by echocardiography in cardiac resynchronization therapy

    Directory of Open Access Journals (Sweden)

    Trifunović Danijela

    2009-01-01

    Full Text Available Introduction. Cardiac resynchronization therapy (CRT or biventricular pacing is a contemporary treatment in the management of advanced heart failure. Echocardiography plays an evolving and important role in patient selection for CRT, follow-up of acute and chronic CRT effects and optimization of device settings after biventricular pacemaker implantation. In this paper we illustrate usefulness of echocardiography for successful AV and VV timing optimization in patients with CRT. A review of up-to-date literature concerning rationale for AV and VV delay optimization, echocardiographic protocols and current recommendations for AV and VV optimization after CRT are also presented. Outline of Cases. The first case is of successful AV delay optimization guided by echocardiography in a patient with dilated cardiomyopathy treated with CRT is presented. Pulsed blood flow Doppler was used to detect mitral inflow while programming different duration of AV delay. The AV delay with optimal transmittal flow was established. The optimal mitral flow was the one with clearly defined E and A waves and maximal velocity time integral (VTI of the mitral flow. Improvement in clinical status and reverse left ventricle remodelling with improvement of ejection fraction was registered in our patient after a month. The second case presents a patient with heart failure caused by dilated cardiomyopathy; six months after CRT implantation the patient was still NYHA class III and with a significantly depressed left ventricular ejection fraction. Optimization of VV interval guided by echocardiography was undertaken measuring VTI of the left ventricular outflow tract (LVOT during programming of different VV intervals. The optimal VV interval was determined using a maximal LVOT VTI. A month after VV optimization our patient showed improvement in LV ejection fraction. Conclusion. Optimal management of patients treated with CRT integrate both clinical and echocardiographic follow

  13. Cardiac function adaptations in hibernating grizzly bears (Ursus arctos horribilis).

    Science.gov (United States)

    Nelson, O Lynne; Robbins, Charles T

    2010-03-01

    Research on the cardiovascular physiology of hibernating mammals may provide insight into evolutionary adaptations; however, anesthesia used to handle wild animals may affect the cardiovascular parameters of interest. To overcome these potential biases, we investigated the functional cardiac phenotype of the hibernating grizzly bear (Ursus arctos horribilis) during the active, transitional and hibernating phases over a 4 year period in conscious rather than anesthetized bears. The bears were captive born and serially studied from the age of 5 months to 4 years. Heart rate was significantly different from active (82.6 +/- 7.7 beats/min) to hibernating states (17.8 +/- 2.8 beats/min). There was no difference from the active to the hibernating state in diastolic and stroke volume parameters or in left atrial area. Left ventricular volume:mass was significantly increased during hibernation indicating decreased ventricular mass. Ejection fraction of the left ventricle was not different between active and hibernating states. In contrast, total left atrial emptying fraction was significantly reduced during hibernation (17.8 +/- 2.8%) as compared to the active state (40.8 +/- 1.9%). Reduced atrial chamber function was also supported by reduced atrial contraction blood flow velocities and atrial contraction ejection fraction during hibernation; 7.1 +/- 2.8% as compared to 20.7 +/- 3% during the active state. Changes in the diastolic cardiac filling cycle, especially atrial chamber contribution to ventricular filling, appear to be the most prominent macroscopic functional change during hibernation. Thus, we propose that these changes in atrial chamber function constitute a major adaptation during hibernation which allows the myocardium to conserve energy, avoid chamber dilation and remain healthy during a period of extremely low heart rates. These findings will aid in rational approaches to identifying underlying molecular mechanisms.

  14. PS, septum magnet for ejection of antiprotons

    CERN Multimedia

    1980-01-01

    Antiprotons circulated in the PS in the sense opposite to that of the so far normal protons (or positive ions). A new ejection system with a new septum magnet was installed in straight section 58 for antiproton ejection, first towards the ISR and then to the principal customer, the SPS p-pbar Collider. Later on, when the PS delivered leptons for LEP, the antiproton ejection system was use for the ejection of electrons.

  15. Myocardial perfusion imaging for predicting cardiac events in Japanese patients with advanced chronic kidney disease: 1-year interim report of the J-ACCESS 3 investigation

    Energy Technology Data Exchange (ETDEWEB)

    Joki, Nobuhiko; Hase, Hiroki [Toho University Ohashi Medical Center, Department of Nephrology, Tokyo (Japan); Kawano, Yuhei; Nakamura, Satoko [National Cerebral and Cardiovascular Center, Division of Hypertension and Nephrology, Osaka (Japan); Nakajima, Kenichi [Kanazawa University Hospital, Department of Nuclear Medicine, Kanazawa (Japan); Hatta, Tsuguru [Hatta Medical Office of Internal Medicine, Kyoto (Japan); Nishimura, Shigeyuki [Saitama Medical University International Medical Center, Saitama (Japan); Moroi, Masao [Toho University Ohashi Medical Center, Department of Cardiology, Tokyo (Japan); Nakagawa, Susumu [Saiseikai Central Hospital, Department of Cardiology, Tokyo (Japan); Kasai, Tokuo [Tokyo Medical University Hachioji Medical Center, Tokyo (Japan); Kusuoka, Hideo [Osaka National Hospital, Osaka (Japan); Takeishi, Yasuchika [Fukushima Medical University, Department of Cardiology and Hematology, Fukushima (Japan); Momose, Mitsuru [Tokyo Women' s Medical University, Department of Diagnostic Imaging and Nuclear Medicine, Tokyo (Japan); Takehana, Kazuya [Kansai Medical University, Department of Cardiology, Osaka (Japan); Nanasato, Mamoru [Cardiovascular Center, Nagoya Daini Red Cross Hospital, Nagoya (Japan); Yoda, Shunichi [Nihon University Itabashi Hospital, Department of Cardiology, Tokyo (Japan); Nishina, Hidetaka [Tsukuba Medical Center Hospital, Department of Cardiology, Tsukuba (Japan); Matsumoto, Naoya [Suruga-dai Nihon University Hospital, Department of Cardiology, Tokyo (Japan); Nishimura, Tsunehiko [Kyoto Prefectural University of Medicine, Kamigyo-ku, Kyoto (Japan)

    2014-09-15

    Whether myocardial perfusion imaging (MPI) can predict cardiac events in patients with advanced conservative chronic kidney disease (CKD) remains unclear. The present multicenter prospective cohort study aimed to clarify the ability of MPI to predict cardiac events in 529 patients with CKD and estimated glomerular filtration rates (eGFR) < 50 ml/min per 1.73{sup 2} without a definitive diagnosis of coronary artery disease. All patients were assessed by stress-rest MPI with {sup 99m}Tc-tetrofosmin and analyzed using summed defect scores and QGS software. Cardiac events were analyzed 1 year after registration. Myocardial perfusion abnormalities defined as summed stress score (SSS) ≥4 and ≥8 were identified in 19 and 7 % of patients, respectively. At the end of the 1-year follow-up, 33 (6.2 %) cardiac events had occurred that included cardiac death, sudden death, nonfatal myocardial infarction, and hospitalization due to heart failure. The event-free rates at that time were 0.95, 0.90, and 0.81 for groups with SSS 0-3, 4-7, and ≥8, respectively (p = 0.0009). Thus, patients with abnormal SSS had a higher incidence of cardiac events. Multivariate Cox regression analysis showed that SSS significantly impacts the prediction of cardiac events independently of eGFR and left ventricular ejection fraction. MPI would be useful to stratify patients with advanced conservative CKD who are at high risk of cardiac events without adversely affecting damaged kidneys. (orig.)

  16. Evaluation of right ventricular volume and mass using retrospective ECG-gated cardiac multidetector computed tomography: comparison with first-pass radionuclide angiography

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Tae Hoon [Yonsei University College of Medicine, Department of Radiology, Seoul (Korea); Yongdong Severance Hospital, Department of Radiology, Seoul (Korea); Ryu, Young Hoon; Hur, Jin; Kim, Sang Jin; Kim, Hyun Soo; Choi, Byoung Wook [Yonsei University College of Medicine, Department of Radiology, Seoul (Korea); Kim, Young; Kim, Hyung Jung [Yonsei University College of Medicine, Department of Pulmonology, Seoul (Korea)

    2005-09-01

    The purposes of this study were to evaluate the right ventricular (RV) volume and mass using cardiac multidetector computed tomography (MDCT) and to compare the cardiac MDCT results with those from first-pass radionuclide angiography (FPRA). Twenty patients were evaluated for the RV end-diastolic volume (RVEDV), the RV end-systolic volume (RVESV), the RV ejection fraction (RVEF), and RV mass using cardiac MDCT with a two-phase reconstruction method based on ECG. The end-diastolic phase was reconstructed at the starting point of the QRS complex on ECG, and the end-systolic phase was reconstructed at the halfway point of the ascending T-wave on ECG. The RV mass was measured for the end-systole. The RVEF was also obtained by FPRA. The mean RVEF (47{+-}7%) measured by cardiac MDCT was well correlated with that (44{+-}6%) measured by FPRA (r=0.854). A significant difference in the mean RVEF was found between cardiac MDCT and FPRA (p=0.001), with an overestimation of 2.9{+-}5.3% by cardiac MDCT versus FPRA. The interobserver variability was 4.4% for the RVEDV, 6.8% for the RVESV, and 7.9% for the RV mass, respectively. Cardiac MDCT is relatively simple and allows the RV volume and mass to be assessed, and the RVEF obtained by cardiac MDCT correlates well with that measured by FPRA. (orig.)

  17. Severe Left Ventricular Hypertrophy, Small Pericardial Effusion, and Diffuse Late Gadolinium Enhancement by Cardiac Magnetic Resonance Suspecting Cardiac Amyloidosis: Endomyocardial Biopsy Reveals an Unexpected Diagnosis

    Directory of Open Access Journals (Sweden)

    Nina P. Hofmann

    2016-01-01

    Full Text Available Left ventricular (LV hypertrophy can be related to a multitude of cardiac disorders, such as hypertrophic cardiomyopathy (HCM, cardiac amyloidosis, and hypertensive heart disease. Although the presence of LV hypertrophy is generally associated with poorer cardiac outcomes, the early differentiation between these pathologies is crucial due to the presence of specific treatment options. The diagnostic process with LV hypertrophy requires the integration of clinical evaluation, electrocardiography (ECG, echocardiography, biochemical markers, and if required CMR and endomyocardial biopsy in order to reach the correct diagnosis. Here, we present a case of a patient with severe LV hypertrophy (septal wall thickness of 23 mm, LV mass of 264 g, and LV mass index of 147 g/m2, severely impaired longitudinal function, and preserved radial contractility (ejection fraction = 55%, accompanied by small pericardial effusion and diffuse late gadolinium enhancement (LGE by cardiac magnetic resonance (CMR. Due to the imaging findings, an infiltrative cardiomyopathy, such as cardiac amyloidosis, was suspected. However, amyloid accumulation was excluded by endomyocardial biopsy, which revealed the presence of diffuse myocardial fibrosis in an advanced hypertensive heart disease.

  18. Insuficiência cardíaca com fração de ejeção preservada e com disfunção sistólica na comunidade Heart failure with preserved ejection fraction and systolic dysfunction in the community

    Directory of Open Access Journals (Sweden)

    Marco Aurélio Esposito Moutinho

    2008-02-01

    Full Text Available FUNDAMENTO: Em países desenvolvidos, a insuficiência cardíaca com fração de ejeção preservada (ICFEP é o modelo mais prevalente que a insuficiência cardíaca com disfunção sistólica (ICDS na comunidade. No entanto, não está plenamente estabelecido se tal fato também é observado na nossa comunidade. OBJETIVO: Determinar o tipo mais prevalente de insuficiência cardíaca (ICFEP ou ICDS e se a prevalência de ICFEP é elevada na comunidade. MÉTODOS: Estudo transversal de pacientes atendidos na comunidade com diagnóstico clínico de IC, de janeiro a dezembro de 2005. O ecodopplercardiograma foi realizado em todos os pacientes. O tipo de IC foi estratificado pela presença de anormalidades e pela fração de encurtamento ao ecodopplercardiograma. RESULTADOS: O estudo avaliou 170 pacientes (61,0±13,3 anos, a maioria mulheres e idosos. A ICFEP foi o tipo de IC mais prevalente (64,2%, pBACKGROUND: In developed countries, heart failure with preserved ejection fraction (HFpEF is more prevalent than heart failure with reduced ejection fraction (HFrEF in the community. However, it has not been completely established if this fact is also observed within our community. OBJECTIVE: To determine the most prevalent form of heart failure (HFpEF or HFrEF and whether the prevalence of HFpEF is higher in the community. METHODS: This is a cross-sectional study conducted with patients clinically diagnosed with HF who were seen in community-based health care centers from January to December 2005. Echodopplercardiograms were performed for all patients. The form of HF was stratified according to the presence of abnormalities and the shortening fraction observed on the echodopplercardiogram. RESULTS: The study evaluated 170 patients (61.0 ± 13.3 years of age, most of them women and elderly. HFpEF was the more prevalent form of HF (64.2%, p<0.001, affecting mostly elderly women (62%, p = 0.07, whereas the opposite condition, HFrEF, was observed mostly in

  19. 高血压患者左室射血分数及心功能改变与正五聚蛋白3的关系研究%Changes of pentraxin-3 in the patients of normal left ventricular ejection fraction with heart failure in hypertention heart disease

    Institute of Scientific and Technical Information of China (English)

    张爱军; 罗波; 黄磊; 代丹娇

    2013-01-01

      目的对比观察正五聚蛋白3(PTX3)在高血压不同心功能状况和射血分数的患者中的变化,并探讨其临床意义。方法连续选取武汉市武昌医院门诊或心内科、老年科诊治的156例初诊原发性高血压患者为研究对象,先依据心脏超声结果分为两组:单纯高血压(PH)组42例和高血压心脏病(HHD)组114例。后者又依据左心室射血分数及有无心功能衰竭症状分为HHD无心力衰竭(NHF)亚组34例、射血分数正常 HHD 心力衰竭(HFNEF)亚组36例和射血分数降低 HHD 心力衰竭(HFREF)亚组44例。抽取静脉血检测所有患者的PTX3、超敏C反应蛋白(hs-CRP)和N端脑钠肽前体(NT-proBNP)并予以比较、分析。结果 PH组PTX3、hs-CRP、NT-proBNP水平明显低于 HHD组,差异有统计学意义(P<0.01)。 HHD组中PTX3、hs-CRP、NT-proBNP水平则从NHF亚组到 HFNEF亚组,再到 HFREF亚组依次升高,两两比较差异均有统计学意义(P<0.01)。PTX3水平与hs-CRP水平呈正相关(r=0.573,P<0.01),与 NT-proBNP水平呈正相关(r=0.452,P<0.01)。结论PTX3在 HHD患者中随病情进展逐渐增高,可以作为监测高血压患者心功能及射血分数变化的一项生物学指标,从而在协助H HD左心室射血分数正常心力衰竭诊断上发挥一定的作用。%Objective To explore the changes of pentraxin-3(PTX-3) in the normal left ventricular ejection fraction of patients with heart failure in patients of hypertention heart disease and discuss its clinical significance .Methods 156 outpatients or inpa-tients of department of Cardiovascular ,Geriatrics ,firstly diagnosed primary hypertension ,of Wuchang hospital in WuHan City were selected as research objects .the subjects were divided into two groups based on the results of echocardiography :simple primary hy-pertension(PH) group(42 cases)and hypertention heart disease(HHD) group(114

  20. Massive right-sided cardiac thrombosis in Chagas' heart disease without left ventricular dysfunction.

    Science.gov (United States)

    Bestetti, Reinaldo B; Corbucci, Hélio A R; Cardinalli-Neto, Augusto

    2011-02-01

    A 63-year-old woman with the diagnosis of mega-oesophagus secondary to chronic Chagas' disease and no past cardiac history was referred for cardiac evaluation. The resting ECG showed right bundle-branch block, whereas a 2-D echocardiogram revealed marked right ventricular dilatation with hypokinesia, right atrial dilatation, normal pulmonary artery pressure, and normal left ventricular ejection fraction. A large, irregularly shaped mass, arising from the right atrium and protruding into the right ventricle through the tricuspid valve, with several different bizarre forms inside the right atrium during systole and/or diastole was seen on 2-D echocardiogram. Therefore, massive right-sided thrombosis can be detected in Chagas' disease patients with no overt right- and left-sided ventricular failure.

  1. Tissue Doppler echocardiography reveals impaired cardiac function in patients with reversible ischaemia

    DEFF Research Database (Denmark)

    Hoffmann, Søren; Mogelvang, Rasmus; Sogaard, Peter;

    2011-01-01

    = 30) or without (false-positive SPECT, n= 12) significant coronary stenoses assessed by CAG. Regional longitudinal systolic (s'), early diastolic (e'), and late diastolic (a') myocardial velocities were measured by colour TDI at six mitral annular sites and averaged to provide global estimates...... of the cardiac function was even more evident in patients with a true-positive SPECT with reduced average s' (5.5 ± 0.8 vs. 6.1 ± 1.1 cm/s; P... velocities could be demonstrated in patients with a false-positive SPECT compared with controls. CONCLUSION: In patients with stable angina pectoris, preserved ejection fraction, and reversible ischaemia assessed by SPECT, echocardiographic colour TDI performed at rest reveals impaired cardiac function...

  2. Cardiac and Skeletal Muscle Defects in a Mouse Model of Human Barth Syndrome*

    Science.gov (United States)

    Acehan, Devrim; Vaz, Frederic; Houtkooper, Riekelt H.; James, Jeanne; Moore, Vicky; Tokunaga, Chonan; Kulik, Willem; Wansapura, Janaka; Toth, Matthew J.; Strauss, Arnold; Khuchua, Zaza

    2011-01-01

    Barth syndrome is an X-linked genetic disorder caused by mutations in the tafazzin (taz) gene and characterized by dilated cardiomyopathy, exercise intolerance, chronic fatigue, delayed growth, and neutropenia. Tafazzin is a mitochondrial transacylase required for cardiolipin remodeling. Although tafazzin function has been studied in non-mammalian model organisms, mammalian genetic loss of function approaches have not been used. We examined the consequences of tafazzin knockdown on sarcomeric mitochondria and cardiac function in mice. Tafazzin knockdown resulted in a dramatic decrease of tetralinoleoyl cardiolipin in cardiac and skeletal muscles and accumulation of monolysocardiolipins and cardiolipin molecular species with aberrant acyl groups. Electron microscopy revealed pathological changes in mitochondria, myofibrils, and mitochondrion-associated membranes in skeletal and cardiac muscles. Echocardiography and magnetic resonance imaging revealed severe cardiac abnormalities, including left ventricular dilation, left ventricular mass reduction, and depression of fractional shortening and ejection fraction in tafazzin-deficient mice. Tafazzin knockdown mice provide the first mammalian model system for Barth syndrome in which the pathophysiological relationships between altered content of mitochondrial phospholipids, ultrastructural abnormalities, myocardial and mitochondrial dysfunction, and clinical outcome can be completely investigated. PMID:21068380

  3. Cardiac mechanics in patients with human immunodeficiency virus: a study of systolic myocardial deformation in children and young adults.

    Science.gov (United States)

    Al-Naami, Ghassan; Kiblawi, Fuad; Kest, Helen; Hamdan, Ayman; Myridakis, Dorothy

    2014-08-01

    Human immunodeficiency virus (HIV) infection causes dysfunction of different organ systems. Myocardial diastolic dysfunction has been reported previously in an adult HIV population. Our aim was to study myocardial strain in children and young adults infected by HIV who have apparently normal ejection fraction. Forty HIV-infected patients (mean age 20.6 ± 1.5 years) with normal ejection fraction and 55 matched normal controls (mean age 17 ± 1.5 years) were studied by two-dimensional echocardiogram. The images were stored then exported to velocity vector imaging software for analysis. Measures considered were left-ventricular peak global systolic strain (LV S) and strain rate (LV SR) as well as right-ventricular peak global systolic strain (RV S) and strain rate (RV SR). Circumferential measures of the left ventricle included the following: LV circumferential peak global systolic strain (LV circ S), strain rate (LV circ SR), radial velocity (LV rad vel), and rotational velocity (LV rot vel) at the level of the mitral valve. Statistical significance was set at p strain and strain rate in children and young adults. Normal ejection fraction might be attributed to preserved circumferential myocardial deformation. Strain and strain rate may help identify HIV patients at high risk for cardiac dysfunction and allow early detection of silent myocardial depression.

  4. Cardiac function in total anomalous pulmonary venous return before and after surgery.

    Science.gov (United States)

    Mathew, R; Thilenius, O G; Replogle, R L; Arcilla, R A

    1977-02-01

    Cardiac performance was evaluated in 12 infants with isolated total anomalous pulmonary venous return. Four had significant pulmonary venous obstruction and severe pulmonary hypertension (group A). Eight had no obvious venous obstruction, and the pulmonary pressures were lower (group B). In all subjects, right ventricular end-diastolic volume was increased (197% of predicted normal) and its ejection fraction was normal. Left ventricular volume was, generally speaking, still in the normal range (87% of predicted normal); however, its ejection fraction was reduced (0.57 vs normal of 0.73) and left ventricular output was low (3.08 L/min/m2 vs normal of 3.98). Left atrial volume was consistently small (53% of predicted normal) with an appendage of normal size. The infants in group A had smaller chamber volumes/m2 BSA than those in group B. Left atrial function was abnormal, characterized by reduced reservoir function and a greater role as "conduit" from right atrium to left ventricle. Left atrial size was not found to be critical in the surgical repair of TAPVR. Cardiac function is restored to normal following surgery.

  5. 左心房容积指数及左心房内径指数对射血分数正常心力衰竭的诊断价值对比分析%Compraison between index left atrium volume and index left atrium diameter of their diagnostic value for heart failure with preserved ejection fraction

    Institute of Scientific and Technical Information of China (English)

    叶茜; 杨昕宇; 朱楠; 何大军

    2012-01-01

    Objective To explore the value of left atrium volume index (LAVI)and left atrium diameter index ( LADI) in diagnosis of heart failure with preserved ejection fraction ( HFPEF). Methods Thirty-live patients with HFPEF and 35 patients with Non-HFPEF recruited from Oct 2010 to Oct 2011 in the second people's hospital of Dazhou were enrolled in this study. A series of parameters including left ventricular ejection fraction (LVEF) , LAVI, LADI, left ventricular mass index (LVMI) , mitral low velocity peak at early diastole ( E) , mitral low velocity peak at the end of diastole (A) , initial mitral low deceleration time ( DT) , mitral ring velocity at early diastole (E') , E/A ratio and E/E'ratio were measured and compared between two groups of patients ( HFPEF and Non-HFPEF). Parameters exhibited significant variations between two groups were tested by Pearson association analysis and ROC curve analysis for their association with HFPEF. Results At the cutting edge of 36 ml/m2 , a remarkable association between LAVI and HFPEF was observed. The specificity, sensitivity and accuracy of LAVI for diagnosing HFPEF were 84%. LADI showed a lesser association with HFPEF at the cutting edge of 2.5 cm/m2 , for which the specificity, sensitivity and accuracy were 65% ,70% and 66% , respectively. Conclusions LAVI might play a role as a potential indicator in the diagnosis of HFPEF.%目的 探讨超声心动图左心房容积指数(LAVI)及左心房内径指数(LADI)对射血分数保存心力衰竭(HFPEF)的诊断价值.方法 选取2010年9月至2011年9月于达州市第二人民医院住院的心力衰竭患者70例,其中HEPEF患者35例,非HEPEF患者35例,分别比较2组患者左心室射血分数(LVEF)、LAVI、LADI、左心室质量指数(LVMI)、舒张早期血流速度(E)、舒张晚期血流速度(A)、早期二尖瓣减速时间(DT)、舒张早期运动速度(E′)、舒张早期血流速度与舒张晚期血流速度比值(E/A)、舒张早期二尖瓣血流速度与

  6. Patterns of left ventricular geometry and the transition to congestive heart failure with preserved versus depressed ejection fraction (Patrones de geometría ventricular izquierda y la transición a la insuficiencia cardíaca congestiva con fracción de eyección conservada versus deprimida

    Directory of Open Access Journals (Sweden)

    José H. Donis Hernández

    2014-12-01

    Full Text Available Abstract (english Analysis of cross-sectional and follow up clinical studies, of hypertensive patients with the different left ventricular geometric patterns, provide plausible explanations for the transition from hypertensive heart disease to the two distinct phenotypes of systolic and diastolic congestive heart failure. According to the LIFE study treated-uncomplicated patients, with normal ventricular geometry (12%, concentric remodeling (11 % and concentric hypertrophy (34 %, may evolve to the eccentric hypertrophy pattern. Patients with the eccentric hypertrophy pattern have selective sympathetic activation and progressive enlargement of the left ventricular cavity with thinning of its walls. This pattern goes on to a stage of systolic dysfunction with diminished ejection fraction and enhanced degradation of the collagen matrix. On the other hand, patients with the concentric hypertrophy pattern have predominant activation of the renin-angiotensin-aldosterone system and progressive shrinking of the left ventricular cavity with thickening of its walls. This pattern usually precedes the stage of diastolic heart failure with preserved ejection fraction, impairment of relaxation and increased deposition of collagen in the myocardial interstitium. Thus, ventricular remodeling preceding diastolic heart failure is opposite to that of hypertensive patients who go on to develop systolic heart failure. Resumen (español El análisis de los estudios transversales y longitudinales, de pacientes hipertensos con diferentes patrones de geometría ventricular izquierda, permite postular posibles mecanismos fisiopatológicos para explicar la transición de la cardiopatía hipertensiva hacia los dos fenotipos conocidos de insuficiencia cardiaca. De acuerdo con el estudio LIFE, los pacientes hipertensos no complicados, con patrones de geometría ventricular normal (12 %, remodelado concéntrico (11 % e hipertrofia concéntrica (34 %, pueden evolucionar hacia

  7. QRS间期与射血分数保留性心力衰竭患者长期预后的关系%Relation between QRS Duration and Long-term Prognosis of Patients with Heart Failure with Preserved Ejection Fraction(HFPEF)

    Institute of Scientific and Technical Information of China (English)

    易莉莎; 武庆平; 谢飞; 郭超; 袁世荧; 刘宏; 漆红; 姚尚龙

    2014-01-01

    目的 探讨QRS间期延长是否影响射血分数保留性心力衰竭(heart failure with preserved ejection fraction,HFPEF)患者的长期预后.方法根据纳入标准,入选264例HFPEF患者,按QRS间期宽度分为正常组(≤120 ms)和延长组(>120 ms),分别为174例和90例,随访至2012年12月,比较两组终点事件(全因死亡)的差异,并通过Cox危险模型分析QRS间期延长对终点事件的影响.结果 平均随访1.8年,延长组全因病死率高于正常组(46.7% vs.31.6%),差异有统计学意义(P<0.01);单因素风险模型分析显示,QRS间期延长增加HFPEF患者的全因病死率(危险比:HR 1.67,95%CI:1.32~2.16,P<0.01),校正相关因素后,趋势仍未改变(HR 1.12,95%CI 1.05~1.19,P<0.05).结论 QRS间期延长是HFPEF患者全因病死率的独立危险因素.

  8. Variation of PⅠCP and PⅢNP in the elderly with hypertension and heart failure with normal ejection fraction%老年高血压合并射血分数正常的心力衰竭患者血清PⅠCP、PⅢNP水平的变化

    Institute of Scientific and Technical Information of China (English)

    杜丽波; 方向明; 何兆初

    2012-01-01

    Objective To define variation of PⅢNP and PⅠCP in the elderly with hypertension and heart failure with normal ejection fraction ( HFNEF). Methods 40 patients ( ≥65 years old) with hypertension and HFPEF were selected, 40 elderly with hypertension without HKNEF were selected as control. Serum of PⅠCP and PⅢNP were measured Results Serum PⅠCP and PⅢNP were significantly increased in patients with hypertension and HFNEF. Conclusions Serum PⅠCP and PⅢNP is positively correlated with left ventricular diastolic function ( LVDF). PⅠCP and PⅢNP can be used to determine the degree of myocardial fibrosis degree and the LVDF in the elderly with hypertension.%目的 探讨老年高血压患者血清Ⅰ型前胶原羧基末端肽(pICp)、Ⅲ型前胶原氨基末端肽(PⅢNP)水平与左室舒张功能(LVDF)的相关性.方法 选取40例年龄≥65岁的高血压合并射血分数正常的心力衰竭( HFN EF),对照组取40例未合并HFPEF的高血压患者,分别测定其血清PICP、PⅢNP水平,并进行统计分析.结果 合并HFPEF的老年高血压患者血清PICP、PⅢNP水平较对照组显著升高.结论 血清PICP、PⅢNP水平与LVDF相关,可作为了解老年高血压患者心肌纤维化程度及LVDF的特异性指标.

  9. 和肽素对左心室射血分数保留的心力衰竭患者的治疗意义%Investigation into the clinical significance of the level of copeptin in heart failure patients with preserved left ventricular ejection fraction

    Institute of Scientific and Technical Information of China (English)

    汪海燕; 杨滨

    2015-01-01

    [目的]探讨射血分数保留的心力衰竭(heart failure with preserved left ventricular ejection fraction,HFPEF)患者和肽素与左心室舒张功能障碍程度、纽约心功能分级(New York Heart Association,NYHA)之间的关系.[方法]选择2012年8月至2013年8月我院心内科明确诊断射血分数保留的心力衰竭组63例,同期选50名无器质性心脏病者为对照组.测定血和肽素水平,心脏彩色多普勒超声测定左心室结构、左心室射血分数、左心室舒张功能.[结果]HFPEF组和肽素水平[(22.54±4.61)pmol/L]明显高于对照组[(4.40±0.72)pmol/L](P<0.01),和肽素水平随NYHA分级的增加而升高(P<0.01);和肽素水平随着左心室舒张功能障碍程度加重而升高(P<0.01).[结论]血和肽素水平有助于评估射血分数保留的心力衰竭者的心功能状态.

  10. Effects of right atrial and ventricular DDD pacing on cardiac function and ventricular contraction synchrony

    Institute of Scientific and Technical Information of China (English)

    支力大; 华伟; 张澍; 史蓉芳; 王方正; 陈新

    2004-01-01

    Background Right ventricular apical pacing has been reported to reduce cardiac performance. But there are few reports on the effects of dual chamber (DDD) pacing on cardiac function compared to sinus rhythm. In this study, we evaluated the effects of right atrial and ventricular DDD pacing on cardiac function and ventricular contraction synchrony using equilibrium radionuclide angiography.Methods Ten patients implanted with a right atrial and ventricular DDD pacemaker underwent equilibrium radionuclide angiography. The scintigraphic data were obtained during sinus rhythm and pacing rhythm. Cardiac function parameters were obtained semimanually. Phase analysis was used to study the ventricular activation sequence and ventricular synchrony.Results The left ventricular 1/3 ejection fraction decreased significantly during pacing compared with that during sinus rhythm[(23.4 ±6.1)% vs(27.7 ±4.5)%, P =0.01]. Regional ejection fraction also decreased during pacing, although the difference was not statistically significant. Phase analysis showed that the right ventricle was activated earlier than the left ventricle during pacing, and that the phase shift was significantly greater during pacing than that during sinus rhythm[64.13°±16.80° vs 52.88°± 9.26°, P =0.007]. The activation of both ventricles occurred simultaneously during sinus rhythm, with the activation sequence from proximal septum or base of left ventricle to apex. The earliest activation during pacing occurred at the right ventricular apex, and subsequently spread to the base and left ventricle.Conclusion Right atrial and ventricular DDD pacing impairs left ventricular systolic function and ventricular synchrony.

  11. Cardiac resynchronization therapy pacemaker: critical appraisal of the adaptive CRT-P device

    Directory of Open Access Journals (Sweden)

    Daoud GE

    2016-01-01

    Full Text Available Georges E Daoud,1 Mahmoud Houmsse2 1Department of the Biomedical Research, 2Division of Cardiovascular Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA Abstract: Cardiac resynchronization therapy (CRT is an effective and well-established therapy for patients suffering with heart failure, left ventricular (LV systolic dysfunction (ejection fraction ≤35%, and electrical dyssynchrony, demonstrated by a surface QRS duration of ≥120 ms. Patients undergoing treatment with CRT have shown significant improvement in functional class, quality of life, LV ejection fraction, exercise capacity, hemodynamics, and reverse remodeling of LV, and ultimately, morbidity and mortality. However, 30%–40% of patients who receive a CRT device may not show improvement, and they are termed as nonresponders. The nonresponders have a poor prognosis; several methods have been developed to try to enhance response to CRT. Echocardiography-guided optimization of CRT has not resulted in significant clinical benefit, since it is done at rest with the patient in supine position. An ideal optimization strategy would provide continuous monitoring and adjustment of device pacing to provide maximal cardiac resynchronization, under a multitude of physiologic states. Intrinsic activation of the right ventricle (RV with paced activation of the RV, even in the setting of biventricular (BiV pacing, may result in an adverse effect on cardiac performance. With this physiology, the use of LV-only pacing may be preferred and may enhance CRT. Adaptive CRT is a novel device-based algorithm that was designed to achieve patient-specific adjustment in CRT so as to provide appropriate BiV pacing or LV-only pacing. This article will review the goals of CRT optimization, and implementation and outcomes associated with adaptive CRT. Keywords: heart failure, cardiac resynchronization, therapy, adaptive, left and biventricular pacing

  12. Galnt1 is required for normal heart valve development and cardiac function.

    Directory of Open Access Journals (Sweden)

    E Tian

    Full Text Available Congenital heart valve defects in humans occur in approximately 2% of live births and are a major source of compromised cardiac function. In this study we demonstrate that normal heart valve development and cardiac function are dependent upon Galnt1, the gene that encodes a member of the family of glycosyltransferases (GalNAc-Ts responsible for the initiation of mucin-type O-glycosylation. In the adult mouse, compromised cardiac function that mimics human congenital heart disease, including aortic and pulmonary valve stenosis and regurgitation; altered ejection fraction; and cardiac dilation, was observed in Galnt1 null animals. The underlying phenotype is aberrant valve formation caused by increased cell proliferation within the outflow tract cushion of developing hearts, which is first detected at developmental stage E11.5. Developing valves from Galnt1 deficient animals displayed reduced levels of the proteases ADAMTS1 and ADAMTS5, decreased cleavage of the proteoglycan versican and increased levels of other extracellular matrix proteins. We also observed increased BMP and MAPK signaling. Taken together, the ablation of Galnt1 appears to disrupt the formation/remodeling of the extracellular matrix and alters conserved signaling pathways that regulate cell proliferation. Our study provides insight into the role of this conserved protein modification in cardiac valve development and may represent a new model for idiopathic valve disease.

  13. Evaluation of left atrial function by three-dimensional speckle-tracking echocardiography in heart failure with preserved ejection fraction patients%三维斑点追踪技术对左室射血分数保留心衰患者左房功能的评估价值

    Institute of Scientific and Technical Information of China (English)

    刘峻松; 王晶; 张波; 刘博罕; 吕文青; 徐勇; 智光

    2015-01-01

    目的 应用三维斑点追踪技术(3D-STE)和实时三维超声心动图(RT3DE)评估探讨左室射血分数保留心衰(HFpEF)患者左房功能变化及意义.方法 将43例HFpEF患者根据左房大小分为A组(左房最大容积指数LAVImax< 34 mL/m2)和B组(LAVImax≥34 ml/m2),18例健康者为对照组.应用3 DSTE分析获取左房基底(Basal)、中间(Middle)、房顶(Roof)和整体(Global)的心室收缩期长轴峰值应变(LSs%)与心房收缩前长轴峰值应变(LSa%),结合RT3 DE和多普勒超声参数进行比较分析.结果 左房中部应变参数具满意可重复性(ICC >0.8),A组左房充盈和排空期形变功能减低以中部为主[与对照组相比:MLSs(33 ±6)%与(45±9)%,MLSa(12±3)%与(17±5)%;P<0.05],B组基底和房顶部形变功能也明显降低[与A组和对照组相比:BLSs(18 ±7)%与(25±8)%与(29±8)%,RLSs (24±9)%与(28±8)%与(32±10)%;与对照组相比:BLSa(11±5)%与(14士4)%,RLSa(12±5)%与(15±5)%;P<0.05].HFpEF患者左房僵硬度明显增加,左房充盈扩张分数(LAEI%)和被动射血分数(LAPEF%)明显降低,B组左房主动射血分数(LAAEF%)也显著降低.结论 3D-STE结合RT3DE可有效评估HFpEF左房功能.左房中部应变参数是评估左房功能的理想指标.HFpEF患者左房储备、通道和泵功能均明显降低,存在明显舒张功能不全,这些变化在左房明显增大患者中更为显著.%Objective To evaluate left atrial function changes inheart failure with preserved ejection fraction (HFpEF) patients by three-dimensional speckle-tracking echocardiography (3D-STE) and Real time three-dimensional echocardiograph(RT3DE).Methods 43 HFpEF patients and a control group with 18 healthy subjectswere enrolled.According to left atrial max volume index (LAVImax),patients were grouped as A (LAVImax < 34 ml/m2) and B (LAVImax≥34 ml/m2).3D-STE deformative parameters,left atrial ventricular-systolic longitudinal peak strain (LSs

  14. Automatic basal slice detection for cardiac analysis

    Science.gov (United States)

    Paknezhad, Mahsa; Marchesseau, Stephanie; Brown, Michael S.

    2016-03-01

    Identification of the basal slice in cardiac imaging is a key step to measuring the ejection fraction (EF) of the left ventricle (LV). Despite research on cardiac segmentation, basal slice identification is routinely performed manually. Manual identification, however, has been shown to have high inter-observer variability, with a variation of the EF by up to 8%. Therefore, an automatic way of identifying the basal slice is still required. Prior published methods operate by automatically tracking the mitral valve points from the long-axis view of the LV. These approaches assumed that the basal slice is the first short-axis slice below the mitral valve. However, guidelines published in 2013 by the society for cardiovascular magnetic resonance indicate that the basal slice is the uppermost short-axis slice with more than 50% myocardium surrounding the blood cavity. Consequently, these existing methods are at times identifying the incorrect short-axis slice. Correct identification of the basal slice under these guidelines is challenging due to the poor image quality and blood movement during image acquisition. This paper proposes an automatic tool that focuses on the two-chamber slice to find the basal slice. To this end, an active shape model is trained to automatically segment the two-chamber view for 51 samples using the leave-one-out strategy. The basal slice was detected using temporal binary profiles created for each short-axis slice from the segmented two-chamber slice. From the 51 successfully tested samples, 92% and 84% of detection results were accurate at the end-systolic and the end-diastolic phases of the cardiac cycle, respectively.

  15. A realistic 3-D gated cardiac phantom for quality control of gated myocardial perfusion SPET: the Amsterdam gated (AGATE) cardiac phantom

    Energy Technology Data Exchange (ETDEWEB)

    Visser, Jacco J.N.; Busemann Sokole, Ellinor; Verberne, Hein J.; Habraken, Jan B.A.; Eck-Smit, Berthe L.F. van [Department of Nuclear Medicine, Academic Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam (Netherlands); Stadt, Huybert J.F. van de; Jaspers, Joris E.N.; Shehata, Morgan; Heeman, Paul M. [Department of Medical Technological Development, Academic Medical Center, Amsterdam (Netherlands)

    2004-02-01

    A realistic 3-D gated cardiac phantom with known left ventricular (LV) volumes and ejection fractions (EFs) was produced to evaluate quantitative measurements obtained from gated myocardial single-photon emission tomography (SPET). The 3-D gated cardiac phantom was designed and constructed to fit into the Data Spectrum anthropomorphic torso phantom. Flexible silicone membranes form the inner and outer walls of the simulated left ventricle. Simulated LV volumes can be varied within the range 45-200 ml. The LV volume curve has a smooth and realistic clinical shape that is produced by a specially shaped cam connected to a piston. A fixed 70-ml stroke volume is applied for EF measurements. An ECG signal is produced at maximum LV filling by a controller unit connected to the pump. This gated cardiac phantom will be referred to as the Amsterdam 3-D gated cardiac phantom, or, in short, the AGATE cardiac phantom. SPET data were acquired with a triple-head SPET system. Data were reconstructed using filtered back-projection following pre-filtering and further processed with the Quantitative Gated SPECT (QGS) software to determine LV volume and EF values. Ungated studies were performed to measure LV volumes ranging from 45 ml to 200 ml. The QGS-determined LV volumes were systematically underestimated. For different LV combinations, the stroke volumes measured were consistent at 60-61 ml for 8-frame studies and 63-65 ml for 16-frame studies. QGS-determined EF values were slightly overestimated between 1.25% EF units for 8-frame studies and 3.25% EF units for 16-frame studies. In conclusion, the AGATE cardiac phantom offers possibilities for quality control, testing and validation of the whole gated cardiac SPET sequence, and testing of different acquisition and processing parameters and software. (orig.)

  16. Dynamical ejections of massive stars from young star clusters under diverse initial conditions

    Science.gov (United States)

    Oh, Seungkyung; Kroupa, Pavel

    2016-05-01

    We study the effects that initial conditions of star clusters and their massive star population have on dynamical ejections of massive stars from star clusters up to an age of 3 Myr. We use a large set of direct N-body calculations for moderately massive star clusters (Mecl ≈ 103.5 M⊙). We vary the initial conditions of the calculations, such as the initial half-mass radius of the clusters, initial binary populations for massive stars and initial mass segregation. We find that the initial density is the most influential parameter for the ejection fraction of the massive systems. The clusters with an initial half-mass radius rh(0) of 0.1 (0.3) pc can eject up to 50% (30)% of their O-star systems on average, while initially larger (rh(0) = 0.8 pc) clusters, that is, lower density clusters, eject hardly any OB stars (at most ≈ 4.5%). When the binaries are composed of two stars of similar mass, the ejections are most effective. Most of the models show that the average ejection fraction decreases with decreasing stellar mass. For clusters that are efficient at ejecting O stars, the mass function of the ejected stars is top-heavy compared to the given initial mass function (IMF), while the mass function of stars that remain in the cluster becomes slightly steeper (top-light) than the IMF. The top-light mass functions of stars in 3 Myr old clusters in our N-body models agree well with the mean mass function of young intermediate-mass clusters in M 31, as reported previously. This implies that the IMF of the observed young clusters is the canonical IMF. We show that the multiplicity fraction of the ejected massive stars can be as high as ≈ 60%, that massive high-order multiple systems can be dynamically ejected, and that high-order multiples become common especially in the cluster. We also discuss binary populations of the ejected massive systems. Clusters that are initially not mass-segregated begin ejecting massive stars after a time delay that is caused by mass

  17. Clinical observation on B-type natriuretic peptide, C-reactive protein and left ventricle ejection fraction in acute myocardial infarction patients with acute heart failure after the continuous renal replacement therapy%连续性肾脏替代治疗对急性心肌梗死后心功能不全患者脑钠肽、C反应蛋白及射血分数的影响

    Institute of Scientific and Technical Information of China (English)

    宋艳东; 李志忠; 张京梅

    2012-01-01

    Objective To summarize our experience in the treatment of acute myocardial infarction (AMI) patients complicated with acute heart failure using continuous renal replacement therapy (CRRT). Method We retrospectively analyzed 181 AMI patients treated in our ward. Eighty-eight of these patients were attacked with acute heart failure after patent blood flow of culprit vessels by primary PTC, and then treated with medications. CRRT was initiated in 50 patients because of the persistence of heart failure. Patient's vital signs and tolerance to CRRT were closely monitored. Blood gas, electrolytes, plasma B-type natriuretic peptide (BNP) and C-reactive protein (CRP) were measured before and after CRRT. Left ventricle ejection fraction (LVEF) was measured. Patients were followed up for one year. Data were analyzed with SPSS 13.0 software. Results CRRT was terminated in 2 patients due to thrombocytopenia, and in one patient due to insufficient perfusion of vital organs. Vital signs and heart failure symptoms improved in 47 patients. After CRRT, electrolytes improved, BNP and CRP decreased (P<0.05), LVEF increased (P < 0.05), and BNP in ultrafiltrate became very low (P < 0.05). Three cases died of sudden cardiac death. Forty-four patients discharged after 20~59 days, and they were followed up for one year. No deterioration of heart dysfunction was found, and no long-term hemodialysis was required. Conclusions CRRT is a relatively safe and effective strategy for patients with acute heart failure after AMI. It can decrease serum BNP and CRP remarkably, and improve heart failure symptoms and LVEF. It also helps the patients survive the dangerous period. Our patients treated with CRRT experienced a gradual improvement of cardiac function, and discharged from the hospital in a stable condition without heart failure recurrence and long-term dialysis during the follow-up period.%目的 探讨连续性肾脏替代治疗(continuous renal replacement therapy,CRRT)对急性心肌梗死

  18. Atrophic cardiac remodeling induced by taurine deficiency in Wistar rats.

    Directory of Open Access Journals (Sweden)

    Mariele Castilho Pansani

    Full Text Available INTRODUCTION: Micronutrient deficiency is observed in heart failure patients. Taurine, for example, represents 50% of total free amino acids in the heart, and in vivo studies have linked taurine deficiency with cardiomyopathy. METHODS: Thirty-four male Wistar rats (body weight = 100 g were weighed and randomly assigned to one of two groups: Control (C or taurine-deficient (T (-. Beta-alanine at a concentration of 3% was added to the animals' water to induce taurine deficiency in the T (- group. On day 30, the rats were individually submitted to echocardiography; morphometrical and histopathological evaluation and metalloproteinase activity, oxidative stress and inflammation evaluation were performed. Tissue samples were collected to determine the taurine concentration in the heart. RESULTS: Taurine deficiency led to decreases in: ventricular wall thickness, left ventricle dry weight, myocyte sectional area, left ventricle posterior wall thickness and ventricular geometry. With regard to heart function, the velocity of the A wave, the ratio between the E and A wave, the ejection fraction, fractional shortening and cardiac output values were decreased in T (- rats, suggesting abnormal diastolic and systolic function. Increased fibrosis, inflammation and increased activation of metalloproteinases were not observed. Oxidative stress was increased in deficient animals. CONCLUSIONS: These data suggest that taurine deficiency promotes structural and functional cardiac alterations with unique characteristics.

  19. Exercise Ameliorates High Fat Diet Induced Cardiac Dysfunction by Increasing Interleukin 10

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    Varun eKesherwani

    2015-04-01

    Full Text Available Increasing evidence suggests that a sedentary lifestyle and a high fat diet (HFD leads to cardiomyopathy. Moderate exercise ameliorates cardiac dysfunction, however underlying molecular mechanisms are poorly understood. Increased inflammation due to induction of pro-inflammatory cytokine such as tumor necrosis factor-alpha (TNF-α and attenuation of anti-inflammatory cytokine such as interleukin10 (IL-10 contributes to cardiac dysfunction in obese and diabetics. We hypothesized that exercise training ameliorates HFD- induced cardiac dysfunction by mitigating obesity and inflammation through upregulation of IL-10 and downregulation of TNF-α. To test this hypothesis, eight week old, female C57BL/6J mice were fed with HFD and exercised (swimming 1hr/day for 5 days/week for eight weeks. The four treatment groups: normal diet (ND, HFD, HFD + exercise (HFD + Ex and ND + Ex were analyzed for mean body weight, blood glucose level, TNF-α, IL-10, cardiac fibrosis by Masson Trichrome, and cardiac dysfunction by echocardiography. Mean body weights were increased in HFD but comparatively less in HFD + Ex. The level of TNF-α was elevated and IL-10 was downregulated in HFD but ameliorated in HFD + Ex. Cardiac fibrosis increased in HFD and was attenuated by exercise in the HFD + Ex group. The percentage ejection fraction and fractional shortening were decreased in HFD but comparatively increased in HFD + Ex. There was no difference between ND and ND + Ex for the above parameters except an increase in IL-10 level following exercise. Based on these results, we conclude that exercise mitigates HFD- induced cardiomyopathy by decreasing obesity, inducing IL-10, and reducing TNF-α in mice.

  20. Dynamical ejections of massive stars from young star clusters under diverse initial conditions

    CERN Document Server

    Oh, Seungkyung

    2016-01-01

    We study the effects of initial conditions of star clusters and their massive star population on dynamical ejections of stars from star clusters up to an age of 3 Myr, particularly focusing on massive systems, using a large set of direct N-body calculations for moderately massive star clusters (Mecl=$10^{3.5}$ Msun). We vary the initial conditions of the calculations such as the initial half-mass radius of the clusters, initial binary populations for massive stars and initial mass segregation. We find that the initial density is the most influential parameter for the ejection fraction of the massive systems. The clusters with an initial half-mass radius of 0.1 (0.3) pc can eject up to 50% (30)% of their O-star systems on average. Most of the models show that the average ejection fraction decreases with decreasing stellar mass. For clusters efficient at ejecting O stars, the mass function of the ejected stars is top-heavy compared to the given initial mass function (IMF), while the mass function of stars remai...

  1. 步行运动对左心室射血分数保留心力衰竭患者的运动耐力的影响%Influence of walk exercise on exercise tolerance in patients with heart failure with preserved left ventricular ejection fraction

    Institute of Scientific and Technical Information of China (English)

    戴玫; 付珞; 赵新; 王超; 蒋晖; 王引利

    2016-01-01

    Objective To evaluate the rehabilitation effects of walk exercise training on the heart function rehabilitation in the patients with heart failure with preserved left ventricular ejection fraction (HFPEF) .Methods A total of 142 cases of HFPEF were randomly assigned to 2 groups on the basis of medication therapy ;the control group (70 cases) was given only routine medica‐tion therapy without the exercise prescription;On the bases of control group ,the exercise group (72 cases) conducted the rehabilita‐tion training according to the exercise prescription .After 24 weeks follow up ,6 min walking distance ,plasma NT‐proBNP level and left ventricular diastolic function were compared between the two groups .Results The 6 min walking distance after walk exercise training in the exercise group was significantly increased compared with before walk exercise training and the control group ,while the level of NT‐proBNP was significant decreased(P<0 .01) .Conclusion The walking exercise training mode according to the ex‐ercise prescription can significantly improve the exercise tolerance in the HFPEF .%目的:观察在药物治疗基础上步行运动训练对左心室射血分数保留心力衰竭(HFPEF)患者心功能康复的效果。方法142例HFPEF患者在药物治疗基础上分为两组;对照组70例,只给予常规药物治疗,但无运动处方;运动组72例,按设定的运动处方进行康复训练。经过24周的随访,比较两组6 min步行试验距离、血浆N末端前脑钠肽(NT‐proBNP)和左心室舒张功能等指标变化。结果运动组与运动训练前及对照组比较6 min步行试验距离、静息心率显著增加、NT‐proBNP显著降低(P<0.01)。结论按运动处方进行步行训练能显著改善HFPEF患者的运动耐力。

  2. Clinical significance of heart rate turbulence in heart failure patients with preserved ejection fraction%左心室射血分数保留的心力衰竭患者心率震荡的临床意义研究

    Institute of Scientific and Technical Information of China (English)

    赵江峰; 董平栓; 曲红培; 李艳云; 畅晓燕

    2016-01-01

    目的 研究左心室射血分数保留的心力衰竭(heart failure with preserved ejection fraction,HFPEF)患者窦性心率震荡(heart rate turbulence,HRT)的变化以及临床意义.方法 选择52例在河南科技大学第一附属医院接受治疗的HFPEF患者作为HEPEF组,另选择无心肌缺血及器质性心脏病变患者30例作为对照组.行24 h动态心电图检查,计算HRT指标:震荡初始值(turbulence onset,TO)和震荡斜率(turbulence slope,TS).行超声心动图检查测定评价心功能不全的相关指标,比较HFPEF组与对照组之间HRT的差异.结果 与对照组比较,HFPEF组TO明显升高[(0.17±1.40)% vs(-0.26±0.99)%,P=0.027],TS明显降低[(0.88±2.51) ms/RRIvs (2.60±2.76) ms/RRI,P=0.003].Pearson相关性分析显示左心室舒张末期容积指数与TO负相关(r=-0.55,P=0.01),与TS呈正相关(r=0.23,P=0.03);舒张早期二尖血流速度和二尖瓣环运动速度比值与TO正相关(r=0.21,P=0.04),与TS呈负相关(r=-0.39,P=0.01).结论 HFPEF患者窦性心率震荡现象明显受损,提示心脏自主神经调节功能下降,并且反映左心室舒张功能.

  3. Rehabilitation Enablement in Chronic Heart Failure—a facilitated self-care rehabilitation intervention in patients with heart failure with preserved ejection fraction (REACH-HFpEF) and their caregivers: rationale and protocol for a single-centre pilot randomised controlled trial

    Science.gov (United States)

    Lang, C C; Smith, K; Jolly, K; Davis, R; Hayward, C; Wingham, J; Abraham, C; Green, C; Warren, F C; Britten, N; Greaves, C J; Doherty, P; Austin, J; Van Lingen, R; Singh, S; Buckingham, S; Paul, K; Taylor, R S; Dalal, H M

    2016-01-01

    Introduction The Rehabilitation EnAblement in CHronic Heart Failure in patients with Heart Failure (HF) with preserved ejection fraction (REACH-HFpEF) pilot trial is part of a research programme designed to develop and evaluate a facilitated, home-based, self-help rehabilitation intervention to improve self-care and quality of life (QoL) in heart failure patients and their caregivers. We will assess the feasibility of a definitive trial of the REACH-HF intervention in patients with HFpEF and their caregivers. The impact of the REACH-HF intervention on echocardiographic outcomes and bloodborne biomarkers will also be assessed. Methods and analysis A single-centre parallel two-group randomised controlled trial (RCT) with 1:1 individual allocation to the REACH-HF intervention plus usual care (intervention) or usual care alone (control) in 50 HFpEF patients and their caregivers. The REACH-HF intervention comprises a REACH-HF manual with supplementary tools, delivered by trained facilitators over 12 weeks. A mixed methods approach will be used to assess estimation of recruitment and retention rates; fidelity of REACH-HF manual delivery; identification of barriers to participation and adherence to the intervention and study protocol; feasibility of data collection and outcome burden. We will assess the variance in study outcomes to inform a definitive study sample size and assess methods for the collection of resource use and intervention delivery cost data to develop the cost-effectiveness analyses framework for any future trial. Patient outcomes collected at baseline, 4 and 6 months include QoL, psychological well-being, exercise capacity, physical activity and HF-related hospitalisation. Caregiver outcomes will also be assessed, and a substudy will evaluate impact of the REACH-HF manual on resting global cardiovascular function and bloodborne biomarkers in HFpEF patients. Ethics and dissemination The study is approved by the East of Scotland Research Ethics

  4. Clinical characteristics and lung CT imaging features in heart failure patients with normal or reduced left ventricular ejection fraction%左室射血分数正常与减低心力衰竭患者的临床特点及肺CT表现比较分析

    Institute of Scientific and Technical Information of China (English)

    林少华; 郭光远; 董凯; 赵新玲; 孙夫平; 楚存坤; 姜领

    2014-01-01

    对85例左室射血分数正常心力衰竭患者(HFNEF组)与89例左室射血分数减低心力衰竭患者(HFREF组)的危险因素、临床特征以及肺CT表现进行比较分析.结果显示,HFNEF组患者较HFREF组患者既往有高血压、糖尿病、肥胖者比例高;咳嗽、呼吸困难常见;肺部CT表现以肺纹理增多、增重,出现胸膜下线、克氏线以及肺实质磨玻璃样变等间质性肺水肿改变为主.而HFREF患者中冠心病者比例较高,临床以急性左心衰表现为主,肺CT表现以肺泡性肺水肿为主.提示HFNEF组患者临床病史较长,症状隐匿,肺部CT表现有别于HFREF组患者.%The clinical features and lung CT findings of 174 heart failure patients,including 85 cases with normal left ventricular ejection fraction (LVEF) and 89 cases with reduced LVEF were reviewed.Patients with normal LVEF had a higher proportion of hypertension,diabetes and obesity than patients with normal LVEF; and cough and dyspnea were more common.The lung CT findings in patients with normal LVEF were frequently presented as interstitial lung edema,increased pulmonary texture,subpleural line,Kerley lines and diffuse ground-glass opacity.Patients with reduced LVEF had a higher proportion of coronary heart disease and clinical manifestations of acute left heart failure,and central alveolar edema presented in lung CT images.Results suggest that heart failure patients with normal LVEF usually have longer clinical history and occult symptoms,and have a different lung CT imaging features from those in heart failure patients with reduced LVEF.

  5. 卡维地洛对扩张型心肌病心力衰竭患者心功能及运动耐量的改善作用%Improving effect of carvedilol on cardiac function and exercise tolerance in patients with congestive heart failure of dilated cardiomyopathy

    Institute of Scientific and Technical Information of China (English)

    吴大庆; 杨永健

    2002-01-01

    Objective To observe the improving effect of carvedilol on cardiac function in patients with congestive heart failure(CHF) of dilated cardiomyopathy(DCM).Methods Total 60 patients with chronic heart failure secondary to DCM were divided into two groups randomly, namely carvedilol group additionally treated with carvedilol (the test group), conventional group receiving placebo (the controls). The left ventricular fraction shortening (FS), ejection fraction (EF), stroke volume (SV), left ventricular diastolic dimension (LVDD) were measured with echocardiography, were measured before and after 4 month treatment. Results After treated for 4 months , the cardiac function improved greatly in both groups.In the test group, LVDD, EF and 6 minute walking distance improved more signicantly compared to the controls. Conclusion Carvedilol can improve cardiac function and exercise tolerance in the patients with CHF of DCM obviously.

  6. Physical Stress Echocardiography: Prediction of Mortality and Cardiac Events in Patients with Exercise Test showing Ischemia

    Directory of Open Access Journals (Sweden)

    Ana Carla Pereira de Araujo

    2014-11-01

    Full Text Available Background: Studies have demonstrated the diagnostic accuracy and prognostic value of physical stress echocardiography in coronary artery disease. However, the prediction of mortality and major cardiac events in patients with exercise test positive for myocardial ischemia is limited. Objective: To evaluate the effectiveness of physical stress echocardiography in the prediction of mortality and major cardiac events in patients with exercise test positive for myocardial ischemia. Methods: This is a retrospective cohort in which 866 consecutive patients with exercise test positive for myocardial ischemia, and who underwent physical stress echocardiography were studied. Patients were divided into two groups: with physical stress echocardiography negative (G1 or positive (G2 for myocardial ischemia. The endpoints analyzed were all-cause mortality and major cardiac events, defined as cardiac death and non-fatal acute myocardial infarction. Results: G2 comprised 205 patients (23.7%. During the mean 85.6 ± 15.0-month follow-up, there were 26 deaths, of which six were cardiac deaths, and 25 non-fatal myocardial infarction cases. The independent predictors of mortality were: age, diabetes mellitus, and positive physical stress echocardiography (hazard ratio: 2.69; 95% confidence interval: 1.20 - 6.01; p = 0.016. The independent predictors of major cardiac events were: age, previous coronary artery disease, positive physical stress echocardiography (hazard ratio: 2.75; 95% confidence interval: 1.15 - 6.53; p = 0.022 and absence of a 10% increase in ejection fraction. All-cause mortality and the incidence of major cardiac events were significantly higher in G2 (p < 0. 001 and p = 0.001, respectively. Conclusion: Physical stress echocardiography provides additional prognostic information in patients with exercise test positive for myocardial ischemia.

  7. Effect of impaired glucose tolerance on cardiac dysfunction in a rat model of prediabetes

    Institute of Scientific and Technical Information of China (English)

    LIANG Jia-liang; FENG Zhi-kuan; LIU Xiao-ying; LIN Qiu-xiong; FU Yong-heng; SHAN Zhi-xin; ZHU Jie-ning; LIN Shu-guang; YU Xi-yong

    2011-01-01

    Background The effect of impaired glucose tolerance (IGT) on cardiac function during the chronic prediabetes state is complicated and plays an important role in clinical outcome. However, the molecular mechanisms are not fully understood. This study was designed to observe cardiac dysfunction in prediabetic rats with IGT and to determine whether glucose metabolic abnormalities, inflammation and apoptosis are linked to it.Methods The IGT rat models were induced by streptozocin, and the heart functions were assessed by echocardiography.Myocardial glucose metabolism was analyzed by glycogen periodic acid-Schiff staining, and the pro-apoptotic effect of IGT was evaluated by TUNEL staining. Additionally, caspase-3 activation, macrophage migration inhibitory factor (MIF) and G-protein coupled receptor kinase 2 (GRK2) were detected by Western blotting in cardiac tissue lysates.Results Area-under-the-curve of blood glucose in rats injected with streptozotocin was higher than that in controls,increased by 16.28%, 38.60% and 38.61% at 2, 4 and 6 weeks respectively (F=15.370, P=0.003). Abnormal cardiac functions and apoptotic cardiomyocytes were observed in the IGT rats, the ejection fraction (EF) being (68.59±6.62)% in IGT rats vs. (81.07±4.59)% in controls (t=4.020, P=0.002). There was more glucose which was converted to glycogen in the myocardial tissues of IGT rats, especially in cardiac perivascular tissues. Compared to controls, the cleaved caspase-3, MIF and GRK2 were expressed at higher levels in the myocardial tissues of IGT rats.Conclusions IGT in the prediabetes period resulted in cardiac dysfunction linked to abnormal glycogen storage and apoptosis. Additionally, MIF and GRK2 may be involved in the pathogenesis of cardiac dysfunction in prediabetes and their regulation may contribute to the design of novel diagnostic and therapeutic strategies for those who have potential risks for diabetic cardiovascular complications.

  8. Native Myocardial T1 as a Biomarker of Cardiac Structure in Non-Ischemic Cardiomyopathy.

    Science.gov (United States)

    Shah, Ravi V; Kato, Shingo; Roujol, Sebastien; Murthy, Venkatesh; Bellm, Steven; Kashem, Abyaad; Basha, Tamer; Jang, Jihye; Eisman, Aaron S; Manning, Warren J; Nezafat, Reza

    2016-01-15

    Diffuse myocardial fibrosis is involved in the pathology of nonischemic cardiomyopathy (NIC). Recently, the application of native (noncontrast) myocardial T1 measurement has been proposed as a method for characterizing diffuse interstitial fibrosis. To determine the association of native T1 with myocardial structure and function, we prospectively studied 39 patients with NIC (defined as left ventricular ejection fraction (LVEF) ≤ 50% without cardiac magnetic resonance (CMR) evidence of previous infarction) and 27 subjects with normal LVEF without known overt cardiovascular disease. T1, T2, and extracellular volume fraction (ECV) were determined over 16 segments across the base, mid, and apical left ventricular (LV). NIC participants (57 ± 15 years) were predominantly men (74%), with a mean LVEF 34 ± 10%. Subjects with NIC had a greater native T1 (1,131 ± 51 vs 1,069 ± 29 ms; p NIC was associated with a greater LVEF (β = -0.59, p = 0.0003), greater right ventricular ejection fraction (β = -0.47, p = 0.006), and smaller left atrial volume index (β = 0.51, p = 0.001). The regional distribution of native myocardial T1 was similar in patients with and without NIC. In NIC, native myocardial T1 is elevated in all myocardial segments, suggesting a global (not regional) abnormality of myocardial tissue composition. In conclusion, native T1 may represent a rapid, noncontrast alternative to ECV for delineating myocardial tissue remodeling in NIC.

  9. [Cardiac contractility modulation. A new form of therapy for patients with heart failure and narrow QRS complex?].

    Science.gov (United States)

    Kleemann, T

    2015-11-01

    Cardiac contractility modulation (CCM) is a stimulation therapy by an implantable impulse generator, which enhances ventricular contractile performance by delivering CCM impulses to the right ventricle during the absolute refractory period. The CCM signals mediate increased inotropy by prolonging the duration of the action potential, which leads to an enhanced influx of calcium into cardiomyocytes and a greater release of calcium by the sarcoplasmic reticulum. The increase of cardiac contractility is not associated with increased oxygen consumption. Several small studies have shown that CCM therapy can safely improve symptoms of heart failure and peak oxygen consumption in patients with moderate to severe heart failure who are not eligible for resynchronization therapy. Therefore, CCM is a novel potential therapy for patients with heart failure, an ejection fraction ≤ 35 % and a normal QRS duration failure or mortality.

  10. Early detection of cardiac dysfunction in the type 1 diabetic heart using speckle-tracking based strain imaging.

    Science.gov (United States)

    Shepherd, Danielle L; Nichols, Cody E; Croston, Tara L; McLaughlin, Sarah L; Petrone, Ashley B; Lewis, Sara E; Thapa, Dharendra; Long, Dustin M; Dick, Gregory M; Hollander, John M

    2016-01-01

    Enhanced sensitivity in echocardiographic analyses may allow for early detection of changes in cardiac function beyond the detection limits of conventional echocardiographic analyses, particularly in a small animal model. The goal of this study was to compare conventional echocardiographic measurements and speckle-tracking based strain imaging analyses in a small animal model of type 1 diabetes mellitus. Conventional analyses revealed differences in ejection fraction, fractional shortening, cardiac output, and stroke volume in diabetic animals relative to controls at 6-weeks post-diabetic onset. In contrast, when assessing short- and long-axis speckle-tracking based strain analyses, diabetic mice showed changes in average systolic radial strain, radial strain rate, radial displacement, and radial velocity, as well as decreased circumferential and longitudinal strain rate, as early as 1-week post-diabetic onset and persisting throughout the diabetic study. Further, we performed regional analyses for the LV and found that the free wall region was affected in both the short- and long-axis when assessing radial dimension parameters. These changes began 1-week post-diabetic onset and remained throughout the progression of the disease. These findings demonstrate the use of speckle-tracking based strain as an approach to elucidate cardiac dysfunction from a global perspective, identifying left ventricular cardiac regions affected during the progression of type 1 diabetes mellitus earlier than contractile changes detected by conventional echocardiographic measurements.

  11. Insuficiência cardíaca com fração de ejeção normal Insuficiencia cardíaca con fracción de eyección normal Heart failure with normal ejection fraction

    Directory of Open Access Journals (Sweden)

    Meliza Goi Roscani

    2010-05-01

    multifactoriales, involucrando la rigidez pasiva del miocardio, la geometría ventricular, la fuerza de contención pericárdica y la interacción entre los ventrículos. Los objetivos principales del tratamiento son reducir la congestión venosa pulmonar, la frecuencia cardíaca y controlar las comorbilidades. Todavía no hay evidencias de que el uso de medicaciones específicas, como inhibidores de la enzima de conversión o betabloqueadores, interfieran en la mortalidad. Los factores de peor pronóstico incluyen la edad avanzada, presencia de disfunción renal, diabetes, clase funcional III y IV (NYHA y estado avanzado de disfunción diastólica, con patrón restrictivo al llenado ventricular. Otro aspecto viene cobrando espacio en la bibliografía es el cuestionamiento del papel de la disfunción sistólica en los cuadros de ICFEN. Todos estos aspectos se abordan detalladamente en la presente revisión.Heart failure with normal ejection fraction (HFNEF is a complex syndrome that has been broadly studied since the last decade. It is caused by diastolic ventricular dysfunction demonstrated by complementary methods, such as hemodynamic study or echocardiogram, in the presence of a normal ejection fraction (EF. It affects primarily elderly individuals with comorbidities, such as systemic arterial hypertension, coronary failure and obesity. The physiopathological mechanisms are complex and multifactorial, involving the myocardial passive stiffness, the ventricular geometry, the pericardial restraint and the interaction between the ventricles. The main objectives of the treatment were to decrease the pulmonary venous congestion and the heart rate and control the comorbidities. There is no strong evidence that the use of specific medications, such as the angiotensin-converting enzyme inhibitors or beta-blockers can influence mortality. The poorer prognostic factors include advanced age, presence of kidney dysfunction, diabetes, functional class III and IV (NYHA and advanced

  12. Cardiac resynchronization induces major structural and functional reverse remodeling in patients with New York Heart Association class I/II heart failure

    DEFF Research Database (Denmark)

    St John Sutton, Martin; Ghio, Stefano; Plappert, Ted;

    2009-01-01

    BACKGROUND: Cardiac resynchronization therapy (CRT) improves LV structure, function, and clinical outcomes in New York Heart Association class III/IV heart failure with prolonged QRS. It is not known whether patients with New York Heart Association class I/II systolic heart failure exhibit left...... ventricular (LV) reverse remodeling with CRT or whether reverse remodeling is modified by the cause of heart failure. METHODS AND RESULTS: Six hundred ten patients with New York Heart Association class I/II heart failure, QRS duration > or =120 ms, LV end-diastolic dimension > or =55 mm, and LV ejection...... reduction in LV end-diastolic and end-systolic volume indexes and a 3-fold greater increase in LV ejection fraction in patients with nonischemic causes of heart failure. CONCLUSIONS: CRT in patients with New York Heart Association I/II resulted in major structural and functional reverse remodeling at 1 year...

  13. Adaptive servo ventilation improves cardiac dysfunction and prognosis in chronic heart failure patients with Cheyne-Stokes respiration.

    Science.gov (United States)

    Yoshihisa, Akiomi; Shimizu, Takeshi; Owada, Takashi; Nakamura, Yuichi; Iwaya, Shoji; Yamauchi, Hiroyuki; Miyata, Makiko; Hoshino, Yasuto; Sato, Takamasa; Suzuki, Satoshi; Sugimoto, Koichi; Yamaki, Takayoshi; Kunii, Hiroyuki; Nakazato, Kazuhiko; Suzuki, Hitoshi; Saitoh, Shu-ichi; Takeishi, Yasuchika

    2011-01-01

    Cheyne-Stokes respiration (CSR) is often observed in patients with chronic heart failure (CHF). Although adaptive servo ventilation (ASV) is effective for CSR, it remains unclear whether ASV improves the cardiac function and prognosis of patients with CHF and CSR.Sixty patients with CHF and CSR (mean left ventricular ejection fraction 38.7%, mean apnea hypopnea index 36.8 times/hour, mean central apnea index 19.1 times/hour) were enrolled in this study. Patients were divided into two groups: 23 patients treated with ASV (ASV group) and 37 patients treated without ASV (Non-ASV group). Measurement of plasma B-type natriuretic peptide (BNP) levels and echocardiography were performed before, 3 and 6 months after treatments in each group. Patients were followed-up for cardiac events (cardiac death and re-hospitalization) after discharge. In the ASV group, NYHA functional class, BNP levels, cardiac systolic and diastolic function were significantly improved with ASV treatment for 6 months. In contrast, none of these parameters changed in the Non-ASV group. Importantly, Kaplan-Meier analysis clearly demonstrated that the event-free rate was significantly higher in the ASV group than in the Non-ASV group.Adaptive servo ventilation improves cardiac function and prognosis in patients with chronic heart failure and Cheyne-Stokes respiration.

  14. Waon therapy improves quality of life as well as cardiac function and exercise capacity in patients with chronic heart failure.

    Science.gov (United States)

    Sobajima, Mitsuo; Nozawa, Takashi; Fukui, Yasutaka; Ihori, Hiroyuki; Ohori, Takashi; Fujii, Nozomu; Inoue, Hiroshi

    2015-01-01

    Waon therapy (WT), which in Japanese means soothing warmth, is a repeated sauna therapy that improves cardiac and vascular endothelial function in patients with chronic heart failure (CHF). We investigated whether WT could improve the quality of life (QOL) of CHF patients in addition to improving cardiac function and exercise capacity.A total of 49 CHF patients (69 ± 14 years old) were treated with a 60°C far infrared-ray dry sauna bath for 15 minutes and then kept in a bed covered with blankets for 30 minutes once a day for 3 weeks. At baseline and 3 weeks after starting WT, cardiac function, 6-minute walk distance (6MWD), flow mediated dilation (FMD) of the brachial artery, and SF36-QOL scores were determined.WT significantly improved left ventricular ejection fraction (LVEF), B-type natriuretic peptide (BNP), 6MWD, and FMD (3.6 ± 2.3 to 5.1 ± 2.8%, P improved not only the physical (PC) but also mental component (MC) of the QOL scores. WT-induced improvement of PC was negatively correlated with changes in BNP (r = -0.327, P improvement was not related directly to changes in BNP, LVEF, or 6MWD. WT-induced changes in MC were not parallel to PC improvement.WT improved QOL as well as cardiac function and exercise capacity in patients with CHF. Mental QOL improved independently of WT-induced improvement of cardiac function and exercise capacity.

  15. Comparative cardiac toxicity of anthracyclines in vitro and in vivo in the mouse.

    Directory of Open Access Journals (Sweden)

    Stefano Toldo

    Full Text Available PURPOSE: The antineoplastic efficacy of anthracyclines is limited by their cardiac toxicity. In this study, we evaluated the toxicity of doxorubicin, non-pegylated liposomal-delivered doxorubicin, and epirubicin in HL-1 adult cardiomyocytes in culture as well as in the mouse in vivo. METHODS: The cardiomyocytes were incubated with the three anthracyclines (1 µM to assess reactive oxygen generation, DNA damage and apoptotic cell death. CF-1 mice (10/group received doxorubicin, epirubicin or non-pegylated liposomal-doxorubicin (10 mg/kg and cardiac function was monitored by Doppler echocardiography to measure left ventricular ejection fraction (LVEF, heart rate (HR and cardiac output (CO both prior to and 10 days after drug treatment. RESULTS: In HL-1 cells, non-pegylated liposomal-doxorubicin generated significantly less reactive oxygen species (ROS, as well as less DNA damage and apoptosis activation when compared with doxorubicin and epirubicin. Cultured breast tumor cells showed similar sensitivity to the three anthracyclines. In the healthy mouse, non-pegylated liposomal doxorubicin showed a minimal and non-significant decrease in LVEF with no change in HR or CO, compared to doxorubicin and epirubicin. CONCLUSION: This study provides evidence for reduced cardiac toxicity of non-pegylated-liposomal doxorubicin characterized by attenuation of ROS generation, DNA damage and apoptosis in comparison to epirubicin and doxorubicin.

  16. In utero dimethadione exposure causes postnatal disruption in cardiac structure and function in the rat.

    Science.gov (United States)

    Aasa, Kristiina L; Purssell, Elizabeth; Adams, Michael A; Ozolinš, Terence R S

    2014-12-01

    In utero exposure of rat embryos to dimethadione (DMO), the N-demethylated teratogenic metabolite of the anticonvulsant trimethadione, induces a high incidence of cardiac heart defects including ventricular septal defects (VSDs). The same exposure regimen also leads to in utero cardiac functional deficits, including bradycardia, dysrhythmia, and a reduction in cardiac output (CO) and ejection fraction that persist until parturition (10 days after the final dose). Despite a high rate of spontaneous postnatal VSD closure, we hypothesize that functional sequelae will persist into adulthood. Pregnant Sprague Dawley rats were administered six 300 mg/kg doses of DMO, one every 12 h in mid-pregnancy beginning on the evening of gestation day 8. Postnatal cardiac function was assessed in control (CTL) and DMO-exposed offspring using radiotelemetry and ultrasound at 3 and 11 months of age, respectively. Adult rats exposed to DMO in utero had an increased incidence of arrhythmia, elevated blood pressure and CO, greater left ventricular volume and elevated locomotor activity versus CTL. The mean arterial pressure of DMO-exposed rats was more sensitive to changes in dietary salt load compared with CTL. Importantly, most treated rats had functional deficits in the absence of a persistent structural defect. It was concluded that in utero DMO exposure causes cardiovascular deficits that persist into postnatal life in the rat, despite absence of visible structural anomalies. We speculate this is not unique to DMO, suggesting possible health implications for infants with unrecognized gestational chemical exposures.

  17. Bacterial flagellin triggers cardiac innate immune responses and acute contractile dysfunction.

    Directory of Open Access Journals (Sweden)

    Joelle Rolli

    Full Text Available BACKGROUND: Myocardial contractile failure in septic shock may develop following direct interactions, within the heart itself, between molecular motifs released by pathogens and their specific receptors, notably those belonging to the toll-like receptor (TLR family. Here, we determined the ability of bacterial flagellin, the ligand of mammalian TLR5, to trigger myocardial inflammation and contractile dysfunction. METHODOLOGY/PRINCIPAL FINDINGS: TLR5 expression was determined in H9c2 cardiac myoblasts, in primary rat cardiomyocytes, and in whole heart extracts from rodents and humans. The ability of flagellin to activate pro-inflammatory signaling pathways (NF-kappaB and MAP kinases and the expression of inflammatory cytokines was investigated in H9c2 cells, and, in part, in primary cardiomyocytes, as well as in the mouse myocardium in vivo. The influence of flagellin on left ventricular function was evaluated in mice by a conductance pressure-volume catheter. Cardiomyocytes and intact myocardium disclosed significant TLR5 expression. In vitro, flagellin activated NF-kappaB, MAP kinases, and the transcription of inflammatory genes. In vivo, flagellin induced cardiac activation of NF-kappaB, expression of inflammatory cytokines (TNF alpha, IL-1 beta, IL-6, MIP-2 and MCP-1, and provoked a state of reversible myocardial dysfunction, characterized by cardiac dilation, reduced ejection fraction, and decreased end-systolic elastance. CONCLUSION/SIGNIFICANCE: These results are the first to indicate that flagellin has the ability to trigger cardiac innate immune responses and to acutely depress myocardial contractility.

  18. Cardiac resynchronization therapy in a young patient with Duchenne muscular dystrophy

    Directory of Open Access Journals (Sweden)

    Kono T

    2015-08-01

    Full Text Available Tamami Kono,1 Akiyoshi Ogimoto,1 Kazuhisa Nishimura,1 Toshihiro Yorozuya,2 Takafumi Okura,1 Jitsuo Higaki1 1Department of Cardiology, Pulmonology, Hypertension and Nephrology, 2Department of Anesthesiology and Resuscitology, Ehime University Graduate School of Medicine, Toon, Ehime, Japan Abstract: A 32-year-old man with Duchenne muscular dystrophy (DMD was admitted to the hospital because of worsening dyspnea and general fatigue. He had received medication therapy for cardiomyopathy with heart failure and home mechanical ventilation for respiratory failure. An electrocardiogram on admission showed intermittent third-degree atrioventricular block. Echocardiography showed global mild left ventricular systolic dysfunction with dyssynchrony (ejection fraction: 45%. He underwent implantation of a cardiac resynchronization therapy–defibrillator. His B-type natriuretic peptide level was improved after cardiac resynchronization therapy–defibrillator implantation, and he remains asymptomatic. The incidence of cardiomyopathy increases with age. By adulthood, 100% of patients have cardiac involvement. Keywords: cardiac resynchronization therapy, Duchenne muscular dystrophy, progression of cardiomyopathy, heart failure, arrhythmia

  19. DPP-4 Inhibitor and Estrogen Share Similar Efficacy Against Cardiac Ischemic-Reperfusion Injury in Obese-Insulin Resistant and Estrogen-Deprived Female Rats

    Science.gov (United States)

    Sivasinprasasn, Sivaporn; Tanajak, Pongpan; Pongkan, Wanpitak; Pratchayasakul, Wasana; Chattipakorn, Siriporn C.; Chattipakorn, Nipon

    2017-01-01

    Estrogen deprivation aggravates cardiac injury after myocardial ischemia and reperfusion (I/R) injury. Although either estrogen or the dipeptidyl peptidase-4 (DPP-4) inhibitor, vildagliptin, reduces myocardial damage following cardiac I/R, their effects on the heart in obese-insulin resistant and estrogen deprived conditions remain unknown. Ovariectomized (O) rats (n = 36) were divided to receive either normal diet (NDO) or high-fat diet (HFO) for 12 weeks, followed by treatment with a vehicle, estrogen or vildagliptin for 4 weeks. The setting of in vivo cardiac I/R injury, 30-min ischemia and 120-min reperfusion, was performed. At 12 weeks after ovariectomy, both NDO and HFO rats exhibited an obese-insulin resistant condition. Both NDO and HFO rats treated with estrogen and vildagliptin showed reduced fasting plasma glucose, insulin and HOMA index. Both treatments improved cardiac function indicated by restoration of heart rate variability and increased %left ventricular ejection fraction (%LVEF). The treatments similarly protected cardiac mitochondrial function against I/R injury, leading to a reduction in the infarct size, oxidative stress and apoptosis in the ischemic myocardium. These findings demonstrate that vildagliptin effectively improves metabolic status, and shares similar efficacy to estrogen in reducing myocardial infarction and protecting cardiac mitochondrial function against I/R injury in estrogen-deprived obese-insulin resistant rats. PMID:28281660

  20. Use of I-123 MIBG cardiac scintigraphy to assess the impact of carvedilol on cardiac adrenergic neuronal function in childhood dilated cardiomyopathy; Interet de la scintigraphie cardiaque a l'I-123 MIBG pour evaluer l'impact du carvedilol sur la fonction neuronale adrenergique cardiaque dans les myocardiopathies dilatees de l'enfant

    Energy Technology Data Exchange (ETDEWEB)

    Maunoury, C. [Hopital Europeen Georges Pompidou (HEGP), Dept. de Physiologie et Radio-Isotopes, 75 - Paris (France); Acar, P. [Centre Hospitalier Universitaire, Service de Cardiologie Pediatrique, Hopital des Enfants, 31 - Toulouse (France); Sidi, D. [Centre Hospitalier Universitaire Necker-Enfants-Malades, 75 - Paris (France)

    2006-04-15

    I-123 MIBG cardiac scintigraphy is a useful tool to assess cardiac adrenergic neuronal function, which is impaired in children with dilated cardiomyopathy (DCM). In adults with DCM, long-term treatment with carvedilol improves both cardiac adrenergic neuronal function and left ventricular function. The aim of this prospective study was to evaluate the impact of carvedilol on cardiac adrenergic neuronal function and on left ventricular function in seventeen patients (11 female, 6 male, mean age 39 {+-} 57 months, range 1 - 168 months) with DCM. All patients underwent I-123 MIBG cardiac scintigraphy and equilibrium radio-nuclide angiography before and after a 6 month period of carvedilol therapy. A static anterior view of the chest was acquired 4 hours after intravenous injection of 20 to 75 MBq of I-123 MIBG. Cardiac neuronal uptake of I-123 MIBG was measured using the heart to mediastinum count ratio (HMR). Radionuclide left ventricular ejection fraction (LVEF) was assessed following a standard protocol. There was no major cardiac events (death or transplantation) during the follow-up period. I-123 MIBG cardiac uptake and left ventricular function respectively increased by 38% and 65% after 6 months of treatment with carvedilol (HMR 223 {+-} 49% vs 162 {+-} 26%, p < 0.0001 and LVEF = 43 {+-} 17% vs 26 {+-} 11%, p < 0.0001). Carvedilol can improve cardiac adrenergic neuronal function and left ventricular function in children with DCM. Further studies are needed to assess the relationship between improvement in I-123 MIBG cardiac uptake and the beneficial effects of carvedilol on morbidity and mortality. (authors)

  1. Space weather and coronal mass ejections

    CERN Document Server

    Howard, Tim

    2013-01-01

    Space weather has attracted a lot of attention in recent times. Severe space weather can disrupt spacecraft, and on Earth can be the cause of power outages and power station failure. It also presents a radiation hazard for airline passengers and astronauts. These ""magnetic storms"" are most commonly caused by coronal mass ejections, or CMES, which are large eruptions of plasma and magnetic field from the Sun that can reach speeds of several thousand km/s. In this SpringerBrief, Space Weather and Coronal Mass Ejections, author Timothy Howard briefly introduces the coronal mass ejection, its sc

  2. Cardiac arrest

    Science.gov (United States)

    ... Article.jsp. Accessed June 16, 2014. Myerburg RJ, Castellanos A. Approach to cardiac arrest and life-threatening ... PA: Elsevier Saunders; 2011:chap 63. Myerburg RJ, Castellanos A. Cardiac arrest and audden aardiac death. In: ...

  3. Fatores biológicos e superestimação da fração de ejeção do ventrículo esquerdo no gated SPECT Biological factors and overestimation of left ventricular ejection fraction by gated SPECT

    Directory of Open Access Journals (Sweden)

    Marco Antônio Condé de Oliveira

    2008-05-01

    Full Text Available FUNDAMENTO: Alguns pacientes apresentam fração de ejeção do ventrículo esquerdo (FEVE superestimada na cintilografia miocárdica com sincronização eletrocardiográfica (gated SPECT. OBJETIVO: Estabelecer a relação entre fatores biológicos e FEVE superestimada. MÉTODOS: Selecionamos 3.838 pacientes que realizaram gated SPECT entre 20/5/2000 e 16/9/2005, com imagens normais de perfusão e FEVE >50%. Analisamos as variáveis: sexo (29,4% feminino e 70,6% masculino, idade (de 20 a 94 anos - média: 56 anos, peso (de 33,5 a 150 kg - média: 79,6 kg, altura (de 138 a 220 cm - média: 171 cm e IMC (de 13,9 a 54 - média: 27,2. Em um subgrupo de 1.002 pacientes que realizaram ecocardiograma, incluímos as variáveis diâmetros diastólico (de 36 a 68 mm - média 47,5 mm e sistólico (de 22 a 41 mm - média 29,8 mm. Dividimos os pacientes em dois grupos: FEVE normal (80%. A Razão de Chances (RC para apresentar FEVE superestimada foi calculada para cada variável por regressão logística. RESULTADOS: Encontramos as seguintes Razões de Chances (p 0,2. No subgrupo de 1.002 pacientes, encontramos influência estatisticamente significativa na obtenção da FEVE superestimada para as variáveis diâmetro sistólico, sexo e altura. CONCLUSÃO: Apesar de o diâmetro sistólico influenciar na obtenção da FEVE superestimada, as variáveis sexo e altura apresentam influência independente na superestimação da FEVE pelo gated SPECT.BACKGROUND: Some patients present an overestimated left ventricular ejection fraction (LVEF on electrocardiogram-gated myocardial scintigraphy (gated SPECT. OBJECTIVE: To establish the relationship between biological factors and overestimated LVEF. METHODS: We selected 3838 patients who underwent gated SPECT between May 20, 2000 and September 16, 2005 with normal perfusion images and LVEF >50%. The following variables were analyzed: gender (29.4% females and 70.6% males, age (from 20 to 94 years - mean: 56 years, weight

  4. RELATIONSHIP BETWEEN ENDOTHELIAL NITRIC OXIDE SYNTHASE GENE POLYMORPHISM AND HEART FAILURE WITH PRESERVED EJECTION FRACTION IN ELDERLY PATIENTS%eNOS基因多态性与老年射血分数保留心力衰竭相关性

    Institute of Scientific and Technical Information of China (English)

    刘佼磊; 蔡智荣; 毛拥军

    2011-01-01

    Objective To investigate the relationship between endothelial nitric oxide synthase gene G894T polymorphism and heart failure with preserved ejection fraction (HFPEF) in elderly patients.Methods Polymerase chain reaction (PCR) and gene chip techniques were employed to study the genotype and allele frequencies in 230 patients with HFPEF and 200 healthy controls.Logistic regression was used to analyze the effects of age, BMI, serum lipid, blood sugar and genotype on HFPEF.Results The GT+TT genotype frequency and T allele frequency of eNOS gene G894T were significantly different between the H FPEF group and the controls (x2=8.341,3.654;P<0.05).Logistic regression study showed that age, BMI, DM,hypertension, TC and eNOS genotype were risk factors for HFPEF, the OR values were 3.252, 1.223, 1.434,1.845, 4.008, and 1.378, respectively.Conclusian This study suggests that age, BMI, DM, hypertension, and TC were risk factors for HFPEF,and eNOS gene might be a predisposing gene for HFPEF.%目的 探讨内皮型一氧化氮合酶(eNOS)基因多态性与老年射血分数保留心力衰竭(HFPEF)的相关性.方法 应用聚合酶链反应(PCR)、基因芯片技术等方法,检测 230 例老年HFPEF病人及200例健康者(对照组)基因型及基因频率,应用Logistic回归分析年龄、体质量指数(BMI)、血脂、血糖及基因型对老年HFPEF的影响.结果 HFPEF 组 eNOS 基因 G894T 中GT+TT基因型频率及T等位基因频率与对照组比较差异均有显著性(X=8.341、3.654,P<0.05);Logistic 回归分析显示,年龄、BMI、糖尿病、高血压、血总胆固醇、eNOS基因型是HFPEF发病的危险因素,OR 值分别为3.252、1.223、1.434、1.845、4.008、1.378.结论 年龄、BMI、糖尿病、高血压、血总胆同醇是HFPEF的危险因素;eNOS基因G894T可能是HFPPEF发病的易感基因.

  5. 血管紧张素转换酶基因导向治疗原发性高血压及左心室射血分数保留的心力衰竭研究进展%Progress of angiotensin-converting enzyme gene directed therapy for essentiaI hypertension and heart faiIure with preserved ejection fraction

    Institute of Scientific and Technical Information of China (English)

    王慧; 陈伟达; 王薇; 王俏; 隋小芳; 张磊艺

    2016-01-01

    Angiotensin converting enzyme (ACE), a drug that has a genetic polymorphisms is a key enzyme in the renin angiotensin aldosterone system (RAAS), are closely related to hypertension, cardiovascular disease and the damage of target organs caused by hypertension. The individual differences in drug reactions can be caused by it in human beings. In recent years, the heart failure of the left ventricular ejection fraction (HFPEF) is gradually attached importance and has become a hot research. At present, the correlation between ACE (I/D) gene polymorphisms and essential hypertension (EH), EH and HFPEF are not consistent with the results of the study. But the overall conclusion tends to the relationship between DD gene ACE genotype or D-allele and EH and HFPEF, and obviously it is higher. The genotype of ACE gene DD is more sensitive to ACEI drugs in patients with EH. The effect of ACE gene DD genotype on the effect of ACEI is better for patients with HFPEF. To investigate the relationship between ACE gene targeting treatment for EH and HFPEF, and to guide the clinical rational and scientific medication have the unprecedented inspiration.%血管紧张素转换酶(ACE)是肾素-血管紧张素-醛固酮系统(RAAS)的一种关键酶,与高血压病、心血管疾病及高血压病所致的靶器官损害密切相关,是一种具有基因多态性的药物代谢酶,可以造成人类对药物反应的显著个体差异。最近几年,左心室射血分数保留的心力衰竭(HFPEF)日渐受到重视,并成为研究的热点。目前,国内外有关ACE(I/D)基因多态性与原发性高血压(EH)及HFPEF的相关性的研究结果各家报道不一致,但总的结论倾向于ACE基因DD基因型或D等位基因与EH及HFPEF有关系,且明显升高;EH患者ACE基因DD基因型对ACEI类降压药物更敏感;HFPEF患者ACE基因DD基因型对ACEI类药物效果更好。故探讨ACE基因导向治疗原发性高血压及HFPEF的关系

  6. 二维斑点追踪技术对评价左室射血分数保留的心力衰竭的价值%The value of 2-dimensional speckle tracking imaging in evaluating heart failure with persevered left ventricular ejection fraction

    Institute of Scientific and Technical Information of China (English)

    陈晓梅; 张丽丽; 李红瑜; 张帆; 张超; 赵丽荣

    2015-01-01

    目的:本研究应用二维斑点追踪成像(2DSTI)技术,比较左室射血分数保留的心力衰竭(HFPEF)患者及无症状的左室舒张功能障碍(LVDD)患者的左室舒张功能及心肌运动同步性,并观察其与血浆 N 末端 B 型钠尿肽前体(NT-pro BNP)之间的相关性。方法实验组 HFPEF 25例,对照组无症状的 LVDD 25例。测量血浆 NT-pro BNP水平;采集左室心尖二腔、三腔、四腔心观动态图像,应用2DSTI 分析测量。结果实验组舒张早期应变率峰值(GLSRe,02-LSRe,03-LSRe,04-LSRe)明显减低(P <0.05);16节段、12节段收缩应变达峰时间的标准差(Ts-SD16、Ts-SD12)增大,任意对应两节段的收缩应变达峰时间的最长时间间隔(Ts-diff)延长(P <0.05)。Log NT-pro BNP 与GLSRe,02-LSRe,03-LSRe,04-LSRe、Ts-SD16显著相关(P <0.05)。结论2DSTI 能够较为准确地评价舒张功能,区分其受损程度;同时可测定心肌运动的不同步性,为 HFPEF 的诊断和治疗提供新的思路。%Objective To assess the diastolic function and synchronicity of heart failure with persevered left ventric-ular ejection fraction (HFPEF)patients and asymptomatic with left ventricular diastolic dysfunction (LVDD)patients using two dimensional speckle-tracking imaging(2DSTI)and observe the correlation between the 2DSTI measured indi-cators and plasma NT-pro BNP levels.Methods Patients with HFPEF 25 examples,and a control group of asympto-matic with LVDD 25 examples,determined of the plasma NT- pro BNP level,collected apical four-chamber,three-chamber,two-chamber view dynamic two-dimensional image,analysed by 2DSTI.Results HFPEF patients’global and two-chamber,three-chamber,four-chamber early diastolic strain rate (GLSRe,02-LSRe,03-LSRe,04-LSRe)was signif-icantly lower than the asymptomatic with LVDD group (P <0.05);the value of 16,12 segments’Ts-SD,Ts-diff is big-ger(P <0.05).LogNT-pro BNP and

  7. Diagnostic Value of Brachial-ankle Artery Pulse Wave Velocity in Patients of Heart Failure With Preserved Ejection Fraction%臂踝动脉脉搏波速度对射血分数保留心力衰竭的诊断价值

    Institute of Scientific and Technical Information of China (English)

    姜莎莎; 丛涛; 钟雷; 刘岩; 王珂; 苏德淳

    2014-01-01

    Objective: To explore the diagnostic value of brachial-ankle artery pulse wave velocity (baPWv) in patients of heart failure with preserved ejection fraction (HFpEF). Methods: A total of 86 consecutive dyspnoea patients without coronary artery diseases (CAD) were studied and they were divided into 2 groups: HFpEF group,n=46 and Control group, the patients had no organic heart disease,n=40. The incremental diagnostic value of HFpEF by baPWv improving the echocardiographic index and plasma BNP level was assessed by logistic regression model, receiver operation curve (ROC) of multi-parameter combination and net reclassiifcation index analysis. Results: Multiple stepwise logistic regression analysis presented that the ratio of early mitral inlfow velocity to tissue Doppler velocity at the lateral mitral annulus, BNP level and baPWv had the independent predictive value for HFpEF diagnosis, P<0.05. The ROC for baPWv with the combination of 2 or 3 parameters was better than the ROC for a single parameter, P<0.05. The baPWv added with 2007 ESC consensus statement signiifcantly improved HFpEF diagnosis, NRI = 0.127,P<0.05. Conclusion: The baPWv combining with current diagnostic criteria could increase the diagnostic value in patients of HFpEF.%目的:探讨臂踝动脉脉搏波速度在诊断非缺血性射血分数保留心力衰竭(心衰)中的价值。方法:因呼吸困难住院的非冠心病患者86例,分射血分数保留心衰组即实验组(n=46)和对照组(n=40),测量超声心动图、B型利钠肽和臂踝动脉脉搏波速度等指标。采用Logistic回归模型、指标联合接受者操作特性曲线(ROC)和净重分类指数评估臂踝脉搏波速度能否改善上述指标对射血分数保留心衰的诊断效果。结果:经多元逐步Logistic分析,二尖瓣舒张早期流速与侧壁瓣环组织多普勒速度比值、B型利钠肽和臂踝脉搏波速度对射血分数保留心衰有独立预测价值(P<0.05

  8. Medida do átrio esquerdo em pacientes com suspeita de insuficiência cardíaca com fração de ejeção normal Left atrium measurement in patients suspected of having heart failure with preserved ejection fraction

    Directory of Open Access Journals (Sweden)

    Antônio José Lagoeiro Jorge

    2012-02-01

    Full Text Available FUNDAMENTO: O modelo fisiopatológico da insuficiência cardíaca com fração de ejeção normal (ICFEN está centrado na presença de disfunção diastólica, o que ocasiona mudanças estruturais e funcionais no átrio esquerdo (AE. A medida do tamanho do AE pode ser utilizada como um marcador da presença de ICFEN, sendo um indicador da elevação crônica da pressão de enchimento do VE, cuja mensuração é de fácil obtenção. OBJETIVO: Estimar a acurácia da medida do tamanho do AE, utilizando os valores indexados do diâmetro e do volume do AE para o diagnóstico de ICFEN em pacientes ambulatoriais. MÉTODOS: Estudamos 142 pacientes (67,3 ± 11,4 anos, 75% de mulheres com suspeita de IC, os quais foram divididos em dois grupos: com ICFEN (n = 35 e sem ICFEN (n = 107. RESULTADOS: A função diastólica, avaliada pelo ecodopplercardiograma, mostrou diferença significativa entre os dois grupos em relação aos parâmetros que avaliaram o relaxamento ventricular (E' 6,9 ± 2,0 cm/s vs. 9,3 ± 2,5 cm/s - p BACKGROUND: The pathophysiological model of heart failure (HF with preserved ejection fraction (HFPEF focuses on the presence of diastolic dysfunction, which causes left atrial (LA structural and functional changes. The LA size, an indicator of the chronic elevation of the left ventricular (LV filling pressure, can be used as a marker of the presence of HFPEF, and it is easily obtained. OBJECTIVE: To estimate the accuracy of measuring the LA size by using indexed LA volume and diameter (ILAV and ILAD, respectively for diagnosing HFPEF in ambulatory patients. METHODS: This study assessed 142 patients (mean age, 67.3 ± 11.4 years; 75% of the female sex suspected of having HF, divided into two groups: with HFPEF (n = 35 and without HFPEF (n = 107. RESULTS: The diastolic function, assessed by use of Doppler echocardiography, showed a significant difference between the groups regarding the parameters assessing ventricular relaxation (E': 6

  9. 贫血对左心室射血分数保留型心力衰竭患者生存状况的影响%Effect of anemia on clinical outcomes in patients with heart failure with preserved ejection fraction

    Institute of Scientific and Technical Information of China (English)

    赵志坤; 曲峰; 郭旗; 刘润梅; 李良; 翟红霞; 殷亚昕; 张津津; 夏云峰

    2015-01-01

    Objective To assess the effect of anemia on clinical outcomes in patients with heart fail‐ure with preserved ejection fraction (HFPEF) by studying the clinical features of HFPEF .Meth‐ods Three hundred and twenty‐five HFPEF patients admitted to our hospital were divided into anemia group (n= 84) and non‐anemia group (n= 241) .Their clinical and laboratory data were collected .The patients were followed up for 9 -26 (17 .5 ± 8 .3) months .The risk factors for HFPEF were analyzed using Kaplan‐Meier survival curve and Cox proportional hazard regression model .Results The all‐cause death rate or end point events during rehospitalization due to HF was significantly higher in anemia group than in non‐anemia group (67 .9% vs 48 .1% ,P=0.002) .Anemia ,NYHA grade and chronic renal insufficiency were the independent risk factors for HFPEF ,and anemia was the most powerful influence factor (OR= 5 .012 ,95% CI:3 .271 -6.160 ,P=0 .006) .Conclusion Anemia is an independent risk factor for HFPEF ,and more atten‐tion should thus be paid to anemia in diagnosis and treatment of HFPEF .%目的:探讨贫血对射血分数保留型心力衰竭(HFPEF)患者预后生存状况的影响。方法选择在我院住院治疗的 HFPEF患者325例,分为贫血组84例和无贫血组241例,收集临床资料,以全因死亡或心力衰竭再住院为终点事件,定期随访9~26(17.5±8.3)个月,用Kaplan‐Meier生存曲线和Cox比例风险回归模型分析。结果贫血组终点事件发生率明显高于无贫血组(67.9% v s 48.1%,P=0.002)。贫血患者中位生存时间较无贫血患者明显降低(16个月 vs 21个月,P=0.019)。贫血是影响预后的独立危险因素(OR=5.012,95% CI:3.271~6.160,P=0.006)。结论贫血是影响 HFPEF患者预后的独立危险因素,在HFPEF患者诊治过程中应当予以高度重视。

  10. 左房容积指数对射血分数保留型心力衰竭的诊断价值分析%The diagnostic value of left atrial volume index for heart failure with preserved ejection fraction

    Institute of Scientific and Technical Information of China (English)

    杨醒; 魏学标; 林耀望; 陈婉雯; 付明; 周颖玲; 陈竹君; 吴樱; 余丹青

    2014-01-01

    Objective To explore the value of left atrium volume index (LAVI) in the diagnosis of heart failure with preserved ejection fraction (HFPEF). Methods Seventy-seven patients with HFPEF and 33 patients without HFPEF who had been treated from May 2012 to September 2013 in Guangdong General Hospital were en-rolled. The clinical data and a series of ultrasound parameters were collected and analysed. The relationship between LAVI, LAV, and other indexes of diastolic function was determined by Pearson correlation analysis. The value of LAVI and LAV for diagnosing HFPEF was compared by the ROC curve. Results LAVI and LAV of were signifi-cantly greater in HFPEF group than in non-HFPEF group. LAV and LAVI were significantly associated wtih HEPEF. The area under the ROC curve (AUC) of LAVI increased significantly as compared with the AUC of LAV (0.832 vs. 0.799, P<0.05). With a cut-off value of 30 mL/m2, the specificity and sensitivity for diagnosing HEPEF were 64.9%and 84.8%, respectively. Conclusions LAVI may be valuable in the diagnosis of HFPEF.%目的:探讨左房容积指数(LAVI)对射血分数保留型心衰(HFPEF)的诊断价值。方法:入选2012年5月至2013年9月期间就诊于广东省人民医院的住院患者110例,包括病例组(HFPEF)77例和对照组(非HFPEF)33例。分别比较两组人群临床资料及超声心动图指标,对左房容积(LAV)、LAVI与各舒张功能指标之间行 Pearson 相关分析,应用 ROC 曲线对比 LAV、LAVI 在 HFPEF 中的诊断价值。结果:HFPEF 组LAVI、LAV 大于对照组,差异有统计学意义(P<0.05);LAV、LAVI 与 HFPEF 具有良好的相关性; LAVI 在诊断HFPEF 中的ROC 曲线下面积较LAV 显著增大(0.832 vs.0.799, P<0.05);以30 mL/m2作为截点,其特异度为64.9%,敏感度为84.8%。结论:LAVI对HFPEF具有一定的诊断价值。

  11. Capacidade funcional máxima, fração de ejeção e classe funcional na cardiomiopatia chagásica: existe relação entre estes índices? Maximal functional capacity, ejection fraction, and functional class in Chagas cardiomyopathy: are these indices related?

    Directory of Open Access Journals (Sweden)

    Charles Mady

    2005-02-01

    Full Text Available OBJETIVO: Avaliar a potencial associação entre a capacidade funcional máxima (VO2max, fração de ejeção do ventrículo esquerdo (FEVE e a classe funcional (CF pela NYHA em pacientes com cardiomiopatia chagásica. MÉTODOS: Foram estudados 104 homens, com idade média de 40.3± 9.0 anos (variação: de 18 a 65, com diagnóstico estabelecido de cardiomiopatia chagásica. A FEVE e VO2max foram classificadas em três categorias: FEVE 0.50 e VO2max 20 ml.kg-1.min-1, respectivamente. RESULTADOS: Do total, 31 (29.8% pacientes estavam em CF II, 41 (39.4% em classe funcional III, e 32 (30.8% em CF IV. Os valores correspondentes do VO2max e da FEVE para CF II, III e IV foram 21.5±4.0 ml.kg-1.min-1, 18.3±5.8 ml.kg-1.min-1 e 14.7±4.9 ml.kg-1.min-1 e 0.50±0.6, 0.35±0.9 e 0.29±0.7, respectivamente. FEVE 0.50 como também VO2max >20 ml.kg-1.min-1. CONCLUSÃO: Existe uma boa associação entre a classe funcional, a capacidade funcional máxima e a fração de ejeção do ventrículo esquerdo em pacientes com cardiomiopatia chagásica. Dados que podem ser úteis no manuseio da insuficiência cardíaca, em chagásicos.OBJECTIVE: Left ventricular ejection fraction (LVEF and maximal functional capacity (VO2max have both been shown to be related to a poor long-term survival in Chagas' disease patients. The aim of this study was to estimate the potential association of VO2max, LVEF, and NYHA functional class in patients with Chagas' disease cardiomyopathy. METHODS: One hundred four male patients, aged 40.3±9.0 years (range, 18 to 65, with a definite diagnosis of Chagas disease cardiomyopathy were studied. LVEF and VO2max were both classified into 3 degrees: LVEF 0.50 and VO2max 20 ml.kg-1.min-1, respectively. RESULTS: Thirty-one patients (29.8% were in NYHA functional class II, 41 (39.4% in functional class III, and 32 (30.8% in functional class IV. The corresponding values of VO2max and LVEF for functional classes II, III, and IV were 21.5±4.0 ml.kg-1

  12. External cardiac compression may be harmful in some scenarios of pulseless electrical activity.

    LENUS (Irish Health Repository)

    Hogan, T S

    2012-10-01

    Pulseless electrical activity occurs when organised or semi-organised electrical activity of the heart persists but the product of systemic vascular resistance and the increase in systemic arterial flow generated by the ejection of the left venticular stroke volume is not sufficient to produce a clinically detectable pulse. Pulseless electrical activity encompasses a very heterogeneous variety of severe circulatory shock states ranging in severity from pseudo-cardiac arrest to effective cardiac arrest. Outcomes of cardiopulmonary resuscitation for pulseless electrical activity are generally poor. Impairment of cardiac filling is the limiting factor to cardiac output in many scenarios of pulseless electrical activity, including extreme vasodilatory shock states. There is no evidence that external cardiac compression can increase cardiac output when impaired cardiac filling is the limiting factor to cardiac output. If impaired cardiac filling is the limiting factor to cardiac output and the heart is effectively ejecting all the blood returning to it, then external cardiac compression can only increase cardiac output if it increases venous return and cardiac filling. Repeated cardiac compression asynchronous with the patient\\'s cardiac cycle and raised mean intrathoracic pressure due to chest compression can be expected to reduce rather than to increase cardiac filling and therefore to reduce rather than to increase cardiac output in such circumstances. The hypothesis is proposed that the performance of external cardiac compression will have zero or negative effect on cardiac output in pulseless electrical activity when impaired cardiac filling is the limiting factor to cardiac output. External cardiac compression may be both directly and indirectly harmful to significant sub-groups of patients with pulseless electrical activity. We have neither evidence nor theory to provide comfort that external cardiac compression is not harmful in many scenarios of pulseless

  13. External cardiac compression may be harmful in some scenarios of pulseless electrical activity.

    Science.gov (United States)

    Hogan, T S

    2012-10-01

    Pulseless electrical activity occurs when organised or semi-organised electrical activity of the heart persists but the product of systemic vascular resistance and the increase in systemic arterial flow generated by the ejection of the left venticular stroke volume is not sufficient to produce a clinically detectable pulse. Pulseless electrical activity encompasses a very heterogeneous variety of severe circulatory shock states ranging in severity from pseudo-cardiac arrest to effective cardiac arrest. Outcomes of cardiopulmonary resuscitation for pulseless electrical activity are generally poor. Impairment of cardiac filling is the limiting factor to cardiac output in many scenarios of pulseless electrical activity, including extreme vasodilatory shock states. There is no evidence that external cardiac compression can increase cardiac output when impaired cardiac filling is the limiting factor to cardiac output. If impaired cardiac filling is the limiting factor to cardiac output and the heart is effectively ejecting all the blood returning to it, then external cardiac compression can only increase cardiac output if it increases venous return and cardiac filling. Repeated cardiac compression asynchronous with the patient's cardiac cycle and raised mean intrathoracic pressure due to chest compression can be expected to reduce rather than to increase cardiac filling and therefore to reduce rather than to increase cardiac output in such circumstances. The hypothesis is proposed that the performance of external cardiac compression will have zero or negative effect on cardiac output in pulseless electrical activity when impaired cardiac filling is the limiting factor to cardiac output. External cardiac compression may be both directly and indirectly harmful to significant sub-groups of patients with pulseless electrical activity. We have neither evidence nor theory to provide comfort that external cardiac compression is not harmful in many scenarios of pulseless

  14. A prediction model for 5-year cardiac mortality in patients with chronic heart failure using {sup 123}I-metaiodobenzylguanidine imaging

    Energy Technology Data Exchange (ETDEWEB)

    Nakajima, Kenichi; Matsuo, Shinro [Kanazawa University Hospital, Department of Nuclear Medicine, Kanazawa (Japan); Nakata, Tomoaki [Sapporo Medical University School of Medicine, Second Department of Internal Medicine (Cardiology), Sapporo (Japan); Hakodate-Goryoukaku Hospital, Department of Cardiology, Hakodate (Japan); Yamada, Takahisa [Osaka Prefectural General Medical Center, Department of Cardiology, Osaka (Japan); Yamashina, Shohei [Toho University Omori Medical Center, Department of Cardiovascular Medicine, Tokyo (Japan); Momose, Mitsuru [Tokyo Women' s Medical University, Department of Nuclear Medicine, Tokyo (Japan); Kasama, Shu [Cardiovascular Hospital of Central Japan, Department of Cardiology, Shibukawa (Japan); Matsui, Toshiki [Social Insurance Shiga General Hospital, Department of Cardiology, Otsu (Japan); Travin, Mark I. [Albert Einstein Medical College, Department of Cardiology and Nuclear Medicine, Montefiore Medical Center, Bronx, NY (United States); Jacobson, Arnold F. [GE Healthcare, Medical Diagnostics, Princeton, NJ (United States)

    2014-09-15

    Prediction of mortality risk is important in the management of chronic heart failure (CHF). The aim of this study was to create a prediction model for 5-year cardiac death including assessment of cardiac sympathetic innervation using data from a multicenter cohort study in Japan. The original pooled database consisted of cohort studies from six sites in Japan. A total of 933 CHF patients who underwent {sup 123}I-metaiodobenzylguanidine (MIBG) imaging and whose 5-year outcomes were known were selected from this database. The late MIBG heart-to-mediastinum ratio (HMR) was used for quantification of cardiac uptake. Cox proportional hazard and logistic regression analyses were used to select appropriate variables for predicting 5-year cardiac mortality. The formula for predicting 5-year mortality was created using a logistic regression model. During the 5-year follow-up, 205 patients (22 %) died of a cardiac event including heart failure death, sudden cardiac death and fatal acute myocardial infarction (64 %, 30 % and 6 %, respectively). Multivariate logistic analysis selected four parameters, including New York Heart Association (NYHA) functional class, age, gender and left ventricular ejection fraction, without HMR (model 1) and five parameters with the addition of HMR (model 2). The net reclassification improvement analysis for all subjects was 13.8 % (p < 0.0001) by including HMR and its inclusion was most effective in the downward reclassification of low-risk patients. Nomograms for predicting 5-year cardiac mortality were created from the five-parameter regression model. Cardiac MIBG imaging had a significant additive value for predicting cardiac mortality. The prediction formula and nomograms can be used for risk stratifying in patients with CHF. (orig.)

  15. Spontaneous Aerosol Ejection: Origin of Inorganic Particles in Biomass Pyrolysis.

    Science.gov (United States)

    Teixeira, Andrew R; Gantt, Rachel; Joseph, Kristeen E; Maduskar, Saurabh; Paulsen, Alex D; Krumm, Christoph; Zhu, Cheng; Dauenhauer, Paul J

    2016-06-08

    At high thermal flux and temperatures of approximately 500 °C, lignocellulosic biomass transforms to a reactive liquid intermediate before evaporating to condensable bio-oil for downstream upgrading to renewable fuels and chemicals. However, the existence of a fraction of nonvolatile compounds in condensed bio-oil diminishes the product quality and, in the case of inorganic materials, catalyzes undesirable aging reactions within bio-oil. In this study, ablative pyrolysis of crystalline cellulose was evaluated, with and without doped calcium, for the generation of inorganic-transporting aerosols by reactive boiling ejection from liquid intermediate cellulose. Aerosols were characterized by laser diffraction light scattering, inductively coupled plasma spectroscopy, and high-speed photography. Pyrolysis product fractionation revealed that approximately 3 % of the initial feed (both organic and inorganic) was transported to the gas phase as aerosols. Large bubble-to-aerosol size ratios and visualization of significant late-time ejections in the pyrolyzing cellulose suggest the formation of film bubbles in addition to the previously discovered jet formation mechanism.

  16. Development and Validation of Predictive Models of Cardiac Mortality and Transplantation in Resynchronization Therapy

    Directory of Open Access Journals (Sweden)

    Eduardo Arrais Rocha

    2015-01-01

    Full Text Available Abstract Background: 30-40% of cardiac resynchronization therapy cases do not achieve favorable outcomes. Objective: This study aimed to develop predictive models for the combined endpoint of cardiac death and transplantation (Tx at different stages of cardiac resynchronization therapy (CRT. Methods: Prospective observational study of 116 patients aged 64.8 ± 11.1 years, 68.1% of whom had functional class (FC III and 31.9% had ambulatory class IV. Clinical, electrocardiographic and echocardiographic variables were assessed by using Cox regression and Kaplan-Meier curves. Results: The cardiac mortality/Tx rate was 16.3% during the follow-up period of 34.0 ± 17.9 months. Prior to implantation, right ventricular dysfunction (RVD, ejection fraction < 25% and use of high doses of diuretics (HDD increased the risk of cardiac death and Tx by 3.9-, 4.8-, and 5.9-fold, respectively. In the first year after CRT, RVD, HDD and hospitalization due to congestive heart failure increased the risk of death at hazard ratios of 3.5, 5.3, and 12.5, respectively. In the second year after CRT, RVD and FC III/IV were significant risk factors of mortality in the multivariate Cox model. The accuracy rates of the models were 84.6% at preimplantation, 93% in the first year after CRT, and 90.5% in the second year after CRT. The models were validated by bootstrapping. Conclusion: We developed predictive models of cardiac death and Tx at different stages of CRT based on the analysis of simple and easily obtainable clinical and echocardiographic variables. The models showed good accuracy and adjustment, were validated internally, and are useful in the selection, monitoring and counseling of patients indicated for CRT.

  17. Heart-Kidney Biomarkers in Patients Undergoing Cardiac Stress Testing

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    Mikko Haapio

    2011-01-01

    Full Text Available We examined association of inducible myocardial perfusion defects with cardiorenal biomarkers, and of diminished left ventricular ejection fraction (LVEF with kidney injury marker plasma neutrophil gelatinase-associated lipocalin (NGAL. Patients undergoing nuclear myocardial perfusion stress imaging were divided into 2 groups. Biomarkers were analyzed pre- and poststress testing. Compared to the patients in the low ischemia group (n=16, the patients in the high ischemia group (n=18 demonstrated a significantly greater rise in cardiac biomarkers plasma BNP, NT-proBNP and cTnI. Subjects were also categorized based on pre- or poststress test detectable plasma NGAL. With stress, the group with no detectable NGAL had a segmental defect score 4.2 compared to 8.2 (P=.06 in the detectable NGAL group, and 0.9 vs. 3.8 (P=.03 at rest. BNP rose with stress to a greater degree in patients with detectable NGAL (10.2 vs. 3.5 pg/mL, P=.03. LVEF at rest and with stress was significantly lower in the detectable NGAL group; 55.8 versus 65.0 (P=.03 and 55.1 vs. 63.8 (P=.04, respectively. Myocardial perfusion defects associate with biomarkers of cardiac stress, and detectable plasma NGAL with significantly lower LVEF, suggesting a specific heart-kidney link.

  18. Clinical study on the changes of serum brain natriuretic peptide,C reactive protein and glycosylated hemoglobin in patients with diabetes and hypertension complicated with heart failure with preserved ejection fraction%糖尿病合并高血压射血分数保留的心力衰竭患者血清脑钠肽、C反应蛋白、糖化血红蛋白变化的临床研究

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    赵英丽; 李志娟

    2016-01-01

    Objective:To investigate the significance of the changes of serum brain natriuretic peptide,C reactive protein and glycosylated hemoglobin in patients with diabetes and hypertension complicated with heart failure with preserved ejection fraction. Methods:241 cases of HFPEF patients with hypertension and (or) diabetes were divided into the diabetic group and the non-diabetic group.The HbA1c,C reactive protein,NT-proBNP of the two groups were compared.Results:The HbA1c,C reactive protein,NT-proBNP and the incidence of major adverse cardial events(MACE) in the diabetic group were significantly higher than those in the non-diabetic group(P<0.05).There were positive correlation between HbA1cC reactive protein,NT-proBNP and the incidence of MACE.Conclusion:NT-proBNP, HbA1c,C reactive protein had higher clinical application value in predicting the incidence of diabetes and hypertension complicated with heart failure with preserved ejection fraction.%目的:探讨糖尿病合并高血压射血分数保留的心力衰竭(HFPEF)患者血清脑钠肽、C反应蛋白、糖化血红蛋白变化的意义。方法:收治合并高血压和(或)糖尿病的 HFPEF 患者241例,分为糖尿病组和非糖尿病组。比较两组HbA1c、C反应蛋白、NT-proBNP。结果:糖尿病组的HbA1c、C反应蛋白、NT-proBNP、MACE发生率显著高于非糖尿病组(P<0.05)。HbA1c、C反应蛋白、NT-proBNP与MACE发生率呈正相关。结论:NT-proBNP、HbA1c、C反应蛋白对糖尿病合并高血压HFPEF发生率的预测具有较高的临床应用价值。

  19. Preventing tomorrow's sudden cardiac death today: part I: Current data on risk stratification for sudden cardiac death.

    Science.gov (United States)

    Al-Khatib, Sana M; Sanders, Gillian D; Bigger, J Thomas; Buxton, Alfred E; Califf, Robert M; Carlson, Mark; Curtis, Anne; Curtis, Jeptha; Fain, Eric; Gersh, Bernard J; Gold, Michael R; Haghighi-Mood, Ali; Hammill, Stephen C; Healey, Jeff; Hlatky, Mark; Hohnloser, Stefan; Kim, Raymond J; Lee, Kerry; Mark, Daniel; Mianulli, Marcus; Mitchell, Brent; Prystowsky, Eric N; Smith, Joseph; Steinhaus, David; Zareba, Wojciech

    2007-06-01

    Accurate and timely prediction of sudden cardiac death (SCD) is a necessary prerequisite for effective prevention and therapy. Although the largest number of SCD events occurs in patients without overt heart disease, there are currently no tests that are of proven predictive value in this population. Efforts in risk stratification for SCD have focused primarily on predicting SCD in patients with known structural heart disease. Despite the ubiquity of tests that have been purported to predict SCD vulnerability in such patients, there is little consensus on which test, in addition to the left ventricular ejection fraction, should be used to determine which patients will benefit from an implantable cardioverter defibrillator. On July 20 and 21, 2006, a group of experts representing clinical cardiology, cardiac electrophysiology, biostatistics, economics, and health policy were joined by representatives of the US Food and Drug administration, Centers for Medicare Services, Agency for Health Research and Quality, the Heart Rhythm Society, and the device and pharmaceutical industry for a round table meeting to review current data on strategies of risk stratification for SCD, to explore methods to translate these strategies into practice and policy, and to identify areas that need to be addressed by future research studies. The meeting was organized by the Duke Center for the Prevention of SCD at the Duke Clinical Research Institute and was funded by industry participants. This article summarizes the presentations and discussions that occurred at that meeting.

  20. AKAP13 Rho-GEF and PKD-binding domain deficient mice develop normally but have an abnormal response to β-adrenergic-induced cardiac hypertrophy.

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    Matthew J Spindler

    Full Text Available BACKGROUND: A-kinase anchoring proteins (AKAPs are scaffolding molecules that coordinate and integrate G-protein signaling events to regulate development, physiology, and disease. One family member, AKAP13, encodes for multiple protein isoforms that contain binding sites for protein kinase A (PKA and D (PKD and an active Rho-guanine nucleotide exchange factor (Rho-GEF domain. In mice, AKAP13 is required for development as null embryos die by embryonic day 10.5 with cardiovascular phenotypes. Additionally, the AKAP13 Rho-GEF and PKD-binding domains mediate cardiomyocyte hypertrophy in cell culture. However, the requirements for the Rho-GEF and PKD-binding domains during development and cardiac hypertrophy are unknown. METHODOLOGY/PRINCIPAL FINDINGS: To determine if these AKAP13 protein domains are required for development, we used gene-trap events to create mutant mice that lacked the Rho-GEF and/or the protein kinase D-binding domains. Surprisingly, heterozygous matings produced mutant mice at Mendelian ratios that had normal viability and fertility. The adult mutant mice also had normal cardiac structure and electrocardiograms. To determine the role of these domains during β-adrenergic-induced cardiac hypertrophy, we stressed the mice with isoproterenol. We found that heart size was increased similarly in mice lacking the Rho-GEF and PKD-binding domains and wild-type controls. However, the mutant hearts had abnormal cardiac contractility as measured by fractional shortening and ejection fraction. CONCLUSIONS: These results indicate that the Rho-GEF and PKD-binding domains of AKAP13 are not required for mouse development, normal cardiac architecture, or β-adrenergic-induced cardiac hypertrophic remodeling. However, these domains regulate aspects of β-adrenergic-induced cardiac hypertrophy.

  1. Novel all-extremity high-intensity interval training improves aerobic fitness, cardiac function and insulin resistance in healthy older adults.

    Science.gov (United States)

    Hwang, Chueh-Lung; Yoo, Jeung-Ki; Kim, Han-Kyul; Hwang, Moon-Hyon; Handberg, Eileen M; Petersen, John W; Christou, Demetra D

    2016-09-01

    Aging is associated with decreased aerobic fitness and cardiac remodeling leading to increased risk for cardiovascular disease. High-intensity interval training (HIIT) on the treadmill has been reported to be more effective in ameliorating these risk factors compared with moderate-intensity continuous training (MICT) in patients with cardiometabolic disease. In older adults, however, weight-bearing activities are frequently limited due to musculoskeletal and balance problems. The purpose of this study was to examine the feasibility and safety of non-weight-bearing all-extremity HIIT in older adults. In addition, we tested the hypothesis that all-extremity HIIT will be more effective in improving aerobic fitness, cardiac function, and metabolic risk factors compared with all-extremity MICT. Fifty-one healthy sedentary older adults (age: 65±1years) were randomized to HIIT (n=17), MICT (n=18) or non-exercise control (CONT; n=16). HIIT (4×4min 90% of peak heart rate; HRpeak) and isocaloric MICT (70% of HRpeak) were performed on a non-weight-bearing all-extremity ergometer, 4×/week for 8weeks under supervision. All-extremity HIIT was feasible in older adults and resulted in no adverse events. Aerobic fitness (peak oxygen consumption; VO2peak) and ejection fraction (echocardiography) improved by 11% (PHIIT, while no changes were observed in MICT and CONT (P≥0.1). Greater improvements in ejection fraction were associated with greater improvements in VO2peak (r=0.57; PHIIT by 26% (P=0.016). Diastolic function, body composition, glucose and lipids were unaffected (P≥0.1). In conclusion, all-extremity HIIT is feasible and safe in older adults. HIIT, but not MICT, improved aerobic fitness, ejection fraction, and insulin resistance.

  2. Transcatheter Closure of Atrial Septal Defects Improves Cardiac Remodeling and Function of Adult Patients with Permanent Atrial Fibrillation

    Institute of Scientific and Technical Information of China (English)

    Liang Chen; Yuan Bai; Fei-Yu Wang; Zhi-Gang Zhang; Xing-Hua Shan; Tao Chen; Xian-Xian Zhao

    2015-01-01

    Background:Permanent atrial fibrillation (AF) is the most common form of dysrhythmia associated with atrial septal defects (ASDs) in patients older than 40 years.However,little is known about cardiac remodeling after transcatheter closure in patients with permanent AF.This study was designed to compare cardiac events and remodeling effects after transcatheter closure in such patients.Methods:Clinical data of 289 adult patients older than 40 years who underwent ASD closure at our center were analyzed retrospectively.Of them,63 patients with permanent AF were assigned to the case group,and the other 226 patients without permanent AF were assigned to the control group.Cardiac events and changes in left and right cardiac cavity dimensions before the procedure and 6 months after the procedure were compared between the two groups.Results:Patients in the case group were significantly older than those in the control group.The right ventricular (RV) volume and right atrial (RA) volume were decreased significantly in both the groups during a median follow-up period of 6 months after closure (P < 0.001).The left atrial dimensions,left ventricular end-systolic dimensions,left ventricular end-diastolic dimensions and left ventricular ejection fraction showed no significant change before and after the procedure in both the groups.Changes of the RV volume and RA volume in the case group were significantly smaller than those in the control group (P =0.005 and P < 0.001).The New York Heart Association cardiac function was improved in both the groups during the 6 months follow-up period.Conclusions:The transcatheter closure of ASD can improve the cardiac remodeling and cardiac function in patients with or without AF.

  3. Transcatheter Closure of Atrial Septal Defects Improves Cardiac Remodeling and Function of Adult Patients with Permanent Atrial Fibrillation

    Directory of Open Access Journals (Sweden)

    Liang Chen

    2015-01-01

    Full Text Available Background: Permanent atrial fibrillation (AF is the most common form of dysrhythmia associated with atrial septal defects (ASDs in patients older than 40 years. However, little is known about cardiac remodeling after transcatheter closure in patients with permanent AF. This study was designed to compare cardiac events and remodeling effects after transcatheter closure in such patients. Methods: Clinical data of 289 adult patients older than 40 years who underwent ASD closure at our center were analyzed retrospectively. Of them, 63 patients with permanent AF were assigned to the case group, and the other 226 patients without permanent AF were assigned to the control group. Cardiac events and changes in left and right cardiac cavity dimensions before the procedure and 6 months after the procedure were compared between the two groups. Results: Patients in the case group were significantly older than those in the control group. The right ventricular (RV volume and right atrial (RA volume were decreased significantly in both the groups during a median follow-up period of 6 months after closure (P < 0.001. The left atrial dimensions, left ventricular end-systolic dimensions, left ventricular end-diastolic dimensions and left ventricular ejection fraction showed no significant change before and after the procedure in both the groups. Changes of the RV volume and RA volume in the case group were significantly smaller than those in the control group (P = 0.005 and P < 0.001. The New York Heart Association cardiac function was improved in both the groups during the 6 months follow-up period. Conclusions: The transcatheter closure of ASD can improve the cardiac remodeling and cardiac function in patients with or without AF.

  4. Glucagon-like peptide-1 and the exenatide analogue AC3174 improve cardiac function, cardiac remodeling, and survival in rats with chronic heart failure

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    Polizzi Clara

    2010-11-01

    Full Text Available Abstract Background Accumulating evidence suggests glucagon-like peptide-1 (GLP-1 exerts cardioprotective effects in animal models of myocardial infarction (MI. We hypothesized that chronic treatment with GLP-1 or the exenatide analog AC3174 would improve cardiac function, cardiac remodeling, insulin sensitivity, and exercise capacity (EC in rats with MI-induced chronic heart failure (CHF caused by coronary artery ligation. Methods Two weeks post-MI, male Sprague-Dawley rats were treated with GLP-1 (2.5 or 25 pmol/kg/min, AC3174 (1.7 or 5 pmol/kg/min or vehicle via subcutaneous infusion for 11 weeks. Cardiac function and morphology were assessed by echocardiography during treatment. Metabolic, hemodynamic, exercise-capacity, and body composition measurements were made at study end. Results Compared with vehicle-treated rats with CHF, GLP-1 or AC3174 significantly improved cardiac function, including left ventricular (LV ejection fraction, and end diastolic pressure. Cardiac dimensions also improved as evidenced by reduced LV end diastolic and systolic volumes and reduced left atrial volume. Vehicle-treated CHF rats exhibited fasting hyperglycemia and hyperinsulinemia. In contrast, GLP-1 or AC3174 normalized fasting plasma insulin and glucose levels. GLP-1 or AC3174 also significantly reduced body fat and fluid mass and improved exercise capacity and respiratory efficiency. Four of 16 vehicle control CHF rats died during the study compared with 1 of 44 rats treated with GLP-1 or AC3174. The cellular mechanism by which GLP-1 or AC3174 exert cardioprotective effects appears unrelated to changes in GLUT1 or GLUT4 translocation or expression. Conclusions Chronic treatment with either GLP-1 or AC3174 showed promising cardioprotective effects in a rat model of CHF. Hence, GLP-1 receptor agonists may represent a novel approach for the treatment of patients with CHF or cardiovascular disease associated with type 2 diabetes.

  5. Transplantation of autologous adipose-derived stem cells ameliorates cardiac function in rabbits with myocardial infarction

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    ZHANG Duan-zhen; GAI Lu-yue; LIU Hong-wei; JIN Qin-hua; HUANG Jian-hua; ZHU Xian-yang

    2007-01-01

    Background Adipose-derived stem cells (ADSCs) are capable of differentiating into cardiomyogenic and endothelial cells in vitro. We tested the hypothesis that transplantation of ADSCs into myocardial scar may regenerate infracted myocardium and restore cardiac function.Methods ADSCs were isolated from the fatty tissue of New Zealand white rabbits and cultured in Iscove's modified dulbecco's medium. Three weeks after ligation of left anterior descending coronary artery of rabbits, either a graft of untreated ADSCs (UASCs, n=14), 5-azacytidine-pretreated ADSCs (AASCs, n=13), or phosphate buffer saline (n=13)were injected into the infarct region. Transmural scar size, cardiac function, and immunohistochemistry were performed 5 weeks after cell transplantation.Results ADSCs in culture demonstrated a fibroblast-like appearance and expressed CD29, CD44 and CD105. Five weeks after cell transplantation, transmural scar size in AASC-implanted hearts was smaller than that of the other hearts.Many ADSCs were differentiated into cardiomyocytes. The AASCs in the prescar appeared more myotube-like. AASCs in the middle of the scar and UASCs, in contrast, were poorly differentiated. Some ADSCs were differentiated into endothelial cells and participate in vessel-like structures formation. All the ADSC-implanted hearts had a greater capillary density in the infarct region than did the control hearts. Statistical analyses revealed significant improvement in left ventricular ejection fraction, myocardial performance index, end-diastolic pressure, and peak +dP/dt, in two groups of ADSC-implanted hearts relative to the control hearts. AASC-implanted hearts had higher peak -dP/dt values than did control, higher ejection fraction and peak +dP/dtvalues than did UASC-implanted hearts.Conclusions ADSCs transplanted into the myocardial scar tissue formed cardiac islands and vessel-like structures,induced angiogenesis and improved cardiac function. 5-Azacytidine pretreatment before

  6. Ablation of C/EBP homologous protein increases the acute phase mortality and doesn't attenuate cardiac remodeling in mice with myocardial infarction.

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    Luo, Guangjin; Li, Qingman; Zhang, Xiajun; Shen, Liang; Xie, Jiahe; Zhang, Jingwen; Kitakaze, Masafumi; Huang, Xiaobo; Liao, Yulin

    2015-08-14

    Endoplasmic reticulum stress is a proapoptotic and profibrotic stimulus. Ablation of C/EBP homologous protein (CHOP) is reported to reverse cardiac dysfunction by attenuating cardiac endoplasmic reticulum stress in mice with pressure overload or ischemia/reperfusion, but it is unclear whether loss of CHOP also inhibits cardiac remodeling induced by permanent-infarction. In mice with permanent ligation of left coronary artery, we found that ablation of CHOP increased the acute phase mortality. For the mice survived to 4 weeks, left ventricular anterior (LV) wall thickness was larger in CHOP knockout mice than in the wildtype littermates, while no difference was noted on posterior wall thickness, LV dimensions, LV fractional shortening and ejection fraction. Similarly, invasive assessment of LV hemodynamics, morphological analysis of heart and lung weight indexes, myocardial fibrosis and TUNEL-assessed apoptosis showed no significant differences between CHOP knockout mice and their wildtype ones, while in mice with ischemia for 45 min and reperfusion for 1 week, myocardial fibrosis and apo