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  1. Renal denervation in heart failure with normal left ventricular ejection fraction. Rationale and design of the DIASTOLE (DenervatIon of the renAl Sympathetic nerves in hearT failure with nOrmal Lv Ejection fraction) trial.

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    Verloop, Willemien L; Beeftink, Martine M A; Nap, Alex; Bots, Michiel L; Velthuis, Birgitta K; Appelman, Yolande E; Cramer, Maarten-Jan; Agema, Willem R P; Scholtens, Asbjorn M; Doevendans, Pieter A; Allaart, Cor P; Voskuil, Michiel

    2013-12-01

    Aim Increasing evidence suggests an important role for hyperactivation of the sympathetic nervous system (SNS) in the clinical phenomena of heart failure with normal LVEF (HFNEF) and hypertension. Moreover, the level of renal sympathetic activation is directly related to the severity of heart failure. Since percutaneous renal denervation (pRDN) has been shown to be effective in modulating elevated SNS activity in patients with hypertension, it can be hypothesized that pRDN has a positive effect on HFNEF. The DIASTOLE trial will investigate whether renal sympathetic denervation influences parameters of HFNEF. Methods DIASTOLE is a multicentre, randomized controlled trial. Sixty patients, diagnosed with HFNEF and treated for hypertension, will be randomly allocated in a 1:1 ratio to undergo renal denervation on top of medical treatment (n = 30) or to maintain medical treatment alone (n = 30). The primary objective is to investigate the efficacy of pRDN by means of pulsed wave Doppler echocardiographic parameters. Secondary objectives include safety of pRDN and a comparison of changes in the following parameters after pRDN: LV mass, LV volume, LVEF, and left atrial volume as determined by magnetic resonance imaging. Also, MIBG (metaiodobenzylguanidine) uptake and washout, BNP levels, blood pressure, heart rate variability, exercise capacity, and quality of life will be assessed. Perspective DIASTOLE is a randomized controlled trial evaluating renal denervation as a treatment option for HFNEF. The results of the current trial will provide important information regarding the treatment of HFNEF, and therefore may have major impact on future therapeutic strategies. Trail registration NCT01583881.

  2. 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 ...

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

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    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

  4. 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

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    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.

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

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    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.

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

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    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.)

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

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    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

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

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    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 (

  9. Diastolic relaxation and compliance reserve during dynamic exercise in heart failure with preserved ejection fraction.

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    Borlaug, Barry A; Jaber, Wissam A; Ommen, Steve R; Lam, Carolyn S P; Redfield, Margaret M; Nishimura, Rick A

    2011-06-01

    Recent studies have examined haemodynamic changes with stressors such as isometric handgrip and rapid atrial pacing in heart failure with preserved ejection fraction (HFpEF), but little is known regarding left ventricular (LV) pressure-volume responses during dynamic exercise. To assess LV haemodynamic responses to dynamic exercise in patients with HFpEF. Twenty subjects with normal ejection fraction (EF) and exertional dyspnoea underwent invasive haemodynamic assessment during dynamic exercise to evaluate suspected HFpEF. LV end-diastolic pressure was elevated at rest (>15 mm Hg, n=18) and with exercise (≥20 mm Hg, n=20) in all subjects, consistent with HFpEF. Heart rate (HR), blood pressure, arterial elastance and cardiac output increased with exercise (all pincreased by 43-56% with exercise (both pincreases in HR and the proportion of diastole that elapsed prior to estimated complete relaxation increased (pincreased 50% during exercise (p=0.0003). Exercise increases in LV filling pressures correlated with changes in diastolic relaxation rates, chamber stiffness and arterial afterload but were not related to alterations in preload volume, HR or cardiac output. In patients with newly diagnosed HFpEF, LV filling pressures increase during dynamic exercise in association with inadequate enhancement of relaxation and acute increases in LV chamber stiffness. Therapies that enhance diastolic reserve function may improve symptoms of exertional intolerance in patients with hypertensive heart disease and early HFpEF.

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

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    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.

  11. Global Longitudinal Strain or Left Ventricular Twist and Torsion? Which Correlates Best with Ejection Fraction?

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    Marcio Silva Miguel Lima

    Full Text Available Abstract Background: Estimative of left ventricular ejection fraction (LVEF is a major indication for echocardiography. Speckle tracking echocardiography (STE allows analysis of LV contraction mechanics which includes global longitudinal strain (GLS and twist/torsion, both the most widely used. Direct comparison of correlations between these novel parameters and LVEF has never been done before. Objective: This study aims to check which one has the highest correlation with LVEF. Methods: Patients with normal LVEF (> 0,55 and systolic dysfunction (LVEF <0,55 were prospectively enrolled, and underwent echocardiogram with STE analysis. Correlation of variables was performed by linear regression analysis. In addition, correlation among levels of LV systolic impairment was also tested. Results: A total of 131 patients were included (mean age, 46 ± 14y; 43%, men. LVEF and GLS showed a strong correlation (r = 0.95; r2 = 0.89; p < 0.001, more evident in groups with LV systolic dysfunction than those with preserved LVEF. Good correlation was also found with global longitudinal strain rate (r = 0.85; r2 = 0.73; p < 0.001. Comparing to GLS, correlation of LVEF and torsional mechanics was weaker: twist (r = 0.78; r2 = 0.60; p < 0.001; torsion (r = 0.75; r2 = 0.56; p < 0.001. Conclusion: GLS of the left ventricle have highly strong positive correlation with the classical parameter of ejection fraction, especially in cases with LV systolic impairment. Longitudinal strain rate also demonstrated a good correlation. GLS increments analysis of LV systolic function. On the other hand, although being a cornerstone of LV mechanics, twist and torsion have a weaker correlation with LV ejection, comparing to GLS.

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

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    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.

  13. Right Ventricular Ejection Fraction Is Incremental to Left Ventricular Ejection Fraction for the Prediction of Future Arrhythmic Events in Patients With Systolic Dysfunction.

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    Mikami, Yoko; Jolly, Umjeet; Heydari, Bobak; Peng, Mingkai; Almehmadi, Fahad; Zahrani, Mohammed; Bokhari, Mahmoud; Stirrat, John; Lydell, Carmen P; Howarth, Andrew G; Yee, Raymond; White, James A

    2017-01-01

    Left ventricular ejection fraction remains the primary risk stratification tool used in the selection of patients for implantable cardioverter defibrillator therapy. However, this solitary marker fails to identify a substantial portion of patients experiencing sudden cardiac arrest. In this study, we examined the incremental value of considering right ventricular ejection fraction for the prediction of future arrhythmic events in patients with systolic dysfunction using the gold standard of cardiovascular magnetic resonance. Three hundred fourteen consecutive patients with ischemic cardiomyopathy or nonischemic dilated cardiomyopathy undergoing cardiovascular magnetic resonance were followed for the primary outcome of sudden cardiac arrest or appropriate implantable cardioverter defibrillator therapy. Blinded quantification of left ventricular and right ventricular (RV) volumes was performed from standard cine imaging. Quantification of fibrosis from late gadolinium enhancement imaging was incrementally performed. RV dysfunction was defined as right ventricular ejection fraction ≤45%. Among all patients (164 ischemic cardiomyopathy, 150 nonischemic dilated cardiomyopathy), the mean left ventricular ejection fraction was 32±12% (range, 6-54%) with mean right ventricular ejection fraction of 48±15% (range, 7-78%). At a median of 773 days, 49 patients (15.6%) experienced the primary outcome (9 sudden cardiac arrest, 40 appropriate implantable cardioverter defibrillator therapies). RV dysfunction was independently predictive of the primary outcome (hazard ratio=2.98; P=0.002). Among those with a left ventricular ejection fraction >35% (N=121; mean left ventricular ejection fraction, 45±6%), RV dysfunction provided an adjusted hazard ratio of 4.2 (P=0.02). RV dysfunction is a strong, independent predictor of arrhythmic events. Among patients with mild to moderate LV dysfunction, a cohort greatly contributing to global sudden cardiac arrest burden, this marker

  14. 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.

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

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    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.

  16. Animal models of heart failure with preserved ejection fraction

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    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

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

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    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

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

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    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.

  19. Impaired left ventricular global longitudinal strain in patients with heart failure with preserved ejection fraction: insights from the RELAX trial.

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    DeVore, Adam D; McNulty, Steven; Alenezi, Fawaz; Ersboll, Mads; Vader, Justin M; Oh, Jae K; Lin, Grace; Redfield, Margaret M; Lewis, Gregory; Semigran, Marc J; Anstrom, Kevin J; Hernandez, Adrian F; Velazquez, Eric J

    2017-07-01

    While abnormal left ventricular (LV) global longitudinal strain (GLS) has been described in patients with heart failure with preserved ejection fraction (HFpEF), its prevalence and clinical significance are poorly understood. Patients enrolled in the RELAX trial of sildenafil in HFpEF (LV ejection fraction ≥50%) in whom two-dimensional, speckle-tracking LV GLS was possible (n = 187) were analysed. The distribution of LV GLS and its associations with clinical characteristics, LV structure and function, biomarkers, exercise capacity and quality of life were assessed. Baseline median LV GLS was -14.6% (25th and 75th percentile, -17.0% and -11.9%, respectively) and abnormal (≥ - 16%) in 122/187 (65%) patients. Patients in the tertile with the best LV GLS had lower N-terminal pro-brain natriuretic peptide (NT-proBNP) [median 505 pg/mL (161, 1065) vs. 875 pg/mL (488, 1802), P = 0.008) and lower collagen III N-terminal propeptide (PIIINP) levels [median 6.7 µg/L (5.1, 8.1) vs. 8.1 µg/L (6.5, 10.5), P = 0.001] compared with the tertile with the worst LV GLS. There was also a modest linear relationship with LV GLS and log-transformed NT-proBNP and PIIINP (r = 0.29, P < 0.001 and r = 0.19, P = 0.009, respectively). We observed no linear association of LV GLS with Minnesota Living with Heart Failure scores, 6-min walk distance, peak oxygen consumption, or expiratory minute ventilation/carbon dioxide excretion slope. Impaired LV GLS is common among HFpEF patients, indicating the presence of covert systolic dysfunction despite normal LV ejection fraction. Impaired LV GLS was associated with biomarkers of wall stress and collagen synthesis and diastolic dysfunction but not with quality of life or exercise capacity, suggesting other processes may be more responsible for these aspects of the HFpEF syndrome. © 2017 The Authors. European Journal of Heart Failure © 2017 European Society of Cardiology.

  20. Animal models of heart failure with preserved ejection fraction

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    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...

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

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    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.

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

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    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.

  3. 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.

  4. Diagnosis of heart failure with preserved ejection fraction.

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    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.

  5. 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

  6. 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.

  7. 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 ...

  8. 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...

  9. 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.

  10. 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 LV systolic function, namely by the increase of end-systolic volume and decrease in the degree of LV fractional shortening size.

  11. 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

  12. 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

  13. [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.

  14. 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)

  15. Right heart dysfunction in heart failure with preserved ejection fraction

    Science.gov (United States)

    Melenovsky, Vojtech; Hwang, Seok-Jae; Lin, Grace; Redfield, Margaret M.; Borlaug, Barry A.

    2014-01-01

    Aim Right heart function is not well characterized in patients with heart failure and preserved ejection fraction (HFpEF). The goal of this study was to examine the haemodynamic, clinical, and prognostic correlates of right ventricular dysfunction (RVD) in HFpEF. Methods and results Heart failure and preserved ejection fraction patients (n = 96) and controls (n = 46) underwent right heart catheterization, echocardiographic assessment, and follow-up. Right and left heart filling pressures, pulmonary artery (PA) pressures, and right-sided chamber dimensions were higher in HFpEF compared with controls, while left ventricular size and EF were similar. Right ventricular dysfunction (defined by RV fractional area change, FAC Right ventricular function was impaired in HFpEF compared with controls using both load-dependent (FAC: 40 ± 10 vs. 53 ± 7%, P Right heart dysfunction is common in HFpEF and is caused by both RV contractile impairment and afterload mismatch from pulmonary hypertension. Right ventricular dysfunction in HFpEF develops with increasing PA pressures, atrial fibrillation, male sex, and left ventricular dysfunction, and may represent a novel therapeutic target. PMID:24875795

  16. 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...

  17. 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.

  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...

  19. 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.

  20. Left atrial decompression pump for severe heart failure with preserved ejection fraction: theoretical and clinical considerations.

    Science.gov (United States)

    Burkhoff, Daniel; Maurer, Mathew S; Joseph, Susan M; Rogers, Joseph G; Birati, Edo Y; Rame, J Eduardo; Shah, Sanjiv J

    2015-04-01

    The purpose of this study was to provide insight into the potential for left atrium (LA) to aortic mechanical circulatory support as a treatment for patients with heart failure with preserved ejection fraction (HFpEF). Although HFpEF arises from different etiologies, 1 hallmark of all forms of this syndrome is a small or minimally-dilated left ventricle (LV). Consequently, the use of traditional mechanical circulatory support in end-stage patients has been difficult. In contrast, HFpEF is also characterized by a large LA. Hemodynamic characteristics of 4 distinct HFpEF phenotypes were characterized from the published data: 1) hypertrophic cardiomyopathies; 2) infiltrative diseases; 3) nonhypertrophic HFpEF; and 4) HFpEF with common cardiovascular comorbidities (e.g., hypertension). Employing a previously-described cardiovascular simulation, the effects of a low-flow, micropump-based LA decompression device were modeled. The effect of sourcing blood from the LV versus the LA was compared. For all HFpEF phenotypes, mechanical circulatory support significantly increased cardiac output, provided a mild increase in blood pressure, and markedly reduced pulmonary and LA pressures. LV sourcing of blood reduced LV end-systolic volume into a range likely to induce suction. With LA sourcing, however, LV end-systolic volume increased compared with baseline. Due to pre-existing LA enlargement, LA volumes remained sufficiently elevated, thus minimizing the risk of suction. This theoretical analysis suggests that a strategy involving pumping blood from the LA to the arterial system may provide a viable option for end-stage HFpEF. Special considerations apply to each of the 4 types of HFpEF phenotypes described. Finally, an HFpEF-specific clinical profile scoring system (such as that of INTERMACS [Interagency Registry for Mechanically Assisted Circulatory Support]) would aid in the selection of patients with the appropriate risk-benefit ratio for implantation of an active pump

  1. 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

  2. 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.

  3. 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

  4. Left-ventricular geometry and risk of sudden cardiac arrest in patients with preserved or moderately reduced left-ventricular ejection fraction.

    Science.gov (United States)

    Aro, Aapo L; Reinier, Kyndaron; Phan, Derek; Teodorescu, Carmen; Uy-Evanado, Audrey; Nichols, Gregory A; Gunson, Karen; Jui, Jonathan; Chugh, Sumeet S

    2017-07-01

    The majority of sudden cardiac arrests (SCAs) occur in patients with left-ventricular (LV) ejection fraction (LVEF) >35%, yet there are no methods for effective risk stratification in this sub-group. Since abnormalities of LV geometry can be identified even with preserved LVEF, we investigated the potential impact of LV geometry as a novel risk marker for this patient population. In the ongoing Oregon Sudden Unexpected Death Study, SCA cases with archived echocardiographic data available were prospectively identified during 2002-15, and compared with geographical controls. Analysis was restricted to subjects with LVEF >35%. Based on established measures of LV mass and relative wall thickness (ratio of wall thickness to cavity diameter), four different LV geometric patterns were identified: normal geometry, concentric remodelling, concentric hypertrophy, and eccentric hypertrophy. Sudden cardiac arrest cases (n = 307) and controls (n = 280) did not differ in age, sex, or LVEF, but increased LV mass was more common in cases. Twenty-nine percent of SCA cases presented with normal LV geometry, 35% had concentric remodelling, 25% concentric hypertrophy, and 11% eccentric hypertrophy. In multivariate model, concentric remodelling (OR 1.76; 95%CI 1.18-2.63; P = 0.005), concentric hypertrophy (OR 3.20; 95%CI 1.90-5.39; P geometry as a potential risk stratification tool in patients with preserved or moderately reduced LVEF.

  5. The cardio-renal-anemia syndrome in elderly subjects with heart failure and a normal ejection fraction: a comparison with heart failure and low ejection fraction.

    Science.gov (United States)

    Cohen, Rose S; Mubashir, Asyia; Wajahat, Raja; Mani, Susan; Hummel, Scott; Maurer, Mathew S

    2006-01-01

    The prevalence and severity of anemia and renal dysfunction in heart failure patients with a normal ejection fraction (HFNEF) is uncharacterized. Two hundred eighty-five consecutive patients admitted to a community hospital with heart failure were stratified by the presence or absence of anemia and a normal or reduced ejection fraction. Comparisons of clinical variables were performed. In this sample, 62% of subjects were anemic, with no difference between those with a normal and a reduced ejection fraction (63% vs. 61%). Anemic HFNEF subjects had a lower glomerular filtration rate (37 +/- 21 mL/min vs. 52 +/- 35 mL/min; p renal dysfunction and anemia. The authors conclude that the degree and magnitude of anemia in elderly inpatients with heart failure does not differ by ejection fraction. Worse symptoms and more severe renal dysfunction were seen in HFNEF subjects with anemia than in HFNEF subjects without anemia.

  6. 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

  7. Enhancing ejection fraction measurement through 4D respiratory motion compensation in cardiac PET imaging

    Science.gov (United States)

    Tang, Jing; Wang, Xinhui; Gao, Xiangzhen; Segars, W. Paul; Lodge, Martin A.; Rahmim, Arman

    2017-06-01

    ECG gated cardiac PET imaging measures functional parameters such as left ventricle (LV) ejection fraction (EF), providing diagnostic and prognostic information for management of patients with coronary artery disease (CAD). Respiratory motion degrades spatial resolution and affects the accuracy in measuring the LV volumes for EF calculation. The goal of this study is to systematically investigate the effect of respiratory motion correction on the estimation of end-diastolic volume (EDV), end-systolic volume (ESV), and EF, especially on the separation of normal and abnormal EFs. We developed a respiratory motion incorporated 4D PET image reconstruction technique which uses all gated-frame data to acquire a motion-suppressed image. Using the standard XCAT phantom and two individual-specific volunteer XCAT phantoms, we simulated dual-gated myocardial perfusion imaging data for normally and abnormally beating hearts. With and without respiratory motion correction, we measured the EDV, ESV, and EF from the cardiac-gated reconstructed images. For all the phantoms, the estimated volumes increased and the biases significantly reduced with motion correction compared with those without. Furthermore, the improvement of ESV measurement in the abnormally beating heart led to better separation of normal and abnormal EFs. The simulation study demonstrated the significant effect of respiratory motion correction on cardiac imaging data with motion amplitude as small as 0.7 cm. The larger the motion amplitude the more improvement respiratory motion correction brought about on the EF measurement. Using data-driven respiratory gating, we also demonstrated the effect of respiratory motion correction on estimating the above functional parameters from list mode patient data. Respiratory motion correction has been shown to improve the accuracy of EF measurement in clinical cardiac PET imaging.

  8. Spironolactone in patients with heart failure and preserved ejection fraction.

    Science.gov (United States)

    Sánchez-Sánchez, C; Mendoza-Ruiz de Zuazu, H F; Formiga, F; Manzano, L; Ceresuela, L M; Carrera-Izquierdo, M; González Franco, Á; Epelde-Gonzalo, F; Cerqueiro-González, J M; Montero-Pérez-Barquero, M

    2015-01-01

    Aldosterone inhibitors have been shown to be beneficial for patients with systolic heart failure. However, the evidence from patients with heart failure and preserved ejection fraction (HFPEF) is limited. We evaluated the role of spironolactone in the prognosis of a cohort of patients with HFPEF. We analyzed the outcomes of patients hospitalized for HFPEF in 52 departments of internal medicine of the Spanish RICA registry according to those who did and did not take spironolactone. We recorded the posthospital mortality rate and readmissions at 1 year and performed a multivariate survival analysis. We included 1212 patients with HFPEF, with a mean age of 79 years (standard deviation, 7.9), (64.1% women), the majority of whom had hypertensive heart disease (50.7%). The patients treated with spironolactone, compared with those who were not treated with this diuretic, had a more advanced functional class, a higher number of readmissions (44.3 vs. 29.1%; p<0.001) and a higher rate in the combined variable of readmissions/mortality (39.0 vs. 29.0%; p=0.001). In the multivariate analysis, the administration of spironolactone was associated with an increase in readmissions (RR, 1.4; 95% CI, 1.16-1.78; p=0.001). For patients with HFPEF, the administration of spironolactone was associated with an increase in all-cause readmission, perhaps due to the higher rate of hyperpotassemia. Copyright © 2015. Published by Elsevier España, S.L.U.

  9. [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.

  10. 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

  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. 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. Cardiosphere-Derived Cells Reverse Heart Failure With Preserved Ejection Fraction in Rats by Decreasing Fibrosis and Inflammation

    Directory of Open Access Journals (Sweden)

    Romain Gallet, MD

    2016-01-01

    Full Text Available The pathogenesis of heart failure with a preserved ejection fraction (HFpEF is unclear. Myocardial fibrosis, inflammation, and cardiac hypertrophy have been suggested to contribute to the pathogenesis of HFpEF. Cardiosphere-derived cells (CDCs are heart-derived cell products with antifibrotic and anti-inflammatory properties. This study tested whether rat CDCs were sufficient to decrease manifestations of HFpEF in hypertensive rats. Starting at 7 weeks of age, Dahl salt-sensitive rats were fed a high-salt diet for 6 to 7 weeks and randomized to receive intracoronary CDCs or placebo. Dahl rats fed normal chow served as controls. High-salt rats developed hypertension, left ventricular (LV hypertrophy, and diastolic dysfunction, without impairment of ejection fraction. Four weeks after treatment, diastolic dysfunction resolved in CDC-treated rats but not in placebo. The improved LV relaxation was associated with lower LV end-diastolic pressure, decreased lung congestion, and enhanced survival in CDC-treated rats. Histology and echocardiography revealed no decrease in cardiac hypertrophy after CDC treatment, consistent with the finding of sustained, equally-elevated blood pressure in CDC- and placebo-treated rats. Nevertheless, CDC treatment decreased LV fibrosis and inflammatory infiltrates. Serum inflammatory cytokines were likewise decreased after CDC treatment. Whole-transcriptome analysis revealed that CDCs reversed changes in numerous transcripts associated with HFpEF, including many involved in inflammation and/or fibrosis. These studies suggest that CDCs normalized LV relaxation and LV diastolic pressure while improving survival in a rat model of HFpEF. The benefits of CDCs occurred despite persistent hypertension and cardiac hypertrophy. By selectively reversing inflammation and fibrosis, CDCs may be beneficial in the treatment of HFpEF.

  14. 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

  15. Acute pulmonary edema in patients with reduced left ventricular ejection fraction is associated with concentric left ventricular geometry.

    Science.gov (United States)

    Imanishi, Junichi; Kaihotsu, Kenji; Yoshikawa, Sachiko; Nishimori, Makoto; Sone, Naohiko; Honjo, Tomoyuki; Iwahashi, Masanori

    2017-08-02

    Although acute pulmonary edema (APE) is common in patients with heart failure (HF) with preserved ejection fraction (EF), its pathogenesis in patients with HF with reduced EF (HFrEF) is not completely understood. The purpose of our study was to explore the contributions of left ventricular (LV) geometry to understand the difference between HFrEF patients with or without APE. We studied 122 consecutive acute decompensated HF patients with HFrEF (≤40%). APE was defined as acute-onset dyspnea and radiographic alveolar edema requiring immediate airway intervention. LV geometry was determined from a combination of the LV mass index and relative wall thickness (RWT). Long-term unfavorable outcome events were tracked during a follow-up of a median of 21 months (interquartile range, 10-28 months), during which APE was observed in 29 patients (24%). Compared to those without APE, hospitalized patients with APE had a higher systolic blood pressure, RWT, and LVEF and lower end-diastolic dimension. Among echocardiographic variables, a multivariate logistic regression analysis identified RWT as the only independent determinant of APE (hazard ratio: 2.46, p geometry (n = 25; RWT > 0.42) had a higher incidence of APE relative to those with non-concentric geometry. Furthermore, among patients with APE, mortality was significantly higher among those with concentric geometry (log-rank, p = 0.008). Compared with non-concentric geometry, concentric geometry (increased RWT, not LV mass) was strongly associated with APE onset and a poorer outcome among APE patients. An easily obtained echocardiographic RWT index may facilitate the risk stratification of patients.

  16. Dual Endothelin-A/Endothelin-B Receptor Blockade and Cardiac Remodeling in Heart Failure With Preserved Ejection Fraction.

    Science.gov (United States)

    Valero-Munoz, Maria; Li, Shanpeng; Wilson, Richard M; Boldbaatar, Batbold; Iglarz, Marc; Sam, Flora

    2016-11-01

    Despite the increasing prevalence of heart failure with preserved ejection fraction (HFpEF) in humans, there remains no evidence-based therapies for HFpEF. Endothelin-1 (ET-1) antagonists are a possibility because elevated ET-1 levels are associated with adverse cardiovascular effects, such as arterial and pulmonary vasoconstriction, impaired left ventricular (LV) relaxation, and stimulation of LV hypertrophy. LV hypertrophy is a common phenotype in HFpEF, particularly when associated with hypertension. In the present study, we found that ET-1 levels were significantly elevated in patients with chronic stable HFpEF. We then sought to investigate the effects of chronic macitentan, a dual ET-A/ET-B receptor antagonist, on cardiac structure and function in a murine model of HFpEF induced by chronic aldosterone infusion. Macitentan caused LV hypertrophy regression independent of blood pressure changes in HFpEF. Although macitentan did not modulate diastolic dysfunction in HFpEF, it significantly reduced wall thickness and relative wall thickness after 2 weeks of therapy. In vitro studies showed that macitentan decreased the aldosterone-induced cardiomyocyte hypertrophy. These changes were mediated by a reduction in the expression of cardiac myocyte enhancer factor 2a. Moreover, macitentan improved adverse cardiac remodeling, by reducing the stiffer cardiac collagen I and titin n2b expression in the left ventricle of mice with HFpEF. These findings indicate that dual ET-A/ET-B receptor inhibition improves HFpEF by abrogating adverse cardiac remodeling via antihypertrophic mechanisms and by reducing stiffness. Additional studies are needed to explore the role of dual ET-1 receptor antagonists in patients with HFpEF. © 2016 American Heart Association, Inc.

  17. Drug treatment effects on outcomes in heart failure with preserved ejection fraction: a systematic review and meta-analysis.

    Science.gov (United States)

    Zheng, Sean Lee; Chan, Fiona T; Nabeebaccus, Adam A; Shah, Ajay M; McDonagh, Theresa; Okonko, Darlington O; Ayis, Salma

    2017-08-05

    Clinical drug trials in patients with heart failure and preserved ejection fraction have failed to demonstrate improvements in mortality. We systematically searched Medline, Embase and the Cochrane Central Register of Controlled Trials for randomised controlled trials (RCT) assessing pharmacological treatments in patients with heart failure with left ventricular (LV) ejection fraction≥40% from January 1996 to May 2016. The primary efficacy outcome was all-cause mortality. Secondary outcomes were cardiovascular mortality, heart failure hospitalisation, exercise capacity (6-min walk distance, exercise duration, VO2 max), quality of life and biomarkers (B-type natriuretic peptide, N-terminal pro-B-type natriuretic peptide). Random-effects models were used to estimate pooled relative risks (RR) for the binary outcomes, and weighted mean differences for continuous outcomes, with 95% CI. We included data from 25 RCTs comprising data for 18101 patients. All-cause mortality was reduced with beta-blocker therapy compared with placebo (RR: 0.78, 95%CI 0.65 to 0.94, p=0.008). There was no effect seen with ACE inhibitors, aldosterone receptor blockers, mineralocorticoid receptor antagonists and other drug classes, compared with placebo. Similar results were observed for cardiovascular mortality. No single drug class reduced heart failure hospitalisation compared with placebo. The efficacy of treatments in patients with heart failure and an LV ejection fraction≥40% differ depending on the type of therapy, with beta-blockers demonstrating reductions in all-cause and cardiovascular mortality. Further trials are warranted to confirm treatment effects of beta-blockers in this patient group. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  18. Burden of Recurrent Hospitalizations Following an Admission for Acute Heart Failure: Preserved Versus Reduced Ejection Fraction.

    Science.gov (United States)

    Santas, Enrique; Valero, Ernesto; Mollar, Anna; García-Blas, Sergio; Palau, Patricia; Miñana, Gema; Núñez, Eduardo; Sanchis, Juan; Chorro, Francisco Javier; Núñez, Julio

    2017-04-01

    Heart failure with preserved ejection fraction and reduced ejection fraction share a high mortality risk. However, differences in the rehospitalization burden over time between these 2 entities remains unclear. We prospectively included 2013 consecutive patients discharged for acute heart failure. Of these, 1082 (53.7%) had heart failure with preserved ejection fraction and 931 (46.2%) had heart failure with reduced ejection fraction. Cox and negative binomial regression methods were used to evaluate the risks of death and repeat hospitalizations, respectively. At a median follow-up of 2.36 years (interquartile range: 0.96-4.65), 1018 patients (50.6%) died, and 3804 readmissions were registered in 1406 patients (69.8%). Overall, there were no differences in mortality between heart failure with preserved ejection fraction and heart failure with reduced ejection fraction (16.7 vs 16.1 per 100 person-years, respectively; P=0794), or all-cause repeat hospitalization rates (62.1 vs 62.2 per 100 person-years, respectively; P=.944). After multivariable adjustment, and compared with patients with heart failure with reduced ejection fraction, patients with heart failure with preserved ejection fraction exhibited a similar risk of all-cause readmissions (incidence rate ratio=1.04; 95%CI, 0.93-1.17; P=.461). Regarding specific causes, heart failure with preserved ejection fraction showed similar risks of cardiovascular and heart failure-related rehospitalizations (incidence rate ratio=0.93; 95%CI, 0.82-1.06; P=.304; incidence rate ratio=0.96; 95% confidence interval, 0.83-1.13; P=.677, respectively), but had a higher risk of noncardiovascular readmissions (incidence rate ratio=1.24; 95%CI, 1.04-1.47; P=.012). Following an admission for acute heart failure, patients with heart failure with preserved ejection fraction have a similar rehospitalization burden to those with heart failure with reduced ejection fraction. However, patients with heart failure with preserved ejection

  19. 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.

  20. 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.

  1. Heart failure with preserved ejection fraction is characterized by dynamic impairment of active relaxation and contraction of the left ventricle on exercise and associated with myocardial energy deficiency.

    Science.gov (United States)

    Phan, Thanh T; Abozguia, Khalid; Nallur Shivu, Ganesh; Mahadevan, Gnanadevan; Ahmed, Ibrar; Williams, Lynne; Dwivedi, Girish; Patel, Kiran; Steendijk, Paul; Ashrafian, Houman; Henning, Anke; Frenneaux, Michael

    2009-07-28

    We sought to evaluate the role of exercise-related changes in left ventricular (LV) relaxation and of LV contractile function and vasculoventricular coupling (VVC) in the pathophysiology of heart failure with preserved ejection fraction (HFpEF) and to assess myocardial energetic status in these patients. To date, no studies have investigated exercise-related changes in LV relaxation and VVC as well as in vivo myocardial energetic status in patients with HFpEF. We studied 37 patients with HFpEF and 20 control subjects. The VVC and time to peak LV filling (nTTPF, a measure of LV active relaxation) were assessed while patients were at rest and during exercise by the use of radionuclide ventriculography. Cardiac energetic status (creatine phosphate/adenosine triphosphate ratio) was assessed by the use of (31)P magnetic resonance spectroscopy at 3-T. When patients were at rest, nTTPF and VVC were similar in patients with HFpEF and control subjects. The cardiac creatine phosphate/adenosine triphosphate ratio was reduced in patients with HFpEF versus control subjects (1.57 +/- 0.52 vs. 2.14 +/- 0.63; p = 0.003), indicating reduced energy reserves. Peak maximal oxygen uptake and the increase in heart rate during maximal exercise were lower in patients with HFpEF versus control subjects (19 +/- 4 ml/kg/min vs. 36 +/- 8 ml/kg/min, p active relaxation and abnormal VVC during exercise.

  2. 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.

  3. 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.

  4. 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.

  5. Exercise hemodynamics in patients with and without diastolic dysfunction and preserved ejection fraction after myocardial infarction

    DEFF Research Database (Denmark)

    Andersen, Mads J; Ersbøll, Mads; Bro-Jeppesen, John

    2012-01-01

    Left ventricular diastolic dysfunction (DD) is common after myocardial infarction (MI) despite preservation of left ventricular ejection fraction, yet it remains unclear how or whether DD affects cardiac hemodynamics with stress....

  6. 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

  7. 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

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

    DEFF Research Database (Denmark)

    Ersbøll, 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 on th...

  9. 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)....

  10. 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...

  11. 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...

  12. 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.

  13. 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

  14. 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

  15. 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.

  16. 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

  17. 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.

  18. Frequency of conduction abnormalities after transcatheter aortic valve implantation with the Medtronic-CoreValve and the effect on left ventricular ejection fraction.

    Science.gov (United States)

    Tzikas, Apostolos; van Dalen, Bas M; Van Mieghem, Nicolas M; Gutierrez-Chico, Juan-Luis; Nuis, Rutger-Jan; Kauer, Floris; Schultz, Carl; Serruys, Patrick W; de Jaegere, Peter P T; Geleijnse, Marcel L

    2011-01-15

    New conduction abnormalities occur frequently after transcatheter aortic valve implantation (TAVI). The relation between new conduction disorders and left ventricular (LV) systolic function after TAVI is unknown. The purpose of the present prospective, single-center study was to investigate the effect of TAVI on LV systolic function in relation to TAVI-induced conduction abnormalities. A total of 27 patients had undergone electrocardiography and transthoracic echocardiography the day before and 6 days after TAVI with the Medtronic-CoreValve system. The LV ejection fraction (EF) was calculated using the biplane Simpson method. The systolic mitral annular velocities and longitudinal strain were measured using speckle tracking echocardiography. After TAVI, 18 patients (67%) had new conduction abnormalities; 4 (15%) had a new paced rhythm and 14 patients (52%) had new left bundle branch block. In the patients with new conduction abnormalities, the EF decreased from 47 ± 12% to 44 ± 10%. In contrast, in those without new conduction abnormalities, the EF increased from 49 ± 12% to 54% ± 12%. The change in EF was significantly different among those with and without new conduction abnormalities (p Medtronic-CoreValve was associated with a lack of improvement in LV systolic function. Copyright © 2011 Elsevier Inc. All rights reserved.

  19. Global longitudinal strain and global circumferential strain by speckle-tracking echocardiography and feature-tracking cardiac magnetic resonance imaging: comparison with left ventricular ejection fraction.

    Science.gov (United States)

    Onishi, Toshinari; Saha, Samir K; Delgado-Montero, Antonia; Ludwig, Daniel R; Onishi, Tetsuari; Schelbert, Erik B; Schwartzman, David; Gorcsan, John

    2015-05-01

    Left ventricular (LV) ejection fraction (EF) is a routine clinical standard to assess cardiac function. Global longitudinal strain (GLS) and global circumferential strain (GCS) have emerged as important LV functional measures. The objective of this study was to determine the relationships of GLS and GCS by speckle-tracking echocardiography and featuring-tracking cardiac magnetic resonance (CMR) to CMR EF as a standard of reference in the same patients. A total of 73 consecutive patients aged 55 ± 15 years clinically referred for both CMR and echocardiography (EF range, 8%-78%) were studied. Routine steady-state free precession CMR images were prospectively analyzed offline using feature-tracking software for LV GLS, GCS, volumes, and EF. GLS was averaged from three standard longitudinal views and GCS from the mid-LV short-axis plane. Echocardiographic speckle-tracking was used from the similar imaging planes for GLS, GCS, LV volumes, and EF. Feature-tracking CMR strain was closely correlated with speckle-tracking strain in the same patients: GLS, r = -0.87; GCS, r = -0.92 (P tracking CMR were significantly correlated with standard manual tracing of multiple CMR short-axis images (r = 0.97, r = 0.98, and r = 0.97, P tracking were closely correlated with standard CMR EF: r = -0.85 and r = -0.95, respectively (P tracking CMR analysis was a rapid means to obtain myocardial strain similar to speckle-tracking echocardiography. GLS and GCS were closely correlated with CMR EF in this patient series and may play a role in the clinical assessment of LV function. Copyright © 2015 American Society of Echocardiography. Published by Elsevier Inc. All rights reserved.

  20. 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.

  1. 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.

  2. Clinical utility of semi-automated estimation of ejection fraction at the point-of-care

    DEFF Research Database (Denmark)

    Frederiksen, Christian Alcaraz; Juhl-Olsen, Peter; Hermansen, Johan Fridolf

    2015-01-01

    INTRODUCTION: To compare estimation of ejection fraction at the bedside by AutoEF compared with conventional methods and to assess feasibility and time consumption. METHODS: A total of 102 relatively hemodynanically stable mixed medical and surgical patients were included. All patients underwent...... ultrasonography of the heart at the bedside performed by a novice examiner. Three assessments of ejection fraction were made: 1) Expert eyeballing by a single specialist in cardiology and expert in echocardiography; 2) Manual planimetry by an experienced examiner; 3) AutoEF by a novice examiner with limited...... experience in echocardiography. RESULTS: Expert eyeballing of ejection fraction was performed in 100% of cases. Manual planimetry was possible in 89% of cases and AutoEF was possible in 83% of cases. The correlation between expert eyeballing and AutoEF was r=0.82, p manual planimetry...

  3. 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....

  4. 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.

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

    DEFF Research Database (Denmark)

    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...

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

    Directory of Open Access Journals (Sweden)

    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.

  7. 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...

  8. 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

  9. 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.

  10. 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

  11. 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

  12. 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

  13. Clinical validation of fully automated computation of ejection fraction from gated equilibrium blood-pool scintigrams

    NARCIS (Netherlands)

    J.H.C. Reiber (Johan); S.P. Lie; M.L. Simoons (Maarten); C. Hoek; J.J. Gerbrands (Jan); W. Wijns (William); W.H. Bakker (Willem); P.P.M. Kooij (Peter)

    1983-01-01

    textabstractA fully automated procedure for the computation of left-ventricular ejection fraction (EF) from cardiac-gated Tc-99m blood-pool (GBP) scintigrams with fixed, dual, and variable ROI methods is described. By comparison with EF data from contrast ventriculography in 68 patients, the dual-RO

  14. Bi-temporal 3D active appearance models with applications to unsupervised ejection fraction estimation

    DEFF Research Database (Denmark)

    Stegmann, Mikkel Bille; Pedersen, Dorthe

    2005-01-01

    Rapid and unsupervised quantitative analysis is of utmost importance to ensure clinical acceptance of many examinations using cardiac magnetic resonance imaging (MRI). We present a framework that aims at fulfilling these goals for the application of left ventricular ejection fraction estimation i...

  15. 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.

  16. 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....

  17. 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...

  18. 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.

  19. 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.

  20. [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.

  1. Renal dysfunction and anemia in patients with heart failure with reduced versus normal ejection fraction.

    Science.gov (United States)

    Villacorta, Humberto; Saenz-Tello, Bolivar F; Santos, Eduarda Barcellos dos; Steffen, Ricardo; Wiefels, Christiane; Lima, Luiz Costa; Sales, Ana Luíza F; Soares, Pedro; Mesquita, Evandro Tinoco

    2010-03-01

    The presence of anemia and renal dysfunction grants a bad prognosis for patients with heart failure and reduced ejection fraction (HFREF). The impact on patients with heart failure and normal ejection fraction (HFNEF) is not widely studied. To study the prevalence and the prognosis of anemia and renal dysfunction (RD) in patients with heart failure according to the type of ventricular dysfunction. A total of 209 patients with chronic and stable heart failure were prospectively studied. Individuals with ejection fraction Anemia was defined, based on WHO criteria, as hemoglobin Renal function was calculated by means of the Simplified Modified Diet Renal Disease (sMDRD) formula. Hospitalizations, emergency admittances and obit by cardiac causes were considered as cardiac events. Ninety patients had HFREF and 119 had HFNEF. The glomerular filtration rate (GFR) was smaller in HFREF group (57.6 +/- 66.2 versus 94.8 +/- 36.6 ml/min/1.73m(2); p=0.01). There was no difference in the prevalence of anemia between groups (23.3% versus 18.5%; p=0.34). Moderate to severe RD prevalence was higher in HFREF group (32.2% versus 16.8%; p=0.01). RD was the only factor associated with anemia that was independently associated with cardiac events (HR 2.52; 95%CI=1.27-5.2; p=0.01). RD was less prevalent in HFNEF, while the prevalence of anemia did not differ between groups. RD was predictor of cardiac events independently on ejection fraction.

  2. 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. Copyright © 2014 Elsevier Inc. All rights reserved.

  3. 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.

  4. 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.

  5. 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.

  6. 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-pro......BNP) requirement in the heart failure diagnosis were assessed by repeating the analyses in the subgroup of patients with elevated NT-proBNP....

  7. 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.)

  8. 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.

  9. 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

  10. Mid-range Ejection Fraction Does Not Permit Risk Stratification Among Patients Hospitalized for Heart Failure.

    Science.gov (United States)

    Gómez-Otero, Inés; Ferrero-Gregori, Andreu; Varela Román, Alfonso; Seijas Amigo, José; Pascual-Figal, Domingo A; Delgado Jiménez, Juan; Álvarez-García, Jesús; Fernández-Avilés, Francisco; Worner Diz, Fernando; Alonso-Pulpón, Luis; Cinca, Juan; Gónzalez-Juanatey, José Ramón

    2017-05-01

    European Society of Cardiology heart failure guidelines include a new patient category with mid-range (40%-49%) left ventricular ejection fraction (HFmrEF). HFmrEF patient characteristics and prognosis are poorly defined. The aim of this study was to analyze the HFmrEF category in a cohort of hospitalized heart failure patients (REDINSCOR II Registry). A prospective observational study was conducted with 1420 patients classified according to ejection fraction as follows: HFrEF, < 40%; HFmrEF, 40%-49%; and HFpEF, ≥ 50%. Baseline patient characteristics were examined, and outcome measures were mortality and readmission for heart failure at 1-, 6-, and 12-month follow-up. Propensity score matching was used to compare the HFmrEF group with the other ejection fraction groups. Among the study participants, 583 (41%) had HFrEF, 227 (16%) HFmrEF, and 610 (43%) HFpEF. HFmrEF patients had a clinical profile similar to that of HFpEF patients in terms of age, blood pressure, and atrial fibrillation prevalence, but shared with HFrEF patients a higher proportion of male participants and ischemic etiology, and use of class I drugs targeting HFrEF. All other features were intermediate, and comorbidities were similar among the 3 groups. There were no significant differences in all-cause mortality, cause of death, or heart failure readmission. The similar outcomes were confirmed in the propensity score matched cohorts. The HFmrEF patient group has characteristics between the HFrEF and HFpEF groups, with more similarities to the HFpEF group. No between-group differences were observed in total mortality, cause of death, or heart failure readmission. Copyright © 2016 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.

  11. 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.

  12. 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.

  13. 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...

  14. 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.

  15. 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.

    Science.gov (United States)

    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.

  16. 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.

  17. 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.

    Directory of Open Access Journals (Sweden)

    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.

  18. Heart failure with preserved ejection fraction in the elderly: scope of the problem.

    Science.gov (United States)

    Upadhya, Bharathi; Taffet, George E; Cheng, Che Ping; 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, 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 older persons is typified by a broad range of cardiac and non-cardiac abnormalities and reduced reserve capacity in multiple organ systems. The globally reduced reserve capacity is driven by: 1) inherent age-related changes; 2) multiple, concomitant co-morbidities; 3) HFpEF itself, which is likely a systemic disorder. These insights help explain why: 1) co-morbidities are among the strongest predictors of outcomes; 2) approximately 50% of clinical events in HFpEF patients are non-cardiovascular; 3) clinical drug trials in HFpEF have been negative on their primary outcomes. Embracing HFpEF as a true geriatric syndrome, with complex, multi-factorial pathophysiology and clinical heterogeneity could provide new mechanistic insights and opportunities for progress in management. This article is part of a Special Issue entitled CV Aging. Copyright © 2015 Elsevier Ltd. All rights reserved.

  19. 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.

  20. Facts and numbers on epidemiology and pharmacological treatment of heart failure with preserved ejection fraction.

    Science.gov (United States)

    Edelmann, Frank

    2015-06-01

    Heart failure with preserved ejection fraction (HFpEF) is a major and growing public health problem. Epidemiologic studies demonstrated that heart failure (HF) can be clinically diagnosed in patients with normal or preserved left ventricular ejection fraction. These patients are therefore termed as having HFpEF. In the past, this was often called diastolic HF. Because of the permanent increase of the prevalence of HFpEF during the past decades, HFpEF now accounts for more than 50% of the total HF population. There are uncertainties and debates regarding the definition, diagnosis, and pathophysiology with the consequence that all outcome trials performed so far used criteria for inclusion and exclusion that were not consistent. These trials also failed to document improved prognosis. Recent smaller proof-of-concept or Phase II clinical trials investigating different pathophysiological approaches with substances such as the neprilysin inhibitor-angiotensin receptor blocker- combination (LCZ 696), ranolazine, or ivabradine were successful to improve biomarkers, haemodynamics, or functional capacity. Future trials will need to document whether also prognosis can be improved.

  1. 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.

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

    Energy Technology Data Exchange (ETDEWEB)

    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)

  3. 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...

  4. 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.

  5. 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.

  6. 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......EF103 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...... to determine a vast array of HFrEF-related urinary peptide biomarkers which might help improving our understanding and diagnosis of heart failure....

  7. 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.

  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. Ventricular fibrillation via torsade des pointes of cardiac sarcoidosis with preserved left ventricular ejection fraction.

    Science.gov (United States)

    Sekihara, Takayuki; Nakane, Eisaku; Nakasone, Kazutaka; Inoko, Moriaki

    2016-10-25

    Generally, low left ventricular ejection fraction (LVEF) is a risk for ventricular arrhythmia in patients with cardiac sarcoidosis. We present a case of cardiac sarcoidosis with preserved LVEF that evoked ventricular fibrillation (VF). A 73-year-old woman with VF presented to our emergency department. She had a history of ocular sarcoidosis, with gradual thinning of the basal intraventricular septum. LVEF was 62% on the most recent echocardiography. The electrocardiogram after defibrillation showed complete atrioventricular block (CAVB) with QT segment prolongation and frequent ventricular premature beats. VF via torsade des pointes (TdP) was suspected, and temporary intravenous ventricular pacing and magnesium sulfate infusion suppressed her VF. Cardiac sarcoidosis was diagnosed, and an implantable cardioverter defibrillator was implanted. Patients with cardiac sarcoidosis with CAVB are at risk of evoking VF via TdP regardless of LVEF. If cardiac sarcoidosis is suspected, early diagnosis and risk stratification of ventricular arrhythmia are important. 2016 BMJ Publishing Group Ltd.

  10. 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

  11. 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.

  12. 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

  13. 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.

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

    Energy Technology Data Exchange (ETDEWEB)

    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.

  15. 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

  16. 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.

  17. 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.

  18. 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.

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

    Directory of Open Access Journals (Sweden)

    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.

  20. 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.

  1. 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

  2. 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。

  3. Left Ventricular Longitudinal Systolic Function in Septic Shock Patients with Normal Ejection Fraction: A Case-control Study

    Directory of Open Access Journals (Sweden)

    Hong-Min Zhang

    2017-01-01

    Conclusions: Compared to the LVEF, longitudinal systolic function might be more sensitive in the detection of cardiac depression in septic shock patients. In the heart function appraisal of septic shock patients with a normal ejection fraction, more attention should be given to longitudinal function parameters such as MAPSE and Sa.

  4. 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...

  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. Impact of left ventricular ejection fraction on occurrence of ventricular events in defibrillator patients with coronary artery disease

    NARCIS (Netherlands)

    B. Schaer (Beat); C. Sticherling (Christian); T. Szili-Torok (Tamas); S. Osswald (Stefan); L.J.L.M. Jordaens (Luc); D.A.M.J. Theuns (Dominic)

    2011-01-01

    textabstractAims Primary preventive implantable cardioverter defibrillator (ICD) therapy is indicated in patients with coronary artery disease (CAD) and left ventricular ejection fraction (LVEF) of ≤35, but some patients in the major trials had LVEF in the range of 3035. We hypothesized that these

  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. 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.

  11. 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.

  12. 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.

  13. 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.

  14. 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

  15. 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.

  16. Effect of Selective Heart Rate Slowing in Heart Failure With Preserved Ejection Fraction.

    Science.gov (United States)

    Pal, Nikhil; Sivaswamy, Nadiya; Mahmod, Masliza; Yavari, Arash; Rudd, Amelia; Singh, Satnam; Dawson, Dana K; Francis, Jane M; Dwight, Jeremy S; Watkins, Hugh; Neubauer, Stefan; Frenneaux, Michael; Ashrafian, Houman

    2015-11-03

    Heart failure with preserved ejection fraction (HFpEF) is associated with significant morbidity and mortality but is currently refractory to therapy. Despite limited evidence, heart rate reduction has been advocated, on the basis of physiological considerations, as a therapeutic strategy in HFpEF. We tested the hypothesis that heart rate reduction improves exercise capacity in HFpEF. We conducted a randomized, crossover study comparing selective heart rate reduction with the If blocker ivabradine at 7.5 mg twice daily versus placebo for 2 weeks each in 22 symptomatic patients with HFpEF who had objective evidence of exercise limitation (peak oxygen consumption at maximal exercise [o2 peak] change in o2 peak. Secondary outcomes included tissue Doppler-derived E/e' at echocardiography, plasma brain natriuretic peptide, and quality-of-life scores. Ivabradine significantly reduced peak heart rate compared with placebo in the HFpEF (107 versus 129 bpm; Pchange in o2 peak in the HFpEF cohort (-2.1 versus 0.9 mL·kg(-1)·min(-1); P=0.003) and significantly reduced submaximal exercise capacity, as determined by the oxygen uptake efficiency slope. No significant effects on the secondary end points were discernable. Our observations bring into question the value of heart rate reduction with ivabradine for improving symptoms in a HFpEF population characterized by exercise limitation. URL: http://www.clinicaltrials.gov. Unique identifier: NCT02354573. © 2015 The Authors.

  17. Targeting Obesity and Diabetes to Treat Heart Failure with Preserved Ejection Fraction

    Directory of Open Access Journals (Sweden)

    Raffaele Altara

    2017-07-01

    Full Text Available Heart failure with preserved ejection fraction (HFpEF is a major unmet medical need that is characterized by the presence of multiple cardiovascular and non-cardiovascular comorbidities. Foremost among these comorbidities are obesity and diabetes, which are not only risk factors for the development of HFpEF, but worsen symptoms and outcome. Coronary microvascular inflammation with endothelial dysfunction is a common denominator among HFpEF, obesity, and diabetes that likely explains at least in part the etiology of HFpEF and its synergistic relationship with obesity and diabetes. Thus, pharmacological strategies to supplement nitric oxide and subsequent cyclic guanosine monophosphate (cGMP—protein kinase G (PKG signaling may have therapeutic promise. Other potential approaches include exercise and lifestyle modifications, as well as targeting endothelial cell mineralocorticoid receptors, non-coding RNAs, sodium glucose transporter 2 inhibitors, and enhancers of natriuretic peptide protective NO-independent cGMP-initiated and alternative signaling, such as LCZ696 and phosphodiesterase-9 inhibitors. Additionally, understanding the role of adipokines in HFpEF may lead to new treatments. Identifying novel drug targets based on the shared underlying microvascular disease process may improve the quality of life and lifespan of those afflicted with both HFpEF and obesity or diabetes, or even prevent its occurrence.

  18. 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.

  19. 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.

  20. 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.

  1. 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.

  2. 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.

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

    Institute of Scientific and Technical Information of China (English)

    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.

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

    Institute of Scientific and Technical Information of China (English)

    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. 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.

  6. Coronary microvascular rarefaction and myocardial fibrosis in heart failure with preserved ejection fraction.

    Science.gov (United States)

    Mohammed, Selma F; Hussain, Saad; Mirzoyev, Sultan A; Edwards, William D; Maleszewski, Joseph J; Redfield, Margaret M

    2015-02-10

    Characterization of myocardial structural changes in heart failure with preserved ejection fraction (HFpEF) has been hindered by the limited availability of human cardiac tissue. Cardiac hypertrophy, coronary artery disease (CAD), coronary microvascular rarefaction, and myocardial fibrosis may contribute to HFpEF pathophysiology. We identified HFpEF patients (n=124) and age-appropriate control subjects (noncardiac death, no heart failure diagnosis; n=104) who underwent autopsy. Heart weight and CAD severity were obtained from the autopsy reports. With the use of whole-field digital microscopy and automated analysis algorithms in full-thickness left ventricular sections, microvascular density (MVD), myocardial fibrosis, and their relationship were quantified. Subjects with HFpEF had heavier hearts (median, 538 g; 169% of age-, sex-, and body size-expected heart weight versus 335 g; 112% in controls), more severe CAD (65% with ≥1 vessel with >50% diameter stenosis in HFpEF versus 13% in controls), more left ventricular fibrosis (median % area fibrosis, 9.6 versus 7.1) and lower MVD (median 961 versus 1316 vessels/mm(2)) than control (Pcoronary microvascular rarefaction, and myocardial fibrosis than controls. Each of these findings may contribute to the left ventricular diastolic dysfunction and cardiac reserve function impairment characteristic of HFpEF. © 2014 American Heart Association, Inc.

  7. 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.

  8. Ethnic differences in the association of QRS duration with ejection fraction and outcome in heart failure.

    Science.gov (United States)

    Gijsberts, Crystel M; Benson, Lina; Dahlström, Ulf; Sim, David; Yeo, Daniel P S; Ong, Hean Yee; Jaufeerally, Fazlur; Leong, Gerard K T; Ling, Lieng H; Richards, A Mark; de Kleijn, Dominique P V; Lund, Lars H; Lam, Carolyn S P

    2016-09-15

    QRS duration (QRSd) criteria for device therapy in heart failure (HF) were derived from predominantly white populations and ethnic differences are poorly understood. We compared the association of QRSd with ejection fraction (EF) and outcomes between 839 Singaporean Asian and 11 221 Swedish white patients with HF having preserved EF (HFPEF)and HF having reduced EF (HFREF) were followed in prospective population-based HF studies. Compared with whites, Asian patients with HF were younger (62 vs 74 years, p120 ms it was 52%; HR for 10 ms increase of QRSd was 1.04 (1.03 to 1.06), p<0.001), with no interaction by ethnicity. We found ethnic differences in the association between EF and QRSd among patients with HF. QRS prolongation was similarly associated with increased risk, but the implications for ethnicity-specific QRSd cut-offs in clinical decision-making require further study. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  9. 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

  10. 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

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

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    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.

  12. Hemodynamic responses to small muscle mass exercise in heart failure patients with reduced ejection fraction

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    Barrett-O'Keefe, Zachary; Lee, Joshua F.; Berbert, Amanda; Witman, Melissa A. H.; Nativi-Nicolau, Jose; Stehlik, Josef; Richardson, Russell S.

    2014-01-01

    To better understand the mechanisms responsible for exercise intolerance in heart failure with reduced ejection fraction (HFrEF), the present study sought to evaluate the hemodynamic responses to small muscle mass exercise in this cohort. In 25 HFrEF patients (64 ± 2 yr) and 17 healthy, age-matched control subjects (64 ± 2 yr), mean arterial pressure (MAP), cardiac output (CO), and limb blood flow were examined during graded static-intermittent handgrip (HG) and dynamic single-leg knee-extensor (KE) exercise. During HG exercise, MAP increased similarly between groups. CO increased significantly (+1.3 ± 0.3 l/min) in the control group, but it remained unchanged across workloads in HFrEF patients. At 15% maximum voluntary contraction (MVC), forearm blood flow was similar between groups, while HFrEF patients exhibited an attenuated increase at the two highest intensities compared with controls, with the greatest difference at the highest workload (352 ± 22 vs. 492 ± 48 ml/min, HFrEF vs. control, 45% MVC). During KE exercise, MAP and CO increased similarly across work rates between groups. However, HFrEF patients exhibited a diminished leg hyperemic response across all work rates, with the most substantial decrement at the highest intensity (1,842 ± 64 vs. 2,675 ± 81 ml/min; HFrEF vs. control, 15 W). Together, these findings indicate a marked attenuation in exercising limb perfusion attributable to impairments in peripheral vasodilatory capacity during both arm and leg exercise in patients with HFrEF, which likely plays a role in limiting exercise capacity in this patient population. PMID:25260608

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

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    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.

  14. Plasma osmolality predicts mortality in patients with heart failure with reduced ejection fraction.

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    Kaya, HakkI; Yücel, Oğuzhan; Ege, Meltem Refiker; Zorlu, Ali; Yücel, Hasan; Güneş, Hakan; Ekmekçi, Ahmet; Yılmaz, Mehmet Birhan

    2017-01-01

    Heart failure (HF) is a fatal disease. Plasma osmolality with individual impacts of sodium, blood urea nitrogen (BUN), and glucose has not been studied prognostically in patients with HF. This study aims to investigate the impact of serum osmolality on clinical endpoints in HF patients. A total of 509 patients (383 males, 126 females) with HF with reduced ejection fraction in three HF centres were retrospectively analysed between January 2007 and December 2013. Follow-up data were completed for 496 patients. Plasma osmolality was calculated as (2 × Na) + (BUN/2.8) + (Glucose/18). Quartiles of plasma osmolality were produced, and the possible relationship between plasma osmolality and cardiovascular mortality was investigated. The mean follow-up was 25 ± 22 months. The mean age was 56.5 ± 17.3 years with a mean EF of 26 ± 8%. The mean levels of plasma osmolality were as follows in the quartiles: 1st % = 280 ± 6, 2nd % = 288 ± 1, 3rd % = 293 ± 2 (95% confidence interval [CI] 292.72-293.3), and 4th % = 301 ± 5 mOsm/kg. The EF and B-type natriuretic peptide levels were similar in the four quartiles. Univariate and multivariate analyses in the Cox proportional hazard model revealed a significantly higher rate of mortality in the patients with hypo-osmolality. The Kaplan-Meier plot showed graded mortality curves with the 1st quartile having the worst prognosis, followed by the 4th quartile and the 2nd quartile, while the 3rd quartile was shown to have the best prognosis. Our study results suggest that normal plasma osmolality is between 275 and 295 mOsm/kg. However, being close to the upper limit of normal range (292-293 mOsm/kg) seems to be the optimal plasma osmolality level in terms of cardiovascular prognosis in patients with HF.

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

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    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.

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

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    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.

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

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    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.

  18. 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.

  19. Peak Exercise Oxygen Uptake Predicts Recurrent Admissions in Heart Failure With Preserved Ejection Fraction.

    Science.gov (United States)

    Palau, Patricia; Domínguez, Eloy; Núñez, Eduardo; Ramón, José María; López, Laura; Melero, Joana; Sanchis, Juan; Bellver, Alejandro; Santas, Enrique; Bayes-Genis, Antoni; Chorro, Francisco J; Núñez, Julio

    2017-06-27

    Heart failure with preserved ejection fraction (HFpEF) is a highly prevalent syndrome with an elevated risk of morbidity and mortality. To date, there is scarce evidence on the role of peak exercise oxygen uptake (peak VO2) for predicting the morbidity burden in HFpEF. We sought to evaluate the association between peak VO2 and the risk of recurrent hospitalizations in patients with HFpEF. A total of 74 stable symptomatic patients with HFpEF underwent a cardiopulmonary exercise test between June 2012 and May 2016. A negative binomial regression method was used to determine the association between the percentage of predicted peak VO2 (pp-peak VO2) and recurrent hospitalizations. Risk estimates are reported as incidence rate ratios. The mean age was 72.5 ± 9.1 years, 53% were women, and all patients were in New York Heart Association functional class II to III. Mean peak VO2 and median pp-peak VO2 were 10 ± 2.8mL/min/kg and 60% (range, 47-67), respectively. During a median follow-up of 276 days [interquartile range, 153-1231], 84 all-cause hospitalizations in 31 patients (41.9%) were registered. A total of 15 (20.3%) deaths were also recorded. On multivariate analysis, accounting for mortality as a terminal event, pp-peak VO2 was independently and linearly associated with the risk of recurrent admission. Thus, and modeled as continuous, a 10% decrease of pp-peak VO2 increased the risk of recurrent hospitalizations by 32% (IRR, 1.32; 95%CI, 1.03-1.68; P = .028). In symptomatic elderly patients with HFpEF, pp-peak VO2 predicts all-cause recurrent admission. Copyright © 2017 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.

  20. Fluid status and outcome in patients with heart failure and preserved ejection fraction.

    Science.gov (United States)

    Koell, Benedikt; Zotter-Tufaro, Caroline; Duca, Franz; Kammerlander, Andreas A; Aschauer, Stefan; Dalos, Daniel; Antlanger, Marlies; Hecking, Manfred; Säemann, Marcus; Mascherbauer, Julia; Bonderman, Diana

    2017-03-01

    Most heart failure with preserved ejection fraction (HFpEF) patients, at some point, present to an emergency department with typical symptoms of volume overload. Clinically, most respond well to standard diuretic therapy, sometimes at the cost of renal function. The study sought to define the prognostic significance of fluid status versus renal function in patients with HFpEF. One hundred sixty-two consecutive patients with HFpEF were enrolled in our prospective registry. Twelve patients with clinically overt decompensation were excluded. Fluid status at baseline was determined by bioelectrical impedance spectroscopy. The primary outcome measure was a combined end point consisting of hospitalization for heart failure and/or death for cardiac reason. Mean age was 74.4±8.4years. Ninety-one (61%) patients were hypo- or normovolemic (relative fluid overload [Rel. FO] -0.7±5.7%) while 59 (39%) patients presented with fluid overload (Rel. FO 11.5±2.7%). During a median follow-up of 24.3months (interquartile range: 19.8-33.2), 34% of patients reached the combined end point. Multivariate Cox hazard analysis identified fluid overload (hazard ratio: 3.09; 95% confidence interval: 1.68-5.68; pfluid overload and normal renal function showed a worse event-free survival compared to the subgroup with normohydration and impaired renal function (log-rank: p=0.042). HFpEF patients with measurable fluid overload face a dismal prognosis as compared to euvolemic patients. Our data, while preliminary, suggest that patients with fluid overload may face a better outcome under continued fluid removal irrespective of changes in eGFR. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  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. 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.

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

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    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.

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

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    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.

  5. Pulmonary hypertension and right heart failure in heart failure with preserved left ventricular ejection fraction: pathophysiology and natural history.

    Science.gov (United States)

    Segers, Vincent F M; Brutsaert, Dirk L; De Keulenaer, Gilles W

    2012-05-01

    Pulmonary hypertension and right heart failure are common findings in patients suffering from heart failure with preserved ejection fraction (HFpEF). In this review, we summarize our current understanding of the pathophysiology of pulmonary hypertension related to heart failure. HFpEF is a clinical syndrome with increasing prevalence and a mortality rate similar to heart failure with reduced ejection fraction. Because the pathophysiology and even the definition of this disease are still controversial, we will first outline the current conceptual framework around heart failure with preserved ejection fraction. Next, we will outline our current knowledge on the pathophysiology of pulmonary hypertension related to left ventricular failure and diastolic dysfunction. Diastolic dysfunction induces pulmonary hypertension through passive transmission of elevated end diastolic pressures, reactive pulmonary vasoconstriction, and vascular remodeling. Eventually, right ventricular failure develops that can further potentiate left ventricular failure because of their close mechanical, cellular, and biochemical integration. Exciting new studies have led to an increased understanding of the underlying pathophysiology and indicate that pulmonary hypertension in heart failure may be treatable.

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

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    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

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

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    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.

  8. Heart Failure With Preserved Ejection Fraction Induces Beiging in Adipose Tissue.

    Science.gov (United States)

    Valero-Muñoz, María; Li, Shanpeng; Wilson, Richard M; Hulsmans, Maarten; Aprahamian, Tamar; Fuster, José J; Nahrendorf, Matthias; Scherer, Philipp E; Sam, Flora

    2016-01-01

    Despite the increasing prevalence of heart failure with preserved ejection fraction (HFpEF) in humans, there are no evidence-based therapies for HFpEF. Clinical studies suggest a relationship between obesity-associated dysfunctional adipose tissue (AT) and HFpEF. However, an apparent obesity paradox exists in some HF populations with a higher body mass index. We sought to determine whether HFpEF exerted effects on AT and investigated the involved mechanisms. Mice underwent d-aldosterone infusion, uninephrectomy, and were given 1% saline for 4 weeks. HFpEF mice developed hypertension, left ventricular hypertrophy, and diastolic dysfunction and had higher myocardial natriuretic peptide expression. Although body weights were similar in HFpEF and sham-operated mice, white AT was significantly smaller in HFpEF than in sham (epididymal AT, 7.59 versus 10.67 mg/g; inguinal AT, 6.34 versus 8.38 mg/g). These changes were associated with smaller adipocyte size and increased beiging markers (ucp-1, cidea, and eva) in white AT. Similar findings were seen in HFpEF induced by transverse aortic constriction. Increased activation of natriuretic peptide signaling was seen in white AT of HFpEF mice. The ratio of the signaling receptor, natriuretic peptide receptor type A, to the clearance receptor, nprc, was increased as was p38 mitogen-activated protein kinase activation. However, HFpEF mice failed to regulate body temperature during cold temperature exposure. In HFpEF, despite a larger brown AT mass (5.96 versus 4.50 mg/g), brown AT showed reduced activity with decreased uncoupling protein 1 (ucp-1), cell death-inducing DFFA-like effector a (cidea), and epithelial V-like antigen (eva) expression and decreased expression of lipolytic enzymes (hormone-sensitive lipase, lipoprotein lipase, and fatty acid binding protein 4) versus sham. These findings show that HFpEF is associated with beiging in white AT and with dysfunctional brown AT. © 2015 American Heart Association, Inc.

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

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    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.

  10. 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.

  11. Outcome of cardiac surgery in patients with low preoperative ejection fraction.

    Science.gov (United States)

    Pieri, Marina; Belletti, Alessandro; Monaco, Fabrizio; Pisano, Antonio; Musu, Mario; Dalessandro, Veronica; Monti, Giacomo; Finco, Gabriele; Zangrillo, Alberto; Landoni, Giovanni

    2016-10-18

    In patients undergoing cardiac surgery, a reduced preoperative left ventricular ejection fraction (LVEF) is common and is associated with a worse outcome. Available outcome data for these patients address specific surgical procedures, mainly coronary artery bypass graft (CABG). Aim of our study was to investigate perioperative outcome of surgery on patients with low pre-operative LVEF undergoing a broad range of cardiac surgical procedures. Data from patients with pre-operative LVEF ≤40 % undergoing cardiac surgery at a university hospital were reviewed and analyzed. A subgroup analysis on patients with pre-operative LVEF ≤30 % was also performed. A total of 7313 patients underwent cardiac surgery during the study period. Out of these, 781 patients (11 %) had a pre-operative LVEF ≤40 % and were included in the analysis. Mean pre-operative LVEF was 33.9 ± 6.1 % and in 290 patients (37 %) LVEF was ≤30 %. The most frequently performed operation was CABG (31 % of procedures), followed by mitral valve surgery (22 %) and aortic valve surgery (19 %). Overall perioperative mortality was 5.6 %. Mitral valve surgery was more frequent among patients who did not survive, while survivors underwent more frequently CABG. Post-operative myocardial infarction occurred in 19 (2.4 %) of patients, low cardiac output syndrome in 271 (35 %). Acute kidney injury occurred in 195 (25 %) of patients. Duration of mechanical ventilation was 18 (12-48) hours. Incidence of complications was higher in patients with LVEF ≤30 %. Stepwise multivariate analysis identified chronic obstructive pulmonary disease, pre-operative insertion of intra-aortic balloon pump, and pre-operative need for inotropes as independent predictors of mortality among patients with LVEF ≤40 %. We confirmed that patients with low pre-operative LVEF undergoing cardiac surgery are at higher risk of post-operative complications. Cardiac surgery can be performed with acceptable mortality rates

  12. 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.

  13. 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...

  14. 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

  15. 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

  16. 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%....

  17. Functional iron deficiency and diastolic function in heart failure with preserved ejection fraction.

    Science.gov (United States)

    Kasner, Mario; Aleksandrov, Aleksandar S; Westermann, Dirk; Lassner, Dirk; Gross, Michael; von Haehling, Stephan; Anker, Stefan D; Schultheiss, Heinz-Peter; Tschöpe, Carsten

    2013-10-12

    Functional iron deficiency (FID) is an independent risk factor for poor outcome in advanced heart failure with reduced EF, but its role in heart failure with preserved EF (HFPEF) remains unclear. We aimed to investigate the impact of FID on cardiac performance determined by pressure-volume loop analysis in HFPEF. 26 HFPEF patients who showed an increase in LV stiffness by pressure-volume (PV) loop analysis obtained by conductance-catheterization, performed exercise testing, echocardiographic examination including tissue Doppler and determination of iron metabolism: serum iron, ferritin and transferrin saturation. HFPEF patients who provided ferritin <100 μg/l or ferritin of 100-299 μg/l in combination with transferrin saturation <20% were defined as having FID. In 14 patients the expression of transferrin receptor was determined from available endomyocardial biopsies. Fifteen out of 26 HFPEF patients showed FID without anemia. Compared to control subjects and HFPEF patients without FID, HFPEF patients with FID showed an up-regulation of the myocardial transferrin receptor expression (p<0.05). No differences between HFPEF patients with and without iron deficiency were found in heart dimensions, systolic and diastolic function obtained by PV-loop and echocardiography analysis. According to the linear regression analysis, LV stiffness was correlated with peak oxygen uptake (r=-0.636, p<0.001) but not with the ferritin level or transferrin saturation. No relation was found between FID and exercise capacity. The association of LV stiffness with exercise performance was independent from the level of iron deficiency. In non-anemic HFPEF patients, cardiac dysfunction and impaired exercise capacity occur independently of FID. © 2013.

  18. 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....

  19. Cardiac Amyloidosis and its New Clinical Phenotype: Heart Failure with Preserved Ejection Fraction.

    Science.gov (United States)

    Mesquita, Evandro Tinoco; Jorge, Antonio José Lagoeiro; Souza, Celso Vale; Andrade, Thais Ribeiro de

    2017-07-01

    Heart failure with preserved ejection fraction (HFpEF) is now an emerging cardiovascular epidemic, being identified as the main phenotype observed in clinical practice. It is more associated with female gender, advanced age and comorbidities such as hypertension, diabetes, obesity and chronic kidney disease. Amyloidosis is a clinical disorder characterized by the deposition of aggregates of insoluble fibrils originating from proteins that exhibit anomalous folding. Recently, pictures of senile amyloidosis have been described in patients with HFpEF, demonstrating the need for clinical cardiologists to investigate this etiology in suspect cases. The clinical suspicion of amyloidosis should be increased in cases of HFPS where the cardio imaging methods are compatible with infiltrative cardiomyopathy. Advances in cardio imaging methods combined with the possibility of performing genetic tests and identification of the type of amyloid material allow the diagnosis to be made. The management of the diagnosed patients can be done in partnership with centers specialized in the study of amyloidosis, which, together with the new technologies, investigate the possibility of organ or bone marrow transplantation and also the involvement of patients in clinical studies that evaluate the action of the new emerging drugs. Resumo A insuficiência cardíaca com fração de ejeção preservada (ICFEP) é hoje uma epidemia cardiovascular emergente, sendo identificada como o principal fenótipo observado na prática clínica. Está mais associado ao sexo feminino, idade avançada e a comorbidades como hipertensão arterial, diabetes, obesidade e doença renal crônica. A amiloidose é uma desordem clínica caracterizada pelo depósito de agregados de fibrilas insolúveis originadas de proteínas que apresentam dobramento anômalo. Recentemente, têm sido descritos quadros de amiloidose senil em pacientes com ICFEP, demonstrando a necessidade de os cardiologistas clínicos investigarem

  20. 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.

  1. 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.

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

    Science.gov (United States)

    Søndergaard, Lars; Reddy, Vivek; Kaye, David; Malek, Filip; Walton, Antony; Mates, Martin; Franzen, Olaf; Neuzil, Petr; Ihlemann, Nikolaj; Gustafsson, Finn

    2014-07-01

    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 outcome of patients treated with a novel device intended to lower left atrial pressure by creating an 8 mm permanent shunt in the atrial septum. Eleven patients were enrolled in the pilot trial. Key inclusion criteria were: EF >45%; baseline PCWP ≥15 mmHg (rest), or ≥ 25 mmHg (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) device was implanted using percutaneous trans-septal access via the femoral vein. The device was successfully implanted in all patients. At 30 days, LV filling pressures were significantly reduced by 5.5 mmHg (19.7 ± 3.4 vs. 14.2 ± 2.7; P = 0.005), and NYHA class was improved by two classes in two 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. Contemporary management of HFpEF patients is confounded by the lack of effective therapies. The use of a device-based approach to reduce left atrial pressure provides a novel means to improve haemodynamic and symptomatic status in HFpEF patients and warrants further investigation. © 2014 The Authors. European Journal of Heart Failure © 2014 European Society of Cardiology.

  3. 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...

  4. 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...

  5. 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.

  6. 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.

  7. 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

  8. 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.

  9. 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.

  10. Relationship between right and left ventricular function in candidates for implantable cardioverter defibrillator with low left ventricular ejection fraction.

    Science.gov (United States)

    Jimenez-Juan, Laura; Karur, Gauri R; Connelly, Kim A; Deva, Djeven; Yan, Raymond T; Wald, Rachel M; Singh, Sheldon; Leung, General; Oikonomou, Anastasia; Dorian, Paul; Angaran, Paul; Yan, Andrew T

    2017-04-01

    Indications for the primary prevention of sudden death using an implantable cardioverter defibrillator (ICD) are based predominantly on left ventricular ejection fraction (LVEF). However, right ventricular ejection fraction (RVEF) is also a known prognostic factor in a variety of structural heart diseases that predispose to sudden cardiac death. We sought to investigate the relationship between right and left ventricular parameters (function and volume) measured by cardiovascular magnetic resonance (CMR) among a broad spectrum of patients considered for an ICD. In this retrospective, single tertiary-care center study, consecutive patients considered for ICD implantation who were referred for LVEF assessment by CMR were included. Right and left ventricular function and volumes were measured. In total, 102 patients (age 62±14 years; 23% women) had a mean LVEF of 28±11% and RVEF of 44±12%. The left ventricular and right ventricular end diastolic volume index was 140±42 mL/m(2) and 81±27 mL/m(2), respectively. Eighty-six (84%) patients had a LVEF right ventricular systolic dysfunction. Although there was a significant and moderate correlation between LVEF and RVEF (r=0.40, pright ventricular systolic dysfunction (Kappa=0.041). Among patients being considered for an ICD, there is a positive but moderate correlation between LVEF and RVEF. A considerable proportion of patients who qualify for an ICD based on low LVEF have preserved RVEF, and vice versa.

  11. Role of Myocardial Collagen in Severe Aortic Stenosis With Preserved Ejection Fraction and Symptoms of Heart Failure.

    Science.gov (United States)

    Echegaray, Kattalin; Andreu, Ion; Lazkano, Ane; Villanueva, Iñaki; Sáenz, Alberto; Elizalde, María Reyes; Echeverría, Tomás; López, Begoña; Garro, Asier; González, Arantxa; Zubillaga, Elena; Solla, Itziar; Sanz, Iñaki; González, Jesús; Elósegui-Artola, Alberto; Roca-Cusachs, Pere; Díez, Javier; Ravassa, Susana; Querejeta, Ramón

    2017-02-16

    We investigated the anatomical localization, biomechanical properties, and molecular phenotype of myocardial collagen tissue in 40 patients with severe aortic stenosis with preserved ejection fraction and symptoms of heart failure. Two transmural biopsies were taken from the left ventricular free wall. Mysial and nonmysial regions of the collagen network were analyzed. Myocardial collagen volume fraction (CVF) was measured by picrosirius red staining. Young's elastic modulus (YEM) was measured by atomic force microscopy in decellularized slices to assess stiffness. Collagen types I and III were measured as CIVF and CIIIVF, respectively, by confocal microscopy in areas with YEM evaluation. Compared with controls, patients exhibited increased mysial and nonmysial CVF and nonmysial:mysial CVF ratio (P < .05). In patients, nonmysial CVF (r = 0.330; P = .046) and the nonmysial:mysial CVF ratio (r = 0.419; P = .012) were directly correlated with the ratio of maximal early transmitral flow velocity in diastole to early mitral annulus velocity in diastole. Both the CIVF:CIIIVF ratio and YEM were increased (P ≤ .001) in nonmysial regions compared with mysial regions in patients, with a direct correlation (r = 0.895; P < .001) between them. These findings suggest that, in patients with severe aortic stenosis with preserved ejection fraction and symptoms of heart failure, diastolic dysfunction is associated with increased nonmysial deposition of collagen, predominantly type I, resulting in increased extracellular matrix stiffness. Therefore, the characteristics of collagen tissue may contribute to diastolic dysfunction in these patients. Copyright © 2016 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.

  12. Heart rate index: an indicator of left ventricular ejection fraction. Comparison of left ventricular ejection fraction and variables assessed by exercise test in patients studied early after acute myocardial infarction

    DEFF Research Database (Denmark)

    Haedersdal, C; Pedersen, F H; Svendsen, Jesper Hastrup

    1992-01-01

    The present study compares the variables assessed by standard exercise test with the left ventricular ejection fraction (LVEF) measured by multigated radionuclide angiocardiography (MUGA) in 77 patients early after myocardial infarction. The exercise test and MUGA were performed within two weeks...... after the myocardial infarction. A significant correlation (Spearman's correlation coefficient rs, p less than 0.05) was found between LVEF at rest and the following variables assessed at exercise test: 1) the heart rate at rest, 2) rise in heart rate, 3) ratio between maximal heart rate and heart rate...... at rest, 4) rise in systolic blood pressure, 5) rate pressure product at rest, 6) rise in rate pressure product, 7) ratio (rHR) between maximal rate pressure product and rate pressure product at rest, 8) total exercise time. The heart rate was corrected for effects caused by age (heart index (HR...

  13. Heart rate index: an indicator of left ventricular ejection fraction. Comparison of left ventricular ejection fraction and variables assessed by exercise test in patients studied early after acute myocardial infarction

    DEFF Research Database (Denmark)

    Haedersdal, C; Pedersen, F H; Svendsen, Jesper Hastrup

    1992-01-01

    at rest, 4) rise in systolic blood pressure, 5) rate pressure product at rest, 6) rise in rate pressure product, 7) ratio (rHR) between maximal rate pressure product and rate pressure product at rest, 8) total exercise time. The heart rate was corrected for effects caused by age (heart index (HR...... after the myocardial infarction. A significant correlation (Spearman's correlation coefficient rs, p less than 0.05) was found between LVEF at rest and the following variables assessed at exercise test: 1) the heart rate at rest, 2) rise in heart rate, 3) ratio between maximal heart rate and heart rate......The present study compares the variables assessed by standard exercise test with the left ventricular ejection fraction (LVEF) measured by multigated radionuclide angiocardiography (MUGA) in 77 patients early after myocardial infarction. The exercise test and MUGA were performed within two weeks...

  14. Arterial Stiffening With Exercise in Patients With Heart Failure and Preserved Ejection Fraction.

    Science.gov (United States)

    Reddy, Yogesh N V; Andersen, Mads J; Obokata, Masaru; Koepp, Katlyn E; Kane, Garvan C; Melenovsky, Vojtech; Olson, Thomas P; Borlaug, Barry A

    2017-07-11

    Aortic stiffening and reduced nitric oxide (NO) availability may contribute to the pathophysiology of heart failure with preserved ejection fraction (HFpEF). This study compared indices of arterial stiffness at rest and during exercise in subjects with HFpEF and hypertensive control subjects to examine their relationships to cardiac hemodynamics and determine whether exertional arterial stiffening can be mitigated by inorganic nitrite. A total of 22 hypertensive control subjects and 98 HFpEF subjects underwent hemodynamic exercise testing with simultaneous expired gas analysis to measure oxygen consumption. Invasively measured radial artery pressure waveforms were converted to central aortic waveforms by transfer function to assess integrated measures of pulsatile aortic load, including arterial compliance, resistance, elastance, and wave reflection. Arterial load and wave reflections in HFpEF were similar to those in control subjects at rest. During submaximal exercise, HFpEF subjects displayed reduced total arterial compliance and higher effective arterial elastance despite similar mean arterial pressures in control subjects. This was directly correlated with higher ventricular filling pressures and depressed cardiac output reserve (both p exercise, increased wave reflections, impaired compliance, and increased resistance and elastance were observed in subjects with HFpEF. A subset of HFpEF subjects (n = 52) received sodium nitrite or placebo therapy in a 1:1 double-blind, randomized fashion. Compared to placebo, nitrite decreased aortic wave reflections at rest and improved arterial compliance and elastance and central hemodynamics during exercise. Abnormal pulsatile aortic loading during exercise occurs in HFpEF independent of hypertension and is correlated with classical hemodynamic derangements that develop with stress. Inorganic nitrite mitigates arterial stiffening with exercise and improves hemodynamics, indicating that arterial stiffening with

  15. Cost-effectiveness Analysis of Sacubitril/Valsartan vs Enalapril in Patients With Heart Failure and Reduced Ejection Fraction.

    Science.gov (United States)

    Gaziano, Thomas A; Fonarow, Gregg C; Claggett, Brian; Chan, Wing W; Deschaseaux-Voinet, Celine; Turner, Stuart J; Rouleau, Jean L; Zile, Michael R; McMurray, John J V; Solomon, Scott D

    2016-09-01

    The angiotensin receptor neprilysin inhibitor sacubitril/valsartan was associated with a reduction in cardiovascular mortality, all-cause mortality, and hospitalizations compared with enalapril. Sacubitril/valsartan has been approved for use in heart failure (HF) with reduced ejection fraction in the United States and cost has been suggested as 1 factor that will influence the use of this agent. To estimate the cost-effectiveness of sacubitril/valsartan vs enalapril in the United States. Data from US adults (mean [SD] age, 63.8 [11.5] years) with HF with reduced ejection fraction and characteristics similar to those in the PARADIGM-HF trial were used as inputs for a 2-state Markov model simulated HF. Risks of all-cause mortality and hospitalization from HF or other reasons were estimated with a 30-year time horizon. Quality of life was based on trial EQ-5D scores. Hospital costs combined Medicare and private insurance reimbursement rates; medication costs included the wholesale acquisition cost for sacubitril/valsartan and enalapril. A discount rate of 3% was used. Sensitivity analyses were performed on key inputs including: hospital costs, mortality benefit, hazard ratio for hospitalization reduction, drug costs, and quality-of-life estimates. Hospitalizations, quality-adjusted life-years (QALYs), costs, and incremental costs per QALY gained. The 2-state Markov model of US adult patients (mean age, 63.8 years) calculated that there would be 220 fewer hospital admissions per 1000 patients with HF treated with sacubitril/valsartan vs enalapril over 30 years. The incremental costs and QALYs gained with sacubitril/valsartan treatment were estimated at $35 512 and 0.78, respectively, compared with enalapril, equating to an incremental cost-effectiveness ratio (ICER) of $45 017 per QALY for the base-case. Sensitivity analyses demonstrated ICERs ranging from $35 357 to $75 301 per QALY. For eligible patients with HF with reduced ejection fraction, the Markov

  16. 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.

  17. 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.

  18. [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.

  19. New strategies for heart failure with preserved ejection fraction: the importance of targeted therapies for heart failure phenotypes.

    Science.gov (United States)

    Senni, Michele; Paulus, Walter J; Gavazzi, Antonello; Fraser, Alan G; Díez, Javier; Solomon, Scott D; Smiseth, Otto A; Guazzi, Marco; Lam, Carolyn S P; Maggioni, Aldo P; Tschöpe, Carsten; Metra, Marco; Hummel, Scott L; Edelmann, Frank; Ambrosio, Giuseppe; Stewart Coats, Andrew J; Filippatos, Gerasimos S; Gheorghiade, Mihai; Anker, Stefan D; Levy, Daniel; Pfeffer, Marc A; Stough, Wendy Gattis; Pieske, Burkert M

    2014-10-21

    The management of heart failure with reduced ejection fraction (HF-REF) has improved significantly over the last two decades. In contrast, little or no progress has been made in identifying evidence-based, effective treatments for heart failure with preserved ejection fraction (HF-PEF). Despite the high prevalence, mortality, and cost of HF-PEF, large phase III international clinical trials investigating interventions to improve outcomes in HF-PEF have yielded disappointing results. Therefore, treatment of HF-PEF remains largely empiric, and almost no acknowledged standards exist. There is no single explanation for the negative results of past HF-PEF trials. Potential contributors include an incomplete understanding of HF-PEF pathophysiology, the heterogeneity of the patient population, inadequate diagnostic criteria, recruitment of patients without true heart failure or at early stages of the syndrome, poor matching of therapeutic mechanisms and primary pathophysiological processes, suboptimal study designs, or inadequate statistical power. Many novel agents are in various stages of research and development for potential use in patients with HF-PEF. To maximize the likelihood of identifying effective therapeutics for HF-PEF, lessons learned from the past decade of research should be applied to the design, conduct, and interpretation of future trials. This paper represents a synthesis of a workshop held in Bergamo, Italy, and it examines new and emerging therapies in the context of specific, targeted HF-PEF phenotypes where positive clinical benefit may be detected in clinical trials. Specific considerations related to patient and endpoint selection for future clinical trials design are also discussed. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2014. For permissions please email: journals.permissions@oup.com.

  20. Ejection fractions and pressure-heart rate product to evaluate cardiac efficiency. Continuous, real-time diagnosis using blood pressure and heart rate.

    Science.gov (United States)

    Kunig, H; Tassani-Prell, P; Engelmann, L

    2014-04-01

    Ejection fractions, derived from ventricular volumes, and double product, related to myocardial oxygen consumption, are important diagnostic parameters, as they describe the efficiency with which oxygen is consumed. Present technology often allows only intermittent determination of physiological status. This deficiency may be overcome if ejection fractions and myocardial oxygen consumption could be determined from continuous blood pressure and heart rate measurements. The purpose of this study is to determine the viability of pressure-derived ejection fractions and pressure-heart rate data in a diverse patient population and the use of ejection fractions to monitor patient safety. Volume ejection fractions, derived from ventricular volumes, EF(V), are defined by the ratio of the difference of end-diastolic volume, EDV, and end-systolic volume, ESV, to EDV. In analogy, pressure ejection fraction, EF(P), may be defined by the ratio of the difference of systolic arterial pressure, SBP, and diastolic arterial pressure, DBP, to SBP. The pressure-heart rate (heart rate: HR) is given by the product of systolic pressure and heart rate, SBP × HR. EF(P) and SBP × HR data were derived for all patients (n = 824) who were admitted in 2008 to the ICU of a university hospital at the specific time 30 min prior to leaving the ICU whether as survivors or non-survivors. The results are displayed in an efficiency/pressure-heart rate diagram. The efficiency/pressure-heart rate diagram reveals one subarea populated exclusively by survivors, another subarea populated statistically significant by non-survivors, and a third area shared by survivors and non-survivors. The efficiency/pressure-heart rate product relationship may be used as an outcome criterion to assess survival and to noninvasively monitor improvement or deterioration in real time to improve safety in patients with diverse dysfunctions.

  1. 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

  2. Associations of Anemia and Renal Dysfunction with Outcomes among Patients Hospitalized for Acute Decompensated Heart Failure with Preserved or Reduced Ejection Fraction

    Science.gov (United States)

    Sato, Naoki; Keida, Takehiko; Sakata, Yasushi; Takano, Teruo

    2014-01-01

    Background and objectives The relationship among anemia, renal dysfunction, left ventricular ejection fraction, and outcomes of patients hospitalized for acute decompensated heart failure is unclear. The aim of this study was to evaluate the association between cardiorenal anemia syndrome and postdischarge outcomes in patients hospitalized for heart failure with a preserved or reduced ejection fraction. Design, setting, participants, & measurements Of 4842 patients enrolled in the Acute Decompensated Heart Failure Syndromes Registry between April 1, 2007 and December 31, 2011, 4393 patients were evaluated to investigate the association among anemia, renal dysfunction, preserved or reduced ejection fraction, and the primary end point (mortality and readmission for heart failure since discharge). The patients were divided into four groups on the basis of eGFR and hemoglobin at discharge. The median follow-up period after discharge was 432 (range=253–659) days. Results The primary end point was reached in 37.6% and 34.8% of the preserved and reduced ejection fraction groups, respectively. After adjustment for multiple comorbidities, there was no significant association of either renal dysfunction or anemia alone with the primary end point in patients with preserved ejection fraction, but the combination of renal dysfunction and anemia was associated with a significantly higher risk than that without either condition (hazard ratio, 1.54; 95% confidence interval, 1.12 to 2.12; P<0.01). In patients with reduced ejection fraction, adjusted analysis showed that a significantly higher risk of the primary end point was associated with renal dysfunction alone (hazard ratio, 1.65; 95% confidence interval, 1.21 to 2.25; P=0.002) and also, renal dysfunction plus anemia relative to the risk without either condition (hazard ratio, 2.19; 95% confidence interval, 1.62 to 2.96; P<0.001). Conclusions The findings show that renal dysfunction combined with anemia is associated with an

  3. 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....

  4. 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

  5. Effect of oral alcohol on left ventricular ejection fraction, volumes, and segmental wall motion in normals and in patients with recent myocardial infarction.

    Science.gov (United States)

    Gould, L; Gopalaswamy, C; Yang, D; Patel, D; Kim, B S; Patel, C; Becker, W H

    1985-11-01

    A first-pass nuclear angiogram and a multiple-gated acquisition study were obtained in 10 normal physicians and in 10 patients with a 7-to-10 day old transmural myocardial infarction. After the scan the subjects drank 2 oz. of whiskey. After 60 minutes, the multiple-gated acquisition study was repeated. In the normal group the left ventricular ejection fraction was 68% before and 72% after alcohol. The left ventricular end-diastolic volume increased from 89 to 97 ml while the left ventricular end-systolic volume decreased from 29 to 27 ml. The stroke volume rose from 61 to 70 ml/beat (p less than 0.05). The cardiac output increased from 4.0 to 5.0 l/min (p less than 0.05). In the infarction group, the left ventricular ejection fraction was 58% before and 56% after alcohol administration. The left ventricular end-diastolic volume fell from 111 to 96 ml, while the left ventricular end-systolic volume declined from 50 to 44 ml. The stroke volume fell from 61 to 52 ml/beat, while the cardiac output fell from 4.5 to 3.8 l/min. In the left ventricular infarction zones, alcohol produced in 9 of the 10 cardiac patients a decline in the left ventricular regional ejection fraction. In the normal group, alcohol produced no significant changes in the regional ejection fraction. The normal and the postinfarction patients responded differently to alcohol.

  6. 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

  7. Quantification of the relative contribution of the different right ventricular wall motion components to right ventricular ejection fraction: the ReVISION method.

    Science.gov (United States)

    Lakatos, Bálint; Tősér, Zoltán; Tokodi, Márton; Doronina, Alexandra; Kosztin, Annamária; Muraru, Denisa; Badano, Luigi P; Kovács, Attila; Merkely, Béla

    2017-03-27

    Three major mechanisms contribute to right ventricular (RV) pump function: (i) shortening of the longitudinal axis with traction of the tricuspid annulus towards the apex; (ii) inward movement of the RV free wall; (iii) bulging of the interventricular septum into the RV and stretching the free wall over the septum. The relative contribution of the aforementioned mechanisms to RV pump function may change in different pathological conditions.Our aim was to develop a custom method to separately assess the extent of longitudinal, radial and anteroposterior displacement of the RV walls and to quantify their relative contribution to global RV ejection fraction using 3D data sets obtained by echocardiography.Accordingly, we decomposed the movement of the exported RV beutel wall in a vertex based manner. The volumes of the beutels accounting for the RV wall motion in only one direction (either longitudinal, radial, or anteroposterior) were calculated at each time frame using the signed tetrahedron method. Then, the relative contribution of the RV wall motion along the three different directions to global RV ejection fraction was calculated either as the ratio of the given direction's ejection fraction to global ejection fraction and as the frame-by-frame RV volume change (∆V/∆t) along the three motion directions.The ReVISION (Right VentrIcular Separate wall motIon quantificatiON) method may contribute to a better understanding of the pathophysiology of RV mechanical adaptations to different loading conditions and diseases.

  8. 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...

  9. 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...

  10. Effects of interleukin-1 blockade with anakinra on aerobic exercise capacity in patients with heart failure and preserved ejection fraction (from the D-HART pilot study)

    NARCIS (Netherlands)

    Tassell, B.W. Van; Arena, R.; Biondi-Zoccai, G.; Canada, J.; Oddi, C.; Abouzaki, N.A.; Jahangiri, A.; Falcao, R.A.; Kontos, M.C.; Shah, K.B.; Voelkel, N.F.; Dinarello, C.A.; Abbate, A.

    2014-01-01

    Heart failure with preserved ejection fraction (HFpEF) is a clinical syndrome of exercise intolerance due to impaired myocardial relaxation and/or increased stiffness. Patients with HFpEF often show signs of chronic systemic inflammation, and experimental studies have shown that interleukin-1 (IL-1)

  11. 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.

  12. 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, ...

  13. Predictors of procedural success and improvement of left ventricular ejection fraction after successful recanalization of coronary chronic total occlusion (CTO

    Directory of Open Access Journals (Sweden)

    Ahmed Magdy

    2017-04-01

    Conclusion: PCI for CTO lesions has achieved a better chance for success especially with modern facilities, but we should revise criteria of success and failure as this success has a considerable effect on LV function and patient outcome.

  14. 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).

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

    Directory of Open Access Journals (Sweden)

    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

  16. Clinical benefit of cardiac resynchronization therapy with a defibrillator in patients with an ejection fraction > 35% estimated by cardiac magnetic resonance.

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    Fabregat-Andrés, Oscar; García-González, Pilar; Valle-Muñoz, Alfonso; Estornell-Erill, Jordi; Pérez-Boscá, Leandro; Palanca-Gil, Victor; Payá-Serrano, Rafael; Quesada-Dorador, Aurelio; Morell, Salvador; Ridocci-Soriano, Francisco

    2014-02-01

    Cardiac resynchronization therapy with a defibrillator prolongs survival and improves quality of life in advanced heart failure. Traditionally, patients with ejection fraction > 35 estimated by echocardiography have been excluded. We assessed the prognostic impact of this therapy in a group of patients with severely depressed systolic function as assessed by echocardiography but with an ejection fraction > 35% as assessed by cardiac magnetic resonance. We analyzed consecutive patients admitted for decompensated heart failure between 2004 and 2011. The patients were in functional class II-IV, with a QRS ≥ to 120 ms, ejection fraction ≤ 35% estimated by echocardiography, and a cardiac magnetic resonance study. We included all patients (n=103) who underwent device implantation for primary prevention. Ventricular arrhythmia, all-cause mortality and readmission for heart failure were considered major cardiac events. The patients were divided into 2 groups according to systolic function assessed by magnetic resonance. The 2 groups showed similar improvements in functional class and ejection fraction at 6 months. We found a nonsignificant trend toward a higher risk of all-cause mortality in patients with systolic function ≤ 35% at long-term follow-up. The presence of a pattern of necrosis identified patients with a worse prognosis for ventricular arrhythmias and mortality in both groups. We conclude that cardiac resynchronization therapy with a defibrillator leads to a similar clinical benefit in patients with an ejection fraction ≤ 35% or > 35% estimated by cardiac magnetic resonance. Analysis of the pattern of late gadolinium enhancement provides additional information on arrhythmic risk and long-term prognosis. Copyright © 2013 Sociedad Española de Cardiología. Published by Elsevier Espana. All rights reserved.

  17. 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.

  18. Diagnostic and Prognostic Value of CMR T1-Mapping in Patients With Heart Failure and Preserved Ejection Fraction.

    Science.gov (United States)

    Rommel, Karl-Philipp; Lücke, Christian; Lurz, Philipp

    2017-03-14

    Heart failure with preserved ejection fraction (HFpEF) presents a major challenge in modern cardiology. Although this syndrome is of increasing prevalence and is associated with unfavorable outcomes, treatment trials have failed to establish effective therapies. Currently, solutions to this dilemma are being investigated, including categorizing and characterizing patients more diversely to individualize treatment. In this regard, new imaging techniques might provide important information. Diastolic dysfunction is a diagnostic and pathophysiological cornerstone in HFpEF and is believed to be caused by systemic inflammation with the development of interstitial myocardial fibrosis and myocardial stiffening. Cardiac magnetic resonance (CMR) T1-mapping is a novel tool, which allows noninvasive quantification of the extracellular space and diffuse myocardial fibrosis. This review provides an overview of the potential of myocardial tissue characterization with CMR T1 mapping in HFpEF patients, outlining its diagnostic and prognostic implications and discussing future directions. We conclude that CMR T1 mapping is potentially an effective tool for patient characterization in large-scale epidemiological, diagnostic, and therapeutic HFpEF trials beyond traditional imaging parameters. Copyright © 2017 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.

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

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    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.

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

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    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.

  1. 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.

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

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    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.

  3. 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

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

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    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.

  5. Sarcopenia in patients with heart failure with preserved ejection fraction: Impact on muscle strength, exercise capacity and quality of life.

    Science.gov (United States)

    Bekfani, Tarek; Pellicori, Pierpaolo; Morris, Daniel A; Ebner, Nicole; Valentova, Miroslava; Steinbeck, Lisa; Wachter, Rolf; Elsner, Sebastian; Sliziuk, Veronika; Schefold, Joerg C; Sandek, Anja; Doehner, Wolfram; Cleland, John G; Lainscak, Mitja; Anker, Stefan D; von Haehling, Stephan

    2016-11-01

    To describe the prevalence of sarcopenia in ambulatory patients with heart failure with preserved ejection fraction (HFpEF) and its relation to reduced exercise capacity, muscle strength, and quality of life (QoL). A total of 117 symptomatic outpatients with HFpEF were prospectively enrolled in Germany, England, and Slovenia as part of the Studies Investigating Co-morbidities Aggravating Heart Failure (SICA-HF). Appendicular skeletal muscle (ASM) mass (the sum of muscle mass in both arms and legs) was assessed by DEXA. Echocardiography, 6-minute walk testing (6-MWT), muscle strength assessment, spiroergometry and QoL evaluation using EQ-5D Questionnaire were performed. Sarcopenia was defined as ASM 2 standard deviations below the mean of a healthy reference group aged 18-40years. Patients were divided into 3 groups according to the E/e' value: ≤8, 9-14, and ≥15. Sarcopenia was detected in 19.7% of all patients. These patients performed worse during 6-MWT (404±116 vs. 307±145m, p=0.003) and showed lower absolute peak oxygen consumption (1579±474 vs. 1211±442mL/min, p15 (p<0.05). Higher values of muscle strength/ASM were associated with a better QoL (r=0.5, p<0.0005). Logistic regression showed ASM to be independently associated with reduced distance walked during the 6-MWT adjusted for NYHA, height, left atrium diameter, ferritin and forced expiratory volume in 1s (FEV1) (odds ratio 1.2, p=0.02). Sarcopenia affects a clinically relevant proportion of patients with HFpEF. Low ASM is strongly linked to reduced muscle strength, exercise capacity and QoL in these patients. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  6. Clinical utility of automated assessment of left ventricular ejection fraction using artificial intelligence-assisted border detection.

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    Rahmouni, Hind W; Ky, Bonnie; Plappert, Ted; Duffy, Kevin; Wiegers, Susan E; Ferrari, Victor A; Keane, Martin G; Kirkpatrick, James N; Silvestry, Frank E; St John Sutton, Martin

    2008-03-01

    Ejection fraction (EF) calculated from 2-dimensional echocardiography provides important prognostic and therapeutic information in patients with heart disease. However, quantification of EF requires planimetry and is time-consuming. As a result, visual assessment is frequently used but is subjective and requires extensive experience. New computer software to assess EF automatically is now available and could be used routinely in busy digital laboratories (>15,000 studies per year) and in core laboratories running large clinical trials. We tested Siemens AutoEF software (Siemens Medical Solutions, Erlangen, Germany) to determine whether it correlated with visual estimates of EF, manual planimetry, and cardiac magnetic resonance (CMR). Siemens AutoEF is based on learned patterns and artificial intelligence. An expert and a novice reader assessed EF visually by reviewing transthoracic echocardiograms from consecutive patients. An experienced sonographer quantified EF in all studies using Simpson's method of disks. AutoEF results were compared to CMR. Ninety-two echocardiograms were analyzed. Visual assessment by the expert (R = 0.86) and the novice reader (R = 0.80) correlated more closely with manual planimetry using Simpson's method than did AutoEF (R = 0.64). The correlation between AutoEF and CMR was 0.63, 0.28, and 0.51 for EF, end-diastolic and end-systolic volumes, respectively. The discrepancies in EF estimates between AutoEF and manual tracing using Simpson's method and between AutoEF and CMR preclude routine clinical use of AutoEF until it has been validated in a number of large, busy echocardiographic laboratories. Visual assessment of EF, with its strong correlation with quantitative EF, underscores its continued clinical utility.

  7. Physicians' adherence to guideline-recommended medications in heart failure with reduced ejection fraction: data from the QUALIFY global survey.

    Science.gov (United States)

    Komajda, Michel; Anker, Stefan D; Cowie, Martin R; Filippatos, Gerasimos S; Mengelle, Bastian; Ponikowski, Piotr; Tavazzi, Luigi

    2016-05-01

    To assess physicians' adherence to guideline-recommended medications for the treatment of chronic heart failure (CHF) with reduced ejection fraction. QUALIFY is an international prospective observational longitudinal survey of 7092 CHF outpatients recruited 1-15 months after hospitalization for heart failure from September 2013 to December 2014 in 547 centres in 36 countries. We constructed a five-class guideline adherence score for angiotensin converting enzyme inhibitors (ACEIs), beta-blockers, angiotensin receptor blockers (ARBs), mineralocorticoid receptor antagonists, and ivabradine. The adherence score was good in 67%, moderate in 25%, and poor in 8% of patients. Adherence was lower in women than men but there were differences in age (65.7 ± 12.5 years women vs. 62.2 ± 12.4 years men, P 67 years (median) (11% vs. 16.2%, P = 0.005). Geographic variations were observed with lower adherence scores in Central/Eastern European countries. The proportion of patients at target dose and ≥50% of target dose was low (27.9% and 63.3% for ACEIs, 14.8% and 51.8% for beta-blockers, 6.9% and 39.5% for ARBs, and 6.9% and 39.5% for ivabradine, respectively). It was also lower in patients most recently hospitalized (medications is relatively satisfactory but the dosage of recommended CHF medications is usually suboptimal. Action plans aimed at improving adherence to guidelines are required. © 2016 The Authors. European Journal of Heart Failure © 2016 European Society of Cardiology.

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

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    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.

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

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    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.

  10. 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

  11. 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

  12. 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.

  13. Measures of Ventricular-Arterial Coupling and Incident Heart Failure With Preserved Ejection Fraction: A Matched Case-Control Analysis.

    Science.gov (United States)

    Lekavich, Carolyn L; Barksdale, Debra J; Wu, Jia-Rong; Neelon, Virginia; Crandell, Jamie; Velazquez, Eric J

    2017-09-01

    Evidence continues to demonstrate increasing prevalence, cost, and mortality implications of heart failure with preserved ejection fraction (HFpEF), but clearly defined parameters that distinguish between control subjects and HFpEF have not been established. This study was designed to detect differences in markers associated with Ventricular-arterial coupling and HFpEF when comparing matched case and control groups. A study cohort of case (incident patients with HFpEF; n = 155) and matched control (patients with no prior heart failure; n = 155) groups was retrospectively identified. Matching criteria included race, sex, age, and date of echocardiography (within 1 year). Physiologic and echocardiographic markers were collected from previously acquired transthoracic echocardiograms. These echocardiographic images were reanalyzed, and measures of ventricular-arterial coupling were calculated. Using conditional logistic regression and controlling for covariates, models were fitted to detect differences in HFpEF markers between case and control subjects. Statistically significant differences in markers that reflect ventricular elastance (Ees; P = .007) and left atrial diameter (LAdiam; P = .04) were detected when comparing the case and control groups. Conditional logistic regression analyses suggested a 40% higher odds of being in the case group with every 1-unit increase in Ees (odds ratio [OR] 1.40, 95% confidence interval [CI] 1.10-1.79) and a 2.92 times higher odds of being in the case group for every 1 cm increase in LAdiam (OR 2.92, 95% CI 1.064-7.994). Ees and LAdiam are easily measurable echocardiographic markers that may have a role in identifying and tracking the progression toward incident HFpEF without increasing cost or risk to the patient. Prospective studies are indicated to explore the use of Ees and LAdiam as predictors of impending HFpEF. Copyright © 2017 Elsevier Inc. All rights reserved.

  14. 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

    survivors of acute myocardial infarction, 47 of whom had Type 2 (non-insulin-dependent) diabetes mellitus. None of the patients were treated with insulin. The prevalence of congestive heart failure during hospitalization was similar in patients with and without diabetes, although mean diuretic dose...... mortality in patients with non-insulin-dependent diabetes mellitus is not explained by available risk markers after myocardial infarction. Even though left ventricular ejection fraction and serum creatinine did not differ significantly, the apparent higher dose of Frusemide in patients with than without non-insulin......Patients with diabetes mellitus have a high morbidity and mortality from acute myocardial infarction, the reason for which is not fully understood. The relationship between congestive heart failure symptoms, left ventricular ejection fraction, and long-term mortality was examined in 578 hospital...

  15. Values of hemodynamic variation in response to passive leg raising in predicting exercise capacity of heart failure with preserved ejection fraction.

    Science.gov (United States)

    Zhou, Hong-Lian; Ding, Ling; Mi, Tao; Zheng, Kai; Wu, Xiao-Fen; Wang, Jing; Liu, Meng-Ying; Zhang, Le; Zhang, Cun-Tai; Quan, Xiao-Qing

    2016-11-01

    In heart failure patients with preserved ejection fraction, their hemodynamic parameters usually change when they are from recumbent to passive leg raising. The authors designed this study to investigate the relationship between hemodynamic parameters measured by impedance cardiography (ICG) and 6-minute walk distance (6MWD) of heart failure with preserved ejection fraction (HFPEF). We recruited 49 subjects with HFPEF in the study, and all the subjects were separated into 2 groups: the patients whose hemodynamic parameters rose after passive leg raising were in group 1 (n = 26) and the patients whose hemodynamic parameters did not rise after passive leg raising were in group 2 (n = 23). Our study then compared the 6MWD, left ventricular ejection fraction, and plasma NT-pro-brain natriuretic peptide between the 2 groups. Group 1 had significantly longer 6MWD than group 2 (515.38 ± 24.97 vs 306.39 ± 20.20 m; P = 0.043). Hemodynamic parameters measured by ICG significantly correlated with 6MWD in both groups. Patients whose hemodynamic parameters rose in response to passive leg raising were more likely to have better exercise capacity. Hemodynamic variation in response to passive leg raising measured by ICG may be more sensitive in predicting exercise capacity of patients with HFPEF.

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

    Directory of Open Access Journals (Sweden)

    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.

  17. Survival Benefits of Invasive Versus Conservative Strategies in Heart Failure in Patients With Reduced Ejection Fraction and Coronary Artery Disease: A Meta-Analysis.

    Science.gov (United States)

    Wolff, Georg; Dimitroulis, Dimitrios; Andreotti, Felicita; Kołodziejczak, Michalina; Jung, Christian; Scicchitano, Pietro; Devito, Fiorella; Zito, Annapaola; Occhipinti, Michele; Castiglioni, Battistina; Calveri, Giuseppe; Maisano, Francesco; Ciccone, Marco M; De Servi, Stefano; Navarese, Eliano P

    2017-01-01

    Heart failure with reduced ejection fraction caused by ischemic heart disease is associated with increased morbidity and mortality. It remains unclear whether revascularization by either coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI) carries benefits or risks in this group of stable patients compared with medical treatment. We performed a meta-analysis of available studies comparing different methods of revascularization (PCI or CABG) against each other or medical treatment in patients with coronary artery disease and left ventricular ejection fraction ≤40%. The primary outcome was all-cause mortality; myocardial infarction, revascularization, and stroke were also analyzed. Twenty-one studies involving a total of 16 191 patients were included. Compared with medical treatment, there was a significant mortality reduction with CABG (hazard ratio, 0.66; 95% confidence interval, 0.61-0.72; P<0.001) and PCI (hazard ratio, 0.73; 95% confidence interval, 0.62-0.85; P<0.001). When compared with PCI, CABG still showed a survival benefit (hazard ratio, 0.82; 95% confidence interval, 0.75-0.90; P<0.001). The present meta-analysis indicates that revascularization strategies are superior to medical treatment in improving survival in patients with ischemic heart disease and reduced ejection fraction. Between the 2 revascularization strategies, CABG seems more favorable compared with PCI in this particular clinical setting. © 2017 American Heart Association, Inc.

  18. Risk of Heart Failure With Preserved Ejection Fraction in Older Women After Contemporary Radiotherapy for Breast Cancer.

    Science.gov (United States)

    Saiki, Hirofumi; Petersen, Ivy A; Scott, Christopher G; Bailey, Kent R; Dunlay, Shannon M; Finley, Randi R; Ruddy, Kathryn J; Yan, Elizabeth; Redfield, Margaret M

    2017-04-11

    Cardiomyocytes are resistant to radiation. However, cardiac radiation exposure causes coronary microvascular endothelial inflammation, a perturbation implicated in the pathogenesis of heart failure (HF) and particularly HF with preserved ejection fraction (HFpEF). Radiotherapy for breast cancer results in variable cardiac radiation exposure and may increase the risk of HF. We conducted a population-based case-control study of incident HF in 170 female residents of Olmsted County, Minnesota (59 cases and 111 controls), who underwent contemporary (1998-2013) radiotherapy for breast cancer with computed tomography-assisted radiotherapy planning. Controls were matched to cases for age, tumor side, chemotherapy use, diabetes mellitus, and hypertension. Mean cardiac radiation dose (MCRD) in each patient was calculated from the patient's computed tomography images and radiotherapy plan. Mean age at radiotherapy was 69±9 years. Of HF cases, 38 (64%) had EF≥50% (HFpEF), 18 (31%) had EF<50% (HF with reduced EF), and 3 (5%) did not have EF measured. The EF was ≥40% in 50 of the 56 HF cases (89%) with an EF measurement. The mean interval from radiotherapy to HF was 5.8±3.4 years. The odds of HF was higher in patients with a history of ischemic heart disease or atrial fibrillation. The MCRD was 2.5 Gy (range, 0.2-13.1 Gy) and higher in cases (3.3±2.7 Gy) than controls (2.1±2.0 Gy; P=0.004). The odds ratio (95% confidence interval) for HF per log MCRD was 9.1 (3.4-24.4) for any HF, 16.9 (3.9-73.7) for HFpEF, and 3.17 (0.8-13.0) for HF with reduced EF. The increased odds of any HF or HFpEF with increasing MCRD remained significant after adjustment for HF risk factors and in sensitivity analyses matching by cancer stage rather than tumor side. Only 18.6% of patients experienced new or recurrent ischemic events between radiotherapy and the onset of HF. The relative risk of HFpEF increases with increasing cardiac radiation exposure during contemporary conformal breast cancer

  19. Cost-effectiveness of sacubitril/valsartan versus enalapril in patients with heart failure and reduced ejection fraction.

    Science.gov (United States)

    Lin, Liang; Bin-Chia Wu, David; Aziz, Mohamed Ismail Abdul; Wong, Raymond; Sim, David; Leong, Kui Toh Gerard; Wei, Yong Quek; Tan, Doreen; Ng, Kwong

    2017-09-29

    Sacubitril/valsartan reduces cardiovascular death and hospitalisations for heart failure (HF). However, decision-makers need to determine whether its benefits are worth the additional costs, given the low-cost generic status of traditional standard of care. To evaluate the cost-effectiveness of sacubitril/valsartan compared to enalapril in patients with HF and reduced ejection fraction, from the Singapore healthcare payer perspective. A Markov model was developed to project clinical and economic outcomes of sacubitril/valsartan versus enalapril for 66-year-old patients with HF over 10 years. Key health states included New York Heart Association classes I to IV and deaths; patients in each state incurred a monthly risk of hospitalisation for HF and cardiovascular death. Sacubitril/valsartan benefits were modelled by applying the hazard ratios (HRs) in PARADIGM-HF trial to baseline probabilities. Primary model outcomes were total and incremental costs and quality-adjusted life years (QALYs) and the incremental cost-effectiveness ratio (ICER) for sacubitril/valsartan relative to enalapril Results: Compared to enalapril, sacubitril/valsartan was associated with an ICER of SGD 74,592 (USD 55,198) per QALY gained. A major driver of cost-effectiveness was the cardiovascular mortality benefit of sacubitril/valsartan. The uncertainty of this treatment benefit in Asian subgroup was tested in sensitivity analyses using a HR of 1 as upper limit, where the ICERs ranged from SGD 41,019 (USD 30,354) to SGD 1,447,103 (USD 1,070,856) per QALY gained. Probabilistic sensitivity analyses showed the probability of sacubitril/valsartan being cost-effective was below 1%, 12%, and 71% at SGD 20,000, SGD 50,000, and SGD 100,000 per QALY gained, respectively. At current daily price of SGD 9.00, sacubitril/valsartan may not represent good value for limited healthcare dollars compared to enalapril in reducing cardiovascular morbidity and mortality in HF in Singapore healthcare setting. This

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

    Directory of Open Access Journals (Sweden)

    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.

  1. 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

  2. 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.

  3. Impaired relaxation despite upregulated calcium-handling protein atrial myocardium from type 2 diabetic patients with preserved ejection fraction.

    Science.gov (United States)

    Lamberts, Regis R; Lingam, Shivanjali J; Wang, Heng-Yu; Bollen, Ilse A E; Hughes, Gillian; Galvin, Ivor F; Bunton, Richard W; Bahn, Andrew; Katare, Rajesh; Baldi, J Chris; Williams, Michael J A; Saxena, Pankaj; Coffey, Sean; Jones, Peter P

    2014-04-05

    Diastolic dysfunction is a key factor in the development and pathology of cardiac dysfunction in diabetes, however the exact underlying mechanism remains unknown, especially in humans. We aimed to measure contraction, relaxation, expression of calcium-handling proteins and fibrosis in myocardium of diabetic patients with preserved systolic function. Right atrial appendages from patients with type 2 diabetes mellitus (DM, n = 20) and non-diabetic patients (non-DM, n = 36), all with preserved ejection fraction and undergoing coronary artery bypass grafting (CABG), were collected. From appendages, small cardiac muscles, trabeculae, were isolated to measure basal and β-adrenergic stimulated myocardial function. Expression levels of calcium-handling proteins, sarcoplasmic reticulum Ca2+ ATPase (SERCA2a) and phospholamban (PLB), and of β1-adrenoreceptors were determined in tissue samples by Western blot. Collagen deposition was determined by picro-sirius red staining. In trabeculae from diabetic samples, contractile function was preserved, but relaxation was prolonged (Tau: 74 ± 13 ms vs. 93 ± 16 ms, non-DM vs. DM, p = 0.03). The expression of SERCA2a was increased in diabetic myocardial tissue (0.75 ± 0.09 vs. 1.23 ± 0.15, non-DM vs. DM, p = 0.007), whereas its endogenous inhibitor PLB was reduced (2.21 ± 0.45 vs. 0.42 ± 0.11, non-DM vs. DM, p = 0.01). Collagen deposition was increased in diabetic samples. Moreover, trabeculae from diabetic patients were unresponsive to β-adrenergic stimulation, despite no change in β1-adrenoreceptor expression levels. Human type 2 diabetic atrial myocardium showed increased fibrosis without systolic dysfunction but with impaired relaxation, especially during β-adrenergic challenge. Interestingly, changes in calcium-handling protein expression suggests accelerated active calcium re-uptake, thus improved relaxation, indicating a compensatory calcium-handling mechanism in diabetes

  4. Dementia-related adverse events in PARADIGM-HF and other trials in heart failure with reduced ejection fraction.

    Science.gov (United States)

    Cannon, Jane A; Shen, Li; Jhund, Pardeep S; Kristensen, Søren L; Køber, Lars; Chen, Fabian; Gong, Jianjian; Lefkowitz, Martin P; Rouleau, Jean L; Shi, Victor C; Swedberg, Karl; Zile, Michael R; Solomon, Scott D; Packer, Milton; McMurray, John J V

    2017-01-01

    Inhibition of neprilysin, an enzyme degrading natriuretic and other vasoactive peptides, is beneficial in heart failure with reduced ejection fraction (HFrEF), as shown in PARADIGM-HF which compared the angiotensin receptor-neprilysin inhibitor (ARNI) sacubitril/valsartan with enalapril. As neprilysin is also one of many enzymes clearing amyloid-β peptides from the brain, there is a theoretical concern about the long-term effects of sacubitril/valsartan on cognition. Therefore, we have examined dementia-related adverse effects (AEs) in PARADIGM-HF and placed these findings in the context of other recently conducted HFrEF trials. In PARADIGM-HF, patients with symptomatic HFrEF were randomized to sacubitril/valsartan 97/103 mg b.i.d. or enalapril 10 mg b.i.d. in a 1:1 ratio. We systematically searched AE reports, coded using the Medical Dictionary for Regulatory Activities (MedDRA), using Standardized MedDRA Queries (SMQs) with 'broad' and 'narrow' preferred terms related to dementia. In PARADIGM-HF, 8399 patients aged 18-96 years were randomized and followed for a median of 2.25 years (up to 4.3 years). The narrow SMQ search identified 27 dementia-related AEs: 15 (0.36%) on enalapril and 12 (0.29%) on sacubitril/valsartan [hazard ratio (HR) 0.73, 95% confidence interval (CI) 0.33-1.59]. The broad search identified 97 (2.30%) and 104 (2.48%) AEs (HR 1.01, 95% CI 0.75-1.37), respectively. The rates of dementia-related AEs in both treatment groups in PARADIGM-HF were similar to those in three other recent trials in HFrEF. We found no evidence that sacubitril/valsartan, compared with enalapril, increased dementia-related AEs, although longer follow-up may be necessary to detect such a signal and more sensitive tools are needed to detect lesser degrees of cognitive impairment. Further studies to address this question are warranted. © 2016 The Authors. European Journal of Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of

  5. 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

  6. 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 <0.001). Unadjusted 30-day mortality rate was the highest in the HFrEF group (0.5%, 3.0%, and 0.7%; p = 0.003). However, cumulative incidences of all-cause death at 5-year was the highest in the HFpEF group (14%, 27%, and 32%, respectively; p <0.001). After adjusting confounders, the risk of all-cause death in the 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.

  7. 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)

  8. 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

  9. Effect of fluid and dietary sodium restriction in the management of patients with heart failure and preserved ejection fraction: study protocol for a randomized controlled trial.

    Science.gov (United States)

    d'Almeida, Karina S M; Rabelo-Silva, Eneida R; Souza, Gabriela C; Trojahn, Melina M; Barilli, Sofia L S; Mansson, Jessica V; Biolo, Andreia; Rohde, Luis E P; Clausell, Nadine; Beck-da-Silva, Luís

    2014-09-04

    Although half of all patients with heart failure (HF) have a normal or near-normal ejection fraction and their prognosis differs little from that of patients with a reduced ejection fraction, the pathophysiology of HF with preserved ejection fraction (HF-PEF) is still poorly understood, and its management poorly supported by clinical trials. Sodium and fluid restriction is the most common self-care measure prescribed to HF patients for management of congestive episodes. However, its role in the treatment of HF-PEF remains unclear. This trial seeks to compare the effects of a sodium- and fluid-restricted diet versus an unrestricted diet on weight loss, neurohormonal activation, and clinical stability in patients admitted for decompensated HF-PEF. This is a randomized, parallel trial with blinded outcome assessment. The sample will include adult patients (aged ≥18 years) with a diagnosis of HF-PEF admitted for HF decompensation. The patients will be randomized to receive a diet with sodium and fluid intake restricted to 0.8 g/day and 800 mL/day respectively (intervention group) or an unrestricted diet, with 4 g/day sodium and unlimited fluid intake (control group), and followed for 7 days or until hospital discharge. The primary outcome shall consist of weight loss at 7 days or discharge. The secondary outcome includes assessment of clinical stability, neurohormonal activation, daily perception of thirst and readmission rate at 30 days. Assessment of the effects of sodium and fluid restriction on neurohormonal activation and clinical course of HF-PEF can promote a deeper understanding of the pathophysiology and progression of this complex syndrome. ClinicalTrials.gov identifier: NCT01896908 (date of registration: 8 August 2013).

  10. Role of two dimensional strain and strain rate imaging in assessment of left ventricular systolic function in patients with rheumatic mitral stenosis and normal ejection fraction

    Directory of Open Access Journals (Sweden)

    Hany Younan

    2015-09-01

    Conclusion: Patients with MS and preserved EF% had lower 2D longitudinal LV systolic S and Sr compared to the control group. 2D longitudinal LV systolic S and Sr imaging appears to be useful in the detection of subclinical LV systolic dysfunction in patients with MS and preserved EF%.

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

    Science.gov (United States)

    Adeniran, Ismail; MacIver, David H.; Hancox, Jules C.; Zhang, Henggui

    2015-01-01

    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 remodeling and concentric left ventricle hypertrophy (LVH). However, it is still unclear how the abnormal calcium homeostasis, ion channel and structural remodeling 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 remodeling 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 toward the understanding of the cellular bases of impaired cardiac electromechanical functions in heart failure. PMID:25852567

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

    Directory of Open Access Journals (Sweden)

    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.

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

    Science.gov (United States)

    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.

  14. 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.

  15. 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.

  16. 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...

  17. 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

  18. Heart rate reduction and exercise performance in recent onset heart failure with reduced ejection fraction: arguments for beta-blocker hypo-response.

    Science.gov (United States)

    Verbrugge, Frederik H; Vrijsen, Jeroen; Vercammen, Jan; Grieten, Lars; Dupont, Matthias; Mullens, Wilfried

    2015-10-01

    Beta blockers reduce all-cause mortality and readmissions in heart failure with reduced ejection fraction (HFrEF), which may be explained by their effect on heart rate (HR). This study assessed the impact of HR reduction with beta blockers on exercise capacity in recent onset HFrEF. Fifty consecutive patients with recent onset HFrEF (exercise protocol with respiratory gas analysis at baseline as well as after 6 and 12 months. Patients participated in a quality of care programme aiming to achieve guideline-recommended target doses for beta-blocker therapy. At baseline, 6 and 12 months, 36%, 70% and 62% of patients, respectively, had a resting HRexercise performance was better when resting HR was controlled <70 bpm with beta-blocker therapy. However, despite aggressive dose uptitration, many patients did not achieve this target as they had little HR reduction with beta-blocker therapy.

  19. Clinical and Hemodynamic Correlates and Prognostic Value of VE/VCO2 Slope in Patients With Heart Failure With Preserved Ejection Fraction and Pulmonary Hypertension.

    Science.gov (United States)

    Klaassen, Sebastiaan H C; Liu, Licette C Y; Hummel, Yoran M; Damman, Kevin; van der Meer, Peter; Voors, Adriaan A; Hoendermis, Elke S; van Veldhuisen, Dirk J

    2017-07-20

    Impaired exercise capacity is one of the hallmarks of heart failure with preserved ejection fraction (HFpEF), but the clinical and hemodynamic correlates and prognostic value of exercise testing in patients with HFpEF is unknown. Patients with HFpEF (left ventricular ejection fraction [LVEF] ≥45%) and pulmonary hypertension underwent cardiopulmonary exercise test (CPX) to measure maximal (peak VO2) and submaximal (ventilatory equivalent for carbon dioxide [VE/VCO2] slope) exercise capacity. In addition, right heart catheterization was performed. Patients were grouped in tertiles based on the VE/VCO2 slope. Univariate and multivariate regression analyses were performed. A Cox regression analysis was performed to determine the mortality during follow-up. We studied 88 patients: mean age 73 ± 9 years, 67% female, mean LVEF 58%, median N-terminal pro-B-type natriuretic peptide (NT-proBNP) 840 (interquartile range 411-1938) ng/L. Patients in the highest VE/VCO2 tertile had the most severe HF, as reflected in higher New York Heart Association functional class and higher NT-proBNP plasma levels (all P < .05 for trend), whereas LVEF was similar between the groups. Multivariable regression analysis with backward elimination on invasive hemodynamic measurements showed that VE/VCO2 slope was independently associated with pulmonary vascular resistance (PVR). Cox regression analysis showed that increased VE/VCO2 slope (but not peak VO2) was independently associated with increased mortality. Increased VE/VCO2 slope was associated with more severe disease and higher PVR and was independently associated with increased mortality in patients with HFpEF. Copyright © 2017 Elsevier Inc. All rights reserved.

  20. 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.)

  1. 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

  2. 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.)

  3. 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.

  4. 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.

  5. Very high rate programming in primary prevention patients with reduced ejection fraction implanted with a defibrillator: Results from a large multicenter controlled study.

    Science.gov (United States)

    Clementy, Nicolas; Challal, Farid; Marijon, Eloi; Boveda, Serge; Defaye, Pascal; Leclercq, Christophe; Deharo, Jean-Claude; Sadoul, Nicolas; Klug, Didier; Piot, Olivier; Gras, Daniel; Bordachar, Pierre; Algalarrondo, Vincent; Fauchier, Laurent; Babuty, Dominique

    2017-02-01

    Programming implantable cardioverter-defibrillators (ICDs) with a high-rate therapy strategy has proven to be effective in reducing shocks and is associated with a reduced mortality. We sought to determine the impact of a very high rate cutoff programming strategy on outcomes in patients with a primary indication for an ICD due to reduced left ventricular ejection fraction. Using data from the multicenter French DAI-PP registry, this cohort-controlled study compared outcomes in 500 patients programmed with a very high rate cutoff (VH-RATE group: monitor zone 170-219 beats/min; ventricular fibrillation zone ≥220 beats/min with 13 ± 4 detection intervals) with 1500 matched control patients programmed with 1 or 2 therapy zone. All ICDs were implanted for primary prevention in patients with systolic dysfunction. Risks of events were compared after propensity score matching of sex, age, ejection fraction, New York Heart Association class, cardiomyopathy, atrial fibrillation, and type of device. After a mean follow-up of 3.6 ± 2.3 years, VH-RATE programming was associated with a reduction of appropriate therapy risk (hazard ratio [HR] 0.40; 95% confidence interval [CI] 0.31-0.51; P programmed with 2 therapy zones. There was no significant difference in overall survival between the groups. In patients implanted with an ICD in primary prevention with left ventricular dysfunction, very high rate cutoff programming (single therapy zone ≥220 beats/min) was associated with a 60% reduction of appropriate therapies as well as inappropriate shocks, without affecting mortality. Copyright © 2016 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.

  6. 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。

  7. 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.)

  8. 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.

  9. Heart rate and outcome in heart failure with reduced ejection fraction: Differences between atrial fibrillation and sinus rhythm-A CIBIS II analysis.

    Science.gov (United States)

    Mulder, Bart A; Damman, Kevin; Van Veldhuisen, Dirk J; Van Gelder, Isabelle C; Rienstra, Michiel

    2017-09-01

    Heart rate has been associated with prognosis in patients with heart failure with reduced ejection fraction (HFREF) and sinus rhythm; whether this also holds true in patients with atrial fibrillation (AF) is unknown. To evaluate cardiac rhythm and baseline heart rate and the influence of outcome in patients with HFREF enrolled in the Cardiac Insufficiency Bisoprolol Study II. In total, 2539 patients were stratified according to their baseline heart rhythm (AF or sinus rhythm) and into quartiles of heart rate (≤70 bpm, 71-78 bpm, 79-90 bpm, and >90 bpm). The primary outcome was all-cause mortality. Mean follow-up was 1.3 years. Mean age was 61 years, mean left ventricular ejection fraction was 28%, and 80% were male. A total of 521 (21%) patients had AF at baseline. The risk associated with all-cause mortality for each 5 bpm increase in heart rate in patients with sinus rhythm (hazard ratio [HR]: 1.06, 95% confidence interval [CI]: 1.01-1.11, P = 0.012) was significantly different from those with AF (HR: 1.00, 95% CI: 0.94-1.07, P = 0.90, P for interaction = 0.041). The risk associated with higher heart rate in sinus rhythm was primarily attributable to excess risk in the highest quartile (HR: 1.64, 95% CI: 1.18-2.30, P = 0.003). Allocation to bisoprolol did not modify the interaction between heart rate, rhythm and outcome. In HFREF patients with AF, a higher heart rate is not associated with increased event rates in contrast to HFREF patients with sinus rhythm. © 2017 Wiley Periodicals, Inc.

  10. 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.

  11. 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

  12. Effects of sildenafil on cardiac structure and function, cardiopulmonary exercise testing and health-related quality of life measures in heart failure patients with preserved ejection fraction and pulmonary hypertension

    NARCIS (Netherlands)

    Liu, Licette C. Y.; Hummel, Yoran M.; van der Meer, Peter; Berger, Rolf M. F.; Damman, Kevin; van Veldhuisen, Dirk J.; Voors, Adriaan A.; Hoendermis, Elke S.

    Aims We recently showed that sildenafil did not improve pulmonary pressures and exercise capacity in a cohort of patients with heart failure and preserved ejection fraction (HFpEF) and predominantly postcapillary pulmonary hypertension. Here, we present the effects of sildenafil on cardiac structure

  13. 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.

  14. 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.

  15. 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.

  16. 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

  17. Influence of Left Ventricular Ejection Fraction on the Effects of Supplemental Use of Angiotensin Receptor Blocker Olmesartan in Hypertensive Patients With Heart Failure.

    Science.gov (United States)

    Miura, Masanobu; Sakata, Yasuhiko; Miyata, Satoshi; Shiba, Nobuyuki; Takahashi, Jun; Nochioka, Kotaro; Takada, Tsuyoshi; Saga, Chiharu; Shinozaki, Tsuyoshi; Sugi, Masafumi; Nakagawa, Makoto; Sekiguchi, Nobuyo; Komaru, Tatsuya; Kato, Atsushi; Fukuchi, Mitsumasa; Nozaki, Eiji; Hiramoto, Tetsuya; Inoue, Kanichi; Goto, Toshikazu; Ohe, Masatoshi; Tamaki, Kenji; Ibayashi, Setsuro; Ishide, Nobumasa; Maruyama, Yukio; Tsuji, Ichiro; Shimokawa, Hiroaki

    2016-09-23

    There is no robust evidence of pharmacological interventions to improve mortality in heart failure (HF) patients with preserved left ventricular ejection fraction (LVEF) (HFpEF). In this subanalysis study of the SUPPORT Trial, we addressed the influence of LVEF on the effects of olmesartan in HF. Among 1,147 patients enrolled in the SUPPORT Trial, we examined 429 patients with reduced LVEF (HFrEF, LVEF olmesartan to the combination of angiotensin-converting enzyme inhibitor (ACEI) and β-blocker (BB) was associated with increased incidence of death (hazard ratio (HR) 2.26, P=0.002) and worsening renal function (HR 2.01, P=0.01), whereas its addition to ACEI or BB alone was not. In contrast, in HFpEF patients, the addition of olmesartan to BB alone was significantly associated with reduced mortality (HR 0.32, P=0.03), whereas with ACEIs alone or in combination with BB and ACEI was not. The linear mixed-effect model showed that in HFpEF, the urinary albumin/creatinine ratio was unaltered when BB were combined with olmesartan, but significantly increased when not combined with olmesartan (P=0.01). LVEF substantially influences the effects of additive use of olmesartan, with beneficial effects noted when combined with BB in hypertensive HFpEF patients. (Circ J 2016; 80: 2155-2164).

  18. 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.

  19. 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.

  20. The significance of post-stress decrease in left ventricular ejection fraction in patients undergoing regadenoson stress gated SPECT myocardial perfusion imaging.

    Science.gov (United States)

    Gomez, Javier; Golzar, Yasmeen; Fughhi, Ibtihaj; Olusanya, Adebayo; Doukky, Rami

    2017-02-08

    The significance of post-stress decrease in left ventricular ejection fraction (LVEF) with regadenoson stress gated SPECT (GSPECT) myocardial perfusion imaging (MPI) has not been studied. Consecutive patients who underwent rest/regadenoson stress GSPECT-MPI followed by coronary angiography within 6 months were analyzed. Change in LVEF by GSPECT-MPI was calculated as stress LVEF minus rest LVEF; a significant decrease was tested at 5% and 10% thresholds. In a diagnostic cohort of 793 subjects, LVEF change was not predictive of severe/extensive coronary artery disease (area under the curve, 0.50; 95% confidence interval, 0.44-0.57; P = 0.946). There was no significant difference in the rates of severe/extensive coronary artery disease in patients with or without a decrease in LVEF, irrespective of MPI findings. In an outcome cohort of the 929 subjects followed for 30 ± 16 months, post-regadenoson stress decrease in LVEF was not associated with increased risk of the composite endpoint of cardiac death or myocardial infarction or in the risk of coronary revascularization. In patients selected to undergo coronary angiography following regadenoson stress GSPECT-MPI, a decrease in LVEF after regadenoson stress is not predictive of severe/extensive CAD or adverse clinical outcomes, irrespective of MPI findings.

  1. 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.)

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

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    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.

  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

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    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. The Restoration of Chronotropic CompEtence in Heart Failure PatientS with Normal Ejection FracTion (RESET) Study: Rationale and Design

    Science.gov (United States)

    Kass, David A.; Kitzman, Dalane W.; Alvarez, Guy E.

    2009-01-01

    Background Heart failure with preserved ejection fraction (HFpEF) is the predominant form of HF among the elderly and in women. However, there are few if any evidence-based therapeutic options for HFpEF. The chief complaint of HFpEF is reduced tolerance to physical exertion. Recent data revealed that one potential mechanism of exertional intolerance in HFpEF patients is inadequate chronotropic response. Although there is considerable evidence demonstrating the benefits of rate-adaptive pacing (RAP) provided from implantable cardiac devices in patients with an impaired chronotropic response, the effect of RAP in HFpEF is unknown. Methods and Results The RESET study is a prospective, multi-center, double-blind, randomized with stratification, study assessing the effect of RAP on peak VO2 and quality of life. RAP therapy will be evaluated in a cross-over paired fashion for each patient within each study stratum. Study strata are based on patient beta-blocker usage at time of enrollment. The study is powered to assess the impact of pacing independently in both strata. Conclusions The RESET study seeks to evaluate the potential benefit of RAP in patients with symptomatic mild to moderate HFpEF and chronotropic impairment. Study enrollment began in July 2008. PMID:20123314

  6. Usefulness of cardiac meta-iodobenzylguanidine imaging to identify patients with chronic heart failure and left ventricular ejection fraction risk for sudden cardiac death.

    Science.gov (United States)

    Kawai, Tsutomu; Yamada, Takahisa; Tamaki, Shunsuke; Morita, Takashi; Furukawa, Yoshio; Iwasaki, Yusuke; Kawasaki, Masato; Kikuchi, Atsushi; Kondo, Takumi; Takahashi, Satoshi; Ishimi, Masashi; Hakui, Hideyuki; Ozaki, Tatsuhisa; Sato, Yoshihiro; Seo, Masahiro; Sakata, Yasushi; Fukunami, Masatake

    2015-06-01

    Patients with chronic heart failure (CHF) at risk of sudden cardiac death (SCD) are often treated with implantable cardiac defibrillators (ICDs). However, current criteria for device use that is based largely on left ventricular ejection fraction (LVEF) lead to many patients receiving ICDs that never deliver therapy. It is of clinical significance to identify patients who do not require ICDs. Although cardiac I-123 meta-iodobenzylguanidine (MIBG) imaging provides prognostic information about CHF, whether it can identify patients with CHF who do not require an ICD remains unclear. We studied 81 patients with CHF and LVEF risk of SCD than those with intermediate and high scores (low [n = 19], 0%; intermediate [n = 37], 19%; high [n = 25], 36%; p = 0.001). The positive predictive value of low MIBG score for identifying patients without SCD was 100%. In conclusion, the MIBG score can identify patients with CHF and LVEF risk of developing SCD. Copyright © 2015 Elsevier Inc. All rights reserved.

  7. Improved interobserver variability and accuracy of echocardiographic visual left ventricular ejection fraction assessment through a self-directed learning program using cardiac magnetic resonance images.

    Science.gov (United States)

    Thavendiranathan, Paaladinesh; Popović, Zoran B; Flamm, Scott D; Dahiya, Arun; Grimm, Richard A; Marwick, Thomas H

    2013-11-01

    Although not recommended in isolation, visual estimation of echocardiographic ejection fraction (EF) is widely applied to confirm quantitative EF. However, interobserver variability for EF estimation has been reported to be as high as 14%. The aim of this study was to determine whether self-directed education could improve the accuracy and interobserver variability of visual estimation of EF and whether a multireader estimate improves measurement precision. Thirty-one participants provided single-point EF estimates for 30 echocardiograms with a spectrum of EFs, image quality, and clinical contexts in patients undergoing cardiac magnetic resonance (CMR) within 48 hours. Participants received their own case-by-case variance from CMR EF, and the 10 cases with the largest reader variability were discussed along with corresponding CMR images. Self-directed learning was undertaken by side-by-side review of echocardiographic and CMR images. Two months later, 20 new cases were shown to the same 31 participants, using the same methodology. The baseline interobserver variability of ±0.120 improved to ±0.097 after the intervention. EF misclassification (defined as ±0.05 of CMR EF) was reduced from 56% to 47% (P self-directed intervention modestly decreased interobserver variability and improved the accuracy of EF measurements. Combined physician-sonographer EF reporting improved the precision of EF estimates. Copyright © 2013 American Society of Echocardiography. Published by Mosby, Inc. All rights reserved.

  8. 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

    Full Text Available Adelina Marioara Mavrea,1 Tiberiu Dragomir,1 Diana Aurora Bordejevic,1 Mirela Cleopatra Tomescu,1 Oana Ancusa,1 Iosif Marincu21Cardiology Department, 2Department of Epidemiology and Infectious Diseases, “Victor Babes” University of Medicine and Pharmacy, Timisoara, RomaniaBackground: Heart failure with preserved ejection fraction (HFpEF is more frequent in the elderly and is associated with important economic implications because of repetitive and prolonged hospitalizations, due to both cardiovascular and noncardiovascular causes.Purpose: To identify the causes, as well as the clinical and biological markers, that could be used as predictors of hospital readmissions in HFpEF patients aged ≥65 years.Patients and methods: Consecutive eligible patients hospitalized for a first heart failure (HF episode were prospectively included and divided into one of two age groups (elderly: ≥65 years; and nonelderly: <65 years. The clinical features, therapeutic approaches, and clinical outcomes during the 1-year follow-up period were analyzed.Results: A total of 178 patients were included, with a mean age of 64.6±8.6 years; 80 (45% were women. A total of 98 patients (55% were aged ≥65 years, and 80 (45% were aged <65 years. In the group aged ≥65 years, 58 patients (59% were women, while in the group aged <65 years, 22 patients (28% were women (P=0.0001. During the 1-year follow-up, no patients died or were lost to follow-up. Moreover, 116 (65% of the HFpEF patients experienced hospital readmissions. The elderly patients had a significantly higher readmission rate (73% vs 55%, respectively; P<0.02; readmissions due to aggravated HF were significantly more frequent in this age group (41% vs 18%, respectively; P<0.002. Multivariate logistic regression analysis indicated that the independent predictors of readmission due to HF aggravation included plasma levels of brain natriuretic peptide >450 pg/mL (P<0.01 and N

  9. 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

  10. Interstitial Fibrosis, Functional Status, and Outcomes in Heart Failure With Preserved Ejection Fraction: Insights From a Prospective Cardiac Magnetic Resonance Imaging Study.

    Science.gov (United States)

    Duca, Franz; Kammerlander, Andreas A; Zotter-Tufaro, Caroline; Aschauer, Stefan; Schwaiger, Marianne L; Marzluf, Beatrice A; Bonderman, Diana; Mascherbauer, Julia

    2016-12-01

    Myocardial extracellular volume (ECV) accumulation is one of the key pathophysiologic features of heart failure with preserved ejection fraction (HFpEF). Our aims were to (1) measure ECV by cardiac magnetic resonance T1 mapping using the modified Look-Locker inversion recovery (MOLLI) sequence, (2) validate MOLLI-ECV against histology, and (3) investigate the relationship between MOLLI-ECV and prognosis in HFpEF. One-hundred seventeen consecutive HFpEF patients underwent cardiac magnetic resonance imaging, coronary angiography, and invasive hemodynamic assessments at baseline. Eighteen patients also underwent left ventricular biopsy for histological analysis (Histo-ECV). To assess the prognostic impact of MOLLI-ECV, its association with hospitalization for heart failure/cardiac death was tested by multivariable Cox regression analysis. Histo-ECV was 30.1±4.6% and was significantly correlated with MOLLI-ECV (R=0.494, P=0.037). Patients were followed for 24.0 months (6.0-32.0 months), during which 34 had a cardiac event. By Kaplan-Meier analysis, patients with MOLLI-ECV ≥ the median (28.9%) had shorter event-free survival (log-rank, P=0.028). MOLLI-ECV significantly correlated with N-terminal prohormone of brain natriuretic peptide (Pfunctional class (P=0.009), right atrial pressure (P=0.037), and stroke volume (P=0.043). By multivariable Cox regression analysis, MOLLI-ECV was associated with outcome among imaging variables (P=0.038) but not after adjustment for clinical and invasive hemodynamic parameters. We demonstrate that MOLLI-ECV in HFpEF accurately reflects histological ECV, correlates with markers of disease severity, and is associated with outcome among cardiac magnetic resonance parameters but not after adjustment for important clinical and invasive hemodynamic parameters. Nevertheless, MOLLI-ECV has the potential of becoming an important biomarker in HFpEF. © 2016 American Heart Association, Inc.

  11. 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

  12. Effects of exercise training on different quality of life dimensions in heart failure with preserved ejection fraction: the Ex-DHF-P trial.

    Science.gov (United States)

    Nolte, Kathleen; Herrmann-Lingen, Christoph; Wachter, Rolf; Gelbrich, Götz; Düngen, Hans-Dirk; Duvinage, André; Hoischen, Nadine; von Oehsen, Karima; Schwarz, Silja; Hasenfuss, Gerd; Halle, Martin; Pieske, Burkert; Edelmann, Frank

    2015-05-01

    Despite suffering from poor prognosis, progressive exercise intolerance, and impaired quality of life (QoL), effective therapeutic strategies in heart failure with preserved ejection fraction (HFpEF) are sparse. Exercise training (ET) improves physical QoL in HFpEF, but the effects on other aspects of QoL are unknown. The multicentre, prospective, randomized, controlled Exercise training in Diastolic Heart Failure Pilot study included 64 HFpEF patients (65 ± 7 years, 56% female). They were randomized to supervised endurance/resistance training in addition to usual care (ET, n = 44) or usual care alone (UC, n = 20). At baseline and after 3 months, QoL was assessed (36-item Short-form Health Survey (SF-36), Minnesota Living With Heart Failure Questionnaire (MLWHFQ), and Patient Health Questionnaire (PHQ-9). Exercise improved the following SF-36 dimensions: physical functioning (p general health perception (p general mental health (p =  0.002), vitality (p = 0.003), social functioning (p change with ET. With ET, also the PHQ-9 total score improved significantly (p = 0.004, p = 0.735 vs. UC). In patients with HFpEF, exercise training improved emotional status, physical and social dimensions of QoL as well as symptoms of depression from pre to post test. Physical dimensions of QoL and general health perception also improved significantly with exercise in comparison to usual care. © The European Society of Cardiology 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

  13. 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

  14. Validation of a novel modified wall motion score for estimation of left ventricular ejection fraction in ischemic and non-ischemic cardiomyopathy

    Energy Technology Data Exchange (ETDEWEB)

    Scholl, David, E-mail: David.Scholl@utoronto.ca [Imaging Research Laboratories, Robarts Research Institute, London, Ontario (Canada); Kim, Han W., E-mail: hanwkim@gmail.com [Duke Cardiovascular Magnetic Resonance Center, Division of Cardiology, Duke University, NC (United States); Shah, Dipan, E-mail: djshah@tmhs.org [The Methodist DeBakey Heart Center, Houston, TX (United States); Fine, Nowell M., E-mail: nowellfine@gmail.com [Division of Cardiology, Department of Medicine, Schulich School of Medicine and Dentistry, University of Western Ontario (Canada); Tandon, Shruti, E-mail: standon4@uwo.ca [Division of Cardiology, Department of Medicine, Schulich School of Medicine and Dentistry, University of Western Ontario (Canada); Thompson, Terry, E-mail: thompson@lawsonimaging.ca [Lawson Health Research Institute, London, Ontario (Canada); Department of Medical Biophysics, University of Western Ontario, London, Ontario (Canada); Drangova, Maria, E-mail: mdrangov@imaging.robarts.ca [Imaging Research Laboratories, Robarts Research Institute, London, Ontario (Canada); Department of Medical Biophysics, University of Western Ontario, London, Ontario (Canada); White, James A., E-mail: jwhite@imaging.robarts.ca [Division of Cardiology, Department of Medicine, Schulich School of Medicine and Dentistry, University of Western Ontario (Canada); Lawson Health Research Institute, London, Ontario (Canada); Imaging Research Laboratories, Robarts Research Institute, London, Ontario (Canada)

    2012-08-15

    Background: Visual determination of left ventricular ejection fraction (LVEF) by segmental scoring may be a practical alternative to volumetric analysis of cine magnetic resonance imaging (MRI). The accuracy and reproducibility of this approach for has not been described. The purpose of this study was to validate a novel segmental visual scoring method for LVEF estimation using cine MRI. Methods: 362 patients with known or suspected cardiomyopathy were studied. A modified wall motion score (mWMS) was used to blindly score the wall motion of all cardiac segments from cine MRI imaging. The same datasets were subjected to blinded volumetric analysis using endocardial contour tracing. The population was then separated into a model cohort (N = 181) and validation cohort (N = 181), with the former used to derive a regression equation of mWMS versus true volumetric LVEF. The validation cohort was then used to test the accuracy of this regression model to estimate the true LVEF from a visually determined mWMS. Reproducibility testing of mWMS scoring was performed upon a randomly selected sample of 20 cases. Results: The regression equation relating mWMS to true LVEF in the model cohort was: LVEF = 54.23 - 0.5761 Multiplication-Sign mWMS. In the validation cohort this equation produced a strong correlation between mWMS-derived LVEF and true volumetric LVEF (r = 0.89). Bland and Altman analysis showed no systematic bias in the LVEF estimated using the mWMS (-0.3231%, 95% limits of agreement -12.22% to 11.58%). Inter-observer and intra-observer reproducibility was excellent (r = 0.93 and 0.97, respectively). Conclusion: The mWMS is a practical tool for reporting regional wall motion and provides reproducible estimates of LVEF from cine MRI.

  15. microRNA-21 promotes cardiac fibrosis and development of heart failure with preserved left ventricular ejection fraction by up-regulating Bcl-2.

    Science.gov (United States)

    Dong, Shuguang; Ma, Wenhan; Hao, Bohan; Hu, Fen; Yan, Lianhua; Yan, Xiaofei; Wang, Ya; Chen, Zhijian; Wang, Zhaohui

    2014-01-01

    The morbidity and mortality of heart failure with preserved left ventricular ejection fraction (HFpEF) were similar to those of systolic heart failure, but the pathogenesis of HFpEF remains poorly understood. It was demonstrated that, in systolic heart failure, microRNA-21 (miR-21) could inhibit the apoptosis of cardiac fibroblasts, leading to cardiac hypertrophy and myocardial fibrosis, but the role of miR-21 in HFpEF remains unknown. By employing cell culture technique, rat myocardiocytes and cardiac fibroblasts were obtained. The expression of miR-21 in the two cell types under different conditions was compared and we found that the miR-21 expression was significantly higher in cardiac fibroblasts than in myocardiocytes. We established a rat HFpEF model and harvested the tissues of cardiac apex for pathological examination, Northern blotting and so forth. We found that miR-21 expression was significantly higher in model rats than in sham-operated rats, and the model rats developed the cardiac atrophy and cardiac fibrosis. After injection of miR-21 antagonist, the the cardiac atrophy and cardiac fibrosis were conspicuously ameliorated. Both in vivo and in vitro, inhibition of miR-21 expression resulted in reduced Bcl-2 expression while over-expression of miR-21 led to elevation of Bcl-2 expression. Our study suggested that miR-21 promoted the development of HFpEF by up-regulating the expression of anti-apoptotic gene Bcl-2 and thereby suppressing the apoptosis of cardiac fibrosis.

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

    Energy Technology Data Exchange (ETDEWEB)

    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.

  17. 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.

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

    Directory of Open Access Journals (Sweden)

    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.

  19. 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.

  20. 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

  1. 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.

  2. Effect of the reverse redistribution pattern on the left ventricular ejection fraction in the Tc- 99m MIBI SPECT myocardial perfusion scintigraphy

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    Bekir Taşdemir

    2015-09-01

    Full Text Available Objective: The causes and prognostic significance of the reverse redistribution pattern (RRP is not clear yet. In this study, we aimed to evaluate the RRP effect on the left ventricular ejection fraction (EF. Methods: Imaging of the patients whose technetium-99m sestamibi myocardial perfusion scintigraphy was carried out and reported as normal were retrospectively examined. One-day protocol and/or pharmacologic stress testing applied patients were excluded. 21 patients with RRP met the inclusion criteria. All of these patients were included in the study as RRP group. Randomly selected 21 patients with non-RRP were included in the study as control group. Transient ischemic dilation (TID scores and EF values were automatically calculated with the Quantitative Gated SPECT (QGS program. Results: While a statistically significant difference was not found between the RRP and control groups in terms of age, sex, hypertension, family history, hyperlipidemia, and diabetes (p>0.05, there was a statistically significant difference in terms of smoking (p=0.019. TID scores in the RRP group were significantly lower compared to the control group (p<0.001. In addition, a statistically significant decrease was determined in the EF values in the rest images compared to the stress images in the RRP group (p=0.002. Furthermore, this decrease was significantly higher than in the control group (p= 0.034. Conclusion: The results related to the TID scores and EF values are suggesting the existence of an ischemic cause in the background of the RRP. Additionally, the relationship found between smoking and RRP may be associated with the tachycardia and / or coronary spasm-inducing effect of smoking. J Clin Exp Invest 2015; 6 (3: 286-290

  3. 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.

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    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.

  4. Effect of Endurance Training on the Determinants of Peak Exercise Oxygen Consumption in Elderly Patients with Stable Compensated Heart Failure and Preserved Ejection Fraction

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    Haykowsky, Mark J.; Brubaker, Peter H.; Stewart, Kathryn P.; Morgan, Timothy M.; Eggebeen, Joel; Kitzman, Dalane W.

    2012-01-01

    Objective Evaluate the mechanism(s) for improved exercise capacity after endurance exercise training (ET) in elderly patients with heart failure and preserved ejection fraction (HFPEF). Background: Exercise intolerance, measured objectively by reduced peak oxygen consumption (VO2), is the primary chronic symptom in HFPEF and is improved by ET. However, the mechanism(s) are unknown. Methods Forty stable, compensated HFPEF outpatients (mean age 69 ± 6 yrs) were examined at baseline and after 4 months of ET (n=22) or attention control (n=18). VO2 and its determinants were assessed during rest and peak upright cycle exercise. Results Following ET, peak VO2 was higher than controls (16.3 ± 2.6 vs. 13.1 ± 3.4 ml/kg/min; p=0.002). This was associated with higher peak heart rate (139 ± 16 vs. 131 ± 20 beats/min; p=0.03), but no difference in peak end-diastolic volume (77 ± 18 vs. 77 ± 17 ml; p=0.51), stroke volume (48 ± 9 vs. 46 ± 9 ml; p=0.83), or cardiac output (6.6 ± 1.3 vs. 5.9 ± 1.5 L/min; p=0.32). However, estimated peak arterial-venous oxygen difference (A-VO2 Diff) was significantly higher in ET (19.8 ± 4.0 vs. 17.3 ± 3.7 ml/dl; p=0.03). The effect of ET on cardiac output was responsible for elderly stable compensated HFPEF patients, peak A-VO2 Diff was higher following ET and was the primary contributor to improved peak VO2. This suggests that peripheral mechanisms (improved microvascular and/or skeletal muscle function) contribute to the improved exercise capacity after ET in HFPEF. PMID:22766338

  5. Impairment of Coronary Flow Reserve Evaluated by Phase Contrast Cine-Magnetic Resonance Imaging in Patients With Heart Failure With Preserved Ejection Fraction.

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    Kato, Shingo; Saito, Naka; Kirigaya, Hidekuni; Gyotoku, Daiki; Iinuma, Naoki; Kusakawa, Yuka; Iguchi, Kohei; Nakachi, Tatsuya; Fukui, Kazuki; Futaki, Masaaki; Iwasawa, Tae; Kimura, Kazuo; Umemura, Satoshi

    2016-02-23

    Phase contrast (PC) cine-magnetic resonance imaging (MRI) of the coronary sinus allows for noninvasive evaluation of coronary flow reserve (CFR), which is an index of left ventricular microvascular function. The objective of this study was to investigate coronary flow reserve in patients with heart failure with preserved ejection fraction (HFpEF). We studied 25 patients with HFpEF (mean and SD of age: 73±7 years), 13 with hypertensive left ventricular hypertrophy (LVH) (67±10 years), and 18 controls (65±15 years). Breath-hold PC cine-MRI images of the coronary sinus were obtained to assess blood flow at rest and during ATP infusion. CFR was calculated as coronary sinus blood flow during ATP infusion divided by coronary sinus blood flow at rest. Impairment of CFR was defined as CFR <2.5 according to a previous study. The majority (76%) of HFpEF patients had decreased CFR. CFR was significantly decreased in HFpEF patients in comparison to hypertensive LVH patients and control subjects (CFR: 2.21±0.55 in HFpEF vs 3.05±0.74 in hypertensive LVH, 3.83±0.73 in controls; P<0.001 by 1-way ANOVA). According to multivariable linear regression analysis, CFR independently and significantly correlated with serum brain natriuretic peptide level (β=-68.0; 95% CI, -116.2 to -19.7; P=0.007). CFR was significantly lower in patients with HFpEF than in hypertensive LVH patients and controls. These results indicated that impairment of CFR might be a pathophysiological factor for HFpEF and might be related to HFpEF disease severity. © 2016 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.

  6. Left ventricular outflow tract velocity time integral outperforms ejection fraction and Doppler-derived cardiac output for predicting outcomes in a select advanced heart failure cohort.

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    Tan, Christina; Rubenson, David; Srivastava, Ajay; Mohan, Rajeev; Smith, Michael R; Billick, Kristen; Bardarian, Samuel; Thomas Heywood, J

    2017-07-03

    Left ventricular outflow tract velocity time integral (LVOT VTI) is a measure of cardiac systolic function and cardiac output. Heart failure patients with low cardiac output are known to have poor cardiovascular outcomes. Thus, extremely low LVOT VTI may predict heart failure patients at highest risk for mortality. Patients with heart failure and extremely low LVOT VTI were identified from a single-center database. Baseline characteristics and heart failure related clinical outcomes (death, LVAD) were obtained at 12 months. Correlation between clinical endpoints and the following variables were analyzed: ejection fraction (EF), pulmonary artery systolic pressure (PASP), NYHA class, renal function, Doppler cardiac output (CO), and LVOT VTI. Study cohort consisted of 100 patients. At the 12-month follow up period, 30 events (28 deaths, 2 LVADs) were identified. Occurrence of death and LVAD implantation was statistically associated with a lower LVOT VTI (p = 0.039) but not EF (p = 0.169) or CO (p = 0.217). In multivariate analysis, LVOT VTI (p = 0.003) remained statistically significant, other significant variables were age (p = 0.033) and PASP (p = 0.022). Survival analysis by LVOT VTI tertile demonstrated an unadjusted hazard ratio of 4.755 (CI 1.576-14.348, p = 0.006) for combined LVAD and mortality at one year. Extremely low LVOT VTI strongly predicts adverse outcomes and identifies patients who may benefit most from advanced heart failure therapies.

  7. Subclinical Systolic Dysfunction among Newly Diagnosed Hypertensives with Preserved Left Ventricular Ejection Fraction Using Two Dimensional Strain Imaging Method; Hospital Based Observational Study

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    Tulika Madaik

    2014-02-01

    Conclusions: The regional LV systolic function in longitudinal axis at apex and apico lateral wall was significantly reduced while the global systolic function in longitudinal and circumferential axis was preserved in hypertensive patients compared to normotensive healthy individuals. [Natl J Med Res 2014; 4(1.000: 27-32

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

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    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.

  9. 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

  10. Effect of If-channel inhibition on hemodynamic status and exercise tolerance in heart failure with preserved ejection fraction: a randomized trial.

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    Kosmala, Wojciech; Holland, David J; Rojek, Aleksandra; Wright, Leah; Przewlocka-Kosmala, Monika; Marwick, Thomas H

    2013-10-08

    The aim of this study was to test the effects of treatment with ivabradine on exercise capacity and left ventricular filling in patients with heart failure with preserved ejection fraction (HFpEF). Because symptoms of HFpEF are typically exertional, optimization of diastolic filling time by controlling heart rate may delay the onset of symptoms. Sixty-one patients with HFpEF were randomly assigned to ivabradine 5 mg twice daily (n = 30) or placebo (n = 31) for 7 days in this double-blind trial. Cardiopulmonary exercise testing with echocardiographic assessment of myocardial function and left ventricular filling were undertaken at rest and after exercise. The ivabradine group demonstrated significant improvement between baseline and follow-up exercise capacity (4.2 ± 1.8 METs vs. 5.7 ± 1.9 METs, p = 0.001) and peak oxygen uptake (14.0 ± 6.1 ml/min/kg vs. 17.0 ± 3.3 ml/min/kg, p = 0.001), with simultaneous reduction in exercise-induced increase in the ratio of peak early diastolic mitral flow velocity to peak early diastolic mitral annular velocity (3.1 ± 2.7 vs. 1.3 ± 2.0, p = 0.004). Work load-corrected chronotropic response (the difference in heart rate at the same exercise time at the baseline and follow-up tests) showed a slower increase in heart rate during exercise than in the placebo-treated group. Therapy with ivabradine (β = 0.34, p = 0.04) and change with treatment in exertional increase in the ratio of peak early diastolic mitral flow velocity to peak early diastolic mitral annular velocity (β = -0.30, p = 0.02) were independent correlates of increase in exercise capacity, and therapy with ivabradine (β = 0.32, p = 0.007) was independently correlated with increase in peak oxygen uptake. In patients with HFpEF, short-term treatment with ivabradine increased exercise capacity, with a contribution from improved left ventricular filling pressure response to exercise as reflected by the ratio of peak early diastolic mitral flow velocity to peak early

  11. 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.

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    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

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

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    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. Copyright © 2015 the American Physiological Society.

  13. Assessment of Longitudinal Reproducibility of Mice LV Function Parameters at 11.7 T Derived from Self-Gated CINE MRI

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    Zuo, Zhi; Subgang, Anne; Abaei, Alireza; Rottbauer, Wolfgang; Stiller, Detlef; Ma, Genshan

    2017-01-01

    The objective of this work was the assessment of the reproducibility of self-gated cardiac MRI in mice at ultra-high-field strength. A group of adult mice (n = 5) was followed over 360 days with a standardized MR protocol including reproducible animal position and standardized planning of the scan planes. From the resulting CINE MRI data, global left ventricular (LV) function parameters including end-diastolic volume (EDV), end-systolic volume (ESV), stroke volume (SV), ejection fraction (EF), and left ventricular mass (LVM) were quantified. The reproducibility of the self-gated technique as well as the intragroup variability and longitudinal changes of the investigated parameters was assessed. Self-gated cardiac MRI proved excellent reproducibility of the global LV function parameters, which was in the order of the intragroup variability. Longitudinal assessment did not reveal any significant variations for EDV, ESV, SV, and EF but an expected increase of the LVM with increasing age. In summary, self-gated MRI in combination with a standardized protocol for animal positioning and scan plane planning ensures reproducible assessment of global LV function parameters. PMID:28321415

  14. Assessment of Longitudinal Reproducibility of Mice LV Function Parameters at 11.7 T Derived from Self-Gated CINE MRI.

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    Zuo, Zhi; Subgang, Anne; Abaei, Alireza; Rottbauer, Wolfgang; Stiller, Detlef; Ma, Genshan; Rasche, Volker

    2017-01-01

    The objective of this work was the assessment of the reproducibility of self-gated cardiac MRI in mice at ultra-high-field strength. A group of adult mice (n = 5) was followed over 360 days with a standardized MR protocol including reproducible animal position and standardized planning of the scan planes. From the resulting CINE MRI data, global left ventricular (LV) function parameters including end-diastolic volume (EDV), end-systolic volume (ESV), stroke volume (SV), ejection fraction (EF), and left ventricular mass (LVM) were quantified. The reproducibility of the self-gated technique as well as the intragroup variability and longitudinal changes of the investigated parameters was assessed. Self-gated cardiac MRI proved excellent reproducibility of the global LV function parameters, which was in the order of the intragroup variability. Longitudinal assessment did not reveal any significant variations for EDV, ESV, SV, and EF but an expected increase of the LVM with increasing age. In summary, self-gated MRI in combination with a standardized protocol for animal positioning and scan plane planning ensures reproducible assessment of global LV function parameters.

  15. Relationship of basal-septal fibrosis with LV outflow tract obstruction in hypertrophic cardiomyopathy: insights from cardiac magnetic resonance analysis.

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    Nakamura, Takashi; Iwanaga, Yoshitaka; Yasuda, Masakazu; Kawamura, Takayuki; Miyaji, Yuki; Morooka, Hanako; Miyazaki, Shunichi

    2016-04-01

    Myocardial fibrosis is frequently observed and may be associated with the prognosis in patients with hypertrophic cardiomyopathy (HCM); however, the clinical pathophysiological features, particularly in terms of fibrosis, of hypertrophic obstructive cardiomyopathy (HOCM) remain unclear. This study aimed to determine a role of local fibrosis in HOCM using cardiac magnetic resonance (CMR). 108 consecutive HCM patients underwent CMR. HOCM was defined as a left ventricular outflow tract (LVOT) pressure gradient ≥30 mmHg at rest. Myocardial mass and fibrosis mass by late gadolinium-enhancement CMR (LGE-CMR) were calculated and the distribution/pattern was analyzed using the AHA 17-segment model. LV ejection fraction (LVEF) was significantly higher in patients with HOCM (n = 19) than in those with nonobstructive HCM (n = 89) (P < 0.05). Both total myocardial and fibrosis masses in LV were similar in the two groups (P = 0.385 and P = 0.859, respectively). However, fibrosis in the basal septum was significantly less frequent in the HOCM group than in the nonobstructive HCM group (P < 0.01). The LVOT pressure gradient was significantly higher in the basal-septal non-fibrosis group than in the fibrosis group (23.6 ± 37.3 vs. 4.8 ± 11.4 mmHg, P < 0.01). Multivariate analysis revealed that basal-septal fibrosis was an independent negative predictor of LVOT obstruction in addition to the local wall thickness and LVEF as positive predictors in HCM patients. In conclusion, a significant association was observed between LVOT obstruction and basal septal fibrosis by LGE-CMR in HCM patients. In addition to negative impact of basal-septal fibrosis, basal-septal hypertrophy and preserved global LV contractility may be associated with the pathophysiological features of LVOT obstruction.

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

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    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.

  17. 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

  18. Older Adults, "Malignant" Left Ventricular Hypertrophy, and Associated Cardiac-Specific Biomarker Phenotypes to Identify the Differential Risk of New-Onset Reduced Versus Preserved Ejection Fraction Heart Failure: CHS (Cardiovascular Health Study).

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    Seliger, Stephen L; de Lemos, James; Neeland, Ian J; Christenson, Robert; Gottdiener, John; Drazner, Mark H; Berry, Jarett; Sorkin, John; deFilippi, Christopher

    2015-06-01

    This study hypothesized that biomarkers of subclinical myocardial injury (high-sensitivity cardiac troponin T [hs-cTnT]) and hemodynamic stress (N-terminal pro-B-type natriuretic peptide [NT-proBNP]) would differentiate heart failure (HF) risk among older adults with left ventricular hypertrophy (LVH). The natural history of LVH, an important risk factor for HF, is heterogeneous. NT-proBNP and hs-cTnT were measured at baseline and after 2 to 3 years in older adults without prior HF or myocardial infarction in the CHS (Cardiovascular Health Study). LVH and left ventricular ejection fraction were determined by echocardiography. HF events were adjudicated over a median of 13.1 years and classified as preserved or reduced left ventricular ejection fraction (heart failure with preserved ejection fraction or heart failure with reduced ejection fraction [HFrEF]). Adjusted risk of HF by LVH and biomarker tertiles, and by LVH and longitudinal increase in each biomarker was estimated using Cox regression. Prevalence of LVH was 12.5% among 2,347 participants with complete measures. Adjusted risk of HF (N = 643 events) was approximately 3.8-fold higher among participants with LVH and in the highest biomarker tertile, compared with those with low biomarker levels without LVH (NT-proBNP, hazard ratio [HR]: 3.78; 95% confidence interval [CI]: 2.78 to 5.15 and hs-cTnT, HR: 3.86; 95% CI: 2.84 to 5.26). The adjusted risk of HFrEF was 7.8 times higher among those with the highest tertile of hs-cTnT and LVH (HR: 7.83; 95% CI: 4.43 to 13.83). Those with LVH and longitudinal increases in hs-cTnT or NT-proBNP were approximately 3-fold more likely to develop HF, primarily HFrEF, compared with those without LVH and with stable biomarkers. The combination of LVH with greater hs-cTnT or NT-proBNP levels, and their longitudinal increase, identifies older adults at highest risk for symptomatic HF, especially HFrEF. These biomarkers may characterize sub-phenotypes in the transition from LVH

  19. Long-term recording of cardiac arrhythmias with an implantable cardiac monitor in patients with reduced ejection fraction after acute myocardial infarction: the Cardiac Arrhythmias and Risk Stratification After Acute Myocardial Infarction (CARISMA) study

    DEFF Research Database (Denmark)

    Bloch Thomsen, Poul Erik; Jons, Christian; Raatikainen, M J Pekka

    2010-01-01

    Knowledge about the incidence of cardiac arrhythmias after acute myocardial infarction has been limited by the lack of traditional ECG recording systems to document and confirm asymptomatic and symptomatic arrhythmias. The Cardiac Arrhythmias and Risk Stratification After Myocardial Infarction (C...... (CARISMA) trial was designed to study the incidence and prognostic significance of arrhythmias documented by an implantable cardiac monitor among patients with acute myocardial infarction and reduced left ventricular ejection fraction.......Knowledge about the incidence of cardiac arrhythmias after acute myocardial infarction has been limited by the lack of traditional ECG recording systems to document and confirm asymptomatic and symptomatic arrhythmias. The Cardiac Arrhythmias and Risk Stratification After Myocardial Infarction...

  20. Comparison of clinical profile and management of outpatients with heart failure with reduced left ventricular ejection fraction treated by general practitioners and cardiologists in contemporary Poland: the results from the DATA-HELP registry.

    Science.gov (United States)

    Jankowska, Ewa A; Kalicinska, Elzbieta; Drozd, Marcin; Kurian, Beata; Banasiak, Waldemar; Ponikowski, Piotr

    2014-10-20

    We sought to determine and compare clinical profile and management of outpatients with heart failure with reduced ejection fraction (HFREF) treated by cardiologists and general practitioners (GPs) in Poland. All the 790 randomly selected cardiologists and GPs in the DATA-HELP registry, which included 5563 patients, filled out questionnaires about 10 consecutive outpatients with HFREF. Outpatients managed by GPs were older (69±10 vs 66±12 years), and the prevalence of men was less marked (58% vs 67%). They also had higher left ventricular ejection fraction (38±6% vs 35±8%) and had more pulmonary congestion (63% vs 49%) and peripheral oedema (66% vs 51%), compared with those treated by cardiologists (all p0.2) and digoxin (20% vs 21%, p>0.2) by GPs and cardiologists was similar. In contemporary Poland, most outpatients with HFREF receive drugs that improve survival and undergo revascularisation procedures, although devices are rare, but the clinical profiles and management of those treated by GPs and cardiologists differ. Outpatients treated by GPs are older and have more co-morbidities. Outpatients treated by cardiologists more commonly receive β-blocker, MRA, ICD, and CRT, and undergo coronary revascularisations. Copyright © 2014. Published by Elsevier Ireland Ltd.

  1. 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.

  2. Asymmetrically thickened posterior wall is associated with decline of ejection fraction after stress on adenosine stress/rest thallium-201 gated myocardial SPECT

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Bom Sahn; Lee, Won Woo; Lee, Dong Soo; Chung, June Key; Lee, Myung Chul; Kim, Sang Eun [College of Medicine, Seoul National University, Seoul (Korea, Republic of)

    2004-07-01

    LV parameters (LVEF. ESVI and EDVI) on adenosine stress/rest thallium-201 gated myocardial SPECT (gSPECT) are various from stress to rest. We investigated the reason why they were various in patients without coronary artery disease. Seventy-one patients(M:F=32:39, age 58.1{+-}9.7yrs), who underwent gSPECT and coronary angiography (CAG) due to chest pain or preoperative evaluation were included. CAG results were normal or insignificant. Exclusion criteria were atrial fibrillation, thyroid disease, primary cardiomyopathy, myocardial bridge, LBBB, MI, and valvular heart disease. Patients were calssified into 3 groups by EF difference ({delta}EF=rest-stress EF) on gSPECT : group1 ({delta}EF{>=}10), group2 (0 {<=}{delta}EF<10), and group3 ({delta}EF<0). LV parameters on gSPECT and thicknesses of IVS (interventricular septum) and LVPW (left ventricular posterior wall) on echocardiography were compared among the 3 groups. Myocardial perfusion status were normal or mild reversible/persistent perfusion defect in 76.1% (54/71). LVEFs at stress were not different among all 3 groups : 59.3{+-}8.54% in group 1 (61.3{+-}10.22% in group 2 and 64.8{+-}7.58% in group 3 (p>0.05). But LVEF at rest was smaller in group 3 (58.7{+-}8.38%) than the other groups (72.5{+-}8.77% in group1 and 66.7{+-}10.6% in group2) (p<0.01). EDVIs and ESVI at stress were larger than those at rest in all groups (p<0.05) except ESVI in group 3 (16.2{+-}6.21ml at stress and 17.5{+-}6.41ml at rest, p<0.01), and that was attributed to EF<0 in group 3. In echocardiographical analysis, group 3 had significantly increased wall thickness of LVPW (10.7{+-}1.2mm versus 9.4{+-}1.6mm, p=0.01) and decreased wall thickness ratio of IVS/LVPW (0.963{+-}0.102 versus 1.048{+-}0.104, p=0.035) than group 1. In patients without coronary artery disease, LVEF, EDVI and ESVI on gSPECT were various and decline of LVEF from stress to rest was caused by unnormalized ESVI . Asymmetrically thickened LVPW may play a crucial role and

  3. Association of left ventricular mechanical dyssynchrony with survival benefit from revascularization: a study of gated positron emission tomography in patients with ischemic LV dysfunction and narrow QRS

    Energy Technology Data Exchange (ETDEWEB)

    AlJaroudi, Wael [Imaging Institute, Heart and Vascular, Cleveland, OH (United States); Sydell and Arnold Miller Family Heart and Vascular Institute, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Cleveland, OH (United States); Alraies, M.C. [Cleveland Clinic, Department of Hospital Medicine, Cleveland, OH (United States); Hachamovitch, Rory; Jaber, Wael A.; Brunken, Richard; Cerqueira, Manuel D.; Marwick, Thomas [Imaging Institute, Heart and Vascular, Cleveland, OH (United States)

    2012-10-15

    LV mechanical dyssynchrony (LVMD) is a risk marker in narrow QRS cardiomyopathy, but its association with treatment outcome is not well defined. We determined the incremental prognostic value of LVMD in ischemic cardiomyopathy, and assessed its interaction with scar, myocardium in jeopardy and subsequent revascularization. Stress and rest {sup 82}Rb gated PET were performed in 486 consecutive patients (66 {+-} 11 years of age, 82 % men, LV ejection fraction 26 {+-} 6 %) with ischemic cardiomyopathy and QRS <120 ms. LVMD was determined as the standard deviation (SD) of the regional time to minimum volume on phase analysis of the gated PET scan. A propensity score was determined to adjust for nonrandomized referral after imaging to coronary artery bypass grafting (CABG). In a Cox proportional hazards model used to determine the association between measures of LVMD and survival time, CABG was included as a time-dependent covariate and the use of an implantable cardiac defibrillator (ICD) after imaging was modeled as a stratification factor. Over 1.9 {+-} 1.4 years, 96 patients (20 %) underwent CABG and 108 (22 %) died. LVMD was a predictor of mortality (HR 1.16. 95 % CI 1.03;1.30, per 10 increase in phase SD, p = 0.02) after adjusting for baseline covariates, prior ICD use, the use of postimaging CABG, and other imaging data. There was a significant interaction between phase SD and CABG. Nested Cox models showed that LVMD carried prognostic information incremental to clinical variables, ejection fraction and CABG. LVMD is an independent predictor of all-cause mortality in ischemic cardiomyopathy, and may identify patients with a differential survival benefit from CABG versus medical therapy. (orig.)

  4. Adherence to optimal heart rate control in heart failure with reduced ejection fraction: insight from a survey of heart rate in heart failure in Sweden (HR-HF study).

    Science.gov (United States)

    Fu, M; Ahrenmark, U; Berglund, S; Lindholm, C J; Lehto, A; Broberg, A Månsson; Tasevska-Dinevska, G; Wikstrom, G; Ågard, A; Andersson, B

    2017-08-09

    Despite that heart rate (HR) control is one of the guideline-recommended treatment goals for heart failure (HF) patients, implementation has been painstakingly slow. Therefore, it would be important to identify patients who have not yet achieved their target heart rates and assess possible underlying reasons as to why the target rates are not met. The survey of HR in patients with HF in Sweden (HR-HF survey) is an investigator-initiated, prospective, multicenter, observational longitudinal study designed to investigate the state of the art in the control of HR in HF and to explore potential underlying mechanisms for suboptimal HR control with focus on awareness of and adherence to guidelines for HR control among physicians who focus on the contributing role of beta-blockers (BBs). In 734 HF patients the mean HR was 68 ± 12 beats per minute (bpm) (37.2% of the patients had a HR >70 bpm). Patients with HF with reduced ejection fraction (HFrEF) (n = 425) had the highest HR (70 ± 13 bpm, with 42% >70 bpm), followed by HF with preserved ejection fraction and HF with mid-range ejection fraction. Atrial fibrillation, irrespective of HF type, had higher HR than sinus rhythm. A similar pattern was observed with BB treatment. Moreover, non-achievement of the recommended target HR (bpm) in HFrEF and sinus rhythm was unrelated to age, sex, cardiovascular risk factors, cardiovascular diseases, and comorbidities, but was related to EF and the clinical decision of the physician. Approximately 50% of the physicians considered a HR of >70 bpm optimal and an equal number considered a HR of >70 bpm too high, but without recommending further action. Furthermore, suboptimal HR control cannot be attributed to the use of BBs because there was neither a difference in use of BBs nor an interaction with BBs for HR >70 bpm compared with HR bpm. Suboptimal control of HR was noted in HFrEF with sinus rhythm, which appeared to be attributable to physician decision making rather

  5. 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 ... creatinine > 121 mumol/L (P = .004), and serum urea > 7.6 mmol/L (P = .007). Patients with congestive heart failure have a poor survival despite intensive medical treatment. Plasma catecholamines and plasma atrial natriuretic peptide are elevated at rest and rises further during exercise; the increase......Survival in congestive heart failure is related to plasma catecholamines and atrial natriuretic peptide at rest, but the prognostic importance of changes during exercise is unknown. The aim of this study was to evaluate the prognostic value of catecholamines and atrial natriuretic peptide at rest...

  6. Evaluation of the role of left atrial strain using two-dimensional speckle tracking echocardiography in patients with diabetes mellitus and heart failure with preserved left ventricular ejection fraction.

    Science.gov (United States)

    Georgievska-Ismail, Ljubica; Zafirovska, Planinka; Hristovski, Zarko

    2016-11-01

    To evaluate additional role of left atrial two-dimensional speckle tracking echocardiography in patients with diabetes mellitus type 2, 218 patients with heart failure with preserved left ventricular ejection fraction divided according to the presence of diabetes mellitus (108 with and 110 without) were enrolled in the study. Traditional parameters using two-dimensional echocardiography and Doppler imaging were measured as expressions of left ventricular diastolic function as well as peak atrial longitudinal strain and peak atrial contraction strain were measured using two-dimensional speckle tracking echocardiography. Global average peak atrial longitudinal strain and peak atrial contraction strain were significantly lower in patients with diabetes mellitus (p = 0.002 and p = 0.001, respectively) and its reduced values were significantly associated with higher prevalence of diabetes mellitus (p = 0.002 and p = 0.001, respectively), its greater severity (p = 0.002 and p = 0.016, respectively) and longer duration only for global average peak atrial longitudinal strain (p = 0.030). Multiple linear regression analysis demonstrated that the presence of diabetes mellitus appeared as independent predictor of reduced global peak atrial longitudinal strain [B = -2.173; 95% confidence interval: -3.870 to (-0.477); p = 0.012] as well of reduced global peak atrial contraction strain [B = -1.30; 95% confidence interval: -2.234 to (-0.366); p = 0.007]. Two-dimensional speckle tracking echocardiography appeared as a useful additional tool for detection of left atrial dysfunction in patients with heart failure who have preserved left ventricular ejection fraction and diabetes mellitus who are especially prone to develop cardiovascular complications. © The Author(s) 2016.

  7. 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.

  8. Efficacy of an inactivated FeLV vaccine compared to a recombinant FeLV vaccine in minimum age cats following virulent FeLV challenge.

    Science.gov (United States)

    Stuke, Kristin; King, Vickie; Southwick, Kendra; Stoeva, Mira I; Thomas, Anne; Winkler, M Teresa C

    2014-05-07

    The aim of the study was to determine the efficacy of an inactivated feline leukemia virus (FeLV) vaccine (Versifel(®) FeLV, Zoetis.) compared to a recombinant FeLV vaccine (Purevax(®) FeLV, Merial Animal Health) in young cats, exposed under laboratory conditions to a highly virulent challenge model. The study was designed to be consistent with the general immunogenicity requirements of the European Pharmacopoeia 6.0 Monograph 01/2008:1321-Feline Leukaemia Vaccine (Inactivated) with the exception that commercial-strength vaccines were assessed. Fifty seronegative cats (8-9 weeks old) were vaccinated subcutaneously on two occasions, three weeks apart, with either placebo (treatment group T01), Versifel FeLV Vaccine (treatment group T02), or Purevax FeLV Vaccine (treatment group T03) according to the manufacturer's directions. Cats were challenged three weeks after the second vaccination with a virulent FeLV isolate (61E strain). Persistent FeLV antigenemia was determined from 3 to 15 weeks postchallenge. Bone marrow samples were tested for the presence of FeLV proviral DNA to determine FeLV latent infection. At week 15 after challenge with the virulent FeLV 61E strain, the Versifel FeLV Vaccine conferred 89.5% protection against FeLV persistent antigenemia and 94.7% protection against FeLV proviral DNA integration in bone marrow cells. In comparison, the Purevax FeLV Vaccine conferred 20% protection against FeLV persistent antigenemia and 35% protection against FeLV proviral DNA integration in bone marrow cells following challenge. The data from this study show that the Versifel FeLV Vaccine was efficacious in preventing both FeLV persistent p27 antigenemia and FeLV proviral DNA integration in bone marrow cells of cats challenged with this particular challenge model under laboratory conditions and provided better protection than Purevax FeLV in this experimental challenge model with highly virulent FeLV.

  9. 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...

  10. Comparison of five-year outcomes of coronary artery bypass grafting versus percutaneous coronary intervention in patients with left ventricular ejection fractions≤50% versus >50% (from the CREDO-Kyoto PCI/CABG Registry Cohort-2).

    Science.gov (United States)

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

    2014-10-01

    Coronary heart disease is a major risk factor for left ventricular (LV) systolic dysfunction. However, limited data are available regarding long-term benefits of percutaneous coronary intervention (PCI) in the era of drug-eluting stent or coronary artery bypass grafting (CABG) in patients with LV systolic dysfunction with severe coronary artery disease. We identified 3,584 patients with 3-vessel and/or left main disease of 15,939 patients undergoing first myocardial revascularization enrolled in the CREDO-Kyoto PCI/CABG Registry Cohort-2. Of them, 2,676 patients had preserved LV systolic function, defined as an LV ejection fraction (LVEF) of >50% and 908 had impaired LV systolic function (LVEF≤50%). In patients with preserved LV function, 5-year outcomes were not different between PCI and CABG regarding propensity score-adjusted risk of all-cause and cardiac deaths. In contrast, in patients with impaired LV systolic function, the risks of all-cause and cardiac deaths after PCI were significantly greater than those after CABG (hazard ratio 1.49, 95% confidence interval 1.04 to 2.14, p=0.03 and hazard ratio 2.39, 95% confidence interval 1.43 to 3.98, p<0.01). In both patients with moderate (35%LV systolic dysfunction, the risk of cardiac death after PCI was significantly greater than that after CABG (hazard ratio 2.25, 95% confidence interval 1.15 to 4.40, p=0.02 and hazard ratio 4.42, 95% confidence interval 1.48 to 13.24, p=0.01). Similarly, the risk of all-cause death tended to be greater after PCI than after CABG in both patients with moderate and severe LV systolic dysfunction without significant interaction (hazard ratio 1.57, 95% confidence interval 0.96 to 2.56, p=0.07 and hazard ratio 1.42, 95% confidence interval 0.71 to 2.82, p=0.32; interaction p=0.91). CABG was associated with better 5-year survival outcomes than PCI in patients with impaired LV systolic function (LVEF≤50%) with complex coronary disease in the era

  11. 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

  12. Protection of LV system against lightning

    OpenAIRE

    Yordanova Nedyalkova, Greta

    2010-01-01

    Lightning is a natural hazard and one of the greatest local mysteries. Scientists have not fully understood the mechanism of lightning. It is one of the most beautiful displays in nature and one of the nature's most dangerous phenomenon known to man. Overvoltage due to lightning is a very important problem of LV systems. Some lightning flashes damage buildings and a few kill or injure people and animals, either directly or indirectly, by causing fire and explosions. The need for protect...

  13. 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

  14. 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

  15. 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。

  16. Measurement of the partial branching fraction for inclusive semileptonic B meson decays to light hadrons B {yields} X{sub u}lv and an improved determination of the quark-mixing matrix element vertical stroke V{sub ub} vertical stroke

    Energy Technology Data Exchange (ETDEWEB)

    Volk, Alexei

    2009-07-01

    This thesis presents an analysis of inclusive semileptonic B{yields} X{sub u}e anti {nu}{sub e} decays using approximately 454 million {upsilon}(4S){yields}B anti B decays collected during the years 1999 to 2008 with the BABAR detector. The electron energy, E{sub e}, and the invariant mass squared of the electron-neutrino pair, q{sup 2}, are reconstructed, where the neutrino kinematics is deduced from the decay products of both B mesons. The final hadronic state, X{sub u}, consists of a sum of many hadronic channels, each of which contains at least one u quark. The variables q{sup 2} and E{sub e} are then combined to compute the maximum kinematically allowed invariant mass squared of the hadronic system, s{sub h}{sup max}. Using these kinematic quantities, the partial branching fraction, {delta}B(B {yields} X{sub u}lv), unfolded for detector effects, is measured to be {delta}B(E{sub e}>2.0 GeV, s{sub h}{sup max}<3.52 GeV{sup 2}) (3.33{+-}0.18{+-}0.21) x 10{sup -4} in the {upsilon}(4S) and {delta}B(E{sub e}>1.9 GeV, s{sub h}{sup max}<3.5 GeV{sup 2})= (4.57{+-}0.24{+-}0.32) x 10{sup -4} in the B meson rest frames. The quoted errors are statistical and systematic, respectively. The CKM matrix element vertical stroke V{sub ub} vertical stroke is determined from the measured {delta}B using theoretical calculation based on Heavy Quark Expansion. The result is vertical stroke V{sub ub} vertical stroke =(4.19{+-}0.18{sub -0.20-0.25}{sup +0.26+0.26}) x 10{sup -3}, where the errors represent experimental uncertainties, uncertainties from HQE parameters and theoretical uncertainties, respectively. (orig.)

  17. Association Between Myocardial Mechanics and Ischemic LV Remodeling.

    Science.gov (United States)

    D'Elia, Nicholas; D'hooge, Jan; Marwick, Thomas H

    2015-12-01

    The outcomes associated with heart failure after myocardial infarction are still poor. Both global and regional left ventricular (LV) remodeling are associated with the progression of the post-infarct patient to heart failure, but although global remodeling can be accurately measured, regional LV remodeling has been more difficult to investigate. Preliminary evidence suggests that post-MI assessment of LV mechanics using stress and strain may predict global (and possibly regional) LV remodeling. A method of predicting both global and regional LV remodeling might facilitate earlier, targeted, and more extensive clinical intervention in those most likely to benefit from novel interventions such as cell therapy.

  18. Effect of Caloric Restriction or Aerobic Exercise Training on Peak Oxygen Consumption and Quality of Life in Obese Older Patients with Heart Failure and Preserved Ejection Fraction A Randomized, Controlled Trial

    Science.gov (United States)

    Kitzman, Dalane W.; Brubaker, Peter; Morgan, Timothy; Haykowsky, Mark; Hundley, Gregory; Kraus, William E.; Eggebeen, Joel; Nicklas, Barbara J.

    2016-01-01

    Importance More than 80% of patients with heart failure with preserved ejection fraction (HFPEF), the most common form of HF among older persons, are overweight/obese. Exercise intolerance is the primary symptom of chronic HFPEF and a major determinant of reduced quality-of-life (QOL). Objective To determine whether caloric restriction (Diet), or aerobic exercise training (Exercise), improves exercise capacity and QOL in obese older HFPEF patients. Design Randomized, attention-controlled, 2x2 factorial trial conducted from February 2009 November 2014. Setting Urban academic medical center. Participants 100 older (67±5 years) obese (BMI=39.3±5.6kg/m2) women (n=81) and men (n=19) with chronic, stable HFPEF enrolled from 577 patients initially screened (366 excluded by inclusion / exclusion criteria, 31 for other reasons, 80 declined participation). Twenty-six participants were randomized to Exercise alone, 24 to Diet alone, 25 to Diet+Exercise, and 25 to Control; 92 completed the trial. Interventions 20 weeks of Diet and/or Exercise; Attention Control consisted of telephone calls every 2 weeks. Main Outcomes and Measures Exercise capacity measured as peak oxygen consumption (VO2, ml/kg/min; primary outcome) and QOL measured by the Minnesota Living with HF Questionnaire (MLHF) total score (co-primary outcome; score range: 0–105, higher scores indicate worse HF-related QOL). Results By main effects analysis, peak VO2 was increased significantly by both interventions: Exercise main effect 1.2 ml/kg/min (95%CI: 0.7,1.7; pExercise+Diet was additive (complementary) for peak VO2 (joint effect 2.5 ml/kg/min). The change in MLHF total score was non-significant with Exercise (main effect −1 unit; 95%CI: −8,5; p=0.70) and with Diet (main effect −6 units; 95%CI: −12,1; p=0.078). The change in peak VO2 was positively correlated with the change in percent lean body mass (r=0.32; p=0.003) and the change in thigh muscle/intermuscular fat ratio (r=0.27; p=0.02). There

  19. Substituição isolada da valva aórtica em pacientes com função ventricular deprimida Aortic valve replacement in patients with depressed left ventricular ejection fraction

    Directory of Open Access Journals (Sweden)

    Gilberto Venossi Barbosa

    1989-12-01

    Full Text Available Para avaliar o valor prognóstico da fração de ejeção do ventrículo esquerdo, entre 210 pacientes com lesões da valva aórtica operados, consecutivamente, entre maio de 1981 e outubro de 1988 e que receberam as próteses Omniscience e Meditronic-Hall, foram selecionados 112 e divididos, de acordo com a fração de ejeção do ventrículo esquerdo, em dois grupos: o G1 = FE > 40%, ficou com 52 pacientes com médias de idade 39 ± 12 anos, FE = 58 ± 10% e classe funcional (NYHA = 2,8; o GE = FE To evaluate the prognostic value of resting left ventricular ejection fraction (LVEF a series of 210 consecutive patients with aortic valve disease operated upon between May 1981 and October 1988 was studied retrospectively. All patients had their aortic valve replaced by Omniscience or Meditronic prosthesis; 112 formed the study group because they have complete follow up and cineangiocardiographic data. Based on pre-operatory left ventricular ejection fraction the patients were divided in two groups: Group 1 = 52 patients with LVEF > 40%, 39 ± 12 years, NYHA functional class 2.8, and EF 58 ± 10%. Group 2 = 60 patients with LVEF < 40, 48 ± 17 years, NYHA functional class 3.6, and LVEF of 27 ± 12%. During surgery moderate hypothermia and hemodilution were utilized, with dubble oxygenator and cardioplegia With St. Thomas cardioplegic solution. Mean extracorporeal circulation and cardiac arrest time were respectively 82 ± 18 and 49 ± 7 minutes in Group 1 and 96 ± 11 and 55 ± 6 minutes in Group 2. The size of the prosthesis were 25.2 ± 1.8 mm in Group 1. The short term mortality was 3.8% in Group 1 and 5.8 in Group 2. The long-term mortality was 4.0% in Group 1 and 8.7% in Group 2. In Group 1 there was a significant association between mortality and left ventricular systolic function. In the follow-up evaluation, among patients in Group 1, 65% were in class I, 28% were in functional class II, 5% in class III, and 2% in class IV. Among patients

  20. Implantable cardiac monitors in high-risk post-infarction patients with cardiac autonomic dysfunction and moderately reduced left ventricular ejection fraction: Design and rationale of the SMART-MI trial.

    Science.gov (United States)

    Hamm, Wolfgang; Rizas, Konstantinos D; Stülpnagel, Lukas von; Vdovin, Nikolay; Massberg, Steffen; Kääb, Stefan; Bauer, Axel

    2017-08-01

    Most deaths after myocardial infarction (MI) occur in patients with left ventricular ejection fraction (LVEF) >35%, for whom no specific prophylactic strategies exist. Deceleration capacity (DC) of heart rate and periodic repolarization dynamics (PRD) are noninvasive electrophysiological markers depending on the vagal and sympathetic tone. The combination of abnormal DC and/or PRD identifies a new high-risk group among postinfarction patients with LVEF 36%-50%. This new high-risk group has similar characteristics with respect to prognosis and patient numbers to those of the established high-risk group identified by LVEF ≤ 35%. The SMART-MI trial is an investigator-initiated randomized prospective multicenter trial that tests the efficacy of implantable cardiac monitors (ICM) in this new high-risk group. The study will enroll approximately 1,600 survivors of acute MI with sinus rhythm and an LVEF of 35%-50% in 17 centers in Germany who will be tested for presence of cardiac autonomic dysfunction. Four hundred patients with either abnormal DC (≤2.5 ms) and/or PRD (≥5.75deg(2)) will be randomized in a 1:1 fashion to intensive follow-up via telemonitoring using an ICM device (experimental arm) or conventional follow-up (control arm). For the ICM arm, specific treatment paths have been developed according to current guidelines. The primary end point is time to detection of predefined serious arrhythmic events during follow-up, including atrial fibrillation ≥6minutes, nonsustained ventricular tachycardia (cycle length≤320 ms; ≥40 beats), atrioventricular block ≥IIb, and sustained ventricular tachycardia/ventricular fibrillation. The median follow-up period is 18months with a minimum follow-up of 6months. The effect of remote monitoring on clinical outcomes will be tested as secondary outcome measure (ClinicalTrials.gov NCT02594488). Copyright © 2017 Elsevier Inc. All rights reserved.

  1. Impact of Preprocedural Left Ventricular Ejection Fraction on 1-Year Outcomes After MitraClip Implantation (from the ACCESS-EU Phase I, a Prospective, Multicenter, Nonrandomized Postapproval Study of the MitraClip Therapy in Europe).

    Science.gov (United States)

    Schäfer, Ulrich; Maisano, Francesco; Butter, Christian; Franzen, Olaf; Baldus, Stephan; Hausleiter, Jörg; Ussia, Gian Paolo; Sievert, Horst; Geist, Volker; Widder, Julian Daniel; Moccetti, Tiziano; Schillinger, Wolfgang

    2016-09-15

    This report describes the 12-month outcomes of the a prospective, multicenter, nonrandomized post-approval study of the MitraClip therapy in Europe (ACCESS-EU postapproval study of MitraClip therapy) with respect to preprocedural left ventricular ejection fraction (LVEF). Transcatheter deployment of the MitraClip device may be considered for patients who are not suitable for conventional surgery. A total of 567 patients with significant mitral regurgitation (MR) underwent MitraClip therapy. Of those, 393 had functional MR (FMR) and were subdivided by preprocedural LVEF (A: 10% to 20%, B: >20% to 30%, C: >30% to 40%, D: >40%). Procedural safety and efficacy and treatment outcomes including MR grade, New York Heart Association (NYHA) functional class, 6-minute walk test, and the Minnesota Living with Heart Failure Questionnaire were analyzed at baseline, 30 days, and 12 months. Baseline mean logistic EuroSCORE was 25 ± 19; 87% of patients were in NYHA classes III or IV (A: 96%, B: 83%, C: 90%, D: 86%). There was no incidence of death or stroke intraprocedurally. Eleven patients died within 30 days with no differences among subgroups. Kaplan-Meier survival at 12 months was 81.8% (A: 71%, B: 79%, C: 87%, D: 86%). There was a significant improvement in MR severity at 30 days and 12 months (p FMR. In conclusion, the low rates of hospital mortality and adverse events in patients with FMR-even in patients with severely reduced LVEF-provide additional evidence of substantial benefits after MitraClip implantation. Copyright © 2016 Elsevier Inc. All rights reserved.

  2. 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.

  3. Increased wave reflection and ejection duration in women with chest pain and nonobstructive coronary artery disease: ancillary study from the Women's Ischemia Syndrome Evaluation.

    Science.gov (United States)

    Nichols, Wilmer W; Denardo, Scott J; Johnson, B Delia; Sharaf, Barry L; Bairey Merz, C Noel; Pepine, Carl J

    2013-07-01

    Wave reflections augment central aortic SBP and increase systolic pressure time integral (SPTI) thereby increasing left ventricular (LV) afterload and myocardial oxygen (MVO2) demand. When increased, such changes may contribute to myocardial ischemia and angina pectoris, especially when aortic diastolic time is decreased and myocardial perfusion pressure jeopardized. Accordingly, we examined pulse wave reflection characteristics and diastolic timing in a subgroup of women with chest pain (Women's Ischemia Syndrome Evaluation, WISE) and no obstructive coronary artery disease (CAD). Radial artery BP waveforms were recorded by applanation tonometry, and aortic BP waveforms derived. Data from WISE participants were compared with data from asymptomatic women (reference group) without chest pain matched for age, height, BMI, mean arterial BP, and heart rate. Compared with the reference group, WISE participants had higher aortic SBP and pulse BP and ejection duration. These differences were associated with increased augmentation index and reflected pressure wave systolic duration. These modifications in wave reflection characteristics were associated with increased SPTI and wasted LV energy (Ew) and a decrease in pulse pressure amplification, myocardial viability ratio, and diastolic pressure time fraction. WISE participants with no obstructive CAD have changes in systolic wave reflections and diastolic timing that increase LV afterload, MVO2 demand, and Ew with the potential to reduce coronary artery perfusion. These alterations in cardiovascular function contribute to an undesirable mismatch in the MVO2 supply/demand that promotes ischemia and chest pain and may contribute to, or increase the severity of, future adverse cardiovascular events.

  4. 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.

  5. 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.

  6. 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...

  7. 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.

  8. 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)

  9. 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.

  10. Different impact of aortic regurgitation assessed by aortic root angiography after transcatheter aortic valve implantation according to baseline left ventricular ejection fraction and N-terminal pro-B-type natriuretic peptide.

    Science.gov (United States)

    Kaneko, Hidehiro; Hoelschermann, Frank; Schau, Thomas; Tambor, Grit; Neuss, Michael; Butter, Christian

    2017-05-31

    Transcatheter aortic valve implantation (TAVI) is an alternative therapeutic option for severe aortic stenosis. Aortic regurgitation (AR) is commonly observed after TAVI and increases the mortality rate. We hypothesized that the influence of significant AR, defined as that more severe than mild AR, on survival rate after TAVI might differ according to the baseline left ventricular ejection fraction (LVEF) and N-terminal pro-B-type natriuretic peptide (NT-pro BNP) level. We categorized 856 patients who underwent transfemoral TAVI into 2 groups according to their baseline LVEF (pro BNP levels (≤5000 and >5000 pg/mL). Significant AR was observed in 92 patients (11%). Among patients with significant AR, the proportion of patients with CoreValve/EvolutR implantation was higher than that of patients with SAPIEN XT/3 implantation. Kaplan-Meier curves and the log-rank test showed that significant AR was not associated with 1-year mortality in patients with LVEF ≥40% and those with NT-pro BNP level ≤5000 pg/mL. On the other hand, it was significantly associated with a higher 1-year mortality in patients with LVEF pro BNP level >5000 pg/mL (p = 0.011). Similarly, multivariate Cox regression analysis showed that the presence of AR was significantly associated with a higher 1-year mortality in patients with LVEF pro BNP level >5000 pg/mL (p = 0.004, HR = 3.221). However, AR was not significantly associated with a higher 1-year mortality in patients with LVEF ≥40% and NT-pro BNP level ≤5000 pg/mL. Thus, the impact of significant AR on mortality after TAVI seems to be considerable in patients with reduced LVEF or high NT-pro BNP levels, but not those with preserved LVEF or low NT-pro BNP levels, suggesting that the influence of AR differs depending on the baseline LVEF and NT-pro BNP level.

  11. 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.

  12. 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。

  13. Application of MV/LV Transformers with OLTC for Increasing the PV Hosting Capacity Of LV Grids

    DEFF Research Database (Denmark)

    Hashemi Toghroljerdi, Seyedmostafa; Heckmann, Wolfram; Geibel, Dominik

    2015-01-01

    the operation of OLTC during high PV generation periods are investigated and the methods are applied to an LV feeder with an MV/LV transformer equipped by OLTC located in Felsberg, Germany. The potential interferences between OLTCs and two other overvoltage prevention methods, the demand side management (DSM...

  14. 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

  15. Generalized fractional integral transform with Whittaker's kernel

    Science.gov (United States)

    Rodrigues, M. Manuela

    2013-10-01

    In this work we present two generalizations (see the operators I0+α,ρ,σ and I-α,ρ,σ defined below) of the classical Liouville fractional integrals. We study their boundedness as operators mapping the space Lv,r into the spaces Lv+2+Re(α)/2-2Re(ρ),r and Lv+1+-Re(ρ),r. In the end, we will apply our generalization to some particular functions.

  16. 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

  17. 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。

  18. 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.

  19. 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。

  20. Value of dobutamine stress tissue Doppler in evaluation of LV ...

    African Journals Online (AJOL)

    Shaimaa Ahmed Mostafa

    2014-12-12

    Dec 12, 2014 ... Prosthetic valve disease. Complicated PCI. LVEF less .... annulus moved toward the cardiac apex due to longitudinal contraction of the LV. ..... to fibrotic tissue is too high and also, improved the integrity of cardiac myocyte cell ...

  1. Noninvasive LV pressure estimation using subharmonic emissions from microbubbles.

    Science.gov (United States)

    Dave, Jaydev K; Halldorsdottir, Valgerdur G; Eisenbrey, John R; Raichlen, Joel S; Liu, Ji-Bin; McDonald, Maureen E; Dickie, Kris; Wang, Shumin; Leung, Corina; Forsberg, Flemming

    2012-01-01

    To develop a new noninvasive approach to quantify left ventricular (LV) pressures using subharmonic emissions from microbubbles, an ultrasound scanner was used in pulse inversion grayscale mode; unprocessed radiofrequency data were obtained with pulsed wave Doppler from the aorta and/or LV during Sonazoid infusion. Subharmonic data (in dB) were extracted and processed. Calibration factor (mm Hg/dB) from the aortic pressure was used to estimate LV pressures. Errors ranged from 0.19 to 2.50 mm Hg when estimating pressures using the aortic calibration factor, and were higher (0.64 to 8.98 mm Hg) using a mean aortic calibration factor. Subharmonic emissions from ultrasound contrast agents have the potential to noninvasively monitor LV pressures.

  2. 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.

  3. 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...

  4. 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.

  5. Disfunção renal e anemia em pacientes com insuficiência cardíaca com fração de ejeção reduzida versus normal Renal dysfunction and anemia in patients with heart failure with reduced versus normal ejection fraction

    Directory of Open Access Journals (Sweden)

    Humberto Villacorta

    2010-03-01

    Full Text Available FUNDAMENTO: A presença de anemia e de disfunção renal confere mau prognóstico em pacientes com insuficiência cardíaca (IC e fração de ejeção reduzida (ICFER. O impacto em pacientes com IC e fração de ejeção normal (ICFEN é pouco estudado. OBJETIVOS: Estudar a prevalência e o prognóstico da anemia e da disfunção renal (DR em pacientes com IC de acordo com o tipo de disfunção ventricular. MÉTODOS: Foram estudados prospectivamente 209 pacientes com IC crônica estável. Pacientes com fração de ejeção BACKGROUND: The presence of anemia and renal dysfunction grants a bad prognosis for patients with heart failure and reduced ejection fraction (HFREF. The impact on patients with heart failure and normal ejection fraction (HFNEF is not widely studied. OBJECTIVES: To study the prevalence and the prognosis of anemia and renal dysfunction (RD in patients with heart failure according to the type of ventricular dysfunction. METHODS: A total of 209 patients with chronic and stable heart failure were prospectively studied. Individuals with ejection fraction <50% were considered as HFREF patients. Anemia was defined, based on WHO criteria, as hemoglobin <13 g/dl for men and <12 g/dl for women. Renal function was calculated by means of the Simplified Modified Diet Renal Disease (sMDRD formula. Hospitalizations, emergency admittances and obit by cardiac causes were considered as cardiac events. RESULTS: Ninety patients had HFREF and 119 had HFNEF. The glomerular filtration rate (GFR was smaller in HFREF group (57.6 ± 66.2 versus 94.8 ± 36.6 ml/min/1.73m²; p=0.01. There was no difference in the prevalence of anemia between groups (23.3% versus 18.5%; p=0.34. Moderate to severe RD prevalence was higher in HFREF group (32.2% versus 16.8%; p=0.01. RD was the only factor associated with anemia that was independently associated with cardiac events (HR 2.52; 95%CI=1.27-5.2; p=0.01. CONCLUSION: RD was less prevalent in HFNEF, while the

  6. 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

  7. 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

  8. 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.

  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. 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)

  11. Formation and characterization of FeLV iscoms.

    NARCIS (Netherlands)

    L. Akerblom; K. Strö mstedt; S. Hö glund; A.D.M.E. Osterhaus (Albert); B. Morein (Bror)

    1989-01-01

    textabstractImmunostimulating complexes (ISCOMs) have been prepared from feline leukaemia virus (FeLV) envelope proteins. The ISCOMs were characterized biochemically in SDS-polyacrylamide gel electrophoresis showing the presence of proteins of estimated molecular weights of 15,000, 27,000 and 70,000

  12. Intra-myocardial injection of both growth factors and heart derived Sca-1+/CD31- cells attenuates post-MI LV remodeling more than does cell transplantation alone: neither intervention enhances functionally significant cardiomyocyte regeneration.

    Directory of Open Access Journals (Sweden)

    Xiaohong Wang

    Full Text Available Insulin-like growth factor 1 (IGF-1 and hepatocyte growth factor (HGF are two potent cell survival and regenerative factors in response to myocardial injury (MI. We hypothesized that simultaneous delivery of IGF+HGF combined with Sca-1+/CD31- cells would improve the outcome of transplantation therapy in response to the altered hostile microenvironment post MI. One million adenovirus nuclear LacZ-labeled Sca-1+/CD31- cells were injected into the peri-infarction area after left anterior descending coronary artery (LAD ligation in mice. Recombinant mouse IGF-1+HGF was added to the cell suspension prior to the injection. The left ventricular (LV function was assessed by echocardiography 4 weeks after the transplantation. The cell engraftment, differentiation and cardiomyocyte regeneration were evaluated by histological analysis. Sca-1+/CD31- cells formed viable grafts and improved LV ejection fraction (EF (Control, 54.5+/-2.4; MI, 17.6+/-3.1; Cell, 28.2+/-4.2, n = 9, P<0.01. IGF+HGF significantly enhanced the benefits of cell transplantation as evidenced by increased EF (38.8+/-2.2; n = 9, P<0.01 and attenuated adverse structural remodeling. Furthermore, IGF+HGF supplementation increased the cell engraftment rate, promoted the transplanted cell survival, enhanced angiogenesis, and minimally stimulated endogenous cardiomyocyte regeneration in vivo. The in vitro experiments showed that IGF+HGF treatment stimulated Sca-1+/CD31- cell proliferation and inhibited serum free medium induced apoptosis. Supperarray profiling of Sca-1+/CD31- cells revealed that Sca-1+/CD31- cells highly expressed various trophic factor mRNAs and IGF+HGF treatment altered the mRNAs expression patterns of these cells. These data indicate that IGF-1+HGF could serve as an adjuvant to cell transplantation for myocardial repair by stimulating donor cell and endogenous cardiac stem cell survival, regeneration and promoting angiogenesis.

  13. 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.

  14. Data on clinical characteristics of a heart failure patients’ cohort with reduced ejection fraction and analysis of the circulating values of five different heart failure biomarkers; high sensitivity troponin T, galectin-3, C-terminal propeptide of type I procollagen, soluble AXL and BNP

    Directory of Open Access Journals (Sweden)

    M. Batlle

    2016-12-01

    Full Text Available In this article, the full description of a heart failure with reduced ejection fraction (HF_REF cohort of 192 patients is provided. Tables with the baseline demographic, prior history, ECG parameters, echocardiographic parameters, laboratory values and pharmacological treatment of these patients are included. Also, the quartile values of the analyzed circulating biomarkers: high sensitivity Troponin T (hs-TnT, galectin-3 (Gal-3, C-terminal propeptide of type I procollagen (CICP, soluble AXL (sAXL and Brain Natriuretic Peptide (BNP are given. The main demographic and clinical features of the patients’ subgroups that have hs-TnT, Gal-3, CICP or BNP above the third quartile are described. Tables with Pearson correlation analysis of the HF_REF patients’ biomarker levels are included. And Pearson correlation analysis of the HF_REF patients’ hs-TnT, Gal-3, CICP levels with patients’ biochemical parameters, blood count and inflammation parameters are also described. These data are related to the research articles (AXL receptor tyrosine kinase is increased in patients with heart failure (M. Batlle, P. Recarte-Pelz, E. Roig, M.A. Castel, M. Cardona, M. Farrero, et al., 2014 [1] and Use of serum levels of high sensitivity troponin T, galectin-3 and C-terminal propeptide of type I procollagen at long term follow-up in Heart Failure patients with reduced ejection fraction: comparison with soluble AXL and BNP (M. Batlle, B. Campos, M. Farrero, M. Cardona, B. González, M.A. Castel, et al., 2016 [2].

  15. Avoided losses on LV networks as a result of microgeneration

    Energy Technology Data Exchange (ETDEWEB)

    Costa, Paulo Moises [Escola Superior Tecnologia Viseu, Instituto Politecnico Viseu, Campus Politecnico Repeses, 3504-510 Viseu (Portugal); Matos, Manuel A. [INESC Porto, Faculdade de Engenharia da Universidade do Porto, Porto (Portugal)

    2009-04-15

    In the scope of the discussions about microgeneration (and microgrids), the avoided electrical losses are often pointed out as an important value to be credited to those entities. Therefore, methods to assess the impact of microgeneration on losses must be developed in order to support the definition of a suitable regulatory framework for the economic integration of microgeneration on distribution networks. This paper presents an analytical method to quantify the value of avoided losses that microgeneration may produce on LV networks. Intervals of expected avoided losses are used to account for the variation of avoided losses due to the number, size and location of microgenerators, as well as for the kind of load distribution on LV networks. (author)

  16. Novel approach for automatic segmentation of LV endocardium via SPCNN

    Science.gov (United States)

    Ma, Yurun; Wang, Deyuan; Ma, Yide; Lei, Ruoming; Wang, Kemin

    2017-02-01

    Automatic segmentation of Left Ventricle (LV) is an essential task in the field of computer-aided analysis of cardiac function. In this paper, a simplified pulse coupled neural network (SPCNN) based approach is proposed to segment LV endocardium automatically. Different from the traditional image-driven methods, the SPCNN based approach is independent of the image gray distribution models, which makes it more stable. Firstly, the temporal and spatial characteristics of the cardiac magnetic resonance image are used to extract a region of interest and to locate LV cavity. Then, SPCNN model is iteratively applied with an increasing parameter to segment an optimal cavity. Finally, the endocardium is delineated via several post-processing operations. Quantitative evaluation is performed on the public database provided by MICCAI 2009. Over all studies, all slices, and two phases (end-diastole and end-systole), the average percentage of good contours is 91.02%, the average perpendicular distance is 2.24 mm and the overlapping dice metric is 0.86.These results indicate that the proposed approach possesses high precision and good competitiveness.

  17. A Dynamic and Heuristic Phase Balancing Method for LV Feeders

    Directory of Open Access Journals (Sweden)

    Samad Taghipour Boroujeni

    2016-01-01

    Full Text Available Due to the single-phase loads and their stochastic behavior, the current in the distribution feeders is not balanced. In addition, the single-phase loads are located in different positions along the LV feeders. So the amount of the unbalanced load and its location affect the feeder losses. An unbalanced load causes the feeder losses and the voltage drop. Because of time-varying behavior of the single-phase loads, phase balancing is a dynamic and combinatorial problem. In this research, a heuristic and dynamic solution for the phase balancing of the LV feeders is proposed. In this method, it is supposed that the loads’ tie could be connected to all phases through a three-phase switch. The aim of the proposed method is to make the feeder conditions as balanced as possible. The amount and the location of single-phase loads are considered in the proposed phase balancing method. Since the proposed method needs no communication interface or no remote controller, it is inexpensive, simple, practical, and robust. Applying this method provides a distributed and dynamic phase balancing control. In addition, the feasibility of reducing the used switches is investigated. The ability of the proposed method in the phase balancing of the LV feeders is approved by carrying out some simulations.

  18. Fração de ejeção e volumes do ventrículo esquerdo medidos com eco 3D e com tomografia ultra-rápida Fracción de eyección y volúmenes del ventrículo izquierdo medidos con eco- 3DTR y con tomografía ultrarrápida Left ventricular ejection fraction and volumes as measured by 3d echocardiography and ultrafast computed tomography

    Directory of Open Access Journals (Sweden)

    Marcelo Luiz Campos Vieira

    2009-04-01

    Full Text Available FUNDAMENTO: O ecocardiograma tridimensional em tempo real (ECO 3D e a tomografia computadorizada ultra-rápida (CT são dois novos métodos de análise da fração de ejeção e dos volumes do VE. OBJETIVO: Comparar as medidas da FEVE e dos volumes do VE aferidos pelo ECO 3D e pela CT ultra-rápida. MÉTODOS: Foram estudados pelo ECO 3D e pela CT ultra-rápida de 64 cortes, 39 pacientes consecutivos (27 homens, média etária de 57±12 anos. Foram analisados: FEVE e volumes do VE. Análise estatística: coeficiente de correlação (r: Pearson, teste de Bland & Altman, teste de regressão linear, 95 % IC, pFUNDAMENTO: La ecocardiografía tridimensional en tiempo real (Eco-3DTR y la tomografía computarizada ultrarrápida (TC ultrarrápida son dos nuevos métodos de análisis de la fracción de eyección (FE y de los volúmenes del ventrículo izquierdo (VI. OBJETIVO: Comparar las mediciones de la fracción de eyección del ventrículo izquierdo (FEVI y de los volúmenes del VI apurados por la Eco-3DTR y por la TC ultrarrápida. MÉTODOS: Se estudiaron, mediante la Eco-3DTR y la TC ultrarrápida de 64 cortes, a 39 pacientes consecutivos (27 varones, promedio de edad de 57±12 años. Se analizaron: FEVI y volúmenes del VI. Análisis estadístico: coeficiente de correlación (r: Pearson, prueba de Bland & Altman, prueba de regresión lineal, 95 % IC, pBACKGROUND: Real-time three-dimensional echocargiography (RT-3D-Echo and ultrafast computed tomography (CT are two novel methods for the analysis of LV ejection fraction and volumes. OBJECTIVE: To compare LVEF and volume measurements as obtained using RT-3D-Echo and ultrafast CT. METHODS: Thirty nine consecutive patients (27 men, mean age of 57±12 years were studied using RT-3D-Echo and 64-slice ultrafast CT. LVEF and LV volumes were analyzed. Statistical analysis: coefficient of correlation (r: Pearson, Bland-Altman analysis, linear regression analysis, 95% CI, p<0.05. RESULTS: RT-3D

  19. 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

  20. 77 FR 21620 - Notice of the Buy America Waiver Request for Vossloh 101-LV Concrete Ties

    Science.gov (United States)

    2012-04-10

    ... Federal Railroad Administration Notice of the Buy America Waiver Request for Vossloh 101-LV Concrete Ties... requirements for the purchase of Vossloh 101-LV concrete ties, which contain certain components not... consist of the installation of Vossloh 101-LV concrete ties. FRA has received this request from the four...

  1. Voltage rise mitigation for solar PV integration at LV grids

    DEFF Research Database (Denmark)

    Yang, Guangya; Marra, Francesco; Juamperez Goñi, Miguel Angel

    2015-01-01

    Solar energy from photovoltaic (PV) is among the fastest developing renewable energy systems worldwide. Driven by governmental subsidies and technological development, Europe has seen a fast expansion of solar PV in the last few years. Among the installed PV plants, most of them are situated...... at the distribution systems and bring various operational challenges such as power quality and power flow management. The paper discusses the modelling requirements for PV system integration studies, as well as the possible techniques for voltage rise mitigation at low voltage (LV) grids for increasing PV penetration...

  2. 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

  3. 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)

  4. 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...

  5. 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.

  6. Automatic LV volume measurement in low dose multi-phase CT by shape tracking

    Science.gov (United States)

    von Berg, Jens; Begemann, Philipp; Stahmer, Felix; Adam, Gerhard; Lorenz, Cristian

    2006-03-01

    Functional assessment of cardiac ventricular function requires time consuming manual interaction. Some automated methods have been presented that predominantly used cardiac magnet resonance images. Here, an automatic shape tracking approach is followed to estimate left ventricular blood volume from multi-slice computed tomography image series acquired with retrospective ECG-gating. A deformable surface model method was chosen that utilized both shape and local appearance priors to determine the endocardial surface and to follow its motion through the cardiac cycle. Functional parameters like the ejection fraction could be calculated from the estimated shape deformation. A clinical validation was performed in a porcine model with 60 examinations on eight subjects. The functional parameters showed a good correlation with those determined by clinical experts using a commercially available semi-automatic short axes delineation tool. The correlation coefficient for the ejection fraction (EF) was 0.89. One quarter of these acquisitions were done with a low dose protocol. All of these degraded images could be processed well. Their correlation slightly decreases when compared to the normal dose cases (EF: 0.87 versus 0.88).

  7. 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

  8. Cloning and characterization of a novel hemocyanin variant LvHMCV4 from shrimp Litopenaeus vannamei.

    Science.gov (United States)

    Lu, Xin; Lu, Hui; Guo, Lingling; Zhang, Zehui; Zhao, Xianliang; Zhong, Mingqi; Li, Shengkang; Zhang, Yueling

    2015-10-01

    Recently, we found 3 variants of hemocyanin subunit with higher molecular weight in shrimp Litopenaeus vannamei (Named as LvHMCV1-3). In this study, a novel L. vannamei hemocyanin variant (Named as LvHMCV4) was further cloned and characterized. Bioinformatic analysis predicted that LvHMCV4 contains one open reading frame of 2137 bp and encodes a polypeptide of 678 amino acids. It shares 84-99% cDNA sequences identity to that of the classical form of L. vannamei hemocyanin (LvHMC, AJ250830.1) and LvHMCV1-3. LvHMCV4 possesses a conserved structure characteristic of the hemocyanin family and can be clustered into one branch along with other arthropod hemocyanins in a phylogenetic tree. Further, the full-length DNA of LvHMCV4 contains 2660 bp and two introns, which are located at the 80-538 bp and 2063-2227 bp regions, respectively. In addition, the mRNA transcript of LvHMCV4 was expressed highly in the hepatopancreas, lymphoid, brain and hemocytes, and weakly in the heart, intestine and gill, while no expression was found in the muscle, stomach and gut. Infection by Escherichia coli K12, Vibrio parahaemolyticus, Vibrio alginolyticus, Vibrio fluvialis, Streptococcus pyogenes or Staphylococcus aureus up-regulated significantly LvHMCV4 mRNA expression in the hepatopancreas. Furthermore, the recombinant protein of LvHMCV4 (rLvHMCV4) was prepared, which showed agglutination activities against six pathogenic bacteria at concentrations ranging from 15.6 to 125 μg/ml. When co-injected with V. parahaemolyticus in L.vannamei, rLvHMCV4 significantly increased the survival rate after 48 h injection. Together, these studies suggested that hemocyanin variant, LvHMCV4, might be involved in shrimp resistance to pathogenic infection.

  9. 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.

  10. 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

  11. Coronal Mass Ejections travel time

    Science.gov (United States)

    Braga, Carlos Roberto; Souza de Mendonça, Rafael Rodrigues; Dal Lago, Alisson; Echer, Ezequiel

    2017-10-01

    Coronal mass ejections (CMEs) are the main source of intense geomagnetic storms when they are earthward directed. Studying their travel time is a key-point to understand when the disturbance will be observed at Earth. In this work, we study the CME that originated the interplanetary disturbance observed on 2013/10/02. According to the observations, the CME that caused the interplanetary disturbance was ejected on 2013/09/29. We obtained the CME speed and estimate of the time of arrival at the Lagrangian Point L1 using the concept of expansion speed. We found that observed and estimated times of arrival of the shock differ between 2 and 23 hours depending on method used to estimate the radial speed.

  12. Efficient Control of Active Transformers for Increasing the PV Hosting Capacity of LV Grids

    DEFF Research Database (Denmark)

    Hashemi Toghroljerdi, Seyedmostafa; Østergaard, Jacob; Degner, Thomas

    2016-01-01

    on decreasing the voltage rise along LV feeders, and the potential of active medium voltage to low voltage (MV/LV) transformers for overvoltage prevention has not been thoroughly investigated. This paper presents the application of active MV/LV transformers for increasing the PV hosting capacity of LV grids...... increase the PV hosting capacity of the grid, while eliminating the need for a complex and centralized controller. The voltages of specific locations or the grid state estimations provide adequate data for adjustments of the droop parameters. The simulations and field test results associated...

  13. 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

  14. Assessment of the LV-S2 & LV-S3 Stack Sampling Probe Locations for Compliance with ANSI/HPS N13.1-1999

    Energy Technology Data Exchange (ETDEWEB)

    Glissmeyer, John A.; Antonio, Ernest J.; Flaherty, Julia E.; Amidan, Brett G.

    2014-09-30

    This document reports on a series of tests conducted to assess the proposed air sampling locations for the Hanford Tank Waste Treatment and Immobilization Plant (WTP) Group 1-2A exhaust stacks with respect to the applicable criteria regarding the placement of an air sampling probe. The LV-C2, LV-S2, and LV-S3 exhaust stacks were tested together as a group (Test Group 1-2A). This report only covers the results of LV-S2 and LV-S3; LV-C2 will be reported on separately. Federal regulations1 require that a sampling probe be located in the exhaust stack according to the criteria established by the American National Standards Institute/Health Physics Society (ANSI/HPS) N13.1-1999, Sampling and Monitoring Releases of Airborne Radioactive Substances from the Stack and Ducts of Nuclear Facilities. 2 These criteria address the capability of the sampling probe to extract a sample that represents the effluent stream.

  15. 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

  16. 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

  17. 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

  18. 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

  19. LvDJ-1 plays an important role in resistance against Vibrio alginolyticus in Litopenaeus vannamei.

    Science.gov (United States)

    Huang, Mingzhu; Liu, Yuan; Xie, Chenying; Wang, Wei-Na

    2015-05-01

    DJ-1 was first identified as an oncogene that transformed mouse NIH3T3 cells in cooperation with activated Ras. It has since exhibited a variety of functions in a range of organisms. In this study, the DJ-1 gene in Litopenaeus vannamei (LvDJ-1) was identified and characterized. A recombinant protein LvDJ-1 was produced in Pichia pastoris. LvDJ-1 expression in vivo was knocked down by dsRNA-mediated RNA interference (RNAi), which led to significantly decreased levels of LvDJ-1 mRNA and protein. When the L. vannamei were challenged with RNAi and Vibrio alginolyticus, the transcription and expression of copper zinc superoxide dismutase (LvCZSOD) in the hepatopancreas were dramatically lower in shrimp with knocked down LvDJ-1 than in controls. Transcription and expression of P53 (LvP53) were significantly higher in shrimp lacking LvDJ-1 than in controls. Hepatopancreas samples were analyzed using real time polymerase chain reaction and Western blot. Moreover, blood samples from the shrimp, assessed with flow cytometry, showed significant increases in respiratory burst and apoptosis in those lacking LvDJ-1 compared to the controls. Cumulative mortality in the shrimp lacking LvDJ-1 was significantly different from that in the control group after challenge with V. alginolyticus. Altogether, the results prove that LvDJ-1 regulates apoptosis and antioxidant activity, and that these functions play an important role in L. vannamei resistance against V. alginolyticus.

  20. 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.

  1. 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.

  2. 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.

  3. 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

  4. Application of SPCALC for chemical and thermodynamic speciation of fluids -example for wells LV-4A, LV-11 and LV-13, Las Tres Virgenes geothermal field, BCS; Aplicacion del SPCALC en la especiacion quimica y termodinamica de fluidos: ejemplo del caso de los pozos LV-4A, LV-11 y LV-13, del campo geotermico de Las Tres Virgenes, BCS

    Energy Technology Data Exchange (ETDEWEB)

    Viggiano Guerra, J.C.; Sandoval Medina, F.; Flores Armenta, M.C. [Comision Federal de Electricidad, Gerencia de Proyectos Geotermoelectricos, Morelia, Michoacan (Mexico)]. E-mail: fernando.sandoval@cfe.gob.mx, E-mail: magaly.flores@cfe.gob.mx; Perez, R.J. [Universidad de Calgary (Canada); Gonzalez Partida, E. [Universidad Nacional Autonoma de Mexico, Centro de Geociencias, Mexico, D.F. (Mexico)

    2009-01-15

    SPCALC is an excellent software application providing chemical and multi-phase speciation for geothermal fluids. Recently it was acquired by the Comision Federal de Electricidad (CFE) through a contract with the National Autonomous University of Mexico (UNAM) and the University of Calgary, Canada. Software methodology consists of calculating thermodynamic variables, such as activity (a) and fugacity (f) of chemical species, as well as the saturation indices (log Q/K) of mineral phases of the reservoir. In other words, it models the thermodynamic conditions of the reservoir (pH among other) and simulates the fluid-corrosion rate. This allows the software to foresee scaling and corrosion. In this paper, pervasive fluids in Cretaceous granitic rocks penetrated by wells LV-4A, LV-11 and LV-13 in Las Tres Virgenes geothermal field, BCS, are modeled, starting with chemical analyses. The more important ratios among activities [those which influence the fluid-rock interaction (i.e. {sup a}K{sup +}/{sup a}H{sup +}, {sup a}Ca{sup ++}/{sup a}H{sup +}, {sup a}Na{sup +}/{sup a}H{sup +}, {sup a}Mg{sup ++}/{sup a}H{sup +}) and whose results are the minerals visible under a microscope] are graphed in balance diagrams compatible with the pressure (P) and temperature (T) conditions in the reservoir. Epidote (zoisite) is the mineral found in congruent equilibrium with the system. The main mineral association at those conditions (200-250 degrees Celsius and {approx}18 bar), as observed in the well cuttings, is calcite+illite-quartz{+-}epidote, which is explained by the hydrolithic reactions that form replacement calcite in the presence of CO{sub 2}, thus restricting the formation of epidote and eventually eliminating it. The process enhances the CO{sub 2} molarity in the residual fluid, even up to {sup m}CO{sub 2} 1, which means the CO{sub 2} can be diluted back into fluid and intervene again in the process of calcite formation (2HCO{sub 3}{sup -} + Ca{sup ++} = calcite + H{sub 2}O

  5. In-ambulance abciximab administration in STEMI patients prior to primary PCI is associated with smaller infarct size, improved LV function and lower incidence of heart failure: results from the Leiden MISSION! acute myocardial infarction treatment optimization program.

    Science.gov (United States)

    Hassan, Ayman K M; Liem, Su San; van der Kley, Frank; Bergheanu, Sandrin C; Wolterbeek, Ron; Bosch, Jan; Bootsma, Marianne; Zeppenfeld, Katja; van der Laarse, Arnoud; Atsma, Douwe E; Jukema, J Wouter; Schalij, Martin J

    2009-08-01

    Our aim was to evaluate the effects of early abciximab administration in the ambulance on immediate, short, and long term outcomes. Early abciximab administration before primary percutaneous coronary intervention (PPCI) for ST-segment elevation myocardial infarction (STEMI) is recommended in practice guidelines. However, optimal timing of administration remains indistinct. Within a fixed protocol for PPCI, December 2006 was the cut-off point for this prospective study. A total of 179 consecutive patients with STEMI were enrolled, 90 patients received abciximab bolus in the hospital (in-hospital group), and 89 patients received abciximab bolus in the ambulance (in-ambulance group). The two groups were comparable for baseline and angiographic characteristics. The in-ambulance group received abciximab within the golden period (median 63 min). The infarct related artery (IRA) patency at onset of the PCI was four times higher in the in-ambulance group compared to in-hospital group (odds ratio = 4.9, 95% CI 2.4-10.1). Enzymatic infarct size was smaller in the in-ambulance group (cumulative 48-h CK release 8011 vs. 11267 U/L, P = 0.004). This was associated with higher left ventricular ejection fraction (LVEF) at 90 days post-PPCI measured by myocardial scintigraphy (59% vs. 54%, P = 0.01), and lower incidence of heart failure through a median of 210 days of clinical follow-up (3% vs.11%, P = 0.04). Early abciximab administration in the ambulance significantly improves early reperfusion in STEMI patients treated with PPCI. Moreover this is associated with a smaller infarct size, improved LV function and a lower risk of heart failure on clinical follow-up. (c) 2009 Wiley-Liss, Inc.

  6. 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

  7. Analysis of regional LV function using radionuclide ventriculography in patients with dilated cardiomyopathy

    Energy Technology Data Exchange (ETDEWEB)

    Morozumi, Takakazu; Ishida, Yoshio; Sato, Hideyuki; Hori, Masatsugu; Kamada, Takenobu; Yamagami, Hidetoshi; Kozuka, Takahiro; Nishimura, Tsunehiko (Osaka Univ. (Japan). Faculty of Medicine)

    1993-02-01

    The study evaluated the clinical significance of RI ventriculography in determining left ventricular regional wall motion abnormality (WMA), i.e., asynergy or asynchrony, in dilated cardiomyopathy (DCM). The subjects were 22 DCM patients and 10 normal persons. RI multi-gated cardiac blood pool scans were performed; and the whole ventricular area was divided into 8 segments to determine regional WMA and coefficients of variation of regional ejection fraction (CV-rEF) and regional ejection time (CV-rET). According to Tl-201 myocardial SPECT images at rest, DCM patients were classified as having no regional myocardial fibrotic lesions (DCM-A, n=17) or as having fibrotic lesions (DCM-B, n=5). CV-rEF and CV-rET were, on the average, increased by +2 SD or more in 14 (82%) and 11 (65%) patients, respectively, in Group DCM-A and respective 4 patients (80%) in Group DCM-B. CV-rEF and CV-rET were 24.7[+-]5.7% and 7.5[+-]2.3%, respectively, in control group; and corresponding figures were 41.1[+-]14.3% and 23.2[+-]13.5% in Group DCM-A and 59.1[+-]19.8% and 19.0[+-]7.2% in Group DCM-B, respectively. Because regional contraction abnormality also existed even in Group DCM-A with no definitive evidence of myocardial fibrosis, regional contraction abnormality associated with DCM may be attributed to other causes than fibrosis. In 5 patients in whom left ventricular EF was increased by giving beta blockers, both CV-rEF and CV-rET improved. This suggested that beta blockers may homogeneously affect contractile function, resulting in the improvement of left ventricular function. (N.K.).

  8. 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.

  9. 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。

  10. 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.

  11. 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

  12. 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...

  13. 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

  14. 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

  15. Characteristics of Coronal Mass Ejections

    Science.gov (United States)

    Talukder, F.; Marchese, A. K.; Tulsee, T.

    2014-12-01

    A coronal mass ejection (CME) is a release of charged particles resulting from solar activity. These charged particles can affect electronics on spacecraft, airplanes, global positioning systems, and communication satellites. The purpose of this research was to study CME data from satellites and correlate these to other properties. Solar wind data collected by STEREO A/B and ACE satellites were analyzed. The data consisted of solar wind flux for various elements (helium through iron), as well as the components of the interplanetary magnetic field. CME events are known to cause a surge in the helium flux, as well as other particles. It is hypothesized that a CME event will cause an increase in the number of lighter elements relative to heavier particles. This is because for a given input of energy, lighter elements are expected to be accelerated to a greater extent than heavier elements. A significant increase was observed in the ratio between helium to oxygen (He/O) prior to intense CMEs. A CME event on November 4, 2003 caused an eleven-fold increase in the He/O ratio, while for another event on April 2, 2001 the He/O ratio increased from 80 to 700. A significant increase in He/O ratio is not observed during weaker CMEs. Furthermore, it was also observed that not all increases in the ratio were accompanied by CMEs. The increase in He/O ratio prior to the CME arrival might be used as a way to predict future events.

  16. 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

  17. 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

  18. 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

  19. 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%.

  20. Relationship Among Plasma Brain Natriuretic Peptide (BNP) Levels, Left Ventricular Ejection Fraction (LVEF) and Left Ventricular End-Diastolic Diameter(LVEDD) in Patients with Heart Failure%心衰患者脑钠肽与左室射血分数等参数的研究

    Institute of Scientific and Technical Information of China (English)

    胡丙清; 陈森

    2011-01-01

    目的 研究慢性稳定性及失代偿性心力衰竭(选择心功能Ⅱ、Ⅲ、Ⅳ级)患者血浆中脑钠肽(BNP)水平的差异及其与左室射血分数(LVEF)、左室舒张末期内径(LVEDD)之间的相关性.方法 选择心力衰竭患者96例,入院后均经心脏彩超检查.按NYHA分级,Ⅱ级40例,其中稳定性心衰14例,失代偿性心衰26例;Ⅲ级40例,其中稳定性心衰16例,失代偿性心衰24例;Ⅳ级16例,其中稳定性心衰4例,失代偿性心衰12例.采用美国雅培12000SR全自动化学发光分析仪测定血浆BNP水平.结果 BNP数值在NYHA分级Ⅱ、Ⅲ、Ⅳ各组间(包括稳定期、失代偿期)差异有统计学意义(P<0.05).LVEDD及LVEF在慢性稳定性心衰组各分级间差异有统计学意义(P<0.05),而LVEDD及LVEF在失代偿性心衰组各分级间差异无统计学意义(P>0.05).结论 脑钠肽的升高与NYHA分级成正相关,左室射血分数及舒张末期内径与慢性稳定性心衰分级成正相关,与慢性失代偿性心衰无明显相关性.%Objective To investigate the level differences of plasma brain natriuretic peptide( BNP) in patients with chronic stable and decompensation heart failure and their relationship among BNP,left ventricular ejection fraction(LVEF) and left ventricular end-diastolic diameter(LVEDD). Methods Ninety-six patients with heart failure were examined by UCG after admission , and they were divided into three groups according to NYHA' s heart function class criterion: NYHA class II group 40 cases, including chronic stable heart failure 14 cases; decompensation heart failure 26 cases; NYH A class IQ group 40 cases; including chronic stable heart failure 16 cases;decompensation heart failure 24 cases;NYHA class IV group 16 cases,including chronic stable heart failure 4 cases; heart failure 12 cases. The concentration of BNP was measured by Achitect I2000SR full-automatic chemiluminesent immunoassay ( CLIA). Results The concentration of BNP between NYHA class

  1. 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

  2. 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.

  3. 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