Cardiac Mechanics Assessment and the Risk of Heart Failure in the General Population

ObjectivesPrevious studies showed a strong association between sarcoidosis and heart failure (HF) but did not consider risk stratification or risk factors to identify useful aetiological insights. We estimated overall and stratified HRs and identified risk factors for HF in sarcoidosis.MethodsSarcoidosis cases were identified from the Swedish National Patient Register (NPR; ≥2 International Classification of Diseases-coded visits, 2003–2013) and matched to general population comparators. They were followed for HF in the NPR. Treated were cases who were dispensed ≥1 immunosuppressant ±3 months from the first sarcoidosis visit (2006–2013). Using Cox models, we estimated HRs adjusted for demographics and comorbidity and identified independent risk factors of HF together with their attributable fractions (AFs).ResultsDuring follow-up, 204 of 8574 sarcoidosis cases and 721 of 84 192 comparators were diagnosed with HF (rate 2.2 vs 0.7/1000 person-years, respectively). The HR associated with sarcoidosis was 2.43 (95% CI 2.06 to 2.86) and did not vary by age, sex or treatment status. It was higher during the first 2 years after diagnosis (HR 3.7 vs 1.9) and in individuals without a history of ischaemic heart disease (IHD; HR 2.7 vs 1.7). Diabetes, atrial fibrillation and other arrhythmias were the strongest independent clinical predictors of HF (HR 2.5 each, 2-year AF 20%, 16% and 12%, respectively).ConclusionsAlthough low, the HF rate was more than twofold increased in sarcoidosis compared with the general population, particularly right after diagnosis. IHD history cannot solely explain these risks, whereas ventricular arrhythmias indicating cardiac sarcoidosis appear to be a strong predictor of HF in sarcoidosis.

Download Full-text

Readability Assessment of Online Patient Education Material on Congestive Heart Failure

Advances in Preventive Medicine ◽

10.1155/2017/9780317 ◽

2017 ◽

Vol 2017 ◽

pp. 1-8 ◽

Cited By ~ 24

Author(s):

Akhil Kher ◽

Sandra Johnson ◽

Robert Griffith

Keyword(s):

Heart Failure ◽

Congestive Heart Failure ◽

Patient Education ◽

General Population ◽

Sixth Grade ◽

Assessment Tools ◽

Flesch Reading Ease ◽

Readability Assessment ◽

Readability Level ◽

Online Patient Education

Background. Online health information is being used more ubiquitously by the general population. However, this information typically favors only a small percentage of readers, which can result in suboptimal medical outcomes for patients. Objective. The readability of online patient education materials regarding the topic of congestive heart failure was assessed through six readability assessment tools. Methods. The search phrase “congestive heart failure” was employed into the search engine Google. Out of the first 100 websites, only 70 were included attending to compliance with selection and exclusion criteria. These were then assessed through six readability assessment tools. Results. Only 5 out of 70 websites were within the limits of the recommended sixth-grade readability level. The mean readability scores were as follows: the Flesch-Kincaid Grade Level (9.79), Gunning-Fog Score (11.95), Coleman-Liau Index (15.17), Simple Measure of Gobbledygook (SMOG) index (11.39), and the Flesch Reading Ease (48.87). Conclusion. Most of the analyzed websites were found to be above the sixth-grade readability level recommendations. Efforts need to be made to better tailor online patient education materials to the general population.

Download Full-text

Diastolic dysfunction in individuals with and without heart failure with preserved ejection fraction

Clinical Research in Cardiology ◽

10.1007/s00392-021-01907-x ◽

2021 ◽

Author(s):

Jan-Per Wenzel ◽

Ramona Bei der Kellen ◽

Christina Magnussen ◽

Stefan Blankenberg ◽

Benedikt Schrage ◽

...

Keyword(s):

Risk Factors ◽

Heart Failure ◽

Cardiovascular Risk ◽

General Population ◽

Diastolic Dysfunction ◽

Cardiovascular Risk Factors ◽

Population Based ◽

Left Ventricular ◽

Health Study ◽

Common Finding

Abstract Aim Left ventricular diastolic dysfunction (DD), a common finding in the general population, is considered to be associated with heart failure with preserved ejection faction (HFpEF). Here we evaluate the prevalence and correlates of DD in subjects with and without HFpEF in a middle-aged sample of the general population. Methods and results From the first 10,000 participants of the population-based Hamburg City Health Study (HCHS), 5913 subjects (mean age 64.4 ± 8.3 years, 51.3% females), qualified for the current analysis. Diastolic dysfunction (DD) was identified in 753 (12.7%) participants. Of those, 11.2% showed DD without HFpEF (ALVDD) while 1.3% suffered from DD with HFpEF (DDwHFpEF). In multivariable regression analysis adjusted for major cardiovascular risk factors, ALVDD was associated with arterial hypertension (OR 2.0, p < 0.001) and HbA1c (OR 1.2, p = 0.007). Associations of both ALVDD and DDwHFpEF were: age (OR 1.7, p < 0.001; OR 2.7, p < 0.001), BMI (OR 1.2, p < 0.001; OR 1.6, p = 0.001), and left ventricular mass index (LVMI). In contrast, female sex (OR 2.5, p = 0.006), atrial fibrillation (OR 2.6, p = 0.024), CAD (OR 7.2, p < 0.001) COPD (OR 3.9, p < 0.001), and QRS duration (OR 1.4, p = 0.005) were strongly associated with DDwHFpEF but not with ALVDD. Conclusion The prevalence of DD in a sample from the first 10,000 participants of the population-based HCHS was 12.7% of whom 1.3% suffered from HFpEF. DD with and without HFpEF showed significant associations with different major cardiovascular risk factors and comorbidities warranting further research for their possible role in the formation of both ALVDD and DDwHFpEF.

Download Full-text

Managing heart failure – home or hospital?

Drug and Therapeutics Bulletin ◽

10.1136/dtb.30.16.61 ◽

1992 ◽

Vol 30 (16) ◽

pp. 61-63

Keyword(s):

Heart Failure ◽

General Practice ◽

General Population ◽

Mortality Rates ◽

The Usa ◽

The Uk

In the USA, heart failure affects about 1% of people in their 50s, rising to 10% of those in their 80s,1 and the figure is probably higher in the UK. The symptoms are distressing, usually relentless, and associated with mortality rates four to eight times greater than those in the general population of the same age.1 This article reviews the treatment of uncomplicated heart failure, concentrating on its management in general practice.

Download Full-text

Cardiac mechanics as predictors of left ventricular reverse remodelling in patients with dilated non-ischemic cardiomyopathy

European Heart Journal ◽

10.1093/eurheartj/ehab724.0281 ◽

2021 ◽

Vol 42 (Supplement_1) ◽

Author(s):

M Ferrandez ◽

F Islas ◽

A Travieso ◽

J Diz-Diaz ◽

A Restrepo ◽

...

Keyword(s):

Heart Failure ◽

Ischemic Cardiomyopathy ◽

Multimodality Imaging ◽

Global Longitudinal Strain ◽

Cardiac Mechanics ◽

Left Ventricular ◽

Cardiac Resynchronization ◽

Imaging Parameters ◽

Reverse Remodelling

Abstract Background and purpose The appearance of left ventricular reverse remodelling (LVRR) is associated with a better prognosis in patients with dilated non-ischemic cardiomyopathy (DCM). Our aim was to identify cardiac imaging parameters, including speckle tracking by transthoracic echocardiography (TTE) and feature tracking by CMR, associated with LVRR in a prospective cohort of patients with DCM. Methods From 2014 to 2021, 182 patients with DCM and left ventricle ejection fraction (LVEF) <40% were prospectively evaluated in our hospital. LVRR was defined as an increase in LVEF ≥10 points or absolute LVEF ≥50%, associated with a reduction in left ventricular end- diastolic diameter ≥10%. Patients underwent multimodality imaging evaluation including CMR with a 1.5 Tesla scanner, and TTE. Cardiac mechanics, including global longitudinal strain (GLS), strain rate (SR) and mechanical dispersion (MD) were measured. Results Median age of our cohort was 62.3 (14.4) years, and 67.7% were male. Most patients (>90%) were treated with beta-blockers or RASS blockers, and 67% with mineralocorticoid receptor antagonists. 30% had cardiac resynchronization therapy (CRT) and 37% had ICD as primary prevention. Mean LVEF was 31.3%. During a mean follow-up period of 35.9 (35.4) months, 38.3% of patients had LVRR. Age and gender distribution were similar in both groups. Regarding cardiovascular risk factors and pharmacological treatment, no differences were found between patients with and without LVRR. Baseline CRT therapy was not associated with LVRR (22.6% vs 34.7%; p=0.249). However, there was a trend towards higher LVRR in those who received CRT during follow-up 18.8% vs 0%; p=0.069). Patients who experienced LVRR had lower basal LVEF (23.4% vs 29%; p<0.008), as well as poorer RV function, including lower RVEF (40.5% vs 51%; p=0.006) and lower TAPSE (16 mm vs 19 mm; p=0.021). Regarding cardiac mechanics, those patients with lower GLS (−9% vs −12%; p=0.001), and higher MD (73 mm vs 55 mm; p=0,050) had LVRR more frequently during follow-up. The presence of a left bundle branch block (LBBB) contraction pattern by strain was associated with higher rate of LVRR (83.3% vs 30.4%; p=0.011). The burden of fibrosis measured by LGE with CMR was not associated with LVRR (14% vs 12%; p=NS). Patients with LVRR had a lower cardiovascular mortality (3.3 vs 14.3%; p=0.117), lower mortality due to heart failure (0% vs 12.2%; p=0.046), less heart failure hospitalizations (20% vs 46.9%; p=0.016), and a lower incidence of ventricular tachyarrhythmias (3.3% vs 18.4%; p=0.051). Conclusions LVRR in patients with DCM receiving optimized medical therapy is associated with a better prognosis. Imaging parameters, including a lower basal LVEF, RVEF, GLS and higher MD, as well as LBBB echo pattern, were associated with a higher frequency of LVRR, and might help to identify patients who could benefit from CRT/and may be helpful to stratify patients's risk. FUNDunding Acknowledgement Type of funding sources: None.

Download Full-text

Humanistic burden and economic impact of heart failure – a systematic review of the literature

F1000Research ◽

10.12688/f1000research.19365.1 ◽

2019 ◽

Vol 8 ◽

pp. 859 ◽

Cited By ~ 1

Author(s):

Lucia Giles ◽

Caroline Freeman ◽

Polly Field ◽

Elisabeth Sörstadius ◽

Bernt Kartman

Keyword(s):

Heart Failure ◽

Systematic Review ◽

General Population ◽

Economic Impact ◽

Chronic Diseases ◽

Resource Use ◽

Kansas City ◽

Short Form ◽

Cochrane Library ◽

Humanistic Burden

Background: Heart failure (HF) is increasing in prevalence worldwide. This systematic review was conducted to inform understanding of its humanistic and economic burden. Methods: Electronic databases (Embase, MEDLINE®, and Cochrane Library) were searched in May 2017. Data were extracted from studies reporting health-related quality of life (HRQoL) in 200 patients or more (published 2007–2017), or costs and resource use in 100 patients or more (published 2012–2017). Relevant HRQoL studies were those that used the 12- or 36-item Short-Form Health Surveys, EuroQol Group 5-dimensions measure of health status, Minnesota Living with Heart Failure Questionnaire or Kansas City Cardiomyopathy Questionnaire. Results: In total, 124 studies were identified: 54 for HRQoL and 71 for costs and resource use (Europe: 25/15; North America: 24/50; rest of world/multinational: 5/6). Overall, individuals with HF reported worse HRQoL than the general population and patients with other chronic diseases. Some evidence identified supports a correlation between increasing disease severity and worse HRQoL. Patients with HF incurred higher costs and resource use than the general population and patients with other chronic conditions. Inpatient care and hospitalizations were identified as major cost drivers in HF. Conclusions: Our findings indicate that patients with HF experience worse HRQoL and incur higher costs than individuals without HF or patients with other chronic diseases. Early treatment of HF and careful disease management to slow progression and to limit the requirement for hospital admission are likely to reduce both the humanistic burden and economic impact of HF.

Download Full-text

The association of hepatic steatosis and fibrosis with heart failure and mortality

Cardiovascular Diabetology ◽

10.1186/s12933-021-01374-8 ◽

2021 ◽

Vol 20 (1) ◽

Author(s):

Jiyun Park ◽

Gyuri Kim ◽

Hasung Kim ◽

Jungkuk Lee ◽

You-Bin Lee ◽

...

Keyword(s):

Heart Failure ◽

General Population ◽

Fatty Liver ◽

Hepatic Steatosis ◽

Patient Group ◽

Cox Regression ◽

Nonalcoholic Fatty Liver ◽

Fatty Liver Index ◽

Increased Risk ◽

All Cause Mortality

Abstract Background Nonalcoholic fatty liver disease (NAFLD) is a hepatic manifestation of metabolic disease and independently affects the development of cardiovascular (CV) disease. We investigated whether hepatic steatosis and/or fibrosis are associated with the development of incident heart failure (iHF), hospitalized HF (hHF), mortality, and CV death in both the general population and HF patients. Methods We analyzed 778,739 individuals without HF and 7445 patients with pre-existing HF aged 40 to 80 years who underwent a national health check-up from January 2009 to December 2012. The presence of hepatic steatosis and advanced hepatic fibrosis was determined using cutoff values for fatty liver index (FLI) and BARD score. We evaluated the association of FLI or BARD score with the development of iHF, hHF, mortality and CV death using multivariable-adjusted Cox regression models. Results A total of 28,524 (3.7%) individuals in the general population and 1422 (19.1%) pre-existing HF patients developed iHF and hHF respectively. In the multivariable-adjusted model, participants with an FLI ≥ 60 were at increased risk for iHF (hazard ratio [HR], 95% confidence interval [CI], 1.30, 1.24–1.36), hHF (HR 1.54, 95% CI 1.44–1.66), all-cause mortality (HR 1.62, 95% CI 1.54–1.70), and CV mortality (HR 1.41 95% CI 1.22–1.63) in the general population and hHF (HR 1.26, 95% CI 1.21–1.54) and all-cause mortality (HR 1.54 95% CI 1.24–1.92) in the HF patient group compared with an FLI < 20. Among participants with NAFLD, advanced liver fibrosis was associated with increased risk for iHF, hHF, and all-cause mortality in the general population and all-cause mortality and CV mortality in the HF patient group (all p < 0.05). Conclusion Hepatic steatosis and/or advanced fibrosis as assessed by FLI and BARD score was significantly associated with the risk of HF and mortality.

Download Full-text

Plakophilin-2 c.419C>T and risk of heart failure and arrhythmias in the general population

European Journal of Human Genetics ◽

10.1038/ejhg.2015.171 ◽

2015 ◽

Vol 24 (5) ◽

pp. 732-738 ◽

Cited By ~ 3

Author(s):

Alex Hørby Christensen ◽

Pia Rørbœk Kamstrup ◽

Estelle Gandjbakhch ◽

Marianne Benn ◽

Jan Skov Jensen ◽

...

Keyword(s):

Heart Failure ◽

General Population ◽

Plakophilin 2

Download Full-text

Abstract 12421: Single Beat Simultaneous Left Atrioventricular Strain-Volume Analysis Using Speckle Tracking Echocardiography

Circulation ◽

10.1161/circ.130.suppl_2.12421 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

Alaa M Omar ◽

Mohamed A Abdel-Rahman ◽

Zaid H Sabe-Eleish ◽

Osama Rifaie ◽

Gianni Pedrizzetti ◽

...

Keyword(s):

Heart Failure ◽

Speckle Tracking ◽

Heart Function ◽

Cardiac Mechanics ◽

Structural Heart Disease ◽

Left Heart ◽

Cardiac Events ◽

Structural Shape ◽

Heart Volume

Introduction: Assessment of cardiac mechanics in relation to left atrial (LA) and ventricular (LV) structural (shape and volume) changes represent a foundation for assessing cardiac remodeling in heart failure (HF) patients. We tested the feasibility of assessing simultaneous LA and LV volumes and deformation within an index cardiac cycle as a marker of total left heart structural and functional remodeling in HF. Methods: Echocardiography was performed in total 101 patients, which included 77 patients with HF (50 had normal EF (HFNEF) and 27 had reduced EF (HFREF)) and 24 young subjects with no structural heart disease (controls) (table 1). Two-dimensional speckle tracking was performed in apical 2- and 4- chamber views for simultaneous measurement of LV and LA volumes and deformation. Peak longitudinal average atrio-ventricular strain (AVS) and early diastolic strain rate (AVSR-E), in addition to the total left heart volume (TLV) during LV systole and diastole (TLVsystole, TLVdiastole), were measured. Occurrence of major adverse cardiac events (MACE) was defined during follow up. Results: In comparison with younger controls, patient with HF showed higher TLV and nearly 50% reduction in AVS and AVSR-E (table 1). These differences persisted even after adjusting for age. During a median follow up of 7 months, MACE occurred in 15 patients (5 hospitalization for heart failure, 1 cerebrovascular stroke, and 9 cardiac deaths). AVS and AVSR-E were predictors for MACE after adjusting for age (HR=0.9, 95% CI: 0.81 to 0.99, p=0.038; HR= 0.14, 95% CI: 0.02 to 0.89, p=0.037; respectively). AVS and AVSR-E had similar diagnostic values in predicting MACE (AUC= 0.77 and 0.79; p=0.001 and <0.001 respectively), with higher event free survival seen for AV-S>14.5%, and AVSR-E>0.92 s-1 (Figure 1). Conclusion: Single beat combined assessments of LA-LV strain and strain rates may be useful integrated markers of total left heart function.

Download Full-text