Beneficial effects of adaptive servo-ventilation on natriuretic peptides and diastolic function in acute heart failure patients with preserved ejection fraction and sleep-disordered breathing

Abstract Background Appropriate pulmonary artery catheter (PAC) use may effectively decrease mortality in acute heart failure patients. The concept that the pulmonary artery catheter (PAC) is a valuable tool for hemodynamic monitoring when used in appropriately selected patients and by physicians trained well to interpret and apply the data correctly provided has not been evaluated adequately yet in acute heart failure patients with preserved ejection fraction (HFpEF). Methods The PERSUIT-HFpEF Registry is a prospective, observational, multicenter cohort study on prognosis of HFpEF in Japan. Patients hospitalized for heart failure (diagnosed by using Framingham criteria) who met both of the following criteria were enrolled: 1) a left ventricular ejection fraction of 50% or more as measured at the local site by echocardiography; 2) an elevated level of N terminal pro brain natriuretic peptide (NT proBNP) (400 pg per milliliter or more) or brain natriuretic peptide (BNP) (100 pg per milliliter or more). In the present study, we evaluated the impact of PAC on all-cause death of the patients with HFpEF. PAC use was left at the discretion of attending physicians. Results The PERSUIT-HFpEF Registry enrolled 486 patients (81±9 years, 259 females, mean follow-up duration 198±195 days). Of these, data of PAC usage was available in 434 patients. Patients were further stratified according to use of a PAC: PAC 153 patients vs. non-PAC 281 patients. Length of hospitalization was numerically shorter in the PAC group than in the non-PAC group [20.3±14.7 vs. 22.5±17.4 days, p=0.182]. Kaplan-Meier estimated 1-year all-cause death rate was significantly lower in the PAC group than in the non-PAC group (9.5% vs. 19.1%, p=0.019). PAC use was associated with significant risk reduction of all-cause death [hazard ratio (HR) 0.425, 95% confidence interval (CI), 0.203–0.890, p=0.023] in the crude analysis. The significant risk reduction still existed after multivariate adjustment including potential confounders [HR 0.427, 95% CI, 0.185–0.984, p=0.046] Kaplan Meier analysis Conclusions In the real-world Asian registry data, PAC use was associated with the improved all-cause death rate, suggesting that the PAC might be a useful guidance tool for treatment of the patients with HFpEF. Acknowledgement/Funding Roche diagnostics FUJIFILM Toyama Chemical

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GLOBAL LONGITUDINAL STRAIN IS SUBSTANTIALLY IMPAIRED IN HOSPITALIZED ACUTE HEART FAILURE PATIENTS WITH PRESERVED EJECTION FRACTION

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(14)60554-4 ◽

2014 ◽

Vol 63 (12) ◽

pp. A554

Author(s):

Hyun Ju Yoon ◽

Fawaz Alenezi ◽

Mads Ersboll ◽

Michel Khouri ◽

Zainab Samad ◽

...

Keyword(s):

Heart Failure ◽

Ejection Fraction ◽

Acute Heart Failure ◽

Longitudinal Strain ◽

Global Longitudinal Strain ◽

Preserved Ejection Fraction ◽

Heart Failure Patients

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Abstract 15264: Clinical Outcomes and Cardiovascular Responses to Exercise Training in Heart Failure Patients with Preserved Ejection Fraction: A Systematic Review and Meta-Analysis

Circulation ◽

10.1161/circ.130.suppl_2.15264 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

Gudrun Dieberg ◽

Hashbullah Ismail ◽

Francesco Giallauria ◽

Neil A Smart

Keyword(s):

Heart Failure ◽

Exercise Training ◽

Ejection Fraction ◽

Diastolic Function ◽

Short Form ◽

Systolic Dysfunction ◽

Cardiovascular Responses ◽

Preserved Ejection Fraction ◽

Medline Search ◽

Heart Failure Patients

Background: Exercise training induces physical adaptations for heart failure patients with systolic dysfunction but less is known about those patients with preserved ejection fraction. Objectives: To establish if exercise training produces changes in peak VO 2 and related measures, quality of life, general health and diastolic function in heart failure patients with preserved ejection fraction (HFpEF). Methods: We conducted a MEDLINE search (1985 to March 2014), for exercise based rehabilitation trials in heart failure, using search terms ‘exercise training, heart failure with preserved ejection fraction, heart failure with normal ejection fraction, peak VO 2 and diastolic heart dysfunction’. Seven intervention studies were included providing a total of 144 exercising subjects and 114 control subjects, a total of 258 participants. Results: Peak VO 2 increased by a mean difference (MD) 2.13 ml.kg -1 .min -1 (95% C.I. 1.54 to 2.71, p<0.00001) in exercise training versus sedentary control, equating to a 17% improvement from baseline. The corresponding data for V E /VCO 2 slope MD 0.85 ml.kg -1 .min -1 (95% C.I. 0.05 to 1.65, p=0.04); maximum heart rate MD 5.60 bpm (95% C.I. 3.95 to 7.25, p<0.00001); and 6 Minute Walk Test (6MWT) MD 32.1m (95% C.I. 17.2 to 47.1, p<0.0001); diastolic function; E/A ratio MD 0.07 (95% C.I. 0.02 to 0.12, p=0.005); E/E’ ratio MD -2.31 (95% C.I. -3.44 to -1.19, p<0.0001); Deceleration time (D T ) MD -13.2 msec (95% C.I. -19.8 to -6.5, p=0.0001); Minnesota Living with Heart Failure Questionnaire (MLHFQ) MD -6.50 (95% C.I. -9.47 to -3.53, p<0.0001); Short Form (36) Health Survey MD 15.6 (95% C.I. 7.4 to 23.8, p=0.0002). In 3,744 hours patient-hours of training, not one death was directly attributable to exercise. Conclusions: Exercise training appears to effect several health-related improvements in people with heart failure and preserved ejection fraction.

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