scholarly journals Can Clinically Relevant Readouts of Exercise Tolerance, Left Atrial Size and BNP be Back-Translated in a Rodent Model of Heart Failure With Preserved Ejection Fraction

2016 ◽  
Vol 22 (8) ◽  
pp. S39
Author(s):  
Chin-hu Huang ◽  
Shu-Yu Sun ◽  
Xiaolan Shen ◽  
Xiaoli Ping ◽  
Xuening Hong ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Exercise Tolerance ◽  
Left Atrial ◽  
Rodent Model ◽  
Preserved Ejection Fraction ◽  
Left Atrial Size ◽  
Atrial Size

Abstract 13493: Mechanism and Prognostic Significance of Cardiothoracic Ratio in Patients With Heart Failure With Preserved Ejection Fraction - Insights From Pursuit-hfpef Registry -

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Masato Okada ◽  
KOICHI INOUE ◽  
Katsuomi Iwakura ◽  
Toshinari Onishi ◽  
Shungo Hikoso ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Left Atrial ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Preserved Ejection Fraction ◽  
Left Atrial Size ◽  
Cardiothoracic Ratio ◽  
Atrial Size

Introduction: The cardiothoracic ratio (CTR) is a widely accepted method of quantifying cardiac size, and carries prognostic information in acquired heart disease. However, little is described in the underlying mechanism and prognostic value in heart failure with preserved ejection fraction (HFpEF). Methods: Analysis was performed from a prospective multicenter observational registry for HFpEF (PURSUIT-HFpEF Registry) conducted in the Osaka region of Japan. A total of 871 patients hospitalized for acute HF (diagnosed by using Framingham criteria) met the inclusion criteria: a left ventricular ejection fraction (LVEF) ≥50% and brain natriuretic peptide (BNP) ≥100 pg/ml. We included 629 patients (age, 81±9 years; men, 46%; atrial fibrillation, 37%) whose follow-up data after survival discharge were available and whose CTR were measured from posterior-anterior chest X-ray. The endpoint was defined as the composite of death, re-hospitalization for HF, and cerebrovascular accident. Results: Median CTR at discharge was 56% (interquartile range: 51-61%). Comparison with echocardiographic data revealed that CTR significantly correlated with increased left atrial size (left atrial volume; r = 0.39, p <0.001) and LV filling pressure (E/e’ ratio; r = 0.13, p = 0.002), but not with LV size (LV end-diastolic volume; r = -0.014; LV end-systolic volume: r = -0.002) and LVEF (r = -0.035). Age (r = 0.16, p <0.001) and log-transformed N-terminal-pro-BNP value (r = 0.21, p <0.001) were also correlated with CTR. Female patients exhibited more higher CTR than male patients (54±7 vs. 58±7%, p <0.001). During a median follow-up of 15 months, 257 patients experienced the endpoint. When patients were classified into the CTR quartile groups, there was a positive correlation between the incidence rate and the quartiles (Q1, 31.0%; Q2, 39.5%; Q3, 35.7%; Q4 55.8%, p <0.001). After adjustment for age and gender, Cox regression analysis revealed that CTR at discharge was a significant predictor of the composite endpoint (hazard ratio per quartile increase; 1.23; 95% confidence interval, 1.10-1.39; p = 0.006). Conclusions: CTR was not associated with LV size but left atrial size in patients with HFpEF. Increased CTR at discharge predicted unfavorable prognosis in patients with HFpEF.

Abstract TP173: Reduced Ejection Fraction and Left Atrial Dilatation are Independently Associated With Cardioembolic Stroke

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Maryam Hosseini Farahabadi ◽  
Shadi Milani-Nejad ◽  
Shimeng Liu ◽  
Wengui Yu ◽  
Mohammad Shafie
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Ejection Fraction ◽  
Left Atrial ◽  
Cardioembolic Stroke ◽  
Left Atrial Size ◽  
Reduced Ejection Fraction ◽  
Atrial Size ◽  
Left Atrial Dilatation

Introduction: The role of heart failure and left atrial dilatation as independent risk factors for ischemic stroke has remained controversial. The goal of this study is to evaluate the association between reduced ejection fraction (EF) and left atrial dilatation with cardioembolic stroke. Methods: Four hundred fifty-three patients with ischemic stroke admitted to the University of California, Irvine between 2016-2017 were included based on the following criteria: age >18 and availability of echocardiogram within 3 months of diagnosis. Stroke was subdivided into cardioembolic and non-cardioembolic based on MRI findings. EF was categorized into normal: 52-72% (male), 54-74% (female), mildly abnormal: 41-51%(male), 41-53% (female), moderately abnormal: 30-40% (same in both genders), and severely abnormal: <30% (same in both genders). Other variables included: left atrial volume size categorized into normal (≤34 ml/m 2 ) vs. enlarged (≥35 ml/m 2 ), gender, hypertension (SBP≥140 or DBP≥ 90), and known history of atrial fibrillation. Results: Two hundred eighteen patients were identified to have cardiomebmolic stroke and two hundred thirty-five with non-cardioembolic stroke. Among patients with cardiomebmolic stroke, 49 (22.4%) and 142 (65%) had reduced EF and enlarged left atrium, respectively, as compared to 19 (8.1%) and 65 (27.7%) in patients with non-cardioembolic stroke. The number of patients with reduced EF and left atrial enlargement were significantly higher in patients with cardioembolic stroke (P<0.001). The odds of cardioembolic stroke were 2.0 and 8.8 times higher in patients with moderately and severely reduced EF, respectively, when compared to patients with normal EF. The odds of cardioembolic stroke was 2.4 times higher in patients with enlarged left atrial size when compared to patients with normal left atrial size. Conclusions: Our results have shown an independent association between moderately and severely reduced EF and enlarged left atrial size with cardioembolic stroke. Heart failure and left atrial dilatation may increase the risk of stroke regardless of the presence of atrial fibrillation, which warrants further studies to determine the appropriate treatment for secondary stroke prevention such as anticoagulation.

Significance of the echocardiographic evaluation of left atrial myocardial strain for early diagnosis of heart failure with preserved ejection fraction

Kardiologiia ◽  
2021 ◽  
Vol 61 (8) ◽  
pp. 68-75
Author(s):  
E. K. Serezhina ◽  
A. G. Obrezan
Keyword(s):  
Heart Failure ◽  
Early Diagnosis ◽  
Ejection Fraction ◽  
Left Atrial ◽  
Myocardial Dysfunction ◽  
Systolic Dysfunction ◽  
Myocardial Strain ◽  
Left Ventricular ◽  
Preserved Ejection Fraction ◽  
Echocardiographic Evaluation

This systematic review is based on 19 studies from Elsevier, PubMed, Embase, and Scopus databases, which were found by the following keywords: LA strain (left atrial strain), STE (speckle tracking echocardiography), HF (heart failure), and HFpEF (heart failure with preserved ejection fraction). The review focuses on results and conclusions of studies on using the 2D echocardiographic evaluation of left atrial (LA) myocardial strain for early diagnosis of HFpEF in routine clinical practice. Analysis of the studies included into this review showed a significant decline of all LA functions in patients with HFpEF. Also, multiple studies have reported associations between decreased indexes of LA strain and old age, atrial fibrillation, left ventricular hypertrophy, left and right ventricular systolic dysfunction, and LV diastolic dysfunction. Thus, the review indicates significant possibilities of using indexes of LA strain in evaluation of early stages of both systolic and diastolic myocardial dysfunction. Notably, LA functional systolic and diastolic indexes are not sufficiently studied despite their growing significance for diagnosis and prognosis of patients with HFpEF. For this reason, in addition to existing models for risk stratification in this disease, including clinical characteristics and/or echocardiographic data, future studies should focus on these parameters. 

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