PREDICTORS OF DECREASED EXERCISE CAPACITY IN PATIENTS WITH HEART FAILURE AND REDUCED EJECTION FRACTION: ROLE OF RIGHT VENTRICULAR FREE WALL LONGITUDINAL STRAIN OBTAINED USING DIFFERENT ECHOCARDIOGRAPHY MACHINES AND ANALYTICAL SOFTWARES

Abstract Purpose: Right ventricle plays an important role in heart failure with preserved and mid-range ejection fraction. Right ventricular dysfunction is common and associated with increased morbidity and mortality in this population. Quantification of right ventricular functional parameters by echocardiography is challenging. Right ventricular strain represents a tool that can provide useful information in the assessment of RV function, offering information with potential prognostic implications.Methods: In a cohort of 71 prospectively included patients admitted for an episode of heart failure with mid-range and preserved ejection fraction (LVEF >40%) right ventricular function was evaluated through right ventricular free wall longitudinal strain. Left ventricular global longitudinal strain was also calculated. Relationship with variables such as hospital readmission and cardiovascular mortality was studied. Results: Worse right ventricular free wall longitudinal strain was associated to higher probability of cardiovascular mortality at six months. In a multivariate analysis RV free wall strain remained a predictor of cardiovascular mortality at 6 months. Significant linear correlation (p <0.01) was observed between longitudinal deformation indices of both ventricles. Conclusion In patients with heart failure with preserved and mid-range ejection fraction, impairment of right ventricular free wall strain is common and is related to worse clinical outcome (increased cardiovascular mortality at six months) regardless of other right ventricular functional parameters and left ventricular ejection fraction. Therefore, representing a sensitive non-invasive prognostic indicator in these patients, and could be useful in stratifying the risk of adverse events. RV and LV strain are correlated indicating biventricular involvement of deformation parameters with prognostic significance.

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Prognostic role of myocardial work in patients with heart failure and reduced ejection fraction treated by sacubitril/valsartan

European Heart Journal ◽

10.1093/ehjci/ehaa946.0040 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

E Galli ◽

Y Bouali ◽

C Laurin ◽

A Gallard ◽

A Hubert ◽

...

Keyword(s):

Heart Failure ◽

Ejection Fraction ◽

Rank Test ◽

Reduced Ejection Fraction ◽

Non Invasive ◽

Patients With Heart Failure ◽

Increase Risk ◽

Echocardiographic Examination ◽

Constructive Work

Abstract Background The non-invasive assessment of myocardial work (MW) by pressure-strain loops analysis (PSL) is a relative new tool for the evaluation of myocardial performance. Sacubitril/Valsartan is a treatment for heart failure with reduced ejection fraction (HFrEF) which has a spectacular effect on the reduction of cardiovascular events (MACEs). Purposes of this study were to evaluate 1) the short and medium term effect of Sacubitril/Valsartan treatment on MW parameters; 2) the prognostic value of MW in this specific group of patients. Methods 79 patients with HFrEF (mean age: 66±12 years; LV ejection fraction: 28±9%) were prospectively included in the study and treated with Sacubitril/Valsartan. Echocardiographic examination was performed at baseline, and after 6- and 12-month of therapy with Sacubitril/Valsartan. Results Sacubitril/Valsartan significantly increased global myocardial constructive work (CW) (1023±449 vs 1424±484 mmHg%, p<0.0001) and myocardial work efficiency (WE) [87 (78–90) vs 90 (86–95), p<0.0001]. During FU (2.6±0.9 years), MACEs occurred in 13 (16%) patients. After correction for LV size, LVEF and WE, CW was the only predictor of MACEs (Table 1). A CW<910 mmHg (AUC=0.81, p<0.0001, Figure 1A) identified patients at particularly increase risk of MACEs [HR 11.09 (1.45–98.94), p=0.002, log-rank test p<0.0001] (Figure 1 B). Conclusions In patients with HFrEF who receive a comprehensive background beta-blocker and mineral-corticoid receptor antagonist therapy, Sacubitril/Valsartan induces a significant improvement of myocardial CW and WE. In this population, the estimation of CW before the initiation of Sacubitril/Valsartan therapy allows the prediction of MACEs. Funding Acknowledgement Type of funding source: None

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Effect of inorganic nitrate on exercise capacity, mitochondria respiration, and vascular function in heart failure with reduced ejection fraction

Journal of Applied Physiology ◽

10.1152/japplphysiol.00850.2019 ◽

2020 ◽

Vol 128 (5) ◽

pp. 1355-1364 ◽

Cited By ~ 1

Author(s):

Mary N. Woessner ◽

Christopher Neil ◽

Nicholas J. Saner ◽

Craig A. Goodman ◽

Luke C. McIlvenna ◽

...

Keyword(s):

Heart Failure ◽

Ejection Fraction ◽

Exercise Capacity ◽

Mitochondrial Respiration ◽

Vascular Function ◽

Reduced Ejection Fraction ◽

Inorganic Nitrate ◽

Patients With Heart Failure ◽

Nitrate Supplementation ◽

Plasma Nitrite

This is the largest study to date to examine the effects of inorganic nitrate supplementation in patients with heart failure with reduced ejection fraction (HFrEF) and the first to include measures of vascular function and mitochondrial respiration. Although daily supplementation increased plasma nitrite, our data indicate that supplementation with inorganic nitrate as a standalone treatment is ineffective at improving exercise capacity, vascular function, or mitochondrial respiration in patients with HFrEF.

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231Global myocardial longitudinal strain by feature tracking cardiac magnetic resonance does not influence the prognosis of patients with heart failure with reduced ejection fraction

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jez113.004 ◽

2019 ◽

Vol 20 (Supplement_2) ◽

Author(s):

M S Amzulescu ◽

L Houard ◽

M R Rousseau ◽

S A Ahn ◽

M B Benaets ◽

...

Keyword(s):

Heart Failure ◽

Cardiac Magnetic Resonance ◽

Magnetic Resonance ◽

Ejection Fraction ◽

Feature Tracking ◽

Longitudinal Strain ◽

Reduced Ejection Fraction ◽

Patients With Heart Failure

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Clinical Utility of Exercise Training in Heart Failure with Reduced and Preserved Ejection Fraction

Clinical Medicine Insights Cardiology ◽

10.4137/cmc.s21372 ◽

2015 ◽

Vol 9 ◽

pp. CMC.S21372 ◽

Cited By ~ 9

Author(s):

Muhammad Asrar Ul Haq ◽

Cheng Yee Goh ◽

Itamar Levinger ◽

Chiew Wong ◽

David L. Hare

Keyword(s):

Heart Failure ◽

Exercise Training ◽

Ejection Fraction ◽

Exercise Tolerance ◽

Exercise Intolerance ◽

Sufficient Evidence ◽

Preserved Ejection Fraction ◽

Reduced Ejection Fraction ◽

Patients With Heart Failure

Reduced exercise tolerance is an independent predictor of hospital readmission and mortality in patients with heart failure (HF). Exercise training for HF patients is well established as an adjunct therapy, and there is sufficient evidence to support the favorable role of exercise training programs for HF patients over and above the optimal medical therapy. Some of the documented benefits include improved functional capacity, quality of life (QoL), fatigue, and dyspnea. Major trials to assess exercise training in HF have, however, focused on heart failure with reduced ejection fraction (HFREF). At least half of the patients presenting with HF have heart failure with preserved ejection fraction (HFPEF) and experience similar symptoms of exercise intolerance, dyspnea, and early fatigue, and similar mortality risk and rehospitalization rates. The role of exercise training in the management of HFPEF remains less clear. This article provides a brief overview of pathophysiology of reduced exercise tolerance in HFREF and heart failure with preserved ejection fraction (HFPEF), and summarizes the evidence and mechanisms by which exercise training can improve symptoms and HF. Clinical and practical aspects of exercise training prescription are also discussed.

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