Effects of long-term β-blockade in patients with chronic heart failure of non-ischemic etiology and restrictive pattern of left ventricular diastolic filling

1999 ◽  
Vol 5 (3) ◽  
pp. 42
Author(s):  
Nikolay P. Nikitin ◽  
Anis L. Alyavi ◽  
Valentina Yu Goloskokova
Keyword(s):  
Heart Failure ◽  
Chronic Heart Failure ◽  
Left Ventricular ◽  
Diastolic Filling ◽  
Restrictive Pattern ◽  
Left Ventricular Diastolic Filling

scholarly journals Etiology and Prognosis of Cardiogenic Shock in a Secondary Center without Surgical Back-Up

2019 ◽  
Vol 2019 ◽  
pp. 1-7 ◽  
Author(s):  
Laurent Bonello ◽  
Marc Laine ◽  
Etienne Puymirat ◽  
Victoria Ceccaldi ◽  
Mélanie Gaubert ◽  
...  
Keyword(s):  
Heart Failure ◽  
Chronic Heart Failure ◽  
Cardiogenic Shock ◽  
Left Ventricular ◽  
Rank Test ◽  
First Episode ◽  
Common Cause ◽  
Secondary Center ◽  
Acute Decompensation

Background. Cardiogenic shock (CS) remains a major challenge in contemporary cardiology. Data regarding CS etiologies and their prognosis are limited and mainly derived from tertiary referral centers. Aims. To investigate the current etiologies of cardiogenic shock and their associated short- and long-term outcomes in a secondary center without surgical back-up. Methods. We performed an observational prospective monocenter study. All patients admitted for a first episode of CS related to left ventricular dysfunction were enrolled. The definition of CS was consistent with the European Society of Cardiology guidelines. Patients were followed for 6 months. Etiologies were analyzed, and survival rates derived from Kaplan-Meier estimates were compared with the log-rank test. Results. Between January 2015 and January 2016, 152 patients were included. The first most common cause of CS was acute decompensation of chronic heart failure (CHF). Acute coronary syndromes (ACS) were the second most common cause of CS (35.4%). At one month, the all-cause mortality rate was 39.5% and was similar between ACS and CHF (43% vs 35%, respectively; p=0.7). In a landmark analysis between 1 and 6 months, we observed a significantly higher mortality in patients with CHF than in patients with ACS (18% vs. 0%; p=0.01). Conclusions. In the present registry, acute decompensation of chronic heart failure was the most common cause of CS, while ACS complicated by CS was the second most common cause. Of importance, acute decompensation of CHF was associated with a significantly worse outcome than ACS in the long term.

scholarly journals Features of structural and geometric remodeling of the heart and changes in heart diastolic filling in patients with chronic heart failure of ischemic genesis with reduced left ventricular ejection fraction

2021 ◽  
Vol 23 (1) ◽  
pp. 17-23
Author(s):  
V. A. Lysenko
Keyword(s):  
Heart Failure ◽  
Chronic Heart Failure ◽  
Left Ventricular Ejection Fraction ◽  
Left Ventricle ◽  
Systolic Pressure ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Diastolic Filling ◽  
Ventricular Ejection Fraction ◽  
Lv Mass

Chronic heart failure (CHF) does not lose its leading position among the problems of cardiovascular disease. Pathological cardiac remodeling combines the processes of hypertrophy and dilatation of cavities and is the main cause of heart failure progression, and consequently results in high cardiac mortality, especially in CHF patients with reduced left ventricular ejection fraction (LV EF). Despite a substantial range of studies on the features of structural and geometric remodeling of the heart, changes in systolic and diastolic function of the ventricles in CHF patients, this issue still presents a challenge and needs to be improved. The aim of the work – to examine changes in structural and geometric parameters and diastolic function of the heart in patients with CHF of ischemic genesis with reduced LV EF. Materials and methods. The study included 79 patients (men – n = 49; women – n = 30) with CHF of ischemic origin with reduced LV EF, sinus rhythm, stage II AB, NYHA II-IV FC (the main group), and 90 patients with coronary heart disease without signs of CHF (men – n = 40, 44.5 %; women – n = 50, 55.5 %), (the comparison group). The patient groups were age-, sex-, height-, weight-, body surface area-matched. Doppler echocardiographic examination was performed on the device Esaote MyLab Eight (Italy). Results. In CHF patients with reduced LV EF, the following indicators prevailed: EDD LV by 18 % (P = 0.001), LV EDV by 45.8 % (P = 0.001), LV EDV index by 44.6 % (P = 0.001), LV ESD by 44.9 % (P = 0.001), PW by 17.7 % (P = 0.001), LV mass index by 66.6 % (P = 0.001) according to the Penn Convention, and by 62.1 % (P = 0.001) according to the ASE; 16.1 % (P = 0.010) increased RV cavity without changes in its wall thickness. In patients with CHF of ischemic origin with reduced LV EF, the main types of LV geometry were: eccentric (70 %) and concentric (24 %) LV hypertrophy. More than half of the CHF patients with reduced LV EF had significant disorders of LV diastolic filling (25 % – “restrictive” and 28 % “pseudonormal”), a 2.3 times increase (P = 0.001) in E/e’ ratio, a 35 % (P = 0.014) increase in the left atrial volume index and 32 % (P = 0.0001) – in pulmonary capillary wedge pressure (PCWP), increased mean and systolic pressure in the pulmonary artery by 1.5 times (P = 0.002) and 1.6 times (P = 0.0001), respectively. Conclusions. Structural and geometric remodeling of the left ventricle in patients with CHF of ischemic origin with reduced LV EF occurs due to an increase in LV myocardial mass via thickening of its walls and cavity dilatation (44.6 % (P = 0.001) increase in the LV EDV index), as well as 66.6 % (P = 0.001) increase in LV mass index with the predominance of eccentric (70 %) and concentric hypertrophy (24 %) over other types of LV geometry. Severe disorders of LV diastolic filling (25 % – “restrictive” and 28 % “pseudonormal”) are attributable to the significant increase in end-diastolic pressure in the left ventricle (2.3 times increase (P = 0.001) in E/e´) with the development of postcapillary pulmonary hypertension (1.5 times increase (P = 0.002) in the mean and 1.6 times (P = 0.0001) – in systolic pressure in the pulmonary artery).

scholarly journals Epidemiology and long-term outcome in outpatients with chronic heart failure in Northwestern Europe

Heart ◽  
2019 ◽  
Vol 105 (16) ◽  
pp. 1252-1259 ◽  
Author(s):  
Hanna Fröhlich ◽  
Niklas Rosenfeld ◽  
Tobias Täger ◽  
Kevin Goode ◽  
Syed Kazmi ◽  
...  
Keyword(s):  
Heart Failure ◽  
Chronic Heart Failure ◽  
Ejection Fraction ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Term Survival ◽  
Period 2 ◽  
Wide Range ◽  
Ambulatory Patients

ObjectiveTo describe the epidemiology, long-term outcomes and temporal trends in mortality in ambulatory patients with chronic heart failure (HF) with reduced (HFrEF), mid-range (HFmrEF) or preserved ejection fraction (HFpEF) from three European countries.MethodsWe identified 10 312 patients from the Norwegian HF Registry and the HF registries of the universities of Heidelberg, Germany, and Hull, UK. Patients were classified according to baseline left ventricular ejection fraction (LVEF) and time of enrolment (period 1: 1995–2005 vs period 2: 2006–2015). Predictors of mortality were analysed by use of univariable and multivariable Cox regression analyses.ResultsAmong 10 312 patients with stable HF, 7080 (68.7%), 2086 (20.2%) and 1146 (11.1%) were classified as having HFrEF, HFmrEF or HFpEF, respectively. A total of 4617 (44.8%) patients were included in period 1, and 5695 (55.2%) patients were included in period 2. Baseline characteristics significantly differed with respect to type of HF and time of enrolment. During a median follow-up of 66 (33–105) months, 5297 patients (51.4%) died. In multivariable analyses, survival was independent of LVEF category (p>0.05), while mortality was lower in period 2 as compared with period 1 (HR 0.81, 95% CI 0.72 to 0.91, p<0.001). Significant predictors of all-cause mortality regardless of HF category were increasing age, New York Heart Association functional class, N-terminal pro-brain natriuretic peptide and use of loop diuretics.ConclusionAmbulatory patients with HF stratified by LVEF represent different phenotypes. However, after adjusting for a wide range of covariates, long-term survival is independent of LVEF category. Outcome significantly improved during the last two decades irrespective from type of HF.

Abstract 2395: Treatment of Nocturnal Cheyne - Stokes - Respiration by Adaptive Servoventilation Improves Sleep Disordered Breathing and Cardiopulmonary Function in Patients with Chronic Heart Failure

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Olaf Oldenburg ◽  
Thomas Bitter ◽  
Anke Schmidt ◽  
Birgit Wellmann ◽  
Roman Lehmann ◽  
...  
Keyword(s):  
Heart Failure ◽  
Chronic Heart Failure ◽  
Left Ventricular ◽  
Peak Oxygen Consumption ◽  
Left Ventricular Ejection ◽  
Apnea Hypopnea Index ◽  
Adaptive Servoventilation ◽  
Ventricular Ejection Fraction ◽  
Before And After

Cheyne - Stokes respiration (CSR) is common in patients (pts) with chronic heart failure (CHF) and accompanied by an impaired prognosis. Nocturnal adaptive servoventilation (ASV) was recently introduced to treat CSR in CHF. Aim of this study was the investigation of long-term ASV effects on CSR and CHF parameters. In 41 pts with CHF treated according to current guidelines (39 male; 64.8 ± 10years, NYHA ≥ II, LV-EF ≤ 40%) cardiorespiratory polygraphy (PG), cardiopulmonary exercise (CPX) testing and echocardiography was performed before and after 11.6 ± 5.9 months (median 10.3 months) of ASV treatment (AutoSet CS ™ 2, ResMed). In our cohort, mean duration of ASV usage during night was 6:25 ± 1:08 h, while the device was used in 82 ± 21% of possible nights. Apnea-hypopnea-index and apnea-index were reduced from 38.2 ± 11/h to 5.5 ± 7/h and 24.2 ± 14/h to 2.5 ± 5/h, respectively (both p < 0.001). Minimum oxygen saturation rose from 81.4 ± 4.9% to 85.6 ± 4.3% (p < 0.001) while mean oxygen desaturation was reduced from 6.8 ± 2.5% to 4.6 ± 1.8% (p < 0.001). Peak oxygen consumption (VO 2 ) during CPX testing increased from 15.2 ± 3.7ml/kg/min to 17.1 ± 4.7ml/kg/min and predicted peak VO 2 from 60.1 ± 13% to 68.5 ± 18% (both p < 0.05). Left ventricular ejection fraction increased from 29.9 ± 6.6% to 33.3 ± 10.6% (p < 0.05). In selected and compliant pts with CHF and CSR, addition of nocturnal ASV therapy to standard heart failure therapy is able to abolish CSR and improve cardiac function. Whether this improvement in SDB and CHF parameters is accompanied with an improvement in CHF prognosis is not yet known.

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