scholarly journals 348Association of arterial stiffness with left ventricular remodelling in heart failure with preserved ejection fraction

2019 ◽  
Vol 20 (Supplement_2) ◽  
Author(s):  
L Athithan ◽  
P K Kanagala ◽  
A Singh ◽  
G S Gulsin ◽  
M P M Graham-Brown ◽  
...  
Keyword(s):  
Heart Failure ◽  
Arterial Stiffness ◽  
Ejection Fraction ◽  
Left Ventricular ◽  
Preserved Ejection Fraction ◽  
Ventricular Remodelling ◽  
Left Ventricular Remodelling

scholarly journals 155 Effects on sacubitril/valsartan on natriuretic peptides in patients with a reduced ejection fraction

2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Norman Lamaida ◽  
Antonio Cerciello
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Positive Impact ◽  
Real Life ◽  
Left Ventricular ◽  
Favourable Effect ◽  
Ventricular Remodelling ◽  
Left Ventricular Remodelling ◽  
Positive Effects

Abstract Aims The PARADIGM-HF trial proved the superiority of sacubitril/valsartan (Sa/Va) vs. enalapril in reducing mortality and hospitalization for heart failure (HF). Sacubitril/valsartan, new drug used in treatment of heart failure with reduced systolic function (HFrEF) has recently been shown to improve tolerance to exercise and cardiovascular performance. Methods and results We prospectively enrolled 40 outpatient patients with HFrEF with indication for therapy with sacubitril/valsartan and subjected to serial controls with blood tests, echocardiogram before and during gradual optimization of therapy, with the aim of evaluating the effects of the drug on left ventricular remodelling. We studied 40 patients treated with sacubitril/valsartan for at least 3 months. After a mean follow-up of 120 ± 40 days, 95% of patients reached the maximum dose of the drug without major side effects. The ejection fraction increased while end-diastolic and end-systolic volumes of the left ventricle decreased. We also observed a significant reduction in NT-proBNP values without significant worsening of renal function or hyperkalaemia. There NYHA functional class has improved with a positive impact on the prognosis of heart failure at 2 years (P = 0.006). Conclusions In our population, medium-term treatment with sacubitril/valsartan demonstrated a favourable effect on left ventricular remodelling and functional status, confirming the data of previous clinical trials in real life. One more follow-up long and a larger population will help confirm these to confirm these positive effects of the drug on patients with HfrEF.

scholarly journals Congestive heart failure with preserved ejection fraction is associated with severely impaired dynamic Starling mechanism

2011 ◽  
Vol 110 (4) ◽  
pp. 964-971 ◽  
Author(s):  
Shigeki Shibata ◽  
Jeff L. Hastings ◽  
Anand Prasad ◽  
Qi Fu ◽  
Paul S. Bhella ◽  
...  
Keyword(s):  
Heart Failure ◽  
Congestive Heart Failure ◽  
Transfer Function ◽  
Arterial Stiffness ◽  
Ejection Fraction ◽  
Diastolic Pressure ◽  
Left Ventricular ◽  
Preserved Ejection Fraction ◽  
Transfer Function Analysis ◽  
And Control

Sedentary aging leads to increased cardiovascular stiffening, which can be ameliorated by sufficient amounts of lifelong exercise training. An even more extreme form of cardiovascular stiffening can be seen in heart failure with preserved ejection fraction (HFpEF), which comprises ∼40∼50% of elderly patients diagnosed with congestive heart failure. There are two major interrelated hypotheses proposed to explain heart failure in these patients: 1) increased left ventricular (LV) diastolic stiffness and 2) increased arterial stiffening. The beat-to-beat dynamic Starling mechanism, which is impaired with healthy human aging, reflects the interaction between ventricular and arterial stiffness and thus may provide a link between these two mechanisms underlying HFpEF. Spectral transfer function analysis was applied between beat-to-beat changes in LV end-diastolic pressure (LVEDP; estimated from pulmonary artery diastolic pressure with a right heart catheter) and stroke volume (SV) index. The dynamic Starling mechanism (transfer function gain between LVEDP and the SV index) was impaired in HFpEF patients ( n = 10) compared with healthy age-matched controls ( n = 12) (HFpEF: 0.23 ± 0.10 ml·m−2·mmHg−1 and control: 0.37 ± 0.11 ml·m−2·mmHg−1, means ± SD, P = 0.008). There was also a markedly increased (3-fold) fluctuation of LV filling pressures (power spectral density of LVEDP) in HFpEF patients, which may predispose to pulmonary edema due to intermittent exposure to higher pulmonary capillary pressure (HFpEF: 12.2 ± 10.4 mmHg2 and control: 3.8 ± 2.9 mmHg2, P = 0.014). An impaired dynamic Starling mechanism, even more extreme than that observed with healthy aging, is associated with marked breath-by-breath LVEDP variability and may reflect advanced ventricular and arterial stiffness in HFpEF, possibly contributing to reduced forward output and pulmonary congestion.

Worsening Renal Function during Index Hospitalization Does Not Predict Prognosis in Heart Failure with Preserved Ejection Fraction Patients

Cardiology ◽  
2021 ◽  
pp. 1-8
Author(s):  
Ravi Rasalingam ◽  
Rachel Parker ◽  
Katherine E. Kurgansky ◽  
Luc Djousse ◽  
David Gagnon ◽  
...  
Keyword(s):  
Heart Failure ◽  
Renal Function ◽  
Ejection Fraction ◽  
Left Ventricular ◽  
Incidence Density ◽  
Preserved Ejection Fraction ◽  
Index Hospitalization ◽  
Risk Of Death ◽  
Worsening Renal Function ◽  
Group 1

<b><i>Introduction:</i></b> Worsening renal function (WRF) predicts poor prognosis in patients with left ventricular systolic dysfunction. The effect of WRF in heart failure with preserved ejection fraction (HFpEF) is unclear. <b><i>Objective:</i></b> The objective of this study was to determine whether WRF during index hospitalization for HFpEF is associated with increased death or readmission for heart failure. <b><i>Methods:</i></b> National Veterans Affairs electronic medical data recorded between January 1, 2002, and December 31, 2014, were screened to identify index hospitalizations for HFpEF using an iterative algorithm. Patients were divided into 3 groups based on changes in serum Cr (sCr) during this admission. WRF was defined as a rise in sCr ≥0.3 mg/dL. Group 1 had no evidence of WRF, group 2 had transient WRF, and group 3 had persistent WRF at the time of discharge. <b><i>Results:</i></b> A total of 10,902 patients with index hospitalizations for HFpEF were identified (mean age 72, 97% male). Twenty-nine percent had WRF during this hospital admission, with 48% showing recovery of sCr and 52% with no recovery at discharge. The mortality rate over a mean follow-up duration of 3.26 years was 72%. Compared to group 1, groups 2 and 3 showed no significant difference in risk of death from any cause (hazard ratio [HR] = 0.95 [95% confidence interval [CI]: 0.87, 1.03] and 1.02 [95% CI: 0.93, 1.11], respectively), days hospitalized for any cause (incidence density ratio [IDR] = 1.01 [95% CI: 0.92, 1.11] and 1.01 [95% CI: 0.93, 1.11], respectively), or days hospitalized for heart failure (IDR = 0.94 [95% CI: 0.80, 1.10] and 0.94 [95% CI: 0.81, 1.09], respectively) in analyses adjusted for covariates affecting renal function and outcomes. <b><i>Conclusions:</i></b> While there is a high incidence of WRF during index hospitalizations for HFpEF, WRF is not associated with an increased risk of death or hospitalization. This suggests that WRF alone should not influence decisions regarding heart failure management.

Sign in / Sign up

Export Citation Format

Share Document