scholarly journals Moderate intensity exercise training in heart failure with preserved ejection fraction: functional and structural benefits (The MIET-HFpEF trial)

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
A El Amrawy ◽  
M Hassanein ◽  
S Ayad ◽  
F Eldabe
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Medical Care ◽  
Diastolic Function ◽  
Functional Capacity ◽  
Left Ventricular ◽  
Preserved Ejection Fraction ◽  
Walk Test ◽  
6 Minute Walk Test ◽  
Minute Walk

Abstract Background Heart failure with preserved ejection fraction (HFpEF) represents more than one half of the heart failure cases worldwide with increased morbidity and mortality. No proven medical treatment till now have shown mortality benefit in HFpEF. This study aims to elucidate the benefits of cardiac rehabilitation (CR) in HFpEF. Methods Sixty patients with HFpEF were included in 2 groups with 1:1 randomization.Group1 received usual medical care plus 2–3 rehabilitation sessions per week using moderate exercise with 40–75% of heart rate reserve on treadmill (up to 60 minutes according to the functional capacity). Group 2 received only usual medical care. Comparison between the 2 groups recording the percentage of improvement in echocardiographic diastolic function parameters, Minnesota living with heart failure questionnaire (MLWHFQ) and 6 -minute walk test at baseline and after 12 weeks. Results Group 1 showed significant improvement in the following: a. MLWHFQ (total score mean percentage of reduction) 305.60±158.44 versus (vs) 69.44±17.71 (p<0.001).b. E/e' mean percentage of reduction 65.96±34.55 vs 18.23±13.98 (p<0.001). c. Left atrial (LA) volume index mean percentage of reduction 27.86±13.27 vs 8.03±4.40 (p<0.001). d. Pulmonary artery systolic pressure mean percentage of reduction was 33.85±14.68 vs 22.97±16.54 (p=0.02). e. 6–minute walk test 111.79±40.97 vs 46.33±11.58 (p<0.001). f. Body mass index percentage of reduction 10.17±3.64 vs 2.80±1.60 (p<0.001). g. Percentage of patients with down-grading of the degree of diastolic dysfunction: 10 patients (33.3%) vs 3 patients (10%) (P=0.028). h. However, there were no significant differences in left ventricular ejection fraction or other parameters as E/A ratio, LA dimension, isovolumetric relaxation time, degree of left ventricular hypertrophy. Conclusion CR not only added significant functional improvement in the quality of life and functional capacity in patients with HFpEF but also a significant structural improvement by improving the core items of diastolic function. In the light of the results of this study, we can recommend CR as a part of HFpEF management. FUNDunding Acknowledgement Type of funding sources: None.

Direct Myocardial Implantation of Human Fetal Stem Cells in Heart Failure Patients: Long-term Results

2010 ◽  
Vol 13 (1) ◽  
pp. 31 ◽  
Author(s):  
Federico Benetti ◽  
Ernesto Pe�herrera ◽  
Teodoro Maldonado ◽  
Yan Duarte Vera ◽  
Valvanur Subramanian ◽  
...  
Keyword(s):  
Heart Failure ◽  
Stem Cells ◽  
Cardiac Function ◽  
Nyha Class ◽  
Left Ventricular ◽  
Long Term Results ◽  
Walk Test ◽  
The Mean ◽  
6 Minute Walk Test ◽  
Minute Walk

Background: End-stage heart failure (HF) is refractory to current standard medical therapy, and the number of donor hearts is insufficient to meet the demand for transplantation. Recent studies suggest autologous stem cell therapy may regenerate cardiomyocytes, stimulate neovascularization, and improve cardiac function and clinical status. Although human fetal-derived stem cells (HFDSCs) have been studied for the treatment of a variety of conditions, no clinical studies have been reported to date on their use in treating HF. We sought to determine the efficacy and safety of HFDSC treatment in HF patients.Methods and Results: Direct myocardial transplantation of HFDSCs by open-chest surgical procedure was performed in 10 patients with HF due to nonischemic, nonchagasic dilated cardiomyopathy. Before and after the procedure, and with no changes in their preoperative doses of medications (digoxin, furosemide, spironolactone, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, betablockers), patients were assessed for New York Heart Association (NYHA) class, performance in the exercise tolerance test (ETT), ejection fraction (EF), left ventricular end-diastolic dimension (LVEDD) via transthoracic echocardiography, performance in the 6-minute walk test, and performance in the Minnesota congestive HF test. All 10 patients survived the operation. One patient had a stroke 3 days after the procedure, and although she later recovered, she was unable to perform the follow-up tests. Another male patient experienced pericardial effusion 3 weeks after the procedure. Although it resolved spontaneously, the patient abandoned his control tests and died 5 months after the procedure. An autopsy of the myocardium suggested that new young cells were present in the cardiomyocyte mix. At 40 months, the mean (SD) NYHA class decreased from 3.4 0.5 to 1.33 0.5 (P = .001); the mean EF increased 31%, from 26.6% 4% to 34.8% 7.2% (P = .005); and the mean ETT increased 291.3%, from 4.25 minutes to 16.63 minutes (128.9% increase in metabolic equivalents, from 2.46 to 5.63) (P < .0001); the mean LVEDD decreased 15%, from 6.85 0.6 cm to 5.80 0.58 cm (P < .001); mean performance in the 6-minute walk test increased by 43.2%, from 251 113.1 seconds to 360 0 seconds (P = .01); the mean distance increased 64.4%, from 284.4 144.9 m to 468.2 89.8 m (P = .004); and the mean result in the Minnesota test decreased from 71 27.3 to 6 5.9 (P < .001).Conclusion: Although these initial findings suggest direct myocardial implantation of HFDSCs is feasible and improves cardiac function in HF patients at 40 months, more clinical research is required to confirm these observations.

scholarly journals Application of the current HFA-ESC consensus guidelines on diagnosis of heart failure with preserved ejection fraction to a population referred for echocardiography

2021 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
K Liang ◽  
R Hearse-Morgan ◽  
S Fairbairn ◽  
Y Ismail ◽  
AK Nightingale
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Ejection Fraction ◽  
Diastolic Function ◽  
Global Longitudinal Strain ◽  
Diagnostic Algorithm ◽  
Left Ventricular ◽  
Lv Function ◽  
Preserved Ejection Fraction ◽  
Consensus Guidelines

Abstract Funding Acknowledgements Type of funding sources: None. BACKGROUND The recent Heart Failure Association (HFA) of the European Society of Cardiology (ESC) consensus guidelines on diagnosis of heart failure with preserved ejection fraction (HFpEF) have developed a simple diagnostic algorithm for clinical use. PURPOSE To assess whether echocardiogram (echo) parameters needed to assess diastolic function are routinely collected in patients referred for assessment of heart failure symptoms. METHODS Retrospective analysis of echo referrals in January 2020 were assessed for parameters of diastolic function as per step 2 of the HF-PEFF diagnostic algorithm.  Echo images and clinical reports were reviewed. Electronic records were utilised to obtain clinical history, blood results (NT-proBNP) and demographic data. RESULTS 1330 patients underwent an echo in our department during January 2020. 83 patients were referred with symptoms of heart failure without prior history of cardiac disease; 20 patients found to have impaired left ventricular (LV) function were excluded from analysis. Of the 63 patients with possible HFpEF, HF-PEFF score was low in 18, intermediate in 33 and high in 12. Median age was 68 years (range 32 to 97 years); 25% had a BMI &gt;30. There was a high prevalence of hypertension (52%), diabetes (19%) and atrial fibrillation (40%) (cf. Table 1). Body surface area (BSA) was documented in 65% of echo reports. Most echo parameters were recorded with the exception of global longitudinal strain (GLS) and indexed LV mass (cf. image 1). NT-proBNP was recorded in only 20 patients (31.7%). 12 patients with an intermediate HF-PEFF score could have been re-categorised to a high score depending on GLS and NT-proBNP (which were not recorded). CONCLUSION More than three quarters of echoes acquired in our department obtained the relevant parameters to assess diastolic function. The addition of BSA, and inclusion of NT-proBNP, and GLS would have been additive to a third of ‘intermediate’ patients to determine definite HFpEF. Our study demonstrates that the current HFA-ESC diagnostic algorithm and HF-PEFF scoring system are easy to use, highly relevant and applicable to current clinical practice. Age &gt;70 years 29 (46.0%) Obesity (BMI &gt;30) 16 (25.4%) Diabetes 12 (19%) Hypertension 33 (52.4%) Atrial Fibrillation 25 (39.7%) ECG abnormalities 18 (28.5%) Table 1. Prevalence of Clinical Risk Factors Abstract Figure. Image 1. HFPEFF score & echo parameters

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