Multi-modality imaging in hypertrophic cardiomyopathy: intermodal discrepancies in key prognostic parameters

Abstract Background/Introduction Multi-modality imaging is crucial for confirming diagnosis and assessing prognosis in patients with hypertrophic cardiomyopathy (HCM). However, inter-modality discrepancies in key parameters are commonly reported. Purpose To assess real-world inter-modal reporting discrepancies between transthoracic echocardiography (TTE) and cardiac magnetic resonance (CMR) imaging in the measurement of four key parameters in HCM patients. Methods Consecutive HCM patients with TTE and CMR performed within 6 months of each other at a tertiary centre were retrospectively assessed for reported maximum wall thickness (MWT), left atrial diameter (LAd), left ventricular ejection fraction (LVEF) and presence of left ventricular apical aneurysm (LVAA). The CMR report was considered gold standard. Data are reported as mean ± standard deviation (SD) or median and interquartile range (IQR) as appropriate. Results 353 consecutive HCM patients (72% male, median age 60.9 years, IQR 49.8–71.6 years) with TTE and CMR within 6 months (median difference 1.7 months, IQR 1.1–3.4 months) were assessed between 4th January 2018 and 9th April 2019. Of 284 patients with paired MWT data, median difference was 0.0 mm (IQR −1.0 to 3.0 mm, p=0.02), likely representing a difference in distributions of MWT. TTE both over and underestimated MWT (in 36% and 46% cases respectively). Of the 94 patients with paired LAd data, mean difference was 0.4±5.7 mm (95% CI −0.8010 to 1.546, p=0.5). N=320 patients with paired LVEF data (after excluding patients with atrial fibrillation (n=20)). Median difference in LVEF was 12% (IQR 5–19% p<0.0001). TTE underestimated LVEF in 88% of cases. CMR and TTE both identified 14 (5%) patients as having LVEF <50%. There were however 8 cases of disagreement in classification of LVEF <50%, due to over (n=4) or underestimation (n=4) by TTE. LVAA was accurately identified by TTE in only 9/30 (30%) of those patients with demonstrable LVAA by CMR (p=0.0008). TTE evidence of a discreet apical chamber (paradoxical jet on spectral or colour Doppler) was present in 16/21 (76%) cases where TTE failed to overtly identify LVAA. However, apical or mid-cavity obliteration was reported in 15/21 (71%) cases where TTE failed to identify LVAA. Conclusion(s) Echocardiography and CMR measurements are often used interchangeably in clinical practice but inter-modality discrepancies can affect diagnosis and sudden cardiac death (SCD) risk assessment. This is particularly important for binary risk factors such as LVEF<50% or LVAA which are considered major SCD risk factors in the latest American Heart Association guidelines. 25 (7%) patients in our cohort had major risk factors identified by CMR that were not identified on TTE. CMR is an important, recommended tool where TTE imaging is suboptimal, but attention to more subtle elements of abnormal intracavity blood flow may be able to increase LVAA detection during TTE. FUNDunding Acknowledgement Type of funding sources: None.

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Mid-regional proatrial natriuretic peptide for predicting prognosis in hypertrophic cardiomyopathy

Heart ◽

10.1136/heartjnl-2019-314826 ◽

2019 ◽

pp. heartjnl-2019-314826 ◽

Cited By ~ 2

Author(s):

Céline Bégué ◽

Stellan Mörner ◽

Dulce Brito ◽

Christian Hengstenberg ◽

John G F Cleland ◽

...

Keyword(s):

Heart Failure ◽

New York ◽

Hypertrophic Cardiomyopathy ◽

Natriuretic Peptide ◽

Nyha Class ◽

Heart Association ◽

Roc Curves ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Ventricular Ejection Fraction

ObjectivesN-terminal probrain natriuretic peptide (NT-proBNP) predicts mortality and the development of heart failure in hypertrophic cardiomyopathy (HCM). Mid-regional proatrial natriuretic peptide (MR-proANP) is a stable by-product of production of atrial natriuretic peptide. We sought to compare the prognostic value of MR-proANP and NT-proBNP in HCM.MethodsWe prospectively enrolled a cohort of patients with HCM from different European centres and followed them. All patients had clinical, ECG and echocardiographic evaluation and measurement of MR-proANP and NT-proBNP at inclusion.ResultsOf 357 patients enrolled, the median age was 52 (IQR: 36–65) years. MR-proANP and NT-proBNP were both independently associated with age, weight, New York Heart Association (NYHA) class, left ventricular ejection fraction (LVEF), wall thickness and left atrial dimension. During a median follow-up of 23 months, 32 patients had a primary end point defined as death (n=6), heart transplantation (n=8), left ventricular assist device implantation (n=1) or heart failure hospitalisation (n=17). Both NT-proBNP and MR-proANP (p<10–4) were strongly associated with the primary endpoint, and the areas under the receiver operating characteristic (ROC) curves for both peptides were not significantly different. However, in a multiple stepwise regression analysis, the best model for predicting outcome was NYHA 1–2 vs 3–4 (HR=0.35, 95% CI 0.16 to 0.77, p<0.01), LVEF (HR=0.96, 95% CI 0.94 to 0.98, p=0.0005) and MR-proANP (HR=3.77, 95% CI 2.01 to 7.08, p<0.0001).ConclusionsMR-proANP emerges as a valuable biomarker for the prediction of death and heart failure related events in patients with HCM.

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Long-term outcomes and left ventricular diastolic function of sarcomere mutation-positive and mutation-negative patients with hypertrophic cardiomyopathy: a prospective cohort study

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jeaa317 ◽

2020 ◽

Author(s):

Ching-Yu Julius Chen ◽

Mao-Yuan Marine Su ◽

Ying-Chieh Liao ◽

Fu-Lan Chang ◽

Cho-Kai Wu ◽

...

Keyword(s):

New York ◽

Hypertrophic Cardiomyopathy ◽

Nyha Class ◽

Global Longitudinal Strain ◽

Heart Association ◽

Left Ventricular Diastolic Function ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Class Iii ◽

Ventricular Ejection Fraction

Abstract Aims Hypertrophic cardiomyopathy (HCM) is an inheritable disease that leads to sudden cardiac death and heart failure (HF). Sarcomere mutations (SMs) have been associated with HF. However, the differences in ventricular function between SM-positive and SM-negative HCM patients are poorly characterized. Methods and results Of the prospectively enrolled 374 unrelated HCM patients in Taiwan, 115 patients underwent both 91 cardiomyopathy-related gene screening and cardiovascular magnetic resonance (45.6 ± 10.6 years old, 76.5% were male). Forty pathogenic/likely pathogenic mutations were identified in 52 patients by next-generation sequencing. The SM-positive group were younger at first cardiovascular event (P = 0.04) and progression to diastolic HF (P = 0.02) with higher N-terminal pro-brain natriuretic peptide (NT-proBNP) [New York Heart Association (NYHA) Class III/IV symptoms with left ventricular ejection fraction > 55%] than the SM-negative group (P < 0.001). SM-positive patients had a greater extent of late gadolinium enhancement (P = 0.01), larger left atrial diameter (P = 0.03), higher normalized peak filling rate (PFR) and PFR ratio, and a greater reduction in global longitudinal strain than SM-negative patients (all P ≤ 0.01). During mean lifelong follow-up time (49.2 ± 15.6 years), SM-positive was a predictor of earlier HF (NYHA Class III/IV symptoms) after multivariate adjustment (hazard ratio 3.5; 95% confidence interval 1.3–9.7; P = 0.015). Conclusion SM-positive HCM patients had a higher extent of myocardial fibrosis and more severe ventricular diastolic dysfunction than those without, which may contribute to earlier onset of advanced HF, suggesting the importance of close surveillance and early treatment throughout life.

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P1395 New predictors of burned-out phase in hypertrophic cardiomyopathy

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jez319.828 ◽

2020 ◽

Vol 21 (Supplement_1) ◽

Author(s):

D M Adamczak ◽

A Rogala ◽

M Antoniak ◽

Z Oko-Sarnowska

Keyword(s):

Risk Factors ◽

Hypertrophic Cardiomyopathy ◽

Left Ventricular Ejection Fraction ◽

Systolic Dysfunction ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Average Strain ◽

Ventricular Ejection Fraction ◽

Study Population ◽

Student Test

Abstract BACKGROUND Hypertrophic cardiomyopathy (HCM) is a heart disease characterized by hypertrophy of the left ventricular myocardium. The structural and functional abnormalities cannot be explained by flow-limiting coronary artery disease or loading conditions. HCM has a benign course, however approximately 5% of these patients suffer from the end-stage of the disease. The so-called burned-out phase, characterized by systolic dysfunction with a left ventricular ejection fraction ≤50%, is often associated with wall thinning and chamber dilation. These patients should have more frequent clinic visits and have a more intensive treatment plan. They are also candidates for heart transplantation. Currently there are no risk factors of progression to burned-out phase before the onset of heart failure symptoms. Therefore, the potential risk factors: left ventricular global longitudinal strain (GLS), left ventricular average strain (ASI), right ventricular average strain (RV-ASI) and left atrial volume index (LAVI), have been examined. GLS, derived from speckle tracking echocardiography, and ASI, derived from tissue doppler imaging, are the sensitive and noninvasive methods of assessing the ventricular function. LAVI more accurately characterizes the size of the left atrium, which usually increases in the course of the disease. METHODS A total of 252 patients with HCM (aged 20-88 years, 49,6% were men), treated in our Department have been enrolled in the study. GLS, ASI, RV-ASI and LAVI assessment has been made in addition to standard echocardiographic examination. Burned-out was characterized as systolic dysfunction with a left ventricular ejection fraction ≤50%. RESULTS 5.6% patients in the study population were diagnosed with burned-out phase in hypertrophic cardiomyopathy. The t-Student test and t-Student test with Cochran-Cox adjustment showed statistically significant differences of GLS and ASI values between burned-out and non-burned-out groups; p = 0.000001 and p < 0.000001, respectively. Average and median values of GLS in burned-out group were -7.4% ± 2.9%, -7.1% and -15.3% ± 4.3%, -15.4% in non-burned-out group. For ASI those values were respectively -7.6% ± 2.2%, -7.1% and -12.9% ± 4.5%, -13.0%. The Mann-Whitney test showed statistically significant differences of RV-ASI and LAVI values between burned-out and non-burned-out groups; p = 0.000208 and p = 0.005302, respectively. Median value of RV-ASI in burned-out group was -15.8% and -27.1% in non- burned-out group. Median value of LAVI in burned-out group was 52.6 ml/m2 and 37.8 ml/m2 in non-burned-out group. CONCLUSIONS Each of the proposed new risk factors of burned-out development was statistically significant in the study population. Therefore, all HCM patients should have regular echocardiographic examinations and those with deteriorating values of new parameters should become the subjects of intensified medical care.

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Рекомендации Американской ассоциации сердца / Американского колледжа кардиологии 2020 года по диагностике и лечению пациентов с гипертрофической кардиомиопатией: что нового?

Patologiya krovoobrashcheniya i kardiokhirurgiya ◽

10.21688/1681-3472-2021-2-108-115 ◽

2021 ◽

Vol 25 (2) ◽

pp. 108

Author(s):

С. А. Будагаев ◽

А. В. Афанасьев ◽

А. В. Богачев-Прокофьев ◽

А. С. Залесов ◽

М. А. Овчаров

Keyword(s):

Hypertrophic Cardiomyopathy ◽

Conflict Of Interest ◽

Severe Heart Failure ◽

Heart Association ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Alcohol Septal Ablation ◽

Ventricular Ejection Fraction ◽

Septal Myectomy ◽

Obstructive Hypertrophic Cardiomyopathy

On 22 December 2020, Circulation published the new American College of Cardiology / American Heart Association guidelines for the diagnosis and treatment of patients with hypertrophic cardiomyopathy. The most important guidelines were those concerning pharmacological and invasive methods of treating symptomatic patients with obstruction of the left ventricular outlet. Considering the most recent clinical studies, the indications for invasive methods of treatment have expanded to include septal myectomy and alcohol septal ablation. A separate section in the guidelines has been devoted to the management of non-obstructive hypertrophic cardiomyopathy with preserved left ventricular ejection fraction. The recommendations for patients with hypertrophic cardiomyopathy with atrial fibrillation, ventricular arrhythmias and severe heart failure have been revised.Received 26 March 2021. Revised 12 May 2021. Accepted 13 May 2021.Funding: The study did not have sponsorship.Conflict of interest: Authors declare no conflict of interest.Author contributions Conception and study design: S.A. Budagaev, A.V. Afanasyev, A.V. Bogachev-Prokophiev Data collection and analysis: S.A. Budagaev, M.A. Ovcharov Drafting the article: S.A. Budagaev, A.V. Afanasyev, A.S. Zalesov Critical revision of the article: A.V. Bogachev-Prokophiev Final approval of the version to be published: S.A. Budagaev, A.V. Afanasyev, A.V. Bogachev-Prokophiev, A.S. Zalesov, M.A. Ovcharov

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An Exploration of Heart Failure Risk in Breast Cancer Patients Receiving Anthracyclines with or without Trastuzumab in Thailand: A Retrospective Study

Clinics and Practice ◽

10.3390/clinpract11030064 ◽

2021 ◽

Vol 11 (3) ◽

pp. 484-493

Author(s):

Jukapun Yoodee ◽

Aumkhae Sookprasert ◽

Phitjira Sanguanboonyaphong ◽

Suthan Chanthawong ◽

Manit Seateaw ◽

...

Keyword(s):

Breast Cancer ◽

Risk Factors ◽

Cancer Patients ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Breast Cancer Patients ◽

Ventricular Ejection Fraction ◽

Factors Associated ◽

Palliative Intent ◽

Increased Risk

Anthracycline-based regimens with or without anti-human epidermal growth factor receptor (HER) 2 agents such as trastuzumab are effective in breast cancer treatment. Nevertheless, heart failure (HF) has become a significant side effect of these regimens. This study aimed to investigate the incidence and factors associated with HF in breast cancer patients treated with anthracyclines with or without trastuzumab. A retrospective cohort study was performed in patients with breast cancer who were treated with anthracyclines with or without trastuzumab between 1 January 2014 and 31 December 2018. The primary outcome was the incidence of HF. The secondary outcome was the risk factors associated with HF by using the univariable and multivariable cox-proportional hazard model. A total of 475 breast cancer patients were enrolled with a median follow-up time of 2.88 years (interquartile range (IQR), 1.59–3.93). The incidence of HF was 3.2%, corresponding to an incidence rate of 11.1 per 1000 person-years. The increased risk of HF was seen in patients receiving a combination of anthracycline and trastuzumab therapy, patients treated with radiotherapy or palliative-intent chemotherapy, and baseline left ventricular ejection fraction <65%, respectively. There were no statistically significant differences in other risk factors for HF, such as age, cardiovascular comorbidities, and cumulative doxorubicin dose. In conclusion, the incidence of HF was consistently high in patients receiving combination anthracyclines trastuzumab regimens. A reduced baseline left ventricular ejection fraction, radiotherapy, and palliative-intent chemotherapy were associated with an increased risk of HF. Intensive cardiac monitoring in breast cancer patients with an increased risk of HF should be advised to prevent undesired cardiac outcomes.

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Myocardial infarctions, subtypes and coronary atherosclerosis in SLE: a case–control study

Lupus Science & Medicine ◽

10.1136/lupus-2021-000515 ◽

2021 ◽

Vol 8 (1) ◽

pp. e000515

Author(s):

Isak Samuelsson ◽

Ioannis Parodis ◽

Iva Gunnarsson ◽

Agneta Zickert ◽

Claes Hofman-Bang ◽

...

Keyword(s):

Risk Factors ◽

Cardiovascular Disease ◽

Coronary Atherosclerosis ◽

Great Majority ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Medical File ◽

Similar Frequency ◽

Ventricular Ejection Fraction ◽

Increased Risk

ObjectivePatients with SLE have increased risk of myocardial infarction (MI). Few studies have investigated the characteristics of SLE-related MIs. We compared characteristics of and risk factors for MI between SLE patients with MI (MI-SLE), MI patients without SLE (MI-non-SLE) and SLE patients without MI (non-MI-SLE) to understand underlying mechanisms.MethodsWe identified patients with a first-time MI in the Karolinska SLE cohort. These patients were individually matched for age and gender with MI-non-SLE and non-MI-SLE controls in a ratio of 1:1:1. Retrospective medical file review was performed. Paired statistics were used as appropriate.ResultsThirty-four MI-SLE patients (88% females) with a median age of 61 years were included. These patients had increased number of coronary arteries involved (p=0.04), and ≥50% coronary atherosclerosis/occlusion was numerically more common compared with MI-non-SLE controls (88% vs 66%; p=0.07). The left anterior descending artery was most commonly involved (73% vs 59%; p=0.11) and decreased (<50%) left ventricular ejection fraction occurred with similar frequency in MI-SLE and MI-non-SLE patients (45% vs 36%; p=0.79). Cardiovascular disease (44%, 5.9%, 12%; p<0.001) and coronary artery disease (32%, 2.9%, 0%; p<0.001), excluding MI, preceded MI/inclusion more commonly in MI-SLE than in MI-non-SLE and non-MI-SLE patients, respectively. MI-SLE patients had lower plasma albumin levels than non-MI-SLE patients (35 (29–37) vs 40 (37–42) g/L; p=0.002).ConclusionIn the great majority of cases, MIs in SLE are associated with coronary atherosclerosis. Furthermore, MIs in SLE are commonly preceded by symptomatic vascular disease, calling for attentive surveillance of cardiovascular disease and its risk factors and early atheroprotective treatment.

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Myocardial work: a new way to predict fibrosis in patients with hypertrophic cardiomyopathy

European Heart Journal ◽

10.1093/ehjci/ehaa946.0089 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

A Valentim Goncalves ◽

S Aguiar Rosa ◽

L Moura Branco ◽

A Galrinho ◽

A Fiarresga ◽

...

Keyword(s):

Hypertrophic Cardiomyopathy ◽

Global Longitudinal Strain ◽

Left Ventricular Pressure ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Prognostic Information ◽

Ventricular Ejection Fraction ◽

Significant Fibrosis ◽

Constructive Work ◽

Global Work

Abstract Aims Late gadolinium enhancement (LGE) on cardiac magnetic resonance (CMR) adds prognostic information in patients with hypertrophic cardiomyopathy (HCM). Whether Myocardial work (MW), a new parameter on transthoracic echocardiographic (TTE), can predict significant fibrosis in HCM patients is unknown. Methods Single-centre evaluation of consecutively recruited HCM patients in which TTE and CMR were performed. MW and related indices were calculated from global longitudinal strain (GLS) and from estimated left ventricular pressure curves. The extent of LGE was quantitatively assessed. LGE ≥15% was chosen to define significant fibrosis. Logistic regression analysis was used to find the variables associated with LGE ≥15% and cut-off values were determined. Results Among the thirty-two patients analysed mean age was 57±16 years, 18 (56%) were male patients and the mean left ventricular ejection fraction by TTE was 67±8%. Global constructive work (GCW), global work index and GLS were significant predictors of LGE ≥15%. A cut-off ≤1550 mmHg% of GCW was able to predict significant fibrosis with a sensitivity of 92% and a specificity of 79%, while the best cut-off for GLS (>−15%) had a sensitivity of 86% and a specificity of 72%. Conclusion GCW was the best parameter to predict significant left ventricular myocardial fibrosis in CMR, suggesting its utility in patients who may not be able to have a CMR study. Myocardial Work and LGE in CMR in HCM Funding Acknowledgement Type of funding source: None

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Major Left Bundle Branch Block and Coronary Heart Disease—Are There Any Differences between the Sexes?

Journal of Clinical Medicine ◽

10.3390/jcm10112284 ◽

2021 ◽

Vol 10 (11) ◽

pp. 2284

Author(s):

Diana Gurzău ◽

Alexandra Dădârlat-Pop ◽

Bogdan Caloian ◽

Gabriel Cismaru ◽

Horaţiu Comşa ◽

...

Keyword(s):

Risk Factors ◽

Heart Disease ◽

Ischemic Heart Disease ◽

Left Bundle Branch Block ◽

Left Ventricular ◽

Ischemic Heart ◽

Left Ventricular Ejection ◽

Bundle Branch Block ◽

Microvascular Angina ◽

Ventricular Ejection Fraction

Left bundle branch block is not a benign pathology, and its presence requires the identification of a pathological substrate, such as ischemic heart disease. Left bundle branch block appears to be more commonly associated with normal coronary arteries, especially in women. The objectives of our study were to describe the particularities of left bundle branch block in women compared to men with ischemic heart disease. Result: We included seventy patients with left bundle branch block and ischemic heart disease, with a mean age of 67.01 ± 8.89 years. There were no differences in the profile of risk factors, except for smoking and uric acid. The ventricular depolarization (QRS) duration was longer in men than women (136.86 ± 8.32 vs. 132.57 ± 9.19 msec; p = 0.018) and also men were observed to have larger left ventricular diameters. Left bundle branch block duration was directly associated with ventricular diameters and indirectly associated with left ventricular ejection fraction value, especially in women (R = −0.52, p = 0.0012 vs. R = −0.50, p = 0.002). In angiography, 80% of women had normal epicardial arteries compared with 65.7% of men; all these patients presented with microvascular dysfunction. Conclusion: The differences between the sexes were not so obvious in terms of the presence of risk factors; instead, there were differences in electrocardiographic, echocardiographic, and angiographic aspects. Left bundle branch block appears to be a marker of microvascular angina and systolic dysfunction, especially in women.

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Baseline global longitudinal strain predictive of anthracycline-induced cardiotoxicity

Cardio-Oncology ◽

10.1186/s40959-021-00090-2 ◽

2021 ◽

Vol 7 (1) ◽

Author(s):

Raquel Araujo-Gutierrez ◽

Kalyan R. Chitturi ◽

Jiaqiong Xu ◽

Yuanchen Wang ◽

Elizabeth Kinder ◽

...

Keyword(s):

Risk Factors ◽

Cancer Therapy ◽

Confidence Interval ◽

Longitudinal Strain ◽

Proportional Hazards ◽

Global Longitudinal Strain ◽

Left Ventricular ◽

Cox Proportional Hazards ◽

Left Ventricular Ejection ◽

Ventricular Ejection Fraction

Abstract Background Cancer therapy-related cardiac dysfunction (CTRD) is a major source of morbidity and mortality in long-term cancer survivors. Decreased GLS predicts decreased left ventricular ejection fraction (LVEF) in patients receiving anthracyclines, but knowledge regarding the clinical utility of baseline GLS in patients at low-risk of (CTRD) is limited. Objectives The purpose of this study was to investigate whether baseline echocardiographic assessment of global longitudinal strain (GLS) before treatment with anthracyclines is predictive of (CTRD) in a broad cohort of patients with normal baseline LVEF. Methods Study participants comprised 188 patients at a single institution who underwent baseline 2-dimensional (2D) speckle-tracking echocardiography before treatment with anthracyclines and at least one follow-up echocardiogram 3 months after chemotherapy initiation. Patients with a baseline LVEF <55% were excluded from the analysis. The primary endpoint, (CTRD), was defined as an absolute decline in LVEF > 10% from baseline and an overall reduced LVEF <50%. Potential and known risk factors were evaluated using univariable and multivariable Cox proportional hazards regression analysis. Results Twenty-three patients (12.23%) developed (CTRD). Among patients with (CTRD), the mean GLS was -17.51% ± 2.77%. The optimal cutoff point for (CTRD) was -18.05%. The sensitivity was 0.70 and specificity was 0.70. The area under ROC curve was 0.70. After adjustment for cardiovascular and cancer therapy related risk factors, GLS or decreased baseline GLS ≥-18% was predictive of (CTRD) (adjusted hazards ratio 1.17, 95% confidence interval 1.00, 1.36; p = 0.044 for GLS, or hazards ratio 3.54; 95% confidence interval 1.34, 9.35; p = 0.011 for decreased GLS), along with history of tobacco use, pre-chemotherapy systolic blood pressure, and cumulative anthracycline dose. Conclusions Baseline GLS or decreased baseline GLS was predictive of (CTRD) before anthracycline treatment in a cohort of cancer patients with a normal baseline LVEF. This data supports the implementation of strain-protocol echocardiography in cardio-oncology practice for identifying and monitoring patients who are at elevated risk of (CTRD).

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Strong risk factors for depression and anxiety in heart failure patients

Pakistan BioMedical Journal ◽

10.52229/pbmj.v4i2.70 ◽

2021 ◽

Author(s):

Naila Niaz ◽

Syed Muhammad Faraz Ali ◽

Attaullah Younas ◽

Tallat Anwar Faridi ◽

Asif Hanif

Keyword(s):

Risk Factors ◽

Heart Failure ◽

Ejection Fraction ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Anxiety And Depression ◽

Team Approach ◽

Depression And Anxiety ◽

Ventricular Ejection Fraction ◽

Heart Failure Patients

Despite advancing medical technology, Heart Failure (HF) is still a prevalent disease with high mortality and high health expenditure. To improve patient outcome and prognosis, it is important to identify the association of risk factors which leads to the co-morbid depression and anxiety in heart failure patients. Objectives: To determine the association of depression and/or anxiety with age, gender and ejection fraction in heart failure patients. Methods: It is an analytical cross sectional study including 323 CHF patients who visited the to the Faisalabad Institute of Cardiology hospital Out-Patient Department, 250 were males and 73 were females, mean age was 54.1 ± 9.2 years having 70 years as maximum and 25 years as minimum. Data collection was done using Hospital Anxiety and Depression Scale (HADS) questionnaire to assess depression and anxiety. Data was analyzed using SPSS version 24. For quantitative data, mean and standard deviation was calculated and for qualitative data frequency and percentages was calculated. To measure the association of anxiety and depression with age categories, ejection fraction and gender, chi square test was used. P values less than and equal to 0.05 were taken as significant. Results: No association of depression and anxiety with gender and Left Ventricular Ejection Fraction (LVEF) was observed. However, depression and anxiety were found to be significantly associated with age Conclusions: The study concluded that age is a strong risk factor of depression and anxiety in congestive heart failure patients. Multidisciplinary health care team approach and interventions are required to cater chronic heart failure (CHF) patients to address the psychological burden.

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