scholarly journals Haemodynamics, dyspnoea, and pulmonary reserve in heart failure with preserved ejection fraction

2018 ◽  
Vol 39 (30) ◽  
pp. 2810-2821 ◽  
Author(s):  
Masaru Obokata ◽  
Thomas P Olson ◽  
Yogesh N V Reddy ◽  
Vojtech Melenovsky ◽  
Garvan C Kane ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Pulmonary Ventilation ◽  
Left Ventricular ◽  
Functional Class ◽  
Gas Analysis ◽  
Peak Exercise ◽  
Preserved Ejection Fraction ◽  
Ventilatory Drive ◽  
Pulmonary Abnormalities

Abstract Aims Increases in left ventricular filling pressure are a fundamental haemodynamic abnormality in heart failure with preserved ejection fraction (HFpEF). However, very little is known regarding how elevated filling pressures cause pulmonary abnormalities or symptoms of dyspnoea. We sought to determine the relationships between simultaneously measured central haemodynamics, symptoms, and lung ventilatory and gas exchange abnormalities during exercise in HFpEF. Methods and results Subjects with invasively-proven HFpEF (n = 50) and non-cardiac causes of dyspnoea (controls, n = 24) underwent cardiac catheterization at rest and during exercise with simultaneous expired gas analysis. During submaximal (20 W) exercise, subjects with HFpEF displayed higher pulmonary capillary wedge pressures (PCWP) and pulmonary artery pressures, higher Borg perceived dyspnoea scores, and increased ventilatory drive and respiratory rate. At peak exercise, ventilation reserve was reduced in HFpEF compared with controls, with greater dead space ventilation (higher VD/VT). Increasing exercise PCWP was directly correlated with higher perceived dyspnoea scores, lower peak exercise capacity, greater ventilatory drive, worse New York Heart Association (NYHA) functional class, and impaired pulmonary ventilation reserve. Conclusion This study provides the first evidence linking altered exercise haemodynamics to pulmonary abnormalities and symptoms of dyspnoea in patients with HFpEF. Further study is required to identify the mechanisms by which haemodynamic derangements affect lung function and symptoms and to test novel therapies targeting exercise haemodynamics in HFpEF.

Abstract 16026: Invasive Hemodynamic Assessment of Patients With Heart Failure With Preserved Ejection Fraction With Anemia and Iron Deficiency

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Anna Subramaniam ◽  
Yogesh Reddy ◽  
Masaru Obokata ◽  
Barry A Borlaug
Keyword(s):  
Heart Failure ◽  
Iron Deficiency ◽  
Ejection Fraction ◽  
Cell Mass ◽  
Left Ventricular ◽  
Peak Exercise ◽  
Preserved Ejection Fraction ◽  
Hemodynamic Assessment ◽  
Patients With Heart Failure ◽  
Hemodynamic Characteristics

Introduction: Anemia is associated with increased mortality, cardiovascular events, and decreased quality of life in patients with heart failure with preserved ejection fraction (HFpEF). Iron deficiency may contribute to disease severity independent of effects on red cell mass. The hemodynamic consequences of anemia and iron deficiency in HFpEF remain unclear. Methods: We analyzed a cohort of 313 consecutive subjects with HFpEF diagnosed by invasive hemodynamic assessment, and compared echocardiographic and hemodynamic characteristics of anemic versus non-anemic subjects. Anemia was defined as hemoglobin <13 g/dL in men and <12 g/dL in women. Iron deficiency was defined as ferritin <100 ug/L. Results: Compared to patients without anemia, HFpEF patients with anemia displayed higher NT-proBNP, elevated pulmonary artery (PA) pressures at rest and at peak exercise, and lower oxygen consumption at peak exercise (Table). There was no difference in pulmonary capillary wedge pressure (PCWP). Patients with iron deficiency were more likely to be women. At rest, patients with iron deficiency displayed lower left ventricular (LV) mass, higher resting SVRI and lower cardiac index (CI), but there were not significant differences with exercise. Conclusions: Anemia in HFpEF is associated with greater evidence of congestion and more severe pulmonary hypertension, contributing to reduced exercise capacity. Iron deficiency in HFpEF is more common in women and associated with lower cardiac output at rest, but hemodynamics are otherwise similar. Further study is required to understand the mechanisms by which anemia and iron deficiency influence cardiac function and outcomes in HFpEF.

scholarly journals PECULIARITIES OF CHRONIC HEART FAILURE WITH PRESERVED EJECTION FRACTION IN PATIENTS WITH ESSENTIAL HYPERTENSION

2013 ◽  
Vol 19 (6) ◽  
pp. 513-519
Author(s):  
R. A. Libis ◽  
A. G. Dushina ◽  
E. A. Oleynik
Keyword(s):  
Physical Activity ◽  
Heart Failure ◽  
Chronic Heart Failure ◽  
Ejection Fraction ◽  
Clinical Status ◽  
Left Ventricular Diastolic Dysfunction ◽  
Left Ventricular ◽  
Functional Class ◽  
Preserved Ejection Fraction ◽  
Main Complaint

Objective. To estimate clinical status, quality of life (QOL), physical activity, structural and functional pe-  structural and functional penal peculiarities of the heart in patients with chronic heart failure with preserved ejection fraction (CHF-PEF).Design and methods. Seventy-two patients with CHF-PEF (age 47–77 years) were examined. Clinical status, QOL by Minnesota questionnaire, 6-minute walk test, heart ultrasound, serum N-terminal brain natriuretic propeptide level were assessed in all patients.Results. Main complaint was dyspnea at physical activity in patients with CHF-PEF (95,8 %). Structural and functional myocardium changes were more expressed in patients with higher functional class. General total score by Minnesota questionnaire was 21,5 [14,5; 40,0] in men and 48,5 [36,0; 59,0] in women. Tolerance to physical activity influenced QOL.Conclusions. All patients had echocardiographic signs of left ventricular diastolic dysfunction. The higher functional class of heart failure was associated with the more pronounced myocardial hypertrophy, decreased QOL and physical activity. QOL was higher in men, than in women. Diabetes mellitus, ischemic heart disease were associated with the clinical progression of CHF.

scholarly journals The H2FPEF and HFA-PEFF Algorithms for Predicting Exercise Intolerance and Abnormal Hemodynamics in Heart Failure with Preserved Ejection Fraction

2021 ◽  
Author(s):  
Shiro Amanai ◽  
Tomonari Harada ◽  
Kazuki Kagami ◽  
Kuniko Yoshida ◽  
Toshimitsu Kato ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Scoring Systems ◽  
Exercise Duration ◽  
Poor Quality ◽  
Gas Analysis ◽  
Exercise Intolerance ◽  
Peak Oxygen Consumption ◽  
Peak Exercise ◽  
Preserved Ejection Fraction

Abstract Exercise intolerance is a primary manifestation of patients with heart failure with preserved ejection fraction (HFpEF) and is associated with abnormal hemodynamics and poor quality of life. Two multiparametric scoring systems have been proposed to diagnose HFpEF. This study sought to determine the performance of the H2FPEF and HFA-PEFF scores for predicting exercise capacity and echocardiographic measures of intracardiac pressures during exercise. Patients with HFpEF (n = 83) and control subjects without HF (n = 104) underwent bicycle exercise echocardiography. In a subset, simultaneous expired gas analysis was performed to measure peak oxygen consumption (VO2). The H2FPEF score was obtainable in all patients while the HFA-PEFF score could not be calculated in 23 patients (feasibility 88%). Both H2FPEF and HFA-PEFF scores were correlated with higher E/e’ ratio (r = 0.49 and r = 0.46), lower systolic tricuspid annular velocity (r=-0.44 and =-0.24), and lower cardiac output (r=-0.28 and r=-0.24) during peak exercise. Peak VO2 and exercise duration decreased with increasing the H2FPEF score (r=-0.40 and r=-0.32), and the H2FPEF score predicted reduced aerobic capacity (AUC 0.71, p = 0.0005), but the HFA-PEFF score did not (p = 0.07). These data provide new insights into the role of the H2FPEF and HFA-PEFF scores for predicting exercise intolerance and abnormal hemodynamics in patients HFpEF.

scholarly journals The H2FPEF and HFA-PEFF algorithms for predicting exercise intolerance and abnormal hemodynamics in heart failure with preserved ejection fraction

2022 ◽  
Vol 12 (1) ◽  
Author(s):  
Shiro Amanai ◽  
Tomonari Harada ◽  
Kazuki Kagami ◽  
Kuniko Yoshida ◽  
Toshimitsu Kato ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Scoring Systems ◽  
Exercise Duration ◽  
Gas Analysis ◽  
Exercise Intolerance ◽  
Peak Oxygen Consumption ◽  
Peak Exercise ◽  
Preserved Ejection Fraction ◽  
Exertional Dyspnea

AbstractExercise intolerance is a primary manifestation in patients with heart failure with preserved ejection fraction (HFpEF) and is associated with abnormal hemodynamics and a poor quality of life. Two multiparametric scoring systems have been proposed to diagnose HFpEF. This study sought to determine the performance of the H2FPEF and HFA-PEFF scores for predicting exercise capacity and echocardiographic findings of intracardiac pressures during exercise in subjects with dyspnea on exertion referred for bicycle stress echocardiography. In a subset, simultaneous expired gas analysis was performed to measure the peak oxygen consumption (VO2). Patients with HFpEF (n = 83) and controls without HF (n = 104) were enrolled. The H2FPEF score was obtainable for all patients while the HFA-PEFF score could not be calculated for 23 patients (feasibility 88%). Both H2FPEF and HFA-PEFF scores correlated with a higher E/e′ ratio (r = 0.49 and r = 0.46), lower systolic tricuspid annular velocity (r =  − 0.44 and =  − 0.24), and lower cardiac output (r =  − 0.28 and r =  − 0.24) during peak exercise. Peak VO2 and exercise duration decreased with an increase in H2FPEF scores (r =  − 0.40 and r =  − 0.32). The H2FPEF score predicted a reduced aerobic capacity (AUC 0.71, p = 0.0005), but the HFA-PEFF score did not (p = 0.07). These data provide insights into the role of the H2FPEF and HFA-PEFF scores for predicting exercise intolerance and abnormal hemodynamics in patients presenting with exertional dyspnea.

Left Ventricular Diastolic Dysfunction and Exercise Intolerance in Obese Heart Failure with Preserved Ejection Fraction

2021 ◽  
Author(s):  
T. Jake Samuel ◽  
Dalane W. Kitzman ◽  
Mark J. Haykowsky ◽  
Bharathi Upadhya ◽  
Peter Brubaker ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Strain Rate ◽  
Left Ventricular ◽  
Exercise Intolerance ◽  
Peak Exercise ◽  
Strain Rates ◽  
Preserved Ejection Fraction ◽  
Diastolic Strain Rate ◽  
Strain And Strain Rate

This study tested the hypothesis that early left ventricular (LV) relaxation is impaired in older obese heart failure with preserved ejection fraction (HFpEF) patients, and related to decreased peak exercise oxygen uptake (peak VO2). LV strain and strain rate were measured by feature tracking of magentic resonance cine images in 79 older obese HFpEF patients (mean age: 66 years; mean BMI: 38 kg/m2) and 54 healthy control participants. LV diastolic strain rates were indexed to cardiac preload as estimated by echocardiography derived diastolic filling pressures (E/e'), and correlated to peak VO2. LV circumferential early diastolic strain rate was impaired in HFpEF compared to controls (0.93±0.05 s-1 vs 1.20±0.07 s-1, p=0.014); however, we observed no group differences in early LV radial or longitudinal diastolic strain rates. Isolating myocardial relaxation by indexing all three early LV diastolic strain rates (i.e. circumferential, radial, and longitudinal) to E/e' amplified the group difference in early LV diastolic circumferential strain rate (0.08±0.03 vs 0.13±0.05, p<0.0001), and unmasked differences in early radial and longitudinal diastolic strain rate. Moreover, when indexing to E/e', early LV diastolic strain rates from all three principal strains, were modestly related with peak VO2 (R=0.36, -0.27, 0.35, respectively, all p<0.01); this response, however, was almost entirely driven by E/e' itself, (R=-0.52, P<0.001). Taken together, we found that while LV relaxation is impaired in older obese HFpEF patients, and modestly correlates with their severely reduced peak exercise VO2, LV filling pressures appear to play a much more important role in determining exercise intolerance.

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.

scholarly journals The link between left ventricular extracellular volume determined by T1 myocardial mapping and gut microbiota composition in individuals with heart failure and preserved ejection fraction

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
A.N Kaburova ◽  
O.M Drapkina ◽  
S.M Uydin ◽  
M.V Vishnyakova ◽  
M.S Pokrovskaya ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Gut Microbiota ◽  
Myocardial Fibrosis ◽  
Volume Fraction ◽  
Extracellular Volume ◽  
Left Ventricular ◽  
Diffuse Myocardial Fibrosis ◽  
Rrna Gene ◽  
Preserved Ejection Fraction

Abstract Introduction Heart failure with preserved ejection fraction (HFpEF) represents a major challenge in modern cardiology. As described previously, in HFpEF comorbidities promote a systemic inflammatory state, leading to diffuse myocardial fibrosis resulting in myocardial stiffening. Gut dysbiosis which is considered as the novel source of chronic systemic inflammation has been actively investigated as the risk factor for the development and aggravation of cardiovascular diseases including heart failure. Cardiac magnetic resonance T1-mapping is a novel tool, which allows noninvasive quantification of the extracellular space and diffuse myocardial fibrosis. Moreover, the extracellular volume (ECV) fraction can be calculated, providing information on the relative expansion of the extracellular matrix, thus being a noninvasive alternative to myocardial biopsy studies. Purpose The research was aimed at investigating the correlation between the left ventricular ECV and gut microbial genera in patients with HFpEF. Methods 42 patients with confirmed HF-pEF (mediana and interquartile range of age 67 [64; 72] years, 47% men, body mass index &lt;35 kg/m2 with no history of myocardial infarction or diabetes mellitus) were enrolled in the study. The patients underwent transthoracic echocardiography with Doppler study, HF-pEF was confirmed according to the recent ESC guidelines (based on E/e' ratio, N-terminal pro-B type natriuretic peptide &gt;125 pg/ml and symptoms of heart failure). The intestinal microbiome was investigated using high-throughput sequencing of bacterial 16S rRNA gene. As the last step of research T1-myocardial mapping with the modified look-locker inversion-recovery protocol (MOLLI) sequence at 1.5 Tesla was performed to assess left ventricular extracellular volume fraction. Results The mean±std in ECV was 31.02±4.4%. The relative abundance (%) of the most prevalent phyla in gut microbiota was 48±22.5 for Firmicutes, 47.4±22.8 for Bacteroidetes and 1.5 [1.5; 2.5] for Proteobacteria. The analysis showed significant negative correlations between ECV and the following bacterial genera: Faecalibacterium (r=−0.35), Blautia (r=−0.43), Lachnoclostridium (r=−0.32). Moreover ECV positively correlated with Holdemania (r=0.4), Victivallis (r=0.38), Dehalobacterium (r=0.38), Enterococcus (r=0.33) and Catabacter (r=0.32). All correlation values with p&lt;0.05. Conclusion We discovered both negative and positive significant correlations between ECV – the non-invasive marker of myocardial fibrosis and several bacterial genera, which may have negative impact on myocardial remodeling in HF-pEF. Funding Acknowledgement Type of funding source: None

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