P6287Analysis of novel cardiac markers sST2 and IL-33 in chronic heart failure with reduced ejection fraction

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
P Jirak ◽  
M Lichtenauer ◽  
B Wernly ◽  
V Paar ◽  
C Jung ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Inverse Correlation ◽  
Serum Levels ◽  
Control Group ◽  
Significant Elevation ◽  
Serum Samples ◽  
Reduced Ejection Fraction ◽  
Stress Studies ◽  
Cardiac Strain

Abstract Background Soluble (s) ST-2 has been recently evaluated as a monitoring parameter in heart failure (HF). Besides being a marker for cardiac strain and hemodynamic stress, studies also found an influence of ST2 on the immune system, above all mediated through its Janus-Face ligand IL-33, an alarmin released under stress conditions or by cellular death. In contrast to sST2, the role of IL-33 in HF is yet unknown. Objective In this project, we aimed for an analysis of the ST2/IL33 pathway in patients with heart failure with reduced ejection fraction (HFrEF). Methods In total, 200 patients were included in the study: 59 with ischemic (ICM), 65 with dilated (DCM) cardiomyopathy (mean LVEF 38%), as well as 76 control patients without coronary artery disease or signs of heart failure. Serum samples were analyzed by use of ELISA after informed consent. Results sST2 showed a significant elevation in all HF patients (p<0.0001) compared to the control group. No significant differences in levels of sST2 were observed between ICM and DCM patients. In contrast to sST2, no differences between HF patients and control group were observed for IL-33. Furthermore, sST2 showed a significant correlation with CRP (p<0.001, r=0.28), NT-pro-BNP (p<0.0001, r=0.40) and an inverse correlation with ejection fraction (p<0.0001, r=−0.40). Additionally, sST2 showed a significant elevation in patients in NYHA stages I-II (p=0.030) and NYHA stages III-IV (p<0.01). Again, no significant correlations were observed between IL-33 and parameters mentioned above. Analysis of sST2 in heart failure Conclusions We observed a significant increase and correlation with disease severity of sST2 in chronic HFrEF patients of both ischemic and non-ischemic origin, but contrary to our expectations, no significant changes in serum levels of IL-33. Thus, a mechanism independent of ST2/IL33 axis could be responsible of sST2 secretion in HF. Further studies including acute decompensated patients could provide a better understanding of the IL-33 role in HF.

scholarly journals Discriminative Utility of Apelin-to-NT-Pro-Brain Natriuretic Peptide Ratio for Heart Failure with Preserved Ejection Fraction among Type 2 Diabetes Mellitus Patients

2022 ◽  
Vol 9 (1) ◽  
pp. 23
Author(s):  
Alexander A. Berezin ◽  
Ivan M. Fushtey ◽  
Alexander E. Berezin
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Brain Natriuretic Peptide ◽  
Natriuretic Peptide ◽  
Serum Levels ◽  
Control Group ◽  
Baseline Serum ◽  
Reduced Ejection Fraction ◽  
Multivariate Logistic Model ◽  
Healthy Control

Background: Apelin is a regulatory vasoactive peptide, which plays a pivotal role in adverse cardiac remodeling and heart failure (HF) with reduced ejection fraction. The purpose of the study was to investigate whether serum levels of apelin is associated with HF with preserved election fraction (HFpEF) in patients with T2DM. Methods: The study retrospectively involved 101 T2DM patients aged 41 to 62 years (48 patients with HFpEF and 28 non-HFpEF patients). The healthy control group consisted of 25 individuals with matched age and sex. Data collection included demographic and anthropometric information, hemodynamic performances and biomarkers of the disease. Transthoracic B-mode echocardiography, Doppler and TDI were performed at baseline. Serum levels of N-terminal pro-brain natriuretic peptide (NT-proBNP) and apelin were measured by ELISA in all patients at the study entry. Results: Unadjusted multivariate logistic model yielded the only apelin to NT-proBNP ratio (OR = 1.44; p = 0.001), BMI > 34 кг/м2 (OR = 1.07; p = 0.036), NT-proBNP > 458 pmol/mL (OR = 1.17; p = 0.042), LAVI > 34 mL/m2 (OR = 1.06; p = 0.042) and E/e’ > 11 (OR = 1.04; p = 0.044) remained to be strong predictors for HFpEF. After obesity adjustment, multivariate logistic regression showed that the apelin to NT-proBNP ratio < 0.82 × 10−2 units remained sole independent predictor for HFpEF (OR = 1.44; 95% CI: 1.18–2.77; p = 0.001) HFpEF in T2DM patients. In conclusion, we found that apelin to NT-proBNP ratio < 0.82 × 10−2 units better predicted HFpEF in T2DM patients than apelin and NT-proBNP alone. This finding could open new approach for CV risk stratification of T2DM at higher risk of HF.

scholarly journals Expression of the Novel Cardiac Biomarkers sST2, GDF-15, suPAR, and H-FABP in HFpEF Patients Compared to ICM, DCM, and Controls

2020 ◽  
Vol 9 (4) ◽  
pp. 1130
Author(s):  
Peter Jirak ◽  
Rudin Pistulli ◽  
Michael Lichtenauer ◽  
Bernhard Wernly ◽  
Vera Paar ◽  
...  
Keyword(s):  
Heart Failure ◽  
Cardiac Biomarkers ◽  
Control Group ◽  
The Novel ◽  
Significant Elevation ◽  
Serum Samples ◽  
Diagnostic Challenge ◽  
Diagnostic Biomarkers ◽  
Diagnostic Potential ◽  
Cardiovascular Biomarkers

Background: Heart failure with preserved ejection fraction (HFpEF) remains an ongoing therapeutic and diagnostic challenge to date. In this study we aimed for an analysis of the diagnostic potential of four novel cardiovascular biomarkers, GDF-15, H-FABP, sST2, and suPAR in HFpEF patients compared to controls as well as ICM, and DCM. Methods: In total, we included 252 stable outpatients and controls (77 DCM, 62 ICM, 18 HFpEF, and 95 controls) in the present study. All patients were in a non-decompensated state and on a stable treatment regimen. Serum samples were obtained and analyzed for GDF-15 (inflammation, remodeling), H-FABP (ischemia and subclinical ischemia), sST2 (inflammation, remodeling) and suPAR (inflammation, remodeling) by means of ELISA. Results: A significant elevation of GDF-15 was found for all heart failure entities compared to controls (p < 0.005). Similarly, H-FABP evidenced a significant elevation in all heart failure entities compared to the control group (p < 0.0001). Levels of sST2 were significantly elevated in ICM and DCM patients compared to the control group and HFpEF patients (p < 0.0001). Regarding suPAR, a significant elevation in ICM and DCM patients compared to the control group (p < 0.0001) and HFpEF patients (p < 0.01) was observed. An AUC analysis identified H-FABP (0.792, 95% CI 0.713–0.870) and GDF-15 (0.787, 95% CI 0.696–0.878) as paramount diagnostic biomarkers for HFpEF patients. Conclusion: Based on their differences in secretion patterns, novel cardiovascular biomarkers might represent a promising diagnostic tool for HFpEF in the future.

scholarly journals Impact of canagliflozin in natriuretic peptides in patients with type 2 diabetes after hospitalization for acute heart failure

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
E Martin Dorado ◽  
R Gonzalez Manzanares ◽  
J.C Castillo Dominguez ◽  
J Lopez Aguilera ◽  
J Perea ◽  
...  
Keyword(s):  
Heart Failure ◽  
Type 2 Diabetes ◽  
Ejection Fraction ◽  
Acute Decompensated Heart Failure ◽  
Signs And Symptoms ◽  
Sglt2 Inhibitors ◽  
Control Group ◽  
Dipeptidyl Peptidase 4 ◽  
Reduced Ejection Fraction

Abstract Background Sodium-glucose cotransporter 2 (SGLT2) inhibitors have demonstrated to reduce the risk of hospitalization for heart failure (HF) in patients with type 2 diabetes mellitus (T2D). We aimed to assess the changes in N-terminal pro-B-type natriuretic peptide (NT-ProBNP) concentrations in a cohort of patients hospitalized for HF according to whether or not they received canagliflozin at discharge. Methods This cohort study included all patients with T2D admitted for HF from January 2017 to December 2019 in a single center. We excluded patients whose treatment with SGLT2 inhibitors were contraindicated (eGFR ≤45 ml/min/1.73 m2) and those who had other SGLT2 inhibitors than canagliflozin in their treatment at discharged. All patients had received a primary diagnosis of acute decompensated heart failure, including signs and symptoms of fluid overload and a concentration of NT-ProBNP of 1400 pg/mL at least. NT-ProBNP concentrations were collected at 3 months, 6 months, and 1 year after hospitalization with laboratory records if available. The aim of this study is to compare mean NT-ProBNP levels at hospital discharge and 3, 6 and 12 moths of follow-up in patients treated with and without canagliflozin. Results We included a total of 102 patients, 45 patients (44.1%) were prescribed canagliflozin and the remaining 57 (55.9%) were not prescribed any SGLT2 inhibitors (control group). There were no significant differences in clinical and comorbidities in both groups, except for age; slightly younger in the canagliflozin group (69,2±10,3 vs 73,2±11,1; p=0,04). Treatment at discharge was also similar, patients in the control group received more dipeptidyl peptidase-4 (DPP-4) inhibitors (21.1% vs 6.7%; p=0.04). Low rate of patients received sacubitril-valsartan (15,6%) in the canagliflozin group and 14% in the control group. More than a half of patients in both groups have HF with reduced ejection fraction. Mean levels of peptides were similar in both groups at hospital admission and discharge. During the first period of 3 months, we observed a decreased of NT-ProBNP concentration in both groups, but significantly inferior in canagliflozin group (p&lt;0,001). At 6 and 12 months, NT-ProBNP levels were practically maintained in patients treated with canagliflozin, whereas levels in patients in the control group were increased. Difference in both groups at a 12 month-period was significantly superior (p=0,004), with a median reduction of concentration levels at discharge of 64.3% in the canagliflozin group and 15,8% in control group. There were no differences in patients with HF from those with reduced ejection fraction and preserved. Conclusions Canagliflozin therapy at discharge was associated with a significant reduction in NT-ProBNP concentration in patients with diabetes after hospitalization for HF. FUNDunding Acknowledgement Type of funding sources: None. NT-ProBNP according to canagliflozin

scholarly journals Follow-up on new marker confirming the optimal status in the treatment of heart failure with reduced ejection fraction

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
L.E Tran ◽  
T Nguyen ◽  
H.O.A Pham ◽  
M.I.N.H Thai ◽  
L.O.C Nguyen ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Femoral Artery ◽  
Fluid Overload ◽  
Femoral Vein ◽  
Physical Exam ◽  
Control Group ◽  
Fluid Restriction ◽  
Reduced Ejection Fraction

Abstract Background At the present time, there is no strong criterion to guarantee the optimal management for patients with heart failure and reduced ejection fraction (HFrEF). In the past, our group suggested the use of the size of the femoral vein (FV), measured by ultrasound as a marker of the fluid status in the venous compartment. Is this criterion still the best marker of optimal treatment of HFrEF at 3 years follow-up, especially for patients with significant co-morbidities (chronic obstructive pulmonary disease (COPD), end stage renal disease (ESRD) on hemodialysis (HD), cirrhosis of liver or sepsis? Methods Patients with HFrEF and co-morbidities as above were enrolled. All patients had echocardiography to confirm EF &lt;45% and underwent the ultrasound test to assess the size and expansibility of the femoral vein (SEFV). The SEFV is the ultrasound study of the FV examining its size and expansibility with cough. The location of the femoral artery (FA) and FV to be checked is the coronal plane immediately proximal to the bifurcation of the superficial and deep femoral artery. The normal size of FV is a little larger than of the FA. If the size of the FV is twice larger than the FA, the patient has fluid overload in the venous compartment (Figure 1). Then the patient was asked to cough in order to measure the size of the FV. If the FV did not increase its size with cough, the venous compartment was full. If the FV increased its size, the venous compartment was not full and could accommodate more fluid. In physical exam, the fluid overload is proved by the presence of extravascular fluid in the abdominal wall, ascites or leg edema or in the intravascular compartment by the presence of the jugular venous distention. During the 3 years of follow-up, the patients were seen in the office and had the SEFV at regular 6 months intervals. A small group of patients also underwent right heart catheterization to measure to the pulmonary capillary wedge pressure (PCWP). Results 180 patients with HFrEF and significant comorbidities were enrolled. All patients were taught to follow a low Na diet, &lt;2000cc of fluid restriction and the guideline directed medical therapy. After about 3 years, 75% patients in the study group were asymptomatic, was not readmitted to the hospital for HF, and the size of the FV was within normal range. Their physical exam showed no fluid in the extravascular compartment. The PCWP became lower than 24mmHg in 18/20 who underwent the RHC. There was significant weight loss (15 lbs). In the control group, 60% of patients were asymptomatic and 50% were not readmitted for HF (p&lt;0.05). Conclusions With the SEFV test, the patients with HFrEF and significant comorbidities were accurately estimated for presence or absence of fluid overload. This SEFV test was especially sensitive to detect fluid overload in patients with multiple co-morbidities. Further randomized trials are needed to confirm the above preliminary results. FUNDunding Acknowledgement Type of funding sources: None. Figure 1. Enlarged size of femoral vein

scholarly journals Serum levels of gamma-glutamyltransferase predict outcome in heart failure with preserved ejection fraction

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Daniel Dalos ◽  
Christina Binder ◽  
Franz Duca ◽  
Stefan Aschauer ◽  
Andreas Kammerlander ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Cox Regression ◽  
Serum Levels ◽  
Right Atrial ◽  
Preserved Ejection Fraction ◽  
Gamma Glutamyltransferase ◽  
Reduced Ejection Fraction ◽  
Mitral Inflow ◽  
Kaplan Meier

AbstractPrevious studies suggested an association between heart failure (HF) and hepatic disorders. Liver function parameters have been shown to predict outcome in HF with reduced ejection fraction, but their impact in HF with preserved ejection fraction (HFpEF) has not yet been investigated. Between January 2011 and February 2017, 274 patients with confirmed HFpEF were enrolled (age 71.3 ± 8.4 years, 69.3% female) in a prospective registry. During a median follow-up of 21.5 ± 18.6 months, 97 patients (35.4%) reached the combined endpoint defined as hospitalization due to HF and/ or death from any cause. By multivariable cox regression, serum gamma-glutamyltransferase (GT) was independently associated with outcome (Hazard Ratio (HR) 1.002, p = 0.004) along with N-terminal pro brain natriuretic peptide (HR 2.213, p = 0.001) and hemoglobin (HR 0.840, p = 0.006). Kaplan-Meier analysis showed that patients with serum gamma-GT levels above a median of 36 U/L had significantly more events as compared to the remainder of the group (log-rank p = 0.012). By multivariable logistic regression, higher early mitral inflow velocity/ mitral peak velocity of late filling (Odds Ratio (OR) 2.173, p = 0.024), higher right atrial (RA) pressure (OR 1.139, p < 0.001) and larger RA diameter (OR 1.070, p = 0.001) were independently associated with serum gamma-GT > 36 U/L. Serum levels of gamma-GT are associated with both left and right-sided cardiac alterations and may serve as a simple tool for risk prediction in HFpEF, especially when further diagnostic modalities are not available.

scholarly journals Hemodynamic responses to small muscle mass exercise in heart failure patients with reduced ejection fraction

2014 ◽  
Vol 307 (10) ◽  
pp. H1512-H1520 ◽  
Author(s):  
Zachary Barrett-O'Keefe ◽  
Joshua F. Lee ◽  
Amanda Berbert ◽  
Melissa A. H. Witman ◽  
Jose Nativi-Nicolau ◽  
...  
Keyword(s):  
Heart Failure ◽  
Blood Flow ◽  
Ejection Fraction ◽  
Muscle Mass ◽  
Maximum Voluntary Contraction ◽  
Exercise Intolerance ◽  
Control Group ◽  
Hemodynamic Responses ◽  
Reduced Ejection Fraction ◽  
Small Muscle

To better understand the mechanisms responsible for exercise intolerance in heart failure with reduced ejection fraction (HFrEF), the present study sought to evaluate the hemodynamic responses to small muscle mass exercise in this cohort. In 25 HFrEF patients (64 ± 2 yr) and 17 healthy, age-matched control subjects (64 ± 2 yr), mean arterial pressure (MAP), cardiac output (CO), and limb blood flow were examined during graded static-intermittent handgrip (HG) and dynamic single-leg knee-extensor (KE) exercise. During HG exercise, MAP increased similarly between groups. CO increased significantly (+1.3 ± 0.3 l/min) in the control group, but it remained unchanged across workloads in HFrEF patients. At 15% maximum voluntary contraction (MVC), forearm blood flow was similar between groups, while HFrEF patients exhibited an attenuated increase at the two highest intensities compared with controls, with the greatest difference at the highest workload (352 ± 22 vs. 492 ± 48 ml/min, HFrEF vs. control, 45% MVC). During KE exercise, MAP and CO increased similarly across work rates between groups. However, HFrEF patients exhibited a diminished leg hyperemic response across all work rates, with the most substantial decrement at the highest intensity (1,842 ± 64 vs. 2,675 ± 81 ml/min; HFrEF vs. control, 15 W). Together, these findings indicate a marked attenuation in exercising limb perfusion attributable to impairments in peripheral vasodilatory capacity during both arm and leg exercise in patients with HFrEF, which likely plays a role in limiting exercise capacity in this patient population.

scholarly journals sST2 Protein Serum Levels in Patients with Chronic Heart Failure

2020 ◽  
Vol 10 (4) ◽  
pp. 342-346
Author(s):  
Roman Tokmachev ◽  
Andrey Kravchenko ◽  
Andrey Budnevsky ◽  
Evgeniy Ovsyannikov ◽  
Tatiana Chernik ◽  
...  
Keyword(s):  
Heart Failure ◽  
Chronic Heart Failure ◽  
Ejection Fraction ◽  
Positive Association ◽  
Serum Levels ◽  
Functional Class ◽  
Reduced Ejection Fraction ◽  
Nyha Classification ◽  
Universal Indicator ◽  
Hs Crp

The purpose of this study was to determine the blood concentration of sST2 and evaluate the correlations between sST2 and the clinical, instrumental, and echocardiographic characteristics of patients with CHFrEF (chronic heart failure with reduced ejection fraction) and CHFpEF (chronic heart failure with preserved ejection fraction), as well as to evaluate the sST2 informativeness in comparison with NT-proBNP. The study involved 160 patients diagnosed with CHF (86 men and 74 women, mean age of 72.4±8.7 years). According to the LVEF value, the patients were divided into two groups: CHFpEF (EF≥50%) was recorded in 69 people, CHFrEF (EF<50%) - in 91 people. The functional class (FC) of CHF was determined according to the NYHA classification (1994). NT-proBNP and hs-CRP levels had a stronger positive association with sST2 levels in CHFrEF patients than in CHFpEF patients. The results obtained (regardless of the EF) indicated a statistically significant direct correlation between the levels of sST2 and LAVI. The weak direct correlation between sST2 and NYHA FC, in contrast to the direct strong correlation between NT-proBNP and sST2, indicates that sST2, which is quite important both for determining the current state of the patient and for predicting the course of the disease, still cannot be used as a single and universal indicator. In this regard, further comprehensive study of the diagnostic and prognostic capabilities of the sST2 and NT-proBNP biomarkers in CHF patients with different EF is required.

scholarly journals Altered serum levels of neprilysin in heart failure patients with reduced ejection fraction

2021 ◽  
Vol 122 (01) ◽  
pp. 28-33
Author(s):  
V. Nemcekova ◽  
E. Malikova ◽  
E. Goncalvesova ◽  
P. Krenek ◽  
J. Klimas
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Serum Levels ◽  
Reduced Ejection Fraction ◽  
Heart Failure Patients ◽  
Altered Serum

P4518Cerebral blood flow is lower in heart failure patients with reduced ejection fraction

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
E Babayigit ◽  
Y Cavusoglu ◽  
M Dural ◽  
K U Mert ◽  
T Ulus ◽  
...  
Keyword(s):  
Heart Failure ◽  
Blood Flow ◽  
Cerebral Blood Flow ◽  
Ejection Fraction ◽  
Control Group ◽  
Mean Flow ◽  
Control Groups ◽  
Reduced Ejection Fraction ◽  
And Control ◽  
Flow Velocities

Abstract Purpose Heart and brain interaction is a well-known entity in heart failure (HF) and left ventricular systolic dysfunction poses an increased risk for stroke and cognitive impairment. Transcranial Doppler (TCD) provides valuable information on cerebral blood flow and detects microembolic signals that can be used to determine the risk of cerebrovascular events. However, less is known about cerebral blood flow in HF patients with reduced EF. So, we aimed to evaluate cerebral blood flow rates by means of TCD in HF patients with reduced ejection fraction (EF). Methods This study included 46 HF patients with an EF less than 35% (mean age 65.2±11 years, mean EF 20.1±3.8%) who underwent to TCD examination. In addition, 26 healthy individuals with sinus rhythm and EF >50% (mean age 64.4±9.0 years, mean EF 63.5±2.38%) were included in the study as a control group. Minimum, maximum and mean flow velocities of the both right middle cerebral artery (RMCA) and left middle cerebral artery (LMCA) determined by TCD were analyzed. Results The average of RMCA maximum and mean flow velocities were found to be significantly lower in HF patients than those in control group (76,06±23,7 cm/s and 48,49±16,4 cm/s in HF group vs 87,84±14,5 cm/s and 56,41±10,7 cm/s in control group, p=0,025 and p=0,016, respectively). The average of LMCA maximum and mean flow velocities were also significantly lower in HF patients than those in control group (75,1±22,3 cm/s and 47,57±14.8 cm/s in HF group vs 88,73±17,7 cm/s and 57,15±12,4 cm/s in control group, p=0,009 and p=0,007, respectively). However, there was no significant difference in minimum RMCA or LMCA flow velocities between HF group and control groups (33,5±10,6 cm/s and 32,86±9,58 cm/s in HF group vs 36,34±9,2 cm/s and 36,53±10,4 cm/s in control group, p=0,226 and p=0,157, respectively). No significant microembolic signals were detected in HF and control groups. Conclusions The results of this study showed that HF patients with reduced EF have lower cerebral blood flow velocities as compared to healthy controls, which might be one of the explanations of the adverse interaction between heart and brain in HF.

Hemodynamic Effects of Dexmedetomidine in Adults With Reduced Ejection Fraction Heart Failure

2020 ◽  
pp. 088506662093441
Author(s):  
Tara L. Ruder ◽  
Kevin R. Donahue ◽  
A. Carmine Colavecchia ◽  
David Putney ◽  
Mukhtar Al-Saadi
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Underlying Disease ◽  
Control Group ◽  
Reduced Ejection Fraction ◽  
End Point ◽  
Time Period ◽  
Significant Difference ◽  
Patients With Heart Failure ◽  
Nonsurgical Patients

Background: Dexmedetomidine (DEX) can cause hypotension complicating its use in critically ill patients with labile hemodynamics secondary to an underlying disease state such as heart failure. The aim of this study was to determine the effect of DEX on mean arterial pressure (MAP) in nonsurgical patients with heart failure and reduced ejection fraction (HFrEF). Methods: This retrospective single-center cohort study evaluated patients who received DEX in the cardiac care and medical intensive care units at a large academic hospital. The primary end point was the change in MAP within 6 hours following DEX initiation. Results: Sixty-five patients with HFrEF diagnosis were compared 1:1 to a control group without HFrEF. Both groups experienced a decrease in MAP over the study period. Patients with HFrEF had a greater absolute percentage reduction in MAP 1 hour following DEX initiation compared to the control group (−9.6% vs −5.2%; P < .01). When accounting for the combined effect of DEX initiation and HFrEF diagnosis on the primary end point, patients with HFrEF did not have a significant difference in MAP compared to the control group over the study period. Conclusions: Within 6 hours following DEX initiation, both groups experienced a decrease in MAP. The effect of DEX on MAP over the composite time period was not found to be significantly different in the HFrEF group compared to the non-HFrEF group. However, patients with HFrEF experienced a greater reduction in MAP in the first hour following DEX initiation compared to the non-HFrEF group. Prospective studies are needed to evaluate the effect of DEX on patients with acute decompensated HFrEF compared to patients with compensated HFrEF.

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