scholarly journals Age-related changes in intraventricular kinetic energy: a physiological or pathological adaptation?

2016 ◽  
Vol 310 (6) ◽  
pp. H747-H755 ◽  
Author(s):  
James Wong ◽  
Radomir Chabiniok ◽  
Adelaide deVecchi ◽  
Nathalie Dedieu ◽  
Eva Sammut ◽  
...  
Keyword(s):  
Kinetic Energy ◽  
Ejection Fraction ◽  
Healthy Subjects ◽  
Cardiac Cycle ◽  
Left Ventricular ◽  
Reduced Ejection Fraction ◽  
Lv Dysfunction ◽  
Age Related ◽  
Early Peak ◽  
Age Related Changes

Aging has important deleterious effects on the cardiovascular system. We sought to compare intraventricular kinetic energy (KE) in healthy subjects of varying ages with subjects with ventricular dysfunction to understand if changes in energetic momentum may predispose individuals to heart failure. Four-dimensional flow MRI was acquired in 35 healthy subjects (age: 1–67 yr) and 10 patients with left ventricular (LV) dysfunction (age: 28–79 yr). Healthy subjects were divided into age quartiles (1st quartile: <16 yr, 2nd quartile: 17–32 yr, 3rd quartile: 33–48 yr, and 4th quartile: 49–64 yr). KE was measured in the LV throughout the cardiac cycle and indexed to ventricular volume. In healthy subjects, two large peaks corresponding to systole and early diastole occurred during the cardiac cycle. A third smaller peak was seen during late diastole in eight adults. Systolic KE ( P = 0.182) and ejection fraction ( P = 0.921) were preserved through all age groups. Older adults showed a lower early peak diastolic KE compared with children ( P < 0.0001) and young adults ( P = 0.025). Subjects with LV dysfunction had reduced ejection fraction ( P < 0.001) and compared with older healthy adults exhibited a similar early peak diastolic KE ( P = 0.142) but with the addition of an elevated KE in diastasis ( P = 0.029). In healthy individuals, peak diastolic KE progressively decreases with age, whereas systolic peaks remain constant. Peak diastolic KE in the oldest subjects is comparable to those with LV dysfunction. Unique age-related changes in ventricular diastolic energetics might be physiological or herald subclinical pathology.

Abstract 16056: The Prevalence, Risk Factors and Outcome of Cardiac Dysfunction in Hospitalized Patients With Covid-19

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Mingxing XIE ◽  
Yuman Li ◽  
He Li ◽  
Yuji Xie ◽  
Meng Li ◽  
...  
Keyword(s):  
Risk Factors ◽  
Heart Failure ◽  
Ejection Fraction ◽  
Cardiac Dysfunction ◽  
Troponin I ◽  
High Sensitivity ◽  
Left Ventricular ◽  
Hospitalized Patients ◽  
Reduced Ejection Fraction ◽  
Lv Dysfunction

Objectives: We aimed to investigate the prevalence, risk factors and outcome of cardiac dysfunction, and explore the potential value of echocardiographic parameters in hospitalized patients with coronavirus disease 2019 (COVID-19). Background: Cardiac involvement is a prominent features in COVID-19. However, the prevalence and clinical significance of cardiac dysfunction in COVID-19 patients have not yet been well described. Methods: We studied 157 consecutive hospitalized COVID-19 patients, whose Left ventricular (LV) and right ventricular (RV) structure and function were evaluated by echocardiography. Results: RV dysfunction was found in 40 (25.5%) patients, and LV dysfunction in 28 (17.8%) patients consisting of 24 (15.3%) with heart failure with preserved ejection fraction and 4 (2.5%) with heart failure with reduced ejection fraction. Hypertension, acute respiratory distress syndrome (ARDS), high-sensitivity troponin I (hs-TNI) level and mechanical ventilation therapy was associated with cardiac dysfunction, which contributed to higher mortality (LV dysfunction: 28.6% vs 11.6%, P = 0.022; RV dysfunction: 37.5% vs 6.8%, P < 0.001, respectively). Moreover, LV and RV dysfunction were more frequent in patients with elevated hs-TNI than those without (37.5% vs 12.5 %, P = 0.001; 40.0 % vs 22.9%, P = 0.043, respectively). During hospitalization, 23 patients died. The mortality was 3.0% for patients without cardiac dysfunction and normal hs-TNI levels, 6.7% for those with cardiac dysfunction and normal hs-TNI levels, 13.3% for those without cardiac dysfunction but elevated hs-TNI levels, and 64.0% for those with cardiac dysfunction and elevated hs-TNI. In Cox analysis, RV dysfunction was independently predictor of higher mortality (hazard ratio=2.79; 95% CI: 1.10 to 7.06; P=0.031). HF, especially HFpEF, was not predictive of increased mortality. Conclusions: The prevalence of RV dysfunction was higher than that of HF. Moreover, HFpEF was more common than HFrEF. RV dysfunction is an independent predictor of higher mortality. Additionally, patients with cardiac dysfunction and elevated hs-TNI had the highest mortality, which may prompt physicians to pay attention not only to the hs-TNI level but also the cardiac dysfunction.

scholarly journals Heart failure with preserved ejection fraction based on aging and comorbidities

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Ying Lin ◽  
Shihui Fu ◽  
Yao Yao ◽  
Yulong Li ◽  
Yali Zhao ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Rapid Development ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Preserved Ejection Fraction ◽  
Ventricular Ejection Fraction ◽  
Reduced Ejection Fraction ◽  
Age Related ◽  
Complex Relationships

AbstractHeart failure (HF) with preserved ejection fraction (HFpEF) is a leading cause of hospitalizations and mortality when diagnosed at the age of ≥ 65 years. HFpEF represents multifactorial and multisystemic syndrome and has different pathophysiology and phenotypes. Its diagnosis is difficult to be established based on left ventricular ejection fraction and may benefit from individually tailored approaches, underlying age-related changes and frequent comorbidities. Compared with the rapid development in the treatment of heart failure with reduced ejection fraction, HFpEF presents a great challenge and needs to be addressed considering the failure of HF drugs to improve its outcomes. Further extensive studies on the relationships between HFpEF, aging, and comorbidities in carefully phenotyped HFpEF subgroups may help understand the biology, diagnosis, and treatment of HFpEF. The current review summarized the diagnostic and therapeutic development of HFpEF based on the complex relationships between aging, comorbidities, and HFpEF.

scholarly journals Exploring kinetic energy as a new marker of cardiac function in the single ventricle circulation

2018 ◽  
Vol 125 (3) ◽  
pp. 889-900 ◽  
Author(s):  
James Wong ◽  
Radomir Chabiniok ◽  
Shane M. Tibby ◽  
Kuberan Pushparajah ◽  
Eva Sammut ◽  
...  
Keyword(s):  
New York ◽  
Kinetic Energy ◽  
Ejection Fraction ◽  
Cardiac Function ◽  
Single Ventricle ◽  
Heart Association ◽  
Left Ventricular ◽  
Particle Energy ◽  
Ventricular Performance ◽  
Lv Dysfunction

Ventricular volumetric ejection fraction (VV EF) is often normal in patients with single ventricle circulations despite them experiencing symptoms related to circulatory failure. We sought to determine if kinetic energy (KE) could be a better marker of ventricular performance. KE was prospectively quantified using four-dimensional flow MRI in 41 patients with a single ventricle circulation (aged 0.5–28 yr) and compared with 43 healthy volunteers (aged 1.5–62 yr) and 14 patients with left ventricular (LV) dysfunction (aged 28–79 yr). Intraventricular end-diastolic blood was tracked through systole and divided into ejected and residual blood components. Two ejection fraction (EF) metrics were devised based on the KE of the ejected component over the total of both the ejected and residual components using 1) instantaneous peak KE to assess KE EF or 2) summating individual peak particle energy (PE) to assess PE EF. KE EF and PE EF had a smaller range than VV EF in healthy subjects (97.9 ± 0.8 vs. 97.3 ± 0.8 vs. 60.1 ± 5.2%). LV dysfunction caused a fall in KE EF ( P = 0.01) and PE EF ( P = 0.0001). VV EF in healthy LVs and single ventricle hearts was equivalent; however, KE EF and PE EF were lower ( P < 0.001) with a wider range indicating a spectrum of severity. Those reporting the greatest symptomatic impairment (New York Heart Association II) had lower PE EF than asymptomatic subjects ( P = 0.0067). KE metrics are markers of healthy cardiac function. PE EF may be useful in grading dysfunction. NEW & NOTEWORTHY Kinetic energy (KE) represents the useful work of the heart in ejecting blood. This article details the utilization of KE indexes to assess cardiac function in health and a variety of pathophysiological conditions. KE ejection fraction and particle energy ejection fraction (PE EF) showed a narrow range in health and a lower wider range in disease representing a spectrum of severity. PE EF was altered by functional status potentially offering the opportunity to grade dysfunction.

scholarly journals Diabetes Associated With Greater Ejection Fraction Improvement After Revascularization in Patients With Reduced Ejection Fraction

2021 ◽  
Vol 8 ◽  
Author(s):  
Shaoping Wang ◽  
Bijan J. Borah ◽  
Shujuan Cheng ◽  
Shiying Li ◽  
Ze Zheng ◽  
...  
Keyword(s):  
Ejection Fraction ◽  
Left Ventricular ◽  
Adverse Outcomes ◽  
Diabetic Patients ◽  
Absolute Increase ◽  
Reduced Ejection Fraction ◽  
Lv Dysfunction ◽  
Artery Disease ◽  
The Impact

Objectives: To investigate the association between diabetes mellitus (DM) and ejection fraction (EF) improvement following revascularization in patients with coronary artery disease (CAD) and left ventricular (LV) dysfunction.Background: Revascularization may improve outcomes of patients with LV dysfunction by improvement of EF. However, the determinants of EF improvement have not yet been investigated comprehensively.Method: A cohort study (No. ChiCTR2100044378) of patient with repeated EF measurements after revascularization was performed. All patients had baseline EF ≤40%. Patients who had EF reassessment 3 months after revascularization were enrolled. Patients were categorized into EF unimproved (absolute increase in EF ≤5%) and improved group (absolute increase in EF &gt;5%).Results: A total of 974 patients were identified. 573 (58.8%) had EF improved. Patients with DM had greater odds of being in the improved group (odds ratio [OR], 1.42; 95% CI, 1.07–1.89; P = 0.014). 333 (34.2%) patients with DM had a greater extent of EF improvement after revascularization (10.5 ± 10.4 vs. 8.1 ± 11.2%; P = 0.002) compared with non-diabetic patients. The median follow-up time was 3.5 years. DM was associated with higher risk of overall mortality (hazard ratio [HR], 1.46; 95% CI, 1.02–2.08; P = 0.037). However, in EF improved group, the risk was similar between diabetic and non-diabetic patients (HR, 1.36; 95% CI, 0.80–2.32; P = 0.257).Conclusions: Among patients with reduced EF, DM was associated with greater EF improvement after revascularization. Revascularization in diabetic patients might partially attenuate the impact of DM on adverse outcomes. Our findings imply the indication for revascularization in patients with LV dysfunction who present with DM.

Heart Failure with Preserved Ejection Fraction – A Review

2012 ◽  
Vol 9 (1) ◽  
pp. 90-95 ◽  
Author(s):  
Otto A Smiseth ◽  
Anders Opdahl ◽  
Espen Boe ◽  
Helge Skulstad
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Diastolic Heart Failure ◽  
The Elderly ◽  
Left Ventricular ◽  
Filling Pressure ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Reduced Ejection Fraction ◽  
Objective Evidence

Heart failure with preserved left ventricular ejection fraction (HF-PEF), sometimes named diastolic heart failure, is a common condition most frequently seen in the elderly and is associated with arterial hypertension and left ventricular (LV) hypertrophy. Symptoms are attributed to a stiff left ventricle with compensatory elevation of filling pressure and reduced ability to increase stroke volume by the Frank-Starling mechanism. LV interaction with stiff arteries aggravates these problems. Prognosis is almost as severe as for heart failure with reduced ejection fraction (HF-REF), in part reflecting co-morbidities. Before the diagnosis of HF-PEF is made, non-cardiac etiologies must be excluded. Due to the non-specific nature of heart failure symptoms, it is essential to search for objective evidence of diastolic dysfunction which, in the absence of invasive data, is done by echocardiography and demonstration of signs of elevated LV filling pressure, impaired LV relaxation, or increased LV diastolic stiffness. Antihypertensive treatment can effectively prevent HF-PEF. Treatment of HF-PEF is symptomatic, with similar drugs as in HF-REF.

Prognostic value of global longitudinal layer specific strain for patients with heart failure with reduced ejection fraction

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
C Johnsen ◽  
M Sengeloev ◽  
P Joergensen ◽  
N Bruun ◽  
D Modin ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Prognostic Value ◽  
Left Ventricular ◽  
Volume Index ◽  
Funding Source ◽  
Reduced Ejection Fraction ◽  
Patients With Heart Failure ◽  
All Cause Mortality ◽  
Echocardiographic Parameters

Abstract Background Novel echocardiographic software allows for layer-specific evaluation of myocardial deformation by 2-dimensional speckle tracking echocardiography. Endocardial, epicardial- and whole wall global longitudinal strain (GLS) may be superior to conventional echocardiographic parameters in predicting all-cause mortality in patients with heart failure with reduced ejection fraction (HFrEF). Purpose The purpose of this study was to investigate the prognostic value of endocardial-, epicardial- and whole wall GLS in patients with HFrEF in relation to all-cause mortality. Methods We included and analyzed transthoracic echocardiographic examinations from 1,015 patients with HFrEF. The echocardiographic images were analyzed, and conventional and novel echocardiographic parameters were obtained. A p value in a 2-sided test &lt;0.05 was considered statistically significant. Cox proportional hazards regression models were constructed, and both univariable and multivariable hazard ratios (HRs) were calculated. Results During a median follow-up time of 40 months, 171 patients (16.8%) died. A lower endocardial (HR 1.17; 95% CI (1.11–1.23), per 1% decrease, p&lt;0.001), epicardial (HR 1.20; 95% CI (1.13–1.27), per 1% decrease, p&lt;0.001), and whole wall (HR 1.20; 95% CI (1.14–1.27), per 1% decrease, p&lt;0.001) GLS were all associated with higher risk of death (Figure 1). Both endocardial (HR 1.12; 95% CI (1.01–1.23), p=0.027), epicardial (HR 1.13; 95% CI (1.01–1.26), p=0.040) and whole wall (HR 1.13; 95% CI (1.01–1.27), p=0.030) GLS remained independent predictors of mortality in the multivariable models after adjusting for significant clinical parameters (age, sex, total cholesterol, mean arterial pressure, heart rate, ischemic cardiomyopathy, percutaneous transluminal coronary angioplasty and diabetes) and conventional echocardiographic parameters (left ventricular (LV) ejection fraction, LV mass index, left atrial volume index, deceleration time, E/e', E-velocity, E/A ratio and tricuspid annular plane systolic excursion). No other echocardiographic parameters remained an independent predictors after adjusting. Furthermore, endocardial, epicardial and whole wall GLS had the highest C-statistics of all the echocardiographic parameters. Conclusion Endocardial, epicardial and whole wall GLS are independent predictors of all-cause mortality in patients with HFrEF. Furthermore, endocardial, epicardial and whole wall GLS were superior prognosticators of all-cause mortality compared with all other echocardiographic parameters. Funding Acknowledgement Type of funding source: Public hospital(s). Main funding source(s): Herlev and Gentofte Hospital

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