Noninvasive Hemodynamic Profiles during Hemodialysis in Patients with and without Heart Failure

Background: Although the dynamics of blood pressure (BP) during dialysis provide information related to the control system, the prognosis and relationships between temporal changes in intradialytic hemodynamic regulation, BP, and decreased cardiac function remain largely unclear. Methods: Hemodynamic parameters, including heart rate (HR), stroke volume (SV), cardiac index, and systemic vascular resistance index, were recorded using a noninvasive hemodynamic device on a beat-by-beat basis in 40 patients on dialysis who were divided into three groups, i.e., those with and without BP lability and those with heart failure (HF). Statistical measurements, including mean, standard deviation, coefficient of variation (CV), and index of nonrandomness of each hemodynamic parameter were derived from the three different phases divided equally during dialysis and compared using 3×3 two-way mixed-model analysis of variance to determine the effects of the different stages of hemodialysis (HD), cardiac function, and intradialytic changes in BP on the hemodynamic parameters. In addition, multivariate Cox regression was performed to determine the association between the changes in the derived parameters and BP lability. Results: The average SV tended to decrease during HD in all groups (p = 0.041). A significant decrease was observed in the CV of SV between the first two stages of HD in patients with labile BP and HF when compared to those without labile BP (p = 0.037). Significant interactions between group and stage of the index of nonrandomness for HR were also noted; this index was significantly higher in patients without labile BP than in those with labile BP or HF (p = 0.048). A higher difference between the early and middle stages of HD for nonrandomness indexes of HR was an independent predictor of reduced BP lability during HD (HR = 0.844, 95% confidence interval 0.722–0.987, p = 0.034). Conclusions: Increases in the CV of SV and the index of nonrandomness for HR during early-stage HD in response to decreased SV may be associated with better BP control during HD. This finding suggests that patients with more structurally meaningful hemodynamic control have a more favorable cardiovascular outcome.

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Sex Differences in Characteristics and Outcomes in Elderly Heart Failure Patients With Preserved Ejection Fraction: A Post-hoc Analysis From TOPCAT

Frontiers in Cardiovascular Medicine ◽

10.3389/fcvm.2021.721850 ◽

2021 ◽

Vol 8 ◽

Author(s):

Jiaxing Sun ◽

Shi Tai ◽

Yanan Guo ◽

Liang Tang ◽

Hui Yang ◽

...

Keyword(s):

Heart Failure ◽

Sex Differences ◽

Elderly Patients ◽

Cardiac Function ◽

Patient Outcomes ◽

Cox Regression ◽

Preserved Ejection Fraction ◽

All Cause Mortality ◽

Baseline Characteristics ◽

The Impact

Introduction: Although the impact of sex on patient outcomes for heart failure (HF) with preserved ejection fraction (HFpEF) has been reported, it is still unclear whether this impact is applicable for elderly patients with HFpEF. This study was conducted as a secondary analysis from a large randomized controlled trial—The Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist Trial (TOPCAT)—to evaluate the impact of sex differences on the baseline characteristics and outcomes of HFpEF patients who were older than 70 years.Methods: Baseline characteristic of elderly patients were compared between men and women. Primary outcomes were cardiovascular (CV) mortality and HF-related hospitalization, whereas secondary outcomes were all-cause mortality and all-cause hospitalization. Cox regression models were used to determine the effect of sex differences on patient outcomes.Results: A total of 1,619 patients were included in the study: 898 (55.5%) women and 721 (44.5%) men. Age was similar between women and men. Women had fewer comorbidities but worse cardiac function than men. The rate of primary outcomes was lower in women than in men (18.4 vs. 27.5%; p < 0.001), including rate of CV mortality (8.9 vs. 14.8%; p < 0.001) and HF-related hospitalization (13.4 vs. 18.2%; p = 0.008). All-cause mortality was also lower in women than in men (15.6 vs. 25.4%; p < 0.001). After adjustment for baseline characteristics, Cox regression analysis showed that female sex was a protective factor for CV mortality [hazard ratio (HR): 0.53; 95% confidence interval (CI): 0.40–0.73], HF-related hospitalization (HR: 0.71; 95% CI: 0.55–0.93), and all-cause mortality (HR: 0.59; 95% CI: 0.47–0.75). Although spironolactone significantly reduced the rate of all-cause mortality in women even after adjusting for baseline characteristics (HR: 0.68; 95% CI: 0.48–0.96; p = 0.028), no significant multivariate association was noted between sex and treatment effects (p = 0.190).Conclusion: Among elderly patients with HFpEF, women had worse cardiac function but better survival and lower HF-related hospitalization rate than men.Clinical Trial Registration: NCT00094302 (TOPCAT). Registered October 15, 2004, https://www.clinicaltrials.gov/ct2/show/NCT00094302.

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Increased oxygen uptake and utilization in the peripheral muscles, rather than cardiac function reserve, may be determinants of increased peak VO2 by cardiac rehabilitation in heart failure

European Heart Journal ◽

10.1093/ehjci/ehaa946.1069 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

H Hasegawa ◽

T Kono ◽

K Sakane ◽

T Matsuoka ◽

A Soyama ◽

...

Keyword(s):

Heart Failure ◽

Oxygen Uptake ◽

Cardiac Function ◽

Cardiac Rehabilitation ◽

Systolic Pressure ◽

Resistance Index ◽

Stroke Volume Index ◽

Peak Oxygen Consumption ◽

Volume Index ◽

Peak Vo2

Abstract Background Peak oxygen consumption (peak VO2) is a major prognostic parameter in heart failure (HF). Previous studies have shown a relationship between peak VO2 and impaired oxygen uptake and utilization in the peripheral muscles. The purpose of this study was to clarify the determinant of increased peak VO2 by cardiac rehabilitation (CR) in patients with HF. Methods We performed echocardiography during upright ramp bicycle cardiopulmonary exercise test in 30 HF patients (61±1 years of age, 80% male) before and 6 months after CR. HR reserve was determined as the change in HR from rest to peak exercise, expressed as a percentage of the predicted maximal HR reserve. Elastance index (EAI) and LV end-systolic elastance index (ELVI) were derived as the ratio of end-systolic pressure to stroke volume index and end-systolic volume index, respectively. End-systolic pressure was estimated from the equation 0.9 × brachial systolic blood pressure. Ventriculo-arterial coupling (VAC) was calculated as the quotient of EAI and ELVI. The ratio of LDEDVI to E/e' mean was used to evaluate LV diastolic compliance. Systemic vascular resistance index was calculated as mean arterial pressure divided by echocardiography calculated cardiac index and multiplied by 80. The arterial venous oxygen content difference (C (A-V) O2 gradient) was calculated by using the Fick equation as: VO2/echocardiography calculated cardiac output. Results Peak VO2 and C (A-V) O2 gradient were increased by CR. However, heart rate reserve, systolic reserve, VAC, diastolic reserve and vasodilation reserve were unchanged by CR (Table 1). Conclusions Increased oxygen uptake and utilization in the peripheral muscles, rather than cardiac function reserve, may be determinants of increased peak VO2 by CR in HF. Table 1 Funding Acknowledgement Type of funding source: None

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Discrepancy between Lung Function Measurements at Home and in the Hospital in Children with Asthma and CF

Journal of Clinical Medicine ◽

10.3390/jcm9061617 ◽

2020 ◽

Vol 9 (6) ◽

pp. 1617 ◽

Cited By ~ 2

Author(s):

Frederick L.G.R. Gerzon ◽

Quirijn Jöbsis ◽

Michiel A.G.E. Bannier ◽

Bjorn Winkens ◽

Edward Dompeling

Keyword(s):

Lung Function ◽

Mixed Model ◽

Linear Mixed Model ◽

Early Stage ◽

Home Monitoring ◽

Clinical Situation ◽

Forced Expiratory Volume ◽

Mixed Model Analysis ◽

Children With Asthma ◽

At Home

The Coronavirus pandemic stresses the importance of eHealth techniques to monitor patients at home. Home monitoring of lung function in asthma and cystic fibrosis (CF) may help to detect deterioration of lung function at an early stage, but the reliability is unclear. We investigated whether lung function measurements at home were comparable to measurements during clinical visits. We analysed prospectively collected data of two one-year observational cohort studies in 117 children (36 with CF and 81 with asthma). All patients performed forced expiratory volume in one second (FEV1) measurements with a monitor at home. Paired FEV1 measurements were included if the measurement on the home monitor was performed on the same day as the FEV1 measurement on the pneumotachometer during a two monthly clinical visit. Bland-Altman plots and linear mixed model analysis were used. The mean difference (home measurement was subtracted from clinical measurement) in FEV1 was 0.18 L in CF (95% confidence interval (CI) 0.08–0.27 L; p < 0.001) and 0.12 L in asthma (95%CI 0.05–0.19 L; p < 0.001). FEV1 measurements at home were significantly lower than clinically obtained FEV1 measurements, which has implications for the application of this technique in the daily clinical situation.

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Chronisch pulmonale Erkrankungen bei Kindern: Chancen von E-Health zur Verbesserung der Therapiesteuerung nutzen

Karger Kompass Pneumologie ◽

10.1159/000510893 ◽

2020 ◽

Vol 8 (5) ◽

pp. 264-265

Author(s):

Maximilian Jorczyk

Keyword(s):

Lung Function ◽

Mixed Model ◽

Linear Mixed Model ◽

Early Stage ◽

Home Monitoring ◽

Clinical Situation ◽

Forced Expiratory Volume ◽

Mixed Model Analysis ◽

One Year ◽

At Home

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TNFα-antagonist neither improve cardiac remodelling or cardiac function at early stage of heart failure in diabetic rats

Autoimmunity ◽

10.1080/08916930802041164 ◽

2008 ◽

Vol 41 (6) ◽

pp. 473-477 ◽

Cited By ~ 6

Author(s):

Azra Isic ◽

Margareta Scharin Täng ◽

Espen Haugen ◽

Michael Fu

Keyword(s):

Heart Failure ◽

Cardiac Function ◽

Early Stage ◽

Diabetic Rats ◽

Cardiac Remodelling

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PET Tracers for Imaging Cardiac Function in Cardio-oncology

Current Cardiology Reports ◽

10.1007/s11886-022-01641-4 ◽

2022 ◽

Author(s):

James M. Kelly ◽

John W. Babich

Keyword(s):

Heart Failure ◽

Cardiac Function ◽

Early Stage ◽

Systolic Dysfunction ◽

Healing Process ◽

Metabolic Imaging ◽

Oncology Research ◽

Positron Emission ◽

Highly Sensitive ◽

Gallium 68

Abstract Purpose of Review Successful treatment of cancer can be hampered by the attendant risk of cardiotoxicity, manifesting as cardiomyopathy, left ventricle systolic dysfunction and, in some cases, heart failure. This risk can be mitigated if the injury to the heart is detected before the onset to irreversible cardiac impairment. The gold standard for cardiac imaging in cardio-oncology is echocardiography. Despite improvements in the application of this modality, it is not typically sensitive to sub-clinical or early-stage dysfunction. We identify in this review some emerging tracers for detecting incipient cardiotoxicity by positron emission tomography (PET). Recent Findings Vectors labeled with positron-emitting radionuclides (e.g., carbon-11, fluorine-18, gallium-68) are now available to study cardiac function, metabolism, and tissue repair in preclinical models. Many of these probes are highly sensitive to early damage, thereby potentially addressing the limitations of current imaging approaches, and show promise in preliminary clinical evaluations. Summary The overlapping pathophysiology between cardiotoxicity and heart failure significantly expands the number of imaging tools available to cardio-oncology. This is highlighted by the emergence of radiolabeled probes targeting fibroblast activation protein (FAP) for sensitive detection of dysregulated healing process that underpins adverse cardiac remodeling. The growth of PET scanner technology also creates an opportunity for a renaissance in metabolic imaging in cardio-oncology research.

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