Abstract 2432: Effect of Left Ventricular Systolic Dysfunction on Wasted Left Ventricular Energy and Tension-Time Index

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Scott J Denardo ◽  
Wilmer W Nichols

Information obtained from the aortic pressure waveform is affected by age, physical condition, systemic hypertension, diabetes mellitus and coronary artery disease. However, alterations in the aortic pressure waveform in patients (pts) with heart failure and left ventricular systolic dysfunction (LVSD) have not been fully described, including a description of the effect on wasted LV pressure energy and tension-time index. Non-invasive high-fidelity radial artery tonometry was used for data acquisition, and a mathematical transfer function used to generate aortic pressure waveforms (see figure ). Pulse wave analysis (PWA) of the aortic pressure waveform was used to obtain information associated with LV/vascular coupling in 23 pts age 55±9.5 yrs with LVSD (mean LV ejection fraction, 22±6%) and compared to data collected from 23 normal subjects matched for age, gender, height, weight and heart rate. Measurements obtained using PWA in heart failure pts with LVSD demonstrate decreased wasted LV energy and tension time index, consistent with poor LV mechanical performance, in addition to decreased unaugmented pressure, pulse pressure, ejection duration and augmentation index. Further standardization of these aortic pressure waveform findings in heart failure pts may allow for the clinical use of arterial PWA to non-invasively estimate LVSD.

Heart ◽  
2001 ◽  
Vol 86 (2) ◽  
pp. 172-178 ◽  
Author(s):  
O W Nielsen ◽  
J Hilden ◽  
C T Larsen ◽  
J F Hansen

OBJECTIVETo examine a general practice population to measure the prevalence of signs and symptoms of heart failure (SSHF) and left ventricular systolic dysfunction (LVSD).DESIGNCross sectional screening study in three general practices followed by echocardiography.SETTING AND PATIENTSAll patients ⩾ 50 years in two general practices and ⩾ 40 years in one general practice were screened by case record reviews and questionnaires (n = 2158), to identify subjects with some evidence of heart disease. Among these, subjects were sought who had SSHF (n = 115). Of 357 subjects with evidence of heart disease, 252 were eligible for examination, and 126 underwent further cardiological assessment, including 43 with SSHF.MAIN OUTCOME MEASURESPrevalence of SSHF as defined by a modified Boston index, LVSD defined as an indirectly measured left ventricular ejection fraction ⩽ 0.45, and numbers of subjects needing an echocardiogram to detect one case with LVSD.RESULTSSSHF afflicted 0.5% of quadragenarians and rose to 11.7% of octogenarians. Two thirds were handled in primary care only. At ⩾ 50 years of age 6.4% had SSHF, 2.9% had LVSD, and 1.9% (95% confidence interval 1.3% to 2.5%) had both. To detect one case with LVSD in primary care, 14 patients with evidence of heart disease without SSHF and 5.5 patients with SSHF had to be examined.CONCLUSIONSSHF is extremely prevalent in the community, especially in primary care, but more than two thirds do not have LVSD. The number of subjects with some evidence of heart disease needing an echocardiogram to detect one case of LVSD is 14.


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