Abstract 4355: Functional Status Is More Strongly Associated with Mortality in Cardiac Amyloid Compared to Echocardiographic Parameters

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Bethany A Austin ◽  
Brendan Duffy ◽  
Rene Rodriguez ◽  
Carmela Tan ◽  
Randall C Starling ◽  
...  
Keyword(s):  
Survival Analysis ◽  
Cardiac Amyloidosis ◽  
Nyha Class ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Proportional Hazard ◽  
Term Survival ◽  
Cox Proportional Hazard ◽  
Lv Mass

Cardiac amyloidosis (CA) is generally associated with a poor prognosis and significantly increased mortality. We sought to identify predictors of longer-term survival in patients with EMB documented CA. Forty-five consecutive EMB documented CA patients were studied from 1/98 –12/03. Age, gender, NYHA class, medications, presence of light chain amyloid and ECG voltage were recorded. Baseline left ventricular ejection fraction (LVEF), deceleration time (DT), diastology, LV mass, interventricular septal (IVS) thickness and myocardial performance index (MPI) [(isovolumic contraction time + isovolumic relaxation time)/ejection time] were recorded. Length of follow-up and all-cause mortality were recorded. Mean age was 66 ±10 years with 34 (76 %) men. NYHA class > 2 and low voltage on ECG [S (V1) + R (V5) ≤12] were noted in 26 (58 %) and 12 (27 %) patients, respectively. Mean LVEF, IVS thickness and LV mass were 46 % ±13, 1.7 cm ±0.42 and 303 grams ±114, respectively. DT <150 msec and MPI > 0.6 were found in 19 (42 %) and 15 (33 %) patients, respectively. At median follow-up of 1.7 years, there were 25 (56%) deaths. On univariate Kaplan-Meier survival analysis, NYHA class > 2, DT <150 msec and lack of beta-blocker use were associated with increased mortality (log-rank statistic p-values <0.001, <0.05 and 0.01, respectively). Cox Proportional Hazard Survival Analysis is shown in the table . In patients with EMB-documented CA, s urvival is more strongly associated with NYHA functional class compared to ECG and echocardiographic variables, including DT and MPI. Evaluation of advanced imaging techniques such as cardiac magnetic resonance in predicting prognosis in these patients is warranted. Table: Cox Proportional Hazard Analysis of Various Clinical, Electrocardiographic and Echocardiographic Predictors of Mortality in Patients with Biopsy Proven Cardiac Amyloidosis

scholarly journals P971 The echocardiographic phenotype in patients with cardiac amyloidosis and heart failure with preserved ejection fraction

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
M D M Perez Gil ◽  
V Mora Llabata ◽  
A Saad ◽  
A Sorribes Alonso ◽  
V Faga ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Cardiac Amyloidosis ◽  
Nyha Class ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Control Group ◽  
Ventricular Ejection Fraction ◽  
Apical Rotation ◽  
Dynamic Torsion

Abstract BACKGROUND New echocardiographic phenotypes of heart failure (HF) are focused on myocardial systolic involvement of the left ventricle (LV), either endocardial and/or transmural. PURPOSE. To study the pattern of myocardial involvement in patients (p) with HF with preserved left ventricular ejection fraction (pLVEF) and cardiac amyloidosis (CA). METHODS. Comparative study of 16 p with CA and HF with pLVEF, considering as cut point LVEF &gt; 50%, in NYHA class ≥ II / IV, and a control group of 16 healthy people. Longitudinal Strain (LS) and Circumferential Strain (CS) were calculated using 2D speckle-tracking echocardiography, along with Mitral Annulus Plane Systolic Excursion (MAPSE) and Base-Apex distance (B-A). Also, the following indexes were calculated: Twist (apical rotation + basal rotation, º); Classic Torsion (TorC): (twist/B-A, º/cm); Torsion Index (Tor.I): (twist/MAPSE, º/cm) and Deformation Index (Def.I): (twist/LS, º). We suggest the introduction of these dynamic torsion indexes as Tor.I and Def.I that include twist per unit of longitudinal systolic shortening of the LV instead of using TorC which is the normalisation of twist to the end-diastolic longitudinal diameter of the LV. RESULTS There were no differences of age between the groups (68.2 ± 11.5 vs 63.7 ± 2.8 years, p = 0.14). Global values of LS and CS were lower in p with CA indicating endocardial and transmural deterioration during systole, while TorC and Twist of the LV remained conserved in p with CA. However, there is an increase of dynamic torsion parameters such as Tor.I and Def.I that show an increased Twist per unit of longitudinal shortening of the LV in the CA group (Table). CONCLUSIONS In p with CA and HF with pLVEF, the impairment of LS and CS indicates endocardial and transmural systolic dysfunction. In these conditions, LVEF would be preserved at the expense of a greater dynamic torsion of the LV. Table LS (%) CS (%) Twist (º) TorC (º/cm) Tor.I (º/cm) Def.I (º/%) CA pLVEF (n = 16) -11.7 ± 4.2 17.2 ± 4.8 19.8 ± 8.3 2.5 ± 1.1 27.7 ± 13.5 -1.8 ± 0.9 Control Group (n = 15) -20.6 ± 2.5 22.7 ± 4.9 21.7 ± 6.1 2.7 ± 0.8 16.4 ± 4.7 -1.0 ± 0.3 p &lt; 0.001 &lt; 0.01 0.46 0.46 &lt; 0.01 &lt; 0.01 Dynamic Torsion Indexes and Classic Torion Parameters in pLVEF CA patients vs Control group.

Additive prognostic value of subjective assessment with respect to clinical cardiological data in patients with chronic heart failure

2011 ◽  
Vol 18 (6) ◽  
pp. 836-842 ◽  
Author(s):  
Giuseppina Majani ◽  
Antonia Pierobon ◽  
Gian Domenico Pinna ◽  
Anna Giardini ◽  
Roberto Maestri ◽  
...  
Keyword(s):  
Heart Failure ◽  
Physical Functioning ◽  
Prognostic Value ◽  
Daily Life ◽  
Nyha Class ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Term Survival ◽  
Ventricular Ejection Fraction ◽  
Subjective Satisfaction

Background: Health-related quality of life tools that better reflect the unique subjective perception of heart failure (HF) are needed for patients with this disorder. The aim of this study was to explore whether subjective satisfaction of HF patients about daily life may provide additional prognostic information with respect to clinical cardiological data. Methods: One hundred and seventy-eight patients (age 51 ± 9 years) with moderate to severe HF [New York Heart Association (NYHA) class 2.0 ± 0.7; left ventricular ejection fraction (LVEF) 29 ± 8%] in stable clinical condition underwent a standard clinical evaluation and compiled the Satisfaction Profile (SAT-P) questionnaire focusing on subjective satisfaction with daily life. Cox regression analysis was used to assess whether SAT-P factors (psychological functioning, physical functioning, work, sleep/eating/leisure, social functioning) had any prognostic value. Results: Forty-six cardiac deaths occurred during a median of 30 months. Patients who died had higher NYHA class, more depressed left ventricular function, reduced systolic blood pressure (SBP), increased heart rate (HR), and worse biochemistry (all p < 0.05). Among the SAT-P factors, only Physical functioning (PF) was significantly reduced in the patients who died ( p = 0.003). Using the best subset selection procedure, Resistance to physical fatigue (RPF) was selected from among the items of the PF factor. RPF showed independent predictive value when entered into a prognostic model including NYHA class, LVEF, SBP, and HR with an adjusted hazard ratio of 0.86 per 10 units increase (95% CI 0.75–0.98, p = 0.02). Conclusions: Patients’ dissatisfaction with physical functioning is associated with reduced long-term survival, after adjustment for known risk factors in HF. Given its user-friendly structure, simplicity, and significant prognostic value, the RPF score may represent a useful instrument in clinical practice.

scholarly journals Differences in the characteristics and contemporary cardiac outcomes of patients with light-chain versus transthyretin cardiac amyloidosis

PLoS ONE ◽  
2021 ◽  
Vol 16 (8) ◽  
pp. e0255487
Author(s):  
Osnat Itzhaki Ben Zadok ◽  
Mordehay Vaturi ◽  
Iuliana Vaxman ◽  
Zaza Iakobishvili ◽  
Noa Rhurman-Shahar ◽  
...  
Keyword(s):  
Heart Failure ◽  
Light Chain ◽  
Cardiac Amyloidosis ◽  
Clinical Laboratory ◽  
Left Ventricular ◽  
Male Predominance ◽  
Cardiac Outcomes ◽  
Lv Mass ◽  
Artery Disease

Aims To compare the baseline cardiovascular characteristics of immunoglobulin light-chain (AL) and amyloid transthyretin (ATTR) cardiac amyloidosis (CA) and to investigate patients’ contemporary cardiac outcomes. Methods Single-center analysis of clinical, laboratory, echocardiographic and cardiac magnetic resonance imaging (CMRi) characteristics of AL and ATTR-CA patients’ cohort (years 2013–2020). Results Included were 67 CA patients of whom 31 (46%) had AL-CA and 36 (54%) had ATTR-CA. Patients with ATTR-CA versus AL-CA were older (80 (IQR 70, 85) years versus 65 (IQR 60, 71) years, respectively, p<0.001) with male predominance (p = 0.038). Co-morbidities in ATTR-CA patients more frequently included diabetes mellitus (19% versus 3.0%, respectively, p = 0.060) and coronary artery disease (39% versus 10%, respectively, p = 0.010). By echocardiography, patients with ATTR-CA versus AL-CA had a trend to worse left ventricular (LV) ejection function (50 (IQR 40, 55)% versus 60 (IQR 45, 60)%, respectively, p = 0.051), yet comparable LV diastolic function. By CMRi, left atrial area (31 (IQR 27, 36)cm2 vs. 27 (IQR 23, 30)cm2, respectively, p = 0.015) and LV mass index (109 (IQR 96, 130)grams/m2 vs. 82 (IQR 72, 98)grams/m2, respectively, p = 0.011) were increased in patients with ATTR-CA versus AL-CA. Nevertheless, during follow-up (median 20 (IQR 10, 38) months), patients with AL-CA were more frequently admitted with heart failure exacerbations (HR 2.87 (95% CI 1.42, 5.81), p = 0.003) and demonstrated increased mortality (HR 2.51 (95%CI 1.19, 5.28), p = 0.015). Conclusion Despite the various similarities of AL-CA and ATTR-CA, these diseases have distinct baseline cardiovascular profiles and different heart failure course, thus merit tailored-cardiac management.

scholarly journals 85 Diuretics trajectories in dilated cardiomyopathy

2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Vincenzo Nuzzi ◽  
Antonio Cannatà ◽  
Paolo Manca ◽  
Caterina Gregorio ◽  
Giulia Barbati ◽  
...  
Keyword(s):  
Dilated Cardiomyopathy ◽  
Nyha Class ◽  
Diuretic Therapy ◽  
Left Ventricular ◽  
Equivalent Dose ◽  
Left Ventricular Ejection ◽  
Class Iii ◽  
Ventricular Ejection Fraction ◽  
Kaplan Meier

Abstract Aims Diuretics in heart failure (HF) are commended to relieve symptoms at lowest dosage effective. Dilated cardiomyopathy (DCM) is a particular HF setting with several variables that may influence disease trajectory. We aimed to assess the long-term use of diuretics in DCM, the possibility of withdrawal and to explore the prognostic correlations. Methods and results All consecutive DCM patients enrolled from 1990 to 2018 were considered eligible. All the patients had available the information about the furosemide-equivalent dose at baseline and at follow-up evaluation within 24 months. Patients were categorized in stable (diuretic dose variation &lt;50%), increasers (diuretics dose increase ≥50% or initiation of diuretic therapy), and decreasers (diuretics dose decrease ≥50% or never prescribed diuretics in the 24-months observation period). The prognostic role of the diuretics trajectory group was assessed with Kaplan Meier analysis and with a time-dependent multivariable model. The outcome measure was a composite of all-cause death/heart transplantation/HF hospitalization (ACD/HTx/HFH). 908 patients were included [mean age 50 ± 16, 70% male sex, 24% NYHA class III or IV, mean left ventricular ejection fraction (LVEF) 31 ± 9%, 66% treated with diuretics at baseline]. The furosemide-equivalent dose at enrolment had a linear association with the risk of outcome. Compared to other groups, decreaser patients were younger, had less HF symptoms, higher LVEF and more dilated left atrium. Decreasers had a lower prescription rate of diuretics and less frequent indication to renin-angiotensin inhibitors and mineralocorticoid receptors antagonists. Over a median follow-up of 122 (62–195) months decreasers had the lowest incidence of outcome, followed by stable, while increasers had the worst outcome (P &lt; 0.001). After adjustment for other prognosticators, compared to stable patients, decreasers had a reduced risk of ACD/HTx/HFH [HR: 0.497 (95% CI: 0.337–0.731)] while increasers had the highest risk of adverse outcome [HR: 2.027 (95% CI: 1.254–3.276)]. Similarly, amongst patients taking diuretics at baseline, the diuretics withdrawal was in independent outcome predictor. The only multivariable predictors of diuretics withdrawal were younger age and lower furosemide-equivalent dose at enrolment. Conclusions In DCM patients the diuretics dose at baseline is a strong prognosticator. Diuretics dose reduction or its withdrawal provides a prognostic benefit on hard outcome. Diuretics tapering in selected patients should be considered in the short-term follow-up to improve DCM prognosis.

scholarly journals The impact of left atrial strain parameters on systolic and diastolic improvement following TAVI

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
B Vattay ◽  
A I Nagy ◽  
A Apor ◽  
M Kolossvary ◽  
A Manouras ◽  
...  
Keyword(s):  
Left Atrial ◽  
Prognostic Value ◽  
Longitudinal Strain ◽  
Global Longitudinal Strain ◽  
Left Ventricular ◽  
Term Survival ◽  
Lv Mass ◽  
Reverse Remodelling ◽  
The Impact

Abstract Introduction Transcatheter aortic valve implantation (TAVI) can improve left ventricular (LV) mechanics and has been shown to improve long term survival. Data on the prognostic value of left atrial (LA) strain following TAVI are scarce. LA strain – a surrogate of LV filling pressure - can aid the early detection of diastolic dysfunction and correlates with the extent of fibrosis in atrial remodelling. Purpose In this multimodality study, we aimed to evaluate the prognostic value of LA function measured before hospital discharge following TAVI and to further elucidate its association with LV and LA reverse remodelling. Methods In this prospective single center study, we investigated 90 patients (mean age 78.5 years, 46.7% female) with severe, symptomatic aortic stenosis (AS) who underwent transthoracic echocardiography immediately after TAVI and 6 months later. LA and LV global longitudinal strain parameters were obtained by speckle tracking echocardiography. CT angiography (CTA) was performed for pre-TAVI planning and repeated at 6 months follow-up. LV mass values were derived from the serial CTA images. We defined LV reverse remodelling as reduction of myocardial mass quantified on CTA and as an improvement of LV global longitudinal strain (GLS). LA reverse remodelling was assessed based on the peak reservoir strain values (LAGS). The association of LA and LV global strain parameters, LA stiffness, systolic and diastolic functional parameters and LV mass based reverse remodelling were analysed using Pearson correlation coefficient and linear regression models. Results The mean LAGS and LVGLS values were 17.7% and 15.3% at discharge and 20.2% and 16.6% at follow-up, respectively (p=0.024, p&lt;0.001). LA and LV strain values improved in 60.6% and 74.5% of all patients. Reduced LAGS (&lt;20%) was found in 66.7% of all patients at baseline. LA strain at discharge correlated significantly with diastolic parameters (E wave, E/e', LAVI, all p&lt;0.05). Atrial reverse remodelling based on LAGS change correlated with LVGLS change (p&lt;0.01, standardized β=0.53) and LAGS at discharge (p=0.012, standardized β=−0.30). LAGS correlated with the extent of morphological LV remodelling based on LV mass reduction (p=0.002, coeff: 0.36). Elevated LA stiffness at discharge (upper tercile) leads to substantially lower LAGS at 6 months versus patients with lower LA stiffness value (1. and 2. tercile): 16.4±10.0 vs 21.9±9.8, p=0.042. Conclusion Patients with reduced LAGS immediately after TAVI showed a larger extent of LV reverse remodelling during follow up. On the other hand, increased LA stiffness at discharge was consistent with irreversible LA damage as demonstrated by a lack of improvement in LA function. FUNDunding Acknowledgement Type of funding sources: None.

P3618Underweight predicts greater risk of cardiac mortality post acute myocardial infarction

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
W Su ◽  
M Wang ◽  
J G Zhu ◽  
W P Li ◽  
H Chen ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Cardiac Death ◽  
Left Ventricular ◽  
Older Age ◽  
Left Ventricular Ejection ◽  
Proportional Hazard ◽  
Cardiac Mortality ◽  
Cox Proportional Hazard ◽  
To Receive

Abstract Background Increased body mass index (BMI) is a well-established risk factor for cardiovascular disease, however, patients with elevated BMI comparing to low BMI seem to have better survival, a phenomenon reported as “obesity paradox” which remains as a controversy. We investigated the effect of BMI, including underweight, normoweight, overweight and obese, on cardiac mortality post acute myocardial infarction (AMI). Methods This analysis included 3562 AMI patients with documented BMI. The baseline characteristics including clinical and laboratory parameters were collected at hospital admission for AMI. Patients were classified into 4 groups based on BMI values: underweight (BMI <18.5), normoweight (BMI 18.5 to 24.9), overweight (BMI 25 to 29.9) and obese (BMI ≥30). Patients were followed up for a median of 1.9 years. The rate of cardiac death (primary endpoint) was compared among the 4 BMI groups. Cox proportional hazard models were used to adjust for potential confounders. Results Of 3562, 110 (3%) were underweight, 1579 (44%) were normoweight, 1493 (42%) were overweight, and 380 (11%) were obese. Compared to the normoweight group, subjects in overweight and obese groups were younger, more men, more hypertension, more likely to receive percutaneous coronary intervention (PCI), and had higher levels of glucose and lipids, but, lower level of N-terminal pro-brain natriuretic peptide (NTproBNP). Subjects in underweight group were older, more women, fewer diabetes, less likely to receive PCI, lower levels of glucose and lipids, but, higher level of NTproBNP and higher rates of left ventricular ejection fraction (LVEF)<50%. Cardiac death over 1.9 years occurred significantly more in the underweight group (30.0%, 10.6%, 7.0% and 5.0% among the 4 groups from underweight to obese, p<0.001 for trend, Figure 1). The Cox proportional hazard model revealed that underweight was an independent predictor of subsequent cardiac death (OR=2.58, 95% CI: 1.52–4.39, p<0.001). Multivariate analysis identified that older age, higher levels of cardiac troponin I (cTnI) and LVEF<50% were independently associated with increased risk of cardiac death. PCI significantly and independently protected AMI patients against cardiac death (OR=0.34, 95% CI: 0.23–0.49, p<0.001). Conclusions Patients who were underweight were at greater risk of cardiac death post AMI. In addition, older age, higher levels of cTnI, LVEF<50%, and not receiving PCI also independently predicted cardiac mortality post AMI. Acknowledgement/Funding Beijing Natural Science Foundation (No. 7194253);Scientific Research Common Program of Beijing Municipal Commission of Education (KM201910025017)

Abstract 16238: Mortality and Predictors of Appropriate ICD Therapy in Japanese Primary Prevention Patients: A 13-year Experience Based on the MADIT2 Criteria

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Yoshimori An ◽  
Kenji Ando ◽  
Michio Nagashima ◽  
Masato Fukunaga ◽  
Kenichi Hiroshima ◽  
...  
Keyword(s):  
Primary Prevention ◽  
Cox Regression ◽  
Biventricular Pacing ◽  
Nyha Class ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Icd Implantation ◽  
Ventricular Ejection Fraction ◽  
Icd Therapy

Background: There are still limited data on the mortality for a long-term follow-up and the clinical factors influencing appropriate therapies in Japanese patients with implantable cardioverter-defibrillator (ICD) for primary prevention, who satisfied the criteria in Multicenter Automatic Defibrillator Implantation Trial 2 (MADIT2). Methods: Between January 2000 and December 2012, a total of 436 patients without prior ventricular arrhythmic event underwent ICD implantation for primary prevention at our institution. Among these patients, we enrolled consecutive 122 patients (69±10 years, male: 84%, biventricular-pacing: 54%, median follow-up: 1390 days) who met the MADIT2 criteria; left ventricular ejection fraction (LVEF) ≤30% with ischemic heart disease, more than 4 weeks after myocardial infarction. Results: At the 3 years of follow-up, the mortality rate (21%) was comparable with that of the original MADIT2 ICD group (20%). The Kaplan-Meier event rate for appropriate ICD therapy (shock and anti-tachycardia pacing therapy) (35%) was also similar to that of the original MADIT2 ICD group (32%). Multivariate analysis by Cox regression model revealed that left ventricular diastolic diameter (LVDd) ≥60mm (Hazard Ratio [HR]: 1.65, 95% Confidence Interval [CI]: 1.16-2.14, P=0.004) and non-sustained ventricular tachycardia (NSVT) (HR: 1.55, 95%CI: 1.13-2.15, P=0.007) were independent predictors for appropriate ICD therapy. On the other hand, LVEF, NYHA class, biventricular-pacing, amiodarone or inducibility of ventricular arrhythmia was not associated with appropriate ICD therapy. Conclusion: Appropriate ICD therapy was delivered in Japanese primary prevention patients as often as in the original MADIT2 ICD group and strongly predicted by dilated left ventricle and NSVT.

Management of Isolated, Congenital Anterior Mitral Valve Cleft

2021 ◽  
Vol 13 (1) ◽  
pp. 60-64
Author(s):  
J. Blade Hargiss ◽  
Joseph A. Dearani ◽  
Elizabeth H. Stephens ◽  
Nathaniel W. Taggart
Keyword(s):  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Surgical Repair ◽  
Nyha Class ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Postoperative Result ◽  
Ventricular Ejection Fraction ◽  
Class 1

Background: Isolated anterior mitral valve clefts (MVC) are rare congenital heart defects, and data are limited regarding the natural history and surgical outcomes for such isolated MVCs. Methods: We conducted a retrospective review of patients with congenital MVC who were evaluated at Mayo Clinic in Rochester, Minnesota between 1993 and 2020. Patients were separated into two cohorts: those who underwent surgical repair of the MVC and those who had not yet undergone repair. Baseline and postoperative clinical and echocardiographic data were analyzed. Results: Fourteen patients were included in the nonsurgical cohort and eight patients in the surgical cohort. Surgical repair was via primary median sternotomy (n = 6) or robot-assisted, minimally invasive (n = 2). All cleft repairs were performed by simple suture closure. Intraoperative evaluation of the clefts did not reveal additional structural factors that could account for the mitral regurgitation (MR). At latest follow-up of the surgical cohort, the median grade of MR was 1 (range 0-1), and median left ventricular ejection fraction was 65% (IQR 59%-67%), both similar to the immediate postoperative result. At latest follow-up, all patients in the nonsurgical cohort were NYHA Class 1, and median MR grade was 1. All patients were asymptomatic (NYHA Class 1). Conclusions: Our findings corroborate prior reports that MVC repair is safe and successful and is followed by a low rate of recurrent mitral valve dysfunction. Durable surgical repair of isolated, congenital MVC can be performed safely in select patients. The decision to intervene should be based on the severity of mitral regurgitation and patient symptoms rather than the presence of the MVC alone.

scholarly journals Tachycardiomyopathy in Patients without Underlying Structural Heart Disease

2019 ◽  
Vol 8 (9) ◽  
pp. 1411 ◽  
Author(s):  
Giulia Stronati ◽  
Federico Guerra ◽  
Alessia Urbinati ◽  
Giuseppe Ciliberti ◽  
Laura Cipolletta ◽  
...  
Keyword(s):  
Heart Rate ◽  
Heart Disease ◽  
Ejection Fraction ◽  
Structural Heart Disease ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Term Survival ◽  
Ventricular Ejection Fraction ◽  
Obstructive Sleep

Tachycardiomyopathy (TCM) is an underestimated cause of reversible left ventricle dysfunction. The aim of this study was to identify the predictors of recurrence and incidence of major cardiovascular events in TCM patients without underlying structural heart disease (pure TCM). The prospective, observational study enrolled all consecutive pure TCM patients. The diagnosis was suspected in patients admitted for heart failure (HF) with a reduced ejection fraction and concomitant persistent arrhythmia. Pure TCM was confirmed after the clinical and echocardiographic recovery during follow-up. From 107 pure TCM patients (9% of all HF admission, the median follow-up 22.6 months), 17 recurred, 51 were hospitalized for cardiovascular reasons, two suffered from thromboembolic events and one died. The diagnosis of obstructive sleep apnoea syndrome (OSAS, hazard ratio (HR) 5.44), brain natriuretic peptide on admission (HR 1.01 for each pg/mL) and the heart rate at discharge (HR 1.05 for each bpm) were all independent predictors of TCM recurrence. The left ventricular ejection fraction at discharge (HR 0.96 for each%) and the heart rate at discharge (HR 1.02 for each bpm) resulted as independent predictors of cardiovascular-related hospitalization. Pure TCM is more common than previously thought and associated with a good long-term survival but recurrences and hospitalizations are frequent. Reversing OSAS and controlling the heart rate could prevent TCM-related complications.

scholarly journals 5 years follow-up of patients with heart failure and cardiac resynchronization: baseline variables associated to death

2021 ◽  
Vol 28 (Supplement_1) ◽  
Author(s):  
S Oliveira ◽  
PEDRO Cunha ◽  
MIGUEL Carmo ◽  
BRUNO Valente ◽  
INÊS Ricardo ◽  
...  
Keyword(s):  
Heart Failure ◽  
Nyha Class ◽  
Demographic Data ◽  
Left Ventricular ◽  
Lifestyle Changes ◽  
Cardiac Resynchronization ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Spearman Test

Abstract Funding Acknowledgements Type of funding sources: None. Introduction  Chronic Heart Failure (HF) has proven to be an increasing challenge for the global health management. Prognosis is affected by pharmacological optimization, comorbidities and risk factors control, lifestyle changes and invasive treatments like resynchronization (CRT) and transplant.  Purpose  To evaluate the association of baseline variables in HF patients, before CRT, with death event at 5 years follow up (FU).  Methods  Single center, post-hoc analysis of a prospective cohort of consecutive HF patients referred to CRT (2013-2015). Demographic data, HF etiology and NYHA class were evaluated at baseline as well as plasmatic of natriuretic peptide (BNP), heart to mediastinum ratio (HMR), left ventricular ejection fraction (LVEF) and volumes. Mortality was evaluated at 5 years. Patients were divided in two groups: "non survivors" and "survivors". Data were analyzed using descriptive statistics. Spearman test was used to evaluate the correlation between baseline variables and death.  Results  102 patients were included (age 68.8 ± 10 years), 68.6% male, 29% ischemic cardiomyopathy, 74% NYHA III/IV, baseline LVEF 26 ± 7. 27% were CRT non-responders. At 5 years follow up 43% died, with 1.96% lost FU. Baseline variables in the two groups are displayed in table 1. Statistical analysis correlating baseline variables with death (Spearman test) showed weak correlation, with the strongest correlation obtained: late HMR with negative correlation 0.34; LV tele-diastolic volume with positive correlation 0.26.  Conclusion The mortality at 5 years of HF patients with CRT was high (43%). Baseline variables (late HMR, LV tele-diastolic volume) were associated to death. These results should call early attention for a possible worst prognosis in severe HF patients to CRT. Table 1 "Non survivors" vs "Survivors" “Non Survivors”(n = 44) “Survivors”(n = 56) Age 67,11 ± 11,17 68,14 ± 10,51 Male 35 (80%) 35 (63%) NYHA III/IV 31 (70%) 43 (77%) Ischemic 15 (34%) 14 (25%) BNP 640,95 ± 606,23 370,41 ± 353,36 Late HMR 1,35 ± 0,16 1,47 ± 0,17 LVEF 27 ± 6,77 26 ± 7,47 Non responders 16 (36%) 12 (21%) LVTdV 225 ± 73,28 191 ± 58,5 PCR 10,33 ± 22,85 5,02 ± 9,27

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