Abstract 16898: Time Course and Associated Cardiac Conditions of Reduced Left Ventricular Ejection Fraction in Patients With Severe Aortic Stenosis

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Saki Ito ◽  
Vuyisile T Nkomo ◽  
Sorin V Pislaru ◽  
Jeremy J Thaden ◽  
Kevin L Greason ◽  
...  
Keyword(s):  
Heart Disease ◽  
Aortic Valve ◽  
Aortic Stenosis ◽  
Ejection Fraction ◽  
Ischemic Heart Disease ◽  
Time Course ◽  
Left Ventricular ◽  
Ischemic Heart ◽  
Left Ventricular Ejection ◽  
Gradual Decline

Objective: In patients with aortic stenosis (AS), the development of left ventricular (LV) systolic dysfunction adversely affects the natural history and is associated with poor outcomes following aortic valve replacement. However, the timing and possible reasons for transition from preserved to impaired LV ejection fraction (LVEF) in patients with AS have not been described. The aim of this study was to describe the time course of development of LV dysfunction and associated conditions in patients with severe AS. Methods & Results: Between 1/1/2009 and 12/31/2012, 667 (19%) of 3528 patients with severe AS (aortic valve area (AVA) ≤1 cm2) identified from the Mayo Clinic, Rochester, MN Echocardiographic Laboratory database; had LVEF ≤50%. Of those 667 patients, 263 (39%) had previous echocardiograms (median: 71.6 months, 25 IQR: 36.3, 75:118.2) before the development of severe AS, allowing an assessment of change in LVEF over time. Among these 263 patients, 8 (3%) had dilated cardiomyopathy (DCM), 225 (86%) had ischemic heart disease (IHD), 5 (2%) had other significant valve disease, and 25 (10%) had no concomitant heart disease before the development of severe AS. The evolution of development of reduced LVEF at several time points is shown in the Figure. The initial LVEF was 34±12 % in DCM patients, 51±13% in IHD patients and 61±9 % in AS patients without other heart diseases (p<0.001, ANOVA). Patients with AS alone or AS+DCM/IHD showed a gradual decline in LVEF before AS became severe, and a more rapid decline in LVEF once the AVA reached ≤ 1 cm2. Conclusion: In patients with severe AS, a majority of the patients (86%) with reduced EF had ischemic heart disease. Although there was a gradual decline in LVEF before development of severe AS, the decline was more rapid after AS became severe in almost all patients regardless of associated cardiac condition. More frequent monitoring may be indicated in AS patients especially when AVA reaches 1cm2 and concomitant IHD.

scholarly journals Trends in Left Ventricular Ejection Fraction for Patients With a New Diagnosis of Heart Failure

2020 ◽  
Vol 13 (9) ◽  
Author(s):  
Rebecca L. Tisdale ◽  
François Haddad ◽  
Shun Kohsaka ◽  
Paul A. Heidenreich
Keyword(s):  
Heart Failure ◽  
Heart Disease ◽  
Left Ventricular Ejection Fraction ◽  
Ejection Fraction ◽  
Ischemic Heart Disease ◽  
Left Ventricular ◽  
Ventricular Ejection ◽  
Ischemic Heart ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction

Background: The left ventricular ejection fraction (LVEF) guides treatment of heart failure, yet this data has not been systematically collected in large data sets. We sought to characterize the epidemiology of incident heart failure using the initial LVEF. Methods: We identified 219 537 patients in the Veterans Affairs system between 2011 and 2017 who had an LVEF documented within 365 days before and 30 days after the heart failure diagnosis date. LVEF was obtained from natural language processing from imaging and provider notes. In multivariate analysis, we assessed characteristics associated with having an initial LVEF <40%. Results: Most patients were male and White; a plurality were within the 60 to 69 year age decile. A majority of patients had ischemic heart disease and a high burden of co-morbidities. Over time, presentation with an LVEF <40% became slightly less common, with a nadir in 2015. Presentation with an initial LVEF <40% was more common in younger patients, men, Black and Hispanic patients, an inpatient presentation, lower systolic blood pressure, lower pulse pressure, and higher heart rate. Ischemic heart disease, alcohol use disorder, peripheral arterial disease, and ventricular arrhythmias were associated with an initial LVEF <40%, while most other comorbid conditions (eg, atrial fibrillation, chronic obstructive pulmonary disease, malignancy) were more strongly associated with an initial LVEF >50%. Conclusions: For patients with heart failure, particularly at the extremes of age, an initial preserved LVEF is common. In addition to clinical characteristics, certain races (Black and Hispanic) were more likely to present with a reduced LVEF. Further studies are needed to determine if racial differences are due to patient or health systems issues such as access to care.

Abstract 14943: Comparison of Heart Failure Patients Newly Prescribed Sacubitril/valsartan With Those Newly Prescribed Aceis/arbs; A Cohort Study Using Us Optum Electronic Health Record Data

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Emil Loefroth ◽  
Xian Shen ◽  
Rachel Studer ◽  
Raymond Schlienger ◽  
Clare Proudfoot ◽  
...  
Keyword(s):  
Heart Failure ◽  
Cohort Study ◽  
Heart Disease ◽  
Ejection Fraction ◽  
Ischemic Heart Disease ◽  
Left Ventricular ◽  
Ischemic Heart ◽  
Left Ventricular Ejection ◽  
Similar Proportion ◽  
Resynchronization Therapy

Background: The clinical development program of sacubitril/valsartan (sac/val) for heart failure with reduced ejection fraction (HFrEF) only included a very limited number of patients being naive to prior angiotensin converting enzyme inhibitors (ACEis) or angiotensin II receptor antagonists (ARBs). Recent studies support the use of sac/val in hospitalised HF patients without prior ACEis/ARBs. This study aims to compare HF patients newly prescribed either sac/val or ACEis/ARBs. Methods: Retrospective non-interventional cohort study describing two mutually exclusive adult patient cohorts diagnosed with HFrEF either initiating sac/val or ACEis/ARBs. All patients were naive to both sac/val and ACEis/ARBs for 12 months prior to the first prescription. All patients had a left ventricular ejection fraction (LVEF) ≤40%. Patients were identified any time between 1 st July 2015 and 31 st Dec 2018 in the Optum® de-identified EHR dataset from providers across the continuum of care. Results: 2,414 patients were initiated on sac/val, 36,563 on ACEis/ARBs. Mean age was 66.1 (SD 12.9) and 67.2 years (SD 13.7) for sac/val and ACEis/ARBs users, respectively. Sac/val patients were more likely to be male: 70.8% vs 67.2% (p<0.0001) and had a lower mean LVEF: 26.9% vs 29.3% (p<0.0001). Patients newly initiated on sac/val had similar proportion of ischemic heart disease (67.9% vs 68.2%, p=0.72), and more often valvular heart disease (48.6% vs 44.3%, p<0.0001), and use of cardio resynchronization therapy device (40.9% vs 24.0%, p<0.0001). Conclusions: This real-world study indicates that sac/val tends to be newly prescribed to younger, male HFrEF patients with lower LVEF and a higher proportion of cardio resynchronization therapy devices compared with patients newly initiated on ACEis/ARBs. The prevalence of ischemic heart disease is similar between the groups.

scholarly journals Evaluation of Left Ventricle Performance in Patients with Ischemic Heart Disease Using Single Photon Emission Computed Tomography (SPECT) in Comparison with Echocardiography

2021 ◽  
pp. 3871-3876
Author(s):  
Marrwa K. Mohammed ◽  
Satar M. Kadam ◽  
Samar I. Essa
Keyword(s):  
Heart Disease ◽  
Left Ventricular Ejection Fraction ◽  
Left Ventricle ◽  
Ejection Fraction ◽  
Ischemic Heart Disease ◽  
Left Ventricular ◽  
Ischemic Heart ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
99Mtc Mibi

Background: Ischemic heart disease is a major cause of the diastolic heart failure. Risk of heart failures was increased with microvascular coronary disease, which is characterized by left ventricular stiffness  with impaired relaxation and reduced compliance. Aim of this study is to estimate the effect of the severity of myocardium ischemia on the left ventricle ejection fraction and left ventricular volume using SPECT with 99mTc MIBI and to compare the results  with the echocardiography. The study included 117 subjects with ischemic heart disease were examined using SPECT and echocardiography techniques. The following parameters were measured: left ventricular end systolic volume (LVESV) , left ventricular end diastolic volume (LVEDV) , and left ventricular ejection fraction (LVEF). Results show that the change difference in EDV between the two technique was (98.79%) with insignificant (p > 0.05). While the change in the LVEF% between both groups was (105.40%) with significant (p <0.05). On the other hand, the difference in ESV and EDV/ESV ratio for both groups were (95.52%), and (103.61%) respectively with insignificant (p >0.05). It was concluded that SPECT with 99mTc MIBI had a good relation with the echocardiography technique for evaluation of the left ventricular ejection fraction and the left ventricular volumes. The results showed that  LVEF was decreased in patients with severe ischemic disease.

Glutamine Is Cardioprotective in Patients with Ischemic Heart Disease following Cardiopulmonary Bypass

2011 ◽  
Vol 14 (6) ◽  
pp. 384 ◽  
Author(s):  
Vladimir V. Lomivorotov ◽  
Sergey M. Efremov ◽  
Vladimir A. Shmirev ◽  
Dmitry N. Ponomarev ◽  
Vladimir N. Lomivorotov ◽  
...  
Keyword(s):  
Heart Disease ◽  
Placebo Group ◽  
Cardiopulmonary Bypass ◽  
Ischemic Heart Disease ◽  
Troponin I ◽  
Left Ventricular ◽  
Ischemic Heart ◽  
Left Ventricular Ejection ◽  
Study Group ◽  
Cardioprotective Effects

<p><b>Background:</b> The aim of the present study was to investigate the cardioprotective effects of the perioperative use of N(2)-L-alanyl-L-glutamine (GLN) in patients with ischemic heart disease (IHD) who undergo their operations under cardiopulmonary bypass (CPB).</p><p><b>Methods:</b> This double-blind, placebo-controlled, randomized study included 50 patients who underwent cardiac surgery with CPB. Exclusion criteria were a left ventricular ejection fraction <50%, diabetes mellitus, <3 months since the onset of myocardial infarction, and emergency surgery. Patients in the study group (n = 25) received 0.4 g/kg GLN (Dipeptiven, 20% solution) per day. Patients in the control group (n = 25) were administered a placebo (0.9% NaCl). The primary end point was the dynamics of troponin I at the following stages: (1) prior to anesthesia, (2) 30 minutes after CPB, (3) 6 hours after CPB, (4) 24 hours after surgery, and (5) 48 hours after surgery. Secondary end points included measurements of hemodynamics with a Swan-Ganz catheter.</p><p><b>Results:</b> On the first postoperative day after the surgery, the median troponin I level was significantly lower in the study group than in the placebo group: 1.280 ng/mL (interquartile range [IQR], 0.840-2.230 ng/mL) versus 2.410 ng/mL (IQR, 1.060-6.600 ng/mL) (<i>P</i> = .035). At 4 hours after cardiopulmonary bypass (CPB), the median cardiac index was higher in the patients in the study group: 2.58 L/min per m<sup>2</sup> (IQR, 2.34-2.91 L/min per m<sup>2</sup>) versus 2.03 L/min per m<sup>2</sup> (IQR, 1.76-2.32 L/min per m<sup>2</sup>) (<i>P</i> = .002). The median stroke index also was higher in the patients who received GLN: 32.8 mL/m<sup>2</sup> (IQR, 27.8-36.0 mL/m<sup>2</sup>) versus 26.1 mL/m<sup>2</sup> (IQR, 22.6-31.8 mL/m<sup>2</sup>) (<i>P</i> = .023). The median systemic vascular resistance index was significantly lower in the study group than in the placebo group: 1942 dyn�s/cm<sup>5</sup> per m<sup>2</sup> (IQR, 1828-2209 dyn�s/cm<sup>5</sup> per m<sup>2</sup>) versus 2456 dyn�s/cm<sup>5</sup> per m<sup>2</sup> (IQR, 2400-3265 dyn�s/cm<sup>5</sup> per m<sup>2</sup>) (<i>P</i> = .001).</p><p><b>Conclusion:</b> Perioperative administration of GLN during the first 24 hours has cardioprotective effects in IHD patients following CPB. This technique enhances the troponin concentration at 24 hours after surgery and is associated with improved myocardial function.</p>

PULMONARY VASCULAR RESISTANCE BY ECHOCARDIOGRAPHY-DOPPLER IN ISCHEMIC HEART DISEASE WITH LEFT VENTRCULAR SYSTOLIC DYSFUNCTION

2017 ◽  
pp. 89-94
Author(s):  
Ke Toan Tran ◽  
Thi Thuy Hang Nguyen
Keyword(s):  
Heart Disease ◽  
Ischemic Heart Disease ◽  
Pulmonary Vascular Resistance ◽  
Vascular Resistance ◽  
Tricuspid Valve ◽  
Left Ventricular ◽  
Ischemic Heart ◽  
Left Ventricular Ejection ◽  
S Wave ◽  
Echocardiography Doppler

Objective: To determine pulmonary vascular resistance (PVR) by echocardiography - Doppler and to find correlation between pulmonary vascular resistance with left ventricular EF, PAPs, TAPSE, tissue S-wave of the tricuspid valve in patients with ischemic heart disease. Subjects and Methods: We studied on 82 patients with ischemic heart disease and EF<40% including 36 females, 46 males. Patients were estimated for pulmonary vascular resistance, EF, PAPs, TAPSE, tissue S-wave of the tricuspid valve by echocardiographyDoppler. Results: 64.6% of patients are increased PVR, average of PVR is 3.91 ± 1.85 Wood units and it is increasing with NYHA severity. There are negative correlations between pulmonary vascular resistance with left ventricular ejection fraction (r = - 0.545; p <0.001), TAPSE index (r= -0.590; p <0.001) and tissue S-wave of the tricuspid valve (r = -0.420; p <0.001); positive correlation with systolic pulmonary artery pressure (r = 0.361, p = 0.001), Conclusions: Increased PVR is the primary mechanism for pulmonary hypertension and right heart failure in patients with left heart disease. Determination of PVR in patients with left ventricular dysfunction by echocardiography is important in clinical practice. Key words: Echocardiography-Doppler; Pulmonary vascular resistance; ischemic heart disease

scholarly journals Major Left Bundle Branch Block and Coronary Heart Disease—Are There Any Differences between the Sexes?

2021 ◽  
Vol 10 (11) ◽  
pp. 2284
Author(s):  
Diana Gurzău ◽  
Alexandra Dădârlat-Pop ◽  
Bogdan Caloian ◽  
Gabriel Cismaru ◽  
Horaţiu Comşa ◽  
...  
Keyword(s):  
Risk Factors ◽  
Heart Disease ◽  
Ischemic Heart Disease ◽  
Left Bundle Branch Block ◽  
Left Ventricular ◽  
Ischemic Heart ◽  
Left Ventricular Ejection ◽  
Bundle Branch Block ◽  
Microvascular Angina ◽  
Ventricular Ejection Fraction

Left bundle branch block is not a benign pathology, and its presence requires the identification of a pathological substrate, such as ischemic heart disease. Left bundle branch block appears to be more commonly associated with normal coronary arteries, especially in women. The objectives of our study were to describe the particularities of left bundle branch block in women compared to men with ischemic heart disease. Result: We included seventy patients with left bundle branch block and ischemic heart disease, with a mean age of 67.01 ± 8.89 years. There were no differences in the profile of risk factors, except for smoking and uric acid. The ventricular depolarization (QRS) duration was longer in men than women (136.86 ± 8.32 vs. 132.57 ± 9.19 msec; p = 0.018) and also men were observed to have larger left ventricular diameters. Left bundle branch block duration was directly associated with ventricular diameters and indirectly associated with left ventricular ejection fraction value, especially in women (R = −0.52, p = 0.0012 vs. R = −0.50, p = 0.002). In angiography, 80% of women had normal epicardial arteries compared with 65.7% of men; all these patients presented with microvascular dysfunction. Conclusion: The differences between the sexes were not so obvious in terms of the presence of risk factors; instead, there were differences in electrocardiographic, echocardiographic, and angiographic aspects. Left bundle branch block appears to be a marker of microvascular angina and systolic dysfunction, especially in women.

Sign in / Sign up

Export Citation Format

Share Document