Abstract 18599: Clinical Assessment of Hemodynamic Profiles Predict Readmission and Mortality in Diastolic Heart Failure Patients

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Mohammed Siddiqui ◽  
Salpy V Pamboukian ◽  
Jose A Tallaj ◽  
Michael Falola ◽  
Sula Mazimba
Keyword(s):  
Heart Failure ◽  
Clinical Assessment ◽  
Diastolic Heart Failure ◽  
Clinical Care ◽  
Systolic Heart Failure ◽  
Health Care Expenditures ◽  
Left Ventricular ◽  
Readmission Rates ◽  
Heart Failure Patients ◽  
Increased Risk

Background: Reducing 30 day readmission rates for patients with heart failure (HF) has been a recent focus of lowering health care expenditures. Hemodynamic profiles (HP) have been associated with clinical outcomes in chronic systolic HF. The relationship of HP to outcomes in acute decompensated diastolic HF (DHF) has not been defined. Methods: This case-control study of 1892 DHF patients discharged alive from an academic hospital between 2002-2012 with left ventricular function greater or equal to 45% were categorized into 4 groups: Profile A, no evidence of congestion and hypoperfusion (dry-warm); Profile B, congestion with adequate perfusion (wet-warm); Profile C, congestion with hypoperfusion (wet-cold); and Profile L, hypoperfusion without congestion (dry-cold). All cause readmissions at 30 days and 1 year and mortality at 30 days and 1 year were examined. Statistical analysis using multivariable Cox Proportional hazard model was performed adjusting for demographic, clinical, care and hospital characteristics. Results: Of the 1892 patients, 1196 (63%) were females; mean age was 68 (±14) years. There were 724(38%), 1000 (53%), 88(5%) and 80 (4%) patients in the hemodynamic profiles A, B, C and L respectively. Profiles B and C were associated with an increased risk for 30-day all-cause HF readmission compared to profiles A and L: Hazard ratio (HR) [1.38 (95% C.I 1.17-1.61)], [1.39 (95% C.I 1.18-1.62)] for B and C profiles respectively. Profiles C and L were associated with increased mortality at 1 year: HR [1.46 (95% CI 1.06-1.89)] and [1.31 (95% CI 1.01-1.64)] for A and L profiles respectively (Table). Conclusions: Clinical assessment of HP can help identify DHF patients at increased risk of readmission and mortality, similar to systolic heart failure patients.

scholarly journals Tissue doppler imaging for estimation of left ventricular filling pressure in patients with systolic and diastolic heart failure: a comparative simultaneous doppler catheterization study

2020 ◽  
Vol 7 (2) ◽  
pp. 319
Author(s):  
Manohar J. Suranagi ◽  
K. Subramanyam ◽  
K. S. Subramani ◽  
K. H. Srinivasa
Keyword(s):  
Heart Failure ◽  
Tissue Doppler Imaging ◽  
Diastolic Heart Failure ◽  
Systolic Heart Failure ◽  
Tissue Doppler ◽  
Left Ventricular ◽  
Filling Pressure ◽  
Doppler Imaging ◽  
Heart Failure Patients ◽  
Mitral Annular Velocity

Background: Noninvasive assessment of diastolic filling by Doppler echocardiography provides important information about left ventricular (LV) status in selected subsets of patients. This study was designed to assess whether the lateral mitral annular velocity as assessed by tissue Doppler imaging is associated with invasive measures of diastolic LV performance in patients with diastolic and systolic heart failure. Aim of the study was to compare the diagnostic accuracy of lateral mitral annular E/E′ as an estimate of LV filling pressure with invasive LVEDP measurement in subjects with systolic or purely diastolic heart failure.Methods: Total 100 patients were studied, 50 patients with diastolic heart failure and 50 patients with systolic heart failure in patients undergoing diagnostic coronary angiogram. Detailed 2D Echocardiography, Trans mitral Doppler and Tissue Doppler velocities of lateral mitral annulus was obtained. The ratio of peak mitral velocity (E) to lateral mitral annular velocity (E′) by TDI (E/E′) was calculated.Results: The ratio of E/E′ in diastolic group was 13.4±4.9 and in systolic group it was 13.7±5.2. The mean LVEDP in diastolic heart failure patients was 14.3±4.5 and 14.2±4.9 in systolic heart failure patients. The ratio of E/E′ showed a better correlation with LVEDP. E/E′ <8 accurately predicted normal LVEDP, and E/E′ >15 identified increased LVEDP ≥15mmHg.Conclusions: E/E′ is a reliable estimate of LV filling pressures in subjects with systolic and diastolic heart failure. In subjects with diastolic heart failure, E/E′ seems helpful to identify those with truly elevated LV filling pressures. In patients with diastolic heart failure and normal E/E′, a search for other causes of symptoms (pulmonary disease, obesity and so forth) may be warranted.

Role of Diastole in Left Ventricular Function, II: Diagnosis and Treatment

2004 ◽  
Vol 13 (6) ◽  
pp. 453-466 ◽  
Author(s):  
Shannan K. Hamlin ◽  
Penelope S. Villars ◽  
Joseph T. Kanusky ◽  
Andrew D. Shaw
Keyword(s):  
Heart Failure ◽  
Diastolic Dysfunction ◽  
Left Atrial ◽  
Diastolic Heart Failure ◽  
Systolic Heart Failure ◽  
Clinical Signs ◽  
Left Ventricular ◽  
Exercise Intolerance ◽  
Radiographic Findings ◽  
Ventricular Compliance

Left ventricular diastolic dysfunction plays an important role in congestive heart failure. Although once thought to be lower, the mortality of diastolic heart failure may be as high as that of systolic heart failure. Diastolic heart failure is a clinical syndrome characterized by signs and symptoms of heart failure with preserved ejection fraction (0.50) and abnormal diastolic function. One of the earliest indications of diastolic heart failure is exercise intolerance followed by fatigue and, possibly, chest pain. Other clinical signs may include distended neck veins, atrial arrhythmias, and the presence of third and fourth heart sounds. Diastolic dysfunction is difficult to differentiate from systolic dysfunction on the basis of history, physical examination, and electrocardiographic and chest radiographic findings. Therefore, objective diagnostic testing with cardiac catheterization, Doppler echocardiography, and possibly measurement of serum levels of B-type natriuretic peptide is often required. Three stages of diastolic dysfunction are recognized. Stage I is characterized by reduced left ventricular filling in early diastole with normal left ventricular and left atrial pressures and normal compliance. Stage II or pseudonormalization is characterized by a normal Doppler echocardiographic transmitral flow pattern because of an opposing increase in left atrial pressures. This normalization pattern is a concern because marked diastolic dysfunction can easily be missed. Stage III, the final, most severe stage, is characterized by severe restrictive diastolic filling with a marked decrease in left ventricular compliance. Pharmacological therapy is tailored to the cause and type of diastolic dysfunction.

scholarly journals Left Ventricular Hypertrophy: Major Risk Factor in Patients with Hypertension: Update and Practical Clinical Applications

2011 ◽  
Vol 2011 ◽  
pp. 1-10 ◽  
Author(s):  
Richard E. Katholi ◽  
Daniel M. Couri
Keyword(s):  
Heart Failure ◽  
Risk Factor ◽  
Left Ventricular Hypertrophy ◽  
Ventricular Hypertrophy ◽  
Diastolic Heart Failure ◽  
Systolic Heart Failure ◽  
Antihypertensive Agents ◽  
Left Ventricular ◽  
Converting Enzyme Inhibitors ◽  
Flow Reserve

Left ventricular hypertrophy is a maladaptive response to chronic pressure overload and an important risk factor for atrial fibrillation, diastolic heart failure, systolic heart failure, and sudden death in patients with hypertension. Since not all patients with hypertension develop left ventricular hypertrophy, there are clinical findings that should be kept in mind that may alert the physician to the presence of left ventricular hypertrophy so a more definitive evaluation can be performed using an echocardiogram or cardiovascular magnetic resonance. Controlling arterial pressure, sodium restriction, and weight loss independently facilitate the regression of left ventricular hypertrophy. Choice of antihypertensive agents may be important when treating a patient with hypertensive left ventricular hypertrophy. Angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers followed by calcium channel antagonists most rapidly facilitate the regression of left ventricular hypertrophy. With the regression of left ventricular hypertrophy, diastolic function and coronary flow reserve usually improve, and cardiovascular risk decreases.

Abstract 2845: Differential Impact of Left Ventricular Remodeling on Septal and Lateral E/Ea Ratio in Predicting Diastolic Staging in Chronic Systolic Heart Failure

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
W. H. Wilson Tang ◽  
Kevin Shrestha ◽  
Wilfried Mullens ◽  
Allen Borowski ◽  
Richard W Troughton ◽  
...  
Keyword(s):  
Heart Failure ◽  
Diastolic Dysfunction ◽  
Ventricular Remodeling ◽  
Diastolic Heart Failure ◽  
Systolic Heart Failure ◽  
Left Ventricular ◽  
Doppler Velocity ◽  
Left Ventricular Volumes ◽  
2D Echocardiography ◽  
Chronic Systolic Heart Failure

Background: The ratio of peak transmitral pulsed Doppler early velocity to early diastolic tissue Doppler velocity of the lateral or septal mitral annulus (E/Ea) is considered a reliable estimation of diastolic dysfunction, and their average has been incorporated as clinical determinant of diastolic heart failure. Their relative relaibility in the setting pf left ventricular volumes has not been established. Methods: We performed comprehensive 2D echocardiography in 214 ambulatory patients with chronic systolic heart failure (LVEF ≤35%, NYHA II-III). Diastolic staging was determined from patterns of transmitral and pulmonary vein flows. Results: In our study population (mean age 57 years, 73% male mean left ventricular end-diastolic volume [LVEDV] 228 ml, mean LVEF 25%) , the median lateral and septal Ea were 6.9 cm/s and 4.5 cm/s, respectively. The median E/lateral Ea, E/septal Ea, and E/average Ea [inter-quartile range] were 10.8 [7.1–15.1], 16.1 [11.1–23.0], and 12.7 [8.8–17.7], respectively. In the first two tertiles of indexed LVEDV (LVEDVi<92.6 ml/m 2 and 92.6–129.5 ml/m 2 ), all three E/Ea indices increased with increasing diastolic stages (all p<0.001). However, in the highest tertile of LVEDVi (>129.5 ml/m 2 ), E/septal Ea (but not E/lateral Ea) increased with increasing diastolic stages (Figure ). Conclusions: Unlike E/septal Ea, E/lateral Ea did not increase with increasing diastolic stage in patients with chronic systolic heart failure presenting with LV dilatation. These observations may suggest that the E/septal Ea measurements may be more reliable than E/lateral Ea to assess diastolic dysfunction in patients with enlarged ventricles.

scholarly journals Increase in plasma adrenomedullin in patients with heart failure characterised by diastolic dysfunction

Heart ◽  
2001 ◽  
Vol 86 (2) ◽  
pp. 155-160
Author(s):  
C-M Yu ◽  
B M Y Cheung ◽  
R Leung ◽  
Q Wang ◽  
W-H Lai ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Diastolic Dysfunction ◽  
Diastolic Heart Failure ◽  
Systolic Heart Failure ◽  
Left Ventricular ◽  
University Teaching ◽  
Patients With Heart Failure ◽  
Filling Pattern ◽  
Pattern Group

OBJECTIVETo investigate the relation between plasma adrenomedullin and the severity of diastolic dysfunction in patients with heart failure.DESIGNProspective study.SETTINGUniversity teaching hospital.PATIENTS77 patients (mean (SEM) age 66.3 (1.2) years; 75% male) who were being followed in the outpatient clinic after admission to hospital for acute heart failure.INTERVENTIONSSame day echocardiography with Doppler studies; determination of venous adrenomedullin concentration by radioimmunoassay.MAIN OUTCOME MEASURESPlasma adrenomedullin concentration and its correlation with systolic and diastolic function.RESULTS31 patients (40%) had isolated diastolic dysfunction (ejection fraction > 50%), and the remaining 46 had a depressed ejection fraction (< 50%). Of the patients with diastolic dysfunction, 17 had a restrictive filling pattern. In all but one of these there was coexisting systolic failure (χ2 = 10.7, p = 0.001). Patients with systolic heart failure and a restrictive filling pattern (group 1, n = 16) had a higher plasma adrenomedullin than those with systolic failure and a non-restrictive filling pattern (group 2, n = 30) or with isolated diastolic heart failure and a non-restrictive filling pattern (group 3, n = 30) (mean (SEM): 91.7 (21.1) v 38.4 (8.8) v 34.0 (6.5) pmol/l, both p < 0.05). All heart failure values were higher (p < 0.01) than the control value (6.9 (1.2) pmol/l). Ejection fraction and left ventricular dimensions were similar in groups 1 and 2. Plasma adrenomedullin did not correlate with ejection fraction or New York Heart Association functional class. Stepwise multiple regression analysis showed that the presence of a restrictive filling pattern was the only independent variable associated with a high plasma adrenomedullin.CONCLUSIONSPlasma adrenomedullin concentrations in patients with heart failure are determined by the presence of diastolic dysfunction, and are especially raised in the presence of a restrictive filling pattern. There appears to be no correlation with systolic dysfunction.

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