Abstract 13146: Clinical Significance of Left Ventricular Diastolic Function on Exercise Capacity and Prognosis: Comparisons Among Heart Failure Patients With Reduced, Preserved and Mid-range Ejection Fraction

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Takamasa Sato ◽  
Akiomi YOSHIHISA ◽  
Takafumi Ishida ◽  
Yasuchika Takeishi
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Oxygen Uptake ◽  
Diastolic Function ◽  
Exercise Capacity ◽  
Cardiac Event ◽  
Left Ventricular ◽  
Adverse Cardiac Event ◽  
Grade 3 ◽  
Event Rates

Introduction: American Society of Echocardiography and European Association of Cardiovascular Imaging have proposed the estimation of left ventricular (LV) filling pressures and grading LV diastolic function in patients with heart failure (HF). However, the associations of LV diastolic dysfunction (LVDD) grade with exercise capacity and prognosis have not been fully elucidated among HF patients with reduced LV ejection fraction (HFrEF, LVEF ≤40%), preserved EF (HFpEF, LVEF ≥50%) and mid-range EF (HFmrEF, LVEF 41% to 49%). We aimed to determine the differences in the associations of LVDD grade with parameters of cardiopulmonary exercise testing (CPX) and prognosis in patients with HFrEF, HFpEF and HFmrEF. Methods and Results: We analyzed data on 891 hospitalized patients with HF and sinus rhythm (SR), who had discharged alive and undergone CPX at stable condition in prior to discharge. Of 891 patients, 38.9% had HFrEF, 40.6% had HFpEF and 20.4% had HFmrEF. The HFrEF group had higher rates of adverse cardiac events, defined as cardiac death and re-hospitalizations for worsening HF, than HFpEF and HFmrEF groups. In HFrEF group, the patients with LVDD grade 1 had the highest peak oxygen uptake (peak VO 2 ), the lowest minute ventilation and carbon dioxide production (VE/VCO 2 slope), the highest oxygen uptake efficiency slope (OUES) and the lowest adverse cardiac event rates. However, there was no difference in CPX parameters and adverse cardiac event rates between patients with LVDD grade 2 and 3. In HFpEF group, the patients with LVDD grade 1 had the highest peak VO 2 , the lowest VE/VCO 2 slope and the highest OUES. In contrast, CPX parameters did not differ between patients with LVDD grade 2 and grade 3. Patients with LVDD grade 3 had the highest adverse cardiac event rates, followed by patients with grade 2 and 1. In HFmrEF group, the patients with LVDD grade 1 had the highest peak VO 2 , the lowest VE/VCO 2 slope and the highest OUES. Patients with grade 1 had the lowest adverse cardiac event rates. However, CPX parameters and adverse cardiac event rates did not differ between patients with grade 2 and 3. Conclusions: LVDD grade was associated with poor exercise capacity and adverse prognosis in patients with HF and SR, regardless of their LVEF.

Abstract 2391: Impact of Therapies for Anemia on Outcomes in Patients with Heart Failure in Randomized Clinical Trials

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Howard M Julien ◽  
Preetika Muthukrishnan ◽  
Eldrin F Lewis
Keyword(s):  
Heart Failure ◽  
Clinical Trials ◽  
Ejection Fraction ◽  
Serum Creatinine ◽  
Exercise Capacity ◽  
Randomized Clinical Trials ◽  
Meta Analysis ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
The Impact

Anemia is common in heart failure (HF) patients and has been well-established as a risk factor for increased risk of HF hospitalization and mortality. Treatment with erythropoietin stimulating agents (ESA) has increased hemoglobin, but outcomes trials are limited and use of ESA has been controversial given disparate results in other populations. This meta-analysis aimed to evaluate the impact of ESA and iron on outcomes in HF patients. A systematic review of four databases was conducted in April 2008 (n = 95 unique trials). Analysis inclusion criteria included randomized controlled trial to ESA/iron with clinically defined HF, yielding 10 eligible trials published between 6/01–3/08. Data was independently extracted and cross-checked for accuracy and reliability (2 investigators). A total of 768 subjects (421 treated and 338 controls) are included (Characteristics in Table 1 ). Randomization to ESA produced a significant improvement in exercise capacity 0.39 standard units [95% CI 0.1– 0.6, p = 0.001], a 5.72% [95% CI 1.2–10.3, p = 0.014] increase in left ventricle ejection fraction and a 0.23 mg/dL [95% CI 0.4 – 0.1 p = 0.001] reduction in serum creatinine. There was no difference in all-cause mortality - RR 0.79 [95% CI 0.49, 1.26, p = 0.320]. Trends were noted in reduced hospitalization rates, decreased brain natriuretic peptide, and improved quality of life. Meta-analysis of randomized studies of treatment of anemia in HF patients suggests significant benefit in exercise capacity, left ventricular ejection fraction, and serum creatinine. There does not appear to be excess mortality with ESA/iron treatment. Despite favorable findings, definitive randomized clinical trials are needed to assess the role of this treatment modality in HF management. Table 1. Baseline Patient and Study Characteristics

scholarly journals Application of the current HFA-ESC consensus guidelines on diagnosis of heart failure with preserved ejection fraction to a population referred for echocardiography

2021 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
K Liang ◽  
R Hearse-Morgan ◽  
S Fairbairn ◽  
Y Ismail ◽  
AK Nightingale
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Ejection Fraction ◽  
Diastolic Function ◽  
Global Longitudinal Strain ◽  
Diagnostic Algorithm ◽  
Left Ventricular ◽  
Lv Function ◽  
Preserved Ejection Fraction ◽  
Consensus Guidelines

Abstract Funding Acknowledgements Type of funding sources: None. BACKGROUND The recent Heart Failure Association (HFA) of the European Society of Cardiology (ESC) consensus guidelines on diagnosis of heart failure with preserved ejection fraction (HFpEF) have developed a simple diagnostic algorithm for clinical use. PURPOSE To assess whether echocardiogram (echo) parameters needed to assess diastolic function are routinely collected in patients referred for assessment of heart failure symptoms. METHODS Retrospective analysis of echo referrals in January 2020 were assessed for parameters of diastolic function as per step 2 of the HF-PEFF diagnostic algorithm.  Echo images and clinical reports were reviewed. Electronic records were utilised to obtain clinical history, blood results (NT-proBNP) and demographic data. RESULTS 1330 patients underwent an echo in our department during January 2020. 83 patients were referred with symptoms of heart failure without prior history of cardiac disease; 20 patients found to have impaired left ventricular (LV) function were excluded from analysis. Of the 63 patients with possible HFpEF, HF-PEFF score was low in 18, intermediate in 33 and high in 12. Median age was 68 years (range 32 to 97 years); 25% had a BMI >30. There was a high prevalence of hypertension (52%), diabetes (19%) and atrial fibrillation (40%) (cf. Table 1). Body surface area (BSA) was documented in 65% of echo reports. Most echo parameters were recorded with the exception of global longitudinal strain (GLS) and indexed LV mass (cf. image 1). NT-proBNP was recorded in only 20 patients (31.7%). 12 patients with an intermediate HF-PEFF score could have been re-categorised to a high score depending on GLS and NT-proBNP (which were not recorded). CONCLUSION More than three quarters of echoes acquired in our department obtained the relevant parameters to assess diastolic function. The addition of BSA, and inclusion of NT-proBNP, and GLS would have been additive to a third of ‘intermediate’ patients to determine definite HFpEF. Our study demonstrates that the current HFA-ESC diagnostic algorithm and HF-PEFF scoring system are easy to use, highly relevant and applicable to current clinical practice. Age >70 years 29 (46.0%) Obesity (BMI >30) 16 (25.4%) Diabetes 12 (19%) Hypertension 33 (52.4%) Atrial Fibrillation 25 (39.7%) ECG abnormalities 18 (28.5%) Table 1. Prevalence of Clinical Risk Factors Abstract Figure. Image 1. HFPEFF score & echo parameters

scholarly journals Prognostic impacts of changes in left ventricular ejection fraction in heart failure patients with preserved left ventricular ejection fraction

Open Heart ◽  
2020 ◽  
Vol 7 (1) ◽  
pp. e001112 ◽  
Author(s):  
Akiomi Yoshihisa ◽  
Yu Sato ◽  
Yuki Kanno ◽  
Mai Takiguchi ◽  
Tetsuro Yokokawa ◽  
...  
Keyword(s):  
Heart Failure ◽  
Left Ventricular Ejection Fraction ◽  
Ejection Fraction ◽  
Cardiac Event ◽  
Troponin I ◽  
Left Ventricular ◽  
Ventricular Ejection ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
All Cause Mortality

BackgroundIt has been reported that recovery of left ventricular ejection fraction (LVEF) is associated with better prognosis in heart failure (HF) patients with reduced EF (rEF). However, change of LVEF has not yet been investigated in cases of HF with preserved EF (HFpEF).Methods and resultsConsecutive 1082 HFpEF patients, who had been admitted to hospital due to decompensated HF (EF >50% at the first LVEF assessment at discharge), were enrolled, and LVEF was reassessed within 6 months in the outpatient setting (second LVEF assessment). Among the HFpEF patients, LVEF of 758 patients remained above 50% (pEF group), 138 patients had LVEF of 40%–49% (midrange EF, mrEF group) and 186 patients had LVEF of less than 40% (rEF group). In the multivariable logistic regression analysis, younger age and presence of higher levels of troponin I were predictors of rEF (worsened HFpEF). In the Kaplan-Meier analysis, the cardiac event rate of the groups progressively increased from pEF, mrEF to rEF (log-rank, p<0.001), whereas all-cause mortality did not significantly differ among the groups. In the multivariable Cox proportional hazard analysis, rEF (vs pEF) was not a predictor of all-cause mortality, but an independent predictor of increased cardiac event rates (HR 1.424, 95% CI 1.020 to 1.861, p=0.039).ConclusionAn initial assessment of LVEF and LVEF changes are important for deciding treatment and predicting prognosis in HFpEF patients. In addition, several confounding factors are associated with LVEF changes in worsened HFpEF patients.

Left ventricular long-axis diastolic function is augmented in the hearts of endurance-trained compared with strength-trained athletes

2002 ◽  
Vol 103 (3) ◽  
pp. 249-257 ◽  
Author(s):  
Dragos VINEREANU ◽  
Nicolae FLORESCU ◽  
Nicholas SCULTHORPE ◽  
Ann C. TWEDDEL ◽  
Michael R. STEPHENS ◽  
...  
Keyword(s):  
Oxygen Consumption ◽  
Ejection Fraction ◽  
Diastolic Function ◽  
Exercise Capacity ◽  
Peak Velocity ◽  
Maximal Oxygen Consumption ◽  
Left Ventricular ◽  
Diastolic Filling ◽  
Functional Reserve ◽  
Mitral Inflow

In order to determine left ventricular global and regional myocardial functional reserve in endurance-trained and strength-trained athletes, and to identify predictors of exercise capacity, we studied 18 endurance-trained and 11 strength-trained athletes with left ventricular hypertrophy (172±27 and 188±39g/m2 respectively), and compared them with 14 sedentary controls. Global systolic (ejection fraction) and diastolic (transmitral flow) function, and regional longitudinal and transverse myocardial velocities [tissue Doppler echocardiography (TDE)], were measured at rest and immediately after exercise. In endurance-trained compared with strength-trained athletes, resting heart rate was lower (59±11 and 76±9beats/min respectively; P<0.001), and the increase at peak exercise was greater (+211% and +139% respectively; P<0.001). In addition, exercise duration, workload, maximal oxygen consumption and global systolic functional reserve (but not peak ejection fraction) were higher in the endurance-trained athletes, and resting global diastolic function (E/A ratio 1.62±0.40 compared with 1.18±0.23; P<0.01) (where E-wave is peak velocity of early-diastolic mitral inflow and A-wave is peak velocity of mitral inflow during atrial contraction) and long-axis diastolic velocities (ETDE/ATDE ratio 2.2±1.2 compared with 1.1±0.3; P<0.01) (where ETDE and ATDE represent peak early- and late-diastolic myocardial or tissue velocity respectively) were augmented. Systolic velocities were similar. Exercise capacity was best predicted from end-diastolic diameter index and E/A ratio at rest, and end-diastolic volume index and diastolic longitudinal velocity during exercise (r = 0.74, n = 43, P<0.001). In conclusion, endurance-trained athletes had higher left ventricular long-axis diastolic velocities, augmented global early diastolic filling, and greater chronotropic and global systolic functional reserve. Maximal oxygen consumption was determined by diastolic loading and early relaxation rather than by systolic function, suggesting that dynamic exercise training improves cardiac performance by an effect on diastolic filling.

scholarly journals Positive effect of dapagliflozin on left ventricular longitudinal function for type 2 diabetic mellitus patients with chronic heart failure

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
H Tanaka ◽  
F Soga ◽  
K Tatsumi ◽  
Y Mochizuki ◽  
H Sano ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Diastolic Function ◽  
Myocardial Function ◽  
Sglt2 Inhibitor ◽  
Left Ventricular ◽  
Sglt2 Inhibitors ◽  
Prospective Multicenter Study ◽  
Lv Diastolic Function

Abstract Background Type 2 diabetes mellitus (T2DM) has come to be considered an independent predictor of mortality, and also a contributor to the development of heart failure (HF) with reduced ejection fraction (HFrEF) and with preserved ejection fraction (HFpEF). Left ventricular (LV) longitudinal myocardial dysfunction as assessed in terms of lower global longitudinal strain (GLS), has been identified even in T2DM patients with preserved LV ejection fraction (LVEF), and should be considered the first marker of a preclinical form of DM-related cardiac dysfunction, leading to HFpEF. Sodium glucose cotransporter type 2 (SGLT2) inhibitors represent a new class of anti-hyperglycemic agents for T2DM, but the effect of SGLT2 inhibitors on LV longitudinal myocardial function in T2DM patients with HF remains uncertain. To examine this effect, as well as the association of LV longitudinal myocardial function with LV diastolic function after administration of SGLT2 inhibitor in T2DM patients with stable HF, we analyzed data from our previous prospective multicenter study, in which we investigated the effect of SGLT2 inhibitor on LV diastolic functional parameters of T2DM patients with stable HF at five institutions in Japan. Methods Our previous trial was a prospective multicenter study of 58 T2DM patients with stable HF at five institutions in Japan. Patients who had been taking at least one antidiabetic drugs other than SGLT2 inhibitors started the administration of 5 mg/day of dapagliflozin. Echocardiography was performed at baseline and 6 months after administration of dapagliflozin. LV diastolic function was defined as the ratio of mitral inflow E to mitral e' annular velocities (E/e'). LV longitudinal myocardial function was assessed as GLS based on the current guidelines. Results E/e' significantly decreased from 9.3 to 8.5 cm/s 6 months after administration of dapagliflozin (p=0.020) as previously described, while GLS showed significant improvement from 15.5±3.5% to 16.9±4.1% (p&lt;0.01) 6 months after administration of dapagliflozin. Furthermore, improvement of GLS in HFpEF patients was more significant from 17.0±1.9% to 18.7±2.0% (p&lt;0.001), compared to that in HFrEF patients from 11.3±3.8% to 11.8±4.6% (p=0.13). It was noteworthy that multiple regression analysis showed that the change in GLS after administration of dapagliflozin was the only independent determinant parameter for the change in E/e' after administration of dapagliflozin. Conclusion Dapagliflozin was found to be associated with improvement of LV longitudinal myocardial function, which led to further improvement of LV diastolic function of T2DM patients with stable HF. GLS-guided management may thus lead to improved management of T2DM patients with stable HF. Representative case Funding Acknowledgement Type of funding source: None

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