Abstract 13398: 4D Flow Cardiac MRI Reveals Subtle Diastolic Dysfunction in Young Adults Born Premature

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Philip A Corrado ◽  
Jacob A Macdonald ◽  
Christopher J François ◽  
Marlowe W Eldridge ◽  
Kara Goss ◽  
...  
Keyword(s):  
Heart Failure ◽  
Young Adults ◽  
Stroke Volume ◽  
Diastolic Dysfunction ◽  
Cardiac Mri ◽  
Stroke Volume Index ◽  
Volume Index ◽  
4D Flow ◽  
Time Curve ◽  
Increased Risk

Introduction: Individuals born premature have smaller ventricular chambers volumes and a reduced cardiac reserve during exercise. Epidemiologic studies demonstrate increased risk of developing heart failure by young adulthood, though whether this is due primarily to systolic or diastolic dysfunction remains unresolved. Hypothesis: We hypothesize that either systolic or diastolic function, quantified as intraventricular kinetic energy (KE) during systolic and diastolic phases, respectively, will be altered in both ventricles of young adults born premature. Methods: A total of 56 young adults participated in this observational cardiac MRI study: 35 subjects born moderately to extremely premature (birth weight <1500 g or gestational age ≤32 weeks), and 21 age-matched term-born subjects. Each subject underwent cardiac MRI, including cine cardiac structure/function assessment and four-dimensional flow-encoded MRI (4D flow MRI). Five 4D flow parameters, normalized by end diastolic volume (EDV) to control for heart size, were extracted from each ventricle’s KE-time curve: average KE/EDV, peak systolic KE/EDV, early diastolic (E-wave) KE/EDV, late diastolic (A-wave) KE/EDV, and the ratio of E-wave KE to A-wave KE. Results: Average KE/EDV and peak systolic KE/EDV were similar between term and preterm subjects. Preterm-born subjects had increased A-wave KE/EDV in the RV and decreased E/A KE ratio in both ventricles (Table 1), indicating subtle diastolic dysfunction. The E/A KE ratio was moderately correlated with stroke volume index in both ventricles (LV: R=0.37, P=0.005; RV: R=0.32, P=0.02). Conclusions: Our results suggest that diastolic dysfunction, along with reduced chamber size, contributes to the reduced stroke volume seen in individuals born premature. In addition, diastolic dysfunction may further limit cardiac functional reserve and increase early heart failure risk in this population.

A novel echocardiographic hemodynamic classification of heart failure based on stroke volume index and left atrial pressure

2017 ◽  
Vol 34 (10) ◽  
pp. 1417-1425 ◽  
Author(s):  
Amr E. Abbas ◽  
Rami Khoury Abdulla ◽  
Anshul Aggrawal ◽  
Jason Crile ◽  
Steven J. Lester ◽  
...  
Keyword(s):  
Heart Failure ◽  
Stroke Volume ◽  
Left Atrial ◽  
Stroke Volume Index ◽  
Atrial Pressure ◽  
Left Atrial Pressure ◽  
Volume Index

scholarly journals Renal Sympathetic Denervation in Patients With Heart Failure With Preserved Ejection Fraction

2021 ◽  
Vol 14 (3) ◽  
Author(s):  
Karl-Patrik Kresoja ◽  
Karl-Philipp Rommel ◽  
Karl Fengler ◽  
Maximilian von Roeder ◽  
Christian Besler ◽  
...  
Keyword(s):  
Heart Failure ◽  
Stroke Volume ◽  
Arterial Hypertension ◽  
Stroke Volume Index ◽  
Aortic Distensibility ◽  
Volume Index ◽  
Renal Sympathetic Denervation ◽  
Preserved Ejection Fraction ◽  
Patients With Heart Failure ◽  
Renal Sympathetic

Background: Arterial hypertension is the most common comorbidity in patients with heart failure with preserved ejection fraction (HFpEF) and mediates adverse hemodynamics through related aortic stiffness and increased pulsatile load. We aimed to investigate the clinical and hemodynamic implications of renal sympathetic denervation (RDN) in patients with HFpEF and uncontrolled arterial hypertension. Methods: Patients undergoing RDN between 2011 and 2018 in a single-center were retrospectively analyzed and classified as HFpEF (n=99) or no HF (n=65). Stroke volume index and aortic distensibility were measured through cardiac magnetic resonance imaging, and left ventricular (LV) systolic and diastolic properties were assessed echocardiographically. Results: At baseline, patients with HFpEF had higher stroke volume index (median 40 [interquartile range, 33–48] versus 33 [26–40] mL/m 2 , P =0.002), pulse pressure (69 [63–77] versus 61 [55–67] mm Hg, P <0.001), but lower LV-VPES 100mm Hg (18 [10–28] versus 24 [15–40] mL, P =0.007) and aortic distensibility (1.5 [1.1–2.6] versus 2.7 [1.1–3.5] 10 −3 mm Hg −1 , P =0.013) as compared to no-HF patients. Systolic blood pressure decreased comparable in patients with HFpEF and no-HF patients following RDN (−9 [−16 to −2], P <0.001). After RDN stroke volume index (−3 [−9 to +3] mL/m 2 , P =0.011) decreased and aortic distensibility (0.2 [−0.1 to +1.1] 10 −3 mm Hg −1 , P =0.007) and systolic stiffness ( P <0.001) increased in HFpEF patients. LV diastolic stiffness and LV filling pressures as well as NT-proBNP (N-terminal pro-B-type natriuretic peptide) decreased after RDN in patients with HFpEF ( P =0.032, P =0.043, and P <0.001, respectively). Conclusions: Patients with HFpEF undergoing RDN showed increased stroke volume index, vascular, and LV stiffness as compared to no-HF patients. Following RDN those hemodynamic alterations and reduced systolic and diastolic LV stiffness were partly normalized, implying RDN might be a potential therapeutic strategy for arterial hypertension and HFpEF.

scholarly journals 563 Early systolic function is impaired in patients with heart failure and preserved ejection fraction and is a more important predictor of clinical outcomes than diastolic function

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
H Gu ◽  
J Webb ◽  
R Razavi ◽  
A Shah ◽  
G Carr-White ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Stroke Volume ◽  
Diastolic Dysfunction ◽  
Clinical Outcomes ◽  
Systolic Function ◽  
Left Atrial Volume ◽  
Volume Index ◽  
Preserved Ejection Fraction ◽  
Powerful Predictor

Abstract Funding Acknowledgements British Heart Foundation Aims First-phase ejection fraction (EF1), the ejection fraction up to the time of maximal ventricular contraction may be impaired in heart failure with preserved ejection fraction (HFpEF), with homeostatic mechanisms preserving the overall ejection fraction. We examined whether EF1 is impaired and whether it predicts adverse outcomes in patients with HFpEF. Methods and Results We examined EF1 in patients with HFpEF diagnosed according to European Society of Cardiology guidelines, in subjects with pre-clinical diastolic dysfunction and in control subjects with no evidence of heart failure. The predictive value of EF1 for a combined end-point of re-hospitalisation for heart failure and death from any cause was compared to that of conventional echocardiographic and other indices. There was a progressive impairment of EF1 in patients with diastolic dysfunction and HFpEF compared to those without evidence of heart failure (P &lt; 0.001). In 180 HFpEF patients followed for a median of 14.7 months, 101 patients reached the primary endpoint (61 deaths and 40 hospitalisations). EF1 was the most powerful predictor of events (table 1). A cut-off value of 19.4% gave hazard ratios (for EF1 &lt; 19.4% compared to ≥19.4%) of 3.04 (figure 1), (95% confidence interval 2.014 – 4.604, P &lt; 0.001) unadjusted, and 2.976 (1.887 – 4.695, P &lt; 0.001) adjusted for age, gender, other echocardiographic indices (including EF, E/e’ ratio, stroke volume and left atrial volume index) and N-terminal pro-brain natriuretic peptide. Conclusion Early systolic function is impaired in HFpEF and is a powerful predictor of clinical outcomes. Therapies targeted at improving early systolic function may improve outcomes in HFpEF. Table 1 HR CI (95%) P value Age 1.020 1.001 - 1.039 0.042 Female Gender 1.989 1.254 - 3.156 0.003 ln NT-proBNP 1.354 1.096 - 1.672 0.005 Haemoglobin 0.992 0.980 - 1.005 0.225 eGFR 0.997 0.988 - 1.006 0.568 Structural Heart Disease 0.748 0.439 - 1.274 0.285 Diastolic Dysfunction 0.694 0.445 - 1.082 0.107 Ejection Fraction 1.031 0.996 - 1.068 0.082 Stroke Volume index 0.963 0.940 - 0.986 0.002 TPAVF 0.995 0.980 - 1.005 0.230 EF1 0.900 0.869 - 0.932 &lt;0.001 Multivariate analysis of predictors of events Abstract 563 Figure 1 Kaplan-Meier Curve

Adaptive Servo-ventilation Treatment Increases Stroke Volume Index in Chronic Heart Failure Patients with Right Heart Dilatation

2014 ◽  
Vol 20 (10) ◽  
pp. S153
Author(s):  
Toshihiro Iwasaku ◽  
Shinichi Hirotani ◽  
Akiyo Eguchi ◽  
Tomokata Ando ◽  
Yoshitaka Okuhara ◽  
...  
Keyword(s):  
Heart Failure ◽  
Chronic Heart Failure ◽  
Stroke Volume ◽  
Stroke Volume Index ◽  
Volume Index ◽  
Right Heart ◽  
Adaptive Servo Ventilation ◽  
Heart Failure Patients

Impedance cardiography versus invasive measurements of stroke volume index in patients with chronic heart failure

2010 ◽  
Vol 143 (2) ◽  
pp. 211-213 ◽  
Author(s):  
Arne G. Kieback ◽  
Adrian C. Borges ◽  
Tania Schink ◽  
Gert Baumann ◽  
Michael Laule
Keyword(s):  
Heart Failure ◽  
Chronic Heart Failure ◽  
Stroke Volume ◽  
Impedance Cardiography ◽  
Stroke Volume Index ◽  
Volume Index

scholarly journals A proof of principle study of atomoxetine for the prevention of vasovagal syncope: the Prevention of Syncope Trial VI

EP Europace ◽  
2019 ◽  
Vol 21 (11) ◽  
pp. 1733-1741 ◽  
Author(s):  
Robert S Sheldon ◽  
Lucy Lei ◽  
Juan C Guzman ◽  
Teresa Kus ◽  
Felix A Ayala-Paredes ◽  
...  
Keyword(s):  
Cardiac Index ◽  
Stroke Volume ◽  
Vasovagal Syncope ◽  
Resistance Index ◽  
Stroke Volume Index ◽  
Study Drug ◽  
Norepinephrine Transporter ◽  
Volume Index ◽  
Head Up Tilt ◽  
Invasive Techniques

Abstract Aims There are few effective therapies for vasovagal syncope (VVS). Pharmacological norepinephrine transporter (NET) inhibition increases sympathetic tone and decreases tilt-induced syncope in healthy subjects. Atomoxetine is a potent and highly selective NET inhibitor. We tested the hypothesis that atomoxetine prevents tilt-induced syncope. Methods and results Vasovagal syncope patients were given two doses of study drug [randomized to atomoxetine 40 mg (n = 27) or matched placebo (n = 29)] 12 h apart, followed by a 60-min drug-free head-up tilt table test. Beat-to-beat heart rate (HR), blood pressure (BP), and cardiac haemodynamics were recorded using non-invasive techniques and stroke volume modelling. Patients were 35 ± 14 years (73% female) with medians of 12 lifetime and 3 prior year faints. Fewer subjects fainted with atomoxetine than with placebo [10/29 vs. 19/27; P = 0.003; risk ratio 0.49 (confidence interval 0.28–0.86)], but equal numbers of patients developed presyncope or syncope (23/29 vs. 21/27). Of patients who developed only presyncope, 87% (13/15) had received atomoxetine. Patients with syncope had lower nadir mean arterial pressure than subjects with only presyncope (39 ± 18 vs. 69 ± 18 mmHg, P < 0.0001), and this was due to lower trough HRs in subjects with syncope (67 ± 30 vs. 103 ± 32 b.p.m., P = 0.006) and insignificantly lower cardiac index (2.20 ± 1.36 vs. 2.84 ± 1.05 L/min/m2, P = 0.075). There were no significant differences in stroke volume index (32 ± 6 vs. 35 ± 5 mL/m2, P = 0.29) or systemic vascular resistance index (2156 ± 602 vs. 1790 ± 793 dynes*s/cm5*m2, P = 0.72). Conclusion Norepinephrine transporter inhibition significantly decreased the risk of tilt-induced syncope in VVS subjects, mainly by blunting reflex bradycardia, thereby preventing final falls in cardiac index and BP.

Stroke Volume Index and Outcomes in Low-Gradient Severe Aortic Stenosis

2021 ◽  
Vol 30 ◽  
pp. S205
Author(s):  
A. Snir ◽  
M. Ng ◽  
G. Strange ◽  
D. Playford ◽  
S. Stewart ◽  
...  
Keyword(s):  
Aortic Stenosis ◽  
Stroke Volume ◽  
Severe Aortic Stenosis ◽  
Stroke Volume Index ◽  
Volume Index

scholarly journals AB0798 EFFECT OF ANTIRHEUMATIC THERAPY ADMINISTERED IN ACCORDANCE WITH “TREAT TO TARGET” PRINCIPLES ON DIASTOLIC DYSFUNCTION OF THE LEFT VENTRICLES IN PATIENTS WITH ACTIVE EARLY PSORIATIC ARTHRITIS

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1699.2-1699
Author(s):  
E. Markelova
Keyword(s):  
Heart Failure ◽  
Diastolic Dysfunction ◽  
Inflammatory Diseases ◽  
Statistical Significance ◽  
Certolizumab Pegol ◽  
Cardiovascular Death ◽  
Treat To Target ◽  
Antirheumatic Therapy ◽  
Time Curve ◽  
Low Prevalence

Background:Рsoriatic arthritis (PsA) are chronic inflammatory diseases, with massive increase of cardiovascular events (CVE) and cardiovascular death. Diastolic dysfunction of the left ventricles (LVDD) is a risk factor for the development of the heart failure.Objectives:to study the effect of antirheumatic therapy administered in accordance with “Treat to target” principles on LVDD in early PsA (EPsA) patients (pts).Methods:48 (F.-23) DMARD-naive PsA pts, according to the CASPAR criteria, age 36[27; 45] years (yrs.), PsA duration – 6[4; 8] months. All pts were assessed for transthoracic echocardiography. Diastolic function was determined by early and atrial peak filling rates derived from differential volume-time-curve analysis. Methotrexate therapy was started in all pts with an escalation of the dose up to 25 mg/week subcutaneously. In case of no remission 3 months later, MT was added with biologic therapy: Adalimumab, Certolizumab pegol, Ustekinumab. Antihypertensive therapy received all pts with arterial hypertension (AH). All p less then 0.05 considered to statistical significance.Results:At baseline LVDD was identified in 5(10.4%). The LVDD pts were older, in more cases they had AH, abdominal obesity (p<0.05). Significant negative correlations were found between LVDD and body mass index (BMI) (r=-0.41), age (r=-0.71), total cholesterol (r=-0.44), triglycerides (r=-0.48), low density lipoproteins (r=-0.44), systolic (r=-0.59) and diastolic blood pressure (r=-0.4), for all p<0,01. By 18 months of therapy significantly decreased DAS from 4.06[3.48; 4.91] to 0,97[0,65;1,48]; C-RP from 19.4 [8.8;37.5] to 2.2 [0.9; 4.6]mg/l, for all p<0,001. DAS remission was achieved in 69% of pts. We didn’t find significant differences between baseline and after treatment the frequency of LVDD – 5(10,4%) to 4(8.3%).Conclusion:in pts with EPsA frequently (10.4%) were detected LVDD, which are associated with a АН, age, higher BMI. Low prevalence LVDD in patients with EPsA is possibly caused by short duration of disease and early start of antirheumatic therapy. This has implications for development of preventive strategies for heart failure in EPsA patients.Disclosure of Interests:None declared

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