Abstract 15733: CD34 + Cell Therapy is Associated With Improved Right Ventricular Function in Heart Failure With Preserved Ejection Fraction

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Sabina Frljak ◽  
Gregor Poglajen ◽  
Gregor Zemljic ◽  
Andraz Cerar ◽  
Francois Haddad ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Cell Therapy ◽  
Right Ventricular ◽  
Cell Transplantation ◽  
Left Ventricular ◽  
Preserved Ejection Fraction ◽  
Group A ◽  
Group B ◽  
Rv Function

Introduction: Right ventricular (RV) dysfunction is an important predictor of adverse prognosis in patients with heart failure with preserved ejection fraction (HFpEF). Hypothesis: We sought to investigate the effects of transendocardial CD34 + cell therapy on RV function in HFpEF patients. Methods: We enrolled 30 patients with HFpEF who underwent transendocardial CD34 + cell transplantation. At baseline, all patients received granulocyte-colony stimulating factor; cells were collected by apheresis and immunomagnetic selection and injected transendocardialy in the left ventricle targeting the areas of local diastolic dysfunction. Patients were followed for 6 months and changes in RV function were assessed by tricuspid annular plane systolic excursion (TAPSE), peak systolic velocity of tricuspid annulus (St), and fractional area change (FAC). Impaired RV function was defined as TAPSE<1.8 cm. Results: At baseline, RV function was impaired in 11 (37%, Group A), and preserved in 19 (63%, Group B) of patients. The groups did not differ in age (64±6 years in Group A vs. 61±11 years in Group B, P=0.37), gender (male: 82% vs. 74%, P=0.61), or left ventricular E/e' (17.7±2.3 vs. 17.3±3.4, P=0.74). Patients in Group A had lower LVEF (55.6±5.1% vs. 61.3±6.5% in Group B, P=0.02), and higher NTproBNP levels (1750±1139 pg/ml vs. 1038±658 pg/ml, P=0.05). At 6 months after cell transplantation we found an overall improvement in all parameters of RV function (TAPSE: +0.21±0.37 cm, P=0.01; St: +0.7±2.1 cm/s, P=0.03; FAC: +8.5±1.9%, P=0.02). However, RV function improvement was significant in Group A (TAPSE: +0.43±0.37 cm, P=0.004; St: +1.4±2.3 cm/s; P=0.01; FAC: +9.8±2.0%, P=0.01), but not in Group B (TAPSE: +0.04±0.27 cm, P=0.65; St: +0.4±1.3 cm/s, P=0.32; FAC: +7.1±3.7%, P=0.08). In both groups we found comparable changes in E/e' (-5.1±3.0 in Group A vs. -5.9±3.2 in Group B, P=0.53), LVEF (1.2±5.7% vs. 1.9±6.5%, P=0.45) and NTproBNP (-462±410 pg/ml vs. -390±398 pg/ml, P=0.64) at 6 months after cell transplantation. Conclusions: Transendocardial CD34 + cell therapy appears to be associated with improvement of right ventricular dysfunction in patients with HFpEF.

scholarly journals Transitioning from Preclinical to Clinical Heart Failure with Preserved Ejection Fraction: A Mechanistic Approach

2020 ◽  
Vol 9 (4) ◽  
pp. 1110 ◽  
Author(s):  
Antoni Bayes-Genis ◽  
Felipe Bisbal ◽  
Julio Núñez ◽  
Enrique Santas ◽  
Josep Lupón ◽  
...  
Keyword(s):  
Heart Failure ◽  
Pulmonary Hypertension ◽  
Ejection Fraction ◽  
Right Ventricular ◽  
Left Atrial ◽  
Interstitial Fibrosis ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Preserved Ejection Fraction ◽  
Ventricular Ejection Fraction

To better understand heart failure with preserved ejection fraction (HFpEF), we need to better characterize the transition from asymptomatic pre-HFpEF to symptomatic HFpEF. The current emphasis on left ventricular diastolic dysfunction must be redirected to microvascular inflammation and endothelial dysfunction that leads to cardiomyocyte remodeling and enhanced interstitial collagen deposition. A pre-HFpEF patient lacks signs or symptoms of heart failure (HF), has preserved left ventricular ejection fraction (LVEF) with incipient structural changes similar to HFpEF, and possesses elevated biomarkers of cardiac dysfunction. The transition from pre-HFpEF to symptomatic HFpEF also involves left atrial failure, pulmonary hypertension and right ventricular dysfunction, and renal failure. This review focuses on the non-left ventricular mechanisms in this transition, involving the atria, right heart cavities, kidneys, and ultimately the currently accepted driver—systemic inflammation. Impaired atrial function may decrease ventricular hemodynamics and significantly increase left atrial and pulmonary pressure, leading to HF symptoms, irrespective of left ventricle (LV) systolic function. Pulmonary hypertension and low right-ventricular function are associated with the incidence of HF. Interstitial fibrosis in the heart, large arteries, and kidneys is key to the pathophysiology of the cardiorenal syndrome continuum. By understanding each of these processes, we may be able to halt disease progression and eventually extend the time a patient remains in the asymptomatic pre-HFpEF stage.

Abstract 14106: Assessment of Right Ventricular to Pulmonary Circulation Uncoupling at Peak Exercise in Heart Failure Patients by the Relationship Between Pulmonary Systolic Pressure vs Right Ventricular Longitudinal Strain

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Valeria Donghi ◽  
Francesco Carbone ◽  
Valentina Labate ◽  
Greta Generati ◽  
Marta Pellegrino ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Right Ventricular ◽  
Speckle Tracking ◽  
Longitudinal Strain ◽  
Systolic Pressure ◽  
Peak Exercise ◽  
Group A ◽  
Group B ◽  
The Relationship

Background: Speckle tracking analysis is an emerging technique that can be useful to assess abnormalities in cardiac contractility before traditional echo parameters. Purpose: To investigate whether right ventricular (RV) 2D speckle tracking analysis at peak exercise could stratify a heart failure reduced ejection fraction (HFrEF) population in different functional phenotypes, with particular emphasis on RV to pulmonary circulation relationship. Methods: 36 HFrEF patients (mean age 69±12; male 69%; NYHA I-II-III-IV 19-17-25-5 %) underwent a maximal cardiopulmonary exercise testing evaluation (bike, incremental ramp protocol) combined with Echo-Doppler and off-line speckle tracking analysis. Study population was divided in two groups according to median value of 2D right ventricle longitudinal strain at peak exercise (Group A RVLG at peak < -16, 17 patients vs Group B ≥ -16, 19 patients). In all patients we performed traditional echo and 2D longitudinal speckle tracking analysis at rest and peak exercise. Results: Despite similar left ventricle ejection fraction (Group A 36± 9% vs Group B 32±9%, p=ns) and global right ventricle longitudinal strain (RVLG) at rest (Group A -18.6±5.6% vs Group B -14.5±8.2%, p=ns), Group B patients showed a similar exercise performance (Peak VO 2 Group A 31.6±7.4 vs Group B 11.6±3.4 mlO 2 /Kg/min, p=ns) but more impaired ventilation (VE/VCO2 slope Group A 31.6±7.4 vs Group B 37.4±8.8, p<0.05), and a clear RV to PC uncoupling at peak exercise as assessed by the relationship between pulmonary systolic pressure vs RVLG (see figure below). Conclusions: In HFrEF RV speckle tracking analysis at peak exercise seems a useful technique for unmasking RV to PC uncoupling and the unfavorable gas exchange and ventilatory phenotypes.

scholarly journals 61 Right ventricular function in patient with heart failure with reduced ejection fraction and sacubitril/valsartan treatment

2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Pietro Mazzeo ◽  
Martino Fortunato ◽  
Francesca Croella ◽  
Simona Alfieri ◽  
Angela Ilaria Fanizzi ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Right Ventricular ◽  
Real World ◽  
Multivariable Analysis ◽  
Left Ventricular ◽  
Doppler Imaging ◽  
Right Atrial ◽  
Reduced Ejection Fraction ◽  
Rv Function

Abstract Aims Observational studies have demonstrated that treatment with sacubitril/valsartan may improve left ventricular (LV) systolic and diastolic function in subjects with reduced LV ejection fraction (LVEF) in real-world studies. Subjects with heart failure and reduced EF (HFrEF), however, are also characterized by an impaired right ventricular (RV) function. We therefore aimed to evaluate whether also RV function may improve after S/V therapy and possible predictors of RV improvement could be identified at echocardiography and tissue Doppler imaging. Methods Fifty consecutive patients (67 ± 8 years, LVEF 28 ± 6%, male 86%) with chronic HFrEF and NYHA Classes II–III were followed up for 6 months after therapy with S/V. LV&RV function was assessed at baseline and after 6 months of therapy. Results After 6-month therapy with S/V a significant improvement was shown in the following echocardiography parameters assessing RV function: PAsP (31 ± 11 vs. 35 ± 10 mmHg, P &lt; 0.001), TAPSE (19 ± 3 vs. 18 ± 3 mm, P &lt; 0.001), RV FAC (38 ± 7 vs. 34 ± 6 mm, P &lt; 0.001), RV S’ (12 ± 2 vs. 10 ± 2 cm/sec, P &lt; 0.001), RV-FW-LS (−20 ± 5 vs. −18 ± 5%, P &lt; 0.001), RV-4Ch-LS (−16 ± 5 vs. −14 ± 5%, P &lt; 0.001). At multivariable analysis improvement in RV-FW-LS was associated to baseline levels of RV S’ (r 0.75, P &lt; 0.01) and RAV (r –0.32, P &lt; 0.05). Conclusions In a real-world scenario, 6-month therapy with S/V was associated with an improved RV function in HFrEF. RV function improvement may be predicted by assessing baseline RV S’ and right atrial volume values.

Abstract 15164: Impact of Conventional Right Ventricular Pacing in Patients With Heart Failure With Preserved Ejection Fraction: Insights From Pursuit-hfpef Registry

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Tetsuya Watanabe ◽  
Shungo Hikoso ◽  
Daisaku D Nakatani ◽  
Masamichi Yano ◽  
Shunsuke Tamaki ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Right Ventricular ◽  
Pacemaker Implantation ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Lv Function ◽  
Preserved Ejection Fraction ◽  
Ventricular Ejection Fraction ◽  
Patients With Heart Failure

Introduction: Previous studies suggest that conventional right ventricular (RV) pacing may have a deleterious effect on left ventricular (LV) function. However, there are no reports examining the effects of permanent pacemakers (PM) in patients with heart failure with preserved ejection fraction (HFpEF) admitted with acute decompensated heart failure (ADHF). Methods and Results: Patients' data were extracted from The Prospective mUlticenteR obServational stUdy of patIenTs with Heart Failure with Preserved Ejection Fraction (PURSUIT-HFpEF) study, which is a prospective multicenter observational registry for ADHF patients with LVEF ≥50% in Osaka. Echocardiographic measurements were performed just before and 1 year after discharge. We analyzed 623 patients (median age: 81[30-101] years) after exclusion of patients on dialysis. At the admission, 55 of 623 patients had a previously implanted pacemaker (PM(+)). There were no significant differences in baseline clinical characteristics before discharge such as age, gender, renal function, echocardiographic parameters between PM(+) and PM(-) groups. One year after discharge, left ventricular ejection fraction (LVEF) in PM(+) group was significantly lower (58.3±8.6 vs 62.3±8.4%, p=0.005) than those in PM(-) group. During a mean follow-up period of 1.25±0.84years, 171patients had heart failure hospitalization (HFH). At the multivariate Cox analysis, pacemaker was significantly associated with HFH, independently of age, serum NT-proBNP level, and LVEF after the adjustment with NYHA functional class, sex, and hemoglobin. Kaplan-Meier curve analysis revealed that patients in PM(+) group had a significantly higher risk of HFH than those in PM(-) group. Conclusion: The development of cardiac systolic and diastolic dysfunction occurred in patients with HFpEF with a RV pacemaker implantation, which would be associated with poor outcome.

Echocardiographic Evaluation of Cardiac Remodeling After Surgical Closure of Ventricular Septal Defect in Different Age Group

2017 ◽  
Vol 2 (2) ◽  
pp. 69-74
Author(s):  
Mohammad Aminullah ◽  
Fahmida Akter Rima ◽  
Asraful Hoque ◽  
Mokhlesur Rahman Sazal ◽  
Prodip Biswas ◽  
...  
Keyword(s):  
Ventricular Septal Defect ◽  
Ejection Fraction ◽  
Cardiac Remodeling ◽  
Septal Defect ◽  
Left Ventricular ◽  
Age Group ◽  
Surgical Closure ◽  
Group A ◽  
Group B ◽  
Fractional Shortening

Background: Cardiac remodeling is important issue after surgical closure of ventricular septal defect.Objective: The purpose of the present study was to evaluate cardiac remodeling by echocardiography by measuring the ejection fraction, fractional shortening, left ventricular internal diameter during diastole (LVIDd) and left ventricular internal diameter during systole (LVIDs) after surgical closure of ventricular septal defect in different age group. Methodology: This prospective cohort studies was conducted in the Department of Cardiac Surgery at National Institute of Cardiovascular Disease (NICVD), Dhaka. Patient with surgical closure of VSD were enrolled into this study purposively and were divided into 3 groups according to the age. In group A (n=10), patients were within the age group of 2.0 to 6.0 years; age of group B (n=8) patients were 6.1-18.0 years and the group C (n=6) aged range was 18.1-42.0 years. Echocardiographic variables such as ejection fraction, fractional shortening, LVIDd, LVIDs were taken preoperatively and at 1st and 3rd month of postoperative values. Result: A total number of 24 patients was recruited for this study. The mean ages of all groups were 12.60±12.09. After 1 month ejection fraction were decreased by 5.97%, 6.71% and 5.66% in group A, group B and group C respectively. After 3 months ejection fraction were increased by 6.13%, 5.13% and 5.14% in group A, group B and group C respectively. After 1 month fractional shortening were decreased by 13.55%, 9.30% and 9.09% in group A, group B and group C respectively. After 3 months fractional shortening were increased by 7.23%, 7.35% and 4.55% in group A, group B and group C respectively. After 1 month LVIDd were increased by 1.97%, 1.91% and 1.32% in group A, group B and group C respectively. After 3 months LVIDd were decreased by 10.84%, 9.89% and 7.34% in group A, group B and group C respectively. After 1 month LVIDs were increased by 2.19%, 2.86% and 1.98% in group A, group B and group C respectively. After 3 months LVIDs were decreased by 11.68%, 10.97% and 8.87% in group A, group B and group C respectively.Conclusion: Cardiac remodeling occurred after surgical closure of ventricular septal defect and remodeling were more significant in younger age group. Journal of National Institute of Neurosciences Bangladesh, 2016;2(2):69-74

ACCESSMENT OF RIGHT VENTRICULAR SYSTOLIC FUNCTION USING TAPSE

2011 ◽  
pp. 62-70
Author(s):  
Lien Nhut Nguyen ◽  
Anh Vu Nguyen
Keyword(s):  
Heart Failure ◽  
Left Ventricular Ejection Fraction ◽  
Ejection Fraction ◽  
Right Ventricular ◽  
Systolic Function ◽  
Systolic Heart Failure ◽  
Left Ventricular ◽  
Ventricular Ejection ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction

Background: The prognostic importance of right ventricular (RV) dysfunction has been suggested in patients with systolic heart failure (due to primary or secondary dilated cardiomyopathy - DCM). Tricuspid annular plane systolic excursion (TAPSE) is a simple, feasible, reality, non-invasive measurement by transthoracic echocardiography for evaluating RV systolic function. Objectives: To evaluate TAPSE in patients with primary or secondary DCM who have left ventricular ejection fraction ≤ 40% and to find the relation between TAPSE and LVEF, LVDd, RVDd, RVDd/LVDd, RA size, severity of TR and PAPs. Materials and Methods: 61 patients (36 males, 59%) mean age 58.6 ± 14.4 years old with clinical signs and symtomps of chronic heart failure which caused by primary or secondary DCM and LVEF ≤ 40% and 30 healthy subject (15 males, 50%) mean age 57.1 ± 16.8 were included in this study. All patients and controls were underwent echocardiographic examination by M-mode, two dimentional, convensional Dopler and TAPSE. Results: TAPSE is significant low in patients compare with the controls (13.93±2.78 mm vs 23.57± 1.60mm, p<0.001). TAPSE is linearly positive correlate with echocardiographic left ventricular ejection fraction (r= 0,43; p<0,001) and linearly negative correlate with RVDd (r= -0.39; p<0.01), RVDd/LVDd (r=-0.33; p<0.01), RA size (r=-0.35; p<0.01), TR (r=-0.26; p<0.05); however, no correlation was found with LVDd and PAPs. Conclusions: 1. Decreased RV systolic function as estimated by TAPSE in patients with systolic heart failure primary and secondary DCM) compare with controls. 2. TAPSE is linearly positive correlate with LVEF (r= 0.43; p<0.001) and linearly negative correlate with RVDd (r= -0.39; p<0.01), RVDd/LVDd (r=-0.33; p<0.01), RA size (r=-0.35; p<0.01), TR (r=-0.26; p<0.05); however, no correlation is found with LVDd and PAPs. 3. TAPSE should be used routinely as a simple, feasible, reality method of estimating RV function in the patients systolic heart failure DCM (primary and secondary).

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