Abstract 15862: Abnormal Exercise-induced Aortic Stiffness in Heart Failure

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Connie W Tsao ◽  
Lana Myerson ◽  
Inbar Raber ◽  
Ulf Neisius ◽  
Warren J Manning
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Aortic Stiffness ◽  
Left Ventricular ◽  
Left Ventricular Volumes ◽  
Bicycle Ergometry ◽  
Cross Sectional ◽  
Post Exercise ◽  
Metabolic Equivalents ◽  
Exercise Induced

Introduction: Afterload conferred by aortic stiffness contributes to heart failure (HF) pathogenesis. Hypothesis: Patients with HF have a greater rise in aortic stiffness with physical exertion compared to individuals without HF. Methods: Outpatients with HF (n=21) and without HF (n=26) underwent cardiovascular magnetic resonance (1.5T CMR) at rest and following submaximal supine bicycle ergometry. Short axis cine steady-state free precession (SSFP) images were obtained to quantify left ventricular volumes and ejection fraction. Cross-sectional aortic SSFP imaging at the level of the pulmonary artery bifurcation was obtained to measure descending aorta (DA) distensibility at rest and immediately after exercise. We compared least squares (LS) means of DA distensibility between HF and control groups, adjusting for age, sex, and metabolic equivalents (METs) achieved. Results: Characteristics of controls and HF patients are presented in the TABLE . There was no difference of DA distensibility between control and HF groups either at rest or after exercise (p=0.77 and p=0.13, respectively). However, compared to controls with no significant change in aortic stiffness with exercise, individuals with HF had a reduction in DA distensibility post-exercise in analyses adjusted for age, sex, and METs achieved ( TABLE ). In subgroup analyses, patients with HF with reduced ejection fraction (n=14) had lower post-exercise DA distensibility vs. rest (adjusted-LS means 3.06 x10 -3 mm Hg -1 , 95% CI 2.35x10 -3 —3.76x10 -3 mm Hg -1 , vs. 4.55 x10 -3 mm Hg -1 , 95% CI 3.84 x10 -3 —5.26 x10 -3 mm Hg - 1, respectively, p=0.020). DA distensibility at rest vs. exercise in patients with HF with preserved ejection fraction was similar (p=0.38). Conclusions: Patients with HF have exercise-induced aortic stiffness not seen in individuals without HF. This may result in less favorable ventricular-vascular coupling with exertion in HF patients. Character count: 1653 (limit=1700)

Abstract 13421: Ventricular and Arterial Elastance During Isometric Handgrip Exercise and Post-exercise Circulatory Arrest in Heart Failure With and Without Preserved Ejection Fraction

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Naoki Fujimoto ◽  
Keishi Moriwaki ◽  
Issei Kameda ◽  
Masaki Ishiyama ◽  
Taku Omori ◽  
...  
Keyword(s):  
Heart Failure ◽  
Blood Pressure ◽  
Heart Rate ◽  
Ejection Fraction ◽  
Circulatory Arrest ◽  
Systolic Pressure ◽  
Left Ventricular ◽  
Isometric Handgrip ◽  
Arterial Elastance ◽  
Post Exercise

Introduction: Isometric handgrip (IHG) training at 30% maximal voluntary contraction (MVC) lowers blood pressure in hypertensive patients. Impacts of IHG exercise and post-exercise circulatory arrest (PECA), which isolates metaboreflex control, have been unclear in heart failure (HF). Purpose: To investigate the impacts of IHG exercise and PECA on ventricular-arterial stiffness and left ventricular (LV) relaxation in HF with preserved (HFpEF) and reduced ejection fraction (HFrEF). Methods: We invasively obtained LV pressure-volume (PV) loops in 20 patients (10 HFpEF, 10 HFrEF) using conductance catheter with microtip-manometer during 3 minutes of IHG at 30%MVC and 3 minutes of PECA. Hemodynamics and LV-arterial function including LV end-systolic elastance (Ees) by the single-beat method, effective arterial elastance (Ea), and time constant of LV relaxation (Tau) were evaluated every minute. Results: At rest, HFpEF had higher LV end-systolic pressure (ESP) and lower heart rate than HFrEF with similar LV end-diastolic pressure (EDP). The coupling ratio (Ees/Ea) was greater in HFpEF than HFrEF (1.0±0.3 vs. 0.6±0.3, p<0.01). IHG for 3minutes similarly increased heart rate in HFpEF (by 10±8 bpm) and HFrEF (by 14±6 bpm). IHG also increased end-diastolic and LVESP (134±21 vs. 158±30 mmHg and 113±25 vs. 139±25 mmHg) in both groups (groupхtime effect p≥0.25). In HFpEF, Ees, Ea and Ees/Ea (1.0±0.3 vs. 1.1±0.4) were unaffected during IHG. In HFrEF, IHG induced variable increases in Ea. LV end-systolic volume and the ESPV volume-axis intercept were larger, and Ees at IHG 3 rd min was greater (1.30±0.7 vs. 3.1±2.1 mmHg/ml, p<0.01) than baseline, resulting in unchanged Ees/Ea at IHG 3 rd min (0.6±0.3 vs. 0.8±0.4, p≥0.37). Tau was prolonged only in HFrEF during IHG and was returned to the baseline value during PECA. During the first 2 minutes of PECA, LVESP was lower than that at IHG 3 rd min only in HFpEF, suggesting less metaboreflex control of blood pressure in HFpEF during IHG. Conclusions: IHG exercise at 30%MVC induced modest increases in LV end-systolic and end-diastolic pressures in HFpEF and HFrEF. Although the prolongation of LV relaxation was observed only in HFrEF, the ventricular and arterial coupling was maintained throughout the IHG exercise in both groups.

Selective matrix metalloproteinase inhibition attenuates progression of left ventricular dysfunction and remodeling in dogs with chronic heart failure

2006 ◽  
Vol 290 (6) ◽  
pp. H2522-H2527 ◽  
Author(s):  
Hideaki Morita ◽  
Sanjaya Khanal ◽  
Sharad Rastogi ◽  
George Suzuki ◽  
Makoto Imai ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Interstitial Fibrosis ◽  
Left Ventricular ◽  
High Dose ◽  
Long Term Effects ◽  
Cross Sectional ◽  
Mmp Inhibitor ◽  
Lv Dysfunction

Matrix metalloproteinases (MMPs) contribute to the progression of left ventricular (LV) dysfunction and remodeling associated with heart failure (HF). The present study examined the long-term effects of a selective MMP inhibitor PG-530742 (PG) on the progression of LV dysfunction and remodeling in dogs with HF. Chronic HF [LV ejection fraction (LVEF), ≤36%] was produced by multiple sequential intracoronary microembolizations in 24 dogs. Two weeks after the last embolization, dogs were randomized to 3 mo of therapy with either high-dose (HD) PG (3.5 mg/kg, n = 8), low-dose (LD) PG (0.2 mg/kg, n = 8), or to a matched placebo (PL, n = 8). PG has been shown to produce complete inhibition of MMP-2, -3, -9, and -13, while sparing MMPs-1 and -7. Hemodynamic and echocardiographic measurements were made before and 3 mo after initiating therapy. In PL and LD dogs, LVEF decreased significantly, and LV end-systolic volume (ESV) and LV end-diastolic volume (EDV) increased significantly during the 3-mo follow-up period. Whereas in HD dogs ejection fraction increased from 36 ± 1 to 40 ± 1% ( P = 0.003), EDV and ESV decreased (59 ± 4 vs. 57 ± 4 ml, P = 0.02; and 38 ± 2 vs. 34 ± 2 ml, P = 0.00001, respectively). When compared with controls, HD-treated dogs showed 30% reduction in replacement fibrosis, 29% reduction in interstitial fibrosis, and 28% reduction in myocyte cross-sectional area. mRNA expression of selective MMPs was also reduced in LV tissue in HD- but not LD-treated dogs. In conclusion, in dogs with moderate HF, long-term monotherapy with HD selective MMP inhibitor PG prevents LV remodeling and the progression of global LV dysfunction.

The Effect of Angiotensin Receptor Inhibitors and Neprilysin on Aortic Stiffness in Patients with Heart Failure and Reduced Ejection Fraction

2021 ◽  
Vol 76 (3) ◽  
pp. 298-306
Author(s):  
Alexey S. Ryazanov ◽  
Evgenia V. Shikh ◽  
Konstantin I. Kapitonov ◽  
Mariya V. Makarovskaya ◽  
Alexey A. Kudryavtsev
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Aortic Stiffness ◽  
Left Atrial Volume ◽  
Left Ventricular ◽  
Volume Index ◽  
Left Atrial Volume Index ◽  
Reduced Ejection Fraction ◽  
Patients With Heart Failure

Background. Compared with enalapril, sacubitril/valsartan reduces mortality from cardiovascular diseases and the number of hospitalizations for heart failure in patients with heart failure and reduced ejection fraction (HFrEF). These benefits may be related to effects on hemodynamics and cardiac remodeling. The aim of the study is to determine the effect of sacubitril/valsartan on aortic stiffness and cardiac remodeling compared with enalapril in HFrEF. Materials and methods. In this long-term outpatient study, 100 patients with HFrEF received sacubitril/valsartan or enalapril. The primary endpoint was the change in arterial impedance (aortic stiffness characteristic) over a 12-month follow-up. Secondary endpoints included changes in N-terminal cerebral natriuretic propeptide (NT-proBNP), ejection fraction, left atrial volume index, E/e index, left ventricular end-systolic and end-diastolic volumes; left ventricular-arterial index (Ea/Ees). Results. During 12 months of follow-up, 100 patients showed significant differences between the groups with respect to changes in arterial impedance, which decreased from 224.0 to 207.9 dynes s/ cm5 in the sacubitrile/valsartan group and increased from 213.5 to 214.1 dyne s/cm5 in the enalapril group (difference between groups: 9.3 dynes s/ cm5; 95% CI: from 16.9 to 12.8 dynes s/cm5; p = 0.69). Also, there were intergroup differences in the change in left ventricular ejection fraction and Ea/Ees index. NT-proBNP level, left ventricular end-diastolic and systolic volume index, left atrial volume index, E/e index were reduced in the sacubitril/valsartan group. Conclusions. Treatment with sacubitril/valsartan compared with enalapril resulted in a significant reduction in aortic stiffness in HFrEF.

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