Abstract 103: Obesity Paradox in Heart failure- Are African Americans Affected?

2012 ◽  
Vol 5 (suppl_1) ◽  
Author(s):  
Minaba A Wariboko ◽  
Kimberli Taylor ◽  
Chimalum Okafor ◽  
Taopheeq Mustapha ◽  
Victor Nwazue ◽  
...  
Keyword(s):  
Heart Failure ◽  
African Americans ◽  
Ejection Fraction ◽  
Emergency Room ◽  
Left Ventricular Systolic Dysfunction ◽  
The United States ◽  
Left Ventricular ◽  
Small Sample ◽  
Emergency Room Visits ◽  
Significant Difference

Background - Obesity is a major risk factor for heart failure. However, many studies have shown that obesity is paradoxically associated with better outcomes in those with chronic heart failure (HF). Initially thought to occur only in those with left ventricular systolic dysfunction (LVSD), recent studies such as CHARM and I-PRESERVE have described the same phenomenon in those with HF with preserved ejection fraction (HFpEF). It is also known that minorities have the highest rates of obesity in the United States, yet no major studies have included a large enough sample (>10% minority representation) to study this relationship. Thus we propose to examine the relationship of different weight categories to HF outcomes in patients with LVSD (45%) utilizing a minority cohort. Methods - Outcomes (HF admissions & cardiac admissions, non-cardiac admissions, and emergency room visits) were assessed for162 HF patients with documentation of body mass index (BMI) and ejection fraction from the Meharry Heart Failure Registry (a registry composed of 80% African Americans and Hispanics). The cohort was evenly divided by EF into HFpEF versus LVSD. Utilizing the Center for Disease Control definitions, 5 categories for BMI were defined: 40.0. ANOVA was applied to test for possible differences among BMI groups and outcomes. Results - There was a trend towards a paradoxical relationship noted between BMI and outcome in males with HFpEF when looking at all-cause readmissions (p<0.0606). This same relationship was noted between BMI and outcome in women with HFpEF when looking at the all-cause emergency room visits (p<0.0677). However, we failed to find a significant difference across BMI categories and outcome for those with LVSD. Conclusion - Our study suggests that irrespective of race, there is a paradoxical relationship noted between BMI and outcome for both men and women with HFpEF. However, contrary to current literature, we failed to find the same relationship in minority patients with LVSD. This may be due to the small sample size hence a larger prospective study of this group is warranted.

Peripartum Cardiomyopathy

2018 ◽  
Author(s):  
Kendra M Gray ◽  
Michael R Foley
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Left Ventricular Systolic Dysfunction ◽  
Systolic Dysfunction ◽  
The United States ◽  
Left Ventricular ◽  
Peripartum Cardiomyopathy ◽  
Left Ventricular Ejection ◽  
Ventricular Systolic Dysfunction ◽  
Ventricular Ejection Fraction

Peripartum cardiomyopathy (PPCM) is a serious and rare disease of late pregnancy or the early postpartum period. It is defined as idiopathic, nonfamilial, nongenetic, heart failure occurring in the absence of any other identifiable causes of heart disease within the last month of pregnancy or within the first 5 months postdelivery in otherwise previously healthy woman. The incidence in the United States is 1 per 3,000 to 4,000 live births. Left ventricular systolic dysfunction develops, almost always leading to a left ventricular ejection fraction of less than 45%. PPCM is unique in its rapid medical course and propensity to spontaneously resolve within 3 to 6 months of disease onset. The mortality rate is high, up to 10%, and the risk of relapse in subsequent pregnancies is also elevated. Treatment for PPCM varies slightly based on whether the woman is pregnant or postpartum. Conventional pharmacologic treatment includes diuretics, angiotensin-converting enzyme inhibitors (postpartum only), vasodilators such as hydralazine, digoxin, β-blockers, and anticoagulants. This review contains 5 figures, 5 tables, and 36 references. Key Words: critical care obstetrics, ejection fraction, heart failure, left ventricular systolic dysfunction, management, maternal mortality, peripartum cardiomyopathy, preeclampsia, pregnancy

scholarly journals Central and obstructive apneas prevalence in heart failure with reduced, mid-range and preserved ejection fraction

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
C Borrelli ◽  
P Sciarrone ◽  
F Gentile ◽  
N Ghionzoli ◽  
G Mirizzi ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Left Ventricular Systolic Dysfunction ◽  
Systolic Function ◽  
Systolic Dysfunction ◽  
Cardiopulmonary Exercise Testing ◽  
Left Ventricular ◽  
Apnea Hypopnea Index ◽  
Preserved Ejection Fraction ◽  
2D Echocardiography

Abstract Background Central apneas (CA) and obstructive apneas (OA) are highly prevalent in heart failure (HF) both with reduced and preserved systolic function. However, a comprehensive evaluation of apnea prevalence across HF according to ejection fraction (i.e HF with patients with reduced, mid-range and preserved ejection fraction- HFrEf, HFmrEF and HFpEF, respectively) throughout the 24 hours has never been done before. Materials and methods 700 HF patients were prospectively enrolled and then divided according to left ventricular EF (408 HFrEF, 117 HFmrEF, 175 HFpEF). All patients underwent a thorough evaluation including: 2D echocardiography; 24-h Holter-ECG monitoring; cardiopulmonary exercise testing; neuro-hormonal assessment and 24-h cardiorespiratory monitoring. Results In the whole population, prevalence of normal breathing (NB), CA and OA at daytime was 40%, 51%, and 9%, respectively, while at nighttime 15%, 55%, and 30%, respectively. When stratified according to left ventricular EF, CA prevalence decreased from HFrEF to HFmrEF and HFpEF: (daytime CA: 57% vs. 43% vs. 42%, respectively, p=0.001; nighttime CA: 66% vs. 48% vs. 34%, respectively, p&lt;0.0001), while OA prevalence increased (daytime OA: 5% vs. 8% vs. 18%, respectively, p&lt;0.0001; nighttime OA: 20 vs. 29 vs. 53%, respectively, p&lt;0.0001). When assessing moderte-severe apneas, defined with an apnea/hypopnea index &gt;15 events/hour, prevalence of CA was again higher in HFrEF than HFmrEF and HFpEF both at daytime (daytime moderate-severe CA: 28% vs. 19% and 23%, respectively, p&lt;0.05) and at nighttime (nighttime moderate-severe CA: 50% vs. 39% and 28%, respectively, p&lt;0.05). Conversely, moderate-severe OA decreased from HFrEF to HFmrEF to HFpEF both at daytime (daytime moderate-severe OA: 1% vs. 3% and 8%, respectively, p&lt;0.05) and nighttime (noghttime moderate-severe OA: 10% vs. 11% and 30%, respectively, p&lt;0.05). Conclusions Daytime and nighttime apneas, both central and obstructive in nature, are highly prevalent in HF regardless of EF. Across the whole spectrum of HF, CA prevalence increases and OA decreases as left ventricular systolic dysfunction progresses, both during daytime and nighttime. Funding Acknowledgement Type of funding source: None

scholarly journals Are high NT-proBNP levels more related to inflammation than to left ventricular systolic dysfunction in acute myocarditis?

2021 ◽  
Vol 10 (Supplement_1) ◽  
Author(s):  
B Sara ◽  
JJ Monteiro ◽  
P Carvalho ◽  
C Ribeiro Carvalho ◽  
J Chemba ◽  
...  
Keyword(s):  
Ejection Fraction ◽  
Plasma Levels ◽  
Left Ventricular Systolic Dysfunction ◽  
Small Sample Size ◽  
Acute Myocarditis ◽  
Systolic Dysfunction ◽  
Left Ventricular ◽  
Small Sample ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction

Abstract Funding Acknowledgements Type of funding sources: None. Background Plasma levels and N-terminal pro B-type natriuretic peptide (NT- proBNP), a cardiac neurohormone released in response to increased ventricular stress, represent an important predictor of clinical outcomes and left ventricular (LV) dysfunction; Although, its diagnostic and prognostic role in patients with acute myocarditis is not completely established; Our aim was to evaluate the relationship of BNP levels and LV ejection fraction (LVEF) in patients with myocarditis; Methods Data from patients (pts) discharged with the diagnosis of myocarditis, from 2008 and 2018 were retrospectively analysed. Results 62 pts were included. Mean age was 39.7 17 years and 89% (58 patients) were men. Plasma levels of NT-proBNP measured at admission ranged from 24 to 3110 pg/mL (median 514, IQR 947), and exceeded upper normal levels in 51 pts (82%). This values positively correlated with C- reactive protein (CRP) (p= 0.005, r = 0.36), leucocytes (p = 0.03, r= 0.37) and neutrophil-to-lymphocyte ratio (p= 0.05, r= 0.35), but not with left ventricular ejection fraction (LVEF) (p= 0.829). Higher levels of BNP were associated with higher troponin peak levels but not with increased mortality (p = 0.811), need of inotropic support (p= 0.059) or arrhythmic events (p= 0.130). Inflammatory parameters were significantly increased when BNP&gt; 514 pg/mL vs BNP &lt;514 pg/mL (CRP 7.2 vs 4 mg/dL, p= 0.008). This relationship was maintained at BNP &gt; 900. LVEF was comparable in both groups (p = 0.938); In this population, the magnitude of recovery of the NT- proBNP values (variation between NT-proBNP at admission and discharge) strongly correlated with the magnitude of the inflammatory markers at admission (all p &lt; 0,005) Conclusion In patients with acute myocarditis, there is a significant relationship between NT-proBNP levels and inflammation (as measured by leucocytes, NLR or CRP), but not with LVEF; Despite the limitation of a small sample size, we could hypothesize that NTproBNP in this subset of patients appears to be regulated not only by hemodynamic changes but also by the underlying systemic inflammatory process and, therefore, it interpretation should take that into account;

scholarly journals The effect of left ventricle ischemia severity on cardiac performance appeared on ejection fraction using radioactive TC 99m MIBI in comparison with echocardiography

2021 ◽  
Vol 2114 (1) ◽  
pp. 012006
Author(s):  
M K Mohammed ◽  
S I Essa
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Mean Value ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Systolic Volume ◽  
End Diastolic Volume ◽  
Significant Difference ◽  
End Systolic Volume ◽  
The Mean

Abstract Ischemic heart disease is a major causes of heart failure. Heart failure patients have predominantly left ventricular dysfunction (systolic or diastolic dysfunction, or both). Acute heart failure is most commonly caused by reduced myocardial contractility, and increased LV stiffness. We performed echocardiography and gated SPECT with Tc99m MIBI within 263 patients and 166 normal individuals. Left ventricular end systolic volume (LVESV), left ventricular end diastolic volume (LVEDV), and left ventricular ejection fraction (LVEF) were measured. For all degrees of ischemia, there was a significant difference between ejection fraction values measured by SPECT and echocardiography, and there were no significant differences among end systolic volume and end diastolic volume value calculated by two methods for all cases. The mean value for EDV (ECHO)/EDV (SPECT) was 1.07 ± 0.31 for degree (1, 2); in the degree 3 the mean value was 1.02 ± 0.08, and 1.005 ± 0.07 for degree 4. The mean value for ESV (ECHO)/ESV (SPECT) was 1.08 ± 0.34 for degree (1, 2); while 1.03 ± 0.12, 1.021 ± 0.128 for degree 3 and 4 respectively. This study was showed a good relation between left ventricular size and ejection fraction measured by SPECT with Tc99m, and echocardiography.

scholarly journals An Echocardiographic Evaluation of Dilated Cardiomyopathy in a Tertiary Care Hospital

2019 ◽  
Vol 57 (215) ◽  
Author(s):  
Raj Kumar Thapa ◽  
Kanchan K.C ◽  
Rishi Khatri ◽  
Devendra Khatri ◽  
Rajeeb Kumar Deo ◽  
...  
Keyword(s):  
Heart Failure ◽  
Congestive Heart Failure ◽  
Left Ventricle ◽  
Ejection Fraction ◽  
Dilated Cardiomyopathy ◽  
Tertiary Care ◽  
Left Ventricular ◽  
Care Hospital ◽  
Echocardiographic Evaluation ◽  
Significant Difference

Introduction: Cardiomyopathies are diseases of heart muscle that may originate from genetic defects, cardiac myocyte injury or infiltration of myocardial tissues. Dilated cardiomyopathy is the most common phenotype and is often a final common pathway of numerous cardiac insults. Mostly it remains unknown in the absence of echocardiography, histopathology and genetic evaluation. Though common it is underdiagnosed with not much of data available in our setup.Methods: This study was analytical cross-sectional study of hospital data on Echocardiographic findings in 65 patients of DCM visiting cardiology unit for Echocardiographic evaluation from 1st of February to 31st July 2018 for the period of six months in Shree Birendra Hospital, a tertiary care military hospital at Chhauni, Kathmandu. Pediatric age group patients and those who refused to give consent were excluded. Data obtained were entered in Microsoft Excel 2010 and analyzed by IBM SPSS 21.Results: Among 65 patients enrolled 40 (61%) were male and 25 (39%) female with male to female ratio of 1.6:1. Elderly people (61-75 years) with an average age of 65 were commonly involved and they presented mostly with congestive heart failure, 32 (49%). Echocardiographic evaluation showed 36 (55%) with mildly dilated Left Ventricle (5.6-6.0cm). Majority had reduced Left ventricular systolic function with an average Ejection fraction (EF) of 39.6%. No significant difference between male and female with the average EF% (P=0.990) and there was no significant relation between age and average EF% (P=0.091).Conclusions: Dilated Cardiomyopathy is the commonest cardiomyopathy phenotype mostly presenting with congestive heart failure. It is often underdiagnosed in our part of the world, however echocardiography will easily detect the condition. Keywords: dilated cardiomyopathy; echocardiography; ejection fraction; left ventricle.

Abstract P232: Screening Past B-Type Natriuretic Peptide (BNP) Values to Identify Candidates for Treatment of Systolic Dysfunction

2011 ◽  
Vol 4 (suppl_1) ◽  
Author(s):  
Parisa Gholami ◽  
Shoutzu Lin ◽  
Paul Heidenreich
Keyword(s):  
Heart Failure ◽  
Left Ventricular Ejection Fraction ◽  
Ejection Fraction ◽  
Left Ventricular ◽  
Ventricular Ejection ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Significant Difference ◽  
The Mean

Background: BNP testing is now common though it is not clear if the test results are used to improve patient care. A high BNP may be an indicator that the left ventricular ejection fraction (LVEF) is low (<40%) such that the patient will benefit from life-prolonging therapy. Objective: To determine how often clinicians obtained a measure of LVEF (echocardiography, nuclear) following a high BNP value when the left ventricular ejection fraction (LVEF) was not known to be low (<40%). Methods and Results: We reviewed the medical records of 296 consecutive patients (inpatient or outpatient) with a BNP values of at least 200 pg/ml at a single medical center (tertiary hospital with 8 community clinics). A prior diagnosis of heart failure was made in 65%, while 42% had diabetes, 79% had hypertension, 59% had ischemic heart disease and 31% had chronic lung disease. The mean age was 73 ± 12 years, 75% were white, 10% black, 15% other and the mean BNP was 810 ± 814 pg/ml. The LVEF was known to be < 40% in 84 patients (28%, mean BNP value of 1094 ± 969 pg/ml). Of the remaining 212 patients without a known low LVEF, 161 (76%) had a prior LVEF >=40% ( mean BNP value of 673 ± 635 pg/ml), and 51 (24%) had no prior LVEF documented (mean BNP 775 ± 926 pg/ml). Following the high BNP, a measure of LVEF was obtained (including outside studies documented by the primary care provider) within 6 months in only 53% (113 of 212) of those with an LVEF not known to be low. Of those with a follow-up echocardiogram, the LVEF was <40% in 18/113 (16%) and >=40% in 95/113 (84%). There was no significant difference in mean initial BNP values between those with a follow-up LVEF <40% (872 ± 940pg/ml), >=40% (704 ± 737 pg/ml), or not done (661 ± 649 pg/ml, p=0.5). Conclusions: Follow-up measures of LVEF did not occur in almost 50% of patients with a high BNP where the information may have led to institution of life-prolonging therapy. Of those that did have a follow-up study a new diagnosis of depressesd LVEF was noted in 16%. Screening of existing BNP and LVEF data and may be an efficient strategy to identify patients that may benefit from life-prolonging therapy for heart failure.

Abstract 13641: Serum Vitamin D3 Levels, Left Ventricular Structure and Incident Hospitalization for Heart Failure With Preserved Ejection Fraction in African Americans: The Jackson Heart Study

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Daisuke Kamimura ◽  
Amil M Shah ◽  
Adebamike Oshunbade ◽  
Arsalan Hamid ◽  
Robert Mentz ◽  
...  
Keyword(s):  
Heart Failure ◽  
African Americans ◽  
Ejection Fraction ◽  
Serum Vitamin ◽  
Left Ventricular ◽  
Structure And Function ◽  
Preserved Ejection Fraction ◽  
Lower Serum ◽  
Heart Study ◽  
And Function

Background: Lower serum vitamin D3 (VitD3) concentration has been associated with cardiovascular disease. However, the associations between serum VitD3 levels and left ventricular (LV) structure and function and heart failure with preserved ejection fraction (HFpEF) have not been well-characterized community. The prevalence of VitD3 deficiency is higher among African Americans than in other race/ethnicity groups. We hypothesized that serum VitD3 levels are associated with LV concentric remodeling and incident heart failure (HF) in African Americans. Methods and Results: Among 4872 African Americans in the Jackson Heart Study cohort, we investigated the relationships between serum VitD3 levels and LV structure and function, evaluated with echocardiography, and incident HF hospitalization, categorized either HF with reduced EF (HFrEF: EF<50%) or HFpEF (EF≥50%). The median and interquartile serum VitD3 levels were 12.0 (8.6-16.7) ng/mL. After adjustment for age, sex, body mass index, systolic blood pressure, anti-hypertensive medication use, current smoking status, and estimated glomerular filtration rate, lower VitD3 levels were associated with greater septal and posterior wall thickness and plasma brain natriuretic peptide (BNP) levels, but not with LV mass index or LVEF (Table). Over a median follow-up period of 11 (10.3~11) years, 313 participants developed incident HF (7.79 cases per 1,000 person-years), including 128 (41%) HFrEF and 185 (59%) HFpEF cases. After adjustment, lower serum VitD3 levels were associated with higher incidence of HF overall and levels seemed to be mostly related to HFpEF (Table). Conclusion: In this community-based African American cohort, lower serum VitD3 levels were associated with LV concentric remodeling and incident HF, mainly HFpEF. Further investigation is required to examine whether the supplementation of VitD3 can prevent LV concentric remodeling and incident HFpEF in African Americans.

scholarly journals Reduction in Left Ventricular Ejection Fraction is Associated with Subsequent Cardiac Events in Outpatients with Chronic Heart Failure

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Yoshitaka Okuhara ◽  
Masanori Asakura ◽  
Yoshiyuki Orihara ◽  
Daisuke Morisawa ◽  
Yuki Matsumoto ◽  
...  
Keyword(s):  
Heart Failure ◽  
Left Ventricular Ejection Fraction ◽  
Ejection Fraction ◽  
Left Ventricular ◽  
Ventricular Ejection ◽  
Left Ventricular Ejection ◽  
Operating Characteristics ◽  
Cardiac Events ◽  
Ventricular Ejection Fraction ◽  
Significant Difference

AbstractLeft ventricular ejection fraction (LVEF) is critical for determining the prognosis and treatment of patients with heart failure (HF). However, the influence of serial LVEF changes in patients with stable chronic HF (CHF) has not yet been completely investigated. We analyzed data of 263 outpatients with CHF from the J-MELODIC study cohort and evaluated the frequency of cardiac events. We stratified patients into tertiles based on the relative difference in LVEF in 1 year and that at baseline. We found a significant difference in the cardiac event rate among the three groups (log-rank test, p = 0.042). We identified a relative 11% LVEF reduction as the optimal cutoff value based on the receiver operating characteristics analysis. LVEF (OR, 1.04; 95% CI, 1.01–1.07; p = 0.015) and E/e′ (OR, 1.06; 95% CI, 1.01–1.12; p = 0.023) at baseline were predictors of >11% LVEF reduction. After adjusting the variables including age and sex, >11% LVEF reduction was an independent predictor of subsequent cardiac events (HR, 5.79; 95% CI, 2.49–13.2; p < 0.001). In conclusion, patients with 1-year relative >11% LVEF reduction may have subsequent worsening outcomes. Such patients should be carefully followed-up as high risk population for development of cardiac events.

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