Favorable effects of peritoneal dialysis in patients with refractory heart failure and overhydration

Background: Patients with refractory to optimal pharmacological treatment heart failure (HF) require frequent hospitalization. Peritoneal dialysis (PD) has been part of the management of such patients mainly for promoting ultrafiltration and management of overhydration independently of kidney function. The aim of this study was to evaluate the efficacy of PD, especially the use of icodextrin solutions and intermittent PD, in the hospitalization rate and cardiac functional status of patients with HF. Methods: We conducted a retrospective study involving patients with New York Heart Association (NYHA) class IV HF and preserved renal function (estimated glomerular filtration rate (eGFR) > 25 ml/min), who were refractory to conservative treatment. Clinical data on weight loss, hospitalization rate before and after PD initiation, cardiac functional status, and technique complications during a 6-month observational period were analyzed. Results: PD treatment was performed in 32 patients with a mean age of 63.8 ± 11.9 years and a follow-up of 20.78 ± 14.24 months. Hospitalizations were significantly reduced from 20.7 ± 13.7 to 7.7 ± 8.9 days/patients at 6 months. All patients showed improvement in NYHA class as well as in left ventricular ejection fraction. Overall, eGFR showed a significant decrease but only six patients reached end-stage renal disease. Complications included 18 cases of peritonitis. PD was well tolerated and no patient dropped out of the method. Survival rate reached 72% at 12 months but mortality rate was high with 23 patients dying at 16.65 ± 12.3 months after the initiation of treatment. Patients survival was not influenced by the type of PD modality or weight reduction achieved. Conclusions: PD showed to be a viable option for the treatment of patients with refractory HF leading to a better cardiac functional status and diminishing the number of hospital admissions.

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The use of peritoneal dialysis in heart failure: A systematic review

Peritoneal Dialysis International ◽

10.1177/0896860819895198 ◽

2020 ◽

Vol 40 (6) ◽

pp. 527-539 ◽

Cited By ~ 1

Author(s):

Chang Yin Chionh ◽

Anna Clementi ◽

Cheng Boon Poh ◽

Fredric O Finkelstein ◽

Dinna N Cruz

Keyword(s):

Heart Failure ◽

Systematic Review ◽

Peritoneal Dialysis ◽

Hospital Admissions ◽

Diuretic Therapy ◽

Heart Association ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Ventricular Ejection Fraction

Heart failure (HF) is a major cause of morbidity and mortality. Extracorporeal (EC) therapy, including ultrafiltration (UF) and haemodialysis (HD), peritoneal dialysis (PD) and peritoneal ultrafiltration (PUF) are potential therapeutic options in diuretic-resistant states. This systematic review assessed outcomes of PD and compared the effects of PD to EC. A comprehensive search of major databases from 1966 to 2017 for studies utilising PD (or PUF) in diuretic-resistant HF was conducted, excluding studies involving patients with end-stage kidney disease. Data were extracted and combined using a random-effects model, expressed as odds ratio (OR). Thirty-one studies ( n = 902) were identified from 3195 citations. None were randomised trials. Survival was variable (0–100%) with a wide follow-up duration (36 h–10 years). With follow-up > 1 year, the overall mortality was 48.3%. Only four studies compared PD with EC. Survival was 42.1% with PD and 45.0% with EC; the pooled effect did not favour either (OR 0.80; 95% confidence interval (CI): 0.24–2.69; p = 0.710). Studies on PD in patients with HF reported several benefits. Left ventricular ejection fraction (LVEF) improved after PD (OR 3.76, 95%CI: 2.24–5.27; p < 0.001). Seven of nine studies saw LVEF increase by > 10%. Twenty-one studies reported the New York Heart Association status and 40–100% of the patients improved by ≥ 1 grade. Nine of 10 studies reported reductions in hospitalisation frequency and/or duration. When treated with PD, HF patients had fewer symptoms, lower hospital admissions and duration compared to diuretic therapy. However, there is inadequate evidence comparing PD versus UF or HD. Further studies comparing these modalities in diuretic-resistant HF should be conducted.

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Mid-regional proatrial natriuretic peptide for predicting prognosis in hypertrophic cardiomyopathy

Heart ◽

10.1136/heartjnl-2019-314826 ◽

2019 ◽

pp. heartjnl-2019-314826 ◽

Cited By ~ 2

Author(s):

Céline Bégué ◽

Stellan Mörner ◽

Dulce Brito ◽

Christian Hengstenberg ◽

John G F Cleland ◽

...

Keyword(s):

Heart Failure ◽

New York ◽

Hypertrophic Cardiomyopathy ◽

Natriuretic Peptide ◽

Nyha Class ◽

Heart Association ◽

Roc Curves ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Ventricular Ejection Fraction

ObjectivesN-terminal probrain natriuretic peptide (NT-proBNP) predicts mortality and the development of heart failure in hypertrophic cardiomyopathy (HCM). Mid-regional proatrial natriuretic peptide (MR-proANP) is a stable by-product of production of atrial natriuretic peptide. We sought to compare the prognostic value of MR-proANP and NT-proBNP in HCM.MethodsWe prospectively enrolled a cohort of patients with HCM from different European centres and followed them. All patients had clinical, ECG and echocardiographic evaluation and measurement of MR-proANP and NT-proBNP at inclusion.ResultsOf 357 patients enrolled, the median age was 52 (IQR: 36–65) years. MR-proANP and NT-proBNP were both independently associated with age, weight, New York Heart Association (NYHA) class, left ventricular ejection fraction (LVEF), wall thickness and left atrial dimension. During a median follow-up of 23 months, 32 patients had a primary end point defined as death (n=6), heart transplantation (n=8), left ventricular assist device implantation (n=1) or heart failure hospitalisation (n=17). Both NT-proBNP and MR-proANP (p<10–4) were strongly associated with the primary endpoint, and the areas under the receiver operating characteristic (ROC) curves for both peptides were not significantly different. However, in a multiple stepwise regression analysis, the best model for predicting outcome was NYHA 1–2 vs 3–4 (HR=0.35, 95% CI 0.16 to 0.77, p<0.01), LVEF (HR=0.96, 95% CI 0.94 to 0.98, p=0.0005) and MR-proANP (HR=3.77, 95% CI 2.01 to 7.08, p<0.0001).ConclusionsMR-proANP emerges as a valuable biomarker for the prediction of death and heart failure related events in patients with HCM.

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Association of Physical Activity and Prognostic Parameters in Elderly Patients With Heart Failure

Journal of Aging and Physical Activity ◽

10.1123/japa.19.1.1 ◽

2011 ◽

Vol 19 (1) ◽

pp. 1-15 ◽

Cited By ~ 10

Author(s):

Melissa Jehn ◽

Arno Schmidt-Trucksäss ◽

Henner Hanssen ◽

Tibor Schuster ◽

Martin Halle ◽

...

Keyword(s):

Physical Activity ◽

Heart Failure ◽

Nyha Class ◽

Clinical Status ◽

Heart Association ◽

Left Ventricular ◽

Functional Class ◽

Left Ventricular Ejection ◽

Ventricular Ejection Fraction ◽

Patients With Heart Failure

Objective:Assessment of habitual physical activity (PA) in patients with heart failure.Methods:This study included 50 patients with heart failure (61.9 ± 4.0 yr). Seven days of PA were assessed by questionnaire (AQ), pedometer, and accelerometer and correlated with prognostic markers including VO2peak, percent left-ventricular ejection fraction, N-terminal pro-B-type natriuretic peptide, and New York Heart Association (NYHA) functional class.Results:Accelerometry showed a stronger correlation with VO2peak and NYHA class (R = .73 and R = −.68; p < .001) than AQ (R = .58 and R = −.65; p < .001) or pedometer (R = .52 and R = −.50; p < .001). In the multivariable regression model accelerometry was the only consistent independent predictor of VO2peak (p = .002). Moreover, when its accuracy of prediction was tested, 59% of NYHA I and 95% of NYHA III patients were correctly classified into their assigned NYHA classes based on their accelerometer activity.Conclusion:PA assessed by accelerometer is significantly associated with exercise capacity in patients with heart failure and is predictive of disease severity. The data suggests that PA monitoring can aid in evaluating clinical status.

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Neopterin is Associated with Disease Severity and Outcome in Patients with Non-Ischaemic Heart Failure

Journal of Clinical Medicine ◽

10.3390/jcm8122230 ◽

2019 ◽

Vol 8 (12) ◽

pp. 2230

Author(s):

Lukas Lanser ◽

Gerhard Pölzl ◽

Dietmar Fuchs ◽

Günter Weiss ◽

Katharina Kurz

Keyword(s):

Heart Failure ◽

Disease Severity ◽

Immune Activation ◽

Nyha Class ◽

Heart Association ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Ventricular Ejection Fraction ◽

Increased Risk ◽

Patients With Heart Failure

Inflammation and immune activation play an important role in the pathogenesis of cardiac remodelling in patients with heart failure. The aim of this study was to assess whether biomarkers of inflammation and immune activation are linked to disease severity and the prognosis of heart failure patients. In 149 patients (65.8% men, median age 49.7 years) with heart failure from nonischaemic cardiomyopathy, the biomarkers neopterin and C-reactive protein were tested at the time of diagnosis. Patients were followed-up for a median of 58 months. During follow-up, nineteen patients died, five had a heart transplantation, two needed a ventricular assistance device, and twenty-one patients had to be hospitalised because of heart failure decompensation. Neopterin concentrations correlated with N-terminal prohormone of brain natriuretic peptide (NT-proBNP) concentrations (rs = 0.399, p < 0.001) and rose with higher New York Heart Association (NYHA) class (I: 5.60 nmol/L, II: 6.90 nmol/L, III/IV: 7.80 nmol/L, p = 0.033). Higher neopterin levels were predictive for an adverse outcome (death or hospitalisation due to HF decompensation), independently of age and sex and of established predictors in heart failure such as NYHA class, NT-proBNP, estimated glomerular filtration rate (eGFR), and left ventricular ejection fraction (LV-EF) (HR 2.770; 95% CI 1.419–5.407; p = 0.003). Patients with a neopterin/eGFR ratio ≥ 0.133 (as a combined marker for immune activation and kidney function) had a more than eightfold increased risk of reaching an endpoint compared to patients with a neopterin/eGFR ratio ≤0.065 (HR 8.380; 95% CI 2.889–24.308; p < 0.001). Neopterin is associated with disease severity and is an independent predictor of prognosis in patients with heart failure.

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CORRELATION BETWEEN CONCENTRATION OF PATHOLOGICAL CYTOKINES AND ERYTHROPOIETIN IN PATIENTS WITH CHRONIC HEART FAILURE WITH ANEMIC SYNDROME

Annals of the Russian academy of medical sciences ◽

10.15690/vramn.v69.i1-2.939 ◽

2015 ◽

Vol 69 (1-2) ◽

pp. 32-37

Author(s):

K. Kh. Zahidova

Keyword(s):

Heart Failure ◽

New York ◽

Chronic Heart Failure ◽

Nyha Class ◽

Heart Association ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Ventricular Ejection Fraction ◽

New York Heart Association ◽

Erythropoietin Treatment

Aim: to study correlation between concentration of pathological cytokines and erythropoietin in patients with chronic heart failure with anemic syndrome and also to prove importance of this communication for need of appointment erythropoietin excitants. Patients and methods: 94 patients with chronic heart failure of New York Heart Association (NYHA) class ІІІ–ІV a left ventricular ejection fraction of 40% or less with anemia w ere included in investigation (58 males, 36 females). Anemia was detected when hemoglobin (Hb) was less than 120 g/l in males and less than 110 g/l in females. 46 patients received traditional treatment of CHF (І group) and 48 patients were treated additionally with erythropoietin (EPO) (ІІ group). Percutaneous EPO 50 IU monthly to patients without iron deficiency for a period of 6 months. Echocardiography parameters, plasma NT and pro-BNP, cytokines, EPO, ferritin and 6-minute walking test were assessed at baseline and after treatment. Results: in patients with CHF and anemia in ІІ group erythropoietin treatment increased Hb levels by 22,4% (p IL 6 by 54,3% (p α by 48,3% (p increase of LVEF by 19,04% (p Conclusions: Correction of anemia in patients with chronic heart failure with percutaneous erythropoietin injections 50 IU monthly for 6 month period to improve erythropoietin deficit and cytokines aggression and associated anemia, symptoms and quality of life.

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Biomarkers-based personalized follow-up in chronic heart failure improves patient’s outcomes and reduces care associate cost

Health and Quality of Life Outcomes ◽

10.1186/s12955-021-01779-9 ◽

2021 ◽

Vol 19 (1) ◽

Author(s):

Antonio Leon-Justel ◽

Jose I. Morgado Garcia-Polavieja ◽

Ana Isabel Alvarez-Rios ◽

Francisco Jose Caro Fernandez ◽

Pedro Agustin Pajaro Merino ◽

...

Keyword(s):

Heart Failure ◽

Hospital Admissions ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Secondary Outcome ◽

Ventricular Ejection Fraction ◽

Number Of Patients ◽

Ed Visits ◽

The Impact

Abstract Background Heart failure (HF) is a major and growing medical and economic problem, with high prevalence and incidence rates worldwide. Cardiac Biomarker is emerging as a novel tool for improving management of patients with HF with a reduced left ventricular ejection fraction (HFrEF). Methods This is a before and after interventional study, that assesses the impact of a personalized follow-up procedure for HF on patient’s outcomes and care associated cost, based on a clinical model of risk stratification and personalized management according to that risk. A total of 192 patients were enrolled and studied before the intervention and again after the intervention. The primary objective was the rate of readmissions, due to a HF. Secondary outcome compared the rate of ED visits and quality of life improvement assessed by the number of patients who had reduced NYHA score. A cost-analysis was also performed on these data. Results Admission rates significantly decreased by 19.8% after the intervention (from 30.2 to 10.4), the total hospital admissions were reduced by 32 (from 78 to 46) and the total length of stay was reduced by 7 days (from 15 to 9 days). The rate of ED visits was reduced by 44% (from 64 to 20). Thirty-one percent of patients had an improved functional class score after the intervention, whereas only 7.8% got worse. The overall cost saving associated with the intervention was € 72,769 per patient (from € 201,189 to € 128,420) and €139,717.65 for the whole group over 1 year. Conclusions A personalized follow-up of HF patients led to important outcome benefits and resulted in cost savings, mainly due to the reduction of patient hospitalization readmissions and a significant reduction of care-associated costs, suggesting that greater attention should be given to this high-risk cohort to minimize the risk of hospitalization readmissions.

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Serum CA125 a potential marker of volume status for peritoneal dialysis patients?

The International Journal of Artificial Organs ◽

10.1177/03913988211016862 ◽

2021 ◽

pp. 039139882110168

Author(s):

Dilushi Wijayaratne ◽

Vasantha Muthu Muthuppalaniappan ◽

Andrew Davenport

Keyword(s):

Heart Failure ◽

Peritoneal Dialysis ◽

Left Ventricular ◽

Volume Status ◽

Left Ventricular Ejection ◽

Cancer Antigen 125 ◽

Membrane Function ◽

Ventricular Ejection Fraction ◽

Potential Marker ◽

Ultrafiltration Failure

Introduction: Serum cancer antigen 125(SeCA125) has been reported to be increased in patients with heart failure and correlate with both extracellular water (ECW) overload and poor prognosis. Ultrafiltration failure and ECW overload are a major cause of peritoneal dialysis (PD) technique failure. We wished to determine whether SeCA125 could also be a marker of volume status in PD patients. Methods: We contemporaneously measured SeCA125, serum N terminal brain natriuretic peptide (NTproBNP) and ECW by bioimpedance in adult PD patients attending for outpatient assessment of peritoneal membrane function. Results: The median SeCA125 was 19 (12–33) U/mL in 489 PD patients, 61.3% male, median age 61.5 (interquartile range 50–75) years. SeCA125 was positively associated with the ratio of ECW/total body water (TBW) ( r = 0.29, p < 0.001), 4-h peritoneal dialysate to serum creatinine ratio ( r = 0.23, p < 0.001), NTproBNP) ( r = 0.18, p < 0.001), and age ( r = 00.17, p = 0.001) and negatively with 24-h PD ultrafiltration volume ( r = −0.28, p < 0.001) serum albumin ( r = −0.22, p < 0.001), and echocardiographic left ventricular ejection fraction ( r = −0.20, p < 0.001), but not with residual renal function or C-reactive protein. Patients with above the median SeCA125, had greater median ECW/TBW 0.403(IQR 0.394–0.410) vs 0.395(0.387–0.404), p < 0.001 and NTproBNP (6870 (IQR 1936–20096) vs 4069 (1345–12291) vs) pg/mL, p = 0.03. Conclusion: Heart failure studies have reported SeCA125 is a marker of ECW overload. Our retrospective analysis suggests that SeCA125 is also associated with ECW volume in PD patients. Further studies are required to determine whether serial measurements of SeCA125 trend with changes in ECW status in PD patients and can be used to aid volume assessments.

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Incidence of Cardiotoxicity and Validation of the Heart Failure Association- International Cardio-Oncology Society risk stratification Tool in Patients Treated with Trastuzumab for HER2-Positive Early Breast Cancer.

10.21203/rs.3.rs-251663/v1 ◽

2021 ◽

Author(s):

Nicolò Matteo Luca Battisti ◽

Maria Sol Andres ◽

Karla A Lee ◽

Tharshini Ramalingam ◽

Tamsin Nash ◽

...

Keyword(s):

Breast Cancer ◽

Heart Failure ◽

Early Breast Cancer ◽

Nyha Class ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Class Iii ◽

Her2 Positive ◽

Ventricular Ejection Fraction ◽

Very High

Abstract PurposeTrastuzumab improves survival in patients with HER2+ early breast cancer. However, cardiotoxicity remains a concern, particularly in the curative setting, and there are limited data on its incidence outside of clinical trials. We retrospectively evaluated the cardiotoxicity rates (left ventricular ejection fraction [LVEF] decline, congestive heart failure [CHF], cardiac death or trastuzumab discontinuation) and assessed the performance of a proposed model to predict cardiotoxicity in routine clinical practice.MethodsPatients receiving curative trastuzumab between 2011-2018 were identified. Demographics, treatments, assessments and toxicities were recorded. Fisher’s exact test, chi-squared and logistic regression were used.Results931 patients were included in the analysis. Median age was 54 years (range 24-83) and Charlson comorbidity index 0 (0-6), with 195 patients (20.9%) aged 65 or older. 228 (24.5%) were smokers. Anthracyclines were given in 608 (65.3%). Median number of trastuzumab doses was 18 (1-18). The HFA-ICOS cardiovascular risk was low in 401 patients (43.1%), medium in 454 (48.8%), high in 70 (7.5%) and very high in 6 (0.6%).Overall, 155 (16.6%) patients experienced cardiotoxicity: LVEF decline≥10% in 141 (15.1%), falling below 50% in 55 (5.9%), CHF NYHA class II in 42 (4.5%) and class III-IV in 5 (0.5%) and discontinuation due to cardiac reasons in 35 (3.8%). No deaths were observed.Cardiotoxicity rates increased with HFA-ICOS score (14.0% low, 16.7% medium, 30.3% high/very high; p=0.002). ConclusionsCardiotoxicity was relatively common (16.6%), but symptomatic heart failure on trastuzumab was rare in our cohort. The HFA-ICOS score identifies patients at high risk of cardiotoxicity

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Plasma Kynurenine Predicts Severity and Complications of Heart Failure and Associates with Established Biochemical and Clinical Markers of Disease

Kidney & Blood Pressure Research ◽

10.1159/000501483 ◽

2019 ◽

Vol 44 (4) ◽

pp. 765-776 ◽

Cited By ~ 1

Author(s):

Thomas Bernd Dschietzig ◽

Karl-Heinz Kellner ◽

Katrin Sasse ◽

Felix Boschann ◽

Robert Klüsener ◽

...

Keyword(s):

Heart Failure ◽

Nyha Class ◽

Linear Regression Analysis ◽

Binary Logistic Regression ◽

Multiple Linear Regression Analysis ◽

Left Ventricular ◽

The Body ◽

Left Ventricular Ejection ◽

Clinical Markers ◽

Ventricular Ejection Fraction

Background: Kynurenine, a metabolite of the L-tryptophan pathway, plays a pivotal role in neuro-inflammation, cancer immunology, and cardiovascular inflammation, and has been shown to predict cardiovascular events. Objectives: It was our objective to increase the body of data regarding the value of kynurenine as a biomarker in chronic heart failure (CHF). Methods: We investigated the predictive value of plasma kynurenine in a CHF cohort (CHF, n = 114); in a second cohort of defibrillator carriers with CHF (AICD, n = 156), we determined clinical and biochemical determinants of the marker which was measured by enzyme immunoassay. Results: In the CHF cohort, both kynurenine and NT-proBNP increased with NYHA class. Univariate binary logistic regression showed kynurenine to predict death within a 6-month follow-up (OR 1.43, 95% CI 1.03–2.00, p = 0.033) whereas NT-proBNP did not contribute significantly. Kynurenine, like NT-proBNP, was able to discriminate at a 30% threshold of left ventricular ejection fraction (LVEF; AUC-ROC, both 0.74). Kynurenine correlated inversely with LVEF (ϱ = –0.394), glomerular filtration fraction (GFR; ϱ = –0.615), and peak VO2 (ϱ = –0.626). Moreover, there was a strong correlation of kynurenine with NT-proBNP (ϱ = 0.615). In the AICD cohort, multiple linear regression analysis demonstrated highly significant associations of kynurenine with GFR, hsCRP, and tryptophan, as well as a significant impact of age. Conclusions: This work speaks in favor of kynurenine being a new and valuable biomarker of CHF, with particular attention placed on its ability to predict mortality and reflect exercise capacity.

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P971 The echocardiographic phenotype in patients with cardiac amyloidosis and heart failure with preserved ejection fraction

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jez319.603 ◽

2020 ◽

Vol 21 (Supplement_1) ◽

Author(s):

M D M Perez Gil ◽

V Mora Llabata ◽

A Saad ◽

A Sorribes Alonso ◽

V Faga ◽

...

Keyword(s):

Heart Failure ◽

Ejection Fraction ◽

Cardiac Amyloidosis ◽

Nyha Class ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Control Group ◽

Ventricular Ejection Fraction ◽

Apical Rotation ◽

Dynamic Torsion

Abstract BACKGROUND New echocardiographic phenotypes of heart failure (HF) are focused on myocardial systolic involvement of the left ventricle (LV), either endocardial and/or transmural. PURPOSE. To study the pattern of myocardial involvement in patients (p) with HF with preserved left ventricular ejection fraction (pLVEF) and cardiac amyloidosis (CA). METHODS. Comparative study of 16 p with CA and HF with pLVEF, considering as cut point LVEF > 50%, in NYHA class ≥ II / IV, and a control group of 16 healthy people. Longitudinal Strain (LS) and Circumferential Strain (CS) were calculated using 2D speckle-tracking echocardiography, along with Mitral Annulus Plane Systolic Excursion (MAPSE) and Base-Apex distance (B-A). Also, the following indexes were calculated: Twist (apical rotation + basal rotation, º); Classic Torsion (TorC): (twist/B-A, º/cm); Torsion Index (Tor.I): (twist/MAPSE, º/cm) and Deformation Index (Def.I): (twist/LS, º). We suggest the introduction of these dynamic torsion indexes as Tor.I and Def.I that include twist per unit of longitudinal systolic shortening of the LV instead of using TorC which is the normalisation of twist to the end-diastolic longitudinal diameter of the LV. RESULTS There were no differences of age between the groups (68.2 ± 11.5 vs 63.7 ± 2.8 years, p = 0.14). Global values of LS and CS were lower in p with CA indicating endocardial and transmural deterioration during systole, while TorC and Twist of the LV remained conserved in p with CA. However, there is an increase of dynamic torsion parameters such as Tor.I and Def.I that show an increased Twist per unit of longitudinal shortening of the LV in the CA group (Table). CONCLUSIONS In p with CA and HF with pLVEF, the impairment of LS and CS indicates endocardial and transmural systolic dysfunction. In these conditions, LVEF would be preserved at the expense of a greater dynamic torsion of the LV. Table LS (%) CS (%) Twist (º) TorC (º/cm) Tor.I (º/cm) Def.I (º/%) CA pLVEF (n = 16) -11.7 ± 4.2 17.2 ± 4.8 19.8 ± 8.3 2.5 ± 1.1 27.7 ± 13.5 -1.8 ± 0.9 Control Group (n = 15) -20.6 ± 2.5 22.7 ± 4.9 21.7 ± 6.1 2.7 ± 0.8 16.4 ± 4.7 -1.0 ± 0.3 p < 0.001 < 0.01 0.46 0.46 < 0.01 < 0.01 Dynamic Torsion Indexes and Classic Torion Parameters in pLVEF CA patients vs Control group.

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