Differential left ventricular and left atrial remodelling in heart failure with preserved ejection fraction patients with and without diabetes

Background: Attempts to characterize cardiac structure in heart failure with preserved ejection fraction (HFpEF) in people with type 2 diabetes (T2D) have yielded inconsistent findings. We aimed to determine whether patients with HFpEF and T2D have a distinct pattern of cardiac remodelling compared with those without diabetes and whether remodelling was related to circulating markers of inflammation and fibrosis and clinical outcomes. Methods: We recruited 140 patients with HFpEF (75 with T2D and 65 without). Participants underwent comprehensive cardiovascular phenotyping, including echocardiography, cardiac magnetic resonance imaging and plasma biomarker profiling. Results: Patients with T2D were younger (age 70 ± 9 versus 75 ± 9y, p = 0.002), with evidence of more left ventricular (LV) concentric remodelling (LV mass/volume ratio 0.72 ± 0.15 versus 0.62 ± 0.16, p = 0.024) and smaller indexed left atrial (LA) volumes (maximal LA volume index 48 ± 20 versus 59 ± 29 ml/m2, p = 0.004) than those without diabetes. Plasma biomarkers of inflammation and extracellular matrix remodelling were elevated in those with T2D. Overall, there were 45 hospitalizations for HF and 22 deaths over a median follow-up period of 47 months [interquartile range (IQR) 38–54]. There was no difference in the primary composite endpoint of hospitalization for HF and mortality between groups. On multivariable Cox regression analysis, age, prior HF hospitalization, history of pulmonary disease and LV mass/volume were independent predictors of the primary endpoint. Conclusions: Patients with HFpEF and T2D have increased concentric LV remodelling, smaller LA volumes and evidence of increased systemic inflammation compared with those without diabetes. This suggests the underlying pathophysiology for the development of HFpEF is different in patients with and without T2D. ClinicalTrials.gov identifier: NCT03050593.

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LEFT ATRIAL TO LEFT VENTRICULAR END SYSTOLIC VOLUME INDEX RATIO BY ECHOCARDIOGRAPHY CAN PREDICT ELEVATED LEFT ATRIAL PRESSURE IN HEART FAILURE WITH PRESERVED EJECTION FRACTION

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(16)31613-8 ◽

2016 ◽

Vol 67 (13) ◽

pp. 1612

Author(s):

Amarbir Bhullar ◽

Manminder Bhullar ◽

Manmeet Singh ◽

Kamil Muhyieddeen ◽

Bhavik Khatri ◽

...

Keyword(s):

Heart Failure ◽

Ejection Fraction ◽

Left Atrial ◽

Left Ventricular ◽

Left Atrial Pressure ◽

Volume Index ◽

Preserved Ejection Fraction ◽

Systolic Volume ◽

End Systolic Volume ◽

Index Ratio

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Left ventricular fibrosis and hypertrophy are associated with mortality in heart failure with preserved ejection fraction

Scientific Reports ◽

10.1038/s41598-020-79729-6 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Pankaj Garg ◽

Hosamadin Assadi ◽

Rachel Jones ◽

Wei Bin Chan ◽

Peter Metherall ◽

...

Keyword(s):

Heart Failure ◽

Ejection Fraction ◽

T1 Mapping ◽

Left Ventricular ◽

Preserved Ejection Fraction ◽

Native T1 ◽

Lv Mass ◽

All Cause Mortality ◽

Ventricular Fibrosis

AbstractCardiac magnetic resonance (CMR) is emerging as an important tool in the assessment of heart failure with preserved ejection fraction (HFpEF). This study sought to investigate the prognostic value of multiparametric CMR, including left and right heart volumetric assessment, native T1-mapping and LGE in HFpEF. In this retrospective study, we identified patients with HFpEF who have undergone CMR. CMR protocol included: cines, native T1-mapping and late gadolinium enhancement (LGE). The mean follow-up period was 3.2 ± 2.4 years. We identified 86 patients with HFpEF who had CMR. Of the 86 patients (85% hypertensive; 61% males; 14% cardiac amyloidosis), 27 (31%) patients died during the follow up period. From all the CMR metrics, LV mass (area under curve [AUC] 0.66, SE 0.07, 95% CI 0.54–0.76, p = 0.02), LGE fibrosis (AUC 0.59, SE 0.15, 95% CI 0.41–0.75, p = 0.03) and native T1-values (AUC 0.76, SE 0.09, 95% CI 0.58–0.88, p < 0.01) were the strongest predictors of all-cause mortality. The optimum thresholds for these were: LV mass > 133.24 g (hazard ratio [HR] 1.58, 95% CI 1.1–2.2, p < 0.01); LGE-fibrosis > 34.86% (HR 1.77, 95% CI 1.1–2.8, p = 0.01) and native T1 > 1056.42 ms (HR 2.36, 95% CI 0.9–6.4, p = 0.07). In multivariate cox regression, CMR score model comprising these three variables independently predicted mortality in HFpEF when compared to NTproBNP (HR 4 vs HR 1.65). In non-amyloid HFpEF cases, only native T1 > 1056.42 ms demonstrated higher mortality (AUC 0.833, p < 0.01). In patients with HFpEF, multiparametric CMR aids prognostication. Our results show that left ventricular fibrosis and hypertrophy quantified by CMR are associated with all-cause mortality in patients with HFpEF.

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Significance of the echocardiographic evaluation of left atrial myocardial strain for early diagnosis of heart failure with preserved ejection fraction

Kardiologiia ◽

10.18087/cardio.2021.8.n1418 ◽

2021 ◽

Vol 61 (8) ◽

pp. 68-75

Author(s):

E. K. Serezhina ◽

A. G. Obrezan

Keyword(s):

Heart Failure ◽

Early Diagnosis ◽

Ejection Fraction ◽

Left Atrial ◽

Myocardial Dysfunction ◽

Systolic Dysfunction ◽

Myocardial Strain ◽

Left Ventricular ◽

Preserved Ejection Fraction ◽

Echocardiographic Evaluation

This systematic review is based on 19 studies from Elsevier, PubMed, Embase, and Scopus databases, which were found by the following keywords: LA strain (left atrial strain), STE (speckle tracking echocardiography), HF (heart failure), and HFpEF (heart failure with preserved ejection fraction). The review focuses on results and conclusions of studies on using the 2D echocardiographic evaluation of left atrial (LA) myocardial strain for early diagnosis of HFpEF in routine clinical practice. Analysis of the studies included into this review showed a significant decline of all LA functions in patients with HFpEF. Also, multiple studies have reported associations between decreased indexes of LA strain and old age, atrial fibrillation, left ventricular hypertrophy, left and right ventricular systolic dysfunction, and LV diastolic dysfunction. Thus, the review indicates significant possibilities of using indexes of LA strain in evaluation of early stages of both systolic and diastolic myocardial dysfunction. Notably, LA functional systolic and diastolic indexes are not sufficiently studied despite their growing significance for diagnosis and prognosis of patients with HFpEF. For this reason, in addition to existing models for risk stratification in this disease, including clinical characteristics and/or echocardiographic data, future studies should focus on these parameters.

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Abstract 4205: Left Atrial Volume Index and Left Ventricular Geometry Independently Predict Mortality in 47,865 Patients with Preserved Ejection Fraction

Circulation ◽

10.1161/circ.118.suppl_18.s_843 ◽

2008 ◽

Vol 118 (suppl_18) ◽

Author(s):

Dharmendrakumar A Patel ◽

Carl J Lavie ◽

Richard V Milani ◽

Hector O Ventura

Keyword(s):

Ejection Fraction ◽

Left Atrial ◽

Left Atrial Volume ◽

Left Ventricular ◽

Mortality Prediction ◽

Volume Index ◽

Left Ventricular Geometry ◽

Preserved Ejection Fraction ◽

Atrial Volume ◽

Left Atrial Volume Index

Background: LV geometry predicts CV events but it is unknown whether left atrial volume index (LAVi) predicts mortality independent of LV geometry in patients with preserved LVEF. Methods: We evaluated 47,865 patients with preserved EF to determine the impact of LAVi and LV geometry on mortality during an average follow-up of 1.7±1.0 years. Results: Deceased patients (n=3,653) had significantly higher LAVi (35.3 ± 15.9 vs. 29.1 ± 11.9, p<0.0001) and abnormal LV geometry (60% vs. 41%, p<0.0001) than survivors (n=44,212). LAVi was an independent predictor of mortality in all four LV geometry groups [Hazard ratio: N= 1.007 (1.002–1.011), p=0.002; concentric remodeling= 1.008 (1.001–1.012), p<0.0001; eccentric hypertrophy= 1.012 (1.006 –1.018), p<0.0001; concentric hypertrophy=1.017 (1.012–1.022), p<0.0001; Figure ]. Comparison of models with and without LAVi for mortality prediction was significant suggesting increased mortality prediction by addition of LAVi to other independent predictors (Table ). Conclusion: LAVi is higher and LV geometric abnormalities are more prevalent in deceased patients with preserved systolic function and are independently associated with increased mortality. LAVi predicts mortality independent of LV geometry and has synergistic influence on all cause mortality prediction in large cohort of patients with preserved ejection fraction.

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Abstract 2284: Non-invasively Determined Ventricular Elastance as a predictor of cardiovascular mortality in Patients With acute myocardial infarction and Preserved ejection fraction: Data from Infarction Prognosis Study (IPS) registry

Circulation ◽

10.1161/circ.116.suppl_16.ii_498-c ◽

2007 ◽

Vol 116 (suppl_16) ◽

Author(s):

Sung Ai Kim ◽

Jong-Won Ha ◽

Hyeon Chang Kim ◽

Sungha Park ◽

Eui-Young Choi ◽

...

Keyword(s):

Myocardial Infarction ◽

Ejection Fraction ◽

Cardiovascular Mortality ◽

Cox Regression ◽

Left Ventricular ◽

Volume Index ◽

Rank Test ◽

Preserved Ejection Fraction ◽

Cox Regression Analysis ◽

Acute Mi

Background : Previous studies of the prognosis of myocardial infarction (MI) have focused primarily on patients with left ventricular (LV) systolic dysfunction. Little is known about the prognosis of patients with MI and preserved ejection fraction (EF), which is increasing. Since the ratio of mitral inflow (E) and annular velocity (E′) to stroke volume (E/E′/SV) has been reported as an index of diastolic elastance (Ed), we hypothesized that Ed has prognostic implication in patients with acute MI and preserved EF. Method : Between May 2005 and January 2007, a total of 421 patients with acute MI were prospectively enrolled in Infarction Prognosis Study (IPS) registry. Among 358 patients who had comprehensive echocardiographic study, 42 patients with significant valvular heart disease or coexisted cardiomyopathy and 50 patients with decreased EF (<40%) were excluded. This left a total of 266 patients, who constituted the study population. The primary end-point was cardiovascular mortality. Results : Median follow-up duration was 12 months. Of 266 patients, cardiovascular death occurred in 11 (4.1%) patients. Age (p< 0.001), LA volume index (p=0.001), the severity of diastolic dysfunction (grade ≥ 2, p=0.04), Ed (p=0.003) were univariate predictors of cardiovascular mortality. However, in multivariate Cox regression analysis, age (p=0.008, HR; 1.14, 95% CI; 1.03–1.25) and Ed (p=0.009, HR; 1.72, 95% CI; 1.14 –2.58) were found to be independent predictors for cardiovascular mortality in patients with acute MI and preserved EF. Cut-off value of Ed for cardiovascular mortality determined by Kaplan-Meier method (p<0.001 by log-rank test) and ROC curve (AUC 0.87, sensitivity 90%, specificity 74%) was 0.25. Conclusion : Non-invasively determined ventricular diastolic elastance is a novel and powerful independent predictor of cardiovascular mortality in patients with acute MI and preserved EF.

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Exercise Training Improved Longitudinal Intrinsic Left Ventricle Function in Heart Failure with Preserved Ejection Fraction

International Journal of Angiology ◽

10.1055/s-0038-1676836 ◽

2019 ◽

Vol 28 (01) ◽

pp. 044-049

Author(s):

Sidhi Purwowiyoto ◽

Budhi Purwowiyoto ◽

Amiliana Soesanto ◽

Anwar Santoso

Keyword(s):

Quality Of Life ◽

Heart Failure ◽

Exercise Training ◽

Ejection Fraction ◽

Left Ventricular ◽

World Health ◽

Volume Index ◽

Lv Function ◽

Preserved Ejection Fraction

Exercise improves morbidity, fatality rate, and quality of life in heart failure with low ejection fraction, but fewer data available in heart failure with preserved ejection fraction (HFPEF).The purpose of this study is to test the hypothesis that exercise training might improve the longitudinal intrinsic left ventricular (LV) function in HFPEF patients.This quasi-experimental study had recruited 30 patients with HFPEF. Exercise training program had been performed for a month with a total of 20 times exercise sessions and evaluated every 2 weeks. Echocardiography was performed before sessions, second week and fourth week of exercise training. Six-minute walk tests (6MWTs) and quality-of-life variables using Minnesota living with HF scoring and the 5-item World Health Organization Well-Being Index scoring were measured before and after exercise as well.Left ventricular filling pressure, represented by the ratio of early diastolic mitral flow velocity/early diastolic annular velocity and left atrial volume index, improved during exercise. The longitudinal intrinsic LV function, represented by four-chamber longitudinal strain, augmented during exercise (p < 0.001). Aerobic capacity, measured by 6MWT, increased significantly (p = 0.001). Quality of life improved significantly during exercise (p < 0.001).Exercise training was suggested to improve the longitudinal intrinsic LV function and quality of life in HFPEF. Clinical Trial Registration: ACTRN12614001042639.

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