Obesity and hemoglobin content impact peak oxygen uptake in human heart failure

Background Exercise intolerance, obesity, and low hemoglobin (hemoglobin<13 and <12 g/dl, men/women, respectively) are common features of heart failure. Despite serving as potent contributors to metabolic dysfunction, the impact of obesity and low hemoglobin on exercise intolerance is unknown. This study tested the hypotheses, compared with non-obese (NO) heart failure with normal hemoglobin, (a) counterparts with low hemoglobin and obesity or non-obesity will demonstrate reduced peak exercise oxygen uptake; (b) obese with normal hemoglobin will demonstrate decreased peak exercise oxygen uptake; (c) compared across stratifications, obese with low hemoglobin will demonstrate the sharpest decrement in peak exercise oxygen uptake. Methods Adults with heart failure ( n = 315; left ventricular ejection fraction≤40%; 77% men) (Group 1: normal hemoglobin and non-obese, n = 137; Group 2: low hemoglobin and non-obese, n = 51; Group 3: normal hemoglobin+obesity, n = 89; Group 4, n = 38: low hemoglobin+obesity; body mass index = 26 ± 3, 26 ± 2, 34 ± 4, 34 ± 4 kg/m2, respectively) completed treadmill cardiopulmonary exercise testing as part of routine clinical management. Peak exercise oxygen uptake was measured via standard metabolic system. Results There were no group-wise differences for heart failure class, gender, left ventricular ejection fraction, and resting cardiopulmonary function. Group 1 demonstrated increased peak exercise oxygen uptake versus Groups 2–4 (20 ± 6 versus 17 ± 6, 17 ± 5, 13 ± 4 ml/kg/min, respectively; all p < 0.001); whereas Group 4 peak exercise oxygen uptake was reduced versus all groups ( p < 0.001). Additionally, both body mass index (R2 = 0.10) and hemoglobin (R2 = 0.12) were significant predictors of peak exercise oxygen uptake in Group 1; which were relationships not mirrored for Groups 2–4. Conclusion These data suggest obesity together with low hemoglobin are potent contributors to impaired peak exercise oxygen uptake and, hence, oxidative metabolic capacity. In diverse populations of heart failure where obesity and/or low hemoglobin are present, it is important to consider these features together when interpreting peak exercise oxygen uptake and underlying exercise limitations.

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Sacubitril/Valsartan Improves Autonomic Function and Cardiopulmonary Parameters in Patients with Heart Failure with Reduced Ejection Fraction

Journal of Clinical Medicine ◽

10.3390/jcm9061897 ◽

2020 ◽

Vol 9 (6) ◽

pp. 1897 ◽

Cited By ~ 1

Author(s):

Francesco Giallauria ◽

Giuseppe Vitale ◽

Mario Pacileo ◽

Anna Di Lorenzo ◽

Alessandro Oliviero ◽

...

Keyword(s):

Heart Failure ◽

Ejection Fraction ◽

Autonomic Function ◽

Left Ventricular ◽

Exercise Stress ◽

Left Ventricular Ejection ◽

Peak Exercise ◽

Ventricular Ejection Fraction ◽

Reduced Ejection Fraction

Background: Heart rate recovery (HRR) is a marker of vagal tone, which is a powerful predictor of mortality in patients with cardiovascular disease. Sacubitril/valsartan (S/V) is a treatment for heart failure with reduced ejection fraction (HFrEF), which impressively impacts cardiovascular outcome. This study aims at evaluating the effects of S/V on HRR and its correlation with cardiopulmonary indexes in HFrEF patients. Methods: Patients with HFrEF admitted to outpatients’ services were screened out for study inclusion. S/V was administered according to guidelines. Up-titration was performed every 4 weeks when tolerated. All patients underwent laboratory measurements, Doppler-echocardiography, and cardiopulmonary exercise stress testing (CPET) at baseline and at 12-month follow-up. Results: Study population consisted of 134 HFrEF patients (87% male, mean age 57.9 ± 9.6 years). At 12-month follow-up, significant improvement in left ventricular ejection fraction (from 28% ± 5.8% to 31.8% ± 7.3%, p < 0.0001), peak exercise oxygen consumption (VO2peak) (from 15.3 ± 3.7 to 17.8 ± 4.2 mL/kg/min, p < 0.0001), the slope of increase in ventilation over carbon dioxide output (VE/VCO2 slope )(from 33.4 ± 6.2 to 30.3 ± 6.5, p < 0.0001), and HRR (from 11.4 ± 9.5 to 17.4 ± 15.1 bpm, p = 0.004) was observed. Changes in HRR were significantly correlated to changes in VE/VCO2slope (r = −0.330; p = 0.003). After adjusting for potential confounding factors, multivariate analysis showed that changes in HRR were significantly associated to changes in VE/VCO2slope (Beta (B) = −0.975, standard error (SE) = 0.364, standardized Beta coefficient (Bstd) = −0.304, p = 0.009). S/V showed significant reduction in exercise oscillatory ventilation (EOV) detection at CPET (28 EOV detected at baseline CPET vs. 9 EOV detected at 12-month follow-up, p < 0.001). HRR at baseline CPET was a significant predictor of EOV at 12-month follow-up (B = −2.065, SE = 0.354, p < 0.001). Conclusions: In HFrEF patients, S/V therapy improves autonomic function, functional capacity, and ventilation. Whether these findings might translate into beneficial effects on prognosis and outcome remains to be elucidated.

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Features of the clinical picture and outcomes in patients from a heart transplantation waiting list with different causes of heart failure

Kardiologiia ◽

10.18087/cardio.2020.7.n931 ◽

2020 ◽

Vol 60 (7) ◽

pp. 15-19

Author(s):

A. N. Kostomarov ◽

M. A. Simonenko ◽

M. A. Fedorova ◽

P. A. Fedotov

Keyword(s):

Heart Failure ◽

Heart Transplantation ◽

Death Rate ◽

Left Ventricular ◽

Waiting List ◽

Left Ventricular Ejection ◽

Circulatory Support ◽

Ventricular Ejection Fraction ◽

Group 2 ◽

Group 1

Aim To identify clinical differences between patients on the heart transplant waiting list (HTWL) in the origin of chronic heart failure (CHF).Materials and methods From January 2010 through September 2019, 235 patients (age, 47+13 years (from 10 to 67 years); men, 79% (n=186)) were included in the HTWL. The patients were divided into two groups; group 1 (n=104, 44 %) consisted of patients with ischemic heart disease (IHD); group 2 (n=131, 56 %) included patients with noncoronarogenic CHF. Clinical and instrumental data and frequency of the mechanical circulatory support (MCS) as a “bridge” to heart transplantation (HT) were retrospectively evaluated.Results Group 1 included more male patients than group 2 [97 % (n=101) and 82 % (n=85), р<0.0001]; patients were older (54±8 and 42±14 years, р=0.0001). On inclusion into the HTWL, the CHF functional class was comparable in the groups, III [III;IV]; there were more patients of the UNOS 2 class in group 1 than in group 2 [75 % (n=78) and 57 % (n=75), р=0.005]. Patient distribution in UNOS 1B and 1A classes was comparable in the groups: 21% (n=22) and 3% (n=4) in group 1 and 33 % (n=43) and 10 % (n=13) in group 2. According to echocardiography patients of group 1 compared to group 2 showed a tendency towards higher values of left ventricular ejection fraction (Simpson method) [22 [18;26] % and 19 [15;24] %, р=0.37] and stroke volume [59 [44;72] % and 50 [36;67] %, р=0.07]. Numbers of patients with a cardioverter defibrillator or a cardiac resynchronization device with a defibrillator function were comparable in the groups [35 % (n=36) and 34 % (n=45)]. Comparison of comorbidities in groups 1 and 2 showed higher incidences of pulmonary hypertension [55 % (n=57) and 36 % (n=47), р=0.005], obesity [20 % (n=21) and 10 % (n=13), р=0.03], and type 2 diabetes mellitus [29 % (n=30) and 10 % (n=13), р=0.0004]. Rates of chronic obstructive lung disease, stroke, chronic kidney disease and other diseases were comparable. Duration of staying on the HTWL was comparable (104 [34; 179] and 108 [37; 229] days). During staying on the HTWL, patients of group 1 less frequently required MCS implantation [3 % (n=3) and 28 % (n=21), р=0.0009]. HT was performed for 59 % patients (n=61) in group 2 and 52 % (n=69) patients in group 2. Death rate in the HTWL was lower in group 1 [13 % (n=14) and 27 % (n=35), р<0.01].Conclusion On inclusion into the HTWL, patients with noncoronarogenic CHF had more pronounced CHF manifestations and a more severe UNOS class but fewer comorbidities than patients with CHF of ischemic origin. With a comparable duration of waiting for HT, patients with noncoronarogenic CHD more frequently required MCS implantation and had a higher death rate.

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Combined effects of ARNI and SGLT2 inhibitors in diabetic patients with heart failure with reduced ejection fraction

Scientific Reports ◽

10.1038/s41598-021-01759-5 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Hyue Mee Kim ◽

In-Chang Hwang ◽

Wonsuk Choi ◽

Yeonyee E. Yoon ◽

Goo-Yeong Cho

Keyword(s):

Heart Failure ◽

Ejection Fraction ◽

Cardiovascular Mortality ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Diabetic Patients ◽

Ventricular Ejection Fraction ◽

Reduced Ejection Fraction ◽

Patients With Heart Failure ◽

Group 1

AbstractAngiotensin receptor-neprilysin inhibitor (ARNI) and sodium–glucose co-transporter-2 inhibitor (SGLT2i) have shown benefits in diabetic patients with heart failure with reduced ejection fraction (HFrEF). However, their combined effect has not been revealed. We retrospectively identified diabetic patients with HFrEF who were prescribed an ARNI and/or SGLT2i. The patients were divided into groups treated with both ARNI and SGLT2i (group 1), ARNI but not SGLT2i (group 2), SGLT2i but not ARNI (group 3), and neither ARNI nor SGLT2i (group 4). After propensity score-matching, the occurrence of hospitalization for heart failure (HHF), cardiovascular mortality, and changes in echocardiographic parameters were analyzed. Of the 206 matched patients, 92 (44.7%) had to undergo HHF and 43 (20.9%) died of cardiovascular causes during a median 27.6 months of follow-up. Patients in group 1 exhibited a lower risk of HHF and cardiovascular mortality compared to those in the other groups. Improvements in the left ventricular ejection fraction and E/e′ were more pronounced in group 1 than in groups 2, 3 and 4. These echocardiographic improvements were more prominent after the initiation of ARNI, compare to the initiation of SGLT2i. In diabetic patients with HFrEF, combination of ARNI and SGT2i showed significant improvement in cardiac function and prognosis. ARNI-SGLT2i combination therapy may improve the clinical course of HFrEF in diabetic patients.

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Abstract 2424: Improvement Of Cardiopulmonary Exercise Capacity In Patients With Chronic Post-infarction Heart Failure (CHF) After Intracoronary Infusion Of Bone Marrow-derived Progenitor Cells (BMC)

Circulation ◽

10.1161/circ.118.suppl_18.s_724-a ◽

2008 ◽

Vol 118 (suppl_18) ◽

Author(s):

Joerg Honold ◽

Lenka Geiger ◽

Ulrich Fischer-Rasokat ◽

Birgit Assmus ◽

Volker Schaechinger ◽

...

Keyword(s):

Heart Failure ◽

Oxygen Uptake ◽

Exercise Capacity ◽

Serum Levels ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Ventricular Ejection Fraction ◽

Cardiopulmonary Exercise ◽

Cardiopulmonary Exercise Capacity ◽

Peak Vo2

Intracoronary (i.c.) infusion of BMC in patients (pts.) with CHF is associated with improvements in left ventricular ejection fraction (LVEF) and reduction of NT-proBNP serum-levels, especially in pts. with more severe heart failure. However, ist is unknown whether the modest improvements in cardiac function translate into an increase in cardiopulmonary exercise capacity. A total of 52 CHF-pts. performed cardiopulmonary exercise tests (CPET) according to a modified Bruce protocol before and 3 months after i.c. infusion of BMC into the infarct-related artery. Anaerobic threshold (AT) was determined by the v-slope method. Overall, pts. were 58±12 years old with a moderately impaired LVEF (mean 42±11%) and a median NYHA-class 2±0.75. NT-proBNP-serum levels were elevated (1007±154 pmol/ml). All pts. received chronic optimized medical therapy with betablockers, ACE-inhibitors and combined diuretics, which was kept constant during the study duration. Initial CPET revealed reduced peak oxygen uptake (peak VO2: 14.0 ml/min/kg), maximal oxygen Pulse (O2Pmax: 11.4 ml/beat) and oxygen uptake at AT (VO2AT: 10.9 ml/min/kg), whereas CO2-equivalents (EqCO2) were elevated (29.7). 3 months after therapy, repeated CPET showed an increase in peak VO2 (14.0±3.9 to 15.3±4.3 ml/min/kg, p=0.07), whereas VO2 AT (10.8±2.5 to 10.8±2.5 ml/min/kg, p= n.s.), O2Pmax (11.2 ± 3.1 to 12.0±3.3 ml/beat, p= n.s.) or EqCO2 (29.7±6.4 to 29.8±6.8, p= n.s.) remained unchanged. However, after dichotomizating the patient cohort according to the median of VO2max at baseline, pts. with lower initial VO2max showed a significant improvement in VO2max (12.8±1.5 to 13.5±2.7ml/min/kg, p= 0.03) and an improvement in VO2AT (9.1±1.8 to 9.5±2.2 ml/min/kg, p= ns), as well as a reduction of EqCO2 (34.7±7.1 to 33.8±8.0, p= ns). In contrast, pts. with initial VO2max > median did not show any significant improvements. These findings indicate that intracoronary BMC-therapy improves exercise capacity in CHF-patients with more advanced heart failure. Therefore, cardiopulmonary exercise testing might help to identify pts. more likely to derive functional benefit from intracoronary BMC administration.

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P1743 The contribution of left atrial dysfunction to exercise intolerance in early heart failure with preserved left ventricular ejection fraction

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jez319.1103 ◽

2020 ◽

Vol 21 (Supplement_1) ◽

Author(s):

A Ovchinnikov ◽

A V Potekhina ◽

A A Borisov ◽

N M Ibragimova ◽

E N Yushchyuk ◽

...

Keyword(s):

Heart Failure ◽

Left Ventricular Ejection Fraction ◽

Ejection Fraction ◽

Left Atrial ◽

Left Ventricular ◽

Ventricular Ejection ◽

Exercise Intolerance ◽

Left Ventricular Ejection ◽

Two Dimensional ◽

Ventricular Ejection Fraction

Abstract Background Diagnosis of early heart failure with preserved ejection fraction (HFpEF) may be challenging because exertional dyspnea is not specific for heart failure, and biomarkers and indicators of volume overload may be absent at rest. We aimed to characterize the contribution of abnormal left atrial (LA) mechanical properties to exercise intolerance in early HFpEF (normal left ventricular filling pressures at rest but elevated during exercise). Methods Diastolic stress testing (DST) was performed in 104 patients with left ventricular ejection fraction ≥50%, in sinus rhythm, and no more than LV diastolic dysfunction grade I, referred for assessment of exertional dyspnoea. Patients exercised supine cycle ergometry at 60 rpm starting with a 3-min period of low-level 25-W workload followed by 25-W increments in 3-minute stages to maximum tolerated levels. According to DST, 43 patients were diagnosed with HFpEF (average mitral E-to-annular e′ ratio [E/e′] > 14, and peak TR velocity >2.8 m/sec at maximal exertion) and 61 as non-cardiac dyspnea (NCD). During the test, two-dimensional images, mitral E/e′, peak tricuspid regurgitation (TR) velociry, and two-dimensional LA mechanical parameters (longitudinal LA strain [LASR] and strain rate [LASRR] during reservoir phase and LA stiffness assessed as a ratio of mitral E/e′ ratio to LASR) were analysed at baseline, and at peak. Results HFpEF and NCD patients were similar in regard to the LA volume index (34.4 [30.2;39.4] vs. 33.6 [28.4;37.1] ml/m2), and NT-proBNP level (132 [80;238] vs. 129 [80;197] pg/ml). As compared with NCD patients, HFpEF patients displayed reduced LA reservoir function assessed by LASR (22.3 [18.9;25.6] vs. 24.2 [21.2;29.8] % at rest, and 25.3 [21.4;30.2] vs. 29.0 [24.2;33.3] % with exercise) and LASRR (0.78 [0.58;0.96] vs. 0.90 [0.68;1.12] /s at rest, and 1.10 [0.79;1.31] vs. 1.24 [1.03;1.56] s–1 with exercise) with increased LA stiffness (0.57 [0.44;0.70] vs. 0.42 [0.30;0.49] mmHg/% at rest, and 0.61 [0.46;0.74] vs. 0.40 [0.32;0.51] mmHg/% with exercise, all P < 0.05). Additionally, HFpEF patients showed smaller exercise elevation in LASRR (+31 [-5;77] vs. +47 [12;85] % as compared with resting values, P < 0.05). Exercised LA stiffness and reservoir strain correlated with exercise LV filling pressures estimated by mitral E/e′ ratio (r = 0.72 and r =–0.35, P < 0.001). LA stiffness showed a good diagnostic accuracy (area under the curve 0.75), and LA stiffness > 0.46 mmHg/% demonstrated reasonable sensitivity (79%) and specificity (71%) to diagnose HFpEF. Neither LV global longitudinal strain and ejection fraction at rest nor their exercise-induced elevation differed between HFpEF and NCD. Conclusion Impaired LA reservoir function and increased stiffness are associated with exercise intolerance in patients with early HFpEF, while LV systolic function seems preserved in this stage of the disease. LA stiffness provides HFpEF diagnostic potential in ambulatory patients with dyspnea

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Near-maximal fractional oxygen extraction by active skeletal muscle in patients with chronic heart failure

Journal of Applied Physiology ◽

10.1152/jappl.2000.88.6.2138 ◽

2000 ◽

Vol 88 (6) ◽

pp. 2138-2142 ◽

Cited By ~ 45

Author(s):

Stuart D. Katz ◽

Carol Maskin ◽

Guillaume Jondeau ◽

Thomas Cocke ◽

Robert Berkowitz ◽

...

Keyword(s):

Heart Failure ◽

Chronic Heart Failure ◽

Oxygen Content ◽

Systolic Function ◽

Femoral Vein ◽

Normal Subjects ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Peak Exercise ◽

Ventricular Ejection Fraction

Systemic oxygen uptake and deep femoral vein oxygen content were determined at peak exercise in 53 patients with chronic heart failure with impaired systolic function (mean left ventricular ejection fraction 0.18; n = 41) or preserved systolic function (mean left ventricular ejection fraction 0.70; n = 12) and in 6 age-matched sedentary normal subjects. At peak exercise, deep femoral vein oxygen content in heart failure patients with impaired systolic function and preserved systolic function were similar, both significantly lower than that of normal subjects (2.5 ± 0.1, 2.9 ± 0.2, and 5.0 ± 0.1 ml/100 ml, respectively; P< 0.05). Deep femoral venous oxygen content was lower in patients with the greater impairment of aerobic capacity, regardless of the underlying systolic function ( r = 0.72, P < 0.01). Fractional oxygen extraction in the skeletal muscle at peak exercise is enhanced in patients with chronic heart failure when compared with normal subjects, in proportion to the degree of aerobic impairment.

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Mechanisms of exercise intolerance in patients with heart failure and preserved ejection fraction. Part I: The role of impairments in the left heart chambers

Kardiologiia ◽

10.18087/cardio.n394 ◽

2019 ◽

Vol 59 (6S) ◽

pp. 4-16

Author(s):

A. G. Ovchinnikov ◽

A. V. Potekhina ◽

N. M. Ibragimova ◽

E. A. Barabanova ◽

E. N. Yushchyuk ◽

...

Keyword(s):

Heart Failure ◽

Ejection Fraction ◽

Left Ventricular Diastolic Dysfunction ◽

Left Ventricular ◽

Exercise Intolerance ◽

Left Ventricular Ejection ◽

Left Heart ◽

Ventricular Ejection Fraction ◽

Patients With Heart Failure ◽

Ventricular Diastolic Dysfunction

During exercise an increase in oxygen delivery to working muscles is achieved through well‑coordinated interaction of many organs and systems: the heart, lungs, blood vessels, skeletal muscles, and the autonomic nervous system. In heart failure with preserved left ventricular ejection fraction, all mechanisms involved in the normal exercise tolerance are impaired. In the first part of this review, the impairments of the left heart chambers are considered ‑ left ventricular diastolic dysfunction, the weakening of the contractile and chronotropic reserves, left atrium dysfunction; the possible ways of their medical correction are also presented.

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Implications of a History of Syncope in Patients Hospitalized With Heart Failure

Angiology ◽

10.1177/0003319716647320 ◽

2016 ◽

Vol 68 (3) ◽

pp. 196-206 ◽

Cited By ~ 1

Author(s):

Ayman El-Menyar ◽

Kadhim Sulaiman ◽

Ali AlSadawi ◽

Alawi A. AlSheikh-Ali ◽

Wael AlMahameed ◽

...

Keyword(s):

Heart Failure ◽

Coronary Vessels ◽

Multivariate Regression Analysis ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Ventricular Ejection Fraction ◽

Patients With Heart Failure ◽

History Of ◽

Group 2 ◽

Group 1

We assessed the frequency and implications of a history of syncope of up to 1 year prior to hospitalization with acute heart failure (AHF) between February and November 2012. Data were collected for 5005 patients hospitalized with AHF and analyzed and compared according to the absence/presence of a history of syncope (group 1 vs group 2). Prior syncope among patients with heart failure was 5.3%. Age, gender, hypertension, atrial fibrillation, bundle branch block, left ventricular ejection fraction (LVEF), and obstructed coronary vessels were comparable in the 2 groups. Group 2 patients were more likely to smoke or have diabetes mellitus, stroke, and cardiac arrest. Group 2 patients frequently required aggressive treatment and had more worse in-hospital and 1-year outcomes compared to group 1. After adjustment for age, sex, ethnicity, and LVEF, multivariate regression analysis showed that history of syncope predicted in-hospital mortality (odds ratio: 2.61; 95% confidence interval: 1.707-4.002). History of syncope during the year prior to the index admission with AHF is a marker of worse outcomes regardless of patient age and LVEF. Further studies are required to confirm this observation and its clinical implications.

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Comorbidities Associated with One-Year Mortality in Patients with Atrial Fibrillation and Heart Failure

Healthcare ◽

10.3390/healthcare9070830 ◽

2021 ◽

Vol 9 (7) ◽

pp. 830

Author(s):

Ruxandra Nicoleta Horodinschi ◽

Camelia Cristina Diaconu

Keyword(s):

Heart Failure ◽

Atrial Fibrillation ◽

Ejection Fraction ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Ventricular Ejection Fraction ◽

Group 3 ◽

Group 2 ◽

One Year ◽

Group 1

Background: Heart failure (HF) and atrial fibrillation (AF) commonly coexist and patients with both diseases have a worse prognosis than those with HF or AF alone. The objective of our study was to identify the factors associated with one-year mortality in patients with HF and AF, depending on the left ventricular ejection fraction (LVEF). Methods: We included 727 patients with HF and AF consecutively admitted in a clinical emergency hospital between January 2018 and December 2019. The inclusion criteria were age of more than 18 years, diagnosis of chronic HF and AF (paroxysmal, persistent, permanent), and signed informed consent. The exclusion criteria were the absence of echocardiographic data, a suboptimal ultrasound view, and other cardiac rhythms than AF. The patients were divided into 3 groups: group 1 (337 patients with AF and HF with reduced ejection fraction (HFrEF)), group 2 (112 patients with AF and HF with mid-range ejection fraction (HFmrEF)), and group 3 (278 patients with AF and HF with preserved ejection fraction (HFpEF)). Results: The one-year mortality rates were 36.49% in group 1, 27.67% in group 2, and 27.69% in group 3. The factors that increased one-year mortality were chronic kidney disease (OR 2.35, 95% CI 1.45–3.83), coronary artery disease (OR 1.67, 95% CI 1.06–2.62), and diabetes (OR 1.66, 95% CI 1.05–2.67) in patients with HFrEF; and hypertension in patients with HFpEF (OR 2.45, 95% CI 1.36–4.39). Conclusions: One-year mortality in patients with HF and AF is influenced by different factors, depending on the LVEF.

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