scholarly journals Load-independent effects of empagliflozin contribute to improved cardiac function in experimental heart failure with reduced ejection fraction

2020 ◽  
Vol 19 (1) ◽  
Author(s):  
Kim A. Connelly ◽  
Yanling Zhang ◽  
Jean-François Desjardins ◽  
Linda Nghiem ◽  
Aylin Visram ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Cardiac Function ◽  
Reduced Ejection Fraction ◽  
Experimental Heart Failure ◽  
Independent Effects

scholarly journals Xiao-Qing-Long-Tang Maintains Cardiac Function during Heart Failure with Reduced Ejection Fraction in Salt-Sensitive Rats by Regulating the Imbalance of Cardiac Sympathetic Innervation

2020 ◽  
Vol 2020 ◽  
pp. 1-11
Author(s):  
Zhaoyu Li ◽  
Yongcheng Wang ◽  
Yuehua Jiang ◽  
Dufang Ma ◽  
Ping Jiang ◽  
...  
Keyword(s):  
Heart Failure ◽  
Blood Pressure ◽  
Ejection Fraction ◽  
Cardiac Function ◽  
Sympathetic Nerve ◽  
Morphological Changes ◽  
Sympathetic Innervation ◽  
Nerve Endings ◽  
Cardiac Sympathetic Innervation ◽  
Reduced Ejection Fraction

Objective. The anatomical and functional imbalances of sympathetic nerves are associated with cardiovascular disease progression. Xiao-Qing-Long-Tang (XQLT), an ancient Chinese herbal formula, has been used to treat cardiovascular diseases in eastern Asia for thousands of years. We determined the effect of XQLT in maintaining cardiac function during heart failure with reduced ejection fraction (HFrEF) with respect to its neurobiological effects in salt-sensitive rats. Methods. Dahl salt-sensitive (DS) rats were fed a high-salt diet to establish an HFrEF model and were divided into model (DS, administered normal saline) and XQL groups (administrated XQLT) randomly, with SS-13BN rats being used as the control. The bodyweight and blood pressure of rats were observed regularly. Electrocardiogram, echocardiography, and plasma N-terminal pro-B-type natriuretic peptide (NT-proBNP) were determined to assess cardiac function. The sympathetic tune and myocardial morphological changes were evaluated. Western blot and qRT-PCR were used to assay the expression of the nerve growth factor (NGF) and leukemia inhibitory factor (LIF). Tyrosine hydroxylase (TH), choline acetyltransferase (CHAT), and growth-associated protein 43 (GAP43) were assayed to confirm sympathetic remodeling. The micromorphological changes in cardiac sympathetic nerve endings were observed by transmission electron microscopy. Results. Four weeks after XQLT treatment, cardiac function and bodyweight were higher and blood pressure was lower than that of the DS group. Myocardial noradrenaline (NA) increased, while the plasma NA level decreased significantly. The morphology demonstrated that XQLT significantly alleviated myocardial damage. XQLT decreased the expression of LIF, increased the expression of NGF, enhanced the TH+/GAP43+ and TH+/CHAT + positive nerve fiber density, and improved the TH and GAP43 protein expression, but had no effect on CHAT. Moreover, XQLT improved the micromorphology of sympathetic nerve endings in the myocardium. Conclusion. XQLT maintains cardiac function during HFrEF in salt-sensitive rats, in part, by regulating the imbalance of cardiac sympathetic innervation.

Pulmonary hypertension detection by computed tomography pulmonary transit time in heart failure with reduced ejection fraction

2019 ◽  
Vol 21 (11) ◽  
pp. 1291-1298
Author(s):  
Geoffrey C Colin ◽  
Anne-Catherine Pouleur ◽  
Bernhard L Gerber ◽  
Pierre-Antoine Poncelet ◽  
Christophe de Meester ◽  
...  
Keyword(s):  
Heart Failure ◽  
Computed Tomography ◽  
Pulmonary Hypertension ◽  
Cardiac Index ◽  
Ejection Fraction ◽  
Pulmonary Artery ◽  
Cardiac Function ◽  
Reduced Ejection Fraction ◽  
Pulmonary Haemodynamics ◽  
Pulmonary Transit Time

Abstract Aims To evaluate the relationships between pulmonary transit time (PTT), cardiac function, and pulmonary haemodynamics in patients with heart failure with reduced ejection fraction (HFrEF) and to explore how PTT performs in detecting pulmonary hypertension (PH). Methods and results In this prospective study, 57 patients with advanced HFrEF [49 men, 51 years ± 8, mean left ventricular (LV) ejection fraction 26% ± 8] underwent echocardiography, right heart catheterization, and cardiac computed tomography (CT). PTT was measured as the time interval between peaks of attenuation in right ventricle (RV) and LV and was compared between patients with or without PH and 15 controls. PTT was significantly longer in HFrEF patients with PH (21 s) than in those without PH (11 s) and controls (8 s) (P < 0.001) but not between patients without PH and controls (P = 0.109). PTT was positively correlated with pulmonary artery wedge pressure (PAWP) (r = 0.74), mean pulmonary artery pressure (r = 0.68), N-terminal pro-B-type natriuretic peptide (r = 0.60), mitral (r = 0.54), and tricuspid (r = 0.37) regurgitation grades, as well as with LV, RV, and left atrial volumes (r from 0.39 to 0.64) (P < 0.01). PTT was negatively correlated with cardiac index (r = −0.63) as well as with LV (r = −0.66) and RV (r = −0.74) ejection fractions. PAWP, cardiac index, mitral regurgitation grade, and RV end-diastolic volume were all independent predictors of PTT. PTT value ≥14 s best-detected PH with 91% sensitivity and 88% specificity (area under the receiver operating characteristic curve: 0.95). Conclusion In patients with HFrEF, PTT correlates with cardiac function and pulmonary haemodynamics, is determined by four independent parameters, and performs well in detecting PH.

scholarly journals The Control of Diastolic Calcium in the Heart

2020 ◽  
Vol 126 (3) ◽  
pp. 395-412 ◽  
Author(s):  
David A. Eisner ◽  
Jessica L. Caldwell ◽  
Andrew W. Trafford ◽  
David C. Hutchings
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Cardiac Function ◽  
Reduced Ejection Fraction ◽  
Intracellular Ca ◽  
Cardiac Relaxation ◽  
Low Levels ◽  
Normal Cardiac Function

Normal cardiac function requires that intracellular Ca 2+ concentration be reduced to low levels in diastole so that the ventricle can relax and refill with blood. Heart failure is often associated with impaired cardiac relaxation. Little, however, is known about how diastolic intracellular Ca 2+ concentration is regulated. This article first discusses the reasons for this ignorance before reviewing the basic mechanisms that control diastolic intracellular Ca 2+ concentration. It then considers how the control of systolic and diastolic intracellular Ca 2+ concentration is intimately connected. Finally, it discusses the changes that occur in heart failure and how these may result in heart failure with preserved versus reduced ejection fraction.

Catheter ablation of atrial fibrillation benefits the patients with heart failure and preserved ejection fraction as well as those with heart failure and reduced ejection fraction

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
R Yamauchi ◽  
I Morishima ◽  
Y Morita ◽  
K Takagi ◽  
H Nagai ◽  
...  
Keyword(s):  
Heart Failure ◽  
Catheter Ablation ◽  
Ejection Fraction ◽  
Cardiac Function ◽  
Functional Class ◽  
Reverse Remodeling ◽  
Reduced Ejection Fraction ◽  
Nyha Functional Class ◽  
Patients With Heart Failure

Abstract Background Although catheter ablation of atrial fibrillation (AF) has recently been shown to improve the cardiac function and even mortality in patients with heart failure (HF) and reduced ejection fraction (HFrEF), few studies have examined the outcomes of AF catheter ablation in patients with HF with preserved ejection fraction (HFpEF). Purpose To verify the impact of AF catheter ablation on the cardiac function and HF status in patients with HFpEF. Methods We studied 306 patients with HF who had a history of an HF hospitalization and/or preprocedural serum BNP levels >100pg/ml (age, 68.9±8.2 years old; male, 66.3%; non-paroxysmal AF, 63.1%, left atrial diameter [LAD], 42.5±6.3 mm; left ventricular ejection fraction [LVEF], 60.6±12.0%) out of 596 consecutive patients who underwent pulmonary vein isolation-based catheter ablation of AF. The patients with an LVEF ≥50% were defined as having HFpEF (n=262; age, 69.0±8.2 years old; male, 64.5%; non-paroxysmal AF, 61.8%, LAD, 42.1±5.9 mm; left LVEF, 64.0±8.2%) and the remaining patients with an LVEF <50% were defined as having HFrEF (n=44, age, 67.9±8.7 years old; male, 77.0%; non-paroxysmal AF, 70.5%, LAD, 44.9±8.2 mm; LVEF, 40.1±10.2%). The patients received periodic follow-ups for 12 months after the catheter ablation. The cardiac function parameters including the echocardiographic findings and HF functional status of the patients were compared between baseline and 12 months, stratified by the HF subgroup. Results AF recurred in 60 patients with HFpEF (22.9%) and in 14 with HFrEF (31.8%) during the 12 month follow-up (p=0.27), however, sinus rhythm was maintained at 12 months in most of the patients (253 patients with HFpEF [96.6%] and 42 patients with HFrEF [95.5%]) (p=0.71). Figure 1 compares the changes in the cardiac function parameters and NYHA functional class from baseline to the 12-month follow-up stratified by the HF subgroup. Both the patients with HFpEF and HFrEF had significant improvements in the serum BNP levels, chest thorax ratio, and LVEF determined by echocardiography. LA reverse remodeling as shown by a significant reduction in the LAD was observed in both HF subgroups, however, the E/E', an index of the LV diastolic function, did not significantly change in either of the subgroups. Similar to the patients with HFrEF, an improvement in the NYHA functional class was seen in those with HFpEF. Conclusions Catheter ablation of AF may benefit patients with HFpEF as well as those with HFrEF. Sinus rhythm maintenance achieved by AF catheter ablation in patients with HFpEF may lead to LA reverse remodeling and a better LV systolic function, thereby improving the NYHA functional class. It is unclear whether changes in the LV diastolic function may contribute to this favorable process. Funding Acknowledgement Type of funding source: None

scholarly journals The Effect of Dietary Inorganic Nitrate Supplementation on Cardiac Function during Submaximal Exercise in Men with Heart Failure with Reduced Ejection Fraction (HFrEF): A Pilot Study

Nutrients ◽  
2020 ◽  
Vol 12 (7) ◽  
pp. 2132
Author(s):  
Mary N. Woessner ◽  
Itamar Levinger ◽  
Jason D. Allen ◽  
Luke C. McIlvenna ◽  
Christopher Neil
Keyword(s):  
Heart Failure ◽  
Cardiac Output ◽  
Pilot Study ◽  
Ejection Fraction ◽  
Cardiac Function ◽  
Submaximal Exercise ◽  
Exercise Intolerance ◽  
Reduced Ejection Fraction ◽  
Inorganic Nitrate ◽  
Nitrate Supplementation

Heart failure with reduced ejection fraction (HFrEF) is a common end point for patients with coronary artery disease and it is characterized by exercise intolerance due, in part, to a reduction in cardiac output. Nitric oxide (NO) plays a vital role in cardiac function and patients with HFrEF have been identified as having reduced vascular NO. This pilot study aimed to investigate if nitrate supplementation could improve cardiac measures during acute, submaximal exercise. Five male participants (61 ± 3 years) with HFrEF (EF 32 ± 2.2%) completed this pilot study. All participants supplemented with inorganic nitrate (beetroot juice) or a nitrate-depleted placebo for ~13 days prior to testing. Participants completed a three-stage submaximal exercise protocol on a recumbent cycle ergometer with simultaneous echocardiography for calculation of cardiac output (Q), stroke volume (SV), and total peripheral resistance (TPR). Heart rate and blood pressure were measured at rest and during each stage. Both plasma nitrate (mean = ~1028%, p = 0.004) and nitrite (mean = ~109%, p = 0.01) increased following supplementation. There were no differences between interventions at rest, but the percent change in SV and Q from rest to stage two and stage three of exercise was higher following nitrate supplementation (all p > 0.05, ES > 0.8). Both interventions showed decreases in TPR during exercise, but the percent reduction TPR in stages two and three was greater following nitrate supplementation (p = 0.09, ES = 0.98 and p = 0.14, ES = 0.82, respectively). There were clinically relevant increases in cardiac function during exercise following supplementation with nitrate. The findings from this pilot study warrant further investigation in larger clinical trials.

scholarly journals Mid- to Late-Life Time-Averaged Cumulative Blood Pressure and Late-Life Cardiac Structure, Function, and Heart Failure

Hypertension ◽  
2020 ◽  
Vol 76 (3) ◽  
pp. 808-818
Author(s):  
Kanako Teramoto ◽  
Wilson Nadruz Junior ◽  
Kunihiro Matsushita ◽  
Brian Claggett ◽  
Jenine E. John ◽  
...  
Keyword(s):  
Heart Failure ◽  
Blood Pressure ◽  
Ejection Fraction ◽  
Cardiac Function ◽  
Specific Effect ◽  
Late Life ◽  
Left Ventricular ◽  
Observation Time ◽  
Preserved Ejection Fraction ◽  
Reduced Ejection Fraction

Limited data exist regarding systolic blood pressure (SBP) through mid- to late-life and late-life cardiac function and heart failure (HF) risk. Among 4578 HF-free participants in the ARIC study (Atherosclerosis Risk in Communities) attending the fifth visit (2011–2013; age 75±5 years), time-averaged cumulative SBP was calculated as the sum of averaged SBPs from adjacent consecutive visits (visits 1–5) indexed to total observation time (24±1 years). Calculations were performed using measured SBPs and also incorporating antihypertensive medication specific effect constants (underlying SBP). Outcomes included comprehensive echocardiography at visit 5 and post-visit 5 incident HF, HF with preserved ejection fraction, and reduced ejection fraction. Higher cumulative SBP was associated with greater left ventricular mass and worse diastolic measures (all P <0.001), associations that were stronger with underlying compared with cumulative SBP (all P <0.05). At 5.6±1.2 years follow-up post-visit 5, higher cumulative measured and underlying SBP were associated with incident HF (hazard ratio per 10 mm Hg for measured: 1.12 [1.01–1.24]; underlying: 1.19 [95% CI, 1.10–1.30]) and HF with preserved ejection fraction (measured: 1.15 [1.00–1.33]; underlying: 1.28 [1.14–1.45]), but not HF with reduced ejection fraction (measured: 1.11 [0.94–1.32]; underlying: 1.11 [0.96–1.24]). Associations with HF and HF with preserved ejection fraction were more robust with cumulative underlying compared with measured SBP (all P <0.05). Time-averaged cumulative SBP in mid to late life is associated with worse cardiac function and risk of incident HF, especially HF with preserved ejection fraction, in late life. These associations were stronger considering underlying as opposed to measured SBP, highlighting the importance of prevention and effective treatment of hypertension to prevent late-life cardiac dysfunction and HF.

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