scholarly journals Impact of drug therapy on long-term prognosis in patients with ischemic chronic heart failure with preserved ejection fraction and renal dysfunction

2016 ◽  
Vol 0 (5) ◽  
Author(s):  
D. A. Lashkul
Keyword(s):  
Heart Failure ◽  
Drug Therapy ◽  
Chronic Heart Failure ◽  
Ejection Fraction ◽  
Renal Dysfunction ◽  
Preserved Ejection Fraction ◽  
Long Term Prognosis

Long-term prognosis of combined chronic heart failure and chronic renal dysfunction after acute stroke

2010 ◽  
Vol 12 (8) ◽  
pp. 849-854 ◽  
Author(s):  
George Tsagalis ◽  
Neratzoula Bakirtzi ◽  
Konstantinos Spengos ◽  
Anastasia Vemmou ◽  
Efstathios Manios ◽  
...  
Keyword(s):  
Heart Failure ◽  
Chronic Heart Failure ◽  
Acute Stroke ◽  
Renal Dysfunction ◽  
Long Term Prognosis

scholarly journals What Type of Patients Did PARAGON-HF Select? Insights from a Real-World Prospective Cohort of Patients with Heart Failure and Preserved Ejection Fraction

2020 ◽  
Vol 9 (11) ◽  
pp. 3669 ◽  
Author(s):  
René Rettl ◽  
Theresa-Marie Dachs ◽  
Franz Duca ◽  
Christina Binder ◽  
Fabian Dusik ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Real World ◽  
Treatment Options ◽  
National Registry ◽  
Preserved Ejection Fraction ◽  
Eligibility Criteria ◽  
Patients With Heart Failure ◽  
Long Term Prognosis

The PARAGON-HF clinical trial suggested that sacubitril/valsartan may become a treatment option for particular subgroups of patients with heart failure and preserved ejection fraction (HFpEF). However, the proportion of real-world HFpEF patients who are theoretically superimposable with the PARAGON-HF population is yet unknown. The present study was performed to define the proportion of real-world PARAGON-HF-like patients and to describe their clinical characteristics and long-term prognosis in comparison with those who would not meet PARAGON-HF criteria. We systematically applied PARAGON-HF inclusion and exclusion criteria to a total of 427 HFpEF patients who have been participating in a prospective national registry between December 2010 and December 2019. In total, only 170 (39.8%) registry patients were theoretically eligible for PARAGON-HF. Patients not meeting inclusion criteria (41.0%) were less impaired with respect to exercise capacity (median 6-min walk distance: 385 m (IQR: 300–450) versus 323 m (IQR: 240–383); p < 0.001) had lower pulmonary pressures (mean pulmonary artery pressure (mPAP): 31.2 mmHg, standard deviation (SD): ±10.2 versus 32.8 mmHg, SD: ±9.7; p < 0.001) and better outcomes (log-rank: p < 0.001) as compared to the PARAGON-like cohort. However, patients theoretically excluded from the trial (19.2%) were those with most advanced heart failure symptoms (median 6-min walk test: 252 m (IQR: 165–387); p < 0.001), highest pulmonary pressures (mPAP: 38.2 mmHg, SD: ±12.4; p < 0.001) and worst outcome (log-rank: p = 0.037). We demonstrate here that < 40% of real-world HFpEF patients meet eligibility criteria for PARAGON-HF. We conclude that despite reasons for optimism after PARAGON-HF, a large proportion of HFpEF patients will remain without meaningful treatment options.

scholarly journals Echocardiographic and Hemodynamic Parameters Associated with Diminishing Renal Filtration among Patients with Heart Failure with Preserved Ejection Fraction

2018 ◽  
Vol 9 (2) ◽  
pp. 83-91 ◽  
Author(s):  
Kevin Bryan Lo ◽  
Kene Mezue ◽  
Pradhum Ram ◽  
Abhinav Goyal ◽  
Mahek Shah ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Renal Dysfunction ◽  
Pressure Ratio ◽  
Left Ventricular ◽  
Right Atrial ◽  
Heart Catheterization ◽  
Preserved Ejection Fraction ◽  
Patients With Heart Failure

Background: Renal dysfunction is an important predictor of poor outcomes in patients with heart failure with preserved ejection fraction (HFpEF). Right ventricular (RV) dysfunction is implicated as one of the explanations for worsening renal function in cardiorenal syndrome. Novel right heart catheterization (RHC) parameters such as pulmonary artery pulsatility index (PAPi) and right atrial to pulmonary capillary wedge pressure ratio (RA:PCWP) have been found as predictors of RV dysfunction. However, most studies investigating these parameters have been done in the setting of myocardial infarction or left ventricular assist device implantation, with limited data on these metrics in patients with HFpEF. Objective: The purpose of this study was to determine whether novel RHC parameters such as RA:PCWP and PAPi correlate with long-term renal outcomes among patients with HFpEF. Methods: A retrospective single-center study of adult patients with a documented diagnosis of heart failure who had RHC was performed between January 2006 and December 2010 at Einstein Med ical Center Philadelphia. Selected patients also had a serum B-type natriuretic peptide level ≥100 pg/mL and a PCWP ≥15 mm Hg. Patients with an ejection fraction < 50%, including those with recovered ejection fraction, and end-stage renal disease were excluded. Results: A total of 81 patients with a clinical diagnosis of HFpEF were identified who met the inclusion criteria. On multivariate analysis, after adjusting for age, sex, race, diabetes, hypertension, and cardiac index, PAPi was associated with long-term estimated glomerular filtration rate (eGFR) (β = 3.43, 95% CI = 0.635–6.23, p = 0.017), and RA:PCWP showed a trend towards significance (β = 14.81, 95% CI = –0.096–29.73, p = 0.051). The results were unchanged after further adjustment for eGFR at the time of RHC. Conclusion: Novel hemodynamic indices obtained by RHC may have predictive value for long-term renal dysfunction in patients with HFpEF.

scholarly journals The effect of renin-angiotensin system blockers on aldosterone levels in patients with chronic heart failure with preserved ejection fraction

2020 ◽  
Vol 11 (4) ◽  
pp. 67-73
Author(s):  
A. N. Shevelok
Keyword(s):  
Heart Failure ◽  
Risk Factor ◽  
Chronic Heart Failure ◽  
Ejection Fraction ◽  
Ace Inhibitors ◽  
Independent Risk Factor ◽  
Preserved Ejection Fraction ◽  
Receptor Antagonists ◽  
Aldosterone Level

Objective: to evaluate the effect of renin-angiotensin-aldosterone system (RAAS) blockers on aldosterone level in patients with chronic heart failure with preserved ejection fraction (HFpEF).Materials and methods: the prospective study included 158 patients (58 men and 100 women, mean age 62,3 ± 7,4 years) with HFpEF (> 50 %) and left ventricular diastolic dysfunction. All patients had no history of primary aldosteronism and did not use the mineralocorticoid receptor antagonists during the last 6 weeks. We evaluated the duration of treatment with angiotensin-converting enzyme (ACE) inhibitors or angiotensin-2 receptor antagonists (ARA-2) and its average daily dose. The dose of RAAS blockers was assessed during previous 6 months as a percentage of target. Aldosterone plasma concentration was measured and the normal level was 40 – 160 pg/ml.Results: according to laboratory results 99 patients (62,7 %) had normal aldosterone level (nAld) and 59 patients (37,3 %) had high aldosterone level (hAld). hAld patients had significantly higher duration of RAAS blockers treatment (6 (3; 8) versus 4 (2; 5) years, p < 0,001) and dose (50 (25; 50) % vs 25 (12,5; 50) % of target, р=0,01). Multiple regression analysis showed that after standartization for age, severity of HFpEF, duration of arterial hypertension and comorbidity only long-term (more than 5 years) treatment with RAAS blockers remained the independent risk factor of high aldosterone level (odds ratio 3,16, 95 % confidence interval 2,08 – 8,24).Conclusions: in HFpEF patients’ plasma aldosterone level is closely associated with RAAS blockers treatment. Long-term (more than 5 years) therapy with ACE inhibitors or ARA-2 is the independent risk factor of secondary hyperaldosteronism. 

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