Direct Myocardial Implantation of Human Fetal Stem Cells in Heart Failure Patients: Long-term Results

2010 ◽  
Vol 13 (1) ◽  
pp. 31 ◽  
Author(s):  
Federico Benetti ◽  
Ernesto Pe�herrera ◽  
Teodoro Maldonado ◽  
Yan Duarte Vera ◽  
Valvanur Subramanian ◽  
...  
Keyword(s):  
Heart Failure ◽  
Stem Cells ◽  
Cardiac Function ◽  
Nyha Class ◽  
Left Ventricular ◽  
Long Term Results ◽  
Walk Test ◽  
The Mean ◽  
6 Minute Walk Test ◽  
Minute Walk

Background: End-stage heart failure (HF) is refractory to current standard medical therapy, and the number of donor hearts is insufficient to meet the demand for transplantation. Recent studies suggest autologous stem cell therapy may regenerate cardiomyocytes, stimulate neovascularization, and improve cardiac function and clinical status. Although human fetal-derived stem cells (HFDSCs) have been studied for the treatment of a variety of conditions, no clinical studies have been reported to date on their use in treating HF. We sought to determine the efficacy and safety of HFDSC treatment in HF patients.Methods and Results: Direct myocardial transplantation of HFDSCs by open-chest surgical procedure was performed in 10 patients with HF due to nonischemic, nonchagasic dilated cardiomyopathy. Before and after the procedure, and with no changes in their preoperative doses of medications (digoxin, furosemide, spironolactone, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, betablockers), patients were assessed for New York Heart Association (NYHA) class, performance in the exercise tolerance test (ETT), ejection fraction (EF), left ventricular end-diastolic dimension (LVEDD) via transthoracic echocardiography, performance in the 6-minute walk test, and performance in the Minnesota congestive HF test. All 10 patients survived the operation. One patient had a stroke 3 days after the procedure, and although she later recovered, she was unable to perform the follow-up tests. Another male patient experienced pericardial effusion 3 weeks after the procedure. Although it resolved spontaneously, the patient abandoned his control tests and died 5 months after the procedure. An autopsy of the myocardium suggested that new young cells were present in the cardiomyocyte mix. At 40 months, the mean (SD) NYHA class decreased from 3.4 0.5 to 1.33 0.5 (P = .001); the mean EF increased 31%, from 26.6% 4% to 34.8% 7.2% (P = .005); and the mean ETT increased 291.3%, from 4.25 minutes to 16.63 minutes (128.9% increase in metabolic equivalents, from 2.46 to 5.63) (P < .0001); the mean LVEDD decreased 15%, from 6.85 0.6 cm to 5.80 0.58 cm (P < .001); mean performance in the 6-minute walk test increased by 43.2%, from 251 113.1 seconds to 360 0 seconds (P = .01); the mean distance increased 64.4%, from 284.4 144.9 m to 468.2 89.8 m (P = .004); and the mean result in the Minnesota test decreased from 71 27.3 to 6 5.9 (P < .001).Conclusion: Although these initial findings suggest direct myocardial implantation of HFDSCs is feasible and improves cardiac function in HF patients at 40 months, more clinical research is required to confirm these observations.

scholarly journals The Long-Term Prognostic Significance of 6-Minute Walk Test Distance in Patients with Chronic Heart Failure

2014 ◽  
Vol 2014 ◽  
pp. 1-7 ◽  
Author(s):  
Lee Ingle ◽  
John G. Cleland ◽  
Andrew L. Clark
Keyword(s):  
Heart Failure ◽  
Chronic Heart Failure ◽  
Prognostic Significance ◽  
Left Ventricular ◽  
Walk Test ◽  
Nyha Classification ◽  
All Cause Mortality ◽  
6 Minute Walk Test ◽  
Minute Walk

Background. The 6-minute walk test (6-MWT) is used to assess patients with chronic heart failure (CHF). The prognostic significance of the 6-MWT distance during long-term followup (>5 years) is unclear.Methods. 1,667 patients (median [inter-quartile range, IQR]) (age 72 [65–77]; 75% males) with heart failure due to left ventricular systolic impairment undertook a 6-MWT as part of their baseline assessment and were followed up for 5 years.Results. At 5 years’ followup, those patients who died (n= 959) were older at baseline and had a higher log NT pro-BNP than those who survived to 5 years (n= 708). 6-MWT distance was lower in those who died [163 (153) m versus 269 (160) m;P< 0.0001]. Median 6-MWT distance was 300 (150–376) m, and quartile ranges were <46 m, 46–240 m, 241–360 m, and >360 m. 6-MWT distance was a predictor of all-cause mortality (HR 0.97; 95% CI 0.96-0.97; Chi-square = 184.1;P< 0.0001). Independent predictors of all-cause mortality were decreasing 6-MWT distance, increasing age, increasing NYHA classification, increasing log NT pro-BNP, decreasing diastolic blood pressure, decreasing sodium, and increasing urea.Conclusion. The 6-MWT is an important independent predictor of all-cause mortality following long-term followup in patients with CHF.

Six-minute walk test and heart rate variability: lack of association in advanced stages of heart failure

1997 ◽  
Vol 6 (5) ◽  
pp. 348-354 ◽  
Author(s):  
MA Woo ◽  
DK Moser ◽  
LW Stevenson ◽  
WG Stevenson
Keyword(s):  
Heart Failure ◽  
Heart Rate ◽  
Heart Rate Variability ◽  
Sudden Death ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Walk Test ◽  
Advanced Stages ◽  
6 Minute Walk Test ◽  
Minute Walk

BACKGROUND: The 6-minute walk and heart rate variability have been used to assess mortality risk in patients with heart failure, but their relationship to each other and their usefulness for predicting mortality at 1 year are unknown. OBJECTIVE: To assess the relationships between the 6-minute walk test, heart rate variability, and 1-year mortality. METHOD: A sample of 113 patients in advanced stages of heart failure (New York Heart Association Functional Class III-IV, left ventricular ejection &lt; 0.25) were studied. All 6-minute walks took place in an enclosed, level, measured corridor and were supervised by the same nurse. Heart rate variability was measured by using (1) a standard-deviation method and (2) Poincare plots. Data on RR intervals obtained by using 24-hour Holter monitoring were analyzed. Survival was determined at 1 year after the Holter recording. RESULTS: The results showed no significant associations between the results of the 6-minute walk and the two measures of heart rate variability. The results of the walk were related to 1-year mortality but not to the risk of sudden death. Both measures of heart rate variability had significant associations with 1-year mortality and with sudden death. However, only heart rate variability measured by using Poincare plots was a predictor of total mortality and risk of sudden death, independent of left ventricular ejection fraction, serum levels of sodium, results of the 6-minute walk test, and the standard-deviation measure of heart rate variability. CONCLUSIONS: Results of the 6-minute walk have poor association with mortality and the two measures of heart rate variability in patients with advanced-stage heart failure and a low ejection fraction. Further studies are needed to determine the optimal clinical usefulness of the 6-minute walk and heart rate variability in patients with advanced-stage heart failure.

Abstract P333: Heart Rate Control in Patients With Chronic Atrial Fibrillation and Heart Failure

2011 ◽  
Vol 4 (suppl_1) ◽  
Author(s):  
Helme Silvet ◽  
Lee Ann Hawkins
Keyword(s):  
Heart Failure ◽  
Heart Rate ◽  
Rate Control ◽  
Nyha Class ◽  
Chronic Atrial Fibrillation ◽  
Walk Test ◽  
Heart Rate Control ◽  
6 Minute Walk Test ◽  
Minute Walk

Background. Heart rate (HR) control is one of the main goals in management of patients with chronic atrial fibrillation (AF). However, rate control can be challenging in patients with heart failure (HF). The goal of our study was to determine if aggressive heart rate control in patients with both chronic AF and HF results in better exercise tolerance and/or quality of life (QOL) as compared to the “usual” care. Methods. This was a single center interventional study at VA Loma Linda Healthcare System using patients as their own controls. Patients with chronic AF and LVEF ≤ 40% were recruited. Intervention consisted of increasing doses of Metoprolol XL to achieve target resting heart rate less than 70 bpm. Clinical data was collected at baseline (“usual care”) and at follow-up (3 months) and included HR data, 6-minute walk test, QOL questionnaire (Minnesota Living with Heart Failure), and brain natriuretic peptide (BNP) levels. Paired t-test was performed to evaluate statistically significant change in these clinical measures. The study had 80% power to detect clinically significant improvement in 6-minute walk test (50 meters). Results. 20 patients were recruited with an average follow-up of 98 days. Mean age was 66 years and all the patients were male with an average LVEF of 30 ± 8% and NYHA class of II-III. Average resting HR was 94 ± 14 bpm at baseline and 85 ± 12 bpm after the intervention. Average Metoprolol XL dose at the end of the study was 121mg with the average increase of the dose during the study of 59 mg. Further increases of Metoprolol doses to achieve target HR were not tolerated by the patients. Conclusion. In this small group of patients with chronic AF and HF aggressive HR control was difficult due to patient intolerance of increasing doses of beta-blockade and was not associated with better exercise tolerance, better QOL or improved HF based on BNP measurement. Further studies are needed to establish guidelines for target HR in patients with chronic AF who also have significant HF. Clinical parameter Baseline Follow-up p-value 6-min walk test (meters) 326 ± 83 330 ± 86 0.47 QOL score 42.5 ± 19 38 ± 21 >0.5 BNP 242 ± 306 279 ± 395 >0.5 NYHA class 2.4 ± 0.7 2.2 ± 0.7 0.009

scholarly journals Assessment of Nutritive Status in Patients with Symptoms of Heart Failure

2020 ◽  
Vol 5 (4) ◽  
pp. 14-20
Author(s):  
O. Yu. Bastrikov ◽  
U. V. Kharlamova ◽  
A. I. Zakharova ◽  
E. A. Pripadchev ◽  
S. A. Shakhov
Keyword(s):  
Heart Failure ◽  
Nutritional Status ◽  
Left Ventricular ◽  
Nutritional Deficiency ◽  
Walk Test ◽  
Functional Characteristics ◽  
Laboratory Parameters ◽  
Coronary Syndromes ◽  
6 Minute Walk Test ◽  
Minute Walk

Aim of the research. To study the parameters of nutritional status of patients with acute and chronic coronary syndromes and symptoms of heart failure in conjunction with clinical, anthropometric, laboratory parameters, structural and functional characteristics of the heart. Materials and methods. A cross-sectional study of 106 patients with acute and chronic coronary syndromes and symptoms of heart failure. All subjects underwent an integrated assessment of the nutritional status (anthropometric, caliperometric (caliper metric) indicators, CONUT scale (lymphocytes, total cholesterol, albumin), hormonal indicators (N-terminal brain natriuretic propeptide), structural changes in the myocardium using echocardiography, exercise tolerance by 6-minute walk test. Results. Nutritional deficiency, according to CONUT scale, was found in 81.1 % of cases (86 patients). In the group of patients with the presence of malnutrition, there were significantly high level of fibrinogen and N-terminal brain natriuretic propeptide. The interpretation of changes in body composition showed a significant upward trend in the prognostic index of hypotrophy and a decrease in lean body mass as heart failure progresses. The dependence of nutritive insufficiency on the CONUT scale with laboratory parameters (creatinine, fibrinogen, brain natriuretic propeptide), structural and functional characteristics of the heart (diastolic and systolic dimensions of the left ventricle, ejection fraction, left ventricular myocardial mass index), a functional indicator of tolerance to the physical load (6-minute walk test) was determined. Conclusion. An integrated analysis of nutritional status indicators of patients with heart failure revealed an increase of malnutrition signs with an increase of the severity of HF. Pathological effects of nutritional deficiency are associated with impaired left ventricular systolic function, reduced exercise tolerance.

scholarly journals Moderate intensity exercise training in heart failure with preserved ejection fraction: functional and structural benefits (The MIET-HFpEF trial)

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
A El Amrawy ◽  
M Hassanein ◽  
S Ayad ◽  
F Eldabe
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Medical Care ◽  
Diastolic Function ◽  
Functional Capacity ◽  
Left Ventricular ◽  
Preserved Ejection Fraction ◽  
Walk Test ◽  
6 Minute Walk Test ◽  
Minute Walk

Abstract Background Heart failure with preserved ejection fraction (HFpEF) represents more than one half of the heart failure cases worldwide with increased morbidity and mortality. No proven medical treatment till now have shown mortality benefit in HFpEF. This study aims to elucidate the benefits of cardiac rehabilitation (CR) in HFpEF. Methods Sixty patients with HFpEF were included in 2 groups with 1:1 randomization.Group1 received usual medical care plus 2–3 rehabilitation sessions per week using moderate exercise with 40–75% of heart rate reserve on treadmill (up to 60 minutes according to the functional capacity). Group 2 received only usual medical care. Comparison between the 2 groups recording the percentage of improvement in echocardiographic diastolic function parameters, Minnesota living with heart failure questionnaire (MLWHFQ) and 6 -minute walk test at baseline and after 12 weeks. Results Group 1 showed significant improvement in the following: a. MLWHFQ (total score mean percentage of reduction) 305.60±158.44 versus (vs) 69.44±17.71 (p&lt;0.001).b. E/e' mean percentage of reduction 65.96±34.55 vs 18.23±13.98 (p&lt;0.001). c. Left atrial (LA) volume index mean percentage of reduction 27.86±13.27 vs 8.03±4.40 (p&lt;0.001). d. Pulmonary artery systolic pressure mean percentage of reduction was 33.85±14.68 vs 22.97±16.54 (p=0.02). e. 6–minute walk test 111.79±40.97 vs 46.33±11.58 (p&lt;0.001). f. Body mass index percentage of reduction 10.17±3.64 vs 2.80±1.60 (p&lt;0.001). g. Percentage of patients with down-grading of the degree of diastolic dysfunction: 10 patients (33.3%) vs 3 patients (10%) (P=0.028). h. However, there were no significant differences in left ventricular ejection fraction or other parameters as E/A ratio, LA dimension, isovolumetric relaxation time, degree of left ventricular hypertrophy. Conclusion CR not only added significant functional improvement in the quality of life and functional capacity in patients with HFpEF but also a significant structural improvement by improving the core items of diastolic function. In the light of the results of this study, we can recommend CR as a part of HFpEF management. FUNDunding Acknowledgement Type of funding sources: None.

Prognostic role of results of dynamic capnography in integral assessment of parameters of respiratory system in 6-minute walk test in patients with chronic heart failure

2020 ◽  
Vol 28 (3) ◽  
pp. 290-299
Author(s):  
Kira A. Ageeva ◽  
Evgenii V. Filippov
Keyword(s):  
Respiratory System ◽  
Prognostic Significance ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Control Group ◽  
Walk Test ◽  
Ventricular Ejection Fraction ◽  
6Mwt Distance ◽  
6 Minute Walk Test ◽  
Minute Walk

Aim. To study the prognostic value of the results of dynamic capnography in the complex assessment of parameters of the respiratory system in 6-minute walk test in patients with chronic heart failure (CHF). Materials and Methods. 73 Patients were examined: the group of study included 48 patients with IIA or IIB stage CHF (mean age 57.94.6 years, 23 men), the control group included 25 practically healthy volunteers (mean age 47.63.5 years, 9 men). The patients were conducted complex determination of parameters of the respiratory system: clinical scaling before and after 6-minute walk test (6MWT), instrumental examinations including spirometry, capnography and pulse oximetry before, during and after physical activity. The analysis of survival was conducted on the basis of the dynamic follow-up of patients within 5 years (60 months). Results. In the analysis of parameters of dyspnea at rest, all the parameters were higher in the group of patients with CHF (р0.05). The distance walked by the patients with CHF in 6 minutes was 488.2390.84 m, which was significantly less than in the control group (815.6053.89 m, р=0.009). Dyspnea as the cause of stoppage/slowing down of walking in 6MWT, was also more often recorded in patients with CHF (93.83.0% and 48.05.1%, р=0.049). Besides, in 6MWT the patients noted: weakness in legs (50.15.0% in the group of CHF and 40.05.0% in the control group, р=0.014), palpitation (29.04.6% and 20.04.1%, respectively, р=0.004). Worsening of dyspnea parameters in 6MWT was more evident in patients with CHF than in the control group (р0.01). In the CHF group, hypocapnic type of ventilation was revealed in 6MWT, analysis of РЕТСО2 trend graphs revealed a wave-like increase in the parameters, the so called periodic breathing (PB). CO2 trend was recorded in CHF group in 58.31.0% of cases (the difference with the control group with р=0.046), the trend of heart rate in 18.80.3% of cases (р=0.027). Cox proportional hazards regression analysis of mortality in patients with CHF showed a prognostic significance of a complex model comprising the following parameters of a patient: body mass index (р=0.005), left ventricular end-diastolic dimension (р=0.034), left ventricular end-systolic dimension (р=0.002), left ventricular ejection fraction (р=0.041), 6MWT distance (р=0.004), desaturation (р=0.009), and the presence of signs of PB during 6MWT (р=0.005). Model coefficients were statistically significant at р0.0001. Conclusions. Dynamic capnography and pulse oximetry allow to identify signs of PB in patients with CHF during 6MWT which may deepen a complex assessment of parameters of the cardio-respiratory system in patients with CHF in order to determine tolerance to physical exercise as well as the effectiveness of the conducted treatment. Complex assessment of survival of patients with CHF showed prognostic significance of the following parameters of a patient: body mass index, left ventricular end-diastolic dimension, left ventricular end-systolic dimension, left ventricular ejection fraction, 6MWT distance, desaturation, PB during 6MWT.

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