scholarly journals Left Ventricular Systolic Dysfunction Due to Atrial Fibrillation: Clinical and Echocardiographic Predictors

2021 ◽  
Vol 7 ◽  
Author(s):  
Erez Marcusohn ◽  
Ofer Kobo ◽  
Maria Postnikov ◽  
Danny Epstein ◽  
Yoram Agmon ◽  
...  
Keyword(s):  
Sinus Rhythm ◽  
Tricuspid Regurgitation ◽  
Ventricular Dysfunction ◽  
Systolic Dysfunction ◽  
Right Ventricular Dysfunction ◽  
Transoesophageal Echocardiography ◽  
Left Ventricular ◽  
Lv Function ◽  
Prosthetic Valves ◽  
Ventricular Response

Background: Diagnosis of AF-induced cardiomyopathy can be challenging and relies on ruling out other causes of cardiomyopathy and, after restoration of sinus rhythm, recovery of left ventricular (LV) function. The aim of this study was to identify clinical and echocardiographic predictors for developing cardiomyopathy with systolic dysfunction in patients with atrial tachyarrhythmia. Methods: This retrospective study was conducted in a large tertiary care centre and compared patients who experienced deterioration of LV ejection fraction (EF) during paroxysmal AF, demonstrated by precardioversion transoesophageal echocardiography with patients with preserved LV function during AF. All patients had documented preserved LVEF at baseline (EF >50%) while in sinus rhythm. Results: Of 482 patients included in the final analysis, 80 (17%) had reduced and 402 (83%) had preserved LV function during the precardioversion transoesophageal echocardiography. Patients with reduced LVEF were more likely to be men and to have a more rapid ventricular response during AF or atrial flutter (AFL). A history of prosthetic valves was also identified as a risk factor for reduced LVEF. Patients with reduced LVEF also had higher incidence of tricuspid regurgitation and right ventricular dysfunction. Conclusion: In ‘real-world’ experience, male patients with rapid ventricular response during paroxysmal AF or AFL are more prone to LVEF reduction. Patients with prosthetic valves are also at risk for LVEF reduction during AF/AFL. Finally, tricuspid regurgitation and right ventricular dysfunction may indicate relatively long-standing AF with an associated reduction in LVEF.

scholarly journals Left ventricular ejection fraction reduction due to atrial fibrillation: clinical and echocardiographic predictors

2021 ◽  
Vol 10 (Supplement_1) ◽  
Author(s):  
E Marcusohn ◽  
O Kobo ◽  
M Postnikov ◽  
D Epstein ◽  
Y Agmon ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Left Ventricular Ejection Fraction ◽  
Ejection Fraction ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Lv Function ◽  
Ventricular Ejection Fraction ◽  
Prosthetic Valves ◽  
Ventricular Response ◽  
History Of

Abstract Funding Acknowledgements Type of funding sources: None. Background  The diagnosis of atrial fibrillation (AF) induced cardiomyopathy can be challenging. It relies on ruling out other causes of dilated cardiomyopathy, upon recovery of left ventricular ejection fraction (LVEF) following return to sinus rhythm (SR). Aim  The aim of this study was to identify clinical and echocardiographic predictors for developing new dilated cardiomyopathy in patients with AF or atrial flutter (AFL). Methods  This is a retrospective study conducted in a large tertiary care center. Patients that suffered deterioration of LVEF under 50% during AF demonstrated by pre-cardioversion trans-esophageal echocardiography (TEE) were compared to those with preserved LV function during AF. All patients had documented preserved LVEF at baseline (EF >50%) while in SR. Patients with a previous history of reduced LVEF during SR were excluded. Results From a total of 482 patients included in the final analysis, 80 (17%) patients had reduced LV function and 402 (83%) had preserved LV function during the pre-cardioversion TEE. Patients with reduced LVEF were more likely to be male and with a more rapid ventricular response during AF/AFL. A history of prosthetic valves was also identified as a risk factor for reduced LVEF. Patients with reduced LVEF also had higher incidence of TR and RV dysfunction. Conclusion In "real world" experience, male patients with rapid ventricular response during AF or AFL are more prone to LVEF reduction. Patients with prosthetic valves are also at risk for LVEF reduction during AF/AFL. Lastly, TR and RV dysfunction may indicate relatively long-standing AF with an associated reduction in LVEF.

B-type Natriuretic Peptide (BNP) Is Useful in Detecting Asymptomatic Left Ventricular Dysfunction in Low-Income, Uninsured Patients

2009 ◽  
Vol 11 (3) ◽  
pp. 280-287 ◽  
Author(s):  
Aurelia Macabasco-O'Connell ◽  
Sheba Meymandi ◽  
Robert Bryg
Keyword(s):  
Natriuretic Peptide ◽  
Left Ventricular Dysfunction ◽  
Low Income ◽  
Ventricular Dysfunction ◽  
Low Cost ◽  
Systolic Dysfunction ◽  
Diagnostic Testing ◽  
Area Under The Curve ◽  
Left Ventricular ◽  
Lv Function

Low-income, uninsured individuals with multiple cardiovascular risk factors (CRFs) are at risk of heart failure (HF). B-type natriuretic peptide (BNP) screening for asymptomatic left ventricular dysfunction (ALVD) has not been tested specifically in this group. The purposes of this study were to describe BNP levels in asymptomatic low-income, uninsured individuals with multiple CRFs and determine the correlation between BNP levels and echocardiography for identifying ALVD. Methods: This correlational study included 53 patients (age 55 ± 10 years, 83% non-White, 64% female). BNP testing and echocardiogram (ECHO) were performed. Results: Of the 30 patients (57%) diagnosed with ALVD by ECHO, 21 (40%) had diastolic and 9 (17%) systolic dysfunction. BNP levels were lower among those with normal left ventricular (LV) function (29.6 ± 24 pg/mL) than those with diastolic (80.2 ± 69 pg/mL, p = .01) and systolic dysfunction (337.1 ± 374 pg/mL, p = .009). sParticipants with BNP ≥50 pg/ mL were 5.75 times more likely to exhibit diastolic dysfunction (odds ratio [OR] = 5.75, 95% confidence interval [CI] 1.29— 25.51; p < .01) and those with BNP ≥100 pg/mL were 7.80 times more likely to have systolic dysfunction (OR = 7.8, 95% CI 1.60—37.14; p < .005) than those with lower levels. With BNP cut point of 50 pg/mL, area under the curve (AUC) was 0.82 (95% CI 0.63—1.00) with sensitivity of 88% and specificity of 67%. Conclusion: BNP is a low-cost method to detect ALVD in high-risk, uninsured, low-income individuals. Elevated BNP levels should prompt initiation of further diagnostic testing and early treatment.

scholarly journals Evaluation of ventricular systolic dysfunction as a risk factor for acute kidney injury in intensive care unit

2021 ◽  
Vol 33 (1) ◽  
Author(s):  
Ahmed Aly Obiedallah ◽  
Ashraf Anwar E. L. Shazly ◽  
Noura Gamal Nasr ◽  
Essam M. Abdel Aziz
Keyword(s):  
Heart Failure ◽  
Acute Kidney Injury ◽  
Right Ventricular ◽  
Left Ventricular Dysfunction ◽  
Ventricular Dysfunction ◽  
Systolic Dysfunction ◽  
Kidney Injury ◽  
Right Ventricular Dysfunction ◽  
Left Ventricular ◽  
Ventricular Systolic Dysfunction

Abstract Background Heart failure (HF) is a major health problem. Cardiac and renal diseases interact in a complex bidirectional manner in both acute and chronic settings. Renal dysfunction in the setting of heart failure, termed the cardio renal syndrome (CRS), has been considered consequence of left ventricular dysfunction (LVD), whereby decreasing cardiac output (COP) results in renal under perfusion and consequent decreased glomerular filtration rate (GFR). Main body of the abstract This study showed that 500 patients were admitted to internal care unit (ICU), and out of them, 100 (20%) patients developed acute kidney injury (AKI) while 400 (80%) patients did not develop AKI. It is also showed that 67 (67%) of those with AKI and 100 (25%) of those with no-AKI had baseline ventricular systolic dysfunction, left ventricular dysfunction (LVD), right ventricular dysfunction (RVD), and biventricular dysfunction (BiVD)presented in 23 (23%), 16 (16%), and 28 (28%) patients of AKI group, respectively, and presented in 60 (15%), 30 (7.50%), and 10 (2.50%) patients, respectively, in patients without acute kidney injury (AKI) Short conclusion Our study revealed that AKI has highest incidence in patient with biventricular dysfunction followed by left ventricular dysfunction and lastly those with right ventricular dysfunction.

Pathophysiology and clinical assessment of the cardiovascular system (including pulmonary artery catheter)

2015 ◽  
Author(s):  
Romain Barthélémy ◽  
Etienne Gayat ◽  
Alexandre Mebazaa
Keyword(s):  
Heart Failure ◽  
Pulmonary Artery ◽  
Right Ventricular ◽  
Pulmonary Artery Catheter ◽  
Acute Heart Failure ◽  
Ventricular Dysfunction ◽  
Systolic Dysfunction ◽  
Right Ventricular Dysfunction ◽  
Left Ventricular ◽  
Haemodynamic Instability

Haemodynamic instability in acute cardiac care may be related to various mechanisms, including hypovolaemia and heart and/or vascular dysfunction. Although acute heart failure patients are often admitted for dyspnoea, many mechanisms can be involved, including left ventricular diastolic and/or systolic dysfunction and/or right ventricular dysfunction. Many epidemiological studies show that clinical signs at admission, morbidity, and mortality differ between the main scenarios of acute heart failure: left ventricular diastolic dysfunction, left ventricular systolic dysfunction, right ventricular dysfunction, and cardiogenic shock. Although echocardiography often helps to assess the mechanism of cardiac dysfunction, it cannot be considered as a monitoring tool. In some cases (in particular, in cases of refractory shock secondary to both vascular and heart dysfunction or in cases of refractory haemodynamic instability associated with severe hypoxaemia), pulmonary artery catheter can help to assess and monitor cardiovascular status and to evaluate response to treatments. Last, macro- and microvascular dysfunctions are also important determinants of haemodynamic instability.

Pathophysiology and clinical assessment of the cardiovascular system (including pulmonary artery catheterization)

2021 ◽  
pp. 115-126
Author(s):  
Alessandro Sionis ◽  
Etienne Gayat ◽  
Alexandre Mebazaa
Keyword(s):  
Heart Failure ◽  
Pulmonary Artery ◽  
Right Ventricular ◽  
Cardiovascular System ◽  
Acute Heart Failure ◽  
Ventricular Dysfunction ◽  
Systolic Dysfunction ◽  
Right Ventricular Dysfunction ◽  
Left Ventricular ◽  
Ventricular Diastolic Dysfunction

The underlying pathophysiological derangements of the cardiovascular system in many medical conditions are often complex. Acute circulatory dysfunction can be related broadly to a cardiogenic cause leading to acute heart failure or be secondary to hypovolaemia or vascular dysfunction (e.g. sepsis). Different mechanisms may be involved, including left ventricular diastolic and/or systolic dysfunction and/or right ventricular dysfunction. Many aspects of left ventricular function are explained by considering ventricular pressure–volume characteristics. Epidemiological studies show that clinical signs at admission, morbidity, and mortality differ between the main scenarios of acute heart failure: left ventricular diastolic dysfunction, left ventricular systolic dysfunction, right ventricular dysfunction, and cardiogenic shock. Although echocardiography is usually the first investigation used to assess the mechanism of cardiac dysfunction, in selected cases (in particular, in cases of refractory shock secondary to both vascular and heart dysfunction or in cases of refractory haemodynamic instability associated with severe hypoxaemia), the pulmonary artery catheter can help to assess and monitor the cardiovascular status and evaluate response to treatments.

Optimising Direct Access Echo Referral in Suspected Heart Failure

2000 ◽  
Vol 45 (2) ◽  
pp. 43-44 ◽  
Author(s):  
M. M. Lindsay ◽  
N.E.R. Goodfield ◽  
K.J. Hogg ◽  
F.G. Dunn
Keyword(s):  
Ventricular Dysfunction ◽  
Left Ventricular Systolic Dysfunction ◽  
Systolic Dysfunction ◽  
Left Ventricular ◽  
Direct Access ◽  
Lv Function ◽  
Ventricular Systolic Dysfunction ◽  
Normal Left Ventricular Function ◽  
Normal Left Ventricular ◽  
History Of

The objective was to prospectively validate a method of increasing the sensitivity, specificity and negative predictive value of a normal ECG in the exclusion of left ventricular systolic dysfunction by the addition of clinical history. We performed a prospective three year study of all referrals to our direct access ECHO service for assessment of LV function. The ECG was reported blind of the result of the ECHO, history of MI or not was noted, and result of the ECHO predicted. Over three years 416 patients were assessed for the presence or absence of left ventricular systolic dysfunction and consequent changes in clinical management. A total of 320(77%) of patients referred with suspected left ventricular dysfunction were found to have normal left ventricular function. Of the 250(60%) patients treated prior to referral for assessment, 183(73%) were treated inappropriately. The combination of a normal ECG and a negative history of myocardial infarction had a sensitivity of 98% and a negative predictive value of 99% in the assessment of LV function. This was an improvement over a normal ECG alone. Our study shows that diagnosis and treatment of heart failure in the community remains sub-optimal. The combination of a normal ECG and no previous history of myocardial infarction is shown to be a sensitive and accurate predictor of normal left ventricular function. If adopted by general practitioners this would be a valuable method of optimising the use of ECHOCARDIOGRAPHIC in patients with suspected left ventricular dysfunction.

scholarly journals Relationship Between CHA2DS2-VASc Score and Right Ventricular Dysfunction in Patients With Acute Pulmonary Thromboembolism

2018 ◽  
Vol 24 (9_suppl) ◽  
pp. 56S-62S ◽  
Author(s):  
Murat Gök ◽  
Alparslan Kurtul ◽  
Murat Harman ◽  
Meryem Kara ◽  
Muhammed Süleymanoglu ◽  
...  
Keyword(s):  
Right Ventricular ◽  
Ventricular Dysfunction ◽  
Pulmonary Thromboembolism ◽  
Left Ventricular Systolic Dysfunction ◽  
Systolic Dysfunction ◽  
Right Ventricular Dysfunction ◽  
Left Ventricular ◽  
Systolic Pulmonary Artery Pressure ◽  
Characteristic Analysis ◽  
Acute Pulmonary Thromboembolism

In this study, the association between the right ventricular dysfunction (RVD) and CHA2DS2-VASc (C: congestive heart failure or left ventricular systolic dysfunction, H: hypertension, A: age of ≥ 75 years, D: diabetes mellitus, S: previous stroke, V: vascular disease, A: age between 65 and 74 years, Sc: female gender) scores was investigated in patients with acute pulmonary thromboembolism (PTE). The patients have been assigned to 3 subgroups as massive, submassive, and nonmassive PTE. The CHA2DS2-VASc scores were calculated for all of the patients, and the scores have been classified into 3 groups as the scores between 0 and 1, the scores of 2, and the scores of 3 and over. The independent predictors of the RVD were investigated by the univariate and multivariate regression analyses. The independent predictors of the RVD were determined to be the CHA2DS2-VASc scores ( P = .034), the systolic pulmonary artery pressure ( P < .001), the presence of acute deep vein thrombosis ( P = .007), high simplified Pulmonary Embolism Severity Index ( P < .001), D-dimer ( P < .006), and the mean platelet volume ( P < .001). The CHA2DS2-VASc scores predicted the RVD with 70% sensitivity and 50% specificity as determined by the receiver operating characteristic analysis. The CHA2DS2-VASc score is an independent predictor of the RVD in patients with acute PTE.

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