scholarly journals Heart reHeart remodeling in patients with severe systolic dysfunction due tocancer chemotherapymodeling in patients with severe systolic dysfunction due tocancer chemotherapy.

Kardiologiia ◽  
2020 ◽  
Vol 60 (3) ◽  
pp. 51-58
Author(s):  
E. I. Emelina ◽  
A. A. Ibragimova ◽  
I. I. Ganieva ◽  
G. E. Gendlin ◽  
I. G. Nikitin ◽  
...  
Keyword(s):  
Systolic Dysfunction ◽  
Systolic Pressure ◽  
Left Atrial Volume ◽  
Left Ventricular ◽  
Volume Index ◽  
Idiopathic Dilated Cardiomyopathy ◽  
Left Ventricular Ejection ◽  
Pulmonary Artery Systolic Pressure ◽  
Ventricular Ejection Fraction ◽  
Men And Women

Objective Comparative analysis of structural and functional specific features of the heart in patients with toxic cardiomyopathy (TCMP) with a low left ventricular ejection fraction (LVEF) and severe, chronic heart failure (CHF) and in patients with idiopathic dilated cardiomyopathy (DCMP) and similar LVEF and CHF severity.Materials and Methods This observational, single-site study included 15 patients with TCMP (12 of them received treatment including anthracycline antibiotics and 3 patients received targeted therapies) and 26 patients with idiopathic DCMP. Data of echocardiography were compared for patients with TCMP and DCMP with comparably low LVEF of <40 %.Results In patients with severe heart damage associated with antitumor therapy with low LVEF, volumetric and linear indexes of left and right ventricles and the left atrium (left atrial volume index (LAVI), 33.7 (21.5–36.9) ml / m2; right ventricular end-diastolic dimension (RVDd), 2.49 (1.77–3.53) cm; and end-diastolic volume index (EDVI), 78.0 (58.7–90.0) ml / m2) were considerably less than in the DCMP group (LAVI, 67.1 (51.1–85.0) ml / m2; RVDd, 4.05 (3.6–4.4) cm; and EDVI, 117.85 (100.6–138.5) ml / m2, p<0.0001). Furthermore, LV wall thickness and pulmonary artery systolic pressure did not differ in these groups. Both in men and women with TCMP, LAVI and EDVI were significantly less than in men and women with DCMP.Conclusion The study showed significant differences in parameters of cardiac remodeling. In TCMP patients as distinct from DCMP patients, despite a pronounced decrease in LVEF, LV dilatation was absent or LV volumetric parameters were moderately increased with a more severe somatic status.

scholarly journals Prevalence of Pulmonary Hypertension in an Unselected Community-Based Population: A Retrospective Echocardiographic Study—RES-PH Study

2021 ◽  
Vol 11 (6) ◽  
pp. 489
Author(s):  
Egidio Imbalzano ◽  
Marco Vatrano ◽  
Alberto Lo Gullo ◽  
Luana Orlando ◽  
Alberto Mazza ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Systolic Dysfunction ◽  
Systolic Pressure ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Pulmonary Artery Systolic Pressure ◽  
Chronic Obstructive ◽  
Cross Sectional ◽  
Equal Distribution ◽  
Ventricular Ejection Fraction

Introduction. The actual prevalence of pulmonary hypertension (PH) in Italy is unknown. Echocardiography is useful in the screening of patients with suspected PH by estimation of the pulmonary artery systolic pressure (PASP) from the regurgitant tricuspid flow velocity evaluation, according to the simplified Bernoulli equation. Objectives. We aimed to evaluate the frequency of suspected PH among unselected patients. Methods. We conducted a retrospective cross-sectional database search of 7005 patients, who underwent echocardiography, to estimate the prevalence of PH, between January 2013 and December 2014. Medical and echocardiographic data were collected from a stratified etiological group of PH, using criteria of the European Society of Cardiology classifications. Results. The mean age of the study population was 57.1 ± 20.5 years, of which 55.3% were male. The prevalence of intermediate probability of PH was 8.6%, with nearly equal distribution between men and women (51.3 vs. 48.7%; p = 0.873). The prevalence of high probability of PH was 4.3%, with slightly but not significant higher prevalence in female patients (43.2 vs. 56.8%; p = 0.671). PH is predominant in patients with chronic obstructive pulmonary disease (COPD) or left ventricle (LV) systolic dysfunction and related with age. PASP was significantly linked with left atrial increase and left ventricular ejection fraction. In addition, an increased PASP was related to an enlargement of the right heart chamber. Conclusions. PH has a frequency of 4.3% in our unselected population, but the prevalence may be more relevant in specific subgroups. A larger epidemiological registry could be an adequate strategy to increase quality control and identify weak points in the evaluation and treatment of these patients.

scholarly journals Effect of rituximab on heart involvement in systemic sclerosis

2019 ◽  
Vol 56 (6) ◽  
pp. 709-715 ◽  
Author(s):  
L. A. Garzanova ◽  
L. P. Ananyeva ◽  
O. A. Koneva ◽  
O. B. Ovsyannikova
Keyword(s):  
Systemic Sclerosis ◽  
Lung Function ◽  
Time Course ◽  
Systolic Pressure ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Pulmonary Artery Systolic Pressure ◽  
Ventricular Ejection Fraction ◽  
Heart Involvement ◽  
One Year

As of now, there has been a great body of data on the use of rituximab (RTM) in systemic sclerosis (SS), mainly on its positive effect on skin fibrosis and lung injury. However, information is still scarce about the effect of RTM on other organs and systems, namely the heart affected by SS.Objective: to assess the time course of changes in the signs of heart involvement in SS patients one year after initiation of RTM therapy.Subjects and methods. The paper gives data on changes in cardiac disorders in 71 patients with SS one year after the prescription of RTM.Results and discussion. The rate of cardiac rhythm and conduction disorders and diastolic dysfunction was unchanged. At the same time, a significant increase in left ventricular ejection fraction (EF) and a reduction in the severity of dyspnea was achieved, which correlated with improved lung function (a significant rise in forced vital capacity). The results of treatment in three patients with predominant heart involvement associated with SS (coronary heart disease and hypertension were ruled out) were considered in detail. These patients displayed pronounced positive changes as increased EF, less severe cardiac arrhythmias, reduced chronic heart failure, better quality of life, as well as the synchronicity of lower disease activity, less skin induction, improved lung function, and stabilized pulmonary artery systolic pressure.Conclusion. RTM in combination with traditional therapy can be considered as a potentially effective drug for the treatment of heart involvement in SS.

scholarly journals Estimation of possible candidates for ivabradine in rural Japan and investigation of their clinical characteristics

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
M Saito ◽  
M Kinoshita ◽  
H Nakagawa ◽  
T Sumimoto
Keyword(s):  
Ejection Fraction ◽  
Clinical Characteristics ◽  
Sinus Node ◽  
Stable Condition ◽  
Left Atrial Volume ◽  
Stroke Volume Index ◽  
Left Ventricular ◽  
Volume Index ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction

Abstract Background In Japan, ivabradine is indicated in patients with heart failure (HF) with sinus rhythm and a resting heart rate (HR) ≥75/min under standard treatment. Particularly, it is effective for HF with reduced left ventricular ejection fraction (LVEF). However, elderly people have a higher incidence of atrial fibrillation than young people, and their sinus node function is further deteriorated, resulting in a lower intrinsic HR. In addition, Japan is an ultra-aging society, especially in the countryside; therefore, the target patients for ivabradine may be limited in these regions. Purpose We sought to estimate the possible candidates for ivabradine and investigate their clinical characteristics in our hospital located in rural Japan. Method and results We retrospectively studied 14733 consecutive patients who were suspected heart disease who underwent echocardiography between January 2006 and October 2018 in Kitaishikai Hospital located in Ozu city (Proportion of the population aged ≥65 years: 34%, in 2015) and did not take ivabradine treatment. Of these, 187 patients with hemodynamically stable condition whose E/A ratio was measured and met the criteria of LVEF &lt;40% and HR ≥75 /min were confirmed. Of these, 153 patients reached HR &lt;75 /min with additional intensive medication within one year after the index echocardiography (Controlled group; mean HR: 82 to 62/min). The remaining 34 patients with uncontrolled HR (Uncontrolled group; mean HR: 84 to 82/min) were considered possible candidates for ivabradine (34/14733: 0.23%, 2.6 patients per year; median age, 74 years; male, 56%; median LVEF, 32%; ischemic cardiomyopathy, 53%). In the comparison of clinical and echocardiographic parameters in these two groups, Uncontrolled group had a significantly smaller left ventricular diastolic volume index (71 [59–85] vs 82 [66–109] /ml/m2, p=0.02), left ventricular systolic volume index (50 [39–59] vs 59 [42–80] / ml/m2, p=0.04), stroke volume index (22 [18–26] vs 26 [20–32] /ml/m2, p=0.02), left atrial volume index (47 [40–64] vs 59 [45–71] /ml/m2, p=0.02), and more hemodialysis (12 vs 3%, p=0.04) than Controlled group. However, the discrimination ability of these parameters for identifying Uncontrolled group was modest (Figure). Conclusion In rural Japan, possible candidates for ivabradine may be rare, so daily attention should be paid. Patients with reduced ejection fraction, small left ventricle, and hemodialysis may be the possible targets for this therapy. FUNDunding Acknowledgement Type of funding sources: None.

scholarly journals The effect of spironolactone on diastolic function in haemodialysis patients

2021 ◽  
Author(s):  
T. Hauser ◽  
◽  
V. Dornberger ◽  
U. Malzahn ◽  
S. J. Grebe ◽  
...  
Keyword(s):  
Ejection Fraction ◽  
Diastolic Function ◽  
Left Atrial Volume ◽  
Left Ventricular ◽  
Volume Index ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Left Atrial Volume Index ◽  
Maintenance Haemodialysis ◽  
Significant Difference

AbstractHeart failure with preserved ejection fraction (HFpEF) is highly prevalent in patients on maintenance haemodialysis (HD) and lacks effective treatment. We investigated the effect of spironolactone on cardiac structure and function with a specific focus on diastolic function parameters. The MiREnDa trial examined the effect of 50 mg spironolactone once daily versus placebo on left ventricular mass index (LVMi) among 97 HD patients during 40 weeks of treatment. In this echocardiographic substudy, diastolic function was assessed using predefined structural and functional parameters including E/e’. Changes in the frequency of HFpEF were analysed using the comprehensive ‘HFA-PEFF score’. Complete echocardiographic assessment was available in 65 individuals (59.5 ± 13.0 years, 21.5% female) with preserved left ventricular ejection fraction (LVEF > 50%). At baseline, mean E/e’ was 15.2 ± 7.8 and 37 (56.9%) patients fulfilled the criteria of HFpEF according to the HFA-PEFF score. There was no significant difference in mean change of E/e’ between the spironolactone group and the placebo group (+ 0.93 ± 5.39 vs. + 1.52 ± 5.94, p = 0.68) or in mean change of left atrial volume index (LAVi) (1.9 ± 12.3 ml/m2 vs. 1.7 ± 14.1 ml/m2, p = 0.89). Furthermore, spironolactone had no significant effect on mean change in LVMi (+ 0.8 ± 14.2 g/m2 vs. + 2.7 ± 15.9 g/m2; p = 0.72) or NT-proBNP (p = 0.96). Treatment with spironolactone did not alter HFA-PEFF score class compared with placebo (p = 0.63). Treatment with 50 mg of spironolactone for 40 weeks had no significant effect on diastolic function parameters in HD patients.The trial has been registered at clinicaltrials.gov (NCT01691053; first posted Sep. 24, 2012).

scholarly journals Multimarker approach for assessing efficiency of cardiac resynchronization therapy in patients with sinus rhythm

2021 ◽  
Vol 28 ◽  
pp. 17-24
Author(s):  
V. A. Kuznetsov ◽  
T. N. Enina ◽  
A. M. Soldatova ◽  
T. I. Petelina ◽  
S. M. Dyachkov ◽  
...  
Keyword(s):  
Cardiac Resynchronization Therapy ◽  
Sinus Rhythm ◽  
Complex Analysis ◽  
Systolic Pressure ◽  
Left Ventricular ◽  
Cardiac Resynchronization ◽  
Left Ventricular Ejection ◽  
Pulmonary Artery Systolic Pressure ◽  
Resynchronization Therapy ◽  
Ventricular Ejection Fraction

Purpose. To design a mathematical model, that can predict a positive response to cardiac resynchronization therapy (CRT) in patients with congestive heart failure (CHF) and sinus rhythm, according to complex analysis of neurohumoral and immune activation biomarkers, fibrosis, renal dysfunction, echocardiography.Methods. Parameters of echocardiography, plasma levels of NT-proBNP, interleukins-1β, 6, 10, tumor necrosis factor α, С-reactive protein (СRP), matrix metalloproteinase-9 (ММР-9), tissue inhibitors of metalloproteinase 1 and 4, cystatin С (CYSTATIN) were studied in 40 CHF patients with sinus rhythm (65% coronary artery disease patients, 75% males, mean age 54.8±10.6 years old) during the period of maximum decrease of left ventricular end-systolic volume (LVESV) (mean duration 27.5 [11.1; 46.3] months). Responders (decrease in LVESV ≥15%) and non-responders (decrease in LVESV <15%) were identified.Results. The number of responders was 26 (65%). The initial set of variables included: age, left ventricular ejection fraction (EF), pulmonary artery systolic pressure, right ventricle size and NT-proBNP, СRP, ММР-9, CYSTATIN. According to logistic regression analysis, a prediction model of positive CRT response was created. The specificity of the model was 92.9%, sensitivity - 83.3%, AUC=0.952 (р˂0.001).Conclusion. The proposed model, based on the assessment of left ventricle EF and circulating biomarkers of inflammation, fibrosis, and renal function, strongly suggests a higher possibility of response to CRT.

P3427Prognostic performance of echocardiography, electrocardiogram, albuminuria, plasma proBNP and hs-TnI in patients with type 2 diabetes

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
N Busch ◽  
M T Jensen ◽  
J P Goetze ◽  
T Biering-Soerensen ◽  
T Fritz-Hansen ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Left Atrial Volume ◽  
Left Ventricular ◽  
Volume Index ◽  
Left Ventricular Ejection ◽  
Composite Outcome ◽  
Risk Markers ◽  
Ventricular Ejection Fraction ◽  
Clinical Variables

Abstract Background A range of diagnostic tests including echocardiography, albuminuria, electrocardiogram (ECG), plasma measurement of high sensitivity troponin T (hs-TnI) and pro-brain natriuretic peptide (proBNP) have been suggested as cardiovascular (CV) risk predictors in patients with type 2 diabetes. In this study we examined prognostic yield from these risk markers. Methods A total of 1,030 out-patients followed at a large secondary care diabetes clinic were recruited. Echocardiography was considered feasible in patients in sinus rhythm with adequate image quality (n=886). Abnormal echocardiography was defined as a left ventricular ejection fraction (LVEF) <50%; a ratio of early diastolic mitral inflow velocity to early diastolic septal annular velocity (E/e'septal) ≥15; increased left ventricular mass index (>95 g/m2 for women and >115 g/m2 for men) or left atrial volume index >34 ml/m2. ECG was performed in 983 patients and was considered abnormal in the presence of abnormal Q-waves; ST-T segment deviation or bundle branch block. We measured urine albumin (n=1,009) and proBNP/hs-TnI (n=933). The end-point of CV event was a composite of CV death and hospitalization with myocardial infarction/revascularization, stroke, peripheral artery disease or heart failure. Results The median follow-up was 4.7 years (interquartile range: 4.0 to 5.3) and 174 patients suffered an CVD event. All markers except hs-TnI were significantly (p<0.001) associated with the composite outcome: Abnormal echocardiogram: Hazard ratio (95% confidence interval): 2.39 (1.69–3.37); albuminuria 2.01 (1.47–2.76); abnormal ECG 2.35 (1.72–3.21); log2(proBNP) 1.60 (1.47–1.75) and hs-TnI 1.05 (0.92–1.19). The findings persisted after adjusting for clinical variables, but after adjusting for the other markers, only log2(proBNP) remained associated with the composite outcome (1.50 (0.20–1.73), p<0.001), figure. Measured by C-index model performance was highest with proBNP (0.70 (0.65–0.75)) and similar to clinical variables (0.71 (0.67–0.76)). Combining risk markers only resulted in very limited increase in C-index (echocardiogram, albuminuria, ECG and proBNP: 0.71 (0.66–0.76)). Uni- and multivariables Conclusions This study identifies proBNP measurement in plasma over echocardiography, ECG and albuminuria for risk prediction in patients with type 2 diabetes. The diagnostic yield in considering more than one risk marker was limited in this population.

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