scholarly journals Revascularization for Stable Chronic Total Occlusion is Essential for Diabetic Patient with Heart Failure

2019 ◽  
Author(s):  
Yunfeng Yan ◽  
Mingduo Zhang ◽  
Zhuo Ma ◽  
Zilong Zhang ◽  
Fei Yuan ◽  
...  
Keyword(s):  
Heart Failure ◽  
Subgroup Analysis ◽  
Chronic Total Occlusion ◽  
Treatment Strategies ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Diabetic Patients ◽  
Cardiac Events ◽  
Total Occlusion ◽  
Ventricular Ejection Fraction

Abstract Background Revascularization is the recommended treatment strategy for patients with heart failure (HF) and coronary artery disease (CAD). However, chronic total occlusion (CTO) is less attempt. Furthermore, there were conflicting debates on if diabetic HF patients gained benefits from revascularization. As to CTO revascularization, no study answered if it offered benefits to diabetic HF patients. Methods Diabetic patients with stable CTO and HF were consecutively enrolled in this retrospective cohort study. Based on treatment strategies to the CTO vessel, patients were assigned to successful revascularization (CTO-SR) or medical therapy (CTO-MT) group. The primary endpoints were major adverse cardiac events (MACE). Subgroup analysis were performed based on left ventricular ejection fraction (LVEF) and relevant baseline variables. Results A population of 680 patients were enrolled in the present study: 344 patients in the CTO-MT group, and 336 patients in the CTO-SR group. After a median follow-up of 34 months, CTO-SR was superior to CTO-MT in MACE (adjusted hazard ratio [HR]: 0.462, 95% conference interval [CI]: 0.337-0.634), which could mainly due to the superiority in cardiac-death and TVR. Propensity matching analysis also confirmed CTO-SR’s superiority (HR: 0.494 [0.337-0.725]). Subgroup analysis further confirmed a consistent superiority in patients with LVEF≥40%, but not in those with LVEF<40%.Conclusions For patients with diabetes, HF and stable CTO, CTO-SR was superior to CTO-MT. CTO-SR’s superiority was consistent in patients with LVEF≥40%, but not for patients with LVEF<40%. Trial registration This study was not registered in an open access database.

Hypertension and diabetes

ESC CardioMed ◽  
2018 ◽  
pp. 445-447
Author(s):  
Laura Ernande
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Diastolic Dysfunction ◽  
Prognostic Value ◽  
Hypertensive Heart Disease ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Diabetic Patients ◽  
Cardiac Events ◽  
Ventricular Ejection Fraction

Both hypertension and diabetes mellitus (DM) are risk factors for coronary artery disease, resulting in a high risk of heart failure. They also directly impact the heart, leading to hypertensive heart disease and diabetic cardiomyopathy and also potentially causing heart failure. The hypertensive heart is characterized by left ventricular hypertrophy and frequently left atrial dilation. DM is also associated with an increased left ventricular mass. Left ventricular hypertrophy has an important prognostic value both in hypertensive and diabetic patients and may regress with antihypertensive medications. The differential diagnosis between hypertensive heart disease and hypertrophic cardiomyopathy can be sometimes challenging and requires a careful evaluation of the echocardiogram but also of the family history, electrocardiographic abnormalities, or the location of late gadolinium enhancement on cardiovascular magnetic resonance imaging. Hypertension and DM also influence ageing-related left ventricular remodelling. Diastolic dysfunction is frequent both in hypertensive and diabetic patients and is predictive of cardiac events and heart failure. However, diastolic dysfunction in diabetic patients seems to be more associated with age and co-morbidities such as obesity and hypertension than with DM itself. The presence of diastolic dysfunction predicts cardiac events and heart failure in those patients. Both hypertension and DM are risk factors for heart failure with preserved but also with reduced and mid-range ejection fraction. Therefore, left ventricular ejection fraction is a major parameter to evaluate in those patients. Myocardial strain is decreased both in hypertensive and in diabetic patients with normal left ventricular ejection fraction allowing the detection of subclinical systolic alteration and providing incremental prognostic value.

Predicting mortality for patients with heart failure beyond oxygen consumption: a prognostic risk score

2021 ◽  
Author(s):  
Hanaa Shafiek ◽  
Andres Grau ◽  
Jaume Pons ◽  
Pere Pericas ◽  
Xavier Rossello ◽  
...  
Keyword(s):  
Heart Failure ◽  
Chronic Heart Failure ◽  
Risk Score ◽  
Cardiac Transplantation ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Functional Evaluation ◽  
Cardiac Events ◽  
Ventricular Ejection Fraction

Background: Cardiopulmonary exercise test (CPET) is a crucial tool for the functional evaluation of cardiac patients. We hypothesized that VO2 max and VE/VCO2 slope are not the only parameters of CPET able to predict major cardiac events (mortality or cardiac transplantation urgently or elective). Objectives: We aimed to identify the best CPET predictors of major cardiac events in patients with severe chronic heart failure and to propose an integrated score that could be applied for their prognostic evaluation. Methods: We evaluated 140 patients with chronic heart failure who underwent CPET between 2011 and 2019. Major cardiac events were evaluated during follow-up. Univariate and multivariate logistic regression analysis were applied to study the predictive value of different clinical, echocardiographic and CPET parameters in relation to the major cardiac events. A score was generated and c-statistic was used for the comparisons. Results: Thirty-nine patients (27.9%) died or underwent cardiac transplantation over a median follow-up of 48 months. Five parameters (maximal workload, breathing reserve, left ventricular ejection fraction, diastolic dysfunction and non-idiopathic cardiomyopathy) were used to generate a risk score that had better risk discrimination than NYHA dyspnea scale, VO2 max, VE/VCO2 slope > 35 alone, and combined VO2 max and VE/VCO2 slope (p= 0.009, 0.004, < 0.001 and 0.005 respectively) in predicting major cardiac events. Conclusions: A composite score of CPET and clinical/echocardiographic data is more reliable than the single use of VO2max or combined with VE/VCO2 slope to predict major cardiac events.

P1964Impact of successful coronary intervention for chronic total occlusion on long-term clinical outcome of patients with impaired and preserved left ventricular ejection fraction

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
H Tanaka ◽  
T Tada ◽  
Y Fuku ◽  
T Goto ◽  
K Kadota
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Chronic Total Occlusion ◽  
Coronary Intervention ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Total Occlusion ◽  
Ventricular Ejection Fraction ◽  
Percutaneous Coronary ◽  
Procedural Success

Abstract Background Successful recanalisation of percutaneous coronary intervention for chronic total occlusion lesions has been associated with improved survival. Purpose This study aimed to assess the impact of successful percutaneous coronary intervention for chronic total occlusion lesions on the long-term outcome of patients with impaired and preserved left ventricular ejection fraction (LVEF). Methods The study sample consisted of 842 consecutive patients (928 chronic total occlusion lesions) undergoing percutaneous coronary intervention at our institution between October 2005 and December 2009. We divided them into 3 groups by the degree of LVEF: less than 40% (severely reduced LVEF, n=140), 40% to 59% (moderately reduced LVEF, n=470), and 60% and above (normal LVEF, n=232). We evaluated mortality during the 10-year follow-up period the basis of procedural success and failure. Results The overall procedural success rate was 89.1%. Median follow-up duration was 7.9 years. The 10-year cumulative incidences of cardiac death in each degree of LVEF are shown in the Figure. Conclusions Successful recanalisation for chronic total occlusion lesions in patients with impaired LVEF may be associated with reduced cardiac mortality.

scholarly journals Prognostic significance of cardiac I-123-metaiodobenzylguanidine imaging in patients with reduced, mid-range, and preserved left ventricular ejection fraction admitted for acute decompensated heart failure: a prospective study in Osaka Prefectural Acute Heart Failure Registry (OPAR)

2020 ◽  
Vol 22 (1) ◽  
pp. 58-66 ◽  
Author(s):  
Masahiro Seo ◽  
Takahisa Yamada ◽  
Shunsuke Tamaki ◽  
Tetsuya Watanabe ◽  
Takashi Morita ◽  
...  
Keyword(s):  
Heart Failure ◽  
Left Ventricular Ejection Fraction ◽  
Ejection Fraction ◽  
Acute Decompensated Heart Failure ◽  
Decompensated Heart Failure ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Mibg Imaging ◽  
Cardiac Events ◽  
Ventricular Ejection Fraction

Abstract Aims Cardiac 123I-metaiodobenzylguanidine (123I-MIBG) imaging provides prognostic information in patients with chronic heart failure (HF). However, there is little information available on the prognostic role of cardiac 123I-MIBG imaging in patients admitted for acute decompensated heart failure (ADHF), especially relating to reduced ejection fraction [HFrEF; left ventricular ejection fraction (LVEF) &lt; 40%], mid-range ejection fraction (HFmrEF; 40% ≤ LVEF &lt; 50%) and preserved ejection fraction (HFpEF; LVEF ≥ 50%). Methods and results We studied 349 patients admitted for ADHF and discharged with survival. Cardiac 123I-MIBG imaging, echocardiography, and venous blood sampling were performed just before discharge. The cardiac 123I-MIBG heart-to-mediastinum ratio (late H/M) was measured on the chest anterior view images obtained at 200 min after the isotope injection. The endpoint was cardiac events defined as unplanned HF hospitalization and cardiac death. During a follow-up period of 2.1 ± 1.4 years, 128 patients had cardiac events (45/127 in HFrEF, 28/78 in HFmrEF, and 55/144 in HFpEF). On multivariable Cox analysis, late H/M was significantly associated with cardiac events in overall cohort (P = 0.0038), and in subgroup analysis of each LVEF subgroup (P = 0.0235 in HFrEF, P = 0.0119 in HFmEF and P = 0.0311 in HFpEF). Kaplan–Meier analysis showed that patients with low late H/M (defined by median) had significantly greater risk of cardiac events in overall cohort (49% vs. 25% P &lt; 0.0001) and in each LVEF subgroup (HFrEF: 48% vs. 23% P = 0.0061, HFmrEF: 51% vs. 21% P = 0.0068 and HFpEF: 50% vs. 26% P = 0.0026). Conclusion Cardiac sympathetic nerve dysfunction was associated with poor outcome in ADHF patients irrespective of HFrEF, HFmrEF, or HFpEF.

scholarly journals Reduction in Left Ventricular Ejection Fraction is Associated with Subsequent Cardiac Events in Outpatients with Chronic Heart Failure

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Yoshitaka Okuhara ◽  
Masanori Asakura ◽  
Yoshiyuki Orihara ◽  
Daisuke Morisawa ◽  
Yuki Matsumoto ◽  
...  
Keyword(s):  
Heart Failure ◽  
Left Ventricular Ejection Fraction ◽  
Ejection Fraction ◽  
Left Ventricular ◽  
Ventricular Ejection ◽  
Left Ventricular Ejection ◽  
Operating Characteristics ◽  
Cardiac Events ◽  
Ventricular Ejection Fraction ◽  
Significant Difference

AbstractLeft ventricular ejection fraction (LVEF) is critical for determining the prognosis and treatment of patients with heart failure (HF). However, the influence of serial LVEF changes in patients with stable chronic HF (CHF) has not yet been completely investigated. We analyzed data of 263 outpatients with CHF from the J-MELODIC study cohort and evaluated the frequency of cardiac events. We stratified patients into tertiles based on the relative difference in LVEF in 1 year and that at baseline. We found a significant difference in the cardiac event rate among the three groups (log-rank test, p = 0.042). We identified a relative 11% LVEF reduction as the optimal cutoff value based on the receiver operating characteristics analysis. LVEF (OR, 1.04; 95% CI, 1.01–1.07; p = 0.015) and E/e′ (OR, 1.06; 95% CI, 1.01–1.12; p = 0.023) at baseline were predictors of >11% LVEF reduction. After adjusting the variables including age and sex, >11% LVEF reduction was an independent predictor of subsequent cardiac events (HR, 5.79; 95% CI, 2.49–13.2; p < 0.001). In conclusion, patients with 1-year relative >11% LVEF reduction may have subsequent worsening outcomes. Such patients should be carefully followed-up as high risk population for development of cardiac events.

scholarly journals Combined effects of ARNI and SGLT2 inhibitors in diabetic patients with heart failure with reduced ejection fraction

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Hyue Mee Kim ◽  
In-Chang Hwang ◽  
Wonsuk Choi ◽  
Yeonyee E. Yoon ◽  
Goo-Yeong Cho
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Cardiovascular Mortality ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Diabetic Patients ◽  
Ventricular Ejection Fraction ◽  
Reduced Ejection Fraction ◽  
Patients With Heart Failure ◽  
Group 1

AbstractAngiotensin receptor-neprilysin inhibitor (ARNI) and sodium–glucose co-transporter-2 inhibitor (SGLT2i) have shown benefits in diabetic patients with heart failure with reduced ejection fraction (HFrEF). However, their combined effect has not been revealed. We retrospectively identified diabetic patients with HFrEF who were prescribed an ARNI and/or SGLT2i. The patients were divided into groups treated with both ARNI and SGLT2i (group 1), ARNI but not SGLT2i (group 2), SGLT2i but not ARNI (group 3), and neither ARNI nor SGLT2i (group 4). After propensity score-matching, the occurrence of hospitalization for heart failure (HHF), cardiovascular mortality, and changes in echocardiographic parameters were analyzed. Of the 206 matched patients, 92 (44.7%) had to undergo HHF and 43 (20.9%) died of cardiovascular causes during a median 27.6 months of follow-up. Patients in group 1 exhibited a lower risk of HHF and cardiovascular mortality compared to those in the other groups. Improvements in the left ventricular ejection fraction and E/e′ were more pronounced in group 1 than in groups 2, 3 and 4. These echocardiographic improvements were more prominent after the initiation of ARNI, compare to the initiation of SGLT2i. In diabetic patients with HFrEF, combination of ARNI and SGT2i showed significant improvement in cardiac function and prognosis. ARNI-SGLT2i combination therapy may improve the clinical course of HFrEF in diabetic patients.

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