Myocardial Deformation Parameters Assessed By CMR Feature Tracking In Chronic Heart Failure: The Influence of An Optimal Medical Therapy On Myocardial Remodeling

2021 ◽  
Author(s):  
Johannes Kersten ◽  
Carsten Hackenbroch ◽  
Paula Gann ◽  
Anna-Sophie Hoestermann ◽  
Peter Bernhardt
Keyword(s):  
Heart Failure ◽  
Chronic Heart Failure ◽  
Right Ventricular ◽  
Medical Therapy ◽  
Feature Tracking ◽  
Left Ventricular ◽  
Optimal Medical Therapy ◽  
Myocardial Deformation ◽  
Reverse Remodeling ◽  
Deformation Parameters

Abstract Background: Myocardial deformation parameters have been shown to yield early detection of pathological changes in chronic heart failure (CHF). Aim of our study was to evaluate myocardial deformation changes under optimal medical therapy (OMT) in CHF patients.Methods: CHF patients were examined longitudinally with two cardiac magnetic resonance imaging (CMR) examinations at a median time interval of 140 days. Left and right ventricular volumes were quantified, and deformation analysis was performed using feature tracking, respectively.Results: 57 patients were included into the study. There was a high rate of OMT with a prescription of beta blockers in 98.2% and ACE-inhibitors/Angiotensin receptor blockers in 93.0%. In the total cohort, there were indications of positive remodeling with a significant improvement in left ventricular (LV) ejection fraction (38.9% ± 11.6 vs. 43.0% ± 12.7, p=0.009), LV enddiastolic volume indexed (92.1ml/m2 ± 23.5 vs. 87.2ml/m2 ± 21.2, p=0.007), LV mass (140.3g ± 35.7 vs. 128.0g ± 34.4, p=0.001) and right ventricular global longitudinal strain (RV GLS) (-18.1% ± 5.1 vs. -20.3% ± 4.5, p<0.001) during follow-up. Discussion: Patients with CHF and OMT show positive reverse remodeling with improvement of LV volumes and function and RV GLS. This has a potential impact on the surveillance of this patient group, which should be further investigated in larger prospective studies.

The RightSTEPS initiative: Continuing education impact on clinicians’ optimal medical therapy practices for chronic heart failure

2020 ◽  
pp. 1-8
Author(s):  
Priya Wanchoo ◽  
Ellen L. Cohen ◽  
Kathleen Donnelly-Bensalah ◽  
Katherine E. Stone ◽  
Margot Embree Fisher ◽  
...  
Keyword(s):  
Heart Failure ◽  
Chronic Heart Failure ◽  
Continuing Education ◽  
Medical Therapy ◽  
Optimal Medical Therapy

scholarly journals Chronic Heart Failure in Rheumatoid Arthritis Patients (Part II): Difficulties of Diagnosis

2019 ◽  
Vol 14 (6) ◽  
pp. 870-878 ◽  
Author(s):  
D. S. Novikova ◽  
H. V. Udachkina ◽  
I. G. Kirillova ◽  
T. V. Popkova
Keyword(s):  
Rheumatoid Arthritis ◽  
Heart Failure ◽  
Chronic Heart Failure ◽  
Ejection Fraction ◽  
Natriuretic Peptides ◽  
Myocardial Dysfunction ◽  
Left Ventricular ◽  
Myocardial Deformation ◽  
Left Ventricular Ejection

Rheumatoid arthritis (RA) is characterized by a twofold increase in morbidity and mortality due to chronic heart failure (CHF). At the same time, the prevalence of CHF among RA patients is significantly underestimated. The aim of the review was to analyze the results of the main studies on the features of the clinical presentation of heart failure (HF) in RA patients, the role of visualization techniques and biomarkers in the diagnosis of HF and preclinical dysfunction of the myocardium. HF in patients with RA is characterized by a predominance of HF with a preserved left ventricular ejection fraction (LVEF). The use of clinical diagnostic criteria in RA patients can lead to both over- or underdiagnosis of CHF. Systolic dysfunction estimated by LVEF is rare in RA and does not reflect the real frequency of myocardial dysfunction. Echocardiography (ECHO-CG) with tissue Doppler echocardiography (TDE) and visualization of myocardial deformation, magnetic resonance imaging (MRI) of the heart in RA patients revealed a high frequency of HF with preserved ejection fraction, left ventricular remodeling and hypertrophy, pre-clinical systolic and diastolic dysfunction. Determination of natriuretic peptides is useful for verifying the diagnosis of HF and estimating the prognosis in this cohort, despite the possible decrease in the sensitivity and specificity of these indicators in RA patients. The review discusses the advantages of MRI of the heart, including quantitative T1 and T2 regimens, in the diagnosis of myocarditis, myocardial fibrosis, and myocardial perfusion disorders in RA patients. In order to verify the diagnosis of heart failure and detect pre-clinical myocardial dysfunction in RA patients, the determination of natriuretic peptides concentration should become part of the routine examination, beginning with the debut of the disease, along with the collection of a cardiological history, physical examination, ECHO-CT with TDE, and visualization of myocardial deformation. Evaluation of the quantitative characteristics of tissue according to MRI of the heart could improve the diagnosis of myocardial damage.

Abstract 11087: Autoantibody Titer Directed Against β1-Adrenergic Receptors is a Predictor of Reverse Remodeling During Carvedilol Therapy for Chronic Heart Failure: Japanese Chronic Heart Failure (J-CHF) Study

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Yuji Nagatomo ◽  
Tsutomu Yoshikawa ◽  
Hiroshi Okamoto ◽  
Akira Kitabatake ◽  
Masatsugu Hori ◽  
...  
Keyword(s):  
Heart Failure ◽  
Chronic Heart Failure ◽  
Adrenergic Receptors ◽  
High Titer ◽  
Left Ventricular ◽  
Idiopathic Dilated Cardiomyopathy ◽  
Left Ventricular Ejection ◽  
Reverse Remodeling ◽  
Ventricular Ejection Fraction ◽  
Lv Volume

Introduction: Autoimmune disorder is one of the features characterizing congestive heart failure (CHF) not only due to idiopathic dilated cardiomyopathy, but due to other etiologies. Autoantibody directed against β1-adrenergic receptors (β1-AAb) exerts agonist-like action inducing receptor uncoupling, and elicits persistent myocardial damage. We, therefore, attempted to determine the significance of β1-AAb in patients with CHF who received β-blocker carvedilol in the substudy of J-CHF study. Methods: In this prospective, randomized, multicenter trial, 117 patients (left ventricular ejection fraction [LVEF] ≤ 40%) with mild to moderate CHF were assigned to 2.5mg/5mg/20mg (n=38/36/43) carvedilol groups according to the target dose. Sera were collected at baseline and β1-AAb titer was determined using ELISA. Results: ELISA showed 66 patients as negative and 36/7/7/1 patients as 20-fold (x20) / x40 / x80 / x160 positive, respectively. When the study population was divided into β1-AAb high titer (≥ x40, H) and low titer (≤ x20, L) groups, there were no significant differences in vital signs or cardiac function at baseline between 2 groups. The % change of LVEF during 56 weeks after carvedilol introduction (ΔLVEF) was significantly larger in H than L (H, +85±78% vs. L, +43±65%, p=0.04). LV end-diastolic volume (LVEDV) and end-systolic volume (LVESV) decreased to a greater extent in H than L during 56 weeks (LVEDV, 182±50 to 119±43 ml vs. 202±52 to 167±58 ml, p<0.005 by ANOVA; LVESV, 136±47 to 62±36 ml vs. 141±47 to 97±53 ml, p=0.048 by ANOVA). β1-AAb titer was significantly correlated with ΔLVEF and the % change of LV volume (LVEF, r=0.24, p=0.02; LVEDV, r=-0.26, p=0.02; LVESV r=-0.27, p=0.01). Multiple regression analysis demonstrated that β1-AAb titer was an independent predictor of ΔLVEF and the % changes of LV volume after adjusting for age, gender, allocated dose of carvedilol, heart rate at baseline, plasma BNP at baseline, etiology of CHF and the presence of atrial fibrillation (ΔLVEF β=0.286, p=0.01; ΔLVEDV β=-0.227, p=0.04; ΔLVESV, β=-0.250, p=0.02). Conclusions: The findings in the present study suggested that β1-AAb has a crucial role as one of the determinants of reverse remodeling during carvedilol therapy for patients with CHF.

scholarly journals Predictive value of 3D left ventricular myocardial deformation parameters after Acute Coronary Syndrome (ACS) in the development of heart failure

2013 ◽  
Vol 34 (suppl 1) ◽  
pp. 5858-5858
Author(s):  
C. Moreno Vinues ◽  
E. Casas Rojo ◽  
D. Becker ◽  
C. Fernandez-Golfin ◽  
L. Salido Tahoces ◽  
...  
Keyword(s):  
Heart Failure ◽  
Acute Coronary Syndrome ◽  
Predictive Value ◽  
Left Ventricular ◽  
Myocardial Deformation ◽  
Coronary Syndrome ◽  
Deformation Parameters
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