scholarly journals Pulmonary Hypertension in Elderly Patients with Diastolic Dysfunction and Preserved Ejection Fraction

2012 ◽  
Vol 6 (1) ◽  
pp. 1-8 ◽  
Author(s):  
Majid Afshar ◽  
Fareed Collado ◽  
Rami Doukky
Keyword(s):  
Heart Failure ◽  
Pulmonary Hypertension ◽  
Ejection Fraction ◽  
Elderly Patients ◽  
Diastolic Dysfunction ◽  
Pulmonary Vascular Resistance ◽  
Vascular Resistance ◽  
The Elderly ◽  
Preserved Ejection Fraction ◽  
The Mean

Purpose:Patients with diastolic dysfunction may have a disproportionate degree of elevation in pulmonary pressure, particularly in the elderly. Higher pulmonary vascular resistance in the elderly patients with heart failure but preserved ejection fraction suggests that beyond the post-capillary contribution of pulmonary venous congestion, a pre-capillary component of pulmonary arterial hypertension occurs. We aim to identify if pulmonary vascular resistance in elderly patients with diastolic dysfunction is disproportionately higher than patients with systolic dysfunction independent of filling pressures.Methods:389 patients identified retrospectively between 2003- 2010; elderly with preserved ejection fraction, elderly with depressed ejection fraction, and primary arterial hypertension who underwent right-heart catheterization at Rush University.Results:No significant difference in pulmonary vascular resistance between systolic and diastolic dysfunction. The mean difference in pulmonary vascular resistance was not statistically significant at 0.40 mmHg·min/l (95% CI -3.03 to 3.83) with similar left ventricular filling pressures with mean difference of 3.38 mmHg (95% CI, -1.27 to 8.02). When adjusted for filling pressures, there remained no difference in pulmonary vascular resistance for systolic and diastolic dysfunction. The mean pulmonary vascular resistance is more elevated in systolic heart failure compared to diastolic heart failure with means 3.13 mmHg·min/l and 3.52 mmHg·min/l, respectively.Conclusion:There was no other association identified for secondary pulmonary hypertension other than diastolic dysfunction and chronic venous pulmonary hypertension. Our results argue against any significant arterial remodeling that would lead to disproportionate pre-capillary hypertension, and implies that treatment should focus on lowering filling pressure rather than treating the pulmonary vascular tree.

scholarly journals Validation of the 2016 ASE/EACVI Guideline for Diastolic Dysfunction in Patients With Unexplained Dyspnea and a Preserved Left Ventricular Ejection Fraction

2021 ◽  
Author(s):  
Arno A. van de Bovenkamp ◽  
Vidya Enait ◽  
Frances S. de Man ◽  
Frank T. P. Oosterveer ◽  
Harm Jan Bogaard ◽  
...  
Keyword(s):  
Heart Failure ◽  
Pulmonary Hypertension ◽  
Ejection Fraction ◽  
Diastolic Dysfunction ◽  
Diastolic Function ◽  
Diagnostic Performance ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Preserved Ejection Fraction ◽  
Ventricular Ejection Fraction

Background Echocardiography is considered the cornerstone of the diagnostic workup of heart failure with preserved ejection fraction. Thus far, validation of the 2016 American Society of Echocardiography/European Association of Cardiovascular Imaging (ASE/EACVI) echo‐algorithm for evaluation of diastolic (dys)function in a patient suspected of heart failure with preserved ejection fraction has been limited. Methods and Results The diagnostic performance of the 2016 ASE/EACVI algorithm was assessed in 204 patients evaluated for unexplained dyspnea or pulmonary hypertension with echocardiogram and right heart catheterization. Invasively measured pulmonary capillary wedge pressure (PCWP) was used as the gold standard. In addition, the diagnostic performance of H 2 FPEF score and NT‐proBNP (N‐terminal pro‐B‐type natriuretic peptide) were evaluated. There was a poor correlation between indexed left atrial volume, E/e′ (septal and average) or early mitral inflow (E), and PCWP ( r =0.25–0.30, P values all <0.01). No correlation was found in our cohort between e′ (septal or lateral) or tricuspid valve regurgitation and PCWP. The correlation between diastolic function grades of the ASE/EACVI algorithm and PCWP was poor ( r =0.17, P <0.05). The ASE/EACVI algorithm had a sensitivity and specificity of 35% and 87%, respectively; an accuracy of 67% and an area under the curve of 0.56. Moreover, in 30% of cases the algorithm was not applicable or indeterminate. H 2 FPEF score had a modest correlation with PCWP ( r =0.44, P <0.0001), and accuracy was 73%; NT‐proBNP correlated weakly with PCWP ( r =0.24, P <0.001), and accuracy was 57%. Conclusions The 2016 ASE/EACVI algorithm for the assessment of diastolic function has a limited diagnostic accuracy in patients evaluated for unexplained dyspnea and/or pulmonary hypertension, and especially sensitivity to detect diastolic dysfunction was low.

Prolonged Survival despite High Disease Burden in Elderly (≥55) Patients with Hb SS or Hb Sβ0 Thalassemia

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 710-710
Author(s):  
Damian Silbermins ◽  
Laura M. De Castro ◽  
Allison E Ashley-Koch ◽  
Jude C Jonassaint ◽  
Melanie E. Garrett ◽  
...  
Keyword(s):  
Heart Failure ◽  
Pulmonary Hypertension ◽  
Elderly Patients ◽  
Sickle Cell ◽  
Disease Burden ◽  
The Elderly ◽  
Study Cohort ◽  
Younger Patients ◽  
The Mean ◽  
Long Acting

Abstract In 1994, the average age of death of patients with sickle cell disease (SCD) in the US was 42 years for males and 48 for females. We theorized that patients who lived appreciably beyond these ages would therefore have lower disease burden than patients overall, and that lack of specific disease complications would be characteristic of such patients. From 2001 until 2006, we enrolled 541 unrelated adult patients (age ≥18) with Hb SS or Hb Sβ0 at three comprehensive sickle cell centers in a study designed to identify factors associated with clinical outcomes in SCD. Our database includes demographic, clinical, and laboratory data on all participants. We identified 61 patients 50 years and older and 32 patients 55 years and older. Among the latter, the average age was 60.6, with a median of 58 years (range 55–83); 65% were female. Although patients with SCD are generally thought to have a low prevalence of hypertension, the mean BP in this older cohort was 142/75, and 55% of patients were taking anti-hypertensives. Patients ≥55 had the following history of SCD-related complications: acute chest syndrome – 69%, priapism (males only) – 46%, stroke – 16%, TIA – 10%, seizure – 3%, AVN of shoulders or hips – 40%, leg ulcers – 38%, heart failure – 16%, gallstones – 64%, and retinopathy – 40%. Compared to all patients, elderly SCD patients had higher prevalence of TIA (10% vs 5%), retinopathy (40% vs 21%), and heart failure (16% vs 6%), and lower prevalence of seizures (3% vs 12%). When compared to younger patients, the elderly had a similar rate of AVN (40% vs 30%) but a significantly higher number had undergone surgical joint interventions (33% vs 10%; p=0.0001). The percentage of patients who had had cholecystectomies and splenectomies was uniform through the whole study cohort. Most interestingly, 60% of patients ≥ 55 had findings consistent with pulmonary hypertension, defined as TR jet ≥ 2.5 m/s on echocardiography. This represented approximately twice the prevalence seen in the entire study cohort. Significant proteinuria (≥ 1+) was present in 41% of patients, again approximately twice as frequently as seen in younger patients. Interviews and review of records showed that 47% of elderly patients had not required any hospitalizations during the past year (compared to only 27% in the total study cohort), while 20% were hospitalized only once, 20% were hospitalized 2–4 times, and 6% were hospitalized >4 times. Review of medication usage revealed that 35% were taking hydroxyurea (HU) at the time of enrollment, and 13% used long-acting narcotics daily (compared to 39% and 24% of the total cohort, respectively). When hematologic parameters were compared for elderly patients who were or were not taking HU, no significant differences were observed for Hb, Hct, WBC and platelet counts, although the mean Hb for patients taking or not taking HU were 8.5 and 7.8 g/dL respectively. We conclude that when compared to the overall population, the elderly had a higher prevalence of pulmonary hypertension, systemic hypertension, TIA and joint replacement, suggesting that contrary to our hypothesis, the degree to which they had experienced SCD-related end-organ damage was not decreased. While the frequency of HU use was similar to all patients, HU did not have clear effects on hematologic parameters in the elderly, raising the question of its efficacy in this population. Finally, the elderly did have some indicators of lower disease severity—namely, lower use of daily long-acting narcotics and fewer admissions for painful episodes. While research has traditionally focused on the high-risk SCD population, we believe that further investigation of elderly patients as a “lower risk” group is warranted to further advance our understanding of the relationship of SCD complications to survival.

scholarly journals The ubiquitin ligase WWP1 contributes to shifts in matrix proteolytic profiles and a myocardial aging phenotype with diastolic heart

2020 ◽  
Vol 319 (4) ◽  
pp. H765-H774
Author(s):  
Lydia E. Matesic ◽  
Lisa A. Freeburg ◽  
Laura B. Snyder ◽  
Lauren-Ashley Duncan ◽  
Amber Moore ◽  
...  
Keyword(s):  
Heart Failure ◽  
Extracellular Matrix ◽  
Ejection Fraction ◽  
Diastolic Dysfunction ◽  
Ubiquitin Ligase ◽  
Protein Turnover ◽  
Ubiquitin Ligases ◽  
The Elderly ◽  
Preserved Ejection Fraction ◽  
Myocardial Aging

Heart failure (HF) with a preserved ejection fraction (HFpEF) is a growing cause of HF and commonly afflicts the elderly. Milestones for HFpEF include diastolic dysfunction and an abnormal extracellular matrix (ECM). The ubiquitin ligases, such as WWP1, change with aging and regulate critical protein turnover/stability processes, such as the ECM. The present study demonstrated that induction of WWP1 in mice induced LV hypertrophy, diastolic dysfunction, and ECM accumulation, consistent with the HFpEF phenotype, and thus may identify a new therapeutic pathway.

scholarly journals Association of polymorphism of the endothelial NO synthase gene (NOS3–786T>C) with severity of left ventricle diastolic dysfunction and pulmonary hypertension in patients with heart failure and preserved ejection fraction

2019 ◽  
Vol 26 (1) ◽  
pp. 51-60 ◽  
Author(s):  
K. M. Amosova ◽  
K. I. Cherniaieva ◽  
Yu. V. Rudenko ◽  
L. V. Natrus ◽  
A. B. Bezrodnyi ◽  
...  
Keyword(s):  
Heart Failure ◽  
Pulmonary Hypertension ◽  
Left Ventricle ◽  
Ejection Fraction ◽  
Arterial Hypertension ◽  
Diastolic Dysfunction ◽  
Elastic Properties ◽  
Preserved Ejection Fraction ◽  
Artery Disease ◽  
Lv Diastolic Dysfunction

The aim – to determine polymorphisms of the nitric oxide synthase gene -786T>C rs 2070744 and the association of the corresponding genotypes with the severity of left ventricle (LV) diastolic dysfunction (DD), pulmonary hypertension (PH) and elastic properties of the arteries in patients with arterial hypertension (AH) and heart failure (HF) with preserved ejection fraction (EF). Materials and methods. We included 69 patients (pts) with AH and HF with preserved EF (31 female (41.9 %) and 33 male (58.1 %)), aged 67.4±10.2 years; II–III class NYHA, hemodynamically stable. According to Shah’s criteria, the «aging» phenotype was identified in 11 (15.9 %) pts, «obesity» – 14 (20.3 %) pts, «coronary artery disease» – 16 (23.2 %) pts, «pulmonary hypertension» – 17 (24.6 %) pts (with a significant predominance of patients with CC genotype), «arterial hypertension» – 17 (24.6 %) pts. Results and discussion. «Wild» homozygous TT genotype was found in 34 pts (49.3 %, TT group), heterozygous TC genotype – in 21 pts (30.4 %, TC group) and «mutant» homozygous CC genotype – in 14 pts (20.3 %, CC group). The groups did not differ in gender (male 19 or 55.9 %, 12 or 60 % and 11 or 61.1 %, p>0.05) and average age (67.1±8.9, 65.4±10.6 and 64.9±10.3 years p>0.05), and in prevalence of comorbidities. The worst result of 6-minute walk test was in the CC group compared with TT and TC (371.8±77.7, 385.7±85.4 and 314.3±69.1, p>0.05), as well as higher NT-proBNP level (668.1±317.8, 636.9±433.2 and 806.9±369.7, p>0.05), greater LVMI (187.4±37.1, 182.2±25.7 and 195.2±28.5, p>0.05). There was markedly more pronounced DD LV in the CC group compared with TT and TC, according to average e’ (p>0.05) and E/e’ (p>0.05). SPAP was the highest in the CC group (p>0.05), as well as PCWP and TPG (p>0.05). Patients of the CC group had worse elastic properties of arteries according to AIx75 (p>0.001) and PWVc-f (p>0.05), with a decrease in SAC (by 38.2 and 29 % compared to TT and TC (p>0.05) and an increase in Ea, respectively, by 21 and 9 % (p>0.05). According to the cuff test in patients of the CC group, compared with those in the TT and TC groups, worsening of endotelium-dependent vasodilation, respectively by 19.8 and 17.3 % (p>0.05) was revealed. Conclusions. Compared to other polymorphisms, the CC genotype of the NOS3 rs 2070744 gene is associated with greater severity of DD LV, LH and impaired LV diastolic function and elastic properties of systemic arteries, according to pulse wave analysis in patients with AH and HF with preserved EF.

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