scholarly journals Dynamics of Indicators of Structural and Functional State of the Heart in the Post-Infarction Period Depending on the Presence of Decompensated Heart Failure

2019 ◽  
Vol 25 (1) ◽  
Author(s):  
Khrystyna Levandovska
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Left Ventricular Systolic Dysfunction ◽  
Systolic Dysfunction ◽  
Decompensated Heart Failure ◽  
Left Ventricular ◽  
Left Ventricular Cavity ◽  
Myocardial Mass ◽  
End Diastolic Volume ◽  
Left Ventricular Myocardial Mass

Echocardiographic indicators in decompensated heart failure demonstrate a high prevalence of structural and hemodynamic abnormalities. In the patients with decompensated heart failure in the early and late post-infarction period, echocardiographic indicators were found to significantly differ from those recorded in the patients without heart failure. Thus, reduced ejection fraction, increased end-diastolic volume and end-diastolic dimension indicate left ventricular systolic dysfunction and left ventricular cavity dilation. Since echocardiography of the heart and the pulmonary artery enables real-time estimation of cardiac filling, signs of systolic dysfunction and pulmonary congestion, it may serve as a predictor of decompensated heart failure development in the early and late post-infarction period. The objective of the research was to determine the main echocardiographic indicators in terms of rapid monitoring of deterioration in the main parameters of left ventricular overload for early diagnosis of decompensated heart failure, as well as structural and geometric remodeling of left ventricular myocardium in the early and late post-infarction period. Materials and methods. There were examined 160 patients with acute myocardial infarction. Depending on the development of decompensated heart failure in the early and late post-infarction period, the patients were divided into two subgroups being homogeneous by age and gender. Results. The results obtained indicated significant hemodynamic changes in the patients with decompensated heart failure in the post-infarction period. They included significantly lower values of ejection fraction indicating left ventricular systolic dysfunction and the signs of left ventricular cavity dilation as evidenced by the increase in left ventricular end-diastolic volume and end-diastolic dimension. The tendency for an increase in left ventricular posterior wall thickness and interventricular septal thickness, as well as left ventricular myocardial mass, left ventricular myocardial mass index and left ventricular radius to wall thickness ratio indicated concentric left ventricular remodeling. Conclusions. Modern management of patients with decompensated heart failure should be guided by an objective value of left ventricular ejection fraction as it plays a key role in selecting management strategy for this cohort of patients since a significant reduction in this parameter indicates cardiac decompensation. Pulmonary artery pressure and concentric left ventricular hypertrophy play a significant role in cardiac failure development as well. 

scholarly journals Central and obstructive apneas prevalence in heart failure with reduced, mid-range and preserved ejection fraction

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
C Borrelli ◽  
P Sciarrone ◽  
F Gentile ◽  
N Ghionzoli ◽  
G Mirizzi ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Left Ventricular Systolic Dysfunction ◽  
Systolic Function ◽  
Systolic Dysfunction ◽  
Cardiopulmonary Exercise Testing ◽  
Left Ventricular ◽  
Apnea Hypopnea Index ◽  
Preserved Ejection Fraction ◽  
2D Echocardiography

Abstract Background Central apneas (CA) and obstructive apneas (OA) are highly prevalent in heart failure (HF) both with reduced and preserved systolic function. However, a comprehensive evaluation of apnea prevalence across HF according to ejection fraction (i.e HF with patients with reduced, mid-range and preserved ejection fraction- HFrEf, HFmrEF and HFpEF, respectively) throughout the 24 hours has never been done before. Materials and methods 700 HF patients were prospectively enrolled and then divided according to left ventricular EF (408 HFrEF, 117 HFmrEF, 175 HFpEF). All patients underwent a thorough evaluation including: 2D echocardiography; 24-h Holter-ECG monitoring; cardiopulmonary exercise testing; neuro-hormonal assessment and 24-h cardiorespiratory monitoring. Results In the whole population, prevalence of normal breathing (NB), CA and OA at daytime was 40%, 51%, and 9%, respectively, while at nighttime 15%, 55%, and 30%, respectively. When stratified according to left ventricular EF, CA prevalence decreased from HFrEF to HFmrEF and HFpEF: (daytime CA: 57% vs. 43% vs. 42%, respectively, p=0.001; nighttime CA: 66% vs. 48% vs. 34%, respectively, p<0.0001), while OA prevalence increased (daytime OA: 5% vs. 8% vs. 18%, respectively, p<0.0001; nighttime OA: 20 vs. 29 vs. 53%, respectively, p<0.0001). When assessing moderte-severe apneas, defined with an apnea/hypopnea index >15 events/hour, prevalence of CA was again higher in HFrEF than HFmrEF and HFpEF both at daytime (daytime moderate-severe CA: 28% vs. 19% and 23%, respectively, p<0.05) and at nighttime (nighttime moderate-severe CA: 50% vs. 39% and 28%, respectively, p<0.05). Conversely, moderate-severe OA decreased from HFrEF to HFmrEF to HFpEF both at daytime (daytime moderate-severe OA: 1% vs. 3% and 8%, respectively, p<0.05) and nighttime (noghttime moderate-severe OA: 10% vs. 11% and 30%, respectively, p<0.05). Conclusions Daytime and nighttime apneas, both central and obstructive in nature, are highly prevalent in HF regardless of EF. Across the whole spectrum of HF, CA prevalence increases and OA decreases as left ventricular systolic dysfunction progresses, both during daytime and nighttime. Funding Acknowledgement Type of funding source: None

scholarly journals A Change of Heart: Case Series of Peripartum Cardiomyopathy

2013 ◽  
Vol 2013 ◽  
pp. 1-4 ◽  
Author(s):  
Sean Martin ◽  
Daniel Short ◽  
Chih Mun Wong ◽  
Dina McLellan
Keyword(s):  
Heart Failure ◽  
Left Ventricular Systolic Dysfunction ◽  
Systolic Dysfunction ◽  
Significant Proportion ◽  
Case Series ◽  
Decompensated Heart Failure ◽  
Left Ventricular ◽  
Peripartum Cardiomyopathy ◽  
Ventricular Systolic Dysfunction ◽  
Diagnostic Challenge

Peripartum cardiomyopathy (PPCM) is an uncommon disease of pregnancy, occurring in about 1 in 2000 live births, and is characterized by the development of heart failure, due to left ventricular systolic dysfunction. It is associated with high rates of maternal and neonatal mortality. Cardiac disease is the leading cause of maternal death in the UK: PPCM accounts for about 17% of these. Clinical findings of decompensated heart failure (HF) are often masked by the normal physiological changes seen in pregnancy making the diagnosis challenging. A high index of suspicion is essential—prompting referral for echocardiogram, which is crucial for diagnosis. Favourable prognosis is dependent on the early initiation of HF medications. Although full recovery occurs in around half of cases, left ventricular systolic dysfunction persists in a significant proportion of patients with PPCM and the risk of recurrence in subsequent pregnancies is high. The pathophysiology of PPCM is under intense research. We present four patients with PPCM and a review of the literature. Owing to the diagnostic challenge of PPCM and decompensated HF in pregnant mothers and its high mortality rate without treatment, prompt investigation and referral are key to improving maternal survival.

scholarly journals DYNAMIC CHANGES IN CARDIOVASCULAR RISK BIOMARKERS AND CYTOKINES OF MYOCARDITIS-FREE PATIENTS WITH DECOMPENSATED HEART FAILURE AND ISCHEMIC SYSTOLIC DYSFUNCTION

2021 ◽  
Vol 23 (4) ◽  
pp. 839-844
Author(s):  
O. N. Ogurkova ◽  
E. V. Kruchinkina ◽  
A. M. Gusakova ◽  
T. E. Suslova ◽  
V. V. Ryabov
Keyword(s):  
Heart Failure ◽  
Cardiovascular Risk ◽  
Ejection Fraction ◽  
Systolic Dysfunction ◽  
Decompensated Heart Failure ◽  
Interleukin 10 ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Reduced Ejection Fraction

The development and progression of heart failure is associated with a variety of pathophysiological mechanisms, of particular interest is the study of the inflammatory response as a fundamental link in the pathogenesis of CHF and its main component – decompensation. An open, non-randomized, prospective study was carried out to evaluate the clinical and morphological features of subclinical inflammation in patients with acute decompensation of ischemic chronic heart failure with a reduced ejection fraction. The study included 25 patients with decompensated ischemic CHF with left ventricular ejection fraction < 40% aged 35 to 75 years (60.12±9.3 y. o.). In this study the dynamics of the serum content of C-reactive protein (CRP), N-terminal fragment of the brain natriuretic peptide precursor protein (NT-proBNP), soluble ST2(sST2), insulin-like growth factor-1 receptor (IGF-1R), interleukin-6 (IL-6), interleukin-10 (IL-10), tumor necrosis factor-α (TNFα) was performed by multiplex immunoassay using the FLEXMAP 3D. All studied patients were divided into two groups depending on the diagnosed myocarditis: patients with no signs of myocarditis and patients with myocarditis. It was found that in the group of patients with diagnosed myocarditis there was an increased content of CRP, IGF-1R, IL-6 and IL-10, TNFα compared to the group of patients without myocarditis. The median concentrations of the NT-proBNP and sST2 in both groups did not differ. At the follow-up visit a year later, there was a decrease in the content of CRP, NT-proBNP, IL-6 in both groups. In the group of patients with myocarditis, an increase in the content of sST2, IGF-1R, IL-10 was observed. Thus, the study carried out in dynamics revealed significant differences in the degree of changes in the serum activity of pro- and anti-inflammatory cytokines and biomarkers of cardiovascular risk in patients with decompensated heart failure with systolic dysfunction with diagnosed myocarditis and in its absence. 

scholarly journals Preemptive ECMO Cannulation in a Patient with Severe Left Ventricular Systolic Dysfunction Undergoing Cesarean Delivery

2019 ◽  
Vol 2019 ◽  
pp. 1-5
Author(s):  
Phuong Bui ◽  
P. Gabriel Mascaro ◽  
Juanita Henao-Mejia ◽  
Selina Patel
Keyword(s):  
Heart Failure ◽  
Cesarean Delivery ◽  
Left Ventricular Systolic Dysfunction ◽  
Systolic Dysfunction ◽  
Decompensated Heart Failure ◽  
Left Ventricular ◽  
Circulatory Support ◽  
Morbidly Obese ◽  
Morbidly Obese Patient ◽  
Patients With Heart Failure

Obstetric patients with heart failure undergoing cesarean delivery are high risk and the perioperative care of these patients poses significant multidisciplinary challenges. In contrast to the nonobstetric patient population the potential role of mechanical circulatory support in parturients with heart failure is not well established and the use of extracorporeal membrane oxygenation (ECMO) has rarely been reported. We report the case of a super morbidly obese patient with decompensated heart failure, pulmonary hypertension, and superimposed preeclampsia undergoing preemptive ECMO cannulation for urgent cesarean delivery.

scholarly journals The Volume Regulation Graph versus the Ejection Fraction as Metrics of Left Ventricular Performance in Heart Failure with and without a Preserved Ejection Fraction: A Mathematical Model Study

2015 ◽  
Vol 9s1 ◽  
pp. CMC.S18748 ◽  
Author(s):  
Theo J.C. Faes ◽  
Peter L.M. Kerkhof
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Diastolic Pressure ◽  
Systolic Dysfunction ◽  
Ventricular Volume ◽  
Systemic Circulation ◽  
Left Ventricular ◽  
Preserved Ejection Fraction ◽  
Ventricular Performance ◽  
End Diastolic Volume

In left ventricular heart failure, often a distinction is made between patients with a reduced and a preserved ejection fraction (EF). As EF is a composite metric of both the end-diastolic volume (EDV) and the end-systolic ventricular volume (ESV), the lucidity of the EF is sometimes questioned. As an alternative, the ESV–EDV graph is advocated. This study identifies the dependence of the EF and the EDV–ESV graph on the major determinants of ventricular performance. Numerical simulations were made using a model of the systemic circulation, consisting of an atrium–ventricle valves combination; a simple constant pressure as venous filling system; and a three-element Windkessel extended with a venous system. ESV–EDV graphs and EFs were calculated using this model while varying one by one the filling pressure, diastolic and systolic ventricular elastances, and diastolic pressure in the aorta. In conclusion, the ESV–EDV graph separates between diastolic and systolic dysfunction while the EF encompasses these two pathologies. Therefore, the ESV–EDV graph can provide an advantage over EF in heart failure studies.

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