scholarly journals Factors determining an unfavorable one-year prognosis of myocardial infarction complicated by left ventricular failure and associated with chronic cerebral ischemia

2020 ◽  
Vol 35 (2) ◽  
pp. 106-113
Author(s):  
N. B. Lebedeva ◽  
L. Yu. Chesnokova ◽  
N. I. Tarasov
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Cerebral Ischemia ◽  
Left Ventricular ◽  
Atherosclerotic Plaques ◽  
Chronic Cerebral Ischemia ◽  
Reduced Ejection Fraction ◽  
Long Term Prognosis ◽  
One Year ◽  
Prior Stroke

Aim. To evaluate factors of unfavorable annual prognosis of myocardial infarction (MI) complicated by heart failure (HF) with reduced ejection fraction (HFrEF) and associated with chronic cerebral ischemia (CCI).Material and Methods. A total of 182 patients with Q wave myocardial infarction complicated by the left ventricular dysfunction concomitant with CCI were included in the study. Of them, 149 (81.9%) patients were men and 33 (18.1%) were women. The mean age was 60.4 (53; 69) years. All patients underwent echocardiography, color duplex scanning of the carotid arteries and examination by an interventional neurologist. Hard endpoints were collected within one year.Results. The majority of the patients included in the study suffered from grade 2 CCI. Atherosclerotic plaques in the brachiocephalic arteries were found in 37.4% of patients; the degree of stenosis did not exceed 50% in all cases. 77 (46.1%) patients achieved hard endpoints within one year. Multivariate logistic regression showed that the most unfavorable predictor of poor 1-year survival was the presence of the positive history of ACVA [RR 7.33 (95% CI 1.97–27.32), p = 0.003], and the most unfavorable predictors of risk of adverse cardiovascular events included prior stroke [RR = 1.92 (95% CI 1.09–3.38), p = 0.025] and carotid atherosclerotic plaques [RR = 2.12 (95% CI 1.34–3.37), p = 0.001].Conclusion. The presence of carotid atherosclerotic plaques and prior stroke affected the long-term prognosis in patients with myocardial infarction complicated by heart failure and chronic cerebral ischemia. 

scholarly journals Risk Factors for Adverse One-year Prognosis in Patients With Low Left Ventricular Ejection Fraction After Myocardial Infarction and Chronic Cerebral Ischemia

2021 ◽  
Author(s):  
Nataliya B. Lebedeva ◽  
L. Yu. Chesnokova
Keyword(s):  
Myocardial Infarction ◽  
Cerebral Ischemia ◽  
Multivariate Regression ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Atherosclerotic Plaques ◽  
Chronic Cerebral Ischemia ◽  
Term Survival ◽  
Previous Stroke ◽  
One Year

Abstract BackgroundRecent studies have reported the correlation between left ventricular dysfunction and asymptomatic carotid artery stenosis So, we aimed to determine the predictors of poor long-term survival in patients with left ventricular systolic dysfunction after MI and chronic cerebral ischemia. Methods182 patients with left ventricular failure and chronic cerebral ischemia presented with Q-wave MI were recruited in a observational study. Of them, 149 (81.9%) were men and 33 (18.1%) were women. Their median age was 60.4 (53; 69) years. All patients underwent echocardiography, coronary angiography, carotid color duplex scanning, and were consulted by an interventional neurologist at the acute phase of MI. One year after MI, the hard endpoints were collected. Univariate and multivariate regression analyzes were performed.ResultsCerebral arteriopathy was confirmed in all patients from the study group. The thickness of the intima-media was over 1.0 mm. The mean carotid intima-media thickness was 1.8±06 mm. The majority of patients had mild to moderate encephalopathy. Carotid atherosclerotic plaques were found in 37.4% of patients. The degree of stenosis did not exceed 50% in all cases. One-year after MI, 77 (46.1%) patients reached hard endpoints. The multivariate regression model showed that previous stroke (RR 7.33 [95% CI 1.97-27.32], p = 0.003) was the most unfavorable predictor of mortality, whereas the most unfavorable predictors of endpoints were prior stroke (RR = 1.92 [95% CI 1.09-3.38], p = 0.025) and the presence of carotid atherosclerotic plaque (RR = 2.12 [95% CI 1.34-3.37], p = 0.001). ConclusionThe presence of carotid atherosclerotic plaques and previous stroke affect the one-year prognosis in patients with myocardial infarction, complicated by heart failure and chronic cerebral ischemia.

scholarly journals Comparative analysis of clinical and neurological manifestations in patients with chronic cerebral ischemia and chronic heart failure with stored and reduced release fraction

2017 ◽  
pp. 43-52
Author(s):  
N. Zhhilova
Keyword(s):  
Heart Failure ◽  
Nervous System ◽  
Comparative Analysis ◽  
Cerebral Ischemia ◽  
Chronic Heart Failure ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Neurological Manifestations ◽  
Chronic Cerebral Ischemia ◽  
Ventricular Ejection Fraction

The activation of the sympathetic nervous system plays an important pathophysiological role in the development of heart failure, in particular, in the development of left ventricular insufficiency. Although high blood pressure is considered as the main determinant of structural changes in the left ventricle, sex, salt intake, obesity, diabetes, as well as neurohumoral and genetic factors can affect the mass and left ventricular geometry. The usual concept of hypertonic re-modeling. In the comparative analysis of clinical and neurological manifestations in patients with chronic cerebral ischemia and chronic heart failure with a preserved and reduced release fraction, changes in the nervous system that showed a tendency to increase the disturbances and deviations from the norm with increasing heart failure, the fraction of release and the presence of hypertensive encephalopathy In the correlation analysis, a direct correlation between the quality of life indicator and the degree of heart failure (r = 0.56), the presence of myocardial infarction in the history (r = 0.42), arterial hypertension (r = 0.33) and the presence of valvular pathology the heart (r = 0.31) and the inverse correlation dependence on the indicator of the left ventricular ejection fraction (r = -0.69). A comparative analysis of correlation relationships indicates a reliable clinical and social significance of the left ventricular ejection fraction in patients with chronic cerebral ischemia and chronic heart failure.

Circulating LIPCAR is a potential biomarker of heart failure in patients post-acute myocardial infarction

2021 ◽  
pp. 153537022110360
Author(s):  
Li Yan ◽  
Yu Zhang ◽  
Mei Wang ◽  
Lu Wang ◽  
Wei Zhang ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Acute Myocardial Infarction ◽  
Noncoding Rna ◽  
Ventricular Remodeling ◽  
Left Ventricular Remodeling ◽  
Left Ventricular ◽  
Reduced Ejection Fraction ◽  
Receiver Operating Characteristic Curves ◽  
Potential Biomarker

In heart failure (HF) patients with reduced ejection fraction, LIPCAR, a long noncoding RNA is elevated and is associated with left ventricular remodeling and poor prognosis. We studied the role of LIPCAR in patients with HF post-acute myocardial infarction (AMI) to find biomarkers for early detection of HF. We conducted a study of 127 patients with AMI, of which 59 were patients with HF post-AMI. LIPCAR levels were higher in HF patients post-AMI than patients without HF, and LIPCAR had a high predictive value for diagnosis of HF, which was estimated by receiver operating characteristic curves (AUC: 0.985). The results indicate that LIPCAR may be a marker of early HF after AMI.

scholarly journals Long-term Prognosis Analysis of PARACHUTE Device Implantation in Patients with Ischemic Heart Failure: A Single-Center Experience of Chinese patients

2020 ◽  
Author(s):  
Jianghua Li ◽  
Huadong Liu ◽  
Qiyun Liu ◽  
Cheng Liu ◽  
Wei Xiong ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Ejection Fraction ◽  
Left Ventricular ◽  
Chinese Patients ◽  
Device Implantation ◽  
Lv Ejection Fraction ◽  
Long Term Prognosis ◽  
Apical Aneurysm

Abstract Background: Heart failure (HF) is one of the leading causes of mortality and morbidity. The PARACHUTE device is designed to partition for left ventricular (LV) apical aneurysm post extensive anterior myocardial infarction. However, the long-term prognosis of the PARACHUTE device post-implantation is unclear.Methods：From November 2015 to April 2017, six subjects with New York Heart Association Class II, III and IV ischemic HF, LV ejection fraction between 15% and 40%, and LV anterior apical aneurysm were enrolled in our center. The cumulative event rates for myocardial infarction, hospitalization, and mortality were documented respectively. Further assessment of LV ejection fraction, LV end-diastolic diameter, and estimated pulmonary artery pressure were determined by echocardiography core laboratory. For quantitative data comparison, paired t‑test was employed.Results: Device implantation was successful in all six enrolled subjects, and acute device association adverse events were not observed. At 4.6 ± 1.7 years follow-up, MACEs were found in 50% patients, and the survival rate was 86.7%. We found that the LV ejection fraction was significantly elevated after deployment (46.00 ± 6.00% vs. 35.83 ± 1.47%, P=0.009). Besides, the LVEDD elevated after MI (51.17 ± 3.71 vs. 62.83 ± 3.25, P<0.001) was revealed, but the device sustained preserved LVEDD after implantation.Conclusion: The PARACHUTE device is an alternative therapy for patients with severe LV maladaptive remodeling. The procedure of PARACHUTE implantation is safe and has a potential benefit in long-term mortality reduction. However, the device seems to increase the HF ratio.Clinical Trial Registration: NCT02240940, https://clinicaltrials.gov/ct2/ show/NCT02240940

scholarly journals Coronary microvascular dysfunction in hypertrophy and heart failure

2020 ◽  
Vol 116 (4) ◽  
pp. 806-816 ◽  
Author(s):  
Paolo G Camici ◽  
Carsten Tschöpe ◽  
Marcelo F Di Carli ◽  
Ornella Rimoldi ◽  
Sophie Van Linthout
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Ejection Fraction ◽  
Pathological Condition ◽  
Microvascular Dysfunction ◽  
Left Ventricular ◽  
Physiological Adaptation ◽  
Coronary Microvascular Dysfunction ◽  
Wall Thickening ◽  
Reduced Ejection Fraction

Abstract Left ventricular (LV) hypertrophy (LVH) is a growth in left myocardial mass mainly caused by increased cardiomyocyte size. LVH can be a physiological adaptation to physical exercise or a pathological condition either primary, i.e. genetic, or secondary to LV overload. Patients with both primary and secondary LVH have evidence of coronary microvascular dysfunction (CMD). The latter is mainly due to capillary rarefaction and adverse remodelling of intramural coronary arterioles due to medial wall thickening with an increased wall/lumen ratio. An important feature of this phenomenon is the diffuse nature of this remodelling, which generally affects the coronary microvessels in the whole of the left ventricle. Patients with LVH secondary to arterial hypertension can develop both heart failure with preserved ejection fraction (HFpEF) and heart failure with reduced ejection fraction (HFrEF). These patients can develop HFrEF via a ‘direct pathway’ with an interval myocardial infarction and also in its absence. On the other hand, patients can develop HFpEF that can then progress to HFrEF with or without interval myocardial infarction. A similar evolution towards LV dysfunction and both HFpEF and HFrEF can occur in patients with hypertrophic cardiomyopathy, the most common genetic cardiomyopathy with a phenotype characterized by massive LVH. In this review article, we will discuss both the experimental and clinical studies explaining the mechanisms responsible for CMD in LVH as well as the evidence linking CMD with HFpEF and HFrEF.

P1874Novel predictors of atrial fibrillation progression

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
A I Tarzimanova ◽  
V I Podzolkov ◽  
M V Pisarev ◽  
R G Gataulin
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Atrial Fibrillation ◽  
Ejection Fraction ◽  
Natriuretic Peptide ◽  
Left Ventricular ◽  
Reduced Ejection Fraction ◽  
Wall Stiffness ◽  
Permanent Form

Abstract Objective To identify predictors of progression of atrial fibrillation (AF) in patients with hypertension, coronary heart disease (CHD) and chronic heart failure (CHF) with recurrent AF. Materials and methods The study included 312 patients with recurrent AF. The patients were divided into 3 groups according to the leading underlying condition: essential hypertension (n=136), CHD (n=112), and CHF (n=64). The average follow-up duration was 60±3 months. “Progression” of AF was defined as development of persistent or permanent AF. Results During the 5-year prospective follow-up in all the groups of patients with recurrent AF, progression of arrhythmia from paroxysmal or persistent to permanent form was noted. The rate of AF progression in patients with CHF was significantly higher, and its percentage was 59%. The progression percentage after 5 years was 46% (p=0.002) in patients with hypertension and 51% (p=0.008) in patients with CHD. AF progression in patients with hypertension correlated significantly with left ventricular hypertrophy (OR 1.25; 95% CI, 1.03 to 1.52) and increased vascular wall stiffness (OR 2.3; 95% CI, 1.95 to 2.65). Independent predictors of arrhythmia worsening in patients with CHD were history of myocardial infarction (OR 1.23; 95% CI, 0.9 to 1.5), irreversible left ventricular (LV) hypokinesis (OR 1.41; 95% CI, 1.1 to 1.7), and increased plasma N-terminal pro–A-type natriuretic peptide (NT-proANP) (OR 1.16; 95% CI, 0.8 to 1.4). Reduced LV ejection fraction (EF) (OR 0.84; 95% CI, 0.7 to 0.89) and increased plasma N-terminal pro–B-type natriuretic peptide (NT-proBNP) (NT-proBNP) (OR 2.3; 95% CI, 1.93 to 2.67) were independent predictors of AF progression from persistent to permanent form in patients with heart failure with reduced ejection fraction. Conclusions Progression of AF is related to the underlying cardiovascular disease. Early vascular aging syndrome and LV hypertrophy are the main factors of AF progression in patients with hypertension. Previous myocardial infarction with irreversible hypokinesis is associated with AF progression in patients with CHD. Reduced LVEF and increased plasma BNP predict AF progression in patients with CHF.

scholarly journals Clinical features and long-term prognosis of patients with congestive heart failure taking tolvaptan: a comparison of patients with preserved and reduced left ventricular ejection fraction

2021 ◽  
Author(s):  
Toshiki Seki ◽  
Yoshiaki Kubota ◽  
Junya Matsuda ◽  
Yukichi Tokita ◽  
Yu-ki Iwasaki ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Univariate Analysis ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Reduced Ejection Fraction ◽  
All Cause Mortality ◽  
Long Term Prognosis

AbstractFew studies have investigated the clinical benefit of the long-term use of tolvaptan (TLV) for heart failure (HF). This study evaluated the long-term prognosis of patients administered TLV for > 1 year among patients who had HF with preserved ejection fraction (HFpEF) and those who had HF with reduced ejection fraction (HFrEF). Overall, 591 consecutive patients were admitted to our hospital and administered TLV for HF between 2011 and 2018. We retrospectively enrolled 147 patients who were administered TLV for > 1 year. We divided them into the HFpEF group (n = 77, 52.4%) and the HFrEF group (n = 70; 47.6%). Their clinical backgrounds and long-term prognosis were examined. Compared with the patients in the HFrEF group, the patients in the HFpEF group were significantly older and included more women. Moreover, the HFpEF group showed significantly lower all-cause mortality (38.6% vs. 24.7%; log-rank, P = 0.014) and cardiovascular mortality during the average 2.7-year follow-up. Univariate analysis revealed that all-cause mortality was correlated with male sex, HFpEF, and changes in serum creatinine levels from baseline. Multivariate analysis revealed that HFpEF was an independent influencing factor for all-cause mortality (hazard ratio, 0.44; 95% confidence interval, 0.23–0.86; P = 0.017). Long-term administration of TLV may be more beneficial for HFpEF than for HFrEF.

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