scholarly journals The Pretibial edema strain ratio obtained by elastography can be used in differential diagnosis of patients with chronic heart failure and nephrotic syndrome

Acta Medica ◽  
2019 ◽  
Vol 50 (4) ◽  
pp. 20-29
Author(s):  
Derya Demirtas
Keyword(s):  
Heart Failure ◽  
Differential Diagnosis ◽  
Nephrotic Syndrome ◽  
Strain Ratio ◽  
Left Ventricular ◽  
Diagnostic Methods ◽  
Color Grade ◽  
Objective Parameter ◽  
Close Relationship ◽  
Laboratory Examinations

Objective: Pretibial edema (PTO) is a common examination finding in patients with both heart failure (HF) and nephrotic syndrome (NS).  We aimed to evaluate the utility of PTO strain ratio (PTO-SR) obtained by strain elastography (SE) in the diagnosis of HF and NS. Materials and Methods: A total of 80 patients (40 patients with HF and 40 patients with NS) were included in this study. Physical examination echocardiography and laboratory examinations were performed. PTO elastographic color grade and PTO-SR measurements were performed in the PTO region by SE. Results: PTO-SR and presence of PTO elastographic color grade-I were found to be higher in HF. Tricuspid regurgitation pressure gradient (TRPG), left ventricular (LV) diameters and volumes were significantly higher and LV ejection fraction (EF) was significantly lower in HF. LVEF and PTO-SR independently determined the presence of HF. The each-0.1 increase in PTO-SR was being to the risk of HF by 29.1%. In predicting the presence of HF, the area under the ROC curve was 0.827 for PTO-SR. The cut-off value for PTO-SR was taken as 0.70, it was determined the patients with HF disease with 80.0% sensitivity and 76.5% specificity. PTO-SR value was found to be closely related to TRPG, LVEF, and LV volumes. A close relationship was found between PTO-SR and TRPG. Conclusion: In patients with HF, the PTO-SR obtained by SE is higher than in patients with NS and can be used as an objective parameter for HF differential diagnosis in addition to conventional HF diagnostic methods. 

Heart failure with preserved ejection fraction: recent concepts in diagnosis, mechanisms and management

Heart ◽  
2022 ◽  
pp. heartjnl-2021-319605
Author(s):  
Andreas B Gevaert ◽  
Rachna Kataria ◽  
Faiez Zannad ◽  
Andrew J Sauer ◽  
Kevin Damman ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Left Ventricular ◽  
Diagnostic Methods ◽  
Left Ventricular Ejection ◽  
Preserved Ejection Fraction ◽  
Ventricular Ejection Fraction ◽  
Cut Points ◽  
Reduced Ejection Fraction ◽  
Comprehensive Management

It is estimated that half of all patients with heart failure (HF) have HF with preserved ejection fraction (HFpEF). Yet this form of HF remains a diagnostic and therapeutic challenge. Differentiating HFpEF from other causes of dyspnoea may require advanced diagnostic methods, such as exercise echocardiography, invasive haemodynamics and investigations for ‘HFpEF mimickers’. While the classification of HF has relied heavily on cut-points in left ventricular ejection fraction (LVEF), recent evidence points towards a gradual shift in underlying mechanisms, phenotypes and response to therapies as LVEF increases. For example, among patients with HF, the proportion of hospitalisations and deaths due to cardiac causes decreases as LVEF increases. Medication classes that are efficacious in HF with reduced ejection fraction (HFrEF) have been less so at higher LVEF ranges, decreasing the risk of HF hospitalisation but not cardiovascular or all-cause death in HFpEF. These observations reflect the burden of non-cardiac comorbidities as LVEF increases and highlight the complex pathophysiological mechanisms, both cardiac and non-cardiac, underpinning HFpEF. Treatment with sodium-glucose cotransporter 2 inhibitors reduces the risk of composite cardiovascular events, driven by a reduction in HF hospitalisations; renin-angiotensin-aldosterone blockers and angiotensin-neprilysin inhibitors result in smaller reductions in HF hospitalisations among patients with HFpEF. Comprehensive management of HFpEF includes exercise as well as treatment of risk factors and comorbidities. Classification based on phenotypes may facilitate a more targeted approach to treatment than LVEF categorisation, which sets arbitrary cut-points when LVEF is a continuum. This narrative review summarises the pathophysiology, diagnosis, classification and management of patients with HFpEF.

scholarly journals SLE strikes the heart! A rare presentation of SLE myocarditis presenting as cardiogenic shock

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Jaydeep J. Raval ◽  
Christina Rodriguez Ruiz ◽  
James Heywood ◽  
Jason J. Weiner
Keyword(s):  
Heart Failure ◽  
Cardiogenic Shock ◽  
Lupus Erythematosus ◽  
De Novo ◽  
Left Ventricular ◽  
Diagnostic Methods ◽  
Cardiac Biomarkers ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Diagnostic Uncertainty

Abstract Background Although systemic lupus erythematosus (SLE) can affect the cardiovascular system in many ways with diverse presentations, a severe cardiogenic shock secondary to SLE myocarditis is infrequently described in the medical literature. Variable presenting features of SLE myocarditis can also make the diagnosis challenging. This case report will allow learners to consider SLE myocarditis in the differential and appreciate the diagnostic uncertainty. Case presentation A 20-year-old Filipino male presented with acute dyspnea, pleuritic chest pain, fevers, and diffuse rash after being diagnosed with SLE six months ago and treated with hydroxychloroquine. Labs were notable for leukopenia, non-nephrotic range proteinuria, elevated cardiac biomarkers, inflammatory markers, low complements, and serologies suggestive of active SLE. Broad-spectrum IV antibiotics and corticosteroids were initiated for sepsis and SLE activity. Blood cultures were positive for MSSA with likely skin source. An electrocardiogram showed diffuse ST-segment elevations without ischemic changes. CT chest demonstrated bilateral pleural and pericardial effusions with dense consolidations. Transthoracic and transesophageal echocardiogram demonstrated reduced left ventricular ejection fraction (LVEF) 45% with no valvular pathology suggestive of endocarditis. Although MSSA bacteremia resolved, the patient rapidly developed cardiopulmonary decline with a repeat echocardiogram demonstrating LVEF < 10%. A Cardiac MRI was a nondiagnostic study to elucidate an etiology of decompensation given inability to perform late gadolinium enhancement. Later, cardiac catheterization revealed normal cardiac output with non-obstructive coronary artery disease. As there was no clear etiology explaining his dramatic heart failure, endomyocardial biopsy was obtained demonstrating diffuse myofiber degeneration and inflammation. These pathological findings, in addition to skin biopsy demonstrating lichenoid dermatitis with a granular “full house” pattern was most consistent with SLE myocarditis. Furthermore, aggressive SLE-directed therapy demonstrated near full recovery of his heart failure. Conclusion Although myocarditis during SLE flare is a well-described cardiac manifestation, progression to cardiogenic shock is infrequent and fatal. As such, SLE myocarditis should be promptly considered. Given the heterogenous presentation of SLE, combination of serologic evaluation, advanced imaging, and myocardial biopsies can be helpful when diagnostic uncertainty exists. Our case highlights diagnostic methods and clinical course of a de novo presentation of cardiogenic shock from SLE myocarditis, then rapid improvement.

scholarly journals AMYLOIDOSIS HEART IN ELDERLY

2015 ◽  
pp. 28-36
Author(s):  
L. I. Dvoretsky ◽  
O. Yu. Karpova ◽  
E. N. Alexandrova ◽  
S. Yu. Petrova
Keyword(s):  
Heart Failure ◽  
Congestive Heart Failure ◽  
Differential Diagnosis ◽  
Clinical Case ◽  
Clinical Presentation ◽  
The Elderly ◽  
Diagnostic Methods ◽  
Different Types

The data on the incidence, clinical presentation, diagnostic methods amyloidosis of the heart in different types of amyloidosis. The features of the current heart amyloidosis, highlights the difficulty of diagnosis and differential diagnosis in the elderly. As an illustration, describes a clinical case of amyloidosis of the heart in 83-year-old patient, the main manifestation of which was congestive heart failure.

scholarly journals Biomarkers in Heart Failure: Current and Future

Kardiologiia ◽  
2021 ◽  
Vol 61 (5) ◽  
pp. 4-16
Author(s):  
M. V. Kozhevnikova ◽  
Yu. N. Belenkov
Keyword(s):  
Risk Factors ◽  
Heart Failure ◽  
Clinical Practice ◽  
Left Ventricular Ejection Fraction ◽  
Left Ventricular ◽  
Diagnostic Methods ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
New Biomarkers ◽  
Insight Into

Heart failure (HF) is the ending of practically all cardiovascular diseases and the reason for hospitalization of 49% of patients in a cardiological hospital. Available instrumental diagnostic methods and biomarkers not always allow verification of HF, particularly in patients with preserved left ventricular ejection fraction. Prediction of chronic HF in patients with risk factors faces great difficulties. Currently, natriuretic peptides (NUP) are widely used for the diagnosis, prognosis and management of patients with HF and are included in clinical guidelines for diagnosis and treatment of HF. Following multiple studies, the understanding of NUP significance has changed. This resulted in a need for new biomarkers to improve the insight into the process of HF and to personalize the treatment by better individual phenotyping. In addition, current technologies, such as transcriptomic, proteomic and metabolomic analyses, provide identification of new biomarkers and better understanding of features of the HF pathogenesis. The aim of this study was to discuss recent reports on NUP and novel, most promising biomarkers in respect of their possible use in clinical practice. 

Pulmonary thromboembolism presenting with chest pain in a case of peripartum cardiomyopathy

2020 ◽  
Vol 16 (4) ◽  
pp. 263-269
Author(s):  
Elham Mahmoudi ◽  
Mohammadreza Tabary ◽  
Isa Khaheshi
Keyword(s):  
Heart Failure ◽  
Differential Diagnosis ◽  
Ventricular Remodeling ◽  
Pulmonary Thromboembolism ◽  
Left Ventricular ◽  
Peripartum Cardiomyopathy ◽  
Short And Long Term ◽  
Peripartum Period ◽  
Cerebral Ischemic

Peripartum cardiomyopathy (PPCM) is an idiopathic reduction in left ventricular function, presenting at the peripartum period. The diagnosis is based on echocardiographic features and excluding other causes of heart failure. Similar to any other cause of heart failure, the management of PPCM consists of diuretics, prevention of ventricular remodeling, preventing short and long-term complications. Ventricular clots, transient cerebral ischemic attacks, lower extremity thrombosis, kidney and liver infarcts and pulmonary thromboembolism have been previously reported in PPCM cases. Among them, pulmonary thromboembolism is one of the most important complications, as it is also a challenging differential diagnosis of PPCM. We discuss a case of PPCM followed by a diagnosis of pulmonary thromboembolism and briefly review the relevant PPCM literature.

scholarly journals INDICATORS OF STRUCTURAL AND FUNCTIONAL CHANGES IN THE MYOCARDIUM AS PREDICTORS OF THE ATRIAL FIBRILLATION IN PATIENTS WITH HEART FAILURE AND PRESERVED EJECTION FRACTION

2019 ◽  
Vol 112 (4) ◽  
pp. 32-46
Author(s):  
Kateryna Cherniaieva ◽  
Yuliia Rudenko ◽  
Galyna Mostbauer ◽  
Andrii Bezrodniy ◽  
Mykhailo Shevchuk ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Ejection Fraction ◽  
Clinical Symptoms ◽  
Left Ventricular ◽  
Functional Class ◽  
Functional Changes ◽  
Nyha Classification ◽  
Close Relationship ◽  
Ventricular Filling Pressure

A large number of recent trials suggested that atrial fibrillation (AF) and heart failure (HF) should be considered as two epidemic cardiovascular pathologies that are closely interrelated, each contributing to the development of the other. The purpose of our work was to analyze the peculiarities of the structural and functional parameters of the heart and blood vessels in patients with HFpEF, as well as to determine the most informative predictors of AF and their predictive value. A study of the literature indicates that AF has a close relationship with both HFpEF and the diagnostic criteria used to determine it. The relevance of the study of this pathology is that AF has a significant impact on the course and prognosis of HFpEF. The study was conducted on a case-control design. This work is based on the results of examination of 115 hemodynamically stable patients with arterial hypertension (AH), clinical symptoms and signs of heart failure (HF), with left ventricular (LV) ejection fraction (EF) ≥ 50% and signs of diastolic dysfunction (DD) according to echocardiography data. Patients' age ranged from 40 to 85 years (mean age 66.3 ± 10.8 years). For the first time, criteria for LV DD were analyzed as possible predictors of atrial fibrillation in patients with HFpEF and thresholds for some of them were determined. The study empirically confirms and theoretically argues that the presence of atrial fibrillation in patients with HFpEF, in contrast to those with sinus rhythm, is associated with a more severe functional class of HF estimated by NYHA classification; higher by 28.1% NTprоBNP level; increased left ventricular filling pressure with LAVI thresholds > 40 ml/m2 and E/e '> 14.75; with impaired endothelium-dependent vasodilation and an initial decrease in glomerular filtration rate. The results of the study may be useful for the screening and detection of AF in patients with established HFpEF, by monitoring of ECG, in case of detection of threshold values of diastolic LV dysfunction.

scholarly journals Pregnancy Counseling in a Young Woman With Left Ventricular Non-Compaction

2021 ◽  
Vol 9 ◽  
pp. 232470962110537
Author(s):  
Saif El Naser H. M. El Nawaa ◽  
Wasawat Vutthikraivit ◽  
Leighann Jenkins
Keyword(s):  
Heart Failure ◽  
Congestive Heart Failure ◽  
Differential Diagnosis ◽  
Young Woman ◽  
Left Ventricular ◽  
Left Ventricular Noncompaction ◽  
Ventricular Noncompaction ◽  
Pregnancy Planning

Left ventricular noncompaction (LVNC) is an uncommon form of cardiomyopathy. Its prevalence in adults is 1:5000. In the differential diagnosis of congestive heart failure, it is rarely the etiology. The etiology of LVNC may be genetic or acquired. There are not guidelines regarding pregnancy planning or outcome in women with this disease. In this presentation, we bring the issue of genetics and pregnancy counseling in women with left ventricular noncompaction.

scholarly journals Effect of cardiac resynchronization therapy on ventricular tachycardias in patients with dilated cardiomyopathy and severe heart failure

2015 ◽  
Vol 18 (4) ◽  
pp. 144
Author(s):  
D. I. Lebedev ◽  
R. Ye. Batalov ◽  
G. M. Savenkova ◽  
S. M. Minin ◽  
S. N. Krivolapov ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ventricular Tachycardia ◽  
Cardiac Resynchronization Therapy ◽  
Dilated Cardiomyopathy ◽  
Left Ventricular ◽  
Diagnostic Methods ◽  
Cardiac Resynchronization ◽  
Resynchronization Therapy ◽  
One Year ◽  
Ventricular Tachycardias

The aim of the study was to elucidate the effects of cardiac resynchronization therapy (CRT) on ventricular tachycardias in patients with dilated cardiomyopathy and to analyze the prospects of radionuclide diagnostic methods for prediction of life-threatening arrhythmias in the presence of therapy. The study included 70 patients (mean age 55 12 years) aged 32 to 75 years with dilated cardiomyopathy, NYHA FC III heart failure, left ventricular (LV) ejection fraction (EF) of 30.1 3.8%, and end-diastolic volume (EDV) of 220.7 50.9 mL. Group 1 comprised 35 patients (50%) diagnosed with paroxysms of ventricular tachycardia, while Group 2 consisted of 35 patients (50%) without episodes of ventricular tachycardia. After one year of CRT, positive clinical changes were documented in all patients: LV EF increased to 42.8 4.8% (p 0.001); functional class of heart failure decreased to II; LV EDV decreased to 197.9 47.8 mL (p 0.005). The patients whose EF increased by 14% and EDV decreased by 35 mL during one-year CRT had no episodes of ventricular tachycardia. The patients, whose paroxysms of ventricular tachycardia persisted during the entire period of the study, showed EF increase by 9% and EDV decrease by 13 mL. The second stage of the study consisted in evaluating the effects of myocardial metabolism defects (MMD). No ventricular tachycardia episodes were registered in patients whose MMD became less than 15% during CRT; if the size of DMM exceeded 15%, paroxysms of ventricular tachycardia were observed. Thus, efficacious CRT in patients with dilated cardiomyopathy results in a statistically significant reduction of the number of ventricular tachycardia episodes. The improvement of fatty acid metabolism contributes to a decrease in the number of ventricular tachycardia episodes in the course of CRT.

scholarly journals Myocardial performance is impaired in cardiac amyloidosis: role of myocardial work-derived parameter in differential diagnosis with phenocopies and prognostic implications

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
G Palmiero ◽  
M Rubino ◽  
E Monda ◽  
M Caiazza ◽  
F Di Fraia ◽  
...  
Keyword(s):  
Differential Diagnosis ◽  
Ejection Fraction ◽  
Cardiac Amyloidosis ◽  
Systolic Function ◽  
Linear Regression Analysis ◽  
Global Longitudinal Strain ◽  
Strain Ratio ◽  
Left Ventricular ◽  
Myocardial Performance ◽  
Global Work

Abstract Background Cardiac amyloidosis (CA) is an infiltrative disorder characterized by left ventricular (LV) thickening and dysfunction. Due to it poor prognosis its early detection and differential diagnosis among other forms of cardiomyopathies is fundamental. Purpose This study aimed to compare the diagnostic accuracy of LV classical and and novel echocardiographic parameters in differentiating CA from other forms of genetic and non-genetic cardiomyopathies with hypertrophic phenotype. Methods We included 50 patients with CA (26 pts with AL and 24 pts with wild type ATTR form) and 75 patients with LV hypertrophy (LVH) [25 patients with hypertrophic cardiomyopathy (HCM), 25 with hypertensive cardiomyopathy (HypCM), and 25 with aortic stenosis (AS)]. Besides routine echocardiographic measurements, we analysed standard and novel echo parameters implied in LV assessment [LV ejection fraction (LVEF), myocardial contraction fraction (MCF), global longitudinal strain (GLS), relative regional strain ratio (RRSR), ejection fraction on strain ratio (EFSR)], included novel Myocardial Work (MW) parameters [Global Work Index (GWI), Global Constructive Work (GCW), Global Wasted Work (GWW), Global Work Efficiency (GWE)]. Results Patients in CA group showed a smallest LV cavity size, higher LV mass and, consequently, a more pronounced concentric hypertrophy compared to LVH group. All LV systolic parameters where more impaired in CA than in LVH group. At ROC curve analysis, among all others, GCW showed the best performance in discriminating CA from LVH (AUC 0.886; 95% CI: 0.819–0.954; P&lt;0,0001), with a cut-off value &lt;1473 mmHg% showing good sensitivity and specificity (90% and 82%, respectively). At linear regression analysis GCW correlated with IVSD (P&lt;0,0001), PWD (p&lt;0,0001), RWT ratio (p&lt;0,0001), LVMi (p&lt;0,0001), MCF (P&lt;0,0001), LVESV (p&lt;0,002), LVEF (P&lt;0,0001), EFSR (p&lt;0,0001) and RRSR (p&lt;0,0001). At multivariate analysis, PWD (P&lt;0,029) and RWT ratio (p&lt;0,014) were the only parameters associated. At 24 months follow-up there were 15 deaths in the CA group and 4 in LVH group. At Kaplan-Meier analysis the overall survival free of cardiovascular death was reduced in the lowest GCW interquartile ranges (log-rank χ2 21,5; p&lt;0,0001). At Cox hazard ratio analysis GCW (β 1,233; 95% CI: 1,201–1,246; P&lt;0,0001) was the only prognostic parameter associated with cardiovascular mortality. Discussion Although CA and and LVH have with similar phenotype, they differ greatly in terms of systolic function. The MW, estimated by non-invasive pressure-strain loops, is a novel method for a load-independent LV systolic function assessment. In the present study the GCW showed the best ability in detecting CA in comparison to other parameters usually implied in clinical practice. Conclusion Myocardial performance is significantly reduced in CA compared to other forms of LVH. GCW showed to be a promising novel diagnostic and prognostic factor in this setting. FUNDunding Acknowledgement Type of funding sources: None. Table 1 Figure 1

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