scholarly journals Body Mass Index: An Effective Predictor of Ejection Fraction Improvement in Heart Failure

2021 ◽  
Vol 8 ◽  
Author(s):  
Li-fang Ye ◽  
Xue-ling Li ◽  
Shao-mei Wang ◽  
Yun-fan Wang ◽  
Ya-ru Zheng ◽  
...  
Keyword(s):  
Heart Failure ◽  
Body Mass Index ◽  
Standard Deviation ◽  
Ejection Fraction ◽  
Body Mass ◽  
Multivariable Analysis ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Standard Deviation Increase ◽  
Ventricular Ejection Fraction

Background: Heart failure patients with higher body mass index (BMI) exhibit better clinical outcomes. Therefore, we assessed whether the BMI can predict left ventricular ejection fraction (EF) improvement following heart failure.Methods and Results: We included 184 patients newly diagnosed with dilated cardiomyopathy and reduced EF in our center and who underwent follow-up examination of EF via echocardiography after 6 months. The EF improved at 6 months in 88 participants, who were included in the heart failure with recovered EF (HFrecEF) subgroup. Patients in whom the EF remained reduced were included in the heart failure with persistently reduced EF (persistent HFrEF) subgroup. Our analyses revealed that EF increase correlated with age (r = −0.254, P = 0.001), left ventricular diastolic dimension (LVDD; r = −0.210, P = 0.004), diabetes (P = 0.034), brain natriuretic peptide (r = −0.199, P = 0.007), and BMI grade (P = 0.000). BMI grade was significantly associated with elevated EF after adjustment for other variables (P = 0.001). On multivariable analysis, compared to patients with persistent HFrEF, those with HFrecEF had higher BMI [odds ratio (OR) = 2.342 per one standard deviation increase; P = 0.001] and lower LVDD (OR = 0.466 per one standard deviation increase; P = 0.001). ROC-curve analysis data showed that BMI > 22.66 kg/m2 (sensitivity 84.1%, specificity 59.4%, AUC 0.745, P = 0.000) indicate high probability of EF recovery in 6 months.Conclusions: Our data suggest that higher BMI is strongly correlated with the recovered EF and that BMI is an effective predictor of EF improvement in patients with heart failure and reduced EF.

scholarly journals A History of Heart Failure Is an Independent Risk Factor for Death in Patients Admitted with Coronavirus 19 Disease

2021 ◽  
Vol 8 (7) ◽  
pp. 77
Author(s):  
Francesco Castagna ◽  
Rachna Kataria ◽  
Shivank Madan ◽  
Syed Zain Ali ◽  
Karim Diab ◽  
...  
Keyword(s):  
Heart Failure ◽  
Body Mass Index ◽  
Risk Factor ◽  
Ejection Fraction ◽  
Hospital Mortality ◽  
Body Mass ◽  
Left Ventricular ◽  
Clinical Severity ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction

Aims: The association between cardiovascular diseases, such as coronary artery disease and hypertension, and worse outcomes in COVID-19 patients has been previously demonstrated. However, the effect of a prior diagnosis of heart failure (HF) with reduced or preserved left ventricular ejection fraction on COVID-19 outcomes has not yet been established. Methods and Results: We retrospectively studied all adult patients with COVID-19 admitted to our institution from March 1st to 2nd May 2020. Patients were grouped based on the presence or absence of HF. We used competing events survival models to examine the association between HF and death, need for intubation, or need for dialysis during hospitalization. Of 4043 patients admitted with COVID-19, 335 patients (8.3%) had a prior diagnosis of HF. Patients with HF were older, had lower body mass index, and a significantly higher burden of co-morbidities compared to patients without HF, yet the two groups presented to the hospital with similar clinical severity and similar markers of systemic inflammation. Patients with HF had a higher cumulative in-hospital mortality compared to patients without HF (49.0% vs. 27.2%, p < 0.001) that remained statistically significant (HR = 1.383, p = 0.001) after adjustment for age, body mass index, and comorbidities, as well as after propensity score matching (HR = 1.528, p = 0.001). Notably, no differences in mortality, need for mechanical ventilation, or renal replacement therapy were observed among HF patients with preserved or reduced ejection fraction. Conclusions: The presence of HF is a risk factor of death, substantially increasing in-hospital mortality in patients admitted with COVID-19.

Observations on obesity patterns in tetralogy of Fallot patients from childhood to adulthood

2016 ◽  
Vol 27 (5) ◽  
pp. 890-894 ◽  
Author(s):  
David A. Briston ◽  
Aarthi Sabanayagam ◽  
Ali N. Zaidi
Keyword(s):  
Body Mass Index ◽  
Left Ventricular Ejection Fraction ◽  
Ejection Fraction ◽  
Tetralogy Of Fallot ◽  
Body Mass ◽  
Nyha Class ◽  
Left Ventricular ◽  
Ventricular Ejection ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction

AbstractObesity is increasingly prevalent, and abnormal body mass index is a risk factor for cardiovascular disease. There are limited data published regarding body mass index and CHD. We tested the hypothesis that body mass index and obesity prevalence are increasing in patients with tetralogy of Fallot over time by analysing time since surgery, age, height, weight, and body mass index among tetralogy of Fallot patients and demographic data from age-matched controls. NYHA class and left ventricular ejection fraction were analysed in adults. Body mass index was categorised into normal, overweight, and obese in this single-centre, retrospective chart review. Data were collected from 137 tetralogy of Fallot patients (71 men:66 women), of whom 40 had body mass index >25 kg/m2. Tetralogy of Fallot patients aged <6 years had lower body mass index (15.9 versus 17.1; p=0.042) until 16–20 years of age (27.4 versus 25.4; p=0.43). For adult tetralogy of Fallot patients, the mean body mass index was 26.5 but not statistically significantly different from the control cohort. Obese adult patients had significantly higher average NYHA class compared with those of normal weight (p=0.03), but no differences in left ventricular ejection fraction by echocardiography (p=0.55) or cardiac MRI (p=0.26) were noted. Lower body mass index was observed initially in tetralogy of Fallot patients, but by late adolescence no significant difference was observed. As adults, tetralogy of Fallot patients with higher body mass index had increased NYHA class but similar left ventricular ejection fraction.

Body mass index and outcomes in ischaemic versus non-ischaemic heart failure across the spectrum of ejection fraction

2020 ◽  
pp. 204748732092761
Author(s):  
Francesco Gentile ◽  
Paolo Sciarrone ◽  
Elisabet Zamora ◽  
Marta De Antonio ◽  
Evelyn Santiago ◽  
...  
Keyword(s):  
Heart Failure ◽  
Body Mass Index ◽  
Ejection Fraction ◽  
Body Mass ◽  
Left Ventricular ◽  
Hazard Ratio ◽  
Left Ventricular Ejection ◽  
Heart Failure Patients ◽  
All Cause Mortality ◽  
Mild Obesity

Aims Obesity is related to better prognosis in heart failure with either reduced (HFrEF; left ventricular ejection fraction (LVEF) <40%) or preserved LVEF (HFpEF; LVEF ≥50%). Whether the obesity paradox exists in patients with heart failure and mid-range LVEF (HFmrEF; LVEF 40–49%) and whether it is independent of heart failure aetiology is unknown. Therefore, we aimed to test the prognostic value of body mass index (BMI) in ischaemic and non-ischaemic heart failure patients across the whole spectrum of LVEF. Methods Consecutive ambulatory heart failure patients were enrolled in two tertiary centres in Italy and Spain and classified as HFrEF, HFmrEF or HFpEF, of either ischaemic or non-ischaemic aetiology. Patients were stratified into underweight (BMI <18.5 kg/m2), normal-weight (BMI 18.5–24.9 kg/m2), overweight (BMI 25–29.9 kg/m2), mild-obese (BMI 30–34.9 kg/m2), moderate-obese (BMI 35–39.9 kg/m2) and severe-obese (BMI ≥40 kg/m2) and followed up for the end-point of five-year all-cause mortality. Results We enrolled 5155 patients (age 70 years (60–77); 71% males; LVEF 35% (27–45); 63% HFrEF, 18% HFmrEF, 19% HFpEF). At multivariable analysis, mild obesity was independently associated with a lower risk of all-cause mortality in HFrEF (hazard ratio, 0.78 (95% confidence interval (CI) 0.64–0.95), p = 0.020), HFmrEF (hazard ratio 0.63 (95% CI 0.41–0.96), p = 0.029), and HFpEF (hazard ratio 0.60 (95% CI 0.42–0.88), p = 0.008). Both overweight and mild-to-moderate obesity were associated with better outcome in non-ischaemic heart failure, but not in ischaemic heart failure. Conclusions Mild obesity is independently associated with better survival in heart failure across the whole spectrum of LVEF. Prognostic benefit of obesity is maintained only in non-ischaemic heart failure.

Correlation of Inflammation, Lipidogram, and Hematological Readings in Chronic Heart Failure Patients

2021 ◽  
Vol 6 (1) ◽  
pp. 7
Author(s):  
Greta Gujytė ◽  
Aušra Mongirdienė ◽  
Jolanta Laukaitienė
Keyword(s):  
Heart Failure ◽  
Body Mass Index ◽  
Ejection Fraction ◽  
Body Mass ◽  
Left Ventricular ◽  
Cholesterol Concentration ◽  
Left Ventricular Ejection ◽  
Low Grade ◽  
Monocyte Count ◽  
History Of

Background and Objectives: Inflammation is a recognized factor in disease progression in both heart failure (HF) patients with reduced ejection fraction (HFrEF) and HF with preserved ejection fraction (HFpEF). Neutrophils take part in maintaining the pro-inflammatory state in HF. Hypercholesterolemia is stated to heighten neutrophil production, which contributes to accelerated cardiovascular inflammation. HF pathogenesis differences in the different HF phenotypes are yet to be investigated. Aim: To determine differences in complete blood count, C-reactive protein (CRP) concentration and lipidogram between chronic HF patients with an absence/presence of myocardial infarction (MI) history and preserved/reduced EF. Materials and Methods: We separated the patients (n = 266) according to chronic HF phenotype: (1) HFrEF patients (n = 149) into groups according to presence of MI: those who had had no MI (n = 91) and those with MI (n = 58); (2) chronic HF without MI according to left ventricular ejection fraction (LVEF): LVEF ≥ 50%, n = 117; LVEF < 50%, n = 91. Laboratory and clinical readings (age, weight, pulse, blood pressure, and body mass index (BMI)) were taken from the patients’ medical histories. Results: Mean corpuscular hemoglobin concentration (MCHC) was lower and red cell distribution width—coefficient of variation (RDW-CV) was higher in the lower EF group without a history of MI (337.32 (10.60) and 331.46 (13.13), p = 0.004; 13.6 (11.5–16.9), and 14.7 (12.6–19.1), p = 0.001). Lymphocyte percentage and lymphocyte-to-monocyte ratio (LYM/MON) were lower in the lower EF group without a history of MI (30.48 (10.87), 26.98 (9.08), p = 0.045; 3.33 (1.22–9.33), 3 (0.44–6.5), p = 0.011). In the group according to LVEF without MI neutrophil count positively correlated with weight (rp = 0.196, p = 0.024); lymphocyte count correlated with RDW-CV (rs = −0.223; p = 0.032) and body mass index (rp = 0.186, p = 0.032). RDW-CV and monocyte count correlated with NT-proBNP and serum creatinine (rs = 0.358, p = 0.034; rs = 0.424, p < 0.001 and rs = 0.354, p = 0.012; rs= 0.205, p = 0.018 respectively). CRP concentration (6.9 (1.46–62.97), 7 (1–33.99), p = 0.012) was higher and HDL concentration was lower (0.96 (0.44–2.2), 0.92 (0.56–1.97), p = 0.010) in HFrEF with MI in comparison with the group without MI. LVEF correlated with MCHC and RDW-CV (rs = 0.273, p = 0.001; rs = −0.404, p < 0.001). HDL cholesterol concentration was lower (0.96 (0.44–2.2); 0.92 (0.56–1.97, p = 0.010) and CRP concentration (6.9 (1.46–62.97), 7 (1–33.99), p = 0.012) was higher in the HFrEF with MI group. Uric acid concentration correlated with platelet-to-lymphocyte ratio and LYM/MON (rs = 0.321, p = 0.032; rs = −0.341, p = 0.023). Creatinine concentration correlated with monocyte percentage and count (rp = 0.312, p = 0.001; rp = 0.287, p = 0.003). A correlation between CRP and MCHC (rs = 0.262, p = 0.008) was observed. Conclusions: Our findings revealed the higher pro-inflammatory condition in HFrEF group without MI in comparison with HFpEF without MI. LYM/MON can be appropriate as additional reading for evaluation of functional condition in HFrEF group without MI. It seems inflammation environment could be higher in HFrEF with MI in disease history in comparison with those without MI. HDL concentration inversely correlated with monocyte count and the percentages could show the relationship between the low-grade inflammation and lipid metabolism in HFrEF. Both MCHC and RDW-CV may be relevant in assessing the chronic HF patients’ condition.

Heart Failure with Preserved Ejection Fraction – A Review

2012 ◽  
Vol 9 (1) ◽  
pp. 90-95 ◽  
Author(s):  
Otto A Smiseth ◽  
Anders Opdahl ◽  
Espen Boe ◽  
Helge Skulstad
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Diastolic Heart Failure ◽  
The Elderly ◽  
Left Ventricular ◽  
Filling Pressure ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Reduced Ejection Fraction ◽  
Objective Evidence

Heart failure with preserved left ventricular ejection fraction (HF-PEF), sometimes named diastolic heart failure, is a common condition most frequently seen in the elderly and is associated with arterial hypertension and left ventricular (LV) hypertrophy. Symptoms are attributed to a stiff left ventricle with compensatory elevation of filling pressure and reduced ability to increase stroke volume by the Frank-Starling mechanism. LV interaction with stiff arteries aggravates these problems. Prognosis is almost as severe as for heart failure with reduced ejection fraction (HF-REF), in part reflecting co-morbidities. Before the diagnosis of HF-PEF is made, non-cardiac etiologies must be excluded. Due to the non-specific nature of heart failure symptoms, it is essential to search for objective evidence of diastolic dysfunction which, in the absence of invasive data, is done by echocardiography and demonstration of signs of elevated LV filling pressure, impaired LV relaxation, or increased LV diastolic stiffness. Antihypertensive treatment can effectively prevent HF-PEF. Treatment of HF-PEF is symptomatic, with similar drugs as in HF-REF.

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