scholarly journals Cardiac Imaging for the Assessment of Left Atrial Mechanics Across Heart Failure Stages

2022 ◽  
Vol 8 ◽  
Author(s):  
Francesco Bandera ◽  
Anita Mollo ◽  
Matteo Frigelli ◽  
Giulia Guglielmi ◽  
Nicoletta Ventrella ◽  
...  

The left atrium (LA) is emerging as a key element in the pathophysiology of several cardiac diseases due to having an active role in contrasting heart failure (HF) progression. Its morphological and functional remodeling occurs progressively according to pressure or volume overload generated by the underlying disease, and its ability of adaptation contributes to avoid pulmonary circulation congestion and to postpone HF symptoms. Moreover, early signs of LA dysfunction can anticipate and predict the clinical course of HF diseases before the symptom onset which, particularly, also applies to patients with increased risk of HF with still normal cardiac structure (stage A HF). The study of LA mechanics (chamber morphology and function) is moving from a research interest to a clinical application thanks to a great clinical, prognostic, and pathophysiological significance. This process is promoted by the technological progress of cardiac imaging which increases the availability of easy-to-use tools for clinicians and HF specialists. Two-dimensional (2D) speckle tracking echocardiography and feature tracking cardiac magnetic resonance are becoming essential for daily practice. In this context, a deep understanding of LA mechanics, its prognostic significance, and the available approaches are essential to improve clinical practice. The present review will focus on LA mechanics, discussing atrial physiology and pathophysiology of main cardiac diseases across the HF stages with specific attention to the prognostic significance. Imaging techniques for LA mechanics assessment will be discussed with an overlook on the dynamic (under stress) evaluation of the chamber.

Author(s):  
Lisa Brandon ◽  
◽  
Brian Kerr ◽  
Ken McDonald ◽  
◽  
...  

LVNC is a relatively new clinical entity, with a significant increase in awareness and diagnosis in recent years. Currently the aetiology and pathogenesis of LVNC remains uncertain, alongside prevalence, however the diagnosis of LVNC appears to be increasing with improving imaging techniques. For educational purposes involving a rare clinical condition, we present the case of a 52 year old gentleman who was diagnosed with LV non compaction via ECHO and CMR. Interestingly it was noted two of his children had congenital heart disease, one daughter had Tetralogy of Fallot, and a second daughter had both an ASD and VSD. Challenges facing LVNC involve difficulty of diagnosis with no gold standard yet available, uncertainty of benefit with standard disease modifying therapies for HF-REF, and apparent increased risk of arrhythmias suggesting early ICD placement may be warranted for patients. Keywords: Hr-Ref; heart failure; lv non compaction; arrhythmias; lcd Risk.


Author(s):  
Mauro Gitto ◽  
Dimitrios A. Vrachatis ◽  
Gianluigi Condorelli ◽  
Konstantinos Papathanasiou ◽  
Bernhard Reimers ◽  
...  

: Sodium-glucose cotransporter 2 (SGLT2) inhibitors are a class of anti-diabetic agents that block the reabsorption of glucose in the proximal convoluted tubule of the nephron, thereby contributing to glycosuria and lowering blood glucose levels. SGLT2 inhibitors have been associated with improved cardiovascular outcomes in patients with diabetes, including a reduced risk of cardiovascular death and hospitalizations for heart failure. Recently, DAPA-HF and EMPEROR REDUCED trials showed the beneficial cardiovascular effect of SGLT2 inhibitors in patients with heart failure with consistently reduced ejection fraction (HFrEF) regardless of the presence of diabetes. Moreover, some exploratory studies suggested that these drugs improve Left Ventricular (LV) systolic function and oppose LV adverse remodeling in patients with HFrEF. However, the exact mechanisms that mediated for this benefit are not fully understood. Beyond glycemic control, enhanced natriuresis, increased erythropoiesis, improved endothelial function, changes in myocardial metabolism, anti-inflammatory and anti-oxidative properties may all play an active role in SGLT2 inhibitors’ cardiovascular benefits. A deep understanding of the pathophysiological interplay is key to define which HF phenotype could benefit more from SGLT2 inhibitors. Current clinical evidence on the comparison of different HF etiologies is limited to posthoc subgroup analysis of DAPA-HF and EMPEROR-REDUCED, which showed similar outcomes in patients with or without ischemic HF. On the other hand, in earlier studies of patients suffering from diabetes, rates of classic ischemic endpoints, such as myocardial infarction, stroke or coronary revascularization, did not differ between patients treated with SGLT2 inhibitors or placebo. The aim of this review is to discuss whether SGLT2 inhibitors may improve prognosis in patients with ischemic HF, not only in terms of reducing re-hospitalizations and improving left ventricular function but also by limiting coronary artery disease progression and ischemic burden.


2019 ◽  
Vol 27 (5) ◽  
pp. 494-510 ◽  
Author(s):  
Alberto Aimo ◽  
Vincenzo Castiglione ◽  
Chiara Borrelli ◽  
Luigi F Saccaro ◽  
Maria Franzini ◽  
...  

Both oxidative stress and inflammation are enhanced in chronic heart failure. Dysfunction of cardiac mitochondria is a hallmark of heart failure and a leading cause of oxidative stress, which in turn exerts detrimental effects on cellular components, including mitochondria themselves, thus generating a vicious circle. Oxidative stress also causes myocardial tissue damage and inflammation, contributing to heart failure progression. Furthermore, a subclinical inflammatory state may be caused by heart failure comorbidities such as obesity, diabetes mellitus or sleep apnoeas. Some markers of both oxidative stress and inflammation are enhanced in chronic heart failure and hold prognostic significance. For all these reasons, antioxidants or anti-inflammatory drugs may represent interesting additional therapies for subjects either at high risk or with established heart failure. Nonetheless, only a few clinical trials on antioxidants have been carried out so far, with several disappointing results except for vitamin C, elamipretide and coenzyme Q10. With regard to anti-inflammatory drugs, only preliminary data on the interleukin-1 antagonist anakinra are currently available. Therefore, a comprehensive, deep understanding of our current knowledge on oxidative stress and inflammation in chronic heart failure is key to providing some suggestions for future research on this topic.


2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Marina Efremovtseva ◽  
Svetlana Avdoshina ◽  
Zhanna Kobalava

Abstract Background and Aims Biomarkers are currently considered as an additional criterion for the diagnosis of AKI. Early diagnosis of AKI is especially important in acute cardiovascular diseases due to increased risk of severe adverse events associated with development of cardiorenal syndrome. The aim of the study to explore the role of biomarkers in early diagnosis of AKI and their prognostic values in patients with acute cardiac diseases. Method 109 patients (51 with acute decompensated heart failure (ADHF), 58 with non-ST-elevation acute coronary syndrome (NSTE-ACS) were examined. Biomarkers of HF (NT-pro BNP in serum) and kidney damage (cystatin C in serum; neutrophil gelatinase-associated lipocalin (NGAL), kidney injury molecule-1 (KIM-1) and interleukine-18 (IL-18) in the urine) were estimated. Mann-Whitney test and multivariate logistic regression analysis were performed, p <0.05 was considered statistically significant. Results Patients with vs without AKI had higher levels of NGAL (344±308.8 vs 37.9±65.1 ng/ml, p <0.001) and KIM-1 (0.774±0.36 vs 0.402±0.59 ng/ml, p <0.01) in all groups. Patients with NSTE-ACS with vs without AKI had higher level of NT-proBNP (12857.1±3108.8 vs 10134±2479, p<0.001), no difference was detected in ADHF group. In course of ROC analyses NGAL and KIM-1 showed the best prognostic values (AUC value 0.948 and 0.760). The сut points for NGAL >60.1 ng/ml (sensitivity 87%, specificity 92%) and KIM-1 > 0.519 ng/ml (sensitivity 87%, specificity 67%) were detected, coefficient of association φ was 0,781 and 0,555 respectively. Simultaneous detection of two markers of structural kidney damage (increase of NGAL and/or KIM-1) in high-risk patients permits to diagnose 95% of AKI cases at admission. Patients with AKI and diagnostically significant levels of biomarkers had higher prevalence of CKD (p<0.01), acute heart failure, ADHF (p<0.05) vs those without increase of biomarkers, in-hospital mortality in this group was 29,8%. Conclusion Positive combined biomarker test is an independent and strong predictor of AKI in patients with acute cardiac diseases, and its implementation in clinical practice improve the early diagnostics of AKI when markers of kidney function are still at normal levels.


2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
Z Chunawala ◽  
A Qamar ◽  
S Arora ◽  
A Pandey ◽  
M Fudim ◽  
...  

Abstract Introduction The prevalence and outcomes of polyvascular disease (PVD) in patients admitted with acute decompensated heart failure (ADHF) have not been previously reported, nor is it known whether associations differ for heart failure (HF) with reduced vs. preserved ejection fraction (HFrEF vs HFpEF, respectively). Purpose To investigate the relationship between atherosclerotic involvement of multiple arterial territories and mortality in patients hospitalized with ADHF. Methods The Atherosclerosis Risk in Communities (ARIC) study conducted hospital surveillance of adjudicated heart failure in 4 US areas from 2005–2014, with events verified by physician review. Medical histories were abstracted from the hospital record. PVD was defined by coexisting disease in ≥2 arterial beds, identified by prevalent coronary artery disease, peripheral arterial disease, and cerebrovascular disease. Mortality hazards of PVD vs. no PVD were analyzed separately for HFpEF and HFrEF, with adjustment for age, race, sex, year of admission and geographic region. All analyses were weighted by the inverse of the sampling probability. Results Of 24,936 ADHF hospitalizations (52% female, 32% Black, mean age 75 years), 19% had PVD (22% among HFrEF hospitalizations, 17% among HFpEF hospitalizations), Figure 1. There was an increasing trend in 1-year mortality with 0, 1 and ≥2 arterial bed involvement, both for patients with HFrEF (29% to 32% to 38%; P-trend=0.0006) and HFpEF (26% to 32% to 37%; P-trend <0.0001). After adjustments, PVD was associated with a 20% higher hazard of 1-year mortality in patients with HFrEF (HR=1.23; 95% CI: 1.06–1.44) and a 30% higher hazard in patients with HFpEF (HR=1.33; 95% CI: 1.09–1.63), with no significant interaction by HF type (P-interaction = 0.5). Conclusion Patients hospitalized with ADHF and coexisting PVD have an increased risk of death, irrespective of HF type. Clinical attention should be directed toward PVD, with secondary prevention strategies enacted to improve the prognosis of this vulnerable population. FUNDunding Acknowledgement Type of funding sources: Public Institution(s). Main funding source(s): National Institutes of Health Distributions of arterial disease Trends in 1-year mortality outcomes


2005 ◽  
Vol 289 (1) ◽  
pp. H8-H16 ◽  
Author(s):  
Kambeez Berenji ◽  
Mark H. Drazner ◽  
Beverly A. Rothermel ◽  
Joseph A. Hill

Ventricular hypertrophy develops in response to numerous forms of cardiac stress, including pressure or volume overload, loss of contractile mass from prior infarction, neuroendocrine activation, and mutations in genes encoding sarcomeric proteins. Hypertrophic growth is believed to have a compensatory role that diminishes wall stress and oxygen consumption, but Framingham and other studies established ventricular hypertrophy as a marker for increased risk of developing chronic heart failure, suggesting that hypertrophy may have maladaptive features. However, the relative contribution of comorbid disease to hypertrophy-associated systolic failure is unknown. For instance, coronary artery disease is induced by many of the same risk factors that cause hypertrophy and can itself lead to systolic dysfunction. It is uncertain, therefore, whether ventricular hypertrophy commonly progresses to systolic dysfunction without the contribution of intervening ischemia or infarction. In this review, we summarize findings from epidemiologic studies, preclinical experiments in animals, and clinical trials to lay out what is known—and not known—about this important question.


2021 ◽  
Author(s):  
Marta Fontes Oliveira ◽  
Ana Leonor Rei ◽  
Maria Isilda Oliveira ◽  
Isabel Almeida ◽  
Mário Santos

Aim: Heart failure with preserved ejection fraction (HFpEF) is a clinically relevant complication of systemic sclerosis (SSc). We aimed to examine the prevalence, correlates and prognostic significance of HFpEF in an SSc population. Materials & methods: HFpEF was defined by the presence of exertional dyspnoea, abnormal cardiac structure (left ventricular hypertrophy or left atrial enlargement) and NT-proBN (>125 pg/ml). Results: Of the 155 studied patients, 27% had HFpEF criteria. These patients were older, had more cardiovascular risk factors, and were more likely to have atrial fibrillation or interstitial lung disease. Conclusion: Over a median follow-up of 9 years, SSc patients with HFpEF had a 3.4-fold increased risk of dying (HR: 3.37, 95% CI: 1.21–9.31), although this association has lost statistical significance after adjusting for age. On the contrary, NT-proBNP was an independent predictor of a worse prognosis.


2020 ◽  
Vol 25 (1) ◽  
pp. 78-82
Author(s):  
E. V. Shlyakhto ◽  
S. V. Villevalde ◽  
A. E. Soloveva ◽  
N. E. Zvartau ◽  
M. Yu. Sitnikova ◽  
...  

Heart failure (HF) is one of the leading causes of adult mortality. Increased risk of death determines need for better understanding of the pathophysiological mechanisms, predictive risk stratification models and applicable methods to improve prognosis. One of the unfavorable prognostic factors may be an inadequate hemodynamic response to orthostatic stress. Orthostatic hypotension (OH) is known to be an independent predictor of many cardiovascular diseases, particularly HF, and death. Singlecenter study of HF population revealed that systolic blood pressure within 3-5 minutes after standing up may be a predictor of long-term unfavorable outcomes. Nevertheless, data about OH in patients with HF are limited and inconsistent due to heterogeneity of populations and different methodology in published studies. In this regard, a population-based study of the orthostatic response in patients with HF (stable and decompensated) is needed. The article describes the rationale and design of a multicenter prospective observational study aimed to assess the clinical and prognostic significance of orthostatic responses in HF patients.


2003 ◽  
Vol 2 (1) ◽  
pp. 105
Author(s):  
F MASSARI ◽  
P GUIDA ◽  
F MASTROPASQUA ◽  
M IACOVIELLO ◽  
B RIZZON ◽  
...  

2008 ◽  
Vol 7 ◽  
pp. 90-91
Author(s):  
S NODARI ◽  
M METRA ◽  
A MANERBA ◽  
G MILESI ◽  
N BERLINGHIERI ◽  
...  

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