scholarly journals ARNi: A Novel Approach to Counteract Cardiovascular Diseases

2019 ◽  
Vol 20 (9) ◽  
pp. 2092 ◽  
Author(s):  
Massimo Volpe ◽  
Speranza Rubattu ◽  
Allegra Battistoni
Keyword(s):  
Heart Failure ◽  
Cardiovascular Diseases ◽  
Ejection Fraction ◽  
Reduced Ejection Fraction ◽  
New Class ◽  
Novel Approach ◽  
Hormonal System ◽  
Therapeutic Tools ◽  
And Control ◽  
New Evidence

Cardiovascular diseases (CVDs) still represent the greatest burden on healthcare systems worldwide. Despite the enormous efforts over the last twenty years to limit the spread of cardiovascular risk factors, their prevalence is growing and control is still suboptimal. Therefore, the availability of new therapeutic tools that may interfere with different pathophysiological pathways to slow the establishment of clinical CVDs is important. Previously, the inhibition of neurohormonal systems, namely the renin–angiotensin–aldosterone system (RAAS) and the sympathetic nervous system, has proven to be useful in the treatment of many CVDs. Attempts have recently been made to target an additional hormonal system, that of the natriuretic peptides (NPs), which, when dysregulated, can also play a role in the development CVDs. Indeed, a new class of drug, the angiotensin receptor–neprilysin inhibitors (ARNi), has the ability to counteract the effects of angiotensin II as well as to increase the activity of NPs. ARNi have already been proven to be effective in the treatment of heart failure with reduced ejection fraction. New evidence has suggested that, in the next years, the field of ARNi application will widen to include other CVDs, such as heart failure, with preserved ejection fraction and hypertension.

scholarly journals Clinical characteristics and correlates of patients with heart failure with mid-range ejection fraction in southwest Nigeria

2021 ◽  
Vol 2 (2) ◽  
Author(s):  
Adeseye Akintunde
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Clinical Characteristics ◽  
Left Ventricular ◽  
Teaching Hospitals ◽  
High Systolic Blood Pressure ◽  
Reduced Ejection Fraction ◽  
New Class ◽  
Southwest Nigeria ◽  
And Gender

A new class of Heart Failure (HF) phenotypes, HF with midrange Ejection Fraction (HFmrEF), was recently introduced, but its clinical characteristics and therapeutic distinctiveness are not yet well understood. This study aimed to describe the clinical characteristics, echocardiographic features, and other correlates of HFmrEF in southwest Nigeria. Two hundred and sixty-nine consecutive HF subjects who had echocardiography done in the cardiology clinics of two teaching hospitals were recruited for this study. Clinical parameters such as age, body mass index, waist-hip ratio, and gender were determined. The presence of comorbidities, such as hypertension and diabetes, was also assessed. Statistical analysis was done, and p <0.05 was taken as statistically significant. HFmrEF subjects constituted 27.5% of total cohort, while subjects with HF with preserved Ejection Fraction (HFpEF) and HF with reduced Ejection Fraction (HFrEF) were 29.0% and 43.5% respectively. HFmrEF was more likely to be associated with high systolic blood pressure and obesity. The clinical characteristics of HFmrEF were intermediate between those of the other two HF phenotypes. Prevalence of comorbidities, such as anaemia, iron deficiency, pulmonary hypertension, and left ventricular hypertrophy were also intermediate between HFpEF and HFrEF. Atrial fibrillation was commonest among HFmrEF subjects. There was no significant age or gender variation between the three phenotypes. Patients with HFmrEF have clinical and demographic distinctiveness that are often intermediate between HFpEF and HFrEF phenotypes. Further studies of this HF phenotype will help in understanding its therapeutic identity and its prognosis among Africans.

P4518Cerebral blood flow is lower in heart failure patients with reduced ejection fraction

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
E Babayigit ◽  
Y Cavusoglu ◽  
M Dural ◽  
K U Mert ◽  
T Ulus ◽  
...  
Keyword(s):  
Heart Failure ◽  
Blood Flow ◽  
Cerebral Blood Flow ◽  
Ejection Fraction ◽  
Control Group ◽  
Mean Flow ◽  
Control Groups ◽  
Reduced Ejection Fraction ◽  
And Control ◽  
Flow Velocities

Abstract Purpose Heart and brain interaction is a well-known entity in heart failure (HF) and left ventricular systolic dysfunction poses an increased risk for stroke and cognitive impairment. Transcranial Doppler (TCD) provides valuable information on cerebral blood flow and detects microembolic signals that can be used to determine the risk of cerebrovascular events. However, less is known about cerebral blood flow in HF patients with reduced EF. So, we aimed to evaluate cerebral blood flow rates by means of TCD in HF patients with reduced ejection fraction (EF). Methods This study included 46 HF patients with an EF less than 35% (mean age 65.2±11 years, mean EF 20.1±3.8%) who underwent to TCD examination. In addition, 26 healthy individuals with sinus rhythm and EF >50% (mean age 64.4±9.0 years, mean EF 63.5±2.38%) were included in the study as a control group. Minimum, maximum and mean flow velocities of the both right middle cerebral artery (RMCA) and left middle cerebral artery (LMCA) determined by TCD were analyzed. Results The average of RMCA maximum and mean flow velocities were found to be significantly lower in HF patients than those in control group (76,06±23,7 cm/s and 48,49±16,4 cm/s in HF group vs 87,84±14,5 cm/s and 56,41±10,7 cm/s in control group, p=0,025 and p=0,016, respectively). The average of LMCA maximum and mean flow velocities were also significantly lower in HF patients than those in control group (75,1±22,3 cm/s and 47,57±14.8 cm/s in HF group vs 88,73±17,7 cm/s and 57,15±12,4 cm/s in control group, p=0,009 and p=0,007, respectively). However, there was no significant difference in minimum RMCA or LMCA flow velocities between HF group and control groups (33,5±10,6 cm/s and 32,86±9,58 cm/s in HF group vs 36,34±9,2 cm/s and 36,53±10,4 cm/s in control group, p=0,226 and p=0,157, respectively). No significant microembolic signals were detected in HF and control groups. Conclusions The results of this study showed that HF patients with reduced EF have lower cerebral blood flow velocities as compared to healthy controls, which might be one of the explanations of the adverse interaction between heart and brain in HF.

Size and function of left atrium in patient with heart failure with reduced ejection fraction

2019 ◽  
pp. 8-13
Author(s):  
Van Khanh Nguyen Truong ◽  
Anh Vu Nguyen
Keyword(s):  
Heart Failure ◽  
Cardiovascular Diseases ◽  
Ejection Fraction ◽  
Diastolic Dysfunction ◽  
Left Atrium ◽  
Left Atrial ◽  
Left Ventricular ◽  
Reduced Ejection Fraction ◽  
Study Results ◽  
And Function

Background: Heart failure is a common clinical syndrome and is the final stage of most cardiovascular diseases. Nowadays, the role of left atrium in cardiovascular diseases, especially in HF diseases, is more and more important. At the early stage of heart failure, the size and pump function of left atrium are increased. When the left ventricular function is reduced significantly, left atrial function is alo impaired. Aims of the study: assess size and function of left atrium in patient with heart failure reduced ejection fraction (HFrEF). Establishing the association between two indexs above with some clinical and subclinical characteristics. Subjects and method: 51 HFrEF patients in Hospital of Hue University of Medicine and Pharmacy, who have including criteria. Cross-sectional study. Results: LAVI (ml/m2): 43.19 ± 12.48 ml/m2, percentage of large left atrial patents is 80.4%. LATEF (%): 31.93 ± 7.72%. LAVI has correlation with: LVEDV (r= 0,45); LVESV (r= 0,43); NT-proBNP (r= 0.371). There is a difference LAVI of diastolic dysfunction grades (r= 0.011), There is a difference LAVI of NYHA class (r= 0.016). LATEF has correlation with NTproBNP (r= -0.349). Conclusion: The left atrium’s size is increased and its function is reduced in HFrEF patient. There is a positive correlation between LAVI and LVEDV, LVESV, NTproBNP. The LAVI varies with the diastolic dysfunction grade. And there is a negative correlation between LATEF and NTproBNP. Key words: heart failure reduced ejection fraction; size of left atrium, function of left atrium

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.

Evaluation of the Efficacy of ST2 and NT-proBNP in the Diagnosis and Prediction of Short- Term Prognosis in Heart Failure with Reduced Ejection Fraction

2017 ◽  
Vol 9 (04) ◽  
Author(s):  
Shivananda B Nayak ◽  
Dharindra Sawh ◽  
Brandon Scott ◽  
Vestra Sears ◽  
Kareshma Seebalack ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Cardiac Biomarkers ◽  
Double Blind Study ◽  
Short Term ◽  
Double Blind ◽  
Reduced Ejection Fraction ◽  
The Mean ◽  
Design And Methods ◽  
The Relationship

Purpose: i) To determine the relationship between the cardiac biomarkers ST2 and NT-proBNP with ejection fraction (EF) in heart failure (HF) patients. ii) Assess whether a superiority existed between the aforementioned cardiac markers in diagnosing the HF with reduced EF. iii) Determine the efficacy of both biomarkers in predicting a 30-day cardiovascular event and rehospitalization in patients with HF with reduced EF iv) To assess the influence of age, gender, BMI, anaemia and renal failure on the ST2 and NT-proBNP levels. Design and Methods: A prospective double-blind study was conducted to obtain data from a sample of 64 cardiology patients. A blood sample was collected to test for ST2 and NT-proBNP. An echocardiogram (to obtain EF value), electrocardiogram and questionnaire were also obtained. Results: Of the 64 patients enrolled, 59.4% of the population had an EF less than 40%. At the end of the 30- day period, 7 patients were warded, 37 were not warded, one died and 17 were non respondent. Both biomarkers were efficacious at diagnosing HF with a reduced EF. However, neither of them were efficacious in predicting 30-day rehospitalization. The mean NT-proBNP values being: not rehospitalized (2114.7486) and 30 day rehospitalization (1008.42860) and the mean ST2 values being: not rehospitalized (336.1975), and 30-day rehospitalization. (281.9657). Conclusion: Neither ST2 or NT-proBNP was efficacious in predicting the short- term prognosis in HF with reduced EF. Both however were successful at confirming the diagnosis of HF in HF patients with reduced EF.

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