scholarly journals Shear Wave Dispersion Predicts Liver Fibrosis and Adverse Outcomes in Patients with Heart Failure

2020 ◽  
Vol 9 (12) ◽  
pp. 3953
Author(s):  
Himika Ohara ◽  
Akiomi Yoshihisa ◽  
Shinji Ishibashi ◽  
Mitsuko Matsuda ◽  
Yukio Yamadera ◽  
...  
Keyword(s):  
Heart Failure ◽  
Liver Fibrosis ◽  
Shear Wave ◽  
Cardiac Event ◽  
Wave Dispersion ◽  
Right Atrial ◽  
Prognostic Impact ◽  
Cardiac Events ◽  
Abdominal Ultrasonography ◽  
Patients With Heart Failure

Background: It has been recently reported that liver stiffness assessed by transient elastography reflects right atrial pressure (RAP) and is associated with worse outcomes in patients with heart failure (HF). However, the relationship between shear wave dispersion (SWD, a novel indicator of liver viscosity) determined by abdominal ultrasonography and RAP, and the prognostic impact of SWD on HF patients have not been fully examined. We aimed to clarify the associations of SWD with parameters of liver function test (LFT) and right heart catheterization (RHC), as well as with cardiac events such as cardiac death and worsening HF, in patients with HF. Methods: We performed abdominal ultrasonography, LFT and RHC in HF patients (n = 195), and followed up for cardiac events. We examined associations between SWD and parameters of LFT and RHC. Results: There were significant correlations between SWD and circulating levels of direct bilirubin (R = 0.222, p = 0.002), alkaline phosphatase (R = 0.219, p = 0.002), cholinesterase (R = −0.184, p = 0.011), and 7S domain of collagen type IV (R = 0.177, p = 0.014), but not with RAP (R = 0.054, p = 0.567) or cardiac index (R = −0.015, p = 0.872). In the Kaplan–Meier analysis, cardiac event rate was significantly higher in the high SWD group (SWD ≥ 10.0 (m/s)/kHz, n = 103) than in the low SWD group (SWD < 10.0 (m/s)/kHz, n = 92; log-rank, p = 0.010). In the Cox proportional hazard analysis, high SWD was associated with high cardiac event rates (hazard ratio, 2.841; 95% confidence interval, 1.234–6.541, p = 0.014). In addition, there were no interactions between SWD and all subgroups, according to the subgroup analysis. Conclusions: SWD assessed by abdominal ultrasonography reflects liver fibrosis rather than liver congestion, and is associated with adverse prognosis in HF patients.

Abstract 13304: Liver Dispersion Predicts Adverse Outcomes in Patients With Heart Failure

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Yu Hotsuki ◽  
Akiomi Yoshihisa ◽  
Koichiro Watanabe ◽  
Yu Sato ◽  
Yusuke Kimishima ◽  
...  
Keyword(s):  
Heart Failure ◽  
Cardiac Death ◽  
Cardiac Event ◽  
Liver Stiffness ◽  
Adverse Outcomes ◽  
Right Atrial ◽  
Gamma Glutamyl Transferase ◽  
Abdominal Ultrasonography ◽  
Patients With Heart Failure ◽  
Glutamyl Transferase

Background: It has been recently reported that liver stiffness assessed by transient elastography reflects right atrial pressure (RAP), and is associated with worse outcome in patients with heart failure (HF). However, the relationship between liver dispersion (LD, a novel indicator of liver viscosity) determined by abdominal ultrasonography and RAP, and prognostic impacts of LD on HF patients have not been fully examined. We aimed to clarify associations of LD with parameters of liver functional test (LFT) and right-heart catheterization (RHC), and cardiac event such as cardiac death and worsening HF in patients with HF. Methods and Results: We performed abdominal ultrasonography, LFT, RHC, and followed up cardiac events including cardiac death and unplanned hospitalization due to HF in patients with HF (n=157). We examined associations of LD with parameters of LFT and RHC. There were significant correlations between LD and circulating levels of gamma-glutamyl transferase (R=0.197, P=0.018), cholinesterase (R=-0.301, P=0.001), and 7S domain of collagen type IV (P4NP 7S, a marker of fibrosis, R=0.334, P<0.001), but not with RAP (R=0.067, P=0.514) or cardiac index (R=-0.038, P=0.667). During the follow up period (median 305 days), 6 cardiac deaths and 18 unplanned hospitalization due to HF occurred. In the Kaplan-Meier analysis ( Figure ), cardiac event rate was significantly higher in the high LD group (LD ≥10.0 (m/s)/kHz, n=79) than in the low LD group (LD < 10.0 (m/s)/kHz, n=78; log-rank, P=0.007). In the multivariable Cox proportional hazard analysis, high LD was found to be an independent predictor of cardiac event (hazard ratio 3.274, 95% confidence interval 1.203-8.912, P=0.020). Conclusions: LD assessed by abdominal ultrasonography reflects liver fibrosis rather than liver congestion, and is associated with adverse prognosis in HF patients.

Abstract 13301: Clinical Implications of Hepatic Hemodynamic Evaluation by Abdominal Ultrasonographic Imaging in Patients With Heart Failure

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Yu Hotsuki ◽  
Akiomi YOSHIHISA ◽  
Yasuhiro Ichijo ◽  
Koichiro Watanabe ◽  
Yu Sato ◽  
...  
Keyword(s):  
Heart Failure ◽  
Liver Stiffness ◽  
Stable Condition ◽  
Right Atrial ◽  
Clinical Implications ◽  
Cardiac Events ◽  
Abdominal Ultrasonography ◽  
Hemodynamic Evaluation ◽  
Patients With Heart Failure ◽  
Hepatic Hemodynamic

Background: It has been reported that liver stiffness assessed by transient elastography is correlated with right atrial pressure (RAP), which is an important hemodynamic parameter in patients with heart failure (HF). We aimed to clarify clinical implications of hepatic hemodynamic evaluation (liver congestion and hypoperfusion) by abdominal ultrasonography in patients admitted for the treatment of decompensated HF. Methods and Results: We performed abdominal ultrasonography, right-heart catheterization (RHC), and echocardiography in HF patients (n=342) at stable condition after treatment, then followed up for cardiac events such as cardiac death and re-hospitalization due to worsening HF. Regarding liver congestion, liver stiffness assessed by shear wave elastography of the liver (SWE) was significantly correlated with RAP determined by RHC (R=0.343, P<0.01) and right atrial end systolic area determined by echocardiography (R=0.293, P<0.01). With regard to liver hypoperfusion, peak systolic velocity (PSV) of the celiac artery was correlated with cardiac index determined by RHC (R=0.291, P<0.001) and tricuspid annular plane systolic excursion determined by echocardiography (R=0.251, P=0.004). Importantly, cardiac event rate was highest in HF patients with high SWE and low PSV ( Figure , subset 4). In the Cox proportional hazard analysis, the combination of high SWE and low PSV was a strong predictor of cardiac events (HR 4.811, 95% CI 1.562-14.818). Conclusions: Abdominal ultrasonography based evaluations of intrahepatic congestion and hypoperfusion predict adverse prognosis in HF patients.

Abstract 13330: Intrarenal Doppler Ultrasonography Reflects Hemodynamics and Predicts Prognosis in Patients With Heart Failure

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Koichiro Watanabe ◽  
Akiomi YOSHIHISA ◽  
Yu Sato ◽  
Yu Hotsuki ◽  
Yasuhiro Ichijo ◽  
...  
Keyword(s):  
Heart Failure ◽  
Cardiac Event ◽  
Doppler Ultrasonography ◽  
Event Rate ◽  
Atrial Pressure ◽  
Right Atrial ◽  
Right Atrial Pressure ◽  
Heart Catheterization ◽  
Cardiac Event Rate ◽  
Patients With Heart Failure

Introduction: We aimed to clarify clinical implications of intrarenal hemodynamics (congestion and hypoperfusion) assessed by intrarenal Doppler ultrasonography (IRD) and their prognostic impacts in patients with heart failure (HF). Methods and Results: We performed IRD and measured interlobar renal artery velocity time integral (VTI) and intrarenal venous flow (IRVF) patterns (monophasic or non-monophasic pattern) to assess intrarenal hypoperfusion and congestion in HF patients (n=341). These patients were categorized based on 1) VTI: high VTI (VTI ≥ 14.0 cm, n=231) or low VTI (VTI < 14.0 cm, n=103); and 2) IRVF: monophasic (n=36) or non-monophasic (n=305) pattern. We performed right-heart catheterization, and examined post-discharge cardiac event rate such as cardiac death and rehospitalization due to worsening HF. Regarding renal perfusion, cardiac index was positively correlated with VTI (R=0.270, P=0.040). Concerning renal congestion, levels of right atrial pressure were higher in monophasic pattern than in non-monophasic pattern (9.0 vs. 7.2 mmHg, P=0.029). Importantly, HF patients with low VTI and a monophasic IRVF pattern (subset 4) had the highest cardiac event rate ( Figure ). In the Cox proportional hazard analysis, the combination of low VTI and a monophasic IRVF pattern was found to be a strong predictor of cardiac events (HR 8.357, 95% CI 3.365-20.752). Conclusion: Intrarenal hypoperfusion and congestion assessed by IRD imaging reflected cardiac output and right atrial pressure, and was useful to risk-stratify HF patients.

Abstract 13334: Cardio-ankle Vascular Index Reflects Impaired Exercise Capacity and Predicts Adverse Prognosis in Patients With Heart Failure

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Koichiro Watanabe ◽  
Akiomi YOSHIHISA ◽  
Yu Sato ◽  
Yu Hotsuki ◽  
Yasuhiro Ichijo ◽  
...  
Keyword(s):  
Heart Failure ◽  
Confidence Interval ◽  
Exercise Capacity ◽  
Cardiac Event ◽  
Multiple Logistic Regression Analysis ◽  
Cardiopulmonary Exercise Testing ◽  
Laboratory Data ◽  
Stable Condition ◽  
Cardiac Events ◽  
Patients With Heart Failure

Aims: We aimed to clarify the associations of cardio-ankle vascular index (CAVI) with exercise capacity and prognosis in patients with heart failure (HF). Methods and Results: We recruited clinical data of total of 273 patients hospitalized for treatment of decompensated HF, and underwent both CAVI and cardiopulmonary exercise testing at stable condition in prior to hospital discharge. For the prediction of impaired peak oxygen uptake (VO 2 ) of < 14 mL/kg/min, receiver-operating characteristic curve demonstrated that the cutoff value of CAVI was 8.9. According to the multiple logistic regression analysis, high CAVI was independently associated with impaired peak VO 2 (odds ratio 2.055, 95% confidence interval 1.015-3.960, P = 0.045). We divided these patients based on CAVI: the low CAVI group (CAVI < 8.9, n = 178, 65.2%) and the high CAVI group (CAVI ≥ 8.9, n = 95, 34.8%). We compared the patients’ characteristics and cardiac events such as cardiac death and re-hospitalization due to worsening HF between the two groups. The high CAVI group was older (69.0 vs. 58.0 years old, P < 0.001) and showed lower body mass index (22.9 vs. 23.8 kg/m 2 , P = 0.018). With respect to laboratory data, levels of estimated glomerular filtration rate were lower in the high CAVI group than in the low CAVI group (56.1 vs. 64.2 mL/min/1.73 m 2 , P = 0.001). During the post-discharge follow-up period of median 1,544 days, 76 cardiac events occurred. The Kaplan-Meier analysis showed that cardiac event rates was higher in the high CAVI group than in the low CAVI group ( Figure , Log-rank P = 0.021). In the multivariable Cox proportional hazard analysis, high CAVI was found to be an independent predictor of cardiac events (hazard ratio 1.765, 95% confidence interval 1.123-2.773, P = 0.014). Conclusions: High CAVI independently associated with impaired exercise capacity accompanied by a high cardiac event rate in HF patients.

scholarly journals High percent body fat mass predicts lower risk of cardiac events in patients with heart failure: an explanation of the obesity paradox

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Katsuhiko Ohori ◽  
Toshiyuki Yano ◽  
Satoshi Katano ◽  
Hidemichi Kouzu ◽  
Suguru Honma ◽  
...  
Keyword(s):  
Heart Failure ◽  
Body Fat ◽  
Fat Mass ◽  
Cardiac Event ◽  
Muscle Wasting ◽  
Obesity Paradox ◽  
Percent Body Fat ◽  
Body Fat Mass ◽  
Cardiac Events ◽  
Kaplan Meier

Abstract Background Although high body mass index (BMI) is a risk factor of heart failure (HF), HF patients with a higher BMI had a lower mortality rate than that in HF patients with normal or lower BMI, a phenomenon that has been termed the “obesity paradox”. However, the relationship between body composition, i.e., fat or muscle mass, and clinical outcome in HF remains unclear. Methods We retrospectively analyzed data for 198 consecutive HF patients (76 years of age; males, 49%). Patients who were admitted to our institute for diagnosis and management of HF and received a dual-energy X-ray absorptiometry scan were included regardless of left ventricular ejection fraction (LVEF) categories. Muscle wasting was defined as appendicular skeletal muscle mass index < 7.0 kg/m2 in males and < 5.4 kg/m2 in females. Increased percent body fat mass (increased FM) was defined as percent body fat > 25% in males and > 30% in females. Results The median age of the patients was 76 years (interquartile range [IQR], 67–82 years) and 49% of them were male. The median LVEF was 47% (IQR, 33–63%) and 33% of the patients had heart failure with reduced ejection fraction. Increased FM and muscle wasting were observed in 58 and 67% of the enrolled patients, respectively. During a 180-day follow-up period, 32 patients (16%) had cardiac events defined as cardiac death or readmission by worsening HF or arrhythmia. Kaplan-Meier survival curves showed that patients with increased FM had a lower cardiac event rate than did patients without increased FM (11.4% vs. 22.6%, p = 0.03). Kaplan-Meier curves of cardiac event rates did not differ between patients with and those without muscle wasting (16.5% vs. 15.4%, p = 0.93). In multivariate Cox regression analyses, increased FM was independently associated with lower cardiac event rates (hazard ratio: 0.45, 95% confidence interval: 0.22–0.93) after adjustment for age, sex, diabetes, muscle wasting, and renal function. Conclusions High percent body fat mass is associated with lower risk of short-term cardiac events in HF patients.

Prevalence and prognostic impact of somatic mutations in patients with heart failure and reduced ejection fraction

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
D.J Vazquez Andres ◽  
A Hernandez Vicente ◽  
M Diez Diez ◽  
M Gomez Molina ◽  
A Quintas ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Somatic Mutations ◽  
Myocardial Dysfunction ◽  
Study Endpoint ◽  
Prognostic Impact ◽  
Reduced Ejection Fraction ◽  
Increased Risk ◽  
Patients With Heart Failure

Abstract Introduction Somatic mutations in hematopoietic cells are associated with age and have been associated with higher mortality in apparently healthy adults, especially due to atherosclerotic disease. In animal models, somatic mutations are associated with atherosclerosis progression and myocardial dysfunction, especially when gene TET2 is affected. Preliminary clinical data, referred to ischemic heart failure (HF), have associate the presence of these acquired mutations with impaired prognosis. Purpose To study the prevalence of somatic mutations in patients with heart failure with reduced ejection fraction (HFrEF) and their impact on long-term prognosis. Methods We studied a cohort of elderly patients (more than 60 years old) hospitalized with HFrEF (LVEF&lt;45%). The presence of somatic mutations was assessed using next generation sequencing (Illumina HiSeq 2500), with a mutated allelic fraction of at least 2% and a panel of 55 genes related with clonal hematopoiesis. Patients were followed-up for a median of three years. The study endpoint was a composite of death or readmission for worsening HF. Kaplan-Meier analysis (log-rank test) and Cox proportional hazards regression models were performed adjusting for age, sex and LVEF. Results A total of 62 patients (46 males (74.2%), age 74±7.5 years) with HFrEF (LVEF 29.7±7.8%) were enrolled in the study. The ischemic etiology was present in 54% of patients. Somatic mutations in Dnmt3a or Tet2 were present in 11 patients (17.7%). No differences existed in baseline characteristics except for a higher prevalence of atrial fibrillation in patients with somatic mutations (70% vs. 40%, p=0.007). During the follow-up period, 40 patients (64.5%) died and 38 (61.3%) had HF re-admission. The KM survival analysis for the combined event is shown in Figure 1. Compared with patients without somatic mutations and after adjusting for covariates, there was an increased risk of adverse outcomes when the somatic mutations were present (HR 3.6, 95% CI [1.6, 7.8], p=0.0014). This results remains considering death as a competing risk (Gray's test p=0.0097) and adjusting for covariates (HR = 2.21 95% CI [0.98, 5], p=0.0556). Conclusions Somatic mutation are present in patients with HFrEF and determine a higher risk of adverse events in the follow-up. Further studies are needed to assess the clinical implications of these findings. Figure 1 Funding Acknowledgement Type of funding source: None

Abstract 3103: A Cardiopulmonary Exercise Testing Score for Predicting Risk in Patients with Heart Failure

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Jonathan Myers ◽  
Ross Arena ◽  
Daniel Bensimhon ◽  
Joshua Abella ◽  
Leon Hsu ◽  
...  
Keyword(s):  
Heart Failure ◽  
Proportional Hazards ◽  
Heart Rate Recovery ◽  
Full Range ◽  
Cardiopulmonary Exercise Testing ◽  
Relative Weight ◽  
Cox Proportional Hazards ◽  
Cardiac Events ◽  
Cardiopulmonary Exercise ◽  
Patients With Heart Failure

Background. Cardiopulmonary exercise test (CPX) responses, including markers of ventilatory inefficiency (eg. the VE/VCO 2 slope and oxygen uptake efficiency slope [OUES]), and hemodynamic responses, such as heart rate recovery (HRR) and chronotropic incompetence (CRI) predict outcomes in patients with heart failure (HF). However, multivariate risk models integrating the full range of CPX variables have not been fully explored. Methods: 710 HF patients (568 male/142 female, mean age 56±13 years, EF 33±14%) underwent CPX and were followed for major cardiac events (death, transplant, LVAD implantation) for a mean of 29± 25 months. The age-adjusted prognostic power of peak VO 2 , VE/VCO 2 slope, OUES (VO 2 = a log 10 VE + b), resting end-tidal CO 2 pressure (PetCO 2 ), HRR, and CRI were determined using Cox proportional hazards, optimal cutpoints were determined, the variables were weighted, and a multivariate score was derived. Results. There were 111 composite outcomes. Multivariately, only CRI was not a significant predictor of risk. The VE/VCO 2 slope (≥ 34) was the strongest predictor, and was attributed a relative weight of 7, with weighted scores for abnormal HRR (≤6 beats at 1 min), OUES (>1.4), PetCO2 (<33mmHg), and peak VO 2 (≤14 ml/kg/min) having scores of 5, 3, 3, and 2, respectively. A Kaplan-Meier curve illustrating the incremental scores is presented in the figure ; a score >15 was associated with an annual mortality rate of 26% and a relative risk of 15. Conclusion . A score using CPX responses provides a simple and integrated method that powerfully predicts outcomes in patients with HF.

scholarly journals Insomnia and Cardiac Events in Patients With Heart Failure　– Reply –

2017 ◽  
Vol 81 (1) ◽  
pp. 126
Author(s):  
Akiomi Yoshihisa ◽  
Yuki Kanno ◽  
Yasuchika Takeishi
Keyword(s):  
Heart Failure ◽  
Cardiac Events ◽  
Patients With Heart Failure

Prevalence and prognostic impact of bundle branch block in patients with heart failure: Evidence from the CHARM programme

2007 ◽  
Vol 9 (5) ◽  
pp. 510-517 ◽  
Author(s):  
Nathaniel M. Hawkins ◽  
Duolao Wang ◽  
John J.V. McMurray ◽  
Marc A. Pfeffer ◽  
Karl Swedberg ◽  
...  
Keyword(s):  
Heart Failure ◽  
Prognostic Impact ◽  
Bundle Branch Block ◽  
Patients With Heart Failure
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