scholarly journals Long-Chain Acylcarnitines and Monounsaturated Fatty Acids Discriminate Heart Failure Patients According to Pulmonary Hypertension Status

Metabolites ◽  
2021 ◽  
Vol 11 (4) ◽  
pp. 196
Author(s):  
Maxime Tremblay-Gravel ◽  
Annik Fortier ◽  
Cantin Baron ◽  
Chloé David ◽  
Pamela Mehanna ◽  
...  
Keyword(s):  
Heart Failure ◽  
Principal Component Analysis ◽  
Pulmonary Hypertension ◽  
Principal Component ◽  
Component Analysis ◽  
Left Ventricular ◽  
Analysis Of Covariance ◽  
Left Ventricular Ejection ◽  
Group 2 ◽  
Long Chain

Defects in fatty acid (FA) utilization have been well described in group 1 pulmonary hypertension (PH) and in heart failure (HF), yet poorly studied in group 2 PH. This study was to assess whether the metabolomic profile of patients with pulmonary hypertension (PH) due HF, classified as group 2 PH, differs from those without PH. We conducted a proof-of-principle cross-sectional analysis of 60 patients with chronic HF with reduced ejection fraction and 72 healthy controls in which the circulating level of 71 energy-related metabolites was measured using various methods. Echocardiography was used to classify HF patients as noPH-HF (n = 27; mean pulmonary artery pressure [mPAP] 21 mmHg) and PH-HF (n = 33; mPAP 35 mmHg). The profile of circulating metabolites among groups was compared using principal component analysis (PCA), analysis of covariance (ANCOVA), and Pearson’s correlation tests. Patients with noPH-HF and PH-HF were aged 64 ± 11 and 68 ± 10 years, respectively, with baseline left ventricular ejection fractions of 27 ± 7% and 26 ± 7%. Principal component analysis segregated groups, more markedly for PH-HF, with long-chain acylcarnitines, acetylcarnitine, and monounsaturated FA carrying the highest loading scores. After adjustment for age, sex, kidney function, insulin resistance, and N-terminal pro-brain natriuretic peptide (NT-proBNP), 5/15 and 8/15 lipid-related metabolite levels were significantly different from controls in noPH-HF and PH-HF subjects, respectively. All metabolites for which circulating levels interacted between group and NT-proBNP significantly correlated with NT-proBNP in HF-PH, but none with HF-noPH. FA-related metabolites were differently affected in HF with or without PH, and may convey adverse outcomes given their distinct correlation with NT-proBNP in the setting of PH.

1409Use of phenomapping to determine response of treatment by sacubitril/valsartan in patients with heart failure with reduced ejection fraction

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
M Godet ◽  
O Raitiere ◽  
H Chopra ◽  
P Guignant ◽  
C Fauvel ◽  
...  
Keyword(s):  
Heart Failure ◽  
Pulmonary Hypertension ◽  
Ejection Fraction ◽  
Left Ventricular ◽  
Heat Map ◽  
Reduced Ejection Fraction ◽  
Patients With Heart Failure ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

Abstract Background Treatment by sacubitril/valsartan decreases mortality, improves KCCQ score and ejection fraction in patients with heart failure with reduced ejection fraction (HF REF), but there is currently no data to predict response to treatment. Purpose The purpose of our work was to assess whether unbiased clustering analysis, using dense phenotypic data, could identify phenotypically distinct HF-REF subtypes with good or no response after 6 months of sacubitril/valsartan administration. Methods A total of 78 patients in NYHA functional class 2–3 and treated by ACE inhibitor or AAR2, were prospectively assigned to equimolar sacubitril/valsartan replacement. We collected demographic, clinical, biological and imaging continuous variables. Phenotypic domains were imputed with 5 eigenvectors for missing value, then filtered if the Pearson correlation coefficient was >0.6 and standardized to mean±SD of 0±1. Thereafter, we used agglomerative hierarchical clustering for grouping phenotypic variables and patients, then generate a heat map (figure 1). Subsequently, participants were categorized using Penalized Model-Based Clustering. P<0,05 was considered significant. Results Mean age was 60.4±13.4 yo and 79.0% patients were males. Mean ejection fraction was 29.3±7.0%. Overall, 16 phenotypic domains were isolated (figure 1) and 3 phenogroups were identified (Table 1). Phenogroup 1 was remarkable by isolated left ventricular involvement (LVTDD 64.3±5.9mm vs 73.9±8.7 in group 2 and 63.8±5.7 in group3, p<0.001) with moderate diastolic dysfunction (DD), no mitral regurgitation (MR) and no pulmonary hypertension (PH). Phenogroups 2 and 3 corresponded to patients with severe PH (TRMV: 2.93±0.47m/s in group 2 and 3.15±0.61m/s in groupe 3 vs 2.16±0.32m/s in group 1), related to severe DD (phenogroup 2) or MR (phenogroup 3). In both phenogroups, the left atrium was significantly enlarged and the right ventricle was remodeled, compared with phenogroup 1. Despite more severe remodeling and more compromised hemodynamic in phenogroups 2 and 3, the echocardiographic response to sacubitril/valsartan was comparable in all groups with similar improvement of EF and reduction of cardiac chambers dimensions (response of treatment, defined by improvement of FE +15% and/or decreased of indexed left ventricule diastolic volume −15% = group 2: 22 (76%); group 3: 18 (60%); group 1: 9 (50%); p=0.17; OR group 2 vs 1: OR=3.14; IC95% [0.9–11.03]; p=0.074; OR group 3 vs 1: OR=1.5; IC95% [0.46–4.87]; p=0.5)). The clinical response was even better in phenogroups 2 and 3 (Group 2: 19 (66%); group 3: 21 (78%) vs group 1: 9 (50%); p=0.05). Heat map Conclusion HF-REF patients with severe diastolic dysfunction, significant mitral regurgitation and elevated pulmonary hypertension by echocardiographic had similar reverse remodeling but better clinical improvement than patients with isolated left ventricular systolic dysfunction.

Features of the clinical picture and outcomes in patients from a heart transplantation waiting list with different causes of heart failure

Kardiologiia ◽  
2020 ◽  
Vol 60 (7) ◽  
pp. 15-19
Author(s):  
A. N. Kostomarov ◽  
M. A. Simonenko ◽  
M. A. Fedorova ◽  
P. A. Fedotov
Keyword(s):  
Heart Failure ◽  
Heart Transplantation ◽  
Death Rate ◽  
Left Ventricular ◽  
Waiting List ◽  
Left Ventricular Ejection ◽  
Circulatory Support ◽  
Ventricular Ejection Fraction ◽  
Group 2 ◽  
Group 1

Aim To identify clinical differences between patients on the heart transplant waiting list (HTWL) in the origin of chronic heart failure (CHF).Materials and methods From January 2010 through September 2019, 235 patients (age, 47+13 years (from 10 to 67 years); men, 79% (n=186)) were included in the HTWL. The patients were divided into two groups; group 1 (n=104, 44 %) consisted of patients with ischemic heart disease (IHD); group 2 (n=131, 56 %) included patients with noncoronarogenic CHF. Clinical and instrumental data and frequency of the mechanical circulatory support (MCS) as a “bridge” to heart transplantation (HT) were retrospectively evaluated.Results Group 1 included more male patients than group 2 [97 % (n=101) and 82 % (n=85), р<0.0001]; patients were older (54±8 and 42±14 years, р=0.0001). On inclusion into the HTWL, the CHF functional class was comparable in the groups, III [III;IV]; there were more patients of the UNOS 2 class in group 1 than in group 2 [75 % (n=78) and 57 % (n=75), р=0.005]. Patient distribution in UNOS 1B and 1A classes was comparable in the groups: 21% (n=22) and 3% (n=4) in group 1 and 33 % (n=43) and 10 % (n=13) in group 2. According to echocardiography patients of group 1 compared to group 2 showed a tendency towards higher values of left ventricular ejection fraction (Simpson method) [22 [18;26] % and 19 [15;24] %, р=0.37] and stroke volume [59 [44;72] % and 50 [36;67] %, р=0.07]. Numbers of patients with a cardioverter defibrillator or a cardiac resynchronization device with a defibrillator function were comparable in the groups [35 % (n=36) and 34 % (n=45)]. Comparison of comorbidities in groups 1 and 2 showed higher incidences of pulmonary hypertension [55 % (n=57) and 36 % (n=47), р=0.005], obesity [20 % (n=21) and 10 % (n=13), р=0.03], and type 2 diabetes mellitus [29 % (n=30) and 10 % (n=13), р=0.0004]. Rates of chronic obstructive lung disease, stroke, chronic kidney disease and other diseases were comparable. Duration of staying on the HTWL was comparable (104 [34; 179] and 108 [37; 229] days). During staying on the HTWL, patients of group 1 less frequently required MCS implantation [3 % (n=3) and 28 % (n=21), р=0.0009]. HT was performed for 59 % patients (n=61) in group 2 and 52 % (n=69) patients in group 2. Death rate in the HTWL was lower in group 1 [13 % (n=14) and 27 % (n=35), р<0.01].Conclusion On inclusion into the HTWL, patients with noncoronarogenic CHF had more pronounced CHF manifestations and a more severe UNOS class but fewer comorbidities than patients with CHF of ischemic origin. With a comparable duration of waiting for HT, patients with noncoronarogenic CHD more frequently required MCS implantation and had a higher death rate.

scholarly journals Transitioning from Preclinical to Clinical Heart Failure with Preserved Ejection Fraction: A Mechanistic Approach

2020 ◽  
Vol 9 (4) ◽  
pp. 1110 ◽  
Author(s):  
Antoni Bayes-Genis ◽  
Felipe Bisbal ◽  
Julio Núñez ◽  
Enrique Santas ◽  
Josep Lupón ◽  
...  
Keyword(s):  
Heart Failure ◽  
Pulmonary Hypertension ◽  
Ejection Fraction ◽  
Right Ventricular ◽  
Left Atrial ◽  
Interstitial Fibrosis ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Preserved Ejection Fraction ◽  
Ventricular Ejection Fraction

To better understand heart failure with preserved ejection fraction (HFpEF), we need to better characterize the transition from asymptomatic pre-HFpEF to symptomatic HFpEF. The current emphasis on left ventricular diastolic dysfunction must be redirected to microvascular inflammation and endothelial dysfunction that leads to cardiomyocyte remodeling and enhanced interstitial collagen deposition. A pre-HFpEF patient lacks signs or symptoms of heart failure (HF), has preserved left ventricular ejection fraction (LVEF) with incipient structural changes similar to HFpEF, and possesses elevated biomarkers of cardiac dysfunction. The transition from pre-HFpEF to symptomatic HFpEF also involves left atrial failure, pulmonary hypertension and right ventricular dysfunction, and renal failure. This review focuses on the non-left ventricular mechanisms in this transition, involving the atria, right heart cavities, kidneys, and ultimately the currently accepted driver—systemic inflammation. Impaired atrial function may decrease ventricular hemodynamics and significantly increase left atrial and pulmonary pressure, leading to HF symptoms, irrespective of left ventricle (LV) systolic function. Pulmonary hypertension and low right-ventricular function are associated with the incidence of HF. Interstitial fibrosis in the heart, large arteries, and kidneys is key to the pathophysiology of the cardiorenal syndrome continuum. By understanding each of these processes, we may be able to halt disease progression and eventually extend the time a patient remains in the asymptomatic pre-HFpEF stage.

scholarly journals Heart failure in human immunodeficiency virus-infected patients

2020 ◽  
Vol 25 (1) ◽  
pp. 26-32
Author(s):  
O. G. Goryacheva ◽  
A. N. Koziolova
Keyword(s):  
Heart Failure ◽  
Human Immunodeficiency Virus ◽  
Hiv Infection ◽  
Clinical Picture ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Immunodeficiency Virus ◽  
Group 2 ◽  
Relationship Of ◽  
Group 1

Aim. To determine the features of heart failure (HF) development in patients with human immunodeficiency virus (HIV) infection.Material and methods. In a general hospital, 160 patients were examined during the year. All of them were divided into 2 groups: group 1 (n=100) — HIV-infected patients with specific clinical picture of HF; group 2 (n=60) — patients without HIV infection and with HF verified by echocardiography and concentration of N-terminal prohormone of brain natriuretic peptide (NT-proBNP).Results. In comparison with group 2, HIV-infected patients had the following statistically significant differences: lower left ventricular ejection fraction (LVEF), lower prevalence and severity of left ventricle diastolic dysfunction, higher LV mass index (LVMI), and lower NT-proBNP. HIV-infected patients had statistically significant moderate inverse relationship of LVEF (r=-0,43; p=0,015), E/e’ (r=-0,32; p=0,045), LVMI (r=-0,46; p=0,002) and strong relationship of NT-proBNP (r=-0,54; p<0,001) with CD4 T-lymphocyte count in 1 mm3 in the presence of HF symptoms and signs and an increase in NT-proBNP over 125 pg/ml. In group 1, there was a significantly higher prevalence of smoking, chronic alcoholism, drug use, chronic hepatitis C and cirrhosis (especially manifested by hepatomegaly and splenomegaly in combination with ascites and hepatic cytolysis), chronic pancreatitis, pneumonia and inflammatory diseases accompanied by higher erythrocyte sedimentation rate and C-reactive protein concentration, and lower hemoglobin level. HIV-infected patients were statistically less likely to use all groups of drugs for HF treatment, with the exception of spironolactone, and more likely to use drugs for multimorbidity treatment.Conclusion. The HF prevalence in hospitalized HIV-infected patients, estimated on the basis of symptoms and NT-proBNP increase >125 pg/ml, was 54%; on the basis of LVEF decrease <50% — 32%. The clinical picture of HIV-infected patients is characterized by various symptoms, including those typical for HF with normal NT-proBNP level, due to the high prevalence of comorbidities and concurrent medication.

scholarly journals Heart Failure Treated with Low-dose Milrinone in a Full-term Newborn

2012 ◽  
Vol 113 (1) ◽  
pp. 58-65
Author(s):  
S. Šebková ◽  
V. Tomek ◽  
P. Zemanová ◽  
Jan Janota
Keyword(s):  
Heart Failure ◽  
Pulmonary Hypertension ◽  
Left Ventricular Ejection Fraction ◽  
Ejection Fraction ◽  
Low Dose ◽  
Oxygenation Index ◽  
Left Ventricular ◽  
Persistent Pulmonary Hypertension ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction

A term newborn with a hypocontractile myocardium complicating persistent pulmonary hypertension of the newborn was successfully treated with a low-dose phosphodiesterase III inhibitor milrinone. Echocardiography diagnosed heart failure with a left ventricular ejection fraction of 35% and a left ventricular shortening fraction of 18% and severe persistent pulmonary hypertension of the newborn with oxygenation index of 28. Milrinone was started at an initial dose of 50 mcg/kg, followed by continuous infusion of 0.20 mcg/kg/min. With lowdose milrinone oxygenation index decreased to 3 within 6 hours, left ventricular ejection fraction and left ventricular shortening fraction increased to 57%, and 30%, respectively. Low doses of milrinone might be promising in the treatment of heart failure and persistent pulmonary hypertension of the newborn in term newborns.

scholarly journals Favourable effects of cardiovascular rehabilitation on funcional capacity and autonomic balance in elderly patients with heart failure

2005 ◽  
Vol 64 (2) ◽  
Author(s):  
Gabriella Malfatto ◽  
Giovanna Branzi ◽  
Caterina Bizzi ◽  
Paola Valli ◽  
Mario Facchini
Keyword(s):  
Heart Failure ◽  
Left Ventricular Ejection Fraction ◽  
Ejection Fraction ◽  
Left Ventricular ◽  
Ventricular Ejection ◽  
Aerobic Performance ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Cardiovascular Rehabilitation ◽  
Group 2

In 42 patients with chronic heart failure we evaluated left ventricular function, exercise capability and autonomic control before and 3 months after a program of cardiovascular rehabilitation. The results were analyzed separately for younger (Group 1, n=18, age 51±6 years) and older patients (Group 2, n=24, age 68±4 years), with comparable clinical characteristics and therapy. Before rehabilitation, compared to younger patients, Group 2 patients showed a lower exercise capability, a comparable left ventricular ejection fraction and similar high sympathetic activity at rest, with no response to regular breathing (= stimulation of cardiopulmonary receptors, i.e. parasympathetic challenge) and active standing (= sympathetic stimulation). After rehabilitation, in both groups a 20% improvement of exercise tolerance and aerobic performance was observed, as well as a slightly increase of left ventricular ejection fraction (about 10%), and a recovery in vagal and sympathetic responsiveness. Thus, in heart failure patients age does not hinder the favorable clinical and autonomic modulation induced by cardiovascular rehabilitation.

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