Association of New Parameters Derived from Relation between RR intervals and Left Ventricular Performances with Heart Failure in Patients with Atrial Fibrillation and Normal Systolic Function

2007 ◽  
Vol 37 (3) ◽  
pp. 119 ◽  
Author(s):  
Kwang Ho Lee ◽  
Kyung Heon Lee ◽  
Yeo Won Choi ◽  
Soo Hee Choi ◽  
Kyung Eun Lee ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Systolic Function ◽  
Left Ventricular ◽  
Rr Intervals ◽  
Normal Systolic Function

scholarly journals Comparison between ivabradine and low-dose digoxin in the therapy of diastolic heart failure with preserved left ventricular systolic function

2013 ◽  
Vol 3 (2) ◽  
pp. 29 ◽  
Author(s):  
Giuseppe Cocco ◽  
Paul Jerie
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Heart Rate ◽  
Low Dose ◽  
Systolic Function ◽  
Diastolic Heart Failure ◽  
Left Ventricular Systolic Function ◽  
Left Ventricular ◽  
Ventricular Systolic Function ◽  
Coronary Patients

Multicenter trials have demonstrated that in patients with sinus rhythm ivabradine is effective in the therapy of ischemic heart disease and of impaired left ventricular systolic function. Ivabradine is ineffective in atrial fibrillation. Many patients with symptomatic heart failure have diastolic dysfunction with preserved left ventricular systolic function, and many have asymptomatic paroxysmal atrial fibrillation. Ivabradine is not indicated in these conditions, but it happens that it is <em>erroneously</em> used. Digoxin is now considered an outdated and potentially dangerous drug and while effective in the mentioned conditions, is rarely used. The aim of the study was to compare the therapeutic effects of ivabradine in diastolic heart failure with preserved left ventricular systolic function. Patients were assigned to ivabradine or digoxin according to a randomization cross-over design. Data were single-blind analyzed. The analysis was performed using an intention-to-treat method. Forty-two coronary patients were selected. In spite of maximally tolerated therapy with renin-antagonists, diuretics and ?-blockers, they had congestive diastolic heart failure with preserved systolic function. Both ivabradine and digoxin had positive effects on dyspnea, Nterminal natriuretic peptide, heart rate, duration of 6-min. walk-test and signs of diastolic dysfunction, but digoxin was high-statistically more effective. Side-effects were irrelevant. Data were obtained in a single-center and from 42 patients with ischemic etiology of heart failure. The number of patients is small and does not allow assessing mortality. In coronary patients with symptomatic diastolic heart failure with preserved systolic function low-dose digoxin was significantly more effective than ivabradine and is much cheaper. One should be more critical about ivabradine and low-dose digoxin in diastolic heart failure. To avoid possible negative effects on the cardiac function and a severe reduction of the cardiac output the resting heart rate should not be decreased to &lt;65 beats/min.

scholarly journals Echocardiographic assessment of Left Ventricular Dyssynchrony in Hypertensive Patients with Normal Systolic Function

2018 ◽  
Vol 14 (1) ◽  
pp. 58-63
Author(s):  
Marwa Tareq Mohammed
Keyword(s):  
Heart Failure ◽  
Systolic Function ◽  
Left Ventricular ◽  
Filling Pressure ◽  
Volume Index ◽  
Left Ventricular Dyssynchrony ◽  
Female Ratio ◽  
Hypertensive Patients ◽  
Ventricular Dyssynchrony ◽  
Normal Systolic Function

Background: Normal Left Ventricular systolic function is present in nearly 50% of patients with congestive heart failure, the majority of such patients have systemic hypertension. Recent studies have demonstrated Left Ventricular dyssynchrony among patients with heart failure and normal systolic function. The co-existence between Left Ventricular dyssynchrony and hypertension with normal systolic function (with no clinical evidence of heart failure) is less well understood. Objective: To assess the Left Ventricular dyssynchrony among hypertensive patients with normal systolic function by using Tissue doppler imaging.To find out the associations between the LV dyssynchrony and other global echocardiographic findings like (LA volume index, LVmassindex , LV sephericity and LV filling pressure E/E`) Type of the study: Prospective case- control study  Methods:  The study conducted in Baghdad Teaching Hospital from 1st of June 2015 to 30th of May 2016 .Study included two groups of people, 40 patients, age_ matched healthy (control) group (group1) and 60 patients with established hypertension (group 2). A Complete 2-D and TDI echocardiography studies with simultaneous ECG were performed for all patients. Examination involved LV septal and posterior wall thicknesses, internal dimensions, left atrial size, ejection fraction and tissue doppler derived waves velocities E', E/E.' Dyssynchrony was determined by measuring T-P max ( the maximal time difference from the onset of QRS to peak systolic velocity on TDI between any opposing LV wall in 3 apical views) . Results: The study included 40 age –matched control people, 27males (67.5%) and 13 females (32.5%) with a male to female ratio was 1.8 :1, ranging from (42.4-58y) with mean age was (50.2 ±7.8y ) (group 1) and 60 hypertensive patients, 38 males (63.3%) and 22 females (36.7%) with a male to female ratio was 1.7 :1, ranging from (48.5- 66.5y) with mean age of (57.5± 9.0 y) (group 2) . Left Ventricular dyssynchrony was identified in 20 of 60 patients (33.3%) .Dyssynchrony had no significant association with age and BSA. But it  was significantly associated with LA volume index (r = 0.61, p=0.001), LV mass index(r=0.52 ,p=0.001) , LV sphericity index (r= 0.5, p = 0.003) ) and LV filling pressure(r=0.6 , p value=0.001) . Dyssynchrony had significant negative correlation with ( E`) velocity (r= - 0.7 ,P =0.001) . Conclusion: Left Ventricular dyssynchrony is frequent among hypertensive patients with normal LV systolic function .The Left Ventricular dyssynchrony is significantly related to LA volume, LV mass, LV sphericity and LV filling pressure.

scholarly journals P1602 An adult with mitochondrial cardiomyopathy

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
A Kandil ◽  
J Daniel ◽  
R Nata ◽  
P Felix
Keyword(s):  
Heart Failure ◽  
Mitochondrial Disease ◽  
Systolic Function ◽  
Mitochondrial Disorder ◽  
Severe Heart Failure ◽  
Left Ventricular ◽  
Inherited Disorders ◽  
Flow Acceleration ◽  
Mitochondrial Cardiomyopathy ◽  
Normal Systolic Function

Abstract Introduction Mitochondrial diseases are a group of rare inherited disorders with diverse phenotypes that are caused by mutation in nuclear or mitochondrial DNA. The prevalence of mitochondrial disease is estimated to be one in 5000 livebirths. The heart depends mainly on the energy produced through aerobic respiration and hence cardiac involvement is common, progressive and its presence is an independent predictor of mortality in patients with mitochondrial disease and may occur as the principal clinical manifestation or part of a multisystem disease. Case report We present a 31 years old lady who was referred to our hospital with a newly diagnosed hypertension and non-specific ECG changes. The patient had no shortness of breath, no palpitation and no chest pain. She was overweight and had short stature. Her blood pressure was elevated 155/90. There was no signs of heart failure and no murmurs on auscultation of the heart and lung. Her ECG showed sinus bradycardia 55-60 b/min, ST segment elevation in the anterior chest leads with non-specific widespread t wave inversion. An Echocardiogram was done and showed concentric left ventricular hypertrophy (LVH) at 1.5 cm with speckling and granite-like appearance of the myocardium with no LV out flow tract (LVOT) obstruction and with normal systolic function and no significant valvular disease. A cardiac MRI was done and showed mildly dilated LV with normal geometry, normal systolic function, concentric LV hypertrophy with papillary muscles hypertrophy, relative sparing of the apical segments and with no LVOT flow acceleration and no late gadolinium enhancement. Our patient had mild hearing loss which is maternally inherited with her mother and her maternal uncle had cochlear implants. She also had borderline diabetes mellitus and she was also found to have the m.3243 &gt; G mutation suggesting a mitochondrial disorder . A diagnosis of mitochondrial cardiomyopathy was made and the patient was started on an antihypertensive and planned to have regular cardiology clinic follow up. Conclusion Hypertrophic remodelling is the dominant pattern of cardiomyopathy in all forms of mitochondrial disease; occurring in up to 40% of patients and its presence is associated with higher mortality. The severity can vary from asymptomatic as in our patient to severe heart failure with acute decompensation that can occur with metabolic disorders or general illnesses. Treatment of mitochondrial disorders is mainly symptomatic with no curative therapy available. We aimed at increasing awareness of this rare disease. Abstract P1602 Figure.

scholarly journals Prevalence and prognosis of severe tricuspid regurgitation in patients with atrial fibrillation with normal left ventricular systolic function

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
N Prapan ◽  
N Ratanasit
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Tricuspid Regurgitation ◽  
Systolic Function ◽  
Systolic Pressure ◽  
Female Gender ◽  
Left Ventricular ◽  
Adverse Outcomes ◽  
Normal Left Ventricular ◽  
Significant Difference

Abstract Background Significant functional tricuspid regurgitation (FTR) can be found in some patients with atrial fibrillation (AF). The results of the previous studies are still controversial whether significant FTR in patients with AF can cause worse outcomes such as heart failure or death. Purpose To study the prevalence, predictors and prognosis of significant FTR in patients with AF with normal left ventricular (LV) systolic function. Methods We conducted a retrospective cohort study in patients with AF and normal LV ejection fraction (LVEF) from May 2013 through January 2018. Significant FTR was defined as moderate to severe FTR. Pulmonary hypertension (PH) was defined as right ventricular systolic pressure &gt;50 mmHg or mean pulmonary artery pressure &gt;25 mmHg. We evaluated the prevalence of significant FTR and evaluated the adverse outcomes between significant and insignificant FTR groups. The adverse outcomes were defined as heart failure visit or hospitalization and all cause death within 2 years of follow up. We also evaluated the factors associated with significant FTR in AF patients. Results There were 498 patients with AF and 300 (mean age 68.8±10.8 years, 50% female) were included in the study. Paroxysmal, persistent and permanent AF were found in 34.7%, 44.7% and 20.6% respectively. Mean LVEF was 65.3±6.3%. PH and significant FTR were reported in 30.7% and 21.7%, respectively. All cause death and heart failure (visit and hospitalization) were found in 26 (8.7%) and 39 (13%) patients, respectively. There was no statistically significant difference in death between patients with significant and insignificant FTR (12.3% vs. 7.7%; 95% confidence interval (CI) 0.70–4.08, p=0.24). Patients with significant FTR had heart failure more often than those with insignificant FTR (61.5% vs. 38.5%; 95% CI 4.15 - 17.75, OR 8.58, p&lt;0.001). The multivariate analysis showed that the predictors of significant FTR were female gender, permanent AF and presence of PH (OR 2.5, 3.6 and 6.1, respectively). The predictors of the adverse outcomes in patients with AF were high CHA2DS2-VASc score (95% CI 1.09 - 1.92, p=0.01) and significant FTR (95% CI 9.61 - 698.17, p&lt;0.01). Conclusions Significant FTR was common in patients with AF and associated with heart failure outcomes. Female gender, permanent AF and presence of PH were independent predictors of significant FTR, while high CHA2DS2-VASc score and significant FTR were independent predictors of the adverse outcomes in patients with AF and normal LVEF. Funding Acknowledgement Type of funding source: None

scholarly journals COVID-19-associated myocarditis presenting as new-onset heart failure and atrial fibrillation

2021 ◽  
Vol 14 (7) ◽  
pp. e244027
Author(s):  
Sean Gaine ◽  
Patrick Devitt ◽  
John Joseph Coughlan ◽  
Ian Pearson
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Systolic Function ◽  
Left Ventricular Systolic Function ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Recent Onset ◽  
Onset Atrial Fibrillation ◽  
New Onset

A 58-year-old man presented to the emergency department with recent-onset palpitations and progressive exertional dyspnoea. ECG demonstrated new-onset atrial fibrillation. Transthoracic echocardiogram showed global impairment in left ventricular systolic function with left ventricular ejection fraction of 20%. Cardiac MRI (CMRI) demonstrated generalised severe myocarditis. A SARS-CoV-2 PCR was positive for SARS-CoV-2 RNA. As such, we diagnosed our patient with COVID-19-associated myocarditis based on CMRI appearances and positive SARS-CoV-2 swab. This case highlights that COVID-19-associated myocarditis can present as new atrial fibrillation and heart failure without the classic COVID-19-associated symptoms.

Atrial fibrillation in patients hospitalized for congestive heart failure: The same prognostic influence independently of left ventricular systolic function?

2006 ◽  
Vol 110 (3) ◽  
pp. 366-372 ◽  
Author(s):  
Lilian Grigorian Shamagian ◽  
Alfonso Varela Roman ◽  
Javier Garcia Seara ◽  
Jose Luis Martinez Sande ◽  
Pedro Rigueiro Veloso ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Congestive Heart Failure ◽  
Systolic Function ◽  
Left Ventricular Systolic Function ◽  
Left Ventricular ◽  
Ventricular Systolic Function

Diastolic Dysfunction- Anaesthesiologist’s Dilemma!

2021 ◽  
Vol 7 (1) ◽  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Left Ventricle ◽  
Diastolic Dysfunction ◽  
Independent Predictor ◽  
Left Ventricular Systolic Dysfunction ◽  
Systolic Function ◽  
Systolic Dysfunction ◽  
Left Ventricular ◽  
Ventricular Compliance

Left ventricular systolic dysfunction is well recognized and ably managed by anesthesiologists. Left ventricular diastolic function needs to be reckoned as well, every single time anaesthesia is planned in a patient with cardiac disease. This article emphasizes why one should take cognizance of diastolic dysfunction during perioperative anaesthesia management. Diastolic dysfunction(DD) is the inefficiency of the left ventricle to allow filling at lower atrial pressures.[1] In other words, it is the abnormal relaxation during diastole along with the reduction in left ventricular compliance which culminates into higher filling pressures of the left ventricle.[2] It is associated with comorbid conditions such as hypertension, diabetes and atrial fibrillation. Oftentimes it is asymptomatic at rest but can manifest in stress-induced circumstances such as acute severe hypertension, tachycardia, overzealous fluid administration or arrhythmias especially atrial fibrillation.[3] Various reciprocal changes occur over time within the systolic function due to long-standing diastolic dysfunction. Also, mild to moderate diastolic dysfunction forms an independent predictor for the risk of mortality in addition to the established risk of hypertension, diabetes, coronary artery disease and advanced age.[4] It is also an independent predictor of major adverse cardiac events (MACE). (5) Most of the patients in whom anaesthesia is given for various surgical procedures have comorbidities like hypertension, diabetes, dyslipidemia, atrial fibrillation and ischemic heart disease which endure high risk for DD. They may have associated heart failure with preserved ejection fraction (HFpEF).DD can contribute to postoperative heart failure [6] and is associated with various complications in the postoperative period.[2] The act of administration of anaesthesia, mechanical ventilation and intraoperative events like tachycardia, hypertension, inordinate fluid therapy along with the overall surgic

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