scholarly journals Left atrial size and heart failure hospitalization in patients with diastolic dysfunction and preserved ejection fraction

2017 ◽  
Vol 27 (1) ◽  
pp. 1 ◽  
Author(s):  
Omar Issa ◽  
JulioG Peguero ◽  
Carlos Podesta ◽  
Denisse Diaz ◽  
Javier De La Cruz ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Diastolic Dysfunction ◽  
Left Atrial ◽  
Preserved Ejection Fraction ◽  
Left Atrial Size ◽  
Heart Failure Hospitalization ◽  
Atrial Size

Abstract 13493: Mechanism and Prognostic Significance of Cardiothoracic Ratio in Patients With Heart Failure With Preserved Ejection Fraction - Insights From Pursuit-hfpef Registry -

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Masato Okada ◽  
KOICHI INOUE ◽  
Katsuomi Iwakura ◽  
Toshinari Onishi ◽  
Shungo Hikoso ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Left Atrial ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Preserved Ejection Fraction ◽  
Left Atrial Size ◽  
Cardiothoracic Ratio ◽  
Atrial Size

Introduction: The cardiothoracic ratio (CTR) is a widely accepted method of quantifying cardiac size, and carries prognostic information in acquired heart disease. However, little is described in the underlying mechanism and prognostic value in heart failure with preserved ejection fraction (HFpEF). Methods: Analysis was performed from a prospective multicenter observational registry for HFpEF (PURSUIT-HFpEF Registry) conducted in the Osaka region of Japan. A total of 871 patients hospitalized for acute HF (diagnosed by using Framingham criteria) met the inclusion criteria: a left ventricular ejection fraction (LVEF) ≥50% and brain natriuretic peptide (BNP) ≥100 pg/ml. We included 629 patients (age, 81±9 years; men, 46%; atrial fibrillation, 37%) whose follow-up data after survival discharge were available and whose CTR were measured from posterior-anterior chest X-ray. The endpoint was defined as the composite of death, re-hospitalization for HF, and cerebrovascular accident. Results: Median CTR at discharge was 56% (interquartile range: 51-61%). Comparison with echocardiographic data revealed that CTR significantly correlated with increased left atrial size (left atrial volume; r = 0.39, p <0.001) and LV filling pressure (E/e’ ratio; r = 0.13, p = 0.002), but not with LV size (LV end-diastolic volume; r = -0.014; LV end-systolic volume: r = -0.002) and LVEF (r = -0.035). Age (r = 0.16, p <0.001) and log-transformed N-terminal-pro-BNP value (r = 0.21, p <0.001) were also correlated with CTR. Female patients exhibited more higher CTR than male patients (54±7 vs. 58±7%, p <0.001). During a median follow-up of 15 months, 257 patients experienced the endpoint. When patients were classified into the CTR quartile groups, there was a positive correlation between the incidence rate and the quartiles (Q1, 31.0%; Q2, 39.5%; Q3, 35.7%; Q4 55.8%, p <0.001). After adjustment for age and gender, Cox regression analysis revealed that CTR at discharge was a significant predictor of the composite endpoint (hazard ratio per quartile increase; 1.23; 95% confidence interval, 1.10-1.39; p = 0.006). Conclusions: CTR was not associated with LV size but left atrial size in patients with HFpEF. Increased CTR at discharge predicted unfavorable prognosis in patients with HFpEF.

Abstract TP173: Reduced Ejection Fraction and Left Atrial Dilatation are Independently Associated With Cardioembolic Stroke

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Maryam Hosseini Farahabadi ◽  
Shadi Milani-Nejad ◽  
Shimeng Liu ◽  
Wengui Yu ◽  
Mohammad Shafie
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Ejection Fraction ◽  
Left Atrial ◽  
Cardioembolic Stroke ◽  
Left Atrial Size ◽  
Reduced Ejection Fraction ◽  
Atrial Size ◽  
Left Atrial Dilatation

Introduction: The role of heart failure and left atrial dilatation as independent risk factors for ischemic stroke has remained controversial. The goal of this study is to evaluate the association between reduced ejection fraction (EF) and left atrial dilatation with cardioembolic stroke. Methods: Four hundred fifty-three patients with ischemic stroke admitted to the University of California, Irvine between 2016-2017 were included based on the following criteria: age >18 and availability of echocardiogram within 3 months of diagnosis. Stroke was subdivided into cardioembolic and non-cardioembolic based on MRI findings. EF was categorized into normal: 52-72% (male), 54-74% (female), mildly abnormal: 41-51%(male), 41-53% (female), moderately abnormal: 30-40% (same in both genders), and severely abnormal: <30% (same in both genders). Other variables included: left atrial volume size categorized into normal (≤34 ml/m 2 ) vs. enlarged (≥35 ml/m 2 ), gender, hypertension (SBP≥140 or DBP≥ 90), and known history of atrial fibrillation. Results: Two hundred eighteen patients were identified to have cardiomebmolic stroke and two hundred thirty-five with non-cardioembolic stroke. Among patients with cardiomebmolic stroke, 49 (22.4%) and 142 (65%) had reduced EF and enlarged left atrium, respectively, as compared to 19 (8.1%) and 65 (27.7%) in patients with non-cardioembolic stroke. The number of patients with reduced EF and left atrial enlargement were significantly higher in patients with cardioembolic stroke (P<0.001). The odds of cardioembolic stroke were 2.0 and 8.8 times higher in patients with moderately and severely reduced EF, respectively, when compared to patients with normal EF. The odds of cardioembolic stroke was 2.4 times higher in patients with enlarged left atrial size when compared to patients with normal left atrial size. Conclusions: Our results have shown an independent association between moderately and severely reduced EF and enlarged left atrial size with cardioembolic stroke. Heart failure and left atrial dilatation may increase the risk of stroke regardless of the presence of atrial fibrillation, which warrants further studies to determine the appropriate treatment for secondary stroke prevention such as anticoagulation.

Abstract 14390: The Cardiac Myosin Inhibitor, Ck-3772271, Attenuates Cardiac Fibrosis and Diastolic Dysfunction in the Dahl/salt Sensitive Rat Model of Heart Failure With Preserved Ejection Fraction

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Xihui Xu ◽  
Darren T Hwee ◽  
James J Hartman ◽  
Jingying Wang ◽  
Yangsong Wu ◽  
...  
Keyword(s):  
Heart Failure ◽  
Blood Pressure ◽  
Ejection Fraction ◽  
Diastolic Dysfunction ◽  
Rat Model ◽  
Left Atrial ◽  
Cardiac Fibrosis ◽  
Preserved Ejection Fraction ◽  
Cardiac Myosin ◽  
Atrial Area

Introduction: Heart failure with preserved ejection fraction (HFpEF) is characterized by underlying contractile dysfunction and progressive myocardial fibrosis and stiffness. CK-3772271 (CK-271) is a novel small molecule cardiac myosin inhibitor that reduces cardiac myosin ATPase activity and reduces cardiac contractility in unloaded isolated cardiomyocytes in vitro and in healthy rats and dogs in vivo . The effect of chronic CK-271 treatment on cardiac function and morphology was evaluated in the Dahl/Salt Sensitive (DSS) rat hypertension model of HFpEF. Methods: DSS male rats were fed either a control low salt (LS, 0.3% NaCl) or high salt (HS, 4% NaCl) diet to induce a hypertension-driven HFpEF disease phenotype. 6 weeks after HS diet treatment, DSS rats were randomized into two sub-groups: continued HS diet or a HS diet formulated with CK-271 (100 ppm) for an additional 6 weeks. Body mass, systolic blood pressure, and cardiac function were measured longitudinally. After 12 weeks of HS treatment, hearts were collected to assess cardiac fibrosis. Results: HS diet treatment increased systolic blood pressure (LS:132.2 ± 4.7 mm Hg vs. HS: 163.5 ± 4.0 mm Hg, mean ± SEM, p< 0.001) and caused cardiac hypercontractility as evidenced by an increase in the end-systolic pressure-volume relationship (LS: 0.8 ± 0.17 vs. HS: 2.1 ± 0.46 mm Hg/ml). HS diet also increased isovolumic relaxation time (IVRT) (LS: 16.8 ± 0.6 vs. HS: 22.8 ± 0.6 ms, p<0.0001), left atrial area (LS: 30.3 ± 0.8 vs. HS: 42.5 ± 2.2 mm 2 , p<0.0001) and cardiac fibrosis (LS: 3.4 ± 0.4 vs. HS: 5.0 ± 0.6 %). 6 weeks of CK-271 treatment reduced fractional shortening (HS: 53.8 ± 1.4 vs. HS+CK-271: 42.7 ± 1.0 %, p<0.0001) and reduced HS diet-induced diastolic dysfunction, including IVRT (HS: 22.8 ± 0.6 vs. HS+CK-271: 19.5 ± 0.5 ms, p<0.0001) and left atrial area (HS: 42.5 ± 2.2 vs. HS+CK-271: 35.4 ± 0.8 mm 2 , p<0.0001). Furthermore CK-271 reduced the development of cardiac fibrosis (HS: 5.0 ± 0.6 vs. HS+CK-271: 3.5 ± 0.3 %, p<0.05) induced by HS diet. Conclusion: The small molecule cardiac myosin inhibitor, CK-3772271, attenuated the development of cardiac hypercontractility, diastolic dysfunction and fibrosis in the DSS rat model of HFpEF. Cardiac myosin inhibition may be a novel approach to mitigate the development of HFpEF.

Global constructive work and left atrial reservoir function is reduced in patients with heart failure with preserved ejection fraction compared with patients with preclinical diastolic dysfunction

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
L.G Tunyan ◽  
A.L Chilingaryan ◽  
K.G Adamyan ◽  
P.H Zelveyan ◽  
L.R Tumasyan ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Diastolic Dysfunction ◽  
Left Atrial ◽  
Speckle Tracking ◽  
Volume Index ◽  
Funding Source ◽  
Preserved Ejection Fraction ◽  
Constructive Work ◽  
Isovolumic Relaxation

Abstract   Heart failure with preserved ejection fraction (HFpEF) remains an unresolved issue with morbidity and mortality comparable with that of reduced EF HF. Diastolic dysfunction (DD) is the hallmark of HFpEF but it is unclear why some patients do not develop symptoms and remain in preclinical DD (PDD) stage with the same degree of DD as patients with HFpEF. We assumed that patients with HFpEF might have more deteriorated global myocardial work (GW) and left atrial reservoir longitudinal strain (LALS) parameters compared with PDD patients. Methods 210 patients (150 female, mean age 71±5 years) of which 118 with PDD and 92 with HFpEF were enrolled in this study. PDD was diagnosed if patients had normal NT-proBNP values, and at least 3 of the following echocardiographic criteria at rest or after diastolic stress echocardiography: end-systolic left atrial volume index (LAVi) &gt;34 ml/m2, LV E/e' &gt;13, average LV e' &gt;8.5, and systolic pulmonary artery pressure &gt;30 mmHg. GW index (GWI) was obtained from pressure-strain loops composed from speckle tracking analysis indexed to brachial systolic blood pressure, global constructive work (GCW) was measured as the sum of positive work due to myocardial shortening during systole and negative work due to lengthening during isovolumic relaxation, global wasted work (GWW) was calculated as energy loss by myocardial lengthening in systole and shortening in isovolumic relaxation, and GW efficiency (GWE) as the percentage ratio of constructive work to the sum of constructive work and wasted work. LALS was measured by speckle tracking echocardiography as average value of two basal segments in apical 4 chamber view along LAVi and 4D LV mass index (LVMi) offline by experienced echocardiographer who was unaware of the study aims. Results Patients with PDD and HFpEF have comparable values of LAVi, LVMi, GWI, GWW, and GWE (LAVi 38.4±3.9 ml/m2 vs 39.1±4.1 ml/m2, p=NS; LVMi 82.8±11.4 g/m2 vs 83.5±10.2 g/m2, p=NS; PDD GWI 2389±154 mmHg% vs 2368±139 mmHg%, p=NS; GWW 62±5 mmHg% vs 65±4 mmHg%, p=NS; GWE PDD 89±9% vs 87±11%, p=NS). LALS and GCW were significantly reduced in patients with HFpEF compared with PDD patients (LALS 21.3±7% vs 29±5%, p&lt;0.01; GCW 1964±112 mmHg% vs 2259±164 mmHg%, p&lt;0.01). Conclusion Patients with HFpEF have reduced LALS and GCW compared with PDD patients. Both parameters are indicative for LA and LV myocardial fibrotic burden respectively which might be one of the probable explanations of PDD transition to HFpEF. Funding Acknowledgement Type of funding source: Public Institution(s). Main funding source(s): Committee of Science at Ministry of Education of Republic of Armenia

Sign in / Sign up

Export Citation Format

Share Document