Left Ventricle–Arterial System Interaction in Heart Failure

Ejection fraction (EF) has been viewed as an important index in assessing the contractile state of the left ventricle (LV). However, it is frequently inadequate for the diagnosis and management of heart failure (HF), as a significant subset of HF patients have been found to have reduced EF (HFrEF) whereas others have preserved EF (HFpEF). It should be noted that the function of the LV is dependent on both preload and afterload, as well as its intrinsic contractile state. Furthermore, stroke volume (SV) is dependent on the properties of the arterial system (AS). Thus, the LV-arterial system interaction plays an important role in those patients with HF. This aspect is investigated through the analysis of the specific parameters involved in the coupling of the LV and AS. This includes contractility and the systolic/diastolic indices of the LV. Furthermore, AS afterload parameters such as vascular stiffness and arterial compliance, and their derived coupling coefficient, are also investigated. We conclude that those parameters, which relate to LV structural changes, are most appropriate in quantifying the LV–AS interaction.

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RIGHT VENTRICULAR FUNCTIONAL AND STRUCTURAL CHANGES MIRROR THOSE OF THE LEFT VENTRICLE IN HEART FAILURE WITH PRESERVED EJECTION FRACTION

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(18)31465-7 ◽

2018 ◽

Vol 71 (11) ◽

pp. A924

Author(s):

Karl-Philipp Rommel ◽

Christian Besler ◽

Maximilian Von Roeder ◽

Stephan Blazek ◽

Karl Fengler ◽

...

Keyword(s):

Heart Failure ◽

Left Ventricle ◽

Ejection Fraction ◽

Right Ventricular ◽

Structural Changes ◽

Preserved Ejection Fraction

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The Mediterranean Diet Benefit on Cardiovascular Hemodynamics and Erectile Function in Chronic Heart Failure Male Patients by Decoding Central and Peripheral Vessel Rheology

Nutrients ◽

10.3390/nu13010108 ◽

2020 ◽

Vol 13 (1) ◽

pp. 108

Author(s):

Athanasios Angelis ◽

Christina Chrysohoou ◽

Evangelia Tzorovili ◽

Aggeliki Laina ◽

Panagiotis Xydis ◽

...

Keyword(s):

Heart Failure ◽

Chronic Heart Failure ◽

Left Ventricle ◽

Ejection Fraction ◽

Mediterranean Diet ◽

Serum Prolactin ◽

Doppler Velocity ◽

Heart Failure Patients ◽

Cardiovascular Hemodynamics ◽

The Mediterranean

Background: Mediterranean diet was evaluated on erectile performance and cardiovascular hemodynamics, in chronic heart failure patients. Methods: 150 male stable heart failure patients were enrolled in the study (62 ± 10 years, New York Heart Association (NYHA) classes I–II, ejection fraction ≤40%). A detailed echocardiographic evaluation including estimation of the global longitudinal strain of the left ventricle and the systolic tissue doppler velocity of the tricuspid annulus was performed. Erectile dysfunction severity was assessed by the Sexual Health Inventory for Men-5 (SHIM-5) score. Adherence to the Mediterranean diet was evaluated by the MedDietScore. Results: The SHIM-5 score was positively correlated with the MedDietScore (p = 0.006) and augmentation index (p = 0.031) and inversely correlated with age (p = 0.002). MedDietScore was negatively associated with intima-media-thickness (p < 0.001) and serum prolactin levels (p = 0.05). Multi-adjusted analysis revealed that the inverse relation of SHIM-5 and prolactin levels remained significant only among patients with low adherence to the Mediterranean diet (p = 0.012). Conclusion: Consumption of Mediterranean diet benefits cardiovascular hemodynamics, while suppressing serum prolactin levels. Such physiology may enhance erectile ability independently of the of the left ventricle ejection fraction.

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First clinical trial with etomoxir in patients with chronic congestive heart failure

Clinical Science ◽

10.1042/cs0990027 ◽

2000 ◽

Vol 99 (1) ◽

pp. 27-35 ◽

Cited By ~ 78

Author(s):

Stephan SCHMIDT-SCHWEDA ◽

Christian HOLUBARSCH

Keyword(s):

Heart Failure ◽

Heart Rate ◽

Sarcoplasmic Reticulum ◽

Left Ventricular Ejection Fraction ◽

Ejection Fraction ◽

Stroke Volume ◽

Left Ventricular ◽

Ventricular Ejection ◽

Left Ventricular Ejection ◽

Ventricular Ejection Fraction

In the failing human myocardium, both impaired calcium homoeostasis and alterations in the levels of contractile proteins have been observed, which may be responsible for reduced contractility as well as diastolic dysfunction. In addition, levels of a key protein in calcium cycling, i.e. the sarcoplasmic reticulum Ca2+-ATPase, and of the α-myosin heavy chain have been shown to be enhanced by treatment with etomoxir, a carnitine palmitoyltransferase inhibitor, in normal and pressure-overloaded rat myocardium. We therefore studied, for the first time, the influence of long-term oral application of etomoxir on cardiac function in patients with chronic heart failure. A dose of 80 mg of etomoxir was given once daily to 10 patients suffering from heart failure (NYHA functional class II–III; mean age 55±4 years; one patient with ischaemic heart disease and nine patients with dilated idiopathic cardiomyopathy; all male), in addition to standard therapy. The left ventricular ejection fraction was measured echocardiographically before and after a 3-month period of treatment. Central haemodynamics at rest and exercise (supine position bicycle) were defined by means of a pulmonary artery catheter and thermodilution. All 10 patients improved clinically; no patient had to stop taking the study medication because of side effects; and no patient died during the 3-month period. Maximum cardiac output during exercise increased from 9.72±1.25 l/min before to 13.44±1.50 l/min after treatment (P < 0.01); this increase was mainly due to an increased stroke volume [84±7 ml before and 109±9 ml after treatment (P < 0.01)]. Resting heart rate was slightly reduced (not statistically significant). During exercise, for any given heart rate, stroke volume was significantly enhanced (P < 0.05). The left ventricular ejection fraction increased significantly from 21.5±2.6% to 27.0±2.3% (P < 0.01). In acute studies, etomoxir showed neither a positive inotropic effect nor vasodilatory properties. Thus, although the results of this small pilot study are not placebo-controlled, all patients seem to have benefitted from etomoxir treatment. Etomoxir, which has no acute inotropic or vasodilatory properties and is thought to increase gene expression of the sarcoplasmic reticulum Ca2+-ATPase and the α-myosin heavy chain, improved clinical status, central haemodynamics at rest and during exercise, and left ventricular ejection fraction.

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Biplane ventriculography in the rat

AJP Heart and Circulatory Physiology ◽

10.1152/ajpheart.1986.250.1.h131 ◽

1986 ◽

Vol 250 (1) ◽

pp. H131-H136

Author(s):

J. L. Heckman ◽

L. Garvin ◽

T. Brown ◽

W. Stevenson-Smith ◽

W. P. Santamore ◽

...

Keyword(s):

Cardiac Output ◽

Left Ventricle ◽

Ejection Fraction ◽

Stroke Volume ◽

Methyl Methacrylate ◽

High Speed ◽

Water Displacement ◽

Systolic Volume ◽

End Diastolic Volume ◽

End Systolic Volume

Biplane ventriculography was performed on nine intact anesthetized rats. Images of the left ventricle large enough for analysis were obtained by placing the rats close to the radiographic tubes (direct enlargement). Sampling rates, adequate for heart rates of 500 beats/min, were obtained by filming at 500 frames/s. From the digitized silhouettes of the left ventricle the following information was obtained (means +/- SE): end-diastolic volume 0.60 +/- 0.03 ml, end-systolic volume 0.22 +/- 0.02 ml, stroke volume 0.38 +/- 0.02 ml, ejection fraction 0.63 +/- 0.02, cardiac output 118 +/- 7 ml/min, diastolic septolateral dimension 0.41 +/- 0.01 mm, diastolic anteroposterior dimension 0.40 +/- 0.01 mm, diastolic base-to-apex dimension 1.58 +/- 0.04 mm. To determine the accuracy with which the volume of the ventricle could be measured, 11 methyl methacrylate casts of the left ventricle were made. The correlation was high (r = 0.99 +/- 0.02 ml E) between the cast volumes determined by water displacement and by use of two monoplane methods (Simpson's rule of integration and the area-length method applied to the analysis of the anteroposterior films) and a biplane method (area-length). These results demonstrate that it is possible to obtain accurate dimensions and volumes of the rat left ventricle by use of high-speed ventriculography.

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An Echocardiographic Evaluation of Dilated Cardiomyopathy in a Tertiary Care Hospital

Journal of Nepal Medical Association ◽

10.31729/jnma.3992 ◽

2019 ◽

Vol 57 (215) ◽

Author(s):

Raj Kumar Thapa ◽

Kanchan K.C ◽

Rishi Khatri ◽

Devendra Khatri ◽

Rajeeb Kumar Deo ◽

...

Keyword(s):

Heart Failure ◽

Congestive Heart Failure ◽

Left Ventricle ◽

Ejection Fraction ◽

Dilated Cardiomyopathy ◽

Tertiary Care ◽

Left Ventricular ◽

Care Hospital ◽

Echocardiographic Evaluation ◽

Significant Difference

Introduction: Cardiomyopathies are diseases of heart muscle that may originate from genetic defects, cardiac myocyte injury or infiltration of myocardial tissues. Dilated cardiomyopathy is the most common phenotype and is often a final common pathway of numerous cardiac insults. Mostly it remains unknown in the absence of echocardiography, histopathology and genetic evaluation. Though common it is underdiagnosed with not much of data available in our setup.Methods: This study was analytical cross-sectional study of hospital data on Echocardiographic findings in 65 patients of DCM visiting cardiology unit for Echocardiographic evaluation from 1st of February to 31st July 2018 for the period of six months in Shree Birendra Hospital, a tertiary care military hospital at Chhauni, Kathmandu. Pediatric age group patients and those who refused to give consent were excluded. Data obtained were entered in Microsoft Excel 2010 and analyzed by IBM SPSS 21.Results: Among 65 patients enrolled 40 (61%) were male and 25 (39%) female with male to female ratio of 1.6:1. Elderly people (61-75 years) with an average age of 65 were commonly involved and they presented mostly with congestive heart failure, 32 (49%). Echocardiographic evaluation showed 36 (55%) with mildly dilated Left Ventricle (5.6-6.0cm). Majority had reduced Left ventricular systolic function with an average Ejection fraction (EF) of 39.6%. No significant difference between male and female with the average EF% (P=0.990) and there was no significant relation between age and average EF% (P=0.091).Conclusions: Dilated Cardiomyopathy is the commonest cardiomyopathy phenotype mostly presenting with congestive heart failure. It is often underdiagnosed in our part of the world, however echocardiography will easily detect the condition. Keywords: dilated cardiomyopathy; echocardiography; ejection fraction; left ventricle.

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Dilated Cardiomyopathy in Children and Adults: What is New?

The Scientific World JOURNAL ◽

10.1100/tsw.2008.105 ◽

2008 ◽

Vol 8 ◽

pp. 762-775 ◽

Cited By ~ 3

Author(s):

Galal E. Nagib Elkilany ◽

Mustafa A. AL-Qbandi ◽

Khaled A. Sayed ◽

Ibrahim Kabbash

Keyword(s):

Risk Factors ◽

Heart Failure ◽

Mitral Valve ◽

Left Ventricle ◽

Ejection Fraction ◽

Dilated Cardiomyopathy ◽

Diastolic Dysfunction ◽

Left Ventricular Ejection ◽

Global Strain ◽

Independent Risk Factors

Dilated cardiomyopathy (DCM) is the most common form of cardiomyopathy and cause of cardiac transplantation in children and young adults; mortality is high among this patient population. However, mortality, clinical course, and illustrative echocardiographic data of DCM in children and adults are not well established. Our objective was to provide a research article of detailed descriptions of the incidence, causes, outcomes, related risk factors, and new echocardiographic criteria of risk of death from DCM. Our results showed that independent risk factors at DCM diagnosis for subsequent death or transplantation in children cohorts were older age, congestive heart failure, lower left ventricular ejection fraction (EF ≤ 25%), low global strain, significant mitral valve incompetence, pulmonary hypertension, diastolic dysfunction, right ventricular involvement, and cause of DCM (p< 0.001 for all). In adults, low ejection fraction (<30–35%), global peak systolic strain <-7.6%, increased EDV, ESV, LBBB, diastolic dysfunction, and left ventricle dyssynchrony were the main independent risk factors for major cardiac events and need for CRT or transplantation (p< 0.001 for all). Our conclusions were that in children and adults, DCM is a diverse disorder with outcomes that depend largely on cause, age, heart failure status at presentation, and echocardiographic parameters of the heart (systolic and diastolic function of left ventricle, pulmonary artery pressure, global strain, and valvular function of the mitral valve). This study will present new findings in the diagnostic area.

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The continuous heart failure spectrum: moving beyond an ejection fraction classification

European Heart Journal ◽

10.1093/eurheartj/ehz158 ◽

2019 ◽

Vol 40 (26) ◽

pp. 2155-2163 ◽

Cited By ~ 57

Author(s):

Filippos Triposkiadis ◽

Javed Butler ◽

Francois M Abboud ◽

Paul W Armstrong ◽

Stamatis Adamopoulos ◽

...

Keyword(s):

Heart Failure ◽

Clinical Trials ◽

Ejection Fraction ◽

Statistical Power ◽

Structural Changes ◽

Randomized Clinical Trials ◽

New Technologies ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Ventricular Ejection Fraction

Abstract Randomized clinical trials initially used heart failure (HF) patients with low left ventricular ejection fraction (LVEF) to select study populations with high risk to enhance statistical power. However, this use of LVEF in clinical trials has led to oversimplification of the scientific view of a complex syndrome. Descriptive terms such as ‘HFrEF’ (HF with reduced LVEF), ‘HFpEF’ (HF with preserved LVEF), and more recently ‘HFmrEF’ (HF with mid-range LVEF), assigned on arbitrary LVEF cut-off points, have gradually arisen as separate diseases, implying distinct pathophysiologies. In this article, based on pathophysiological reasoning, we challenge the paradigm of classifying HF according to LVEF. Instead, we propose that HF is a heterogeneous syndrome in which disease progression is associated with a dynamic evolution of functional and structural changes leading to unique disease trajectories creating a spectrum of phenotypes with overlapping and distinct characteristics. Moreover, we argue that by recognizing the spectral nature of the disease a novel stratification will arise from new technologies and scientific insights that will shape the design of future trials based on deeper understanding beyond the LVEF construct alone.

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