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1.
Impairment of Left Atrial Mechanics Is an Early Sign of Myocardial Involvement in Systemic Sclerosis
Adél Porpáczy Ágnes Nógrádi Dániel Kehl Maja Strenner Tünde Minier László Czirják András Komócsi Réka Faludi 《Journal of cardiac failure》2018,24(4):234-242
Background
Left ventricular (LV) diastolic dysfunction is common in systemic sclerosis (SSc). Less is known, however, about left atrial (LA) mechanics in this context. The aim of this study was to investigate the correlation between LV diastolic function and LA mechanics in SSc patients with the use of volumetric and 2-dimensional speckle tracking–derived strain techniques and to compare the results with those obtained in healthy subjects.Methods and Results
Seventy-two SSc patients and 30 healthy volunteers (H) were investigated. LV diastolic function was classified as normal (I), impaired relaxation (II), and pseudonormal pattern (III). LA reservoir (H: 51.8?±?7.4%; I: 45.1?±?8.1%; II: 42.2?±?6.6%; III: 36.6?±?7.3%; analysis of variance: P?<?.001) and contractile strain (H: 24.8?±?4.9%; I: 18.2?±?4.4%; II: 21.5?±?2.8%; III: 16.8?±?3.6%; P?<?.001) already showed significant worsening in SSc patients with preserved LV diastolic function compared with healthy subjects. LA conduit strain (H: 27.1?±?4.6%; I: 26.9?±?5.7%; II: 20.6?±?6.1%; III: 19.5?±?5.3%; P?<?.001) was preserved in this early phase. Further deterioration of reservoir strain was pronounced in the pseudonormal group only. LA contractile strain increased significantly in the impaired relaxation group and then decreased with the further worsening of the LV diastolic function. Regarding phasic volume indices, the differences between groups were not always statistically significant.Conclusion
LA mechanics strongly reflects the changes in LV diastolic function in SSc. On the other hand, strain parameters of the LA reservoir and contractile function already show significant worsening in SSc patients with preserved LV diastolic function, suggesting that impairment of the LA mechanics is an early sign of myocardial involvement in SSc. 相似文献2.
Pablo Sanchez Jordan J. Lancaster Kyle Weigand Saffie-Alrahman Ezz-Eldin Mohran Steven Goldman Elizabeth Juneman 《Journal of cardiac failure》2017,23(10):753-761
Objective
For chronic heart failure (CHF), more emphasis has been placed on evaluation of systolic as opposed to diastolic function. Within the study of diastology, measurements of left ventricular (LV) longitudinal myocardial relaxation have the most validation. Anterior wall radial myocardial tissue relaxation velocities along with mitral valve inflow (MVI) patterns are applicable diastolic parameters in the differentiation between moderate and severe disease in the ischemic rat model of CHF. Myocardial tissue relaxation velocities correlate with traditional measurements of diastolic function (ie, hemodynamics, Tau, and diastolic pressure-volume relationships).Methods and Results
Male Sprague-Dawley rats underwent left coronary artery ligation or sham operation. Echocardiography was performed at 3 and 6 weeks after coronary ligation to evaluate LV ejection fraction (EF) and LV diastolic function through MVI patterns (E, A, and E/A) and Doppler imaging of the anterior wall (e′ and a′). The rats were categorized into moderate or severe CHF according to their LV EF at 3 weeks postligation. Invasive hemodynamic measurements with solid-state pressure catheters were obtained at the 6-week endpoint. Moderate (N?=?20) and severe CHF (N?=?22) rats had significantly (P?<?.05) different EFs, hemodynamics, and diastolic pressure-volume relationships. Early diastolic anterior wall radial relaxation velocities as well as E/e′ ratios separated moderate from severe CHF and both diastolic parameters had strong correlations with invasive hemodynamic measurements of diastolic function.Conclusion
Radial anterior wall e′ and E/e′ can be used for serial assessment of diastolic function in rats with moderate and severe CHF. 相似文献3.
Luise Holzhauser Teruhiko Imamura Hemal M. Nayak Nitasha Sarswat Gene Kim Jayant Raikhelkar Sara Kalantari Amit Patel David Onsager Tae Song Takeyoshi Ota Valluvan Jeevanandam Gabriel Sayer Nir Uriel 《Journal of cardiac failure》2018,24(2):101-108
Background
Cardiovascular implantable electronic devices (CIEDs) are common in patients undergoing heart transplantation (HT), and complete removal is not always possible at the time of transplantation.Methods
We retrospectively assessed the frequency of retained CIED leads and clinical consequences in consecutive HT patients from 2013 to 2016. Clinical outcomes included bacteremia, upper-extremity deep venous thrombosis (UEDVT), lead migration, and inability to perform magnetic resonance imaging (MRI).Results
A total of 138 patients (55?±?11 years of age, 76% male) were identified; 37 (27%) had retained lead fragments (RLFs) at discharge. Patients with RLFs were older, had longer lead implantation time before HT, and a higher prevalence of dual-coil CIED leads compared with those without RLFs (P?<?.05 for all). Lead implantation time was identified as an independent predictor for RLFs (P?<?.05). Patients with RLFs had a higher frequency of DVT compared with the non-RLF group during the 1-year study period (42% vs 21%; P?<?.04). There was no difference in bacteremia. Fourteen patients (38%) could not undergo clinically indicated MRI.Conclusion
RLFs after HT occur commonly and are associated with a higher rate of UEDVT and limit the use of MRI. Although no significant difference was found in the rates of bacteremia between the groups, this finding might be explained by the overall low incidence. Patients with risk factors for RLFs should be identified before transplantation, and complete lead removal should be considered with a multidisciplinary approach. 相似文献4.
Christian Jung Bernhard Wernly Mikael Bjursell John Wiseman Therese Admyre Johannes Wikström Malin Palmér Frank Seeliger Michael Lichtenauer Marcus Franz Charlotte Frick Ann-Katrin Andersson Margareta Elg John Pernow Per-Ove Sjöquist Mohammad Bohlooly-Y Qing-Dong Wang 《Journal of cardiac failure》2018,24(7):470-478
Background
Oxytocin (Oxt) and its receptor (Oxtr) gene system has been implicated in cardiomyogenesis and cardioprotection; however, effects of chronic activation of Oxtr are not known. We generated and investigated transgenic (TG) mice that overexpress Oxtr specifically in the heart.Methods and Results
Cardiac-specific overexpression of Oxtr was obtained by having the α-major histocompatibility complex promoter drive the mouse Oxtr gene (α-Mhc-Oxtr). Left ventricular (LV) function and remodeling were assessed by magnetic resonance imaging and echocardiography. In α-Mhc-Oxtr TG mice, LV ejection fraction was severely compromised at 14 weeks of age compared with wild-type (WT) littermates (25?±?6% vs 63?±?3%; P?<?.001). LV end-diastolic volume was larger in the TG mice (103?±?6?µL vs 67?±?5?µL; P?<?.001). α-Mhc-Oxtr TG animals displayed cardiac fibrosis, atrial thrombus, and increased expression of pro-fibrogenic genes. Mortality of α-Mhc-Oxtr TG animals was 45% compared with 0% (P?<?.0001) of WT littermates by 20 weeks of age. Most cardiomyocytes of α-Mhc-Oxtr TG animals but not WT littermates (68.0?±?12.1% vs 5.6?±?2.4%; P?=?.008) were positive in staining for nuclear factor of activated T cells (NFAT). To study if thrombin inhibitor prevents thrombus formation, a cohort of 7-week-old α-Mhc-Oxtr TG mice were treated for 12 weeks with AZD0837, a potent thrombin inhibitor. Treatment with AZD0837 reduced thrombus formation (P?<?.05) and tended to attenuate fibrosis and increase survival.Conclusions
Cardiac-specific overexpression of Oxtr had negative consequences on LV function and survival in mice. The present findings necessitate further studies to investigate potential adverse effects of chronic Oxt administration. We provide a possible mechanism of Oxtr overexpression leading to heart failure by nuclear factor of activated T cell signaling. The recapitulation of human heart failure and the beneficial effects of the antithrombin inhibitor render the α-Mhc-Oxtr TG mice a promising tool in drug discovery for heart failure. 相似文献5.
Masayoshi Oikawa Atsushi Kobayashi Kento Wada Takamasa Sato Satoshi Suzuki Akiomi Yoshihisa Kazuhiko Nakazato Hitoshi Suzuki Shu-ichi Saitoh Takafumi Ishida Yasuchika Takeishi 《Journal of cardiac failure》2018,24(1):29-32
Background
Several echocardiographic parameters are currently used to evaluate left ventricular (LV) filling pressure. However, these parameters are not always consistent in the clinical setting. We aimed to determine a novel parameter by multiplying log B-type natriuretic peptide (lnBNP) and the ratio of mitral inflow early and late diastolic filling velocities (E/A) for the prediction of pulmonary capillary wedge pressure (PCWP).Methods and Results
One hundred ninety-eight patients suspected of chronic heart failure were analyzed. The product of lnBNP and E/A (BNP?×?E/A) showed the highest correlation coefficient with mean PCWP (R?=?0.7326) compared with E/A (R?=?0.7010) and E/e′ (R?=?0.3922). Multivariate logistic regression analysis revealed that BNP?×?E/A was associated with elevated PCWP (odds ratio 1.640, 95% confidence interval 1.312–2.197; P?<.01). In the receiver operating characteristic curve analysis for detecting elevated PCWP, BNP?×?E/A showed the largest area under the curve (AUC) compared with E/A and E/e′ (0.880 vs 0.827 and 0.788, respectively; P?<.05). BNP?×?E/A still showed large AUC (0.842) for detection of elevated PCWP in patients with normal LV ejection fraction.Conclusion
BNP?×?E/A is a useful parameter for detecting elevated PCWP regardless of the LV ejection fraction. 相似文献6.
R. Scott Evans Abdallah G. Kfoury Benjamin D. Horne James F. Lloyd Jose Benuzillo Kismet D. Rasmusson Colleen Roberts Donald L. Lappé 《Journal of cardiac failure》2017,23(10):719-726
Background
Patients who need and receive timely advanced heart failure (HF) therapies have better long-term survival. However, many of these patients are not identified and referred as soon as they should be.Methods
A clinical decision support (CDS) application sent secure email notifications to HF patients' providers when they transitioned to advanced disease. Patients identified with CDS in 2015 were compared with control patients from 2013 to 2014. Kaplan-Meier methods and Cox regression were used in this intention-to-treat analysis to compare differences between visits to specialized and survival.Results
Intervention patients were referred to specialized heart facilities significantly more often within 30 days (57% vs 34%; P?<?.001), 60 days (69% vs 44%; P?<?.0001), 90 days (73% vs 49%; P?<?.0001), and 180 days (79% vs 58%; P?<?.0001). Age and sex did not predict heart facility visits, but renal disease did and patients of nonwhite race were less likely to visit specialized heart facilities. Significantly more intervention patients were found to be alive at 30 (95% vs 92%; P?=?.036), 60 (95% vs 90%; P?=?.0013), 90 (94% vs 87%; P?=?.0002), and 180 days (92% vs 84%; P?=?.0001). Age, sex, and some comorbid diseases were also predictors of mortality, but race was not.Conclusions
We found that CDS can facilitate the early identification of patients needing advanced HF therapy and that its use was associated with significantly more patients visiting specialized heart facilities and longer survival. 相似文献7.
Parul U. Gandhi Sheryl L. Chow Thomas S. Rector Henry Krum Hanna K. Gaggin John J. McMurray Michael R. Zile Michel Komajda Robert S. McKelvie Peter E. Carson James L. Januzzi Inder S. Anand 《Journal of cardiac failure》2017,23(1):20-28
Background
The prognostic merit of insulin-like growth factor-binding protein 7 (IGFBP7) is unknown in heart failure and preserved ejection fraction (HFpEF).Methods and Results
Baseline IGFBP7 (BL-IGFBP7; n?=?302) and 6-month change (Δ; n?=?293) were evaluated in the Irbesartan in Heart Failure and Preserved Ejection Fraction (I-PRESERVE) trial. Primary outcome was all-cause mortality or cardiovascular hospitalization with median follow-up of 3.6 years; secondary outcomes included HF events. Median BL-IGFBP7 concentration was 218?ng/mL. BL-IGFBP7 was significantly correlated with age (R2?=?0.13; P?<?.0001), amino-terminal pro-B-type NP (R2?=?0.22; P?<?.0001), and estimated glomerular filtration rate (eGFR; R2?=?0.14; P?<?.0001), but not with signs/symptoms of HFpEF. BL-IGFBP7 was significantly associated with the primary outcome (hazard ratio [HR]?=?1.007 per ng/mL; P?<?.001), all-cause mortality (HR?=?1.008 per ng/mL; P?<?.001), and HF events (HR?=?1.007 per ng/mL; P?<?.001). IGFBP7 remained significant for each outcome after adjustment for ln amino-terminal pro-B-type NP and eGFR but not all variables in the I-PRESERVE prediction model. After 6 months, IGFBP7 did not change significantly in either treatment group. ΔIGFBP7 was significantly associated with decrease in eGFR in patients randomized to irbesartan (R2?=?0.09; P?=?.002). ΔIGFBP7 was not independently associated with outcome.Conclusions
Higher concentrations of IGFBP7 were associated with increased risk of cardiovascular events, but after multivariable adjustment this association was no longer present. Further studies of IGFBP7 are needed to elucidate its mechanism.8.
Susan Feng Lu Lauren Xiaoyuan Lu Sidney C. Smith Xuming Dai 《The American journal of medicine》2018,131(5):574.e1-574.e11
Background
Cardiovascular disease has become a leading cause of death for patients with paraplegia. Acute myocardial infarction in patients with paraplegia has not been described in the literature. This study investigates clinical features, management strategies, and outcomes of these patients.Methods
Acute myocardial infarction in patients with or without paraplegia was identified in the New York State Inpatient Database between 2007 and 2013. Clinical comorbidities, management strategies and their associated outcomes were compared using propensity score–matching analysis.Results
Among 402,569 patients with acute myocardial infarction, 1400 had a concomitant diagnosis of paraplegia. Compared with those without, patients with paraplegia were younger, more likely to be black, and had a higher prevalence of hypertension, anemia, congestive heart failure, coagulopathy, and depression, but a lower prevalence of diabetes, hyperlipidemia, obesity, chronic lung disease, and renal failure. Patients with paraplegia were more likely to receive medical therapy without a diagnostic cardiac catheterization than those without (83.7% vs 64.5%, P?<?.001). Nine percent of patients with paraplegia received revascularization, which was significantly lower than that without paraplegia. In terms of the clinical outcome, patients with paraplegia had higher in-hospital mortality than those without (22.4% vs 16.8%, P?<?.001). Among the patients with paraplegia, the subcohort that received revascularization had lower in-hospital mortality (9.5% vs 22.0%, P?<?.01), had shorter length of stay (13.0 vs 16.9 days, P?=.08), and higher hospital charges ($130,079 vs $92,125, P?<?.001) than those without revascularization. Furthermore, the paraplegic subcohort underwent coronary artery bypass grafting that was associated with higher in-hospital mortality (21.7% vs 1.7%, P?<?.001), longer length of stay (24.8 vs 14.2 days, P?<?.001), and higher hospital charges ($231,323 vs $144,449, P?<?.01) than subcohort that received percutaneous coronary intervention.Conclusions
Acute myocardial infarction patients with concomitant paraplegia had distinct clinical characteristics and comorbidity profiles; were less likely to receive revascularization therapy; and had higher in-hospital mortality. Acute myocardial infarction patient with paraplegia who underwent revascularization were associated with better clinical outcomes, in particular, those who were treated with percutaneous coronary intervention had significantly lower in-hospital mortality than those treated with coronary artery bypass grafting. 相似文献9.
Colleen Juricek Teruhiko Imamura Ann Nguyen Ben Chung Daniel Rodgers Nitasha Sarswat Gene Kim Jayant Raikhelkar Takeyoshi Ota Tae Song Daniel Burkhoff Gabriel Sayer Valluvan Jeevanandam Nir Uriel 《Journal of cardiac failure》2018,24(4):249-254
Background
Recurrent gastrointestinal bleeding is one of the most significant adverse events in patients with left ventricular assist devices (LVADs).Methods
We enrolled LVAD patients who had received an intramuscular injection of 20?mg octreotide every 4 weeks as secondary prevention for recurrent gastrointestinal bleeding despite conventional medical therapies and repeated transfusions. The frequency of gastrointestinal bleeding and other associated clinical outcomes before and during octreotide therapy were compared.Results
Thirty LVAD patients (66.4?±?8.8 years old, 16 men [53%]) received octreotide therapy for 498.8?±?356.0 days without any octreotide-associated adverse events. The frequency of gastrointestinal bleeding was decreased significantly during octreotide therapy (from 3.4?±?3.1 to 0.7?±?1.3 events/year; P?<?.001), accompanied by significant reductions in red blood cell and flesh frozen plasma transfusions, days in hospital, and need for endoscopic procedures (P?<?.05 for all).Conclusions
Octreotide therapy reduced the frequency of recurrent gastrointestinal bleeding and may be considered for secondary prevention. 相似文献10.
Masayoshi Yamamoto Tomoko Ishizu Yoshihiro Seo Yoshimi Suto Seika Sai Dongzhu Xu Nobuyuki Murakoshi Taizo Kimura Yasushi Kawakami Kazutaka Aonuma 《Journal of cardiac failure》2018,24(1):53-60
Background
We investigated the effects of the dipeptidyl peptidase 4 inhibitor teneligliptin on cardiac function and hemodynamics during heart failure in hypertensive model rats.Methods and Results
Fifty-five male Dahl salt-sensitive rats were divided into 4 groups: control group (0.3% NaCl chow; n?=?13), hypertension (HT) group (8% NaCl chow; n?=?20), HT–early TNL group (8% NaCl chow and teneligliptin from 6 weeks; n?=?10), and HT–late TNL group (8% NaCl chow and teneligliptin from 10 weeks; n?=?12). Hemodynamic measurement and tissue analyses were performed at 18 weeks. In all of the HT groups, systolic blood pressures were similarly elevated (P?=?.66) and heart weights similarly increased (P?=?.36) with and without TNL administration. LV end-diastolic dimension was significantly enlarged only in the HT–early TNL group compared with the control group (P?=?.025). Histologic analysis showed less fibrosis (P?=?.008) and cardiomyocyte widths (P?=?.009) in the HT–early TNL group compared with the HT group. On hemodynamic analysis, only the HT group showed significant LV end-diastolic pressure elevation (P?=?.049) and lung congestion (P?<?.001) compared with the control group.Conclusions
These results suggest that teneligliptin prevents concentric LV hypertrophy, fibrosis, and development of congestive heart failure in Dahl salt-sensitive rats. Teneligliptin may inhibit pressure-overload hypertrophic adaption and result in LV eccentric hypertrophy with reduced LV ejection fraction. 相似文献11.
Charles F. McTiernan Penelope Morel Leslie T. Cooper Navin Rajagopalan Vinay Thohan Mark Zucker John Boehmer Biykem Bozkurt Paul Mather John Thornton Jalal K. Ghali Karen Hanley-Yanez James Fett Indrani Halder Dennis M. McNamara 《Journal of cardiac failure》2018,24(1):33-42
Objective
The aim of this work was to evaluate the hypothesis that the distribution of circulating immune cell subsets, or their activation state, is significantly different between peripartum cardiomyopathy (PPCM) and healthy postpartum (HP) women.Background
PPCM is a major cause of maternal morbidity and mortality, and an immune-mediated etiology has been hypothesized. Cellular immunity, altered in pregnancy and the peripartum period, has been proposed to play a role in PPCM pathogenesis.Methods
The Investigation of Pregnancy-Associated Cardiomyopathy (IPAC) study enrolled 100 women presenting with a left ventricular ejection fraction of <0.45 within 2 months of delivery. Peripheral T-cell subsets, natural killer (NK) cells, and cellular activation markers were assessed by flow cytometry in PPCM women early (<6 wk), 2 months, and 6 months postpartum and compared with those of HP women and women with non–pregnancy-associated recent-onset cardiomyopathy (ROCM).Results
Entry NK cell levels (CD3–CD56+CD16+; reported as % of CD3– cells) were significantly (P?<?.0003) reduced in PPCM (6.6?±?4.9% of CD3– cells) compared to HP (11.9?±?5%). Of T-cell subtypes, CD3+CD4–CD8–CD38+ cells differed significantly (P?<?.004) between PPCM (24.5?±?12.5% of CD3+CD4–CD8– cells) and HP (12.5?±?6.4%). PPCM patients demonstrated a rapid recovery of NK and CD3+CD4–CD8–CD38+ cell levels. However, black women had a delayed recovery of NK cells. A similar reduction of NK cells was observed in women with ROCM.Conclusions
Compared with HP control women, early postpartum PPCM women show significantly reduced NK cells, and higher CD3+CD4–CD8–CD38+ cells, which both normalize over time postpartum. The mechanistic role of NK cells and “double negative” (CD4–CD8–) T regulatory cells in PPCM requires further investigation. 相似文献12.
Kevin Damman Serge Masson Donata Lucci Marco Gorini Renato Urso Aldo P. Maggioni Luigi Tavazzi Luigi Tarantini Gianni Tognoni Adriaan Voors Roberto Latini 《Journal of cardiac failure》2017,23(1):2-9
Background
Data on the natural change in renal function in patients with chronic heart failure (HF) are limited.Methods and Results
Estimated glomerular filtration rate (eGFR) was assessed over 36 months in 6934 patients included in the GISSI-HF study. Associations from baseline, changes in renal function, and occurrence of cardiovascular death or HF hospitalization were assessed. Mean age was 67 years, mainly men (78%), and mean eGFR was 68?mL???min?1???1.73?m?2. Change in eGFR in the 1st year was ?1.5?±?16?mL???min?1???1.73?m?2, and over 36 months it was ?3.7?±?18?mL???min?1???1.73?m?2. Over the latter period, only 25% deteriorated ≥1 Kidney Disease Outcomes Quality Initiatives (KDOQI) class of chronic kidney disease (CKD). Fifteen percent of patients had >15?mL???min?1???1.73?m?2 decrease in eGFR in the 1st 12 months. Lower eGFR was associated with outcome: hazard ratio (HR) 1.10, 95% confidence interval (CI) 1.08–1.10 (P?<?.001) per 10?mL???min?1???1.73?m?2 decrease, as well as every 10?mL???min?1???1.73?m?2 decrease over the 1st year (HR 1.10, 95% CI 1.04–1.17; P?<?.001). A deterioration in eGFR >15?mL???min?1???1.73?m?2 in the 1st year showed the highest risk of events (HR 1.22, 95% CI 1.10–1.36; P?<?.001).Conclusions
Mean decrease in renal function over time in patients with chronic HF was modest. Only 25% deteriorated ≥1 KDOQI class of CKD after 3 years. Any decrease in eGFR over time was associated with strongly increased event rates. 相似文献13.
Jennifer J. Huang Sridhar Reddy Tam H. Truong Prakash Suryanarayana Joseph S. Alpert 《The American journal of medicine》2018,131(4):442.e13-442.e17
Background
The risk of stroke and thromboembolism in atrial fibrillation is established. However, the evidence surrounding the risk of thromboembolism in patients with atrial flutter is not as clear. We hypothesized that atrial flutter would have indicators of less risk for thromboembolism compared with atrial fibrillation on transesophageal echocardiography, thereby possibly leading to a lower stroke risk.Methods
A retrospective review of 2225 patients undergoing transesophageal echocardiography was performed. Those with atrial fibrillation or atrial flutter were screened. Exclusion criteria were patients being treated with chronic anticoagulation, the presence of a prosthetic valve, moderate to severe mitral regurgitation or stenosis, congenital heart disease, or a history of heart transplantation. A total of 114 patients with atrial fibrillation and 55 patients with atrial flutter met the criteria and were included in the analysis.Results
Twelve patients (11%) in the atrial fibrillation group had left atrial appendage thrombus versus zero patients in the atrial flutter group (P?<?.05). The prevalence of spontaneous echocardiography contrast was significantly higher and left atrial appendage emptying velocity was significantly lower in the atrial fibrillation group compared with the atrial flutter group (P?<?.001). No spontaneous contrast was seen when the left atrial appendage emptying velocity was >60?cm/sec.Conclusions
Patients with atrial flutter have a lower incidence of left atrial appendage thrombi, higher left atrial appendage emptying velocity, and less left atrial spontaneous contrast compared with patients with atrial fibrillation, suggesting a lower risk for potential arterial thromboembolism. 相似文献14.
Background
Left ventricular (LV) global longitudinal strain (GLS) reliably assesses LV systolic function. The precise relation between LV wall stress and serum Brain natriuretic peptide (BNP) concentrations in hemodialysis (HD) patients needs to be clarified. BNP levels are raised in patients with end-stage renal disease (ESRD) and could reflect LV impairment among HD patients.Aim of this work
This study sought to evaluate the clinical utility of LV-GLS, wall stress and serum BNP levels in chronic HD patients. The correlations between BNP levels with both LV wall stress and LV-GLS were assessed.Patients and methods
30 ESRD patients on regular HD {categorized into 15 patients with LV ejection fraction (EF)?≤?50% and 15 patients with LV EF?>?50%} and 15-age matched healthy subjects were included. LV function and structure were assessed by conventional echocardiography including LV meridional wall stress (LVMWS), LV mass index (LVMI) and 2-dimensional speckle tracking echocardiography for determination of LV-GLS. Serum BNP levels were evaluated after HD session.Results
There were significant increase of LVMSW (189.2?±?81 vs. 72.2?±?20.6?dynes/cm2?×?1000, P?<?0.0001), higher levels of BNP (1238?±?1085.5 vs. 71?±?23.4?pg/ml, P?<?0.0001) while LV-GLS was significantly reduced (15.1?±?3.1 vs. 20.8?±?1.7%, P?<?0.0001) in HD patients compared to controls. Higher values of LVMWS (246.9?±?67.5 vs. 131.5?±?43.6?dynes/cm2?×?1000, P?<?0.0001) and BNP (1925.4?±?1087 vs. 550.5?±?496.5?pg/ml, P?<?0.0005) with further impairment of LV-GLS (13.8?±?2.5 vs. 16.4?±?5.4%, P?<?0.05) were found in patients with LV EF?≤?50% than those with LV EF?>?50%. Serum levels of BNP were positively correlated with LVMI (r?=?0.896, P?<?0.0001) and LVMWS (r?=?0.697, P?<?0.0001) but negatively correlated with LV-GLS (r?=??0.587, P?<?0.0001).Conclusion
LV-GLS and LVMWS are useful imaging markers for detection of LV dysfunction in HD patients. Serum BNP level is influenced by LV structural abnormalities and suggested to be a crucial hemodynamic biomarker in those patients. 相似文献15.
16.
Matthew C. Konerman Joshua C. Greenberg Theodore J. Kolias James R. Corbett Ravi V. Shah Venkatesh L. Murthy Scott L. Hummel 《Journal of cardiac failure》2018,24(2):90-100
Introduction
Coronary microvascular dysfunction (MVD) may contribute to the pathogenesis of heart failure with preserved ejection fraction (HFpEF). Using myocardial flow reserve (MFR) measured by positron emission tomography (PET) as an assessment of microvascular function, we hypothesized that abnormal MFR is associated with LV diastolic dysfunction (DD) and reduced LV and LA strain in patients with risk factors for HFpEF and normal epicardial perfusion on cardiac PET.Methods and Results
Retrospective study of patients without heart failure who underwent cardiac rubidium-82 PET and echocardiography. Global MFR was calculated as the ratio of global stress to rest myocardial blood flow. Echocardiographic measures of diastolic function were recorded. Global longitudinal LA and LV strain were measured with a 2-dimensional speckle-tracking technique. Relationships among MFR and echocardiographic measures were assessed with linear regression, analysis of variance, and test for trend. Seventy-three patients (age 64 ± 11 years, 52% male) were identified with no epicardial perfusion defect on cardiac PET and an ejection fraction ≥50%. Decreased MFR was associated with LV DD (P = .02) and increased E/e', an estimation of LV filling pressure (low E/e' [<8] vs. high E/e' [>15], P < .001). MFR was associated with LA strain independent of age, gender, and common comorbidities (adjusted β = 2.6% per unit MFR, P = 0.046); however, MFR was only marginally related to LV strain.Conclusions
In patients with risk factors for HFpEF, MVD assessed with MFR was associated with DD, increased estimated LV filling pressure, and abnormal LA strain. 相似文献17.
Ashish Correa Achint Patel Kinsuk Chauhan Harshil Shah Aparna Saha Mihir Dave Priti Poojary Abhishek Mishra Narender Annapureddy Shaman Dalal Ioannis Konstantinidis Renu Nimma Shiv Kumar Agarwal Lili Chan Girish Nadkarni Sean Pinney 《Journal of cardiac failure》2018,24(7):442-450
Background
Dialysis-requiring acute kidney injury (D-AKI) is a serious complication in hospitalized heart failure (HF) patients. However, data on national trends are lacking after 2002.Methods
We used the Nationwide Inpatient Sample (2002–2013) to identify HF hospitalizations with and without D-AKI. We analyzed trends in incidence, in-hospital mortality, length of stay (LoS), and cost. We calculated adjusted odds ratios (aORs) for predictors of D-AKI and for outcomes including in-hospital mortality and adverse discharge (discharge to skilled nursing facilities, nursing homes, etc).Results
We identified 11,205,743 HF hospitalizations. Across 2002–2013, the incidence of D-AKI doubled from 0.51% to 1.09%. We found male sex, younger age, African-American and Hispanic race, and various comorbidities and procedures, such as sepsis and mechanical ventilation, to be independent predictors of D-AKI in HF hospitalizations. D-AKI was associated with higher odds of in-hospital mortality (aOR 2.49, 95% confidence interval [CI] 2.36–2.63; P?<?.01) and adverse discharge (aOR 2.04, 95% CI 1.95–2.13; P?<?.01). In-hospital mortality and attributable risk of mortality due to D-AKI decreased across 2002–2013. LoS and cost also decreased across this period.Conclusions
The incidence of D-AKI in HF hospitalizations doubled across 2002–2013. Despite declining in-hospital mortality, LoS, and cost, D-AKI was associated with worse outcomes. 相似文献18.
Camilla Tuttle Matthew Reeves Ta-chi Zhong Hu Ashley K. Keates Stephen Brady Graeme Maguire Simon Stewart 《Journal of cardiac failure》2017,23(10):729-738
Objective
The aim of this work was to understand the pattern and outcomes for heart failure (HF)–related hospitalization among Indigenous and non-Indigenous patients living in Central Australia.Methods and Results
A retrospective analysis of administrative data for patients presenting with a primary or secondary diagnosis of HF to Central Australia's Alice Springs Hospital during 2008–2012 was performed. The population rate of admission and subsequent outcomes (including mortality and readmission) during the 5-year study period were examined. A total of 617 patients, aged 55.8?±?17.5 years and 302 (49%) female constituted the study cohort. The 446 Indigenous patients (72%) were significantly younger (50.8?±?15.9 vs 68.7?±?14.9; P?<?.001) and clinically more complex compared with the non-Indigenous patients. Annual prevalence of any HF hospitalization was markedly higher in the Indigenous population (1.9%, 95% CI 1.7–2.1) compared with the non-Indigenous population (0.5%, 95% CI 0.4–0.6); the greatest difference being for women. Overall, non-Indigenous patients had poorer outcomes and were significantly more likely to die (P?<?.0001), but this was largely driven by age differences. Alternatively, Indigenous patients were significantly more likely to have a higher number of hospitalizations, although indigeneity was not a predictor for 30- or 365-day rehospitalization from the index admission.Conclusion
The pattern of HF among Indigenous Australians in Central Australia is characterized by a younger population with more clinically complex cases and greater health care utilization. 相似文献19.
Dian Wang Gen Shan Ma Xiao Yan Wang Qiang Qiang Lu Yu Wang Nai Feng Liu 《Sleep & breathing》2016,20(1):135-144
Background
Previous studies have demonstrated that patients with obstructive sleep apnea (OSA) may develop left ventricular (LV) diastolic dysfunction. We aimed to study whether OSA patients have LV regional systolic dysfunction with myocardial deformation changes, despite a normal LV ejection fraction, using real-time 3D speckle-tracking echocardiography (Rt3D-STE).Methods
Seventy-eight patients with OSA and no comorbidities were studied. They were divided into the following three groups according to the apnea–hypopnea index (AHI): 5~15/h as group I (mild OSA, 26 cases), 15~30/h as group II (moderate OSA, 29 cases), and ≥30/h as group III (severe OSA, 23 cases). Thirty gender–age-matched normal subjects were included as controls. The parameters of LV diastolic function were acquired with traditional echocardiography. The LV myocardial deformation parameters were obtained, including the longitudinal (LS), circumferential (CS), radial (RS), and area (AS) strains, with Rt3D-STE.Results
LV global systolic function was normal in all patients, but diastolic function was impaired in groups II and III (E/E′ was 9.6?±?2.8 and 10.4?±?2.5, respectively, p?<?0.0001). The global LS and AS were significantly reduced in groups II and III compared with the controls and group I (LS 15.9?±?1.4 % and 14.8?±?1.5 % vs 18.2?±?1.7 % and 17.8?±?1.5 %; AS 27.4?±?1.8 % and 24.9?±?2.3 % vs 33.4?±?2.2 % and 32.7?±?2.9 %, respectively, p?<?0.0001), but the global CS and RS were significantly reduced only in group III (17.3?±?1.4 % and 43.1?±?6.5 % vs 19.6?±?1.6 % and 55.4?±?4.0 %, respectively, <0.0001). The severity of OSA was significantly associated with the LV global AS value (r?=??0.80, p?<?0.0001), LS (r?=??0.64, p?<?0.0001), CS (r?=??0.51, p?<?0.0001), and RS (r?=??0.62, p?<?0.0001).Conclusions
Patients with moderate and severe OSA tended to have both LV diastolic dysfunction and abnormalities in regional systolic function with myocardial deformation changes, in spite of the normal LV ejection fraction. Myocardial strains of the LV were negatively correlated with the AHI. Rt-3DST had important clinical significance in the early evaluation of cardiac dysfunction in OSA patients.20.
Teruhiko Imamura Sirtaz Adatya Ben Chung Ann Nguyen Daniel Rodgers Gabriel Sayer Nitasha Sarswat Gene Kim Jayant Raikhelkar Takeyoshi Ota Tae Song Colleen Juricek Diego Medvedofsky Valluvan Jeevanandam Roberto Lang Jerry D. Estep Daniel Burkhoff Nir Uriel 《Journal of cardiac failure》2018,24(3):159-166