scholarly journals Stroke in Heart Failure in Sinus Rhythm: The Warfarin versus Aspirin in Reduced Cardiac Ejection Fraction Trial

2013 ◽  
Vol 36 (1) ◽  
pp. 74-78 ◽  
Author(s):  
Patrick M. Pullicino ◽  
John L.P. Thompson ◽  
Ralph L. Sacco ◽  
Alexandra R. Sanford ◽  
Min Qian ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Sinus Rhythm ◽  
Cardiac Ejection Fraction

scholarly journals Heart Rate–Induced Myocardial Ca 2+ Retention and Left Ventricular Volume Loss in Patients With Heart Failure With Preserved Ejection Fraction

2020 ◽  
Vol 9 (17) ◽  
Author(s):  
Daniel N. Silverman ◽  
Mehdi Rambod ◽  
Daniel L. Lustgarten ◽  
Robert Lobel ◽  
Martin M. LeWinter ◽  
...  
Keyword(s):  
Heart Failure ◽  
Heart Rate ◽  
Ejection Fraction ◽  
Sinus Rhythm ◽  
Left Ventricular ◽  
Atrial Pacing ◽  
Preserved Ejection Fraction ◽  
Volume Loss ◽  
Heart Rates ◽  
Patients With Heart Failure

Background Increases in heart rate are thought to result in incomplete left ventricular (LV) relaxation and elevated filling pressures in patients with heart failure with preserved ejection fraction (HFpEF). Experimental studies in isolated human myocardium have suggested that incomplete relaxation is a result of cellular Ca 2+ overload caused by increased myocardial Na + levels. We tested these heart rate paradigms in patients with HFpEF and referent controls without hypertension. Methods and Results In 22 fully sedated and instrumented patients (12 controls and 10 patients with HFpEF) in sinus rhythm with a preserved ejection fraction (≥50%) we assessed left‐sided filling pressures and volumes in sinus rhythm and with atrial pacing (95 beats per minute and 125 beats per minute) before atrial fibrillation ablation. Coronary sinus blood samples and flow measurements were also obtained. Seven women and 15 men were studied (aged 59±10 years, ejection fraction 61%±4%). Patients with HFpEF had a history of hypertension, dyspnea on exertion, concentric LV remodeling and a dilated left atrium, whereas controls did not. Pacing at 125 beats per minute lowered the mean LV end‐diastolic pressure in both groups (controls −4.3±4.1 mm Hg versus patients with HFpEF −8.5±6.0 mm Hg, P =0.08). Pacing also reduced LV end‐diastolic volumes. The volume loss was about twice as much in the HFpEF group (controls −15%±14% versus patients with HFpEF −32%±11%, P =0.009). Coronary venous [Ca 2+ ] increased after pacing at 125 beats per minute in patients with HFpEF but not in controls. [Na + ] did not change. Conclusions Higher resting heart rates are associated with lower filling pressures in patients with and without HFpEF. Incomplete relaxation and LV filling at high heart rates lead to a reduction in LV volumes that is more pronounced in patients with HFpEF and may be associated with myocardial Ca 2+ retention.

scholarly journals New score scale for assessing the risk of establishing chronic heart failure with preserved ejection fraction

2021 ◽  
Vol 25 (3) ◽  
pp. 83-96
Author(s):  
O. M. Zherko ◽  
E. I. Shkrebneva
Keyword(s):  
Heart Failure ◽  
Heart Disease ◽  
Chronic Heart Failure ◽  
Ejection Fraction ◽  
Sinus Rhythm ◽  
Preserved Ejection Fraction ◽  
Dispersion Index ◽  
Diagnostic Reliability ◽  
Mechanical Dispersion ◽  
Instrumental Study

The aim of the study was to develop a score scale for assessing the high risk of establishing chronic heart failure with preserved ejection fraction (HFpEF), based on echocardiography (EchoCG) evidence.Materials and methods. A clinical and instrumental study of 175 patients, of which 108 (61.7%) women and 67 (38.3%) men, aged 71 [64; 78] years was performed in the 1st City Clinical Hospital in Minsk in 2017–2018. In order to validate the score scale for assessing the risk of HFpEF establishment in 2019–2020 a reproductive clinical and instrumental study of 129 patients was performed at the Minsk Scientific and Practical Center for Surgery, Transplantology and Hematology, of which 55 (42.6%) were men and 74 (57.4%) women aged 65 [58; 70] years. Inclusion criteria: sinus rhythm, essential arterial hypertension, chronic coronary heart disease: atherosclerotic heart disease, past myocardial infarction of left ventricle (LV), after which at least six months have passed, necessary to stabilize the structural and functional parameters of the LV, HFpEF, informed consent of the patient. Exclusion criteria: primary mitral regurgitation, mitral stenosis, mitral valve repair or prosthetics, congenital heart defects, acute and chronic diseases of the kidneys, lungs. EchoCG was performed on ultrasound machines Siemens Acuson S1000 (Germany) and Vivid E9 (GE Healthcare, USA).Results. The developed scale for assessing the risk of establishing HFpEF in a patient with sinus rhythm including the criteria: LV diastolic dysfunction type II – 47 points, deceleration time of peak E of the transmitral blood flow DTE ≤171 ms – 25 points, the speed of early diastolic movement of the septal part of the mitral fibrous ring e'septal ≤7 cm/s – 25 points, LV early diastolic filling index E/е'septal >7.72 – 20 points, index of the end-systolic volume of the left atrium >34.3 ml/m2 – 24 points, has high diagnostic reliability (AUC 0.96, sensitivity (S) 96.6%, specificity (Sp) 83.2%) and reproducibility of results in an examination cohort of patients (AUC 0.99, S 98.8%, Sp 98.0%). A total score > 45 indicates a high probability of HFpEF. If the total score is ≤45, it is recommended to perform 2D Speckle Tracking EchoCG. The leading patho-functional mechanisms for the development of HFpEF are a decrease of LV global systolic longitudinal strain GLSAVG > −18.9% (S 94.9%, Sp 98.0%), GLS of the right ventricle (RV) > −19.9% (S 76.5%, Sp 88.5%), mechanical dispersion with LV mechanical dispersion index > 54.69 ms (S 70.7%, Sp 90.2%), RV mechanical dispersion index > 50.29 msec (S 78.1%, Sp 73.9%) and ventricular dyssynergy with LV global post systolic index >5.59% (S 82.6%, Sp 87.5%), RV global post systolic index > 2.17% (S 84.5%, Sp 69.9%).Conclusions. The use of the developed scale will improve the efficiency of ultrasound imaging of HFpEF.

Chronic heart failure: definitions, investigation, and management

2010 ◽  
pp. 2728-2728
Author(s):  
John G.F Cleland ◽  
Andrew L Clark
Keyword(s):  
Heart Failure ◽  
Heart Disease ◽  
Chronic Heart Failure ◽  
Ejection Fraction ◽  
Sinus Rhythm ◽  
Mineralocorticoid Receptor ◽  
Angiotensin Receptor ◽  
Mineralocorticoid Receptor Antagonists ◽  
Receptor Antagonists ◽  
High Concentrations

Heart failure is a common clinical syndrome, often presenting with breathlessness, fatigue and peripheral oedema. It is predominantly a disease of older people. The prevalence is increasing, exceeding 2% of the adult population in developed countries. The pathophysiology of heart failure is complex. A common feature is salt and water retention, possibly triggered by a relative fall in renal perfusion pressure. Common aetiologies include ischaemic heart disease, hypertension, and valvular heart disease. The early diagnosis of heart failure relies on a low threshold of suspicion and screening of people at risk before the onset of obvious symptoms or signs. In patients with suspected heart failure, routine investigation with electrocardiography and blood tests for urea and electrolytes, haemoglobin and BNP/NT-proBNP are recommended. Low plasma concentrations of BNP/NT-proBNP exclude most forms of heart failure. Intermediate or high concentrations should prompt referral for echocardiography to identify possible causes of heart failure and the left ventricular ejection fraction (LVEF). Patients can be classified as reduced (<40%) LVEF (HFrEF), normal (>50%) LVEF (HFnEF), or borderline (40–50%) LVEF (HFbEF). Currently HFbEF and HFnEF are managed similarly by current guidelines. Treatable causes for heart failure (e.g. valvular disease, tachyarrhythmias, thyrotoxicosis, anaemia or hypertension) should be identified and corrected. Patients with heart failure will generally benefit from lifestyle advice (diet, exercise, vaccination). Pharmacological therapy is given to improve symptoms and prognosis. Diuretic therapy is the mainstay for control of congestion and symptoms; it may be life-saving for patients with acute heart failure but its effect on long-term prognosis is unknown. For patients with HFrEF, either angiotensin converting enzyme (ACE) inhibitors, angiotensin receptor blockers, or, more recently, angiotensin receptor neprilysin inhibitors, combined with β‎-blockers and mineralocorticoid receptor antagonists (triple therapy) provide both symptomatic and prognostic benefit. Ivabridine may be added for those in sinus rhythm where the heart rate remains above 70 bpm. Whether digoxin still has a role in contemporary management is uncertain. Cardiac resynchronization therapy is appropriate for symptomatic patients with HFrEF if they are in sinus rhythm and have a broad QRS (>140 ms). Implantable defibrillators provide additional prognostic benefit in selected patients with an ejection fraction below 35%. For patients with HFnEF, treatments directed at comorbid conditions (e.g. hypertension, atrial fibrillation) and congestion (e.g. diuretics and mineralocorticoid receptor antagonists) are appropriate but there is no robust evidence that any treatment can improve prognosis. Heart transplantation or assist devices may be options for highly selected patients with endstage heart failure; many others may benefit from palliative care services. Effective management of chronic heart failure requires a coordinated multidisciplinary team, including heart failure nurse specialists, primary care physicians, and cardiologists. New treatments have improved the prognosis of heart failure substantially over the past two decades. The annual mortality is now probably less than 5% for patients with HFrEF receiving good contemporary care whose symptoms are stable and controlled. For patients with recurrent or recalcitrant congestion requiring admission to hospital, the prognosis is much worse. In-patient mortality is about 5% for those aged less than 75 years but threefold higher for older patients; mortality in the year after discharge ranges from 20% to 40% depending on age.

HFrEF pharmacological treatment: ivabradine

ESC CardioMed ◽  
2018 ◽  
pp. 1863-1867
Author(s):  
Michel Komajda
Keyword(s):  
Heart Failure ◽  
Clinical Trial ◽  
Heart Rate ◽  
Chronic Heart Failure ◽  
Ejection Fraction ◽  
Sinus Rhythm ◽  
Pharmacological Treatment ◽  
Beta Blockers ◽  
Reduced Ejection Fraction ◽  
Background Therapy

Ivabradine slows down the heart rate through a blockade of the funny current channels in the sinoatrial node cells. The efficacy of the drug was tested in a large outcome clinical trial in stable chronic heart failure with reduced ejection fraction, in sinus rhythm, on a contemporary background therapy including beta blockers.

scholarly journals β-Blocker Doses and Heart Rate in Patients with Heart Failure: Results from the National Norwegian Heart Failure Registry

2020 ◽  
Vol 5 (1) ◽  
pp. 1-10
Author(s):  
Torfinn Eriksen-Volnes ◽  
Arne Westheim ◽  
Lars Gullestad ◽  
Eva Kjøl Slind ◽  
Morten Grundtvig
Keyword(s):  
Heart Failure ◽  
Heart Rate ◽  
Ejection Fraction ◽  
Sinus Rhythm ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Categorical Variables ◽  
Target Dose ◽  
Β Blocker ◽  
Β Blockers

Background: Use of β-blockers and titration to the highest tolerated dose are highly recommended by the European Society of Cardiology (ESC) guidelines for treatment of chronic heart failure (HF) with a reduced ejection fraction (HFrEF), but little attention has been paid to the achieved heart rate (HR) during this treatment. Objectives: The aim of the present study was to examine the achieved HR in relation to the use of β-blockers in these patients. Methods: All of the patients (n = 2,689) in the National Norwegian Heart Failure Registry as part of the Norwegian Cardiovascular Disease Registry with a sinus rhythm and left ventricular ejection fraction (LVEF) <40% at stable follow-up visiting specialised hospital outpatient HF clinics in Norway were included. The β-blocker doses were calculated as a percent of the target dose according to ESC HF guidelines. Differences between baseline variables according to the achieved HR were analysed by the Student’s t test for continuous variables and Pearson’s χ2 test for categorical variables. Linear regression was used to determine the predictors of HR ≥70 beats/min (bpm) in the multivariate analysis. Results: One third of the patients had a resting HR ≥70 bpm. Of the patients with an HR ≥70 bpm, 72.3% used less than the target dose of β-blocker; they were younger and had a higher NYHA class, more diabetes mellitus and chronic obstructive pulmonary disease (COPD), and higher N-terminal pro-B type natriuretic peptide (NT-proBNP) levels and estimated glomerular filtration rates compared to the patients with an HR <70 bpm. The 1-year mortality was 3.1, 3.7, 5.8, and 9.1% among the patients with an HR <70, 70–79, 80–89, and >89 bpm, respectively. Only 2 patients used ivabradine. Conclusions: In patients with HFrEF and sinus rhythm, an HR ≥70 bpm was associated with worse clinical variables and outcomes. A high proportion of the patients who had an HR ≥70 bpm was not treated with or/did not tolerate the target dose of a β-blocker, although the β-blocker dose was higher than in patients with an HR <70 bpm. This may suggest that increased efforts should be made to further increase the β-blocker dose, and treatment with ivabradine could be considered among patients with an HR ≥70 bpm.

Acute Effects of Biventricular Pacing in Heart Failure Patients with a Normal Ejection Fraction and Mechanical Dyssynchrony

Cardiology ◽  
2015 ◽  
Vol 130 (2) ◽  
pp. 112-119 ◽  
Author(s):  
Yi-Chih Wang ◽  
Chih-Chieh Yu ◽  
Fu-Chun Chiu ◽  
Vincent Splett ◽  
Ruth Klepfer ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Sinus Rhythm ◽  
Normal Sinus Rhythm ◽  
Biventricular Pacing ◽  
Mechanical Dyssynchrony ◽  
Left Ventricular ◽  
Acute Effects ◽  
Heart Failure Patients ◽  
Normal Sinus

Objectives: We tested the acute effects of resynchronization in heart failure patients with a normal (>50%) left ventricular (LV) ejection fraction (HFNEF) and mechanical dyssynchrony. Methods: Twenty-four HFNEF patients (72 ± 6 years, 5 male) with mechanical dyssynchrony (standard deviation of electromechanical time delay among 12 LV segments >35 ms) were studied with temporary pacing catheters in the right atrium, LV, and right ventricle (RV), and high-fidelity catheters for pressure recording. Using selected atrioventricular (AV) intervals of 60, 90, 120, 150, and 180 ms to optimize transmitral flow during simultaneous biventricular pacing, the RV-LV (VV) interval was then evaluated at RV30, RV15, 0, LV15, LV30, and LV45 (RV or LV indicates which ventricle was paced first, the number indicates by how many ms). Results: During simultaneous pacing, longer AV intervals were associated with improved LV pressure-derivative minimums and increased aortic pressures (p < 0.05 vs. normal sinus rhythm). In the VV interval from RV30 to LV45, there was a graded increase in the aortic velocity time integral and a decrease in dyssynchrony during simultaneous or LV-first pacing (p < 0.05 vs. normal sinus rhythm). Conclusions: For HFNEF patients with mechanical dyssynchrony, acute simultaneous biventricular or LV-first pacing with longer AV intervals reduced mechanical dyssynchrony and improved diastolic and systolic hemodynamics.

scholarly journals CHA2DS2-VASc score and adverse outcomes in patients with heart failure with reduced ejection fraction and sinus rhythm

2016 ◽  
Vol 18 (10) ◽  
pp. 1261-1266 ◽  
Author(s):  
Siqin Ye ◽  
Min Qian ◽  
Bo Zhao ◽  
Richard Buchsbaum ◽  
Ralph L. Sacco ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Sinus Rhythm ◽  
Adverse Outcomes ◽  
Reduced Ejection Fraction ◽  
Patients With Heart Failure
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