Novel Cardiac Contractility Index and Ventricular-Arterial Matching Index to Serve as Markers of Heart Failure

2016 ◽  
pp. 71-91
Author(s):  
Liang Zhong ◽  
Dhanjoo Ghista ◽  
Ghassan Kassab ◽  
Ru Tan
Keyword(s):  
Heart Failure ◽  
Cardiac Contractility ◽  
Matching Index

scholarly journals Advances in understanding the role of cardiac glycosides in control of sodium transport in renal tubules

2014 ◽  
Vol 222 (1) ◽  
pp. R11-R24 ◽  
Author(s):  
Syed Jalal Khundmiri
Keyword(s):  
Heart Failure ◽  
Intracellular Signaling ◽  
Cardiac Contractility ◽  
Myocardial Cell ◽  
Renal Tubules ◽  
Intracellular Signaling Pathway ◽  
Body Sodium ◽  
Membrane Bound ◽  
Total Body

Cardiotonic steroids have been used for the past 200 years in the treatment of congestive heart failure. As specific inhibitors of membrane-bound Na+/K+ATPase, they enhance cardiac contractility through increasing myocardial cell calcium concentration in response to the resulting increase in intracellular Na concentration. The half-minimal concentrations of cardiotonic steroids required to inhibit Na+/K+ATPase range from nanomolar to micromolar concentrations. In contrast, the circulating levels of cardiotonic steroids under physiological conditions are in the low picomolar concentration range in healthy subjects, increasing to high picomolar levels under pathophysiological conditions including chronic kidney disease and heart failure. Little is known about the physiological function of low picomolar concentrations of cardiotonic steroids. Recent studies have indicated that physiological concentrations of cardiotonic steroids acutely stimulate the activity of Na+/K+ATPase and activate an intracellular signaling pathway that regulates a variety of intracellular functions including cell growth and hypertrophy. The effects of circulating cardiotonic steroids on renal salt handling and total body sodium homeostasis are unknown. This review will focus on the role of low picomolar concentrations of cardiotonic steroids in renal Na+/K+ATPase activity, cell signaling, and blood pressure regulation.

scholarly journals Pursuing the non-invasive assessment of cardiac contractility: the added value of pressure-area-strain loop analysis in volume overload-induced heart failure

2021 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
M Tokodi ◽  
BK Lakatos ◽  
M Ruppert ◽  
A Olah ◽  
AA Sayour ◽  
...  
Keyword(s):  
Heart Failure ◽  
Mitral Valve ◽  
Cardiac Contractility ◽  
Volume Overload ◽  
Left Ventricular ◽  
Stroke Work ◽  
Loading Conditions ◽  
Innovation And Technology ◽  
Pressure Area ◽  
Area Strain

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): This work was supported by the New National Excellence Programme (ÚNKP-19-3-I) of the Ministry for Innovation and Technology in Hungary, and the Artificial Intelligence Research Field Excellence Programme of the National Research, Development and Innovation Office of the Ministry of Innovation and Technology in Hungary. Background Global longitudinal strain (GLS) by speckle-tracking echocardiography (STE) is a sensitive parameter of left ventricular (LV) systolic function. Nevertheless, GLS is dependent on loading conditions. Through the analysis of pressure-strain loops, myocardial work was recently introduced and tested in different clinical scenarios. Myocardial work incorporates afterload, but still, it neglects changes in preload and LV geometry. Purpose Accordingly, our aim was to test our hypothesis that adding instantaneous LV size to myocardial work calculation can further mitigate the load-dependency of GLS, and therefore, a better correlation with intrinsic myocardial contractility can be achieved. Methods Volume overload-induced heart failure was established by an aortocaval fistula (ACF) in male Wistar rats (n = 12). Age-matched sham-operated animals served as controls (n = 12). STE was performed to assess GLS, which was immediately followed by invasive pressure-volume (P-V) analysis to assess LV pressure and to compute a gold-standard index of cardiac contractility (preload recruitable stroke work [PRSW]). Global myocardial work index (GMWI) was calculated from GLS and the invasively measured LV pressure. To compute GMWI indexed to LV area (GMWIA), the instantaneous power (calculated by multiplying the strain rate and the instantaneous LV pressure) was divided by the instantaneous LV area, and then it was integrated from mitral valve closure until mitral valve opening. Results LV ejection fraction did not differ significantly (ACF vs. controls: 59 ± 4 vs. 65 ± 9%, p = NS), whereas GLS (Figure 1A - representative animals) was slightly decreased in the ACF group (-13.2 ± 2.3 vs. -15.4 ± 1.9%, p < 0.05). In contrast, PRSW, GMWI (Figure 1B - representative animals) and GMWIA (Figure 1C - representative animals) were considerably reduced in ACF compared to controls (57 ± 13 vs. 111 ± 38mmHg, 1383 ± 382 vs. 1928 ± 281mmHg%, 11.6 ± 3.7 vs. 47.9 ± 22.8mmHg%/mm2, all p < 0.01). GLS showed moderate correlation with PRSW (r=-0.550, p < 0.01), whereas GMWI correlated more significantly, but still moderately with the invasively measured LV contractility (r = 0.681, p < 0.001). Correlation between the pressure-area-strain loop-derived GMWIA and P-V analysis-derived PRSW (Figure 1D) was found to be very strong (r = 0.924, p < 0.001). Conclusions In the case of LV volume overload-induced heart failure, our pressure-area-strain loop-derived metric reflected LV contractility better than GLS and even GMWI. Therefore, the incorporation of instantaneous LV size into myocardial work calculation represents a promising clinical tool to assess and monitor intrinsic myocardial function independently of loading conditions. Abstract Figure 1

scholarly journals Positive impact of cardiac contractile modulation on myocardial contractility and left ventricular synchronization in a patient with a left ventricular noncompaction

2020 ◽  
Vol 35 (2) ◽  
pp. 157-162
Author(s):  
I. A. Ryabov ◽  
I. N. Mamchur ◽  
T. Yu. Chichkova ◽  
S. E. Mamchur ◽  
I. N. Sizova ◽  
...  
Keyword(s):  
Heart Failure ◽  
Myocardial Contractility ◽  
Positive Impact ◽  
Cardiac Contractility ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Cardiac Contractile ◽  
Heart Failure Questionnaire

The article provides a clinical case of a 58-year-old man with the fi rst clinical manifestation of chronic heart failure in the presence of a signifi cant decrease in the left ventricular ejection fraction. Left ventricular non-compaction cardiomyopathy was diagnosed by echocardiography. After 12 months, a cardiac contractility modulation device was implanted to the patient in the presence of disease progression despite optimal medical therapy. We assessed the course of disease, quality of life, exercise tolerance, and myocardial contractility of the patient before and six months after surgery. The methods of assessment were collection of patient complaints, physical examination, electrocardiography (ECG), fi lling out the Minnesota Living with Heart Failure Questionnaire (MLHFQ), sixminute walk test, spiroergometry, and echocardiography.

Novel Non-Pharmaceutical Advancements in Heart Failure Management: The Emerging Role of Technology

2021 ◽  
Vol 17 ◽  
Author(s):  
Mark T. Nolan ◽  
Neville Tan ◽  
Christopher J. Neil
Keyword(s):  
Heart Failure ◽  
Cardiac Contractility ◽  
Baroreflex Activation Therapy ◽  
Public Health Burden ◽  
Heart Failure Care ◽  
Cardiac Devices ◽  
Randomized Controlled Studies ◽  
Technological Advances ◽  
Activation Therapy

Purpose of Review: To summarise and discuss the implications of recent technological advances in heart failure care. Recent Findings: Heart failure remains a significant source of morbidity and mortality in the US population despite multiple classes of approved pharmacological treatments. Novel cardiac devices and technologies may offer an opportunity to improve outcomes. Baroreflex Activation Therapy and Cardiac Contractility Remodelling may improve myocardial contractility by altering neurohormonal stimulation of the heart. Implantable Pulmonary Artery Monitors and Biatrial Shunts may prevent heart failure admissions by altering the trajectory of progressive congestion. Phrenic Nerve Stimulation offers potentially effective treatment for comorbid conditions. Smartphone applications offer an intriguing strategy for improving medication adherence. Summary: Novel heart failure technologies offer promise for reducing this public health burden. Randomized controlled studies are indicated for assessing the future role of these novel therapies.

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