scholarly journals Diagnostic capabilities of electrocardiography systolic heart failure

2018 ◽  
Vol 20 (3) ◽  
pp. 86-90
Author(s):  
Yu S Malov ◽  
I M Borisov ◽  
E P Galova ◽  
I I Yarovenko
Keyword(s):  
Heart Failure ◽  
Left Ventricle ◽  
Myocardial Contractility ◽  
Systolic Heart Failure ◽  
Functional Class ◽  
Preserved Ejection Fraction ◽  
Ventricular Systole ◽  
Patients With Heart Failure ◽  
Diagnostic Capabilities ◽  
Contractility Of The Myocardium

The contractility of the myocardium is determined by the strength and speed of contraction of the ventricles. It can be estimated from the Q-T interval of the electrocardiogram, which is an electrical systole of the ventricles. Set the change in ventricular systole by the deviation of the actual interval of Q-T from the corrected one. Elongation of ventricular systole indicates a violation of myocardial contractility, which causes the development of systolic heart failure. When comparing this indicator with the results of echocardiography, reflecting the contractility of the left ventricle, their direct dependence was established. The greater the degree of breach of myocardial contractility, the higher the percentage of the deviation of the actual Q-T interval from the corrected one. The maximum figures were recorded in patients with a global contractility disorder. This indicator can be used to detect both acute and chronic systolic insufficiency. It was established that in all patients with heart failure there was an increase in the Q-T interval. The magnitude of it depended on the degree of manifestation of heart failure. The increase in the percentage deviation of the actual value from the control occurred in patients with heart failure from I functional class to IV. Only in 1/5 of patients with heart failure of I functional class, the actual value did not differ from the control one, but under physical load, it increased significantly, which indicates the presence of latent systolic insufficiency. It is also found in patients with heart failure with a preserved ejection fraction, the development of which is associated with diastolic dysfunction. Electrocardiography can be used as a method of diagnosing systolic heart failure, which is highly informative and specific.

Effect of atorvastatin on the lipid profile, markers of immune inflammation and symptomatic severity of heart failure in patients with myocarditis

2020 ◽  
Vol 22 (3) ◽  
pp. 76-81
Author(s):  
N. N. Ryzhman ◽  
S. L. Grishaev ◽  
D. V. Cherkashin ◽  
E. V. Gladysheva ◽  
V. Yu. Filippov ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Clinical Course ◽  
Systolic Function ◽  
Functional Class ◽  
Pleiotropic Effects ◽  
Preserved Ejection Fraction ◽  
Chronic Myocarditis ◽  
Patients With Heart Failure ◽  
Positive Effect

Abstract. The effect of atorvastatin on the immune system and lipid metabolism after 24-week treatment of patients with chronic myocarditis is considered. Statins have been found to improve the clinical course of heart failure with a preserved ejection fraction in patients with myocarditis: they reduce the functional class of heart failure, improve the systolic function of the heart and its arrhythmogenic potential. Despite the large amount of conflicting data in the field of statin use in heart failure, one can think about the possible influence of molecular differences in statins on their pharmacological and pleiotropic effects. In particular, atorvastatin, which has lipophilic properties, is able to penetrate cardiomyocytes in contrast to hydrophilic rosuvastatin, which may partially explain the positive cardiac effects of atorvastatin in patients with heart failure with a preserved ejection fraction. The probable basis for the positive effect of atorvastatin on morphofunctional parameters in heart failure is its positive pleiotropic effects associated with a decrease in рro-inflammatory immune markers and subsequent leveling of negative neurohumoral activation. An additional mechanism that caused the positive effect of atorvastatin on the clinical course of heart failure can be considered a factor of preservation of systolic function of the left ventricle.

scholarly journals Clinical case of borreliosis myocarditis

2020 ◽  
Vol 24 (2) ◽  
pp. 232-235
Author(s):  
Yu. Yu. Shushkovska ◽  
O.I. Afanasiuk ◽  
R.V. Matyash
Keyword(s):  
Heart Failure ◽  
Lyme Disease ◽  
Left Ventricle ◽  
Ejection Fraction ◽  
Ventricular Arrhythmia ◽  
Atrioventricular Block ◽  
Clinical Case ◽  
Functional Class ◽  
Preserved Ejection Fraction ◽  
Atrial Rhythm

Annotation. The purpose of the work is to demonstrate the peculiarities of its course, modern methods of diagnosis and treatment on the example of a clinical case of borreliosis myocarditis. According to the results of the patient's ECG, a transient atrio-ventricular block of the first degree was established. The results of general clinical methods of examination of the patient generally corresponded to the reference values. According to the results of Holter ECG monitoring, a diagnosis of mild myocarditis, heart failure I, functional class I, with preserved ejection fraction (50 %) of the left ventricle was made. Ventricular arrhythmia – 4th grade according to Laun. Competitive atrial rhythm, transient atrioventricular block. Because specific cardiovascular lesions occurred for no apparent reason and symptoms occurred during peak tick activity, the patient was re-interviewed for migratory erythema and tick bites. The patient confirmed being in the forest during the disease season and sucking the mite without specific skin lesions. To further search for the etiological factor that led to the identified changes, the patient was tested for antibodies to Burrelia burgdorferi by ELISA. The obtained positive result (Ig G – 3.89 IU/ml, Ig M – 33.74 IU/ml) indicated an acute period of Lyme disease. Thus, the final diagnosis was: Lyme disease, stage II (early disseminal). Subacute infectious (borreliosis) myocarditis, mild course, heart failure I, functional class I, with preserved ejection fraction (50 %) of the left ventricle. Ventricular arrhythmia – 4th grade according to Laun. Competitive atrial rhythm, transient atrioventricular block of the I degree. Treatment is prescribed: doxycycline 100 mg x 2 times/day, metoprolol 25 mg x 2 times/day, metabolic therapy and serological tests are recommended after 3, 6, 12 months and 2 years. Thus, the clinical case shows the difficulties of diagnosing “borreliosis myocarditis”, emphasizes the prospects for the development of algorithms for the diagnosis and treatment of borreliosis myocarditis.

scholarly journals Effect of Empagliflozin on Worsening Heart Failure Events in Patients with Heart Failure and a Preserved Ejection Fraction: The EMPEROR-Preserved Trial

Circulation ◽  
2021 ◽  
Author(s):  
Milton Packer ◽  
Javed Butler ◽  
Faiez Zannad ◽  
Gerasimos Filippatos ◽  
Joao Pedro Ferreira ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Statistical Significance ◽  
Cardiovascular Death ◽  
Functional Class ◽  
Hazard Ratio ◽  
Preserved Ejection Fraction ◽  
Double Blind ◽  
Clinical Trial Registration ◽  
Patients With Heart Failure

Background: Empagliflozin reduces the risk of cardiovascular death or hospitalization for heart failure in patients with heart failure and a preserved ejection fraction, but additional data are needed about its effect on inpatient and outpatient heart failure events. Methods: We randomly assigned 5988 patients with class II-IV heart failure with an ejection fraction of >40% to double-blind treatment with placebo or empagliflozin (10 mg once daily), in addition to usual therapy, for a median of 26 months. We prospectively collected information on inpatient and outpatient events reflecting worsening heart failure and prespecified their analysis in individual and composite endpoints. Results: Empagliflozin reduced the combined risk of cardiovascular death, hospitalization for heart failure or an emergent/urgent heart failure visit requiring intravenous treatment (432 vs 546 patients; empagliflozin vs placebo, respectively; hazard ratio 0.77, 95% CI: 0.67-0.87), P <0.0001. This benefit reached statistical significance at 18 days after randomization. Empagliflozin reduced the total number of heart failure hospitalizations that required intensive care (hazard ratio 0.71, 95% CI 0.52-0.96, P=0.028) and the total number of all hospitalizations that required a vasopressor or positive inotropic drug (hazard ratio 0.73, 95% CI: 0.55-0.97,P=0.033). As compared with placebo, fewer patients in the empagliflozin group reported outpatient intensification of diuretics (482 vs 610, hazard ratio 0.76, 95% CI: 0.67-0.86, P<0.0001), and patients assigned to empagliflozin were 20-50% more likely to have a better NYHA functional class, with significant effects at 12 weeks that were maintained for at least 2 years. The benefit on total heart failure hospitalizations was similar in patients with an ejection fraction of >40-<50% and 50-<60%, but was attenuated at higher ejection fractions. Conclusions: In patients with heart failure and a preserved ejection fraction, empagliflozin produced a meaningful, early and sustained reduction in the risk and severity of a broad range of inpatient and outpatient worsening heart failure events. Clinical Trial Registration: The registration identifier at ClinicalTrials.gov is NCT03057977

scholarly journals Prognostic value of secondary hyperaldosteronism in patients with chronic heart failure with preserved ejection fraction

2021 ◽  
Vol 12 (2) ◽  
pp. 81-91
Author(s):  
A. N. Shevelok
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Prognostic Value ◽  
Functional Class ◽  
Plasma Aldosterone ◽  
Preserved Ejection Fraction ◽  
Aldosterone Level ◽  
Patients With Heart Failure ◽  
Secondary Hyperaldosteronism ◽  
Plasma Aldosterone Level

Purpose: to investigate the prognostic value of secondary hyperaldosteronism patients with heart failure with preserved ejection fraction. Materials and methods: prospective cohort study included 158 patients with hyperaldosteronism and heart failure with preserved ejection fraction. Baseline blood aldosterone levels were determined in all patients. Hyperaldosteronemia was diagnosed when the plasma aldosterone level was > 160 pg/ml. The primary endpoint was all-cause mortality. Results: at baseline, hyperaldosteronemia was detected in 59 of 158 patients (37.3%). Hyperaldosteronemic patients were younger, had higher functional class and NT-proBNP level, and a higher rate of comorbidity (all Ps <0.05). Over a median follow‐up of 32 (28-38) months, a total of 50 (37.6%) patients died. Cardiovascular death occurred in 32 (20.3%) cases, non-cardiovascular – in 18 (11.4%) cases. A total of 65 (41.1%) patients were hospitalized for HF. High aldosterone levels were associated with a significant (p <0.05) increase in the risk of hospitalization for HF (adjusted odds ratio (OR) 2.14, 95% confidence interval (CI) 1.34-9.68), all-cause death (OR 1.64; 95% CI 1.23-7.65, P = 0.033) and HF death (OR 1.56; 95 % CI 1.14-11.3, P = 0.021). Conclusion: Hyperaldosteronism in patients with heart failure with preserved ejection fraction secondary hyperaldosteronism is an independent predictor of hospitalization for heart failure, all-cause, and cardiovascular mortality. The inclusion of plasma aldosterone level in the existing prognosis models of heart failure with preserved ejection fraction will help improve their predictive value and optimize the management of high-risk patients.

scholarly journals Heart failure with preserved ejection fraction – onset

2021 ◽  
Vol 27 (2) ◽  
pp. 17-36
Author(s):  
Branimir Kanazirev
Keyword(s):  
Heart Failure ◽  
Left Ventricle ◽  
Ejection Fraction ◽  
Diastolic Dysfunction ◽  
Systolic Function ◽  
Diastolic Heart Failure ◽  
Preserved Ejection Fraction ◽  
Reduced Ejection Fraction ◽  
Rich Variety ◽  
Patients With Heart Failure

During these more than 20 years of evolution in understandings of the mechanisms of heart failure (HF) with preserved fractional ejection, there has been a rich variety of terminology, including „diastolic heart failure“, „heart failure with preserved systolic function“ and „heart failure with preserved fraction“. By defi nition, the latter term “ejection fraction-induced heart failure” proved to be the most appropriate and was accepted as the most correct, as the presence of diastolic dysfunction is not unique only to this group and exists in these patients, albeit subclinically and discrete disturbance in the longitudinal systolic function of the left ventricle against the background of the preserved ejection fraction. The problem, however, is not in the value of the ejection fraction or in the paradox of the combination of a well-functioning left ventricle and classic symptoms of heart failure, but in the non-infl uence of the prognosis of these patients in the way it is in patients with suppressed EF. Unlike patients with heart failure with a reduced ejection fraction, the prognosis and results in patients with HF with preserved EF do not mark the expected results and so far there are not enough effective and promising therapies.

The Results of the Use of Angiotensin Receptor Inhibitors and Neprilisin in Secondary Functional Mitral Regurgitation in Outpatient Practice

2020 ◽  
Vol 75 (5) ◽  
pp. 514-522
Author(s):  
Alexey S. Ryazanov ◽  
Konstantin I. Kapitonov ◽  
Mariya V. Makarovskaya ◽  
Alexey A. Kudryavtsev
Keyword(s):  
Heart Failure ◽  
Left Ventricle ◽  
Mitral Regurgitation ◽  
Effective Area ◽  
Left Ventricular ◽  
Functional Mitral Regurgitation ◽  
Angiotensin Receptor ◽  
Optimal Drug ◽  
Patients With Heart Failure ◽  
Valsartan Group

Background. Morbidity and mortality in patients with functional mitral regurgitation (FMR) remains high, however, no pharmacological therapy has been proven to be effective.Aimsto study the effect of sacubitrile/valsartan and valsartan on functional mitral regurgitation in chronic heart failure.Methods.This double-blind study randomly assigned sacubitrile/valsartan or valsartan in addition to standard drug therapy for heart failure among 100 patients with heart failure with chronic FMR (secondary to left ventricular (LV) dysfunction). The primary endpoint was a change in the effective area of the regurgitation hole during the 12-month follow-up. Secondary endpoints included changes in the volume of regurgitation, the final systolic volume of the left ventricle, the final diastolic volume of the left ventricle, and the area of incomplete closure of the mitral valves.Results.The decrease in the effective area of the regurgitation hole was significantly more pronounced in the sacubitrile/valsartan group than in the valsartan group (0.070.066against0.030.058sm2; p=0.018)in the treatment efficacy analysis, which included 100patients (100%). The regurgitation volume also significantly decreased in the sacubitrile/valsartan group compared to the valsartan group (mean difference:8.4ml; 95%CI, from 13.2 until 1.9;р=0.21). There were no significant differences between the groups regarding changes in the area ofincomplete closure of the mitral valves and LV volumes, with the exception of the index of the final LV diastolic volume (p=0.07).Conclusion.Among patients with secondary FMR, sacubitril/valsartan reduced MR more than valsartan. Thus, angiotensin receptor inhibitors and neprilysin can be considered for optimal drug treatment of patients with heart failure and FMR.

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