scholarly journals Protective Effects of a Discontinuous Treatment with Alpha-Lipoic Acid in Obesity-Related Heart Failure with Preserved Ejection Fraction, in Rats

Antioxidants ◽  
2020 ◽  
Vol 9 (11) ◽  
pp. 1073
Author(s):  
Cristina Pop ◽  
Maria-Georgia Ștefan ◽  
Dana-Maria Muntean ◽  
Laurențiu Stoicescu ◽  
Adrian Florin Gal ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Lipoic Acid ◽  
Heart Function ◽  
Antioxidant Systems ◽  
Control Group ◽  
Protective Effects ◽  
Alpha Lipoic Acid ◽  
Preserved Ejection Fraction ◽  
Sprague Dawley

Obesity induces hemodynamic and humoral changes that are associated with functional and structural cardiac remodeling, which ultimately result in the development of heart failure (HF) with preserved ejection fraction (HFpEF). In recent years, pharmacological studies in patients with HFpEF were mostly unsatisfactory. In these conditions, alternative new therapeutic approaches are necessary. The aim of our study was (1) to assess the effects of obesity on heart function in an experimental model and (2) to evaluate the efficacy of an alpha-lipoic acid (ALA) antioxidant treatment. Sprague-Dawley rats (7 weeks old) were either included in the control group (n = 6) or subjected to abdominal aortic banding (AAB) and divided into three subgroups, depending on their diet: standard (AAB + SD, n = 8), hypecaloric (AAB + HD, n = 8) and hypecaloric with discontinuous ALA treatment (AAB + HD + ALA, n = 9). Body weight (BW), glycemia, echocardiography parameters and plasma hydroperoxides were monitored throughout the study. After 36 weeks, plasma adiposity (leptin and adiponectin) and inflammation (IL-6 and TNF-alpha) markers, together with B-type natriuretic peptide and oxidative stress markers (end-products of lipid peroxidation and endogenous antioxidant systems) were assessed. Moreover, cardiac fiber diameters were measured. In our experiment, diet-induced obesity generated cardiometabolic disturbances, and in association with pressure-overload induced by AAB, it precipitated the onset of heart failure, cardiac hypertrophy and diastolic dysfunction, while producing a pro-oxidant and pro-inflammatory plasmatic status. In relationship with its antioxidant effects, the chronic ALA-discontinuous treatment prevented BW gain and decreased metabolic and cardiac perturbations, confirming its protective effects on the cardiovascular system.

Abstract P394: Angiotensin-(1-7) Attenuates Diastolic Dysfunction And Cardiac Remodeling In Murine Model Of Heart Failure With Preserved Ejection Fraction

2021 ◽  
Vol 129 (Suppl_1) ◽  
Author(s):  
Pariya Edalat ◽  
Karina Gomes ◽  
Noura N Ballasy ◽  
Anshul S Jadli ◽  
Darrell D Belke ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Cardiac Hypertrophy ◽  
Diastolic Dysfunction ◽  
Murine Model ◽  
Cardiac Remodeling ◽  
Control Group ◽  
Chow Diet ◽  
Preserved Ejection Fraction ◽  
Phosphorylation Level

Background: Heart failure with preserved ejection fraction (HFpEF) is a global public health epidemic that accounts for half of the heart failure cases. Various therapeutic approaches have been tested to block the activation of the Renin-Angiotensin System (RAS), including AT1R blockers (ARBs), Angiotensin-Converting Enzyme (ACE) inhibitors (ACEi), and direct renin inhibitors (DRIs) with modest to negligible benefits. The discovery of ACE2, a novel homolog of ACE, has advanced our understanding of the RAS. ACE2 is a monocarboxypeptidase that degrades Ang II into Ang-(1-7), which works via the activation of the Mas receptor. It has been well understood that the actions of Ang-(1-7) attenuate cardiac remodeling, production of ROS, and cardiac fibrosis. Objective: To determine the therapeutic role of Ang-(1-7) in HFpEF and identify the molecular mechanism related to its action. Methods and Results: To generate a murine model of HFpEF, male WT mice (n=24) were subjected to HFD in addition to eNOS inhibition with L-NAME (0.5 g l-1 in drinking water), as previously described. The control group (n=12) received chow diet and normal tap water. The murine model of HFpEF was validated using the non-invasive transthoracic echocardiography and invasive pressure-volume (PV) loop analyses, which exhibited diastolic dysfunction as well as cardiac hypertrophy. To evaluate the effects of Ang-(1-7) on HFpEF, animals were administered with either saline (n=12) or Ang-(1-7) (n=12) (24 μg/kg/day) for four weeks. Ang-(1-7) treatment improved diastolic function by reducing LVEDP (Ctrl: 8.267±1.254; HFD+L-NAME: 17.64±1.925; Ang-(1-7): 9.100±1.578) and Tau value (Ctrl: 7.365±0.5752; HFD+L-NAME: 9.224±0.3569; Ang-(1-7): 7.381±0.3041). Furthermore, Ang-(1-7) reduced cardiac hypertrophy by reducing the phosphorylation level of MAPK ERK 1/2 (Ctrl: 0.9074±0.1088; HFD+L-NAME: 1.212±0.1369; Ang-(1-7): 0.5615±0.1502) and increasing the phosphorylation level of AMPK (Ctrl: 0.1502±0.1502; HFD+L-NAME: 0.6127±0.06414; Ang-(1-7): 0.7852±0.1006). Ang-(1-7) treatment also reduces cardiomyocytes’ size and decreases interstitial fibrosis, as indicated by WGA and PSR staining. Conclusion: Ang-(1-7) treatment attenuated the development of HFD+L-NAME-induced HFpEF, reduced cardiac hypertrophy, and improved metabolic function.

Abstract 420: Characterization of Dahl Salt-Sensitive Rat Model for Heart Failure with Preserved Ejection Fraction Research: Defining Diagnostic Criteria

Hypertension ◽  
2014 ◽  
Vol 64 (suppl_1) ◽  
Author(s):  
Natale Rolim ◽  
Jose B Moreira ◽  
Alessandra Medeiros ◽  
Marcia Alves ◽  
Xiaojuan Yang ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Diagnostic Criteria ◽  
Diastolic Pressure ◽  
Control Group ◽  
Chronic Hypertension ◽  
Preserved Ejection Fraction ◽  
Cross Sectional ◽  
Criteria For Diagnosis ◽  
Novel Therapeutic Strategies

Heart failure with preserved ejection fraction (HFpEF) is a condition that accounts for approximately 50 % of heart failure cases with the prevalence increased with advancing age. As of now, no effective treatment is available for HFpEF, which calls for continued efforts towards novel therapies. Dahl salt-sensitive (Dahl SS) rats have recently been reported as an experimental model of HFpEF, although a specific diagnostic criteria for HFpEF is still unclear in rodents. We aimed to provide clear criteria to identify HFpEF in Dahl SS rats. After a follow-up of 28 weeks, adult female Dahl SS rats receiving high salt (HS, 8 % NaCl) diet developed chronic hypertension (209 ± 80 vs. 147 ± 55 mm Hg; P <0.05 vs. low salt-fed control group (LS, 0.3 % NaCl) with consistent left ventricle (LV) remodeling compared to LS rats (LV hypertrophy index: 2.62 ± 0.07 vs. 1.79 ± 0.03 mg/mm, and cardiomyocyte cross-sectional area: 497 ± 38.9 vs. 290 ± 8.15 μm 2 , respectively; P < 0.05) and EF > 50 % (67.7 ± 1.5 %). Evidence that HS rats have developed HFpEF was observed only in rats with left atrial dimension (LAD)/body weight (BW), E/A, and E/E’ ratios above the 75 th percentile of the LS group (17.50 mm/kg, 1.53, and 14.25, respectively). In addition, HS rats diagnosed with HFpEF had increased LV end-diastolic pressure and plasma NT-proBNP compared to LS rats (12.8 ± 3.4 vs. 5.8 ± 0.8 mm Hg, and 78.7 ± 18.0 vs. 17.7 ± 3.5 pg/mL, respectively; P < 0.05), while no significant changes in LAD/BW, E/A, E/E’, and plasma NT-proBNP were demonstrated in HS rats not matching the suggested criteria for HFpEF. Distance run was not different between HS and LS groups. Survival rate was 39.9 % in HS compared to 94.7 % in LS rats ( P = 0.0001), with stroke as the main cause of death (69.6 % incidence in HS rats). These results provide the first clear criteria for diagnosis of HFpEF in Dahl SS rats. Our findings have important implications for future preclinical studies aiming to develop novel therapeutic strategies targeting diastolic dysfunction in HFpEF.

scholarly journals Profile of sleep disordered breathing in heart failure with preserved ejection fraction

2020 ◽  
Vol 90 (4) ◽  
Author(s):  
Nitesh Gupta ◽  
Sumita Agrawal ◽  
Akhil D. Goel ◽  
Pranav Ish ◽  
Shibdas Chakrabarti ◽  
...  
Keyword(s):  
Heart Failure ◽  
Sleep Apnea ◽  
Ejection Fraction ◽  
Diastolic Dysfunction ◽  
Sleep Disordered Breathing ◽  
Control Group ◽  
Preserved Ejection Fraction ◽  
Control Subjects ◽  
Obstructive Sleep ◽  
Disordered Breathing

Heart failure (HF) with preserved ejection fraction (HFpEF) represents nearly half of HF cases and is increasingly being recognized as a cause of morbidity and mortality. Hypertension (essential or secondary) is an important risk factor of HFpEF, owing to permanent structural changes in heart. A common cause of secondary hypertension is obstructive sleep apnea (OSA). In the present study, we have attempted to seek the frequency and characteristics of sleep disordered breathing (SDB) in HFpEF. Also, we tried to investigate if any correlation exists between the severity of SDB and the severity of diastolic dysfunction. This was a prospective, cross-sectional, case-control study in which 25 case patients with HFpEF and 25 control subjects were included. All the case patients and control subjects went through a detailed clinical, biochemical, echocardiography evaluation and overnight polysomnography. SDB was seen in 64% of the case patients having HFpEF and in 12% of control group with [odds ratio (OR)= 12.2, 95% confidence interval (CI) = 2.83-52.74; p<0.001]. A significant correlation of apnea-hypopnea index (AHI) severity was observed with degree of diastolic dysfunction (r = 0.67; p<0.001). Among HFpEF patients with SDB (16/25), 13 had OSA and only 3 had central sleep apnea (CSA). CSA was present in patients with severe diastolic dysfunction. There were no clinical or sleep quality differences among the OSA and the CSA group. To conclude, a higher frequency of SDB is observed in HFpEF patients. AHI severity correlates with degree of diastolic dysfunction. The underlying mechanisms of correlation between SDB and diastolic dysfunction either through uncontrolled hypertension or direct causation warrant further evaluation. 

scholarly journals Influence of polypharmacy on patients with heart failure with preserved ejection fraction: a retrospective analysis on adverse outcomes in the TOPCAT trial

2020 ◽  
Vol 71 (702) ◽  
pp. e62-e70
Author(s):  
Yuzhong Wu ◽  
Wengen Zhu ◽  
Xin He ◽  
Ruicong Xue ◽  
Weihao Liang ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Retrospective Analysis ◽  
Heart Function ◽  
Left Ventricular ◽  
Adverse Outcomes ◽  
Left Ventricular Ejection ◽  
Controlled Study ◽  
Preserved Ejection Fraction ◽  
Ventricular Ejection Fraction

BackgroundPolypharmacy is common in heart failure (HF), whereas its effect on adverse outcomes in patients with HF with preserved ejection fraction (HFpEF) is unclear.AimTo evaluate the prevalence, prognostic impacts, and predictors of polypharmacy in HFpEF patients.Design and settingA retrospective analysis performed on patients in the Americas region (including the US, Canada, Argentina, and Brazil) with symptomatic HF and a left ventricular ejection fraction ≥45% in the TOPCAT (Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist) trial, an international, randomised, double-blind, placebo-controlled study conducted during 2006–2013 in six countries.MethodPatients were categorised into four groups: controls (<5 medications), polypharmacy (5–9 medications), hyperpolypharmacy, (10–14 medications), and super hyperpolypharmacy (≥15 medications). The outcomes and predictors in all groups were assessed.ResultsOf 1761 participants, the median age was 72 years; 37.5% were polypharmacy, 35.9% were hyperpolypharmacy, and 19.6% were super hyperpolypharmacy, leaving 7.0% having a low medication burden. In multivariable regression models, three experimental groups with a high medication burden were all associated with a reduction in all-cause death, but increased risks of HF hospitalisation and all-cause hospitalisation. Furthermore, several comorbidities (dyslipidemia, thyroid diseases, diabetes mellitus, and chronic obstructive pulmonary disease), a history of angina pectoris, diastolic blood pressure <80 mmHg, and worse heart function (the New York Heart Association functional classification level III and IV) at baseline were independently associated with a high medication burden among patients with HFpEF.ConclusionA high prevalence of high medication burden at baseline was reported in patients with HFpEF. The high medication burden might increase the risk of hospital readmission, but not the mortality.

P3538Effect of beta-blockers on mortality in heart failure with mid-range and preserved ejection fraction: a meta-analysis

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
H Fukuta ◽  
N Ohte
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Beta Blockers ◽  
Meta Analysis ◽  
Small Sample ◽  
Control Group ◽  
Forest Plot ◽  
Preserved Ejection Fraction ◽  
Risk Of Mortality ◽  
Reduced Risk

Abstract Background Despite the high mortality rate, there is no established therapy to improve survival in heart failure with mid-range ejection fraction (HFmrEF) or in heart failure with preserved ejection fraction (HFpEF). An individual patient-level analysis of major randomized controlled trials (RCTs) conducted by the Beta-Blockers in Heart Failure Collaborative Group (BB-HF) did not show clear mortality benefit of beta-blockers (BBs) in HFmrEF or HFpEF. However, due to the strict enrollment criteria, the patients who participated in these trials might represent a selected group of patients that is poorly representative of patients treated in routine clinical practice. In contrast, clinical characteristics of real-world patients are similar to those of patients enrolled in observational cohort studies (OCSs). Although many OCSs have examined the prognostic effect of BBs in HFmrEF/HFpEF, results are inconsistent due to limited power with small sample sizes and/or inadequate adjustment for known prognostic factors. Purpose We aimed to conduct a meta-analysis of OCSs and RCTs to determine the effect of BBs on mortality in HFmrEF/HFpEF. Methods A search of MEDLINE and EMBASE was conducted in November 2018. Clinical studies reporting the outcome of mortality for HF patients with EF≥0.40, being assigned to BB treatment and non-BB control group, were included. Results Seven OCSs with propensity score (PS) analysis (16,295 patients), 6OCSs without PS analysis (15,275 patients), and 4RCTs (1222 patients) were included for this meta-analysis. Forest plot of the effect of BBs on mortality is shown in Figure 1. Use of BBs was associated with reduced risk of mortality in the pooled analysis of OCSs with PS analysis (RR [95% CI] = 0.83 [0.74–0.92], P<0.001) and in that of OCSs without PS analysis (0.70 [0.52–0.94], P<0.05), but not in that of RCTs (0.88 [0.62–1.24], P=0.45). Overall, use of BBs was associated with reduced risk of mortality (RR [95% CI] = 0.82 [0.75–0.89], P<0.001). No evidence of publication bias was found either in visual inspection of funnel plots or using the Egger test (P>0.1). Figure 1 Conclusions Our meta-analysis showed that treatment with BBs for the HF patients with EF≥0.40 was associated with reduced risk of mortality. Our findings emphasize the importance of conducting new well-designed studies such as registry-based RCTs to confirm our observed potential survival benefit of BBs in HFmrEF or HFpEF.

Abnormal nailfold videocapillaroscopic findings in heart failure patients with preserved ejection fraction

2020 ◽  
pp. 1-7
Author(s):  
Serkan Yüksel ◽  
Esra Pancar Yüksel ◽  
Murat Meriç
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Control Group ◽  
Preserved Ejection Fraction ◽  
Control Groups ◽  
Nailfold Videocapillaroscopy ◽  
Heart Failure Patients ◽  
Significant Difference ◽  
Patients With Heart Failure ◽  
And Control

BACKGROUND: Microvascular dysfunction is one of the pathophysiological mechanisms in heart failure. Nailfold videocapillaroscopy is a noninvasive technique used to examine the microvasculature. OBJECTIVE: In this study; we aimed to investigate the nailfold capillaroscopic abnormalities in heart failure patients with reduced and preserved ejection fraction and compare those with control group. METHODS: Three groups of patients were recruited for the study: HFrEF group includes the patients with heart failure with reduced ejection fraction (HFrEF), HFpEF group, patients with heart failure with preserved ejection fraction (HFpEF) and control group, healthy asymptomatic individuals. Nailfold videocapillaroscopy was performed with a videodermatoscope and all nailfold images were evaluated for enlargement and hemorrhages. RESULTS: Abnormal videocapillaroscopic findings including enlargement and/or hemorrhages were present in 7 (24%) patients in HFrEF group, 19 (66%) patients in HFpEF group and 11 (37%) in control group. The number of patients with abnormal videocapillaroscopic findings were significantly greater in HFpEF group compared to HFrEF (p <  0.05) and control groups (p <  0.05). However, no significant difference was observed in videocapillaroscopic findings between HFrEF and control groups. CONCLUSIONS: Our study showed that microvascular abnormalities demonstrated by videodermatoscopic examination of nailfold capillaries are considerably more common in HFpEF patients compared to HFrEF and control groups.

scholarly journals Heart failure: the influence of different types on the main arteries kinetics

2021 ◽  
Vol 10 (Supplement_1) ◽  
Author(s):  
O Germanova ◽  
G Galati ◽  
YV Shchukin ◽  
AV Germanov ◽  
VA Germanov ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Clinical Manifestations ◽  
Renal Arteries ◽  
Blood Analysis ◽  
Control Group ◽  
Preserved Ejection Fraction ◽  
Group I ◽  
Patients With Heart Failure ◽  
Group Ii

Abstract Funding Acknowledgements Type of funding sources: None. Nowadays the term "heart-vessels failure" does not exist. Aim. To study the kinetics and hemodynamics of arteries in the patients with heart failure with different ejection fraction. Materials and methods. In our investigation we included 74 patients with heart failure with preserved ejection fraction more than 55% (44 were men and 30 women). Mediana age – 71,3 years old. In the control group we included 52 practically healthy people without cardiac and vessels pathologies.  We divided patients into two groups (I and II) in accordance to the presence of clinical manifestations of heart failure in them. Group I - with clinical symptoms of heart failure (32), group II –without heart failure symptoms (42).  We paid attention to the symptoms of  heart failure, myocardial infarction, cardiomyopathies, valves defects, operations on heart in anamnesis. We performed 24-hours ECG monitoring, general blood analysis, biochemical blood analysis (lipids, electrolytes, urine, creatinine, bilirubin, potassium, glucose, NT-proBNP),  transthoracic echocardiography, ultrasound doppler of brachiocephalic arteries, abdominal aorta branches, lower extremities arteries, renal arteries, chest radiography, ultrasound investigation of B-lines. If prescribed we performed stress echocardiography, transesophageal echocardiography, coronary angiography, renal arteries angiography, pancerebral angiography, magnet tomography of heart. All patients were registered sphygmography of main arteries: a.carotis communis, ulnaris, radialis, a.tibialis posterior. We analyzed the regular contractions in each type of arteries. The main parameters main arteries kinetics using sphygmography we calculated in automatic mode: speed, acceleration, power, work in period of prevalence of inflow over outflow and in period of  prevalence of outflow over inflow.  Results. We analysed the main parameters of arteries kinetics and hemodynamics in each group of patients as well as in control group. We observed the effects: 1)In group II the parameters of arteries kinetics were higher than in group I. It indicates the active propulsive work of arteries in spreading the stroke volume of the heart. 2)In group I the parameters of arteries kinetics were lower than in control group. It indicates that propulsive function of the arteries is reduced in patients with heart failure. Conclusion. Arterial vessels are active, full-fledged participant in cardiovascular system. Vessels make an active work in blood movement from the heart to the distal parts and tissues. The clinical manifestations of heart failure are determined not only the heart function but also the function of arteries that is needed to be examined. In patients with preserved ejection fraction we can observe the symptoms of heart failure, the function abilities of arteries are reduced. The term "heart-vessels failure" should be used and applied not only to the heart but also to the arteries function in their coupling with heart. Abstract Figure.

scholarly journals Hyponatremia at discharge is associated with adverse prognosis in acute heart failure syndromes with preserved ejection fraction: a report from the JASPER registry

2019 ◽  
Vol 8 (7) ◽  
pp. 623-633 ◽  
Author(s):  
Yu Sato ◽  
Akiomi Yoshihisa ◽  
Masayoshi Oikawa ◽  
Toshiyuki Nagai ◽  
Tsutomu Yoshikawa ◽  
...  
Keyword(s):  
Heart Failure ◽  
Confidence Interval ◽  
Ejection Fraction ◽  
Left Ventricular ◽  
Hazard Ratio ◽  
Left Ventricular Ejection ◽  
Control Group ◽  
Preserved Ejection Fraction ◽  
Primary Endpoints ◽  
Patients With Heart Failure

Introduction: Hyponatremia predicts adverse prognosis in patients with heart failure in particular with reduced ejection fraction. In contrast, it has recently been reported that hyponatremia on admission is not a predictor of post-discharge mortality in patients with heart failure with preserved ejection fraction. We investigated the prognostic impact of hyponatremia at discharge in patients with heart failure with preserved ejection fraction and its clinical characteristics. Methods and results: The Japanese Heart Failure Syndrome with Preserved Ejection Fraction (JASPER) registry is a nationwide, observational, prospective registration of consecutive Japanese patients hospitalised with heart failure with preserved ejection fraction and left ventricular ejection fraction of 50% or greater. Five hundred consecutive patients were enrolled in this analysis. We divided the patients into two groups based on their sodium serum levels at discharge: hyponatremia group (sodium <135 mEq/L, n=50, 10.0%) and control group (sodium ⩾135 mEq/L, n=450, 90.0%). This present analysis had two primary endpoints: all-cause death and all-cause death or rehospitalisation for heart failure. At discharge, the hyponatremia group had lower systolic blood pressure (110.0 mmHg vs. 114.5 mmHg, P=0.014) and higher levels of urea nitrogen (31.9 mg/dL vs. 24.2 mg/dL, P=0.032). In the Kaplan–Meier analysis, more patients in the hyponatremia group reached the primary endpoints than those in the control group (log rank <0.01, respectively). In the Cox proportional hazard analysis, hyponatremia at discharge was a predictor of the two endpoints (all-cause death, hazard ratio 2.708, 95% confidence interval 1.557–4.708, P<0.001; all-cause death or rehospitalisation for heart failure, hazard ratio 1.829, 95% confidence interval 1.203–2.780, P=0.005). Conclusions: Hyponatremia at discharge is associated with adverse prognosis in hospitalised patients with heart failure with preserved ejection fraction.

scholarly journals Endocardial Endothelial Dysfunction and Unknown Polymorphic Composite Accumulation in Heart Failure

Biomedicines ◽  
2021 ◽  
Vol 9 (10) ◽  
pp. 1465
Author(s):  
Hsuan-Fu Kuo ◽  
I-Fan Liu ◽  
Chia-Yang Li ◽  
Chien-Sung Tsai ◽  
Yung-Hsiang Chen ◽  
...  
Keyword(s):  
Heart Failure ◽  
Heart Function ◽  
Artery Bypass ◽  
Bypass Graft ◽  
The Other ◽  
Control Group ◽  
Sprague Dawley ◽  
Artery Ligation ◽  
Sprague Dawley Rats ◽  
Composite Deposition

The accumulation of unknown polymorphic composites in the endocardium damages the endocardial endothelium (EE). However, the composition and role of unknown polymorphic composites in heart failure (HF) progression remain unclear. Here, we aimed to explore composite deposition during endocardium damage and HF progression. Adult male Sprague–Dawley rats were divided into two HF groups—angiotensin II-induced HF and left anterior descending artery ligation-induced HF. Heart tissues from patients who had undergone coronary artery bypass graft surgery (non-HF) and those with dilated cardiomyopathy (DCM) and ischemic cardiomyopathy (ICM) were collected. EE damage, polymorphic unknown composite accumulation, and elements in deposits were examined. HF progression reduced the expression of CD31 in the endocardium, impaired endocardial integrity, and exposed the myofibrils and mitochondria. The damaged endocardial surface showed the accumulation of unknown polymorphic composites. In the animal HF model, especially HF caused by myocardial infarction, the weight and atomic percentages of O, Na, and N in the deposited composites were significantly higher than those of the other groups. The deposited composites in the human HF heart section (DCM) had a significantly higher percentage of Na and S than the other groups, whereas the percentage of C and Na in the DCM and ICM groups was significantly higher than those of the control group. HF causes widespread EE dysfunction, and EndMT was accompanied by polymorphic composites of different shapes and elemental compositions, which further damage and deteriorate heart function.

scholarly journals The method for prediction of high-grade premature ventricular contractions in patients with heart failure and preserved ejection fraction

Kardiologiia ◽  
2020 ◽  
Vol 60 (4) ◽  
pp. 70-76
Author(s):  
T. V. Konovalova ◽  
N. B. Perepech
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Prognostic Model ◽  
Clinical Signs ◽  
Holter Monitoring ◽  
Volume Index ◽  
Control Group ◽  
High Grade ◽  
Preserved Ejection Fraction ◽  
Premature Ventricular Contractions

Aim To develop a method for prediction of high-grade ventricular extrasystole (VE) in patients with chronic heart failure with preserved ejection fraction (CHF-PEF) based on results of an echocardiography (EchoCG) study.Material and methods At the first step, the study included 121 patients of the Cardiology Department, Municipal Clinical Hospital #31, St. Petersburg (calculation group) with symptoms and clinical signs of CHF-PEF (median age, 62 years). For testing accuracy of the developed formula, a control group was formed, which consisted of 42 patients with CHF-PEF (median age, 59 years). EchoCG at rest and ECG Holter monitoring were performed for all patient. The VE classification according to B. Lown and M. Wolf (1971) in the M. Ryan (1975) modification was used. Results of the evaluation were determined by the most significant recorded grade. Grade III or higher VE were considered as high-grade VE.Results Using logistic regression analysis of data for patients of the calculation group, a statistical model was constructed and a respective formula was developed to predict a probability of high-grade VE in CHF-PEF patients depending on the presence of risk factors (EchoCG criteria). According to the obtained data the following factors primarily contributed to the model: interventricular septal (IVS) thickness (p=0.007; Wald=7.44), end-diastolic volume index (EDVI) (p=0.044; Wald=4.13), and the degree of diastolic dysfunction (DD) (p<0.0001; Wald=19.90). For testing the formula accuracy, the analysis was performed in the control group. Based on data of both stages, the following values were obtained: for the calculation group, the method sensitivity was 77.8 %, the specificity was 82.4 %, the accuracy was 81.0 %; for the control group, 81.8 %, 70 %, and 76.2 %, respectively; for both groups together, 79.3 %, 80.0 %, and 79.8 %, respectively. In ROC-analysis of this prognostic model, the area under the ROC-curve (AUC) was 0.852 (95 % CI: 0.776–0.910; p<0.0001) for the calculation group; 0.818 (95 % CI: 0.669–0.920; p<0.0001) for the control group; and 0.855 (95 % CI: 0.792–0.905; p<0.0001) for both groups together, which indicated a good quality of the prognostic model.Conclusion The EchoCG predictors of high-grade VE in patients with CHF-PEF included degree of DD, EDVI, and IVS thickness. The developed method with the constructed formula for prediction of high-grade VE in CHF-PEF patients showed high sensitivity, specificity and accuracy.

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