615 research outputs found
Non-invasive imaging in acute decompensated heart failure with preserved ejection fraction
No full textNon-invasive imaging plays an increasingly important role in emergency medicine, given the trend towards smaller, portable ultrasound devices, the integration of ultrasound imaging across diverse medical disciplines, and the growing evidence supporting its clinical benefits for the patient. Heart failure with preserved ejection fraction (HFpEF) provides a compelling illustration of the impactful role that imaging plays in distinguishing diverse clinical presentations of heart failure with numerous associated comorbidities, including pulmonary, renal, or hepatic diseases. While a preserved left ventricular ejection fraction might misguide the clinician away from diagnosing cardiac disease, there are several clues provided by cardiac, vascular, and lung ultrasonography, as well as other imaging modalities, to rapidly identify (decompensated) HFpEF. Congestion remains the primary reason why patients with heart failure (irrespective of ejection fraction) seek emergency care. Furthermore, comprehensive phenotyping is becoming increasingly important, considering the development of targeted treatments for conditions exhibiting HFpEF physiology, such as cardiac amyloidosis. Timely recognition in such cases has lasting implications for long-term outcomes.Funding
Sebastiaan Dhont is supported as predoctoral fundamental research fellow by the Fund for Scientific Research Flanders (FWO 11PGA24N)
Mitral and/or tricuspid regurgitation in patients undergoing TAVR: two's company, three's a crowd?
No full textS.D. was supported as pre-doctoral fundamental research fellow by the Fund for Scientific Research Flanders (FWO 11PGA24N)
Empagliflozin in heart failure with preserved ejection fraction: from randomized trials to real-world evidence
No full textBackground : The EMPEROR-Preserved clinical trial established empagliflozin as an effective therapy in heart failure with preserved ejection fraction (HFpEF), yet real-world validation in elderly, comorbid populations remain limited. We aimed to evaluate the clinical profile, tolerability, and outcomes of empagliflozin in a large Belgian HFpEF cohort. Methods : This retrospective, single-centre observational study of consecutive HFpEF patients (LVEF >50%) initiated on empagliflozin (10 mg daily) between April 2023 and April 2024. Baseline characteristics, clinical parameters, laboratory values, and outcomes were collected from electronic health records. Results : Of 798 screened patients, 577 were included (median age 82 years, 58% female). Atrial fibrillation (67%) and hypertension (78%) were highly prevalent. Empagliflozin use was associated with significant improvements in NYHA functional class (NYHA II: 56% to 77%, p < 0.001) and reduction in peripheral oedema (26% to 9%, p < 0.001). Modest reductions were observed in systolic blood pressure (131 to 130 mmHg, p = 0.017), heart rate (71 to 68 bpm, p = 0.004), body weight (76 to 75 kg, p < 0.001), and BMI (27.7 to 27.2 kg/m2, p < 0.001). Haemoglobin levels increased (p = 0.002), while renal function declined modestly without clinical sequelae. Treatment discontinuation occurred in 2.8% of patients, mainly due to genitourinary infections. During a median follow-up period of 16 months, the all-cause mortality rate was 6.9%. Conclusion : In real-world elderly and comorbid HFpEF population, empagliflozin was well tolerated and associated with improvements in congestion and functional status, supporting the external validity of randomised trial findings.Funding
Sebastiaan Dhont is supported as predoctoral fundamental research fellow by the Fund for Scientific Research Flanders (FWO 11PGA24N)
Sodium loading in ambulatory patients with heart failure with reduced ejection fraction: Mechanistic insights into sodium handling
No full textAims Sodium restriction was not associated with improved outcomes in heart failure patients in recent trials. The skin might act as a sodium buffer, potentially explaining tolerance to fluctuations in sodium intake without volume overload, but this is insufficiently understood. Therefore, we studied the handling of an increased sodium load in patients with heart failure with reduced ejection fraction (HFrEF).Methods and results Twenty-one ambulatory, stable HFrEF patients and 10 healthy controls underwent a 2-week run-in phase, followed by a 4-week period of daily 1.2 g (51 mmol) sodium intake increment. Clinical, echocardiographic, 24-h urine collection, and bioelectrical impedance data were collected every 2 weeks. Blood volume, skin sodium content, and skin glycosaminoglycan content were assessed before and after sodium loading. Sodium loading did not significantly affect weight, blood pressure, congestion score, N-terminal pro-brain natriuretic peptide, echocardiographic indices of congestion, or total body water in HFrEF (all p > 0.09). There was no change in total blood volume (4748 ml vs. 4885 ml; p = 0.327). Natriuresis increased from 150 mmol/24 h to 173 mmol/24 h (p = 0.024), while plasma renin decreased from 286 to 88 mu U/L (p = 0.002). There were no significant changes in skin sodium content, total glycosaminoglycan content, or sulfated glycosaminoglycan content (all p > 0.265). Healthy controls had no change in volume status, but a higher increase in natriuresis without any change in renin.Conclusions Selected HFrEF patients can tolerate sodium loading, with increased renal sodium excretion and decreased neurohormonal activation. [GRAPHICS]Jeroen Dauw, Evelyne Meekers, Sebastiaan Dhont and Wilfried Mullens are researchers for the Limburg Clinical Research Center (LCRC) UHasselt-ZOL-Jessa, supported by the foundation Limburg Sterk Merk (LSM), province of Limburg, Flemish government, Hasselt University, Ziekenhuis Oost-Limburg, and Jessa Hospital
Atrial Functional Mitral Regurgitation: Definition, Mechanisms, and Treatment Perspectives
No full textPurpose of ReviewThis review aims to explore the complex interplay between atrial functional mitral regurgitation (AFMR), atrial fibrillation (AF), and heart failure with preserved ejection fraction (HFpEF). The goal is to define these conditions, examine their underlying mechanisms, and discuss treatment perspectives, particularly addressing diagnostic challenges.Recent FindingsRecent research highlights the rising prevalence of AFMR, now accounting for nearly one-third of significant mitral regurgitation cases. Advances in percutaneous treatment options have improved management for vulnerable HFpEF patients, but long-term outcomes remain unclear, and symptom relief is inconsistent.SummaryAF and HFpEF share the left atrium as a common pathological substrate, with progressive LA remodeling contributing to AFMR. Diagnostic limitations hinder effective symptom management with current mitral valve interventions. Future research should focus on better diagnostic tools to determine the contributions of valvular disease, arrhythmia, or myocardial dysfunction to clinical outcomes, as we currently lack definitive tests to establish this connection.Fund for Scientific Research Flanders [FWO 11PGA24N
Delayed interventricular septum perforation with mitral chordal rupture after left bundle branch area pacing
No full textFund for Scientific Research Flanders [FWO 11PGA24N
Exercise-induced pulmonary hypertension: rationale for correcting pressures for flow and guide to non-invasive diagnosis
No full textExercise-induced pulmonary hypertension (exPHT) is a haemodynamic condition linked to increased morbidity and mortality across various cardiopulmonary diseases. Traditional definitions of exPHT rely on absolute cut-offs, such as mean pulmonary artery pressure (mPAP) above 30 mmHg during exercise. However, recent research suggests that these cut-offs may not accurately reflect pathophysiological changes, leading to false positives and false negatives. Instead, the mPAP over cardiac output (CO) slope, which incorporates both pressure and flow measurements, has emerged as a more reliable indicator. A slope exceeding 3 mmHg/L/min is now considered diagnostic for exPHT and strongly correlates with adverse outcomes. Stress echocardiography serves as a viable alternative to invasive assessment, enabling broader implementation. This review discusses the physiological basis of pulmonary haemodynamics during exercise, the advantages of the mPAP/CO slope over absolute pressure measurements, the evidence supporting its inclusion in clinical guidelines, and provides a practical guide for non-invasive determining the mPAP/CO slope in clinical practice. Graphical Abstract The rationale for correcting pressures for flow. CO, cardiac output; iCPET, invasive cardiopulmonary exercise testing; mPAP, mean pulmonary arterial pressure; PHT, pulmonary hypertension.Fund for Research Foundation- Flanders (FWO) [11PGA24N
The interaction between atrial fibrillation and mitral regurgitation: Insights from the CABANA randomized clinical trial
No full textAims Atrial fibrillation (AF) and mitral regurgitation (MR) frequently coexist. While catheter ablation is a key rhythm-control strategy in AF, its impact on MR severity remains uncertain. This study evaluates the effects of catheter ablation on AF recurrence, functional status, and MR progression in patients with AF and baseline MR. Methods and results This sub-analysis included 1423 patients (65% of the overall CABANA cohort) with available baseline echocardiography. Participants were randomized to catheter ablation or pharmacological therapy. The primary endpoint was the composite of all-cause mortality and cardiovascular hospitalization. Secondary endpoints included AF recurrence, changes in MR severity, and functional status. At baseline, 722 patients (52%) had MR, including 582 with mild and 140 with >= moderate MR, with characteristics suggestive of an atrial functional mechanism. Catheter ablation significantly reduced AF recurrence compared to pharmacological therapy (odds ratio [OR] 0.56, 95% confidence interval [CI] 0.50-0.62, p < 0.001). The presence or absence of MR did not interact with randomization in terms of its neutral effect on all-cause mortality and cardiovascular hospitalization (p for interaction = 0.115). Baseline MR increased the risk of AF recurrence (OR 1.46, 95% CI 1.40-1.74, p < 0.001). However, the benefit of ablation on functional status was greater in patients with MR compared to those without (p for interaction < 0.001). Follow-up echocardiography (n = 248) showed a greater reduction in MR severity in the ablation group versus drug therapy (p for interaction = 0.040). Conclusion Catheter ablation was superior to pharmacological therapy in rhythm control and may reduce MR severity over time. These findings highlight ablation's potential structural and symptomatic benefits, pending specifically designed clinical trials.Sebastiaan Dhont is supported as predoctoral fundamental research fellow by the Fund for Scientific Research Flanders (FWO 11PGA24N). The Biologic Specimen and Data Repository Information Coordinating Center (BioLINCC) is funded by the National Institutes of Health. Conflict of interest: W.H.W.T. is a consultant for Sequana Medical, Cardiol Therapeutics Inc, Genomics plc, Zehna Therapeutics, Boston Scientific, WhiteSwell, Intellia Therapeutics, CardiaTec Biosciences, Bristol Myers Squibb, Alleviant Medical, Alexion Pharmaceuticals, Salubris Biotherapeutics, BioCardia Inc, and has received honorarium from Springer, Belvoir Media Group, and American Board of Internal Medicine. All other authors have nothing to disclose
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