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Value of combined cardiopulmonary and echocardiography stress test to characterize the haemodynamic and metabolic responses of patients with heart failure and mid-range ejection fraction
No full textAims
To characterize heart failure (HF) with mid-range ejection fraction (HFmrEF), combining cardiopulmonary exercise test, and exercise stress echocardiography.
Methods and results
We studied 169 consecutive subjects (age 62.3 ± 11 years; 74% male): 30 healthy controls, 45 patients with HF and preserved EF (HFpEF), 40 HFmrEF, and 54 with HF and reduced EF (HFrEF). Left ventricular (LV) stroke volume (SV), EF, elastance, global longitudinal strain, E/E’, oxygen consumption (VO2), and arterial-venous oxygen content difference (AVO2diff) were measured in all exercise stages. HFmrEF revealed baseline features intermediate between HFrEF and HFpEF, except for B-type natriuretic peptide levels, which was similar to HFpEF and significantly lower than HFrEF. Peak VO2 was not significantly different between HF groups. HFrEF exhibited a significantly lower peak SV as compared to either HFpEF or HFmrEF (74.3 ± 21.8 mL vs. 88.0 ± 17.4 mL and 96.5 ± 25.1 mL; P < 0.01), whereas peak heart rate was not significantly different between HF groups. A significantly reduced AVO2diff at peak exercise was apparent in HFpEF and HFmrEF (15.2 ± 3.3 mL/dL and 13.3 ± 4.2 mL/dL) vs. HFrEF (17.±6.6 mL/dL; P < 0.01), whereas no significant difference was reported between HFpEF and HFmrEF. Multivariate analysis in the overall population and all groups revealed peak parameters as independent predictors of peak VO2 (R2 = 0.90, P < 0.0001); AVO2diff showed the largest standardized regression coefficient.
Conclusion
In HFpEF and HFmrEF, effort intolerance is predominantly due to peripheral factors (AVO2diff), whereas in HFrEF peak VO2 is restricted by low increases in SV. Individual therapy according to which component of VO2 is more impaired is advisable
Translational cardiovascular imaging: A new integrated approach to target myocardial fibrosis turnover in different forms of cardiac remodeling
Full text linkDramatic loss of weight in an obese patient with heart failure: a mighty heart in a big man
No full textAbstract
Obesity has reached global epidemic proportions and has been associated with numerous comor-
bidities, including major cardiovascular diseases and heart failure. It has many adverse effects on hemodynamics and cardiovascular structure and function; it increases total blood volume and cardiac output, and also activates several neurohumoral systems that play an important role in causing cardiac dysfunction. Typically, obese patients have a higher cardiac output but a lower level of total peripheral resistance at any given level of arterial pressure. Over the past few years, experimental evidence has unraveled some important pathogenetic mechanisms that may underlie a specifi c form of “obesity cardiomyopathy”. However, many unanswered questions remain regarding the pathophysiological interactions between obesity and the heart. L Heart Metab; 2013;61
Professional education, training and role of the cardiac sonographer in different countries
No full text
Incremental value of left ventricular capacitance in predicting outcome in patients undergoing to percutaneous aortic valve implantation
No full textIncremental value of left ventricular capacitance in predicting outcome in patients undergoing to percutaneous aortic valve implantationPurpose: To evaluate the incremental value of Left Ventricular Capacitance in predicting outcome of patients undergoing to Percutaneous Aortic Valve Implantation (TAVI) using a partial non-invasive approach.
Methods: We retrospectively evaluated 160 patients (Age 82±5 years; Female 60%) with severe symptomatic aortic valve stenosis (AVAi50%) at high surgical risk (Log Euroscore 17,1±8,7%) who performed TAVI procedure with Corevalve Prosthesis. Single beat method for estimation of left ventricular end diastolic pressure volume relationship (EDPVR) was used to characterize diastolic properties of LV, on the basis of the premise that volume normalized EDPVRs share a common shape (LVEDP= α x EDVβ). LVEDP was estimated invasively, before TAVI. LVEDV was evaluated non invasively by 2D echocardiography. Derived α and β indices were used to predict EDV at LVEDP 20 mmHg (EDV20). Qualitative angiographic method to grade paravalvular leak (PVL) was used according to the VARC-2 criteria. The primary end point of the study was one year death from any causes. Secondary end-point was one year death from cardiovascular causes after TAVI.
Results: After TAVI, a prosthetic regurgitation (PVL) was observed in 128 patients (80%). Moderate regurgitation was observed in 30 patients (18,7%) and severe in 4 patients (2,5%). During 1 year follow-up the primary end point (all cause mortality) was reached in 19 patients (11.8%). The secondary end point (cardiovascular mortality) occurred in 13 patients (8.1%). On Univariate Cox regression analysis several parameters were significantly associated to all cause mortality but on multivariate analysis we identified only moderate/severe PVL (HR 5, CI 2,1 to 12,5, p=0,0004), NYHA functional class (HR 2,5, CI 1,2 to 5,5, p=0,015) and EDV20 (HR 0,95, CI 0,94 to 0,99, p=0,009) as independent risk factors for all cause mortality. EDV20 and moderate/severe PVL were also associated with Cardiovascular Mortality (Multiple Cox regression: PVL HR 5,6 IC 95% 2 to 16; p=0,0015; EDV20 HR 0,96 IC95% 0,93 to 0,99; p=0,02).
Conclusions: Paravalvular aortic regurgitation (PVL) after TAVI adversely affects outcome of patients. Diastolic left ventricular properties play a pivotal role in determining the response of left ventricle to the changes in haemodynamic conditions. A severely reduced left ventricular compliance is a strong independent predictor of adverse events. Partial non invasive estimation of left ventricular diastolic properties is an useful tool in predicting the outcome and in risk stratification after TAVI
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