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1
Mbasu, Richard Juma. "Distinguishing heart failure with preserved ejection fraction from heart failure with reduced ejection fraction using proteomics techniques." Thesis, University of Leicester, 2016. http://hdl.handle.net/2381/39013.
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Heart failure is the second leading cause of morbidity and mortality in the world after cancer. In the UK, over 500,000 people are living with heart failure of which 30-40% die within 1 year of diagnosis. Some biomarkers for diagnosis and prognosis of heart failure have been established. However, they suffer from poor levels of accuracy and efficacy and their roles in clinical use is poorly understood. Thus, new biomarkers are needed. In this research, mass spectrometry based proteomics was used to profile patients plasma for clinical biomarker discovery due to its ability to perform both quantitative and qualitative protein profiling on clinical samples. Ninety samples from control, heart failure with preserved ejection fraction and heart failure with reduced ejection fraction subjects were used. Plasma protein profiling was performed using an optimised UPLC-IMS-DIA-MSE label free quantitation method. Bioinformatics analysis was used to analyse the changes observed in the protein profiles to identify potential biomarkers of heart failure. A novel method, termed mixed mode matrix was used for pilot study prior to main study with lipid removal agent. Samples were analysed using Waters Synapt G2S HDMS QToF mass spectrometer in triplicate on positive mode electrospray ionisation. Statistical comparisons of protein profiles was carried out using Progenesis LC-MS prior to data mining using SPSS, RapidMiner and SIMCA 14 to identify potential biomarkers. Thirty proteins were identified as potential biomarkers and shown to be involved in various pathophysiological processes leading to heart failure. ASL which plays role in nitrogen oxide production in the epithelium was upregulated in heart failure cohort. Conversely, GPX3 which scavenges free radicals in blood preventing apoptosis and necrosis of cells was downregulated in heart failure cohort. These two proteins were proposed as potential biomarkers for heart failure with preserved ejection fraction. Future studies to validate these biomarkers with the developed targeted LC-MS based MRM assay is needed.
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Phan, Thanh Trung. "The pathophysiology of heart failure with preserved ejection fraction." Thesis, University of Birmingham, 2010. http://etheses.bham.ac.uk//id/eprint/828/.
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Our studies demonstrate that patients with HfpEF have impaired myocardial energetics as indicated by the diminished in vivo myocardial PCr/ATP ratio. Data acquired during semi-supine cycling exercise indicates that patients with HfpEF had a dynamic impairment of LV active relaxation. In addition, ventricular-vascular coupling ratio was unchanged during exercise in HfpEF patients in contrast to healthy controls where the ratio fell substantially during exercise. In addition, we found patients with HfpEF with normal LA dimensions had increased LA contribution during exercise as compared to controls. Furthermore, we showed patients with HfpEF exhibited contractile inefficiency as well as systolic and diastolic dyssynchrony as measured by speckle tracking imaging (STI). And that the LV anterior wall appears to be the most delayed segment. We also demonstrated that HfpEF patients exhibited chronotropic incompetence during peak exercise testing and abnormal HR recovery following exercise compared to age-gender-matched healthy controls and hypertensive patients. In a separate study, we showed that changes in LV torsion, untwist and LV strain and strain rate in patients with HfpEF at rest were similar to changes found in normal aging.
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Patel, Hitesh Chandrakant. "Renal denervation in heart failure with preserved ejection fraction." Thesis, Imperial College London, 2016. http://hdl.handle.net/10044/1/42993.
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There are no treatments proven to significantly reduce heart failure hospitalisations or mortality in patients with heart failure with preserved ejection fraction (HFpEF). Activity of the sympathetic nervous system (SNS) is elevated in heart failure regardless of ejection fraction and may be an important target in HFpEF. Renal denervation (RDT) is a percutaneous technique that seeks to attenuate SNS activity. The aim of this thesis was to investigate the role of RDT in patients with HFpEF. A randomised (2:1) open-controlled trial with blinded endpoint analysis was planned. 10 228 patients were screened for the Renal DenervaTion in heart failure with Preserved Ejection Fraction trial (RDT-PEF), and ultimately 25 were randomised (17 received RDT and 8 were allocated to the open control arm). The primary endpoint was an improvement in a minimum of three out of the following six surrogate endpoints: Minnesota Living with Heart Failure questionnaire score, peak oxygen uptake on exercise, B-type natriuretic peptide, E/e' from echocardiography, left atrial volume from cardiac magnetic resonance imaging (CMR) and left ventricular mass from (CMR). The primary endpoint was not met but the study was underpowered. On post-hoc analysis there was an improvement in a composite score of all six endpoint in the RDT arm compared to the control arm at three months but this did not persist to 12 months. The study satisfied its safety endpoints. However, two patients required balloon angioplasty during the RDT procedure for significant renal artery spasm/oedema. RDT had no effect on blood pressure, renal function, vascular function, renin-angiotensin system or SNS activity. In summary, this thesis has shown that HFpEF is not as prevalent as reported. RDT did not improve quality of life, exercise function, biomarkers and left heart remodelling in HFpEF. The procedure was safe though not without complications in patients with HFpEF.
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Wright, Gabriel J. T. "Automated 3D echocardiography analysis : advanced methods and their evaluation on clinical data." Thesis, University of Oxford, 2003. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.275378.
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Ma, Chao [Verfasser]. "Evaluation of mouse models of heart failure with preserved ejection fraction / Chao Ma." Berlin : Medizinische Fakultät Charité - Universitätsmedizin Berlin, 2021. http://d-nb.info/123498489X/34.
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Niebauer, Josef. "Metabolic abnormalities in patients with chronic heart failure : assessment of cytokines, endotoxin, pro-oxidant substrates and exercise training." Thesis, Imperial College London, 1999. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.312600.
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Carlbom, Charlotte. "Measurement of ejection fraction of the left ventricular - A comparison between echocardiography and isotope angiography." Thesis, Uppsala University, Department of Medical Biochemistry and Microbiology, 2008. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-9293.
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Nilsson, Calle. "VO2peak/THV-ratio differ between heart failure patients with preserved ejection fraction and healthy controls." Thesis, Högskolan Kristianstad, Sektionen för lärande och miljö, 2017. http://urn.kb.se/resolve?urn=urn:nbn:se:hkr:diva-17863.
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Heart failure is a term for a group of complex symtoms characterized by reduced heart function. One of these syndromes, referred to as heart failure with preserved ejection fraction (HFpEF), has increased in prevalence compared to other types of heart failures during the recent years. A concern is the difficulty in diagnosing patients with HFpEF, since current tools are considered insufficient. The aim of this thesis was to examine Peak Oxygen Uptake (VO2peak) in relation to Total Heart Volume (THV) among heart failure patients with preserved ejection fraction (HFpEF, EF >40 %) compared to healthy controls. THV was acquired by delineating images acquired using cardiovascular magnetic resonance imaging, while VO2peak was measured in oxygen curves acquired from cardiopulmonary exercise tests. Ratios were calculated by dividing VO2peak with THV. In order to determine if blood hemoglobin concentration (b-Hb) could affect the ratio, ratios were adjusted to b-Hb using an adjusting factor. Mean THV was nearly 250 ml larger in HFpEF patients compared to the controls. Patients’ mean VO2peak was more than 1000 ml lower compared to the controls. Mean VO2peak/THV ratio calculated for the patients were less than half of that calculated for the controls. Adjusting the ratio to b-Hb did not affect the ratios significantly. The study was limited by the size of the test group, but the findings suggest that a VO2peak/THV ratio can be used to separate HFpEF patients from healthy controls.Hjärtsvikt är ett begrepp för en grupp med komplexa symtom och kännetecknas av försämrad hjärtfunktion. Ett av dessa syndrom, hjärtsvikt med bevarad ejektionsfraktion (HFpEF), har ökat i prevalens jämfört med andra varianter av hjärtsvikt under de senaste åren. Ett problem är de svårigheter som finns med att diagnosticera patienter med HFpEF, då nuvarande verktyg inte är tillräckliga. Syftet med detta examensarbete var att undersöka maximalt syreupptag (VO2peak) i förhållande till total hjärtvolym (THV) bland hjärtsviktspatienter med bevarad ejektionsfraktion (HFpEF, EF >40 %) jämfört med friska kontroller. THV erhölls genom att utlinjera bilder tagna med hjälp av magnetisk resonanstomografi, medan VO2peak mättes i syrevolymkurvor som registrerats under ergospirometri-undersökningar. Index beräknades genom att dividera VO2peak med THV. För att undersöka huruvida halten hemoglobin i blodet (b-Hb) kunde påverka index justerades index mot b-Hb med hjälp av en justeringsfaktor. Medel-THV var nästan 250 ml större hos HFpEF-patienter jämfört med kontroller. Medel-VO2peak var mer än 1000 ml lägre hos patienterna jämfört med kontroller. Medel VO2peak/THV-index som beräknats för patienter var mindre än hälften så högt som index beräknat för kontroller. Att justera index mot b-Hb påverkade inte index signifikant. Studien begränsades av mängden deltagare, men fynden indikerar att VO2peak/THV-index kan användas för att skilja HFpEF-patienter från friska kontroller.
9
Kasner, Mario [Verfasser]. "Novel echocardiographic modalities for evaluation of pathophysiology and diagnostic in heart failure with normal ejection fraction / Mario Kasner." Berlin : Medizinische Fakultät Charité - Universitätsmedizin Berlin, 2015. http://d-nb.info/1172077010/34.
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Stoodley, Paul. "Echocardiographic measurement of cardiac function in breast cancer patients treated with anthracycline chemotherapy." Thesis, The University of Sydney, 2014. http://hdl.handle.net/2123/10526.
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Introduction Anthracyclines are the cornerstone of breast cancer chemotherapy, however anthracyclines can be cardiotoxic. Left ventricular (LV) ejection fraction (LVEF) is the key echocardiographic measurement for monitoring cardiotoxicity, although LVEF has limitations. Myocardial strain imaging is new technology that may improve the measurement of cardiac function. The aim of this research was to study strain imaging for potentially earlier detection of dysfunction than LVEF, in breast cancer patients treated with anthracyclines. Method Anthracycline naïve breast cancer patients were prospectively studied; 78 short-term (over 3 months), and 50 in the intermediate-term (over 12 months). Patients were treated with standard anthracycline regimens. Echocardiograms were performed at 4 time points; 1) 7 days before chemotherapy, 2) 7 days after chemotherapy, 3) 6 months after, and 4) 12 months after chemotherapy. Results Global LV longitudinal systolic strain (GLS) was significantly reduced in the short-term (p<0.001), without a clinically significant reduction in LVEF. In the intermediate-term, strain values remained significantly reduced at 6 months (p<0.01), but normalized 12 months after chemotherapy. GLS at the 4 time points was: -19.0% ± 2.3%, -17.5% ± 2.3%, -18.2% ± 2.2%, -19.1% ± 1.9%. Persistently reduced strain at 12 months (in 16% of participants) was related to significantly higher anthracycline doses. Conclusion Significantly reduced LV systolic strain was detected in the short and intermediate-term after anthracyclines, without discernible changes in LVEF. In the majority, LV systolic dysfunction was transient: persistently reduced systolic strain was associated with higher anthracycline doses. Strain imaging is a more sensitive measure than LVEF in the short and intermediate-term monitoring of cardiac function after anthracycline chemotherapy.
11
Barrett-O'Keefe, Zachary. "Cardiovascular control during exercise and the role of the sympathetic nervous system in heart failure with reduced ejection fraction." Thesis, The University of Utah, 2016. http://pqdtopen.proquest.com/#viewpdf?dispub=10001028.
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The objective of this dissertation was to systematically investigate the hemodynamic response to exercise in heart failure with reduced ejection fraction (HFrEF) and healthy individuals of a similar age, with an emphasis on how the sympathetic nervous system (SNS) may contribute to the dysregulation of the cardiovascular system in this cohort. The first study aimed to determine how varying levels of metaboreceptor activation alters the mean arterial pressure (MAP) response as well as the degree in which cardiac output (CO) and systemic vascular conductance (SVC) contribute to the metaboreflex-induced increase in MAP. We observed similar increases in MAP induced by metaboreceptor activation in both groups; however, this response was driven primarily by increases in CO in the control group and reductions in SVC in the HFrEF group. These data suggest a preserved role of the metaboreflex-induced increase in MAP in HFrEF, but suggest that this response is governed by the peripheral circulation in this cohort, a maladaptation that may exacerbate systolic dysfunction through an increase in afterload. The second study of this dissertation was focused on investigating the peripheral vasodilatory and hyperemic response to exercise in isolation of central hemodynamic limitations in both the upper and lower limbs. This study documented an impaired hyperemic response to both static-intermittent handgrip exercise as well as dynamic single-leg knee-extensor exercise in HFrEF patients - impairments primarily attributed to vasodilatory dysfunction, as the increase in MAP induced by these exercise modalities was preserved compared to healthy individuals. Together, these findings have identified a significant attenuation of the exercise-induced hyperemic response during both upper and lower limb exercise, implicating maladaptions in the peripheral hemodynamic response to exercise as a potential contributor limiting exercise capacity in this patient group. The third study sought to address the contribution of the alpha-adrenergic receptor pathway in the regulation of blood flow to exercising skeletal muscle in HFrEF patients. At rest, alpha-1-adrenergic receptor vasoconstriction induced by local intra-arterial infusion of phenylephrine (PE) was reduced in HFrEF compared to control subjects. During exercise, the vasoconstrictor responsiveness to PE was significantly attenuated in the control group and preserved in HFrEF patients compared to rest. Additionally, nonspecific alpha-adrenergic receptor antagonism induced by local intra-arterial infusion of phentolamine increased blood flow to a greater degree in HFrEF compared to the control subjects, both at rest and during exercise. Together, these findings demonstrate a marked contribution of alpha-adrenergic receptor restraint of leg blood flow in HFrEF patients during exercise. Collectively, these three studies have provided new insight into the role the SNS and peripheral hemodynamics play in the maladaptive cardiovascular response to exercise displayed in patients with HFrEF, further implicating the peripheral expression of SNS activity as a primary contributor to impaired exercise capacity in this patient group.
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Kanamori, Norio. "Prognostic Impact of Aortic Valve Area in Conservatively Managed Patients With Asymptomatic Severe Aortic Stenosis With Preserved Ejection Fraction." Doctoral thesis, Kyoto University, 2021. http://hdl.handle.net/2433/263349.
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Bode, David [Verfasser]. "Cellular mechanisms of left atrial contractile dysfunction in heart failure with preserved ejection fraction and hypertensive heart disease / David Bode." Berlin : Medizinische Fakultät Charité - Universitätsmedizin Berlin, 2021. http://d-nb.info/1241540748/34.
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Lanfermann, Simon Verfasser], and Tanja [Akademischer Betreuer] [Zeller. "Novel Biomarkers in Heart Failure with Reduced and Preserved Ejection Fraction in the General Population / Simon Lanfermann ; Betreuer: Tanja Zeller." Hamburg : Staats- und Universitätsbibliothek Hamburg, 2020. http://nbn-resolving.de/urn:nbn:de:gbv:18-104233.
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Shorikova, D. V. "The collagen-induced platelet aggregation and artery status in patients with arterial hypertension and heart failure with preserved ejection fraction." Thesis, БДМУ, 2021. http://dspace.bsmu.edu.ua:8080/xmlui/handle/123456789/18601.
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Schmacht, Luisa [Verfasser]. "Cardiac involvement in myotonic dystrophy type 2 patients with preserved ejection fraction : detection by cardiovascular magnetic resonance / Luisa Maria Schmacht." Berlin : Medizinische Fakultät Charité - Universitätsmedizin Berlin, 2018. http://d-nb.info/1153768658/34.
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Schmacht, Luisa Maria [Verfasser]. "Cardiac involvement in myotonic dystrophy type 2 patients with preserved ejection fraction : detection by cardiovascular magnetic resonance / Luisa Maria Schmacht." Berlin : Medizinische Fakultät Charité - Universitätsmedizin Berlin, 2018. http://d-nb.info/1153768658/34.
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Lanfermann, Simon [Verfasser], and Tanja [Akademischer Betreuer] Zeller. "Novel Biomarkers in Heart Failure with Reduced and Preserved Ejection Fraction in the General Population / Simon Lanfermann ; Betreuer: Tanja Zeller." Hamburg : Staats- und Universitätsbibliothek Hamburg, 2020. http://d-nb.info/1212180941/34.
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Andersson, Jim. "LEFT VENTRICULAR EJECTION FRACTION: A RETROSPECTIVE STUDY COMPARING 2D ECHOCARDIOGRAPHY AND GATED SINGLE PHOTON EMISSION COMPUTED TOMOGRAPHY (SPECT) IN CLINICAL USE." Thesis, Uppsala University, Department of Medical Biochemistry and Microbiology, 2009. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-114139.
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Objectives
The aim of this study was to compare left ventricular ejection fraction (LVEF) results derived from gated single photon emission computed tomography (SPECT) using Cedars-Sinai quantitative gated SPECT (QGS) processing software with results from 2D echocardiography, both obtained in routine clinical diagnostic use.
Methods
Data from previously performed tests were obtained from 73 patients who had undergone both 2D echocardiography and gated SPECT within a time span of 6 months and had not had significant events that could influence LVEF. LVEF from 2D echocardiography was reassessed to obtain discrete values and then the data was compared using Bland-Altman analysis.
Results
The correlation between the tests was shown to be good, but precision lacked. Bland-Altman analysis showed a bias of -0.8 percentage points when gated SPECT compared to mean values and 2 standard deviations (SD) ranged from -20.2 to 18.6.
Conclusions
LVEF values from the two methods can differ quite a bit and comparisons between them should be done with great caution.
Syfte
Syftet med studien var att jämföra hur bra ultraljud av hjärta och isotopundersökning av hjärta stämmer överens när det gäller att visa hjärtats pumpförmåga.
Metod
Data från tidigare utförda undersökningar av 73 patienter jämfördes. Patienter som hade gjort båda undersökningarna inom 6 månader och under perioden mellan undersökningarna inte hade haft hjärtinfarkt eller någon annan händelse som kan påverka hjärtats pumpförmåga valdes till studien.
Resultat
Utslaget över hela studiepopulationen stämde resultaten från de båda undersökningarna bra överens. Jämförde man däremot resultaten från de båda undersökningarna med varandra patient för patient förekom mycket stora variationer.
Slutsats
Resultaten angående hjärtats pumpförmåga kan skilja sig mycket från varandra. Jämförelser av värden från dessa två metoder bör därför göras med väldigt stor försiktighet.
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Rariden, Brandi Scot. "Sedentary Time and the Cumulative Risk of Preserved and Reduced Ejection Fraction Heart Failure: from the Multi-Ethnic Study of Atherosclerosis." UNF Digital Commons, 2018. https://digitalcommons.unf.edu/etd/792.
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ABSTRACT
Purpose: The purpose of this study was to examine the relationship between self-reported sedentary time (ST) and the cumulative risk of preserved ejection fraction heart failure (HFpEF) and reduced ejection fraction heart failure (HFrEF) using a diverse cohort of U.S. adults 45-84 years of age.
Methods: Using data from the Multi-Ethnic Study of Atherosclerosis (MESA), we identified 6,814 subjects (52.9% female). All were free of baseline cardiovascular disease. Cox regression was used to calculate the hazard ratios (HR) associated with baseline ST and risk of overall heart failure (HF), HFpEF, and HFrEF. Weekly self-reported ST was dichotomized based on the 75th percentile (1,890 min/wk).
Results: During an average of 11.2 years of follow-up there were 178 first incident HF diagnoses; 74 HFpEF, 69 HFrEF and 35 with unknown EF. Baseline ST >1,890 min/wk was significantly associated with an increased risk of HFpEF (HR [95% CI]; 1.87 [1.13 – 3.09], p= 0.01), but not HFrEF (HR [95% CI]; 1.30 [0.78 – 2.15], p= 0.32). The relationship with HFpEF remained significant in separate fully adjusted models including either waist circumference (HR [95% CI]; 2.16 [1.23 – 3.78], p < 0.01) or body mass index (HR [95% CI]; 2.17 [1.24 – 3.80], p < 0.01). Additionally, every 60 minute increase in weekly ST was associated with a significant 3% increased risk of HFpEF (HR [95% CI]; 1.03 [1.01 – 1.05], p < 0.01).
Conclusions: Sedentary time > 1,890 min/wk (~4.5 h/d) is a significant independent predictor of HFpEF, but not HFrEF.
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Jorstig, Stina. "On the assessment of right ventricular function using cardiac magnetic resonance imaging and echocardiography." Doctoral thesis, Örebro universitet, Institutionen för medicinska vetenskaper, 2016. http://urn.kb.se/resolve?urn=urn:nbn:se:oru:diva-51662.
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Transthoracic echocardiography (TTE) and cardiac magnetic resonance (CMR) imaging are two commonly used imaging modalities for evaluating the size and function of the heart. There are advantages and disadvantages associated with both modalities when examining the right ventricle (RV). The RV is positioned partly behind the sternum and lung, sometimes causing shadows in the TTE images. This along with the complex shape of the RV makes volume calculations challenging by 2D TTE. CMR is considered to be the reference method for volume calculations of the ventricles. The valve separating the RV from the right atrium is however often oblique compared to the valve separating the left ventricle from the left atrium. This complicates RV volume calculations using conventional CMR short-axis stack images. The aim of this thesis was to find ways to improve the RV stroke volume and ejection fraction calculations using TTE and CMR. A method, transferring the position of the tricuspid plane from RV long-axis images to short-axis images, was developed to improve the separation of the right atrium from the RV when calculating RV stroke volumes by CMR. The method provided calculations of RV stroke volumes with good agreement to reference volumes. Further, the movements contributing to the RV stroke volume was studied aiming to find new ways of calculating RV stroke volumes and ejection fraction by TTE. A model for RV stroke volume and ejection fraction calculations was evaluated showing underestimation of stroke volumes by TTE compared to CMR, which probably depend on differences in distance measurements using the two modalities. The model provided, however, promising results for ejection fraction calculations which was validated in a study of 37 participants that covered a wide range of EF.
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Tandon, Animesh. "Dystrophin genotype-cardiac phenotype correlations in Duchenne and Becker muscular dystrophy using cardiac magnetic resonance imaging." University of Cincinnati / OhioLINK, 2014. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1396453528.
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Yaku, Hidenori. "Association of Mineralocorticoid Receptor Antagonist Use With All-Cause Mortality and Hospital Readmission in Older Adults With Acute Decompensated Heart Failure." Kyoto University, 2019. http://hdl.handle.net/2433/244523.
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Flamarz, Diana. "UTFÖRANDE AV EJEKTIONFRAKTIONSMÄTNING MED HJÄLP AV SIMPSON METOD AV EN STUDENT OCH EN ERFAREN BIOMEDICINSK ANALYTIKER." Thesis, Örebro universitet, Institutionen för hälsovetenskaper, 2020. http://urn.kb.se/resolve?urn=urn:nbn:se:oru:diva-84617.
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Echocardiography examination is an important and familiar method for heart`s examination. Echocardiography is used to assess the function of the heart during to check the heart disease. In an echocardiography examination, the heart´s flow rates, contractility (pumping capacity), wall thickness, and inner diameter can be examined. All these examinations are done with the help of evolution of the ultrasonic waves that the ultrasonic transducer sends out and receives. The transducer consists of piezoelectric crystals that can both transmit and receive ultrasonic waves with frequencies exceeding 20 kHz. The purpose of the study is to compare the measurement of the left ventricular ejection fraction (LVEF) between an experienced biomedical scientist (BMA) and a student. In addition to see how the image quality affects the result. The measurement was performed by using the Simpson method. The result was analyzed by using with a static method. The results were analyzed by using a paired t-test to see if there is any significant difference between the performance of a BMA and a student. The measurement was performed on apical 4-chamber and apical 2-chamber image. The study included 30 patients, both heart -healthy and cardiac patients of the genders. The result showed that there is a significant difference in the performance of LVEF- measurements between BMA and student, with lower values measured by the student.Ekokardiografiundersökning är en viktig och vanlig metod vid undersökning av hjärtat. Ekokardiografi används för att bedöma hjärtats funktion vid utredning av hjärtsjukdomar. Vid en ekokardiografiundersökning kan hjärtats flödeshastigheter, kontraktilitet (pumpförmåga), väggtjocklek, och innerdiameter undersökas. Alla dessa undersökningar görs med hjälp av tolkning av ultraljudsvågorna som ultraljudsgivaren skickar ut och tar emot. Givaren består av piezoelektriska kristaller som kan både sända och tar emot ultraljudsvågor med frekvens på över 20 kHz. Syftet med denna studie är att jämföra mätningen av den vänstra ventrikulära ejektionsfraktion (LVEF) mellan en erfaren biomedicinsk analytiker (BMA) och en student samt att se hur bildkvalitén påverkar resultatet. Mätningen utfördes med Simpsons- metoden. Resultatet analyserades med hjälp av en statistisk metod. Resultatet analyserades med hjälp av parat t-test för att se om det finns någon signifikant skillnad mellan utförandet av en BMA och en student. Mätningen utfördes på apikala 4-kammarbilder och apikala 2-kammarblider. Studien inkluderade 30 patienter, både hjärtfriska och hjärtsjuka patienter av både könen. Resultatet visade att det finns en signifikant skillnad i utförande av LVEF- mätningar mellan BMA och student, med lägre uppmätta värden av studenten.
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Sanchis, Ruiz Laura. "Characterization of heart failure with preserved ejection fraction in the outpatient setting: improvement in prognosis assessment and applicability of new echocardiographic techniques." Doctoral thesis, Universitat de Barcelona, 2016. http://hdl.handle.net/10803/401866.
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Heart failure with preserved left ventricular ejection fraction (HFPEF) is the most prevalent type of heart failure (HF) in the outpatient setting. Left ventricular ejection fraction values (considered as a surrogate of systolic function measured by standard echocardiography) are normal in HFPEF, making its diagnosis more challenging. In the present project, the underlying mechanisms involved in the early stages of HFPEF were analysed in outpatients with new onset HF and healthy controls. We observed that left atrial dysfunction was similar in HF patients with preserved or reduced left ventricular ejection fraction, but left ventricular function of HFPEF patients showed normal left ventricular ejection fraction and strain analysis similar values to that observed in a control group of patients without HF. Interatrial dyssynchrony was also observed in patients with new HFPEF onset. Both mechanisms seem to be present at the moment of symptoms onset, before ventricular dysfunction occurs. The study of these earliest alterations may be useful to achieve an early diagnosis and develop specific treatments, such as stepwise intensive management of atrial fibrillation or electrostimulation to resynchronizing the atria.
On the other hand, previous studies in patients diagnosed with HF as the cause of a hospital admission indicated a similar prognosis for patients with HFPEF and those with reduced ejection fraction (HFREF). In our study, outpatients with new-onset HFPEF and HFREF also showed similar midterm cardiovascular prognosis. We performed a discriminant analysis to identify the best combination of clinical, echocadiographic and analytical variables to determine the cardiovascular outcome of our cohort. Several biomarkers showed prognostic value, including high-sensitivity troponine I, matrix metalloprotease type 2, tissue inhibitor of metalloprotease-1, haemoglobin, left atrial volume and brain natriuretic peptide type B. The status of atrial function, analysed by the mean left atrial deformation, was also identified as an important prognostic marker.
The present project demonstrates that the presence of underlying abnormalities such as atrial contractile dysfunction and dyssynchrony may contribute to the common clinical presentation of HF in patients with preserved left ventricular ejection fraction. These findings suggest the potential for alternative treatments in this syndrome. Additionally, the prognostic implications of several biomarkers and atrial dysfunction were demonstrated, allowing for the early identification of high-risk patients who should receive close follow-up and intensive treatment.La insuficiencia cardiaca con fracción de eyección preservada (ICFEP) es el tipo más frecuente de insuficiencia cardiaca (IC) a nivel ambulatorio, pese a ello no existe un tratamiento eficaz de la misma. Dado que la función ventricular es aparentemente normal, su diagnóstico es difícil requiriendo un alto nivel de sospecha. En nuestro estudio hemos analizado los mecanismos implicados en las fases iniciales de la ICFEP, objetivando la existencia de disfunción auricular izquierda de similar magnitud a la objetivada en pacientes con IC y fracción de eyección reducida (ICFER), pero con una función ventricular izquierda (fracción de eyección y strain) normal en los pacientes con ICFEP. En esta población con debut de ICFEP también hemos podido objetivar la presencia de disincronía interauricular. Ambos mecanismos parecen estar presentes en el momento del debut clínico de ICFEP precediendo al inicio de la disfunción ventricular. Por otro lado, estudios previos, realizados en población con diagnóstico hospitalario de IC, sugirieron un pronóstico similar entre los pacientes con ICFEP o ICFER. En nuestro estudio con pacientes con debut ambulatorio de IC, los pacientes con ICFEP o ICFER también presentaron un similar pronóstico cardiovascular. Mediante la aplicación de un análisis discriminante se determinó una combinación de parámetros que podrían ser útil para estratificar el pronóstico cardiovascular a medio plazo de pacientes con debut de IC: sexo masculino, hipertensión arterial, fibrilación auricular, índice E/e’, Troponina I ultrasensible, metaloproteinasas MMP2 y TIMP1, hemoglobina, volumen auricular izquierdo y BNP. Así mismo, en una fase más tardía del seguimiento, se identificó la función auricular evaluada mediante strain (especialmente la onda A del strain-rate indicadora de la función contráctil de la aurícula izquierda) como un importante marcador pronóstico en esta cohorte de pacientes. El trabajo presentado muestra como diferentes alteraciones (disfunción de la aurícula izquierda o la disincronía interauricular) pueden desembocar en una presentación clínica común de IC en pacientes con fracción de eyección preservada. La presencia de estos hallazgos puede permitir el desarrollo de nuevos tratamientos para este síndrome. Así mismo, se han demostrado las implicaciones pronósticas de diversos biomarcadores y de la disfunción auricular, identificando de manera temprana los pacientes de alto riesgo permitiendo realizar un seguimiento y tratamiento más intensivo de dichos pacientes.
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Rouhana, Sarah. "Etude cellulaire et moléculaire de l'insuffisance cardiaque à fonction systolique préservée." Thesis, Montpellier, 2018. http://www.theses.fr/2018MONTT067/document.
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L'insuffisance cardiaque à fraction d’éjection préservée (IC/FEp) constitue un problème de santé croissant. Elle pourrait devenir la principale cause d'IC d'ici une décennie. C’est une pathologie associée à un taux élevé de morbidité et de mortalité. La prise en charge thérapeutique de l’IC/FEp reste limitée en raison de sa physiopathologie encore mal élucidée. Dans le présent travail, après avoir mis au point un modèle d’IC/FEp sur le rat adulte mâle et l’avoir caractérisé, nous avons évalué le phénotype fonctionnel et l’homéostasie calcique des cardiomyocytes. Les cœurs de ces animaux ont montré une fraction d’éjection supérieure à 50%, associée à une congestion pulmonaire, une hypertrophie concentrique avec une augmentation de la masse du ventricule gauche, une rigidité myocardique, une relaxation et un remplissage ventriculaire passif altérés et une dilatation auriculaire. Au niveau cellulaire, la contraction mesurée sur des cardiomyocytes isolés ainsi que le transitoire calcique sont augmentées. On note, de même, une surcharge en Ca2+ diastolique favorisée par une fuite à travers les canaux Ryanodine 2 et par un dysfonctionnement de l’échangeur Na+ /Ca2+ qui contribuent à générer des événements calciques spontanés. La phosphorylation du phospholamban, régulateur de l’activité de la SERCA2a, a également augmenté, laissant suggérer une compensation adaptative du cycle de Ca2+. Enfin, en présence de Ranolazine, inhibiteur du courant sodique soutenu, les évènements calciques spontanés ont été réprimés. En conclusion, le remodelage cardiaque dans l’IC/FEp semble être diffèrent de celui observé dans l’IC/FEr et ouvre la voie vers de nouveaux acteurs physiopathologiques et thérapeutiquesHeart failure with preserved ejection fraction (HFpEF) is a growing health problem. It could become the leading cause of HF within a decade. It is a pathology associated with high morbidity and mortality. Therapeutic options are limited due to a lack of knowledge of the pathology and its evolution. In this work, we investigated the cellular phenotype and Ca2+ handling in hearts recapitulating HFpEF criteria. HFpEF was induced in a portion of male Wistar rats four weeks after abdominal aortic banding. These animals had nearly normal ejection fraction and presented elevated blood pressure, lung congestion, concentric hypertrophy, increased LV mass, wall stiffness, impaired active relaxation and passive filling of the left ventricle, enlarged left atrium, and cardiomyocyte hypertrophy. Left ventricular cell contraction was stronger and the Ca2+ transient larger. Ca2+ cycling was modified with a RyR2 mediated Ca2+ leak from the sarcoplasmic reticulum and impaired Ca2+ extrusion through the Na+ /Ca2+ (NCX), which promoted an increase in diastolic Ca2+ and spontaneous Ca2+ waves. PLN phosphorylation which promotes SERCA2a activity, was increased, suggesting an adaptive compensation of Ca2+ cycling. In the presence of Ranolazine, a sustained sodium current inhibitor, spontaneous Ca2+ events were suppressed. Cardiac remodeling in hearts with a HFpEF status differs from that known for HFrEF and opens the way to new pathophysiological and therapeutic actors
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You, Cindy. "Impact of Left Ventricular Heart Failure With Preserved Ejection Fraction and Right Ventricular Systolic Heart Failure on Outcomes in the Intensive Care Unit." Thesis, Harvard University, 2015. http://nrs.harvard.edu/urn-3:HUL.InstRepos:17295904.
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Heart failure is a common diagnosis in the intensive care unit (ICU) with many studies regarding left ventricular systolic dysfunction and ICU outcomes. Less commonly explored are heart failure with preserved ejection fraction (HFpEF), also known as diastolic heart failure, and right ventricular heart failure in ICU outcomes. We sought to study the impact of both diastolic heart failure and right ventricular heart failure on general ICU outcomes.
This retrospective cohort study includes 919 patients admitted to an ICU of a major tertiary care medical center with HFpEF, and 298 patients from the same medical center with right ventricular heart failure, comparing outcomes to 6955 control patients without left ventricular systolic or right ventricular heart failure in this general intensive care setting. Primary endpoint was 28-day mortality, with secondary endpoints of 1-year mortality, hospital and intensive care length of stay, length of use of vasopressors, and days on mechanical ventilation.
Multivariable regression demonstrated a significant association between HFpEF and improved mortality as compared to controls, but this association is lost at 1-year follow-up. Right ventricular heart failure does not demonstrate any association with 28-day mortality, which was corroborated on sensitivity analysis excluding cardiac or cardiac surgery intensive care patients.
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SIRI, GIACOMO. "The use of the Joint Models to improve the accuracy of prognostication of death in patients with heart failure and reduced ejection fraction (HFrEF)." Doctoral thesis, Università degli studi di Genova, 2021. http://hdl.handle.net/11567/1057805.
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The work presented in this thesis has been developed during a scholarship at the Scientific Directorate - Unit of Biostatistics of the Galliera Hospital in Genoa under the supervision of Dr. Matteo Puntoni. This scholarship was partially supported by a grant from Ministry of Health, Italy "Bando Ricerca Finalizzata - Giovani Ricercatori" (Project code: GR-2013-02355479) won by Dr. Puntoni for conducting a cancer research study. The main objective of my research was to apply the Joint Model for longitudinal and survival data to improve the dynamic prediction of cardiovascular diseases in patients undergoing cancer treatment. These patients are usually followed after the start of the therapy with several visits in the course of which different longitudinal data are collected. These data are usually collected and interpreted by clinicians but not in a systematic way. The innovation of my project consisted in a more formal use of these data in a statistical model.
The Joint Model is essentially based on the simultaneous modelling of a linear mixed model for longitudinal data and a survival model for the probability of an event. The utility of this model is twofold: on one hand it links the change of a longitudinal measurement to a change in the risk of an event, on the other hand the prediction of survival probabilities using the Joint Model can be updated whenever a new measurement is taken.
Unfortunately, the clinical study on cancer therapy for which the project was thought is still ongoing at this moment and the longitudinal data are not available. So, we applied the developed methods based on Joint Model to another dataset with a similar clinical interest. The case of study presented in the Chapter 6 of this thesis is developed after a meeting between Dr. Puntoni and me and Dr. Marco Canepa of the Cardiovascular Disease Unit of the San Martino Hospital in Genoa. The necessity of the last one was to prove that the longitudinal data collected in patients after a heart failure could be used to improve the prognostication of death and, more in general, the patient management and care with a personalized therapy. The last one could be better calibrated by a dynamic update of the prognosis of patients related to a better analysis of the longitudinal data provided during each follow-up visit.
The Joint Model for longitudinal and survival data solves the problem of the simultaneous analysis of the biomarkers collected at each follow-up visits and the dynamic update of the survival probabilities each time a new measurements are collected (see Chapter 4). The next step, developed in the Chapter 5, was to find a statistical index that was simple to understand and practical for clinicians but also methodologically adequate to assess and prove that the longitudinal data are advantage in the prognostication of death. To do this, two different indexes seemed most suitable: the area under the Receiver Operating Characteristic Curve (AUC-ROC) to assess the prediction capability of the Joint Model, and the Net Reclassification Improvement (NRI) to evaluate the improvement in prognostication in comparison with other approaches commonly used in clinical studies.
In Section 5.3, a new definition of time-dependent AUC-ROC and time-dependent NRI in the Joint Model context is given. Even if a function to derive the AUC after a Joint Model was present in literature, we needed to reformulate it and implement in the statistical software R to make it comparable with the index derived after the use of the common survival models, such as the Weibull Model. Regarding the NRI, no indexes are present in the literature. Some methods and functions were developed for binary and survival context but no one for the Joint Model. A new definition of time-dependent NRI is presented in Section 5.3.2 and used to compare the common Weibull survival model and the Joint Model.
This thesis is divided in 6 chapters. Chapters 1 and 2 are preparatory to the introduction of the Joint Model in Chapter 3. In particular, Chapter 1 is an introduction to the analysis of longitudinal data with the use of Linear Mixed Models while Chapter 2 presents concepts and models used in the thesis from survival analysis. In Chapter 3 the elements introduced in the first two chapters are joined to defined the Joint Model for longitudinal and survival data following the approach proposed by Rizopoulos (2012). Chapter 4 introduces the main ideas behind dynamic prediction in the Joint Model context. In Chapter 5 relevant notions of prediction capability are introduced in relation to the indexes AUC and NRI. Initially, these two indexes are presented in relation to a binary outcome. Then, it is shown how they change when the outcome is the time to an event of interest. Ending, the definitions of time-dependent AUC and NRI are formulated in the Joint Model context. The case of study is presented in the Chapter 6 along with strength and limitations related to the use of the Joint Model in clinical studies.
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Jonsson, Åsa. "How to create and analyze a Heart Failure Registry with emphasis on Anemia and Quality of Life." Doctoral thesis, Linköpings universitet, Avdelningen för kardiovaskulär medicin, 2017. http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-137351.
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Background and aims Heart failure (HF) is a major cause of serious morbidity and death in the population and one of the leading medical causes of hospitalization among people older than 60 years. The aim of this thesis was to describe how to create and how to analyze a Heart Failure Registry with emphasis on Anemia and Quality of Life. (Paper I) We described the creation of the Swedish Heart Failure Registry (SwedeHF) as an instrument, which may help to optimize the handling of HF patients and show how the registry can be used to improve the management of patients with HF. (Paper II) In order to show how to analyze a HF registry we investigated the prevalence of anemia, its predictors, and its association with mortality and morbidity in a large cohort of unselected patients with HFrEF included in the SwedeHF, and to explore if there are subgroups of HF patients identifying high--‐risk patients in need of treatment. (Paper III) In order to show another way of analyzing a HF registry we assessed the prevalence of, associations with, and prognostic impact of anemia in patients with HFmrEF and HFpEF. (Paper IV) Finally we examined the usefulness of EQ--‐ 5D as a measure of patient--‐reported outcomes among HF patients using different analytical models and data from the SwedeHF, and comparing results about HRQoL for patients with HFpEF and HFrEF. Methods An observational study based on the SwedeHF database, consisting of about 70 variables, was undertaken to describe how a registry is created and can be used (Paper I). One comorbidity (anemia) was applied to different types of HF patients, HFrEF (EF <40%) (II) and HFmrEF (EF 40--‐49% ) or HFpEF (> 50%) (III) analyzing the data with different statistical methods. The usefulness of EQ--‐5D as measure of patient--‐ reported outcomes was studied and the results about HRQoL were compared for patients with HFpEF and HFrEF (IV). Results In the first paper (Paper I) we showed how to create a HF registry and presented some characteristics of the patients included, however not adjusted since this was not the purpose of the study. In the second paper (Paper II) we studied anemia in patients with HFrEF and found that the prevalence of anemia in HFrEF were 34 % and the most important independent predictors were higher age, male gender and renal dysfunction. One--‐year survival was 75 % with anemia vs. 81 % without (p<0,001). In the matched cohort after propensity score the hazard ratio associated with anemia was for all--‐cause death 1.34. Anemia was associated with greater risk with lower age, male gender, EF 30--‐39%, and NYHA--‐class I--‐II. In the third paper (Paper III) we studied anemia in other types of HF patients and found that the prevalence in the overall cohort in patients with EF > 40% was 42 %, in HFmrEF 38 % and in HFpEF (45%). Independent associations with anemia were HFpEF, male sex, higher age, worse New York Heart Association class and renal function, systolic blood pressure <100 mmHg, heart rate ≥70 bpm, diabetes, and absence of atrial fibrillation. One--‐year survival with vs. without anemia was 74% vs. 89% in HFmrEF and 71% vs. 84% in HFpEF (p<0.001 for all). Thus very similar results in paper II and III but in different types of HF patients. In the fourth paper (Paper IV) we studied the usefulness of EQ--‐5D in two groups of patients with HF (HFpEF and HFrEF)) and found that the mean EQ--‐5D index showed small reductions in both groups at follow--‐up. The patients in the HFpEF group reported worsening in all five dimensions, while those in the HFrEF group reported worsening in only three. The Paretian classification showed that 24% of the patients in the HFpEF group and 34% of those in the HFrEF group reported overall improvement while 43% and 39% reported overall worsening. Multiple logistic regressions showed that treatment in a cardiology clinic affected outcome in the HFrEF group but not in the HFpEF group (Paper IV). Conclusions The SwedeHF is a valuable tool for improving the management of patients with HF, since it enables participating centers to focus on their own potential for improving diagnoses and medical treatment, through the online reports (Paper I). Anemia is associated with higher age, male gender and renal dysfunction and increased risk of mortality and morbidity (II, III). The influence of anemia on mortality was significantly greater in younger patients in men and in those with more stable HF (Paper II, III). The usefulness of EQ--‐5D is dependent on the analytical method used. While the index showed minor differences between groups, analyses of specific dimensions showed different patterns of change in the two groups of patients (HFpEF and HFrEF). The Paretian classification identified subgroups that improved or worsened, and can therefore help to identify needs for improvement in health services (Paper IV).
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Rienzo, Mario. "Caractérisation physiopathologique et pharmacologique d'un modèle porcin de dysfonction diastolique avec éjection préservée." Thesis, Paris Est, 2013. http://www.theses.fr/2012PEST0072/document.
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On estime qu'approximativement 20 millions de personnes dans le monde souffrent d'insuffisance cardiaque et la prévalence de cette pathologie ne cesse d'augmenter avec le vieillissement croissant de la population. L'évaluation de la fonction ventriculaire gauche par la mesure de la fraction d'éjection permet en fait de distinguer deux populations distinctes de patients insuffisants cardiaques : l'une avec et l'autre sans altération de la fraction d'éjection, encore dénommées respectivement Heart Failure with Reduced Ejection Fraction (IC-FEr) et Heart Failure with Preserved Ejection Fraction (IC-FEp). On ne sait pas aujourd'hui si ces deux entités représentent deux pathologies distinctes ou, au contraire, deux entités intimement liées. L'IC-FEp est actuellement observée chez environ 40 à 50% des patients présentant une insuffisance cardiaque et son évolution est semblable à celle des patients IC-FEr.Le concept d'IC-FEp soulève toutefois des difficultés conceptuelles : d'une part car la notion d'une fraction d'éjection préservée implique la connaissance de sa valeur de base et d'autre part, les valeurs dites "normales" de la fraction d'éjection sont encore à établir. Par ailleurs, la vision mécanique du cœur comme une pompe hémodynamique ou musculaire conditionne la compréhension de la physiopathologie de la IF-FEp.Dans ce contexte, nous avons mis au point un modèle porcin de dysfonction diastolique avec éjection préservée secondaire à une hypertension artérielle induite par une perfusion continue d'angiotensine II pendant 28 jours. Dans ces conditions, nous avons démontré une altération de la fonction ventriculaire gauche alors même que l'éjection était préservée. Ceci était objectivé par 1) une augmentation paradoxale des durées relatives de contraction et de relaxation isovolumiques, 2) des réponses inappropriées des phases isovolumiques du cycle cardiaque à des augmentations de la fréquence et de l'inotropisme cardiaques et 3) une étroite relation entre ces deux phases isovolumiques (couplage contraction-relaxation). L'inadéquation entre les niveaux de fréquence cardiaque et des phases isovolumiques nous a amené à évaluer les effets de la modulation pharmacologique de la fréquence cardiaque sur le couplage contraction-relaxation. Ainsi la réduction sélective de la fréquence cardiaque par l'administration d'ivabradine, un inhibiteur des canaux If, a réduit significativement la durée de ces deux phases et favorisé le remplissage. Cependant, cette normalisation n'était qu'apparente puisque le ratio entre la contraction et la relaxation isovolumiques restait augmenté à J28, en défaveur de la contraction isovolumique.En conclusion, le développement d'une dysfonction diastolique avec une éjection préservée s'accompagne d'une dysfonction systolique qui entrave une réponse adéquate du myocarde à un stress dans un contexte d'hypertension chroniqueApproximately 20 millions individuals in the world experience heart failure symptoms; heart failure prevalence is continuously rising with population aging. Left ventricular function evaluation by the ejection fraction allows distinguishing two different patient sets: one with and one other without ejection fraction alteration, respectively named Heart Failure with Reduced Ejection Fraction (HF-rEF) and Heart Failure with Preserved Ejection Fraction (HF-pEF). It is unknown if these two clinical presentations represent two different pathologies or two manifestations of the same clinical entity. HF-pEF is found in about 40-50% of patients with heart failure and its evolution is similar to that of patients with HF-rEF.However, several conceptual difficulties deal with the HFpEF: on one hand, talking about preserved ejection fraction implies the knowledge of its basal value; on the other, the normality needs to be established. Moreover, considering the heart either as a hemodynamic pump or as a muscular pump may modify the understanding of HFpEF physiopathology.We therefore set up a swine model of diastolic dysfunction with preserved ejection induced by chronic hypertension, which was obtained by continuous perfusion of angiotensin II during 28 days. In these conditions, we clearly demonstrated a LV function impairment, while the ejection phase parameters remained preserved. The LV impairment is demonstrated by: 1) the paradox increase of the relative durations of isovolumic contraction and relaxation; 2) the blunted responses of the isovolumic phases of cardiac cycle to heart rate augmentation and cardiac inotropisme; 3) a straight relationship between these two isovolumic phases (contraction-relaxation relationship).The mismatch between the heart rate and the isovolumic phases behaviour led us to investigate the possible effects of the heart rate pharmacological modulation on the contraction-relaxation coupling. The selective reduction of the heart rate by ivabradine administration (a selective If channel inhibitor) was able to significantly reduce the isovolumic contraction and relaxation phases' durations, thus improving filling phase dynamics. Anyway, this “normalisation” was only apparent, because the contraction to relaxation ratio was increased at day 28, to the detriment of the isovolumic contraction.In conclusion, chronic hypertension induces a diastolic dysfunction with a preserved ejection fraction paralleled by a systolic dysfunction which is responsible of a blunted myocardial response to stress
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Chilali, Karim El [Verfasser], and Philipp [Akademischer Betreuer] Kahlert. "Impact of baseline left ventricular ejection fraction on thirty-day and one-year mortality after transfemoral aortic valve implantation / Karim El Chilali ; Betreuer: Philipp Kahlert." Duisburg, 2018. http://d-nb.info/1155097238/34.
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Coles, Andrew H. "Long-Term Survival and Prognostic Factors in Patients with Acute Decompensated Heart Failure According to Ejection Fraction Findings: A Population-Based Perspective: A Master Thesis." eScholarship@UMMS, 2014. https://escholarship.umassmed.edu/gsbs_diss/722.
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Limited data exists describing the long-term prognosis of patients with acute decompensated heart failure (ADHF) further stratified according to currently recommended ejection fraction (EF) findings. In addition, little is known about the magnitude of, and factors associated with, long-term prognosis for these patients. Based on previously validated and clinically relevant criteria, we defined HF-REF as patients with an EF value ≤40%, HF-PEF was defined as an EF value > 50%, and HF-BREF was defined as patients with an EF value during their index hospitalization between 41 and 49%. The hospital medical records of residents of the Worcester (MA) metropolitan area who were discharged after ADHF from all 11 medical centers in central Massachusetts during the 5 study years of 1995, 2000, 2002, 2004, and 2006 were reviewed. Follow-up was completed through 2011 for all patient cohorts. The average age of this population was 75 years, the majority was white, and 44% were men. Patients with HF-PEF experienced higher post discharge survival rates than patients with either HF-REF or HF-BREF at 1, 2, and 5-years after discharge. Advanced age and lower estimated glomerular filtration rate findings at the time of hospital admission were important predictors of 1-year death rates, irrespective of EF findings. Previously diagnosed chronic obstructive pulmonary disease, chronic kidney disease, and atrial fibrillation were associated with a poor prognosis in patients with PEF and REF whereas a history of diabetes was an important prognostic factor for patients with REF and BREF. In conclusion, although improvements in 1-year post-discharge survival were observed for patients in each of the 3 EF groups examined to varying degrees, the post- 7 discharge prognosis of all patients with ADHF remains guarded. In addition, we observed differences in several prognostic factors between patients with ADHF with varying EF findings, which have implications for more refined treatment and surveillance plans for these patients.
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Coles, Andrew H. "Long-Term Survival and Prognostic Factors in Patients with Acute Decompensated Heart Failure According to Ejection Fraction Findings: A Population-Based Perspective: A Master Thesis." eScholarship@UMMS, 2008. http://escholarship.umassmed.edu/gsbs_diss/722.
Full textAbstract:
Limited data exists describing the long-term prognosis of patients with acute decompensated heart failure (ADHF) further stratified according to currently recommended ejection fraction (EF) findings. In addition, little is known about the magnitude of, and factors associated with, long-term prognosis for these patients. Based on previously validated and clinically relevant criteria, we defined HF-REF as patients with an EF value ≤40%, HF-PEF was defined as an EF value > 50%, and HF-BREF was defined as patients with an EF value during their index hospitalization between 41 and 49%. The hospital medical records of residents of the Worcester (MA) metropolitan area who were discharged after ADHF from all 11 medical centers in central Massachusetts during the 5 study years of 1995, 2000, 2002, 2004, and 2006 were reviewed. Follow-up was completed through 2011 for all patient cohorts. The average age of this population was 75 years, the majority was white, and 44% were men. Patients with HF-PEF experienced higher post discharge survival rates than patients with either HF-REF or HF-BREF at 1, 2, and 5-years after discharge. Advanced age and lower estimated glomerular filtration rate findings at the time of hospital admission were important predictors of 1-year death rates, irrespective of EF findings. Previously diagnosed chronic obstructive pulmonary disease, chronic kidney disease, and atrial fibrillation were associated with a poor prognosis in patients with PEF and REF whereas a history of diabetes was an important prognostic factor for patients with REF and BREF. In conclusion, although improvements in 1-year post-discharge survival were observed for patients in each of the 3 EF groups examined to varying degrees, the post- 7 discharge prognosis of all patients with ADHF remains guarded. In addition, we observed differences in several prognostic factors between patients with ADHF with varying EF findings, which have implications for more refined treatment and surveillance plans for these patients.
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El, Chilali Karim [Verfasser], and Philipp [Akademischer Betreuer] Kahlert. "Impact of baseline left ventricular ejection fraction on thirty-day and one-year mortality after transfemoral aortic valve implantation / Karim El Chilali ; Betreuer: Philipp Kahlert." Duisburg, 2018. http://d-nb.info/1155097238/34.
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Lin, Jonathan Lee. "Evaluation of 18F-FDG PET Agent in Cardiac Gated Imaging." The Ohio State University, 2012. http://rave.ohiolink.edu/etdc/view?acc_num=osu1342817999.
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Belley-Côté, Emilie-Prudence. "Projet ROSE: Récupération Objective de la fonction Systolique évaluée par Échocardiographie." Mémoire, Université de Sherbrooke, 2015. http://hdl.handle.net/11143/8149.
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Résumé: Mise en contexte : Les infarctus antérieurs avec élévation du segment ST (IMAEST) causent fréquemment une dysfonction ventriculaire gauche. Une diminution de la fraction d’éjection du ventricule gauche (FeVG) est associée à une augmentation du risque d’accident vasculaire cérébral (AVC). Les lignes directrices recommandaient jusqu’à récemment (Classe I, niveau d’évidence C) l’anticoagulation des patients qui, après un IMAEST, étaient jugés à haut risque d’embolie systémique tels que les infarctus étendus ou de la paroi antérieure. Généralement, ces patients reçoivent une anticoagulation d’une durée de trois mois en combinaison avec une double thérapie antiplaquettaire pour au moins quatre semaines. Si les anomalies régionales de la contractilité se normalisaient avant trois mois, la durée de l’anticoagulation pourrait potentiellement être écourtée. La cinétique de récupération des infarctus antérieurs revascularisés par angioplastie primaire est mal décrite. Objectif : Chez des patients ayant subi un IMAEST de la paroi antérieure revascularisés par angioplastie primaire, évaluer si la FeVG et la récupération de l’akinésie antérieure et apicale est différente à un mois et trois mois post infarctus. Méthode : De façon prospective, nous avons recruté 42 patients présentant une FEVG de 45% ou moins et une akinésie de la paroi antérieure ou apicale lors de l’échocardiographie réalisée 48 heures post IMAEST. Des échocardiographies étaient obtenues à un mois et trois mois post IMAEST. Chaque échocardiographie était interprétée par deux cardiologues indépendants à l’aveugle des données cliniques. Résultats : Lorsque comparée à la FeVG à 48 heures post IMAEST, la FeVG à un mois s’était déjà améliorée de façon significative (38% à 42%, p=0.03). Il n’y avait pas d’amélioration significative supplémentaire entre un mois et trois mois (42% à 44%, p=NS). La dynamique des segments apicaux et antérieurs s’améliorait de façon significative entre 48 heures et un mois, mais aussi entre un mois et trois mois. Conclusion : Vu l’amélioration significative de la FeVG et de l’akinésie antérieure et apicale à un mois post IMAEST, il pourrait être justifié de ré-évaluer la FeVG plus précocement chez les patients anticoagulés pour cette indication afin de minimiser la durée de l’anticoagulation et le risque de saignement qui y est associé.Abstract: Background: Anterior ST-elevation myocardial infarction (STEMI) frequently causes left ventricular dysfunction. Worsening left ventricular ejection fraction (LVEF) is associated a higher stroke rate. Prior guidelines recommended anticoagulation for patients after STEMI who are at high risk for systemic emboli and specified that large or anterior myocardial infarctions (MI) are part of that group (Class I, level of Evidence C). The 2013 Guidelines made it a Class IIB recommendation and restricted the recommendation to those with anterior or apical akinesia and dyskinesia. These patients are usually given three months of anticoagulation. If the regional wall motion abnormalities were to normalize earlier, the duration of anticoagulation could be shortened. However, the kinetics of recovery after an anterior MI revascularized with primary percutaneous intervention are not well described. Objective: To evaluate if LVEF and apical and anterior akinesia recuperation is different at one month and three months after STEMI in patients treated with primary percutaneous angioplasty. Methods: We prospectively recruited 42 patients who had a LVEF of 45% or less and apical or anterior akinesia on echocardiography at 48 hours post STEMI. Echocardiography was repeated one month and three months post STEMI. Each echocardiogram was interpreted by two different cardiologists who were blinded to clinical information. Results: When compared to 48 hours post STEMI, LVEF at one month had already improved significantly (38% to 42%, p=0.03) and there was no further significant improvement at three months (44%, p=NS). Anterior and apical akinesia decreased significantly between the 48 hours and one month echocardiograms, but also between one month and three months. Conclusion: Given that LVEF and anterior/apical akinesia improve significantly within the first post STEMI month, it may be worth re-evaluating the LVEF earlier in patients in whom the decision was made to start anticoagulation for that indication in order to minimize the duration of anti-coagulation and the associated bleeding risk.
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Sharp, III Thomas E. "DRUG AND CELL–BASED THERAPIES TO REDUCE PATHOLOGICAL REMODELING AND CARDIAC DYSFUNCTION AFTER ACUTE MYOCARDIAL INFARCTION." Diss., Temple University Libraries, 2017. http://cdm16002.contentdm.oclc.org/cdm/ref/collection/p245801coll10/id/445275.
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PhysiologyPh.D.
Remarkable advances have been made in the treatment of cardiovascular diseases (CVD), however, CVD still accounts for the most deaths in industrialized nations. Ischemic heart disease (IHD) can lead to acute coronary syndrome (ACS) (myocardial infarction [MI]). The standard of care is reperfusion therapy followed by pharmacological intervention to attenuate clinical symptoms related to the MI. While survival from MI has dramatically increased with the implementation of reperfusion therapy, these individuals will inevitably suffer progressive pathological remodeling leaving them predispose to develop heart failure (HF). HF is a clinical syndrome defined as the impairment of the heart to maintain organ perfusion at rest and/or during times of exertion (i.e. exercise intolerance). Clinically, this is accompanied by dyspnea, pulmonary or splanchnic congestion and peripheral edema. Physiologically, there is neurohormal activation through the classical β–adrenergic and PKA–dependent signalin
Temple University--Theses
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HSU, BO-CHENG, and 許博程. "Prognostic Relevance of Anxiety in Distinct Phenotypes of Heart Failure:Heart Failurewith Reduced Ejection Fraction and Heart Failure with Preserved Ejection Fraction." Thesis, 2019. http://ndltd.ncl.edu.tw/handle/38g28t.
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碩士國立中正大學
心理學系臨床心理學研究所
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Purpose: This study aimed to distinguish between heart failure with reduced ejection fraction (HFrEF; LVEF < 40%) and heart failure with preserved ejection fraction (HFpEF; LVEF ≥ 50%) to examine the prognostic relevance of state anxiety and trait anxiety on prognostic outcomes (ie, all-cause mortality, cardiac mortality, all-cause readmission, and cardiac readmission) between HFrEF and HFpEF phenotypes. Methods: The database collected by the projects supported by Buddhist Tzu Chi Medical Foundation (TCRD-I101-03) to Chih-Wei Chen. 266 inpatients, who cardiologists diagnosed clinical heart failure, were recruited in this study. Basic information questionnaires, healthy behaviors questionnaire, Spielberger State-Trait Anxiety Inventory, and Beck Depression Inventory-II scale were administrated at baseline. Clinical characteristics and laboratory biomarkers at discharge, as well as the18-month follow-up prognostic outcomes (ie, all-cause mortality, cardiac mortality, all-cause readmission, and cardiac readmission), were obtained from the electronic medical records database or via direct contact by telephone. Results: According to 2016 European Society of Cardiology Heart Failure Guidelines, 266 heart failure inpatients distinguished 158 HFrEF phenotype (LVEF = 28.51% ± 7.53) from 108 HFpEF phenotype (LVEF = 64.53% ± 9.67). There were significant differences between HFrEF and HFpEF inpaients in demographic characteristics (ie, age, gender, and surgical history), comorbidities (ie, rates of hypertension, respiratory disease, and kidney disease), laboratory biomarkers (ie, heart rate, QRS duration, systolic blood pressure, pulse pressure, HDL-C, uric acid, and hemoglobin), discharge medications (ie, the usage rates of diuretics, ACEIs, ARBs, digoxin, and CCB), unhealthy behaviors (ie, smoking and drinking habit), and depression symptoms (all p < 0.05). Two distinct phenotypes had no difference in state anxiety, trait anxiety, and 18-month prognostic outcomes (all p > 0.05). Multiple logistic regression analyses showed that there were no significant associations between anxiety and 18-month outcomes in patients with HFrEF after adjusting for possible confounders (all p > 0.05). However, state anxiety were significantly associated with 18-month all-cause readmission (β =.072, EXP(B) = 1.075, p = .036), as well as borderline significantly associated with 18-month all-cause mortality (β =.407, EXP(B) = 1.502, p = .071) and cardiac readmission (β =.061, EXP(B) = 1.062, p = .073) in HFpEF inpatients. Also, trait anxiety could predict 18-month all-cause mortality (β =.357, EXP(B) = 1.429, p = .038), all-cause readmission(β =.138, EXP(B) = 1.147, p = .008), and cardiac readmission (β =.125, EXP(B) = 1.133, p = .010) in HFpEF inpatients. Conclusions: Consistent with previous studies, our findings showed that there were significant differences between HFrEF and HFpEF phenotypes in research variables, which supported that HFrEF and HFpEF represent two distinct phenotypes in this study. To differentiate HFpEF from HFrEF inpatients, this study found that state anxiety and trait anxiety were independently associated with 18-month all-cause mortality, all-cause readmission, and cardiac readmission in inpatients with HFpEF, but not those with HFrEF, even though there were no significant differences in state anxiety, trait anxiety and the 18-month outcomes between these two phenotypes. Remarks: This study have been published in JAHA journal in accordance with the cardiological properties and groups of researchers who meet different languages (Lin et al., 2019).
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Li, Shanpeng. "Novel pathways of heart failure with preserved ejection fraction." Thesis, 2015. https://hdl.handle.net/2144/16263.
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INTRODUCTION: Diastolic heart failure (HF) i.e., HF with preserved ejection fraction (HFpEF) accounts for ~50% of all clinical HF presentations; but unlike systolic HF i.e., HF with reduced ejection fraction (HFrEF), there are no evidenced based therapies. Obesity is commonly associated with HFpEF. However, there exist a sub-group of obese patients that exhibit a higher survival rate to HFpEF as compared to average patients. Hypertension is the most important risk factor for HFpEF, with a prevalence of 60-89% reported by large controlled trials, epidemiological studies and HF registries. HFpEF morbidity and mortality rates are staggering: 50-60% 5 year mortality rate, 50% 6 month rehospitalization rate and severe clinical disability. However, there remains an incomplete mechanistic understanding about HFpEF.
OBJECTIVES: We wanted to explore new pathways related to HFpEF in order to better understand the mechamisms behind its pathophysiology. To do so, we first wanted to explore the potential crosstalk between the heart and adipose tissue during HFpEF by analyzing the adipose tissue in our HFpEF model. Secondly, we sought to test the hypothesis that chronic ETA/ETB inhibition with macitentan (mac) modulates pathologic cardiac remodeling in hypertension-induced HFpEF.
METHODS: Mice (20-25 g) were anesthetized, underwent uninephrectomy and received either a continuous infusion of saline (sham) or d-aldosterone (0.3 ug/hour for 4-weeks via osmotic minipumps). All mice were maintained on standard rodent chow and 1.0% sodium chloride drinking water for 4 weeks and then harvested.
Second group of mice underwent the same surgical procedure and infusion. They were maintained on standard chow for 2 weeks and then each group was randomized to chow containing macitentan (30 mg/kg/day, HFpEFmac) or standard rodent chow. After 2 additional weeks, the 4 groups of mice (n=4-8/group) were harvested.
Blood pressure (BP) was obtained weekly. Prior to sacrifice, body weight and echocardiography parameters (total wall thickness (TWT) and relative wall thickness (RWT)) were determined. We also obtained diastolic dysfunction parameters including deceleration time (DT), isovolumetric relaxation time (IVRT), and E/A ratio. Furthermore, we measured organ weight after harvesting the mice and obtained histological images for the adipose tissues collected. Glucose tolerance test and acute cold tolerance test were performed on HFpEF mice to determine their metabolic state.
RESULTS: HFpEF mice developed hypertension, LV hypertrophy, and diastolic dysfunction. Epididymal and inguinal adipose tissue showed significantly reduced weight and adipocyte size. HFpEF mice displayed regular glucose metabolism but were not able to endure a cold tolerance test as their body temperature dropped too low.
After 4 weeks, there was no difference in body weight between sham, HFpEF, shammac and HFpEFmac. As expected HFpEF increased systolic BP (117±14 vs 133±16mmHg; P=NS); macitentan did not lower systolic BP after 2 weeks in either shammac or HFpEFmac. Similarly there was no difference in systolic BP between HFpEF and HFpEFmac. Both kidney and spleen weights were increased in HFpEF but not altered by macitentan therapy. There was no change in lung congestion as measured by wet-dry lung ratio.
HFpEF increased TWT (0.998±0.04 vs. 0.79±0.11 mm; P<0.01 vs. sham) and RWT (0.686± 0.10 vs. 0.476±0.05 mm; P<0.001 vs. sham) but were modulated by macitentan (HFpEF vs. HFpEFmac; P<0.05 and P<0.001, respectively). There was no difference in chamber size between HFpEF and HFpEFmac. Similarly, IVRT, DT, left ventricular ejection fraction were no different between HFpEF and and HFpEFmac. Furthermore E/A ratio was increased in HFpEF but was not affected by macitentan
CONCLUSIONS: Adipose tissue collected from our HFpEF mice displayed a very different phenotype. This demonstrates that inter-tissue communication is definitely occurring between the adipose tissue and the heart. Further research is required to explore what that communication encompasses and how they can be used to improve HFpEF.
Macitentan did not lower systolic BP in sham or mice with HFpEF after the development of hypertension. Diastolic dysfunction, as measured by an increased E/A ratio, was not affected by macitentan. Macitentan significantly modulated TWT and RWT after 2 weeks of therapy. It is thus plausible that macitentan may improve HFpEF by improving adverse cardiac remodeling.
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"Ergometry stress echocardiography in heart failure with preserved ejection fraction." 2014. http://repository.lib.cuhk.edu.hk/en/item/cuhk-1291307.
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Wang, Jing.Thesis Ph.D. Chinese University of Hong Kong 2014.
Includes bibliographical references (leaves 123-151).
Abstracts also in Chinese.
Title from PDF title page (viewed on 19, September, 2016).
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Martins, Alexandrina Campos. "Heart failure with preserved ejection fraction: the role of adenosine." Master's thesis, 2021. https://hdl.handle.net/10216/134828.
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Martins, Alexandrina Campos. "Heart failure with preserved ejection fraction: the role of adenosine." Dissertação, 2021. https://hdl.handle.net/10216/134828.
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Lopes, Vanessa Filipa de Sousa. "Heart failure with mid-range ejection fraction: who are these patients?" Master's thesis, 2019. http://hdl.handle.net/10316/89932.
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Trabalho Final do Mestrado Integrado em Medicina apresentado à Faculdade de MedicinaIntrodução: A classificação da insuficiência cardíaca (IC) tem sido baseada na fração de ejeção do ventrículo esquerdo (FEVE). A Sociedade Europeia de Cardiologia (ESC) introduziu, em 2016, nas suas guidelines de abordagem clínica de IC, uma nova categoria: a de FEVE compreendida entre 40 a 49%, designando-a como IC com FEVE intermédia (ICFEI). Devido à sua recente conceção, a sua história natural é ainda desconhecida. O objetivo do presente estudo é caracterizar os doentes com ICFEI, comparando-os com os doentes com IC com FEVE reduzida (ICFER) e IC com FEVE preservada (ICFEP), já extensamente descritos na literatura.Métodos: Estudo retrospetivo e unicêntrico envolvendo 263 doentes consecutivamente admitidos numa Unidade de Cuidados Intensivos Cardíacos (UCIC) com o diagnóstico de IC aguda (ICA), durante 6 anos. Os participantes foram discriminados em três grupos, com base na FEVE: ICFER (FEVE <40%, N=182), ICFEI (LVEF 40-49%, N=34) e ICFEP (FEVE ≥50%, N=47). Procedeu-se à comparação de ICFEI com ICFER e ICFEP, no que toca aos domínios demográfico, clínico, laboratorial, ecocardiográfico, terapêutico e prognóstico. Foi realizado follow-up a 5 anos para reinternamento por ICA e mortalidade geral. O software estatístico utilizado foi o IBM SPSS, na sua versão 25. Assumiu-se significância estatística para valor p inferior a 0.05.Resultados: A idade média foi 70±14 anos e o sexo masculino foi predominante (78%). A readmissão hospitalar por ICA ocorreu em 48% dos casos, enquanto a mortalidade foi de 14% a nível intra-hospitalar e de 42% em follow-up. A prevalência de etiologia isquémica na ICFEI foi intermédia entre a ICFER e a ICFEP (ICFER 34.3% vs. ICFEI 23.5% vs. ICFEP 12.8%, p<0.001). Não foram encontradas diferenças significativas quanto à presença de congestão pulmonar, valores séricos de NT-proBNP e creatinina, bem como quanto à utilização de diuréticos da ansa por via endovenosa, inotrópicos/vasopressores simpaticomiméticos e ventilação não invasiva. Em comparação com ICFER, a ICFEI exibe taxas apenas numericamente inferiores de mortalidade hospitalar (ICFER 13.7% vs. ICFEI 5.9%, p=0.267) e de readmissão hospitalar por ICA (ICFER 52.9% vs. ICFEI 36.7%, p=0.151). Contudo, apresenta, com significância estatística, menor mortalidade no follow-up (ICFER 44.4% vs. ICFEI 20.6%, p=0.009). Quando comparada com ICFEP, a ICFEI patenteia significativamente menos mortalidade, quer hospitalar (ICFEP 23.4% vs. ICFEI 5.9%, p=0.034), quer em follow-up (ICFEP 47.8% vs. ICFEI 20.6%, p=0.012), mas semelhante risco de readmissão por ICA.Conclusões: A FEVE assume efeito diminuto em achados clínico-laboratoriais e na abordagem aguda de doentes críticos com IC. A ICFEI exibe características distintas e, notavelmente, menor mortalidade em comparação com ICFER e ICFEP. Os resultados deste estudo podem ter sido influenciados por um número relativamente reduzido de doentes com ICFEI.
Introduction: Heart failure (HF) classification has been based on left ventricular ejection fraction (LVEF). 2016 European Society of Cardiology (ESC) guidelines for the management of HF introduced a new category: LVEF between 40 and 49%, termed HF with mid-range LVEF (HFmrEF). Due to its recent conception, its natural history is unknown. The purpose of this study is to characterize HFmrEF patients, comparing them to better described HF with reduced ejection fraction (HFrEF) and HF with preserved ejection fraction (HFpEF) patients. Methods: Retrospective and single-centre study involving 263 patients consecutively admitted into a Cardiac Intensive Care Unit (CICU) for acute HF (AHF) for 6 years. Three groups were created according to LVEF: HFrEF (LVEF <40%, N=182), HFmrEF (LVEF 40-49%, N=34) and HFpEF (FEVE ≥50%, N=47). Demographic, clinical, laboratory, echocardiographic, therapeutic and prognostic data were assessed and compared. Clinical follow-up of 5 years was performed, targeting for hospital readmission for AHF and mortality. Statistical analysis was performed using IBM SPSS version 25. P-value of less than 0.05 was regarded as statistically significant.Results: Mean age was 70±14 years and male sex was predominant (78%). Hospital readmission for AHF occurred in 48%, whereas in-hospital mortality was 14% and follow-up mortality 42%. Ischemic aetiology in HFmrEF was intermediate between HFrEF and HFpEF (HFrEF 34.3% vs. HFmrEF 23.5% vs. HFpEF 12.8%, p<0.001). No statistically significant differences were found regarding congestive status, NT-proBNP and creatinine serum levels, as well as therapy with intravenous loop diuretics, sympathomimetic inotropes/vasopressors or noninvasive ventilation. When compared to HFrEF, HFmrEF patients displayed only numerically lower rates of in-hospital mortality (HFrEF 13.7% vs. HFmrEF 5.9%, p=0.267) and hospital readmission for AHF (HFrEF 52.9% vs. HFmrEF 36.7%, p=0.151) but statistically significant lesser follow-up mortality (HFrEF 44.4% vs. HFmrEF 20.6%, p=0.009). When compared to HFpEF, HFmrEF patients exhibited significantly lower mortality, both in-hospital (HFpEF 23.4% vs. HFmrEF 5.9%, p=0.034) and during follow-up (HFpEF 47.8% vs. HFmrEF 20.6%, p=0.012), but similar burden of hospitalization for AHF.Conclusions: LVEF class exerts a minor effect on both clinical and laboratory findings and on the acute management of critical AHF patients. HFmrEF patients presented distinctive features and, notably, lower mortality than both HFrEF and HFpEF patients. The results of this study might have been influenced by a relatively low number of HFmrEF patients.
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Santos, Filipe Martins da Cunha. "Prognosis of Post-Acute Myocardial Infarction Patients with Preserved Left Ventricular Ejection Fraction." Master's thesis, 2017. https://repositorio-aberto.up.pt/handle/10216/109187.
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Cerqueira, Maria Luisa Gomes. "Extracellular Vesicles Mediate of Cardiac Fibrosis in Heart Failure With Preserved Ejection Fraction." Master's thesis, 2021. https://hdl.handle.net/10216/135541.
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Cerqueira, Maria Luisa Gomes. "Extracellular Vesicles Mediate of Cardiac Fibrosis in Heart Failure With Preserved Ejection Fraction." Dissertação, 2021. https://hdl.handle.net/10216/135541.
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Santos, Filipe Martins da Cunha. "Prognosis of Post-Acute Myocardial Infarction Patients with Preserved Left Ventricular Ejection Fraction." Dissertação, 2017. https://repositorio-aberto.up.pt/handle/10216/109187.
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Glazyrine, Vassili. "The role of vascular endothelial growth factor in heart failure with preserved ejection fraction." Thesis, 2015. https://hdl.handle.net/2144/16220.
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To this day heart failure with preserved ejection fraction (HFpEF) remains a poorly understood malady. Half of all heart failure (HF) cases are HFpEF, and the prevalence of HF is on the rise. Unlike HF with reduced ejection fraction, HFpEF has no treatment options and is often times difficult to diagnose because victims of HFpEF often have pre-existing conditions. Vascular endothelial growth factor (VEGF) has been implicated in maintaining myocardial health and is thought to play a role in HFpEF. We sought to test the hypothesis that VEGF-A plays a role in HFpEF in a hypertensive murine model of HFpEF. Using Western blot analysis we found that there was an up regulation of VEGF-A in the homogenized left ventricle (LV) of our HFpEF mice. Unexpectedly, there was a down regulation of VEGF-A in the homogenized tissue from the aorta in those mice. To study the circulating levels of VEGF in our HFpEF mice we used an ELISA. We found that our HFpEF mice had similar levels of circulating VEGF as our control. This suggests that VEGF has paracrine/autocrine role in our HFpEF model rather than endocrine, like our human data suggested. To identify the cells responsible for the expression profile we saw in the homogenized tissue data we looked at the response of adult rat ventricular myocytes (ARVM) and vascular smooth muscle cells (VSMC) to aldosterone stimulation at short (1hr) and long (24hr) time points at both physiological (50nm) and pathological (1μm) concentrations. To do this analysis we recruited the help of Western blot, ELISA and RT-PCR techniques to construct a consistent VEGF expression profile. The Western blot ARVM data showed statistically significant (P<0.05) increase in VEGF-A to pathological doses of aldosterone, especially at the longer time point. When we tested the VSMC using Western blot analysis, we found that the trend of our n=1 sample suggested a strong response to the physiological dose of aldosterone in the short term. Using the more sensitive ELISA technique to measure the VEGF content of our VCMS we increasing our sample size to n=4 and found no statistically significant (p=NS) response to aldosterone stimulation from the VSMC. However, looking at the trends in the data it is clear that VSMC increases VEGF in response to long-term physiological doses of aldosterone. This is contrary to what we found using Western blot analysis, so we queried the VEGF mRNA from the VSMC to settle the score. Unfortunately, this too proved fruitless. The RT-PCR data was not significant and the trend was that of the ARVM expression profile. We initially turned to VSMC because we hypothesized that they could contribute to the paracrine/autocrine activity similar to what we saw in the LV from the ARVM. It is unclear if VSMC play a role in HFpEF progression, but their lack of consistent response to aldosterone could potential explain the down regulation of VEGF-A we observed in the aorta of our HFpEF mice. We initially sough to test the hypothesis that VEGF-A plays a role in our HFpEF mouse model, what we found was that ARVM contribute to localized VEGF-A increased production in the LV while in the aorta there is a down regulation of VEGF-A in our HFpEF model, we are unable to make any conclusion about VSMC response to aldosterone because of insufficient sample size. Thus in conclusion, it appears that VEGF-A does play a role in our HFpEF model specifically in a paracrine/autocrine manner in the LV where the ARVM contributes to the increased production of the cytokine.
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Chang, Hua-Yen, and 張驊嫣. "Evaluation of Feasible Ejection Fraction of Left Ventricular by MDCT for Cardiac Coronary Artery." Thesis, 2015. http://ndltd.ncl.edu.tw/handle/x8726p.
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碩士義守大學
資訊工程學系
103
The left ventricular ejection fraction (LVEF) estimated by multiple detector computed tomography (MDCT) is adopted to provide clinical applications. However, the estimated methods for LVEF were lack of comparison of accuracy. Hence, the geometric methods for LVEF were evaluated the accuracy and feasibility by MDCT. The estimations of LVEF on MDCT angiography were measured by single-plane area-length technique (SPA), modified Simpson technique (MST), biplane area-length technique (BPA), cylinder method (Hemi-ellipse), Teichholz, and manual drawing (i.e., the Golden of True, GOT) approaches. The significant difference between geometric method and GOT was applied t-test and analysis of variance test (ANOVA). Meanwhile, the correlation between geometric method and GOT was used regression model, Pearson’s correlation coefficients, and M-A Plot (Bland–Altman Plot). The LVEF computed by BPA was no significant difference with those of GOT (P=0.084). Moreover, the LVEF of BPA was high positive relation with those of GOT. The LVEF computed by MSA and BPA were closed to those of GOT investigated by M-A Plot with respectively to original and rotated MDCT. However, the coefficient of regression between BPA and GOT were closed to unitary no matter what original and rotated MDCT. In this study, the LVEF or LV computed by BPA could be a reliable approach to evaluate the left ventricular ejection fraction.
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Morgado, Diogo Jácome. "Iron deficiency in patients with heart failure with mid-range and preserved ejection fraction." Master's thesis, 2019. http://hdl.handle.net/10451/42951.
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Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2019Introdução: O ferro é essencial para a produção de bioenergia, eficácia do sistema imunitário e desenvolvimento do sistema nervoso central. Em pacientes com Insuficiência Cardíaca Crónica (ICC), o défice de ferro (DF) compromete a capacidade funcional, piora a qualidade de vida e aumenta a mortalidade. Não há dados sobre a identificação do DF e correção com carboximaltose férrica intravenosa (CMFiv) em pacientes com fração de ejeção intermédia e preservada (ICFEi/p). Métodos: Entre 2015 e 2016, identificámos e caracterizámos os pacientes sintomáticos com ICFEi/p que realizaram CMFiv para correção do DF, com ou sem anemia, e comparámo-los com os pacientes com ICFEr tratados no mesmo período. Depois, entre 2015 e 2018, examinámos a evolução dos pacientes com ICFEi/p face à sua classe NYHA, porção N-terminal do péptido natriurético tipo B (NTproBNP), e função renal aos três e seis meses após o tratamento. Resultados: No estudo de comparação, 52 pacientes com ICC e DF foram avaliados: idade média 86 anos, 69% eram homens. 34,6% apresentavam ICFEr e 65,4% ICFEi/p. 90,4% tinha anemia. DF funcional estava presente em 13% e 23% de ICFEr e ICFEi/p, respetivamente. Os pacientes com ICFEi/p tinham menos doença arterial coronária (44% e 78%) e menos diabetes mellitus (26% e 44%). Não se observaram diferenças nas outras comorbidades. No estudo de seguimento dos pacientes submetidos a CMFiv, identificámos 56 pacientes. 83% tinha DF absoluto e 75% anemia. 50% na classe II da NYHA e 46% na classe III. NTproBNP foi 6492pg/mL e a eGFREPI foi de 47,8mL/min/m^2. Aos três e seis meses, 59% e 61% estavam na classe II da NYHA e 39% e 37% na classe III. O NTproBNP foi 5331pg/mL e 4000pg/mL, e a eGFREPI foi 45,8mL/min/m^2 e 45,8mL/min/m^2. Conclusão: O DF é per si subavaliado na prática clínica. Aos três e seis meses após o tratamento com CMFiv, não observámos alterações significativas na eGFREPI, e constatámos uma melhoria funcional, conforme avaliada pela classe NYHA, bem como uma redução dos níveis de NTproBNP.
Introduction: Iron is essential in bioenergy production, immune system efficacity and central nervous system development. In Chronic Heart Failure (CHF) patients, ID impairs functional capacity, worsens quality of life and increases mortality. There is no data on identification and correction of ID with intravenous ferric carboxymaltose (ivFCM) in CHF patients with midrange and preserved ejection fraction (HFmr/pEF). Methods: Between 2015 and 2016 we identified and characterized symptomatic HFmr/pEF patients submitted to ivFCM treatment for ID correction with or without anemia and, compared them to the CHF patients with reduced ejection fraction (HFrEF) treated on the same period. Then, between 2015 and 2018, we investigated the evolution of HFmr/pEF patients’ NYHA class, NTproBNP and kidney function, at three and six months after treatment. Results: In the comparison study, 52 CHF patients with ID were evaluated: mean age 86 years, 69% were men, 34.6% had HFrEF and 65.4% HFmr/pEF. 90,4% had anemia. 13% and 23% of HFrEF and HFmr/pEF had respectively functional ID. HFmr/pEF patients had less ischemic heart disease (44% and 78%) and less diabetes mellitus (26% and 44%). No difference was seen in other comorbidities. In the evaluation study of patients submitted to ivFCM, 56 patients were included. 83% had absolute ID, 75% patients were anemic. 50% in NYHA class II and 46% in class III. NTproBNP was 6492pg/mL and eGFREPI was 47,8mL/min/m^2. At three and six months, 59% and 61% were in NYHA class II and 39% and 37% in class III. NTproBNP was 5331pg/mL and 4000pg/mL, the eGFREPI was 45,8mL/min/m^2 and 45,8mL/min/m^2. Conclusion: ID is per se poorly evaluated in routine practice. At three and six months after treatment with ivFCM, although no significant changes were seen in eGFREPI, a functional improvement, as assessed by the NYHA class, and a reduction of NTproBNP levels were observed.