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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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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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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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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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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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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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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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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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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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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.
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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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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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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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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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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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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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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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Wicramasingha, Arachchilage Nuwan Tharanga Karunathilaka. "The clinical utility of salivary galectin-3 in heart failure." Thesis, Queensland University of Technology, 2019. https://eprints.qut.edu.au/130826/3/Nuwan%20ArachchilageThesis.pdf.
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Heart failure (HF) is a complex syndrome that is associated with a high incidence of morbidity and mortality, currently affecting more than 26 million people worldwide and accounts for a substantial number of hospitalisations, major healthcare resource utilisation and cost. Galectin-3 plays an important role in inflammation and cardiac remodelling and is potentially a novel biomarker for HF. Recent studies have shown the prognostic value of serum galectin-3 levels in HF. However, this requires blood sampling, which limits its broader application within a community setting. Saliva is emerging as a diagnostic fluid of choice due to its non-invasiveness, ease of collection and the possibility to collect multiple samples from a person within a day, which makes it an attractive biological fluid for analysis. The potential role of salivary galectin-3 in HF has not been explored. Our aim was to investigate the potential prognostic utility of salivary galectin-3 levels in HF patients.
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Kadri, Amer N., Roop Kaw, Yasser Al-Khadra, Hasan Abumasha, Keyvan Ravakhah, Adrian V. Hernandez, and Wai Hong Wilson Tang. "The role of B-type natriuretic peptide in diagnosing acute decompensated heart failure in chronic kidney disease patients." Termedia Publishing House Ltd, 2018. http://hdl.handle.net/10757/624714.
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Introduction: Chronic kidney disease (CKD) and congestive heart failure (CHF) patients have higher serum B-type natriuretic peptide (BNP), which alters the test interpretation. We aim to define BNP cutoff levels to diagnose acute decompensated heart failure (ADHF) in CKD according to CHF subtype: heart failure with preserved ejection fraction (HFpEF) and heart failure with reduced ejection fraction (HFrEF). Material and methods: We reviewed 1,437 charts of consecutive patients who were admitted for dyspnea. We excluded patients with normal kidney function, without measured BNP, echocardiography, or history of CHF. BNP cutoff values to diagnose ADHF for CKD stages according to CHF subtype were obtained for the highest pair of sensitivity (Sn) and specificity (Sp). We calculated positive and negative likelihood ratios (LR+ and LR–, respectively), and diagnostic odds ratios (DOR), as well as the area under the receiver operating characteristic curves (AUC) for BNP. Results: We evaluated a cohort of 348 consecutive patients: 152 had ADHF, and 196 had stable CHF. In those with HFpEF with CKD stages 3–4, BNP < 155 pg/ml rules out ADHF (Sn90%, LR– = 0.26 and DOR = 5.75), and BNP > 670 pg/ml rules in ADHF (Sp90%, LR+ = 4 and DOR = 6), with an AUC = 0.79 (95% CI: 0.71–0.87). In contrast, in those with HFrEF with CKD stages 3–4, BNP < 412.5 pg/ml rules out ADHF (Sn90%, LR– = 0.19 and DOR = 9.37), and BNP > 1166.5 pg/ml rules in ADHF (Sp87%, LR+ = 3.9 and DOR = 6.97) with an AUC = 0.78 (95% CI: 0.69–0.86). All LRs and DOR were statistically significant. Conclusions: BNP cutoff values for the diagnosis of ADHF in HFrEF were higher than those in HFpEF across CKD stages 3–4, with moderate discriminatory diagnostic ability.Revisión por pares
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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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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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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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Averin, Konstantin M. D. "Diagnosis of Occult Diastolic Dysfunction Late After the Fontan Procedure Using a Rapid Volume Expansion Technique." University of Cincinnati / OhioLINK, 2016. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1458299500.
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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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Herdy, Artur Haddad. "Resposta anormal da função sistólica do ventrículo esquerdo ao exercício submáximo em pacientes submetidos à ventriculectomia parcial esquerda." reponame:Biblioteca Digital de Teses e Dissertações da UFRGS, 2002. http://hdl.handle.net/10183/2951.
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Introdução. Pacientes com insuficiência cardíaca submetidos à ventriculectomia parcial esquerda apresentam melhora na função sistólica do ventrículo esquerdo em repouso, porém continuam apresentando limitação funcional. Objetivo. Para melhor compreender os mecanismos desta limitação funcional, estudamos a função sistólica e diastólica do ventrículo esquerdo em repouso e durante exercício submáximo em pacientes submetidos a ventriculectomia parcial esquerda e em pacientes com insuficiência cardíaca não operados, pareados para capacidade funcional máxima e submáxima. Métodos. Foram estudados 9 pacientes submetidos previamente a ventriculografia parcial esquerda (VPE) e 9 pacientes com insuficiência cardíaca não operados previamente (IC). Todos os pacientes foram submetidos inicialmente a um teste cardiopulmonar para determinação do consumo de oxigênio no limiar anaeróbio (LA) e de pico (VO2 pico). Após, foram estudados através da ventriculografia radioisotópica e analisadas a fração de ejeção (FE) e a taxa máxima de enchimento (TME) do ventrículo esquerdo, em repouso e exercício na intensidade do LA. Resultados. Os grupos apresentaram capacidade funcional semelhante avaliada pelo VO2 pico (VPE: [média ± DP] 13,1 ± 3,3 ml/kg.min; IC: 14,1 ± 3,6 ml/kg.min; P > 0,05) e LA (VPE: 7,9 ± 1.3 ml/kg.min; IC: 8,5 ± 1,6 ml/kg.min; P > 0,05). A frequência cardíaca máxima foi maior no grupo IC em comparação ao grupo da VPE (VPE: 119 ± 20 bpm; IC: 149 ± 21 bpm; P < 0.05) A FE em repouso era mais elevada no grupo VPE (VPE: 40 ± 12 %; IC: 32 ± 9 %; P < 0,0125), entretanto a FE elevou-se do repouso ao LA apenas no grupo IC (VPE: 44 ± 17 %; IC: 39 ± 11 %; P < 0,0125). A TME foi semelhante em repouso (VPE: 1,41 ± 0,55 VDF/s; IC: 1,39 ± 0,55 VDF/s; P > 0,05) e aumentou na intensidade do LA similarmente em ambos os grupos (VPE: 2,28 ± 0,55 VDF/s; IC: 2,52 ± 1,07 VDF/s; P < 0,0125). Conclusão. Pacientes submetidos a ventriculectomia parcial esquerda apresentam uma o limiar anaeróbio (LA) resposta anormal da função sistólica do ventrículo esquerdo ao exercício na intensidade do LA e uma resposta cronotrópica diminuida ao exercício máximo. Essas respostas anormais podem contribuir para a limitada capacidade ao exercício destes pacientes, a despeito da melhora na função ventricular sistólica em repouso.Background. Patients with heart failure who have undergone partial left ventriculectomy improve resting left ventricular systolic function, but maintain limited functional capacity. Objective. In order to better understand the mechanisms associated with this limitation, we studied the systolic and diastolic left ventricular function at rest and during submaximal exercise in patients with previous partial left ventriculectomy and in patients with heart failure who had not been operated, matched for maximal and submaximal exercise capacity. Methods: Nine patients with heart failure who were previously submitted to partial left ventriculectomy (PLV) were compared with a group of 9 patients with heart failure who had not been operated. All patients performed a cardiopulmonary exercise testing with measurement of peak oxygen uptake (VO2 peak) and anaerobic threshold (AT). In a second evaluation, radionuclide left ventriculography was performed to analyze ejection fraction (EF) and peak filling rate (PFR) at rest and during exercise at the intensity corresponding to the AT. Results: Groups presented similar exercise capacity evaluated by VO2peak (PLV: [mean ± SD] 13.1 ± 3.3 mL/Kg.min; HF: 14.1 ± 3.6 mL/Kg.min; P > 0.05) and AT (PLV: 7.9 ± 1.3 mL/Kg.min; HF: 8.5 ± 1.6 mL/Kg.min; P > 0.05). Maximal heart rate was higher in the HF group when compared to the PLV group (PLV: 119 ± 20 bpm; HF: 149 ± 21 bpm; P < 0.05). EF at rest was higher in the PLV group (PLV: 40 ± 12 %; HF: 32 ± 9 %; P < 0.0125), however EF increased from rest to AT only in the HF group (PLV: 44 ± 17 %; HF: 39 ± 11 %; P < 0.0125). PFR was similar at rest (PLV: 1.41 ± 0.55 EDV/sec; HF: 1.39 ± 0.55 EDV/sec; P > 0.05) and increased in both groups at the AT intensity (PLV: 2.28 ± 0.55 EDV/sec; HF: 2.52 ± 1.07 EDV/sec; P < 0,0125). Conclusion: Patients who had partial left ventriculectomy present an abnormal response of left ventricular systolic function to exercise at the AT intensity and an impaired chronotropic response to maximal exercise. These abnormal responses may contribute to the limited exercise capacity of these patients, despite the improvement in resting left ventricular systolic function.
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Lachaux, Marianne. "Nouvelles cibles pharmacologiques du traitement de la dysfonction cardiovasculaire associée au syndrome métabolique." Thesis, Normandie, 2019. http://www.theses.fr/2019NORMR010.
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Le syndrome métabolique (SM) est associé avec une augmentation du risque de survenue d’évènements cardiovasculaires et plus particulièrement d’insuffisance cardiaque à fraction d’éjection préservée (ICFEp). L’ICFEp représente environ 50% des IC totales, cependant, à ce jour, aucun traitement n’a permis de diminuer significativement la mortalité. L’ICFEp associée au SM, bien que d’origine multifactorielle, est caractérisée par une activation du système endothélinergique, une surexpression du récepteur minéralocorticoïde ainsi qu’une dysfonction mitochondriale participant à l’établissement et au maintien de la pathologie. Nous avons évalué dans trois études distinctes les effets à court-terme (1 semaine) et long-terme (3 mois) de trois médicaments ciblant ces systèmes biologiques, sur les dysfonctions cardiovasculaires observées dans un modèle d’ICFEp associée au SM, le rat Zucker fa/fa. Ainsi nous avons utilisé un antagoniste des récepteurs de l’endothéline, le macitentan, un antagoniste du récepteur minéralocorticoide, la finérénone, ainsi que d’une molécule diminuant la dysfonction mitochondriale, l’iméglimine. Dans les trois études à court-terme nous avons retrouvé une amélioration de la dysfonction diastolique, une augmentation de la perfusion cardiaque ainsi qu’une restauration de la relaxation coronaire endothélium dépendante. Ces améliorations étaient associées à une diminution de la production d’espèces réactives de l’oxygène au niveau du ventricule gauche. Dans les trois études à long-terme nous avons obtenus les mêmes résultats sur les fonctions vasculaire et cardiaque avec au niveau structurel une diminution du collagène interstitiel cardiaque. La production d’espèces réactives de l’oxygène était également diminuée avec les trois traitements Cette étude montre que, dans un modèle d’ICFEp associée au SM, le blocage des récepteurs de l’endothéline ou du récepteur minéralocorticoide, ou la prévention de la dysfonction mitochondriale permettent d’améliorer les dysfonctions cardiaque et vasculaire probablement via une diminution du stress oxydantMetabolic Syndrome (MS) is associated with an increase in cardiovascular adverse events and specifically with heart failure with preserved ejection fraction (HFpEF). HFpEF represents up to 50% of HF however, no treatment effective on mortality has been yet identified. MS related-HFpEF is a multifactorial syndrome in which an increase in endothelin signaling, in mineralocorticoid receptor activation as well as mitochondria dysfunction is found and participate to the pathology. The present goal of the thesis was to evaluate in three different projects the effects of short- (1 week) and long-term (3 months) treatments, each targeting one of these biological systems, on cardiovascular dysfunction observed in a rat model of MS associated HFpEF. We have chosen the endothelin receptors antagonist macitentan, the mineralocorticoid receptor antagonist finerenone and the new glucose-lowering agent imeglimin. Our results clearly show after the short-term studies an improvement in diastolic dysfunction, an increase in myocardial perfusion as well as restoration of endothelium-dependent coronary relaxation with the 3 treatments. All these improvements were associated with a decrease in left ventricular (LV) reactive oxygen species production (ROS). We obtained the same results after the long-term studies with a decrease in LV interstitial collagen deposition. ROS production was also decreased with the 3 components. This study clearly shows that in a rat model of MS related-HFpEF, blocking endothelin receptors or mineralocorticoid receptors as well as preventing mitochondrial dysfunction is associated with an improvement in cardiac and vascular dysfunctions. These improvements probably involve, among other mechanisms, a decrease in oxidative stress
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Champ-Rigot, Laure. "Nouvelles perspectives diagnostiques et thérapeutiques dans la prise en charge rythmologique des patients en situation d'insuffisance cardiaque Rationale and Design for a Monocentric Prospective Study: Sleep Apnea Diagnosis Using a Novel Pacemaker Algorithm and Link With Aldosterone Plasma Level in Patients Presenting With Diastolic Dysfunction (SAPAAD Study) Usefulness of sleep apnea monitoring by pacemaker sensor in elderly patients with diastolic dysfunction : the SAPAAD Study Clinical outcomes after primary prevention defibrillator implantation are better predicted when the left ventricular ejection fraction is assessed by magnetic resonance imaging Predictors of clinical outcomes after cardiac resynchronization therapy in patients ≥75 years of age: a retrospective cohort study Comparison between novel and standard high-density 3D electro-anatomical mapping systems for ablation of atrial tachycardia Safety and acute results of ultra-high density mapping to guide catheter ablation of atrial arrhythmias in heart failure patients Long-term clinical outcomes after catheter ablation of atrial arrhythmias guided by ultra-high density mapping system in heart failure patients." Thesis, Normandie, 2019. http://www.theses.fr/2019NORMC430.
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L’insuffisance cardiaque est un problème de santé publique dans les pays développés, touchant 1 à 2% de la population générale, mais dont la prévalence atteint 10% après 70 ans. Les progrès thérapeutiques ont permis d’améliorer le pronostic des patients, notamment ceux ayant une altération de la fonction systolique ventriculaire gauche. Les troubles du rythme sont fréquents et nécessitent une pris en charge particulière au cours des situations d’insuffisance cardiaque. Cependant, il reste des questions non résolues : comment améliorer l’efficacité du traitement de l’insuffisance cardiaque à fonction systolique préservée, comment mieux sélectionner les patients pouvant bénéficier de la prévention primaire de la mort subite par un défibrillateur implantable, les patients âgés peuvent-ils bénéficier de la même prise en charge que les patients plus jeunes, et pour finir comment améliorer les résultats de l’ablation de fibrillation auriculaire dans les situations d’insuffisance cardiaque. Nous avons mis en place une étude prospective chez des patients présentant une dysfonction diastolique pour évaluer l’intérêt de l’algorithme de surveillance de l’apnée du sommeil disponible dans des stimulateurs cardiaques. En parallèle, nous avons analysé l’impact de l’évaluation par résonance magnétique des patients candidats à un défibrillateur sur la prédiction des évènements rythmiques, mais aussi le devenir des patients de plus de 75 ans appareillés avec un système de resynchronisation cardiaque. Enfin, nous nous sommes intéressés aux résultats d’un nouveau système de cartographie électroanatomique ultra-haute densité pour guider les procédures d’ablation de troubles du rythme supraventriculaires complexes chez des patients insuffisants cardiaques comparés à des patients contrôlesHeart failure is a major public health issue in developed countries, with a prevalence of 1-2% of global population, rising to 10% after 70 years of age. Therapeutic progresses have succeeded in improving patients’ prognosis, particularly in case of reduced left ventricular ejection fraction. Rhythm abnormalities are frequent, and need special consideration in case of heart failure. Meanwhile, there are still some gaps in the evidence: heart failure with preserved systolic function is complex and difficult to treat, primary prevention of sudden cardiac death is effective but there is a need to better select candidates, whether elderly patients should be treated as younger individuals, and finally how to improve outcomes of atrial fibrillation catheter ablation. Firstly, we have conducted a prospective study to evaluate the Sleep Apnea Monitoring algorithm provided in a novel pacemaker in patients with diastolic dysfunction. Besides, we analyzed whether magnetic resonance imaging could predict cardiac outcomes in patients with an implantable cardioverter defibrillator better than echocardiography. We also reported the outcomes of the cardiac resynchronization therapy in patients ≥75 years old compared to younger patients. Finally, we studied the results of a novel ultra-high density mapping system to guide ablation procedures of complex atrial arrhythmias in heart failure patients compared to controls
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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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Teixeira, Hugo Ricardo Leal. "Characterization of patients with heart failure and reduced ejection fraction attending two Heart Failure clinics in Portugal and in Mozambique." Master's thesis, 2013. https://repositorio-aberto.up.pt/handle/10216/82850.
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Teixeira, Hugo Ricardo Leal. "Characterization of patients with heart failure and reduced ejection fraction attending two Heart Failure clinics in Portugal and in Mozambique." Dissertação, 2013. https://repositorio-aberto.up.pt/handle/10216/82850.
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Ferreira, Mariana Filipa Pereira. "Catheter Ablation of Atrial Fibrillation in Patients with Heart Failure with Reduced Left Ventricular Ejection Fraction: An Updated Systematic Review." Master's thesis, 2020. https://hdl.handle.net/10216/128722.
Full textAbstract:
Objetivo: Realizar uma revisão sistemática dos ensaios clínicos randomizados relativa à ablação por cateter da fibrilhação auricular (FA) em doentes com insuficiência cardíaca (IC) com fração de ejeção reduzida.
Métodos: Pesquisa efetuada em duas bases de dados: Medline (PubMed) and ISI Web of Science.
Resultados: Nove estudos foram selecionados para a análise sistemática. Doentes submetidos a ablação tiveram maiores taxas de resolução de FA em comparação com doentes a fazer a tratamento médico. Para além disso observou-se melhoria da sintomatologia associada à IC, capacidade funcional, qualidade de vida e função ventricular esquerda.
Conclusão: A ablação por cateter poderá ser uma valiosa opção terapêutica a ter em conta em doentes com associação de FA e IC com fração de ejeção reduzida uma vez que este mostrou ser um tratamento com melhores resultados clínicos em comparação com o tratamento médico, nomeadamente no que respeita à sintomatologia, capacidade funcional, qualidade de vida, função ventricular esquerda e resolução da FA. Além disso, poderá ainda ter um papel relevante na diminuição da mortalidade global.
Palavras-chave: Ablação por cateter; Fibrilhação Auricular; Insuficiência cardíaca; Fração de ejeção reduzida; Revisão sistemática.Aim: Systematic review of clinical trials concerning catheter ablation of atrial fibrillation (AF) in patients with heart failure with reduced left ventricular ejection fraction (HF). Methods: Search conducted in two databases: Medline (PubMed) and ISI Web of Science. Results: Nine studies were selected for further analysis. Ablation led to higher AF freedom rates compared to medical treatment, and also improved heart failure symptoms, functional capacity, quality of life and left ventricular function. Conclusions: Catheter ablation can be a valuable treatment option in patients with of atrial fibrillation and heart failure with reduced ejection fraction since it leads to favourable clinical outcomes such as improvement of heart failure symptoms, functional capacity, quality of life, left ventricular function improvement as well as higher AF freedom rates when compared with medical treatment. Furthermore, catheter ablation may have a relevant role in reduction of overall mortality. KEYWORDS: Catheter Ablation; Atrial Fibrillation; Heart Failure; Reduced Left Ventricular Ejection Fraction; Systematic Review.
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Ferreira, Mariana Filipa Pereira. "Catheter Ablation of Atrial Fibrillation in Patients with Heart Failure with Reduced Left Ventricular Ejection Fraction: An Updated Systematic Review." Dissertação, 2020. https://hdl.handle.net/10216/128722.
Full textAbstract:
Objetivo: Realizar uma revisão sistemática dos ensaios clínicos randomizados relativa à ablação por cateter da fibrilhação auricular (FA) em doentes com insuficiência cardíaca (IC) com fração de ejeção reduzida.
Métodos: Pesquisa efetuada em duas bases de dados: Medline (PubMed) and ISI Web of Science.
Resultados: Nove estudos foram selecionados para a análise sistemática. Doentes submetidos a ablação tiveram maiores taxas de resolução de FA em comparação com doentes a fazer a tratamento médico. Para além disso observou-se melhoria da sintomatologia associada à IC, capacidade funcional, qualidade de vida e função ventricular esquerda.
Conclusão: A ablação por cateter poderá ser uma valiosa opção terapêutica a ter em conta em doentes com associação de FA e IC com fração de ejeção reduzida uma vez que este mostrou ser um tratamento com melhores resultados clínicos em comparação com o tratamento médico, nomeadamente no que respeita à sintomatologia, capacidade funcional, qualidade de vida, função ventricular esquerda e resolução da FA. Além disso, poderá ainda ter um papel relevante na diminuição da mortalidade global.
Palavras-chave: Ablação por cateter; Fibrilhação Auricular; Insuficiência cardíaca; Fração de ejeção reduzida; Revisão sistemática.Aim: Systematic review of clinical trials concerning catheter ablation of atrial fibrillation (AF) in patients with heart failure with reduced left ventricular ejection fraction (HF). Methods: Search conducted in two databases: Medline (PubMed) and ISI Web of Science. Results: Nine studies were selected for further analysis. Ablation led to higher AF freedom rates compared to medical treatment, and also improved heart failure symptoms, functional capacity, quality of life and left ventricular function. Conclusions: Catheter ablation can be a valuable treatment option in patients with of atrial fibrillation and heart failure with reduced ejection fraction since it leads to favourable clinical outcomes such as improvement of heart failure symptoms, functional capacity, quality of life, left ventricular function improvement as well as higher AF freedom rates when compared with medical treatment. Furthermore, catheter ablation may have a relevant role in reduction of overall mortality. KEYWORDS: Catheter Ablation; Atrial Fibrillation; Heart Failure; Reduced Left Ventricular Ejection Fraction; Systematic Review.
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Lopes, José Carlos Martins. "Endothelial progenitor cells and circulating endothelial cells in heart failure: a cross-sectional study." Master's thesis, 2021. http://hdl.handle.net/10773/30667.
Full textAbstract:
The objective of the present thesis was to compare the levels of circulating
endothelial progenitor cells (EPCs), circulating endothelial cells (CECs), and
hematopoietic stem cells (HSCs) between patients with heart failure with reduced
ejection fraction (HFrEF) and a group of subjects with cardiovascular risk factors.
We also compared the levels of circulating EPCs, CECs, and HSCs between
subgroups regarding the presence of cardiovascular risk factors (e.g. diabetes
mellitus) and the etiology of heart failure (HF). To achieved this, whole peripheral
blood was drawn from patients previously diagnosed with HFrEF (n = 42) and
age-matched subjects presenting similar cardiovascular risk factors but without
established cardiovascular disease (n = 42). Then, a combination of markers was
used in peripheral blood samples in order to assess the number of circulating
EPCs, CECs, and HSCs via flow cytometry analysis. Patients with HFrEF had
significantly decreased levels of circulating EPCs (5.28 x 10-3 ± 6.83 x 10-4 % vs
7.76 x 10-3 ± 4.91 x 10-4 %, P ≤ 0.001) and CECs (5.11 x 10-3 ± 7.87 x 10-4 % vs
6.51 x 10-3 ± 5.21 x 10-4 %, P = 0.005) compared to subjects with cardiovascular
risk factors. However, levels of HSCs were not significantly different between the
two groups (P = 0.590). Additionally, CECs (6.69 x 10-3 ± 6.38 x 10-3 % vs 3.61 x
10-3 ± 2.71 x 10-3 %, P = 0.057) tended to circulate in higher number in patients
with ischemic HF compared to patients with non-ischemic HF. Patients with
HFrEF and diagnosed as overweight/obese had significantly higher levels of
circulating EPCs (6.10 x 10-3 ± 4.78 x 10-3 % vs 4.13 x 10-3 ± 3.55 x 10-3 %, P =
0.043) and CECs (6.27 x 10-3 ± 5.66 x 10-3 % vs 3.47 x 10-3 ± 3.54 x 10-3 %, P =
0.019) when compared to patients with HFrEF presenting a normal weight.
Lastly, when comparing subjects from the age-matched group, subjects with
dyslipidemia had significantly higher levels of CECs (7.74 x 10-3 ± 3.64 x 10-3 %
vs 5.34 x 10-3 ± 2.59 x 10-3 %, P = 0.042) compared to subjects without
dyslipidemia. In conclusion, the main result of this study is that the circulating
levels of EPCs and CECs were significantly decreased in patients with HFrEF in
comparison to subjects with cardiovascular risk factors. The current observations
regarding cardiovascular risk factors suggest that EPCs, CECs, and HSCs play
an important role in the detection and repair of vascular damage and endothelial
dysfunction.O presente trabalho teve como principal objetivo comparar os níveis de células endoteliais progenitoras (CEPs), células endoteliais circulantes (CECs) e células estaminais hematopoiéticas (CEHs) em circulação entre doentes com insuficiência cardíaca com fração de ejeção reduzida (ICFEr) e um grupo de adultos com fatores de risco cardiovasculares. Adicionalmente, os níveis das CEPs, CECs e CEHs foram comparados entre subgrupos em função da presença de fatores de risco (ex. diabetes) e da etiologia da insuficiência cardíaca. Inicialmente foram recolhidas amostras de sangue periférico de doentes com ICFEr (n = 42) e indivíduos da mesma faixa etária com fatores de risco cardiovasculares, mas sem qualquer doença cardiovascular estabelecida (n = 42). Em seguida, foi utilizada uma combinação de anticorpos nas amostras de sangue periférico para quantificação do número de CEPs, CECs e CEHs por citometria de fluxo. Doentes com ICFEr apresentaram níveis de CEPs (5.28 x 10-3 ± 6.83 x 10-4 % vs 7.76 x 10-3 ± 4.91 x 10-4 %, P ≤ 0.001) e CECs (5.11 x 10- 3 ± 7.87 x 10-4 % vs 6.51 x 10-3 ± 5.21 x 10-4 %, P = 0.005) significativamente inferiores aos indivíduos com fatores de risco cardiovasculares. Contudo, não foram encontradas diferenças significativas nos níveis de CEHs entre os dois grupos (P = 0.590). Adicionalmente, observou-se que as CECs (6.69 x 10-3 ± 6.38 x 10-3 % vs 3.61 x 10-3 ± 2.71 x 10-3 %, P = 0.057) tendem a circular em maior número em doentes com ICFEr com etiologia isquémica comparativamente a doentes com ICFEr não isquémica. Doentes com ICFEr e com sobrepeso/obesidade apresentaram níveis de CEPs (6.10 x 10-3 ± 4.78 x 10-3 % vs 4.13 x 10-3 ± 3.55 x 10-3 %, P = 0.043) e CECs (6.27 x 10-3 ± 5.66 x 10- 3 % vs 3.47 x 10-3 ± 3.54 x 10-3 %, P = 0.019) significativamente superiores comparativamente a doentes com ICFEr e com peso normal. Por último, dentro do grupo de indivíduos com fatores de risco cardiovasculares, indivíduos com dislipidemia apresentaram níveis de CECs (7.74 x 10-3 ± 3.64 x 10-3 % vs 5.34 x 10-3 ± 2.59 x 10-3 %, P = 0.042) significativamente superiores em comparação a indivíduos sem dislipidemia. Em conclusão, os principais resultados deste estudo indicam que o número de CECs e CEPs em circulação encontra-se significativamente reduzido em doentes com ICFEr comparativamente a indivíduos com fatores de risco para doenças cardiovasculares. As observações atuais em relação aos fatores de risco para doenças cardiovasculares sugerem que CEPs, CECs e CEHs desempenham um papel fundamental na sinalização e reparação do dano vascular e disfunção endotelial.
Mestrado em Biomedicina Molecular
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Woessner, Mary. "BEET-HF: The Effects of Dietary Inorganic Nitrate Supplementation on Aerobic Exercise Performance, Vascular Function, Cardiac Performance and Mitochondrial Respiration in Patients with Heart Failure with Reduced Ejection Fraction." Thesis, 2019. https://vuir.vu.edu.au/40041/.
Full textAbstract:
Chronic heart failure (CHF) is characterised by an inability of the heart to pump enough blood to meet the body’s metabolic needs, resulting in exercise intolerance. A reduction in nitric oxide (NO) bioavailability has been implicated as an initiator and/or contributor to many of the peripheral skeletal tissue dysfunctions that contribute to the exercise intolerance in patients with CHF. Inorganic nitrate supplementation has been identified as an important mediator of exercise tolerance via increasing NO bioavailability, but the potential efficacy of this on patients with heart failure with reduced ejection fraction (HFrEF) as well as the effect on vascular function is not well understood and was the focus of Study 1. Additionally, to our knowledge, no previous study has examined the potential impact of nitrate supplementation on cardiac performance during submaximal exercise and mitochondrial respiration in individuals with HFrEF. These were the foci of Studies 2 and 3 respectively.
Study 1: The effect of dietary inorganic nitrate supplementation on exercise tolerance and vascular function in patients with HFrEF.
The primary aim of this study was to determine the effect of chronic inorganic nitrate supplementation on exercise tolerance, as measured by peak aerobic capacity (VO2peak) and time to exhaustion (TTE), during treadmill exercise in patients with HFrEF. A secondary aim was to determine the effect of chronic supplementation on vascular function (endothelial function) in these patients. Methods: Sixteen patients with HFrEF (15 men and 1 woman, 63 ± 4 y, BMI: 31.8 ±2.1 kg∙m-2) completed the primary outcome of this study (exercise tolerance), and 12 completed the vascular function component. Participants were randomly allocated, in a double-blind, crossover design, to consume either a nitrate rich beetroot juice (16mmol nitrate/day), or a nitrate-depleted placebo for five days prior to the first testing visit. Participants then continued daily dosing until they completed a cardiopulmonary exercise test (CPX) and a battery of vascular function assessments (peripheral and central blood pressure (BP) as well as aortic stiffness and brachial artery flow mediated dilation (BAFMD)). Results: There were significant increases in both plasma nitrate (p<0.001) and nitrite (p<0.05) following nitrate supplementation. No significant differences were observed in either VO2peak (nitrate 18.5 ± 5.7 ml∙kg-1∙min-1, placebo: 19.3 ± 1.4 ml∙kg-1∙min-1; p=0.13) or TTE (nitrate: 1165 ± 92 sec, placebo: 1207 ± 96 sec, p=0.16) between the two interventions. Similarly, there were no significant (p>0.05) changes in peripheral tissue oxygenation during exercise, as measured non-invasively with near-infrared spectroscopy (NIRS). There were no differences in the brachial blood pressure measurements including systolic blood pressure (SBP) (nitrate: 130 ± 4 mmHg, placebo: 132 ± 5 mmHg, p=0.58), diastolic blood pressure (DBP) (nitrate: 80 ± 3 mmHg, placebo: 81 ± 3 mmHg, p= .74) and mean arterial pressure (MAP) (nitrate: 96 ± 3 mmHg, placebo: 98 ± 4 mmHg, p=0.67). There were also no significant differences in aortic pressure or stiffness. BAFMD reactive hyperaemic percent change tended to improve (nitrate: 5.7% ± 1.1, placebo: 4.1% ± 0.7, (p=0.06), and this change had a moderate effect size (ES) (Cohen’s d 0.607). Conclusions: Results from this study indicate the nitrate appears ineffective at improving exercise tolerance and vascular function in HFrEF. Future studies should explore alternative interventions to improve peripheral muscle tissue function in HFrEF.
Study 2: The effect of dietary nitrate supplementation on cardiac output and stroke volume during submaximal exercise in men with HFrEF: a pilot study.
The primary aim of this exploratory study was to determine the effect of chronic inorganic nitrate supplementation on cardiac performance during three submaximal exercise bouts. Methods: Five male patients with HFrEF (61 ± 3y) completed this pilot study. Participants consumed either the nitrate-rich beetroot juice (16 mmol nitrate) or the placebo an average of 13 ± 2 days prior to the testing visit. They completed a three-stage (15-25 watts, 25-40 watts and 35-60 watts) discontinuous exercise protocol on an echo-compatible recumbent cycle ergometer with simultaneous Doppler echocardiography. Cardiac output (Q̇) and stroke volume (SV) were derived using the Doppler velocity time integral via the Huntsman method. Results: There were significant increases in both plasma nitrate (p=0.004, ES=3.54) and nitrite (p=0.01, ES=0.82) following nitrate supplementation. Although not statistically significant (all p>0.27), the differences in Q̇during stage two and stage three had medium to large ES (stage two: nitrate: 6.4 ± .4 L∙min-1, placebo: 5.3 ±. 2 L∙min-1, ES=1.51; stage three: nitrate: 7.5 ± 0.6 L∙min-1, placebo: 6.4 ± 0.7 L∙min-1, ES=0.50) exercise. Changes in Q̇ were accompanied by medium to large ES changes in SV (stage two: ES=0.97 and stage three: ES=0.57) and medium to large increases in heart rate (HR) at rest and all exercise stages. These differences were likely mediated by a reduction in total peripheral resistance (TPR) at stage two (ES=-1.62) and stage three (ES=-0.81). Conclusions: We report potentially clinically important improvements in measures of cardiac performance during submaximal exercise following nitrate supplementation in patients with HFrEF. The initial findings from this pilot study warrant further investigation in larger and more diverse samples in order to determine the efficacy of this intervention.
Study 3: The effect of dietary nitrate supplementation on mitochondrial respiration in men with HFrEF.
The primary aim of this exploratory study was to determine the effect of chronic inorganic nitrate supplementation on parameters of mitochondrial respiration in patients with HFrEF. Methods: Seven male participants (62 ± 2y) completed this invasive study. Participants consumed the nitrate rich beetroot juice (16mmol nitrate/day) or a placebo for an average of 15 ± 2 days prior to their muscle biopsy. Muscle samples were taken from the vastus lateralis. Mitochondrial respiration was assessed using high resolution respirometry. Western blot analysis was used to assess the protein content of mechanistic target of rapamycin complex 1 (mTORC1), p38 mitogen activated protein kinase (p38MAPK), protein kinase B (Akt), and peroxisome proliferator-activated receptor gamma coactivator 1 alpha (PGC-1α). Results: Plasma nitrate increased (831%, p<0.001) following supplementation. Plasma nitrite also increased (100%) but this was not statistically significant (p=0.22). There were no differences in skeletal muscle maximal oxidative phosphorylation capacity as assessed as either mass-specific (p=0.93) or mitochondrial-specific (p=0.68) respiratory function of (CI+CII)p, nor were there any significant differences in other parameters of mitochondrial respiration (all p>0.05). Similarly, there were no differences in mitochondrial content, as assessed by citrate synthase activity (p=0.73) and no differences were noted in total and phosphorylated forms of mTORC1, p38MAPK, Akt, or PGC-1α (all p>0.10). Conclusions: Short-term nitrate supplementation, as a standalone treatment, may not be an effective way to improve mitochondrial function in patients with HFrEF and, as such, it may be clinically important to combine nitrate supplementation with other interventions known to affect mitochondrial function, such as exercise training.
General Conclusions.
Short-term inorganic nitrate supplementation had no effect on exercise tolerance (Study 1-Chapter 4), peripheral tissue oxygenation (Study 1- Chapter 4), or mitochondrial respiration (Study 3- Chapter 6) in patients with HFrEF. However, it may have a meaningful clinical effect on Q̇and SV during submaximal exercise (Study 2- Chapter 5). It may also improve vascular function (Chapter 4), reduce TPR (Chapter 5) and reduce DBP and MAP during submaximal exercise (Chapter 5) in these patients. Overall the data suggest that nitrate supplementation may be used in conjunction with other pharmacological and non-pharmacological (exercise training) interventions to improve clinical outcomes in this population. This hypothesis should be explored in the future by conducting a large-scale clinical trial.
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Sasse, André. "Einfluss des lymphatischen Systems auf die Entwicklung einer Herzinsuffizienz durch Erhöhung der Nachlast." Doctoral thesis, 2017. http://hdl.handle.net/11858/00-1735-0000-0023-3F97-4.
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Durstewitz, Kathleen. "Einfluss von typischen Komorbiditäten auf die Ausprägung der Symptomatik bei Herzinsuffizienz mit eingeschränkter und erhaltener linksventrikulärer Funktion." Doctoral thesis, 2012. http://hdl.handle.net/11858/00-1735-0000-000D-F02A-D.
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Li, Shanpeng. "Novel pathways of heart failure with preserved ejection fraction." Thesis, 2015. https://hdl.handle.net/2144/16263.
Full textAbstract:
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.
Full textAbstract:
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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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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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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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.
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Silva, Daniela Maria Miranda da. "Plasma levels of adipokines in an model of heart failure with preserved ejection fraction." Master's thesis, 2012. https://repositorio-aberto.up.pt/handle/10216/91951.
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Leite, Sara Vanessa de Amorim. "New physiological mechanisms, diagnostic and therapeutic approaches in heart failure with preserved ejection fraction." Doctoral thesis, 2020. https://hdl.handle.net/10216/129305.
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Leite, Sara Vanessa de Amorim. "New physiological mechanisms, diagnostic and therapeutic approaches in Heart Failure with Preserved Ejection Fraction." Tese, 2020. https://hdl.handle.net/10216/129305.
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