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充血性心力衰竭

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Sex Differences in Heart Failure With Preserved Ejection Fraction Pathophysiology: A Detailed Invasive Hemodynamic and Echocardiographic Analysis In acute HF and iron deficiency, IV ferric carboxymaltose reduced HF hospitalizations, but not CV death, at 1 y A Fully Magnetically Levitated Circulatory Pump for Advanced Heart Failure Baseline Features of the VICTORIA (Vericiguat Global Study in Subjects With Heart Failure With Reduced Ejection Fraction) Trial The year in cardiology: heart failure: The year in cardiology 2019 Nuclear Imaging of the Cardiac Sympathetic Nervous System: A Disease-Specific Interpretation in Heart Failure The pyruvate-lactate axis modulates cardiac hypertrophy and heart failure Age-Related Characteristics and Outcomes of Patients With Heart Failure With Preserved Ejection Fraction Mechanical circulatory support devices in advanced heart failure: 2020 and beyond Natriuretic Peptide-Guided Heart Failure Therapy After the GUIDE-IT Study

Clinical Trial2018 Dec;11(12):1737-1746.

JOURNAL:JACC Cardiovasc Imaging. Article Link

Association of Abnormal Left Ventricular Functional Reserve With Outcome in Heart Failure With Preserved Ejection Fraction

Kosmala W, Przewlocka-Kosmala M, Marwick TH et al. Keywords: LV diastolic and systolic responses to exercise; LV diastolic function; global longitudinal strain rate; heart failure with preserved ejection fraction; risk prediction

ABSTRACT


OBJECTIVES - This study sought to determine the prognostic value of abnormal diastolic and systolic responses to exercise (on the basis of exertional E/e' and global longitudinal strain rate [GSR]) in a well-characterized population of patients with heart failure with preserved ejection fraction (HFpEF).

 

BACKGROUND - Impaired cardiovascular functional reserve is believed to contribute to adverse outcomes in HFpEF. However, the exact characteristics of pathophysiological profiles associated with increased clinical risk are still poorly defined.

 

METHODS - A complete echocardiogram (including assessment of myocardial deformation) was performed at rest in 205 patients (64 ± 8 years of age) with symptomatic HFpEF. Echocardiography following maximal exercise was undertaken to assess abnormal diastolic reserve (AbnDR) (exertional E/e' >14) and exercise GSR. Patients were followed over 26 ± 5 months for death and cardiovascular or heart failure (HF) hospitalization.

 

RESULTS - Cardiovascular hospitalization or death occurred in 64 patients (31%), including 51 (25%) with HF hospitalization. The composite endpoint was associated with AbnDR (hazard ratio: 2.69; 95% confidence interval: 1.44 to 5.04; p = 0.002) and reduced exercise GSR (hazard ratio: 0.14; 95% confidence interval: 0.04 to 0.49; p = 0.002). Both exercise parameters showed prognostic value, independent from and incremental to clinical data and B-type natriuretic peptide. The ability of E/e' and GSR measurements to predict outcomes on exertion exceeded their prognostic value at rest, and the presence of reduced exertional GSR in patients with AbnDR was associated with worse prognosis (p = 0.03 for the composite endpoint and p = 0.01 for HF hospitalization).

 

CONCLUSIONS - Both left ventricular systolic and diastolic reserves contribute to risk prediction in HFpEF. The inclusion of the exertional assessment of left ventricular function to diagnostic algorithms may improve the prognostication process in this disease condition.

 

Copyright © 2018 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.