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Rahim A, Riaz Gondal MU, Ali F, Ullah A, Burki AUH, Kumar D, Vishal H, Iqbal A, Malik J. Association of Supranormal Left Ventricular Function With Major Adverse Cardiovascular Events: A Systematic Review of Literature. Cardiol Rev 2024:00045415-990000000-00331. [PMID: 39235236 DOI: 10.1097/crd.0000000000000783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/06/2024]
Abstract
This systematic review aims to assess the prognostic implications of supranormal left ventricular ejection fraction (snLVEF) in cardiovascular disease, particularly heart failure (HF), and explore its association with major adverse cardiovascular events (MACE). A comprehensive search of electronic databases was conducted to identify relevant studies examining the relationship between snLVEF and cardiovascular outcomes. Studies utilizing various imaging modalities, including echocardiography, cardiac positron emission tomography, computed tomography, and cardiac magnetic resonance imaging, were included. Data extraction and quality assessment were performed according to predefined criteria. The review identified several studies investigating the association between snLVEF and cardiovascular outcomes. Findings revealed an increased risk of MACE, including HF hospitalization and stroke, in patients with snLVEF, particularly in women. Coronary microvascular dysfunction and autonomic dysregulation were proposed mechanisms underlying these associations. However, conflicting results were observed when focusing exclusively on snLVEF, with some studies reporting similar outcomes between snLVEF and other HF subgroups. snLVEF (>65%) appears to be associated with an elevated risk of MACE, particularly in women, suggesting a U-shaped mortality curve. However, the prognostic implications may vary among HF patients, necessitating further research to elucidate the specific contributions of HF phenotypes and comorbidities. These findings underscore the importance of tailored risk assessment and management strategies for patients with snLVEF, particularly in the context of HF.
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Affiliation(s)
- Abdul Rahim
- From the Department of Cardiology, Saidu Teaching Hospital, Swat, Pakistan
| | | | - Farman Ali
- Department of Cardiology, National Institute of Cardiovascular Disease, Karachi, Pakistan
| | - Asif Ullah
- Department of Cardiology, KMU Institute of Medical Sciences, Kohat, Pakistan
| | - Atta Ul Haq Burki
- Department of Medicine, Shifa Tameer e Millat University, Islamabad, Pakistan
| | - Danesh Kumar
- Department of Medicine, Liaquat University of Medical and Health Sciences, Jamshoro, Pakistan
| | - Hari Vishal
- Department of Medicine, Liaquat University of Medical and Health Sciences, Jamshoro, Pakistan
| | - Arham Iqbal
- Department of Medicine, Dow Medical College, Karachi, Pakistan
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Sagmeister P, Rosch S, Fengler K, Kresoja KP, Gori T, Thiele H, Lurz P, Burkhoff D, Rommel KP. Running on empty: Factors underpinning impaired cardiac output reserve in heart failure with preserved ejection fraction. Exp Physiol 2024. [PMID: 38421268 DOI: 10.1113/ep091776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 02/13/2024] [Indexed: 03/02/2024]
Abstract
Heart failure with preserved ejection fraction (HFpEF) is frequently attributed etiologically to an underlying left ventricular (LV) diastolic dysfunction, although its pathophysiology is far more complex and can exhibit significant variations among patients. This review endeavours to systematically unravel the pathophysiological heterogeneity by illustrating diverse mechanisms leading to an impaired cardiac output reserve, a central and prevalent haemodynamic abnormality in HFpEF patients. Drawing on previously published findings from our research group, we propose a pathophysiology-guided phenotyping based on the presence of: (1) LV diastolic dysfunction, (2) LV systolic pathologies, (3) arterial stiffness, (4) atrial impairment, (5) right ventricular dysfunction, (6) tricuspid valve regurgitation, and (7) chronotopic incompetence. Tailored to each specific phenotype, we explore various potential treatment options such as antifibrotic medication, diuretics, renal denervation and more. Our conclusion underscores the pivotal role of cardiac output reserve as a key haemodynamic abnormality in HFpEF, emphasizing that by phenotyping patients according to its individual pathomechanisms, insights into personalized therapeutic approaches can be gleaned.
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Affiliation(s)
- Paula Sagmeister
- Department of Cardiology, Heart Center Leipzig at University of Leipzig and Leipzig Heart Science, Leipzig, Germany
| | - Sebastian Rosch
- Department of Cardiology, University Hospital Mainz, Mainz, Germany
| | - Karl Fengler
- Department of Cardiology, Heart Center Leipzig at University of Leipzig and Leipzig Heart Science, Leipzig, Germany
| | | | - Tommaso Gori
- Department of Cardiology, University Hospital Mainz, Mainz, Germany
| | - Holger Thiele
- Department of Cardiology, Heart Center Leipzig at University of Leipzig and Leipzig Heart Science, Leipzig, Germany
| | - Philipp Lurz
- Department of Cardiology, University Hospital Mainz, Mainz, Germany
| | | | - Karl-Philipp Rommel
- Department of Cardiology, Heart Center Leipzig at University of Leipzig and Leipzig Heart Science, Leipzig, Germany
- Cardiovascular Research Foundation, New York, New York, USA
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Ono R, Falcão LM. Supra-Normal Left Ventricular Function. Am J Cardiol 2023; 207:84-92. [PMID: 37734305 DOI: 10.1016/j.amjcard.2023.08.169] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 08/25/2023] [Accepted: 08/25/2023] [Indexed: 09/23/2023]
Abstract
Heart failure (HF) is often categorized by left ventricular (LV) ejection fraction (LVEF). A new category of HF characterized by supra-normal LVEF (>65%), named HF with supra-normal ejection fraction (HFsnEF), has been recently proposed. Some studies reported that patients with supra-normal LVEF might have an increased risk of long-term major adverse cardiovascular events and U-shaped mortality patterns. Currently, the prognosis of HFsnEF is not well established but seems to be associated with an increased risk of long-term major adverse cardiovascular events. It has been reported that HFsnEF is more prevalent in women and is associated with higher prevalence of nonischemic HF, higher blood urea nitrogen plasma levels, lower levels of natriuretic peptides, and to be less likely treated with β blockers. The pathophysiology of HFsnEF would be associated with microvascular dysfunction because of microvascular inflammation or reduced coronary flow reserve, and low stroke volume index with smaller cardiac chamber dimensions and concentric LV geometry. In this study, we systematically reviewed published data on patients with s supra-normal LV function and reported its definition, proposed pathophysiology, phenotypes, diagnostic strategy, and prognosis.
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Affiliation(s)
- Ryohei Ono
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan.
| | - Luiz Menezes Falcão
- Department of Clinical Semiology, Academic Medical Center of Lisbon (CAML); Cardiovascular Center University of Lisbon (CCUL@RISE), Faculty of Medicine University of Lisbon, Lisbon, Portugal
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Iaconelli A, Pellicori P, Caiazzo E, Rezig AOM, Bruzzese D, Maffia P, Cleland JGF. Implanted haemodynamic telemonitoring devices to guide management of heart failure: a review and meta-analysis of randomised trials. Clin Res Cardiol 2023; 112:1007-1019. [PMID: 36241896 PMCID: PMC9568893 DOI: 10.1007/s00392-022-02104-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 09/06/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND AIMS Congestion is a key driver of morbidity and mortality in heart failure. Implanted haemodynamic monitoring devices might allow early identification and management of congestion. Here, we provide a state-of-the-art review of implanted haemodynamic monitoring devices for patients with heart failure, including a meta-analysis of randomised trials. METHODS AND RESULTS We did a systematic search for pre-print and published trials in Medline, Embase, and the Cochrane Central Register of Controlled Trials (CENTRAL) on the 22nd of September 2021. We included randomised trials that compared management with or without information from implanted haemodynamic monitoring devices for patients with heart failure. Outcomes selected were hospitalisation for heart failure and all-cause mortality. Changes in treatment associated with haemodynamic monitoring resulted in only a small reduction in mean pulmonary artery pressure (typically < 1 mmHg as a daily average), which generally remained much greater than 20 mmHg. Haemodynamic monitoring reduced hospitalisations for heart failure (HR 0.75; 95% CI 0.58-0.96; p = 0.03) but not mortality (RR 0.92; 95% CI 0.68-1.26; p = 0.48). CONCLUSIONS Haemodynamic monitoring for patients with heart failure may reduce the risk of hospitalization for heart failure but this has not yet translated into a reduction in mortality, perhaps because the duration of trials was too short or the reduction in pulmonary artery pressure was not sufficiently large. The efficacy and safety of aiming for larger reductions in pulmonary artery pressure should be explored. After selecting key words, a systematic review for implanted haemodynamic telemonitoring devices was performed in different dataset and 4 randomised clinical trials were identified and included in this meta-analysis. Three different devices (Chronicle, Chronicle/ICD and CardioMEMS) were tested. All-cause mortality and total heart failure hospitalisations were selected as outcomes. No reduction in all-cause mortality rate was reported but a potential benefit on total heart failure hospitalisation was identified.
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Affiliation(s)
- Antonio Iaconelli
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK.
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168, Rome, Italy.
| | - Pierpaolo Pellicori
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
| | - Elisabetta Caiazzo
- School of Infection and Immunity, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
- Department of Pharmacy, School of Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Asma O M Rezig
- School of Infection and Immunity, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Dario Bruzzese
- Department of Public Health, School of Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Pasquale Maffia
- School of Infection and Immunity, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
- Department of Pharmacy, School of Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - John G F Cleland
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
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Ageev FT, Ovchinnikov AG, Ageeva SF, Mareev VY. [What is "normal left ventricular ejection fraction" and its relationship with the pathogenesis and effectiveness of the treatment of heart failure]. KARDIOLOGIIA 2023; 63:69-74. [PMID: 37470736 DOI: 10.18087/cardio.2023.6.n2404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 02/10/2023] [Indexed: 07/21/2023]
Abstract
The article focuses on modern views on the role and place of left ventricular ejection fraction (LV EF) in determining the status of cardiovascular patients (primarily patients with heart failure) in the algorithm for their diagnosis, treatment, and prediction of the outcome. Conclusions and recommendations on the use of LV EF in patients with chronic heart failure (CHF) are the following: 1) LV EF remains a familiar and convenient instrumental indicator not so much of myocardial contractility as of hemodynamics in general. Assessment of LV EF is useful for selection and ranking of CHF patients whereas the LV EF dynamics is useful for assessing the quality of their management. 2) In the entire population of cardiovascular patients, the "normal" LV EF (mortality nadir) is in the range of 60-65%. 3) LV EF demonstrates a U-shaped relationship with prognosis: in cardiovascular patients with LV EF below the mortality nadir, the relationship is inversely proportional, and above the mortality nadir, it is directly proportional. The question of the boundary between "normal" and "reduced" LV EF in terms of CHF syndrome remains open, but obviously, this boundary is most likely within the range of 50 to 60%. 4) LV EF determines the effectiveness of CHF treatment, but this rule is not applicable to all LV EF ranges and not to all classes of drugs.
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Affiliation(s)
- F T Ageev
- Myasnikov Institute of Clinical Cardiology of the Chazov National Medical Research Center, Moscow
| | - A G Ovchinnikov
- Myasnikov Institute of Clinical Cardiology of the Chazov National Medical Research Center, Moscow; Evdokimov Moscow State University of Medicine and Dentistry, Moscow
| | - S F Ageeva
- Lomonosov Moscow State University, Moscow
| | - V Yu Mareev
- Medical Research and Science Center of the Lomonosov Moscow State University, Moscow
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Chrysohoou C, Fragoulis C, Leontsinis I, Gastouniotis I, Fragouli D, Georgopoulos M, Mantzouranis E, Noutsou M, Tsioufis KP. Cardiometabolic Care: Assessing Patients with Diabetes Mellitus with No Overt Cardiovascular Disease in the Light of Heart Failure Development Risk. Nutrients 2023; 15:1384. [PMID: 36986114 PMCID: PMC10056430 DOI: 10.3390/nu15061384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Revised: 03/02/2023] [Accepted: 03/10/2023] [Indexed: 03/16/2023] Open
Abstract
The mechanisms leading to the development of heart failure (HF) in diabetes mellitus (DM) patients are multifactorial. Assessing the risk of HF development in patients with DM is valuable not only for the identification of a high-risk subgroup, but also equally important for defining low-risk subpopulations. Nowadays, DM and HF have been recognized as sharing similar metabolic pathways. Moreover, the clinical manifestation of HF can be independent of LVEF classification. Consequently, approaching HF should be through structural, hemodynamic and functional evaluation. Thus, both imaging parameters and biomarkers are important tools for the recognition of diabetic patients at risk of HF manifestation and HF phenotypes, and arrhythmogenic risk, and eventually for prognosis, aiming to improve patients' outcomes utilizing drugs and non-pharmaceutical cardioprotective tools such as diet modification.
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Affiliation(s)
- Christina Chrysohoou
- 1st Cardiology Clinic, Hippokration Hospital, National and Kapodistrian University of Athens, 11528 Attica, Greece
| | - Christos Fragoulis
- 1st Cardiology Clinic, Hippokration Hospital, National and Kapodistrian University of Athens, 11528 Attica, Greece
| | - Ioannis Leontsinis
- 1st Cardiology Clinic, Hippokration Hospital, National and Kapodistrian University of Athens, 11528 Attica, Greece
| | - Ioannis Gastouniotis
- 1st Cardiology Clinic, Hippokration Hospital, National and Kapodistrian University of Athens, 11528 Attica, Greece
| | - Dimitra Fragouli
- 1st Cardiology Clinic, Hippokration Hospital, National and Kapodistrian University of Athens, 11528 Attica, Greece
| | - Maximos Georgopoulos
- 1st Cardiology Clinic, Hippokration Hospital, National and Kapodistrian University of Athens, 11528 Attica, Greece
| | - Emmanouil Mantzouranis
- 1st Cardiology Clinic, Hippokration Hospital, National and Kapodistrian University of Athens, 11528 Attica, Greece
| | - Marina Noutsou
- Diabetes Center, 2nd Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, Hippokration General Hospital of Athens, 11528 Athens, Greece
| | - Konstantinos P. Tsioufis
- 1st Cardiology Clinic, Hippokration Hospital, National and Kapodistrian University of Athens, 11528 Attica, Greece
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Affiliation(s)
- David A Kass
- Division of Cardiology, The Johns Hopkins University School of Medicine, Baltimore, MD
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