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Ali ZS, Bhuiyan A, Vyas P, Miranda-Arboleda AF, Tse G, Bazoukis G, Burak C, Abuzeid W, Lee S, Gupta S, Meghdadi A, Baranchuk A. PR prolongation as a predictor of atrial fibrillation onset: A state-of-the-art review. Curr Probl Cardiol 2024; 49:102469. [PMID: 38369207 DOI: 10.1016/j.cpcardiol.2024.102469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Accepted: 02/15/2024] [Indexed: 02/20/2024]
Abstract
First-degree atrioventricular block (1-AVB), characterized by a PR interval exceeding 200 milliseconds, has traditionally been perceived as a benign cardiac condition. Recently, this perception has been challenged by investigations that indicate a potential association between PR prolongation and an elevated risk of atrial fibrillation (AF). To consolidate these findings, we performed a comprehensive review to assess the available evidence indicating a relationship between these two conditions. We searched MEDLINE and EMBASE databases as well as manually searched references of retrieved articles. We selected 18 cohort studies/meta-analyses involving general and special populations. Consistent findings across expansive cohort studies reveal that incremental increases in the PR interval may serve as an independent risk factor for AF. However, our analyses underscore the need for further research into the association between 1-AVB, defined by a specified PR interval cutoff, and the risk of AF.
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Affiliation(s)
- Zain S Ali
- Faculty of Health Sciences, School of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Abdullah Bhuiyan
- Faculty of Health Sciences, School of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Purav Vyas
- Faculty of Health Sciences, School of Medicine, Queen's University, Kingston, Ontario, Canada
| | | | - Gary Tse
- Department of Medicine and Therapeutics, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong Special Administrative Region; Li Ka Shing Institute of Health Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong Special Administrative Region
| | - George Bazoukis
- Department of Cardiology, Larnaca General Hospital, Larnaca, Cyprus; School of Medicine, European University Cyprus, Nicosia, Cyprus
| | - Cengiz Burak
- Department of Medicine, Kingston Health Sciences Center, Queen's University, Kingston, Ontario, Canada
| | - Wael Abuzeid
- Department of Medicine, Kingston Health Sciences Center, Queen's University, Kingston, Ontario, Canada
| | - Sharen Lee
- Li Ka Shing Institute of Health Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong Special Administrative Region
| | - Shyla Gupta
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Amin Meghdadi
- Faculty of Health Sciences, School of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Adrian Baranchuk
- Department of Medicine, Kingston Health Sciences Center, Queen's University, Kingston, Ontario, Canada.
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Wu Y, Song M, Wu M, Lin L. Advances in device-based treatment of heart failure with preserved ejection fraction: evidence from clinical trials. ESC Heart Fail 2024; 11:13-27. [PMID: 37986663 PMCID: PMC10804156 DOI: 10.1002/ehf2.14562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 09/10/2023] [Accepted: 10/02/2023] [Indexed: 11/22/2023] Open
Abstract
Heart failure with preserved ejection fraction (HFpEF) is a group of clinical syndromes that exhibit a remarkably heterogeneous phenotype, characterized by symptoms and signs of heart failure, left ventricular diastolic dysfunction, elevated levels of natriuretic peptides, and an ejection fraction greater than or equal to 50%. With the aging of the population and the escalating prevalence of hypertension, obesity, and diabetes, the incidence of HFpEF is progressively rising. Drug therapy options for HFpEF are currently limited, and the associated high risk of cardiovascular mortality and heart failure rehospitalization significantly impact patients' quality of life and longevity while imposing a substantial economic burden on society. Recent research indicates that certain device-based therapies may serve as valuable adjuncts to drug therapy in patients with specific phenotypes of HFpEF, effectively improving symptoms and quality of life while reducing the risk of readmission for heart failure. These include inter-atrial shunt and greater splanchnic nerve ablation to reduce left ventricular filling pressure, implantable heart failure monitor to guide diuresis, left atrial pacing to correct interatrial dyssynchrony, cardiac contractility modulation to enhance cardiac calcium handling, as well as renal denervation, baroreflex activation therapy, and vagus nerve stimulation to restore the autonomic imbalance. In this review, we provide a comprehensive overview of the mechanisms and clinical evidence pertaining to these devices, with the aim of enhancing therapeutic strategies for HFpEF.
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Affiliation(s)
- Ying Wu
- Department of CardiologyAffiliated Hospital of Putian University, School of Clinical Medicine, Fujian Medical UniversityPutianChina
| | - Meiyan Song
- Department of CardiologyAffiliated Hospital of Putian University, School of Clinical Medicine, Fujian Medical UniversityPutianChina
| | - Meifang Wu
- Department of CardiologyAffiliated Hospital of Putian University, School of Clinical Medicine, Fujian Medical UniversityPutianChina
| | - Liming Lin
- Department of CardiologyAffiliated Hospital of Putian University, School of Clinical Medicine, Fujian Medical UniversityPutianChina
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Cronin EM, Vedage N, Israel CW. Alternative atrial pacing site to improve cardiac function: focus on Bachmann's bundle pacing. Eur Heart J Suppl 2023; 25:G44-G55. [PMID: 37970517 PMCID: PMC10637835 DOI: 10.1093/eurheartjsupp/suad118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2023]
Abstract
Pacing from the right atrial appendage (RAA) prolongs the P wave duration and can induce interatrial and especially left-sided atrio-ventricular dyssynchrony. Pacing from Bachmann's bundle closely reproduces normal physiology and has the potential to avoid the electromechanical dysfunction associated with conventional RAA pacing. Interatrial conduction delay is associated with an increased risk of stroke, heart failure, and death. In addition to a reduction in atrial fibrillation, Bachmann's bundle pacing has emerging applications as a hemodynamic pacing modality. This review outlines the pathophysiology of atrial conduction disturbances and their potential remedies and provides the reader with a practical guide to implementing Bachmann's bundle pacing with an emphasis on the recapitulation of normal electrical and mechanical function.
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Affiliation(s)
- Edmond M Cronin
- Section of Cardiology, Department of Medicine, Lewis Katz School of Medicine at Temple University, Philadelphia, USA
| | - Natasha Vedage
- Section of Cardiology, Department of Medicine, Lewis Katz School of Medicine at Temple University, Philadelphia, USA
| | - Carsten W Israel
- Department of Medicine—Cardiology, Diabetology, and Nephrology, Bethel-Clinic, Bielefeld, Germany
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Kaimori R, Iwakawa H, Suzuki N, Aokawa M, Tashiro H, Terata K, Watanabe H. Asymmetric remodeling between the left and right atria in patients with advanced interatrial block and atrial fibrillation. J Electrocardiol 2023; 80:63-68. [PMID: 37257248 DOI: 10.1016/j.jelectrocard.2023.05.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 05/01/2023] [Accepted: 05/18/2023] [Indexed: 06/02/2023]
Abstract
BACKGROUND Advanced interatrial block (A-IAB) on electrocardiography (ECG) represents the conduction delay between the left and right atria. We investigated the association of A-IAB with left and right atrial (LA/RA) remodeling in patients with atrial fibrillation (AF). METHODS We enrolled 74 patients who underwent ECG, cardiac computed tomography (CCT), and echocardiography during sinus rhythm before catheter ablation of AF. A-IAB was defined as P-wave duration ≥120 ms with a biphasic morphology in leads III and aVF or notched morphology in lead II. We compared the maximum and minimum LA/RA volume indices (max and min LAV/RAVI), LA/RA expansion index (LAEI/RAEI), and total, passive, and active LA/RA emptying fraction (LAEF/RAEF) between patients with and without A-IAB. RESULTS Of the 74 patients (mean age, 64.3 ± 9.6 years), 35 (47%) showed A-IAB. Patients with A-IAB had a significantly higher likelihood of hypertension and left ventricular diastolic dysfunction than those without. Patients with A-IAB had significantly larger max (69.2 [60.7-79.7]mL/m2 vs. 60.9 [50.4-68.3]mL/m2, P < 0.01) and min (44.0 [37.2-52.1]mL/m2 vs. 34.1 [29.2-43.5]mL/m2, P < 0.01) LAVI than those without. The max and min RAVI were not significantly different between groups. LAEI (55.1 [48.2-78.5]% vs. 72.1 [57.8-84.8]%, P < 0.05), total LAEF (35.5 [32.5-44.0]% vs. 41.9 [36.6-45.9]%, P < 0.05), and passive LAEF (12.2 [10.0-14.4]% vs. 15.5 [11.2-19.6]%, P < 0.05) were significantly lower in patients with A-IAB than without. CONCLUSIONS A-IAB was associated with LA, but not RA enlargement, in patients with AF. A-IAB may indicate LA functional remodeling in the reservoir and conduit phases.
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Affiliation(s)
- Ryota Kaimori
- Department of Cardiovascular Medicine, Akita University Graduate School of Medicine, Akita, Japan
| | - Hidehiro Iwakawa
- Department of Cardiovascular Medicine, Akita University Graduate School of Medicine, Akita, Japan
| | - Nobuhiro Suzuki
- Department of Cardiovascular Medicine, Akita University Graduate School of Medicine, Akita, Japan
| | - Mako Aokawa
- Department of Cardiovascular Medicine, Akita University Graduate School of Medicine, Akita, Japan
| | - Haruwo Tashiro
- Department of Cardiovascular Medicine, Akita University Graduate School of Medicine, Akita, Japan
| | - Ken Terata
- Department of Cardiovascular Medicine, Akita University Graduate School of Medicine, Akita, Japan
| | - Hiroyuki Watanabe
- Department of Cardiovascular Medicine, Akita University Graduate School of Medicine, Akita, Japan.
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Van Ommen AM, Kessler EL, Valstar G, Onland-Moret NC, Cramer MJ, Rutten F, Coronel R, Den Ruijter H. Electrocardiographic Features of Left Ventricular Diastolic Dysfunction and Heart Failure With Preserved Ejection Fraction: A Systematic Review. Front Cardiovasc Med 2021; 8:772803. [PMID: 34977187 PMCID: PMC8719440 DOI: 10.3389/fcvm.2021.772803] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 11/16/2021] [Indexed: 01/08/2023] Open
Abstract
Background: Electrocardiographic features are well-known for heart failure with reduced ejection fraction (HFrEF), but not for left ventricular diastolic dysfunction (LVDD) and heart failure with preserved ejection fraction (HFpEF). As ECG features could help to identify high-risk individuals in primary care, we systematically reviewed the literature for ECG features diagnosing women and men suspected of LVDD and HFpEF. Methods and Results: Among the 7,127 records identified, only 10 studies reported diagnostic measures, of which 9 studied LVDD. For LVDD, the most promising features were T-end-P/(PQ*age), which is the electrocardiographic equivalent of the passive-to-active filling (AUC: 0.91-0.96), and repolarization times (QTc interval ≥ 350 ms, AUC: 0.85). For HFpEF, the Cornell product ≥ 1,800 mm*ms showed poor sensitivity of 40% (AUC: 0.62). No studies presented results stratified by sex. Conclusion: Electrocardiographic features are not widely evaluated in diagnostic studies for LVDD and HFpEF. Only for LVDD, two ECG features related to the diastolic interval, and repolarization measures showed diagnostic potential. To improve diagnosis and care for women and men suspected of heart failure, reporting of sex-specific data on ECG features is encouraged.
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Affiliation(s)
- Anne-Mar Van Ommen
- Laboratory of Experimental Cardiology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Elise Laura Kessler
- Laboratory of Experimental Cardiology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Gideon Valstar
- Laboratory of Experimental Cardiology, University Medical Center Utrecht, Utrecht, Netherlands
| | - N. Charlotte Onland-Moret
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands
| | - Maarten Jan Cramer
- Department of Cardiology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Frans Rutten
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands
| | - Ruben Coronel
- Department of Experimental Cardiology, Amsterdam University Medical Center, Amsterdam, Netherlands
- Institut de rythmologie et modélisation cardiaque (IHU-Liryc), Pessac, France
| | - Hester Den Ruijter
- Laboratory of Experimental Cardiology, University Medical Center Utrecht, Utrecht, Netherlands
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6
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Abstract
Heart failure with preserved ejection fraction (HFpEF) is a significantly symptomatic disease and has a poor prognosis similar to that of heart failure with reduced ejection fraction (HFrEF). Contrary to HFrEF, HFpEF is difficult to diagnose, and the recommended diagnostic algorithm of HFpEF is complicated. Several therapies for HFpEF have failed to reduce mortality or morbidity. HFpEF is thought to be a complex and heterogeneous systemic disorder that has various phenotypes and multiple comorbidities. Therefore, therapeutic strategies of HFpEF need to change depending on the phenotype of the patient. This review highlights the pharmacologic and nonpharmacologic treatment of HFpEF.
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Ali SB, Cooper J, McCabe M, Bhardwaj R, Mandapati R, Contractor T. Interatrial conduction block-related atrioventricular dyssynchrony treated with dual-site atrial pacing. HeartRhythm Case Rep 2021; 7:224-228. [PMID: 34026501 PMCID: PMC8129042 DOI: 10.1016/j.hrcr.2021.01.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Saif B. Ali
- Department of Cardiology, Loma Linda University Medical Center, Loma Linda, California
| | - Joshua Cooper
- Section of Cardiac Electrophysiology, Temple University Hospital, Philadelphia, Pennsylvania
| | - Melissa McCabe
- Department of Anesthesiology, Loma Linda University Medical Center, Loma Linda, California
| | - Rahul Bhardwaj
- Department of Cardiology, Loma Linda University Medical Center, Loma Linda, California
| | - Ravi Mandapati
- Department of Cardiology, Loma Linda University Medical Center, Loma Linda, California
| | - Tahmeed Contractor
- Department of Cardiology, Loma Linda University Medical Center, Loma Linda, California
- Address reprint requests and correspondence: Dr Tahmeed Contractor, Loma Linda University Medical Center, 11234 Anderson St, Loma Linda, CA 92354.
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8
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Biffi M, Spadotto A, Piemontese GP, Toniolo S, Bartoli L, Sorrentino S, Minguzzi A, Massaro G, Capobianco C, Statuto G. Cardiac Stimulation in the Third Millennium: Where Do We Head from Here? Hearts 2021; 2:15-35. [DOI: 10.3390/hearts2010003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Over the years, pacemakers have evolved from a life-saving tool to prevent asystole to a device to treat heart rhythm disorders and heart failure, aiming at improving both cardiac function and clinical outcomes. Cardiac stimulation nowadays aims to correct the electrophysiologic roots of mechanical inefficiency in different structural heart diseases. This has led to awareness of the concealed risks of customary cardiac pacing that can inadvertently cause atrioventricular and inter-/intra-ventricular dyssynchrony, and has promoted the development of new pacing modalities and the use of stimulation sites different from the right atrial appendage and the right ventricular apex. The perspective of truly physiologic pacing is the leading concept of the continued research in the past 30 years, which has made cardiac stimulation procedure more sophisticated and challenging. In this article, we analyze the emerging evidence in favor of the available strategies to achieve an individualized physiologic setting in bradycardia pacing.
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Biffi M, Capobianco C, Spadotto A, Bartoli L, Sorrentino S, Minguzzi A, Piemontese GP, Angeletti A, Toniolo S, Statuto G. Pacing devices to treat bradycardia: current status and future perspectives. Expert Rev Med Devices 2020; 18:161-177. [PMID: 33336616 DOI: 10.1080/17434440.2021.1866543] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Introduction: Cardiac stimulation evolved from life-saving devices to prevent asystole to the treatment of heart rhythm disorders and heart failure, capable of remote patient and disease-progression monitoring. Cardiac stimulation nowadays aims to correct the electrophysiologic roots of mechanical inefficiency in different structural heart diseases.Areas covered: Clinical experience, as per available literature, has led to awareness of the concealed risks of customary cardiac pacing, that can inadvertently cause atrio-ventricular and inter/intra-ventricular dyssynchrony. New pacing modalities have emerged, leading to a new concept of what truly represents 'physiologic pacing' beyond maintenance of atrio-ventricular coupling. In this article we will analyze the emerging evidence in favor of the available strategies to achieve an individualized physiologic setting in bradycardia pacing, and the hints of future developments.Expert opinion: 'physiologic stimulation' technologies should evolve to enable an effective and widespread adoption. In one way new guiding catheters and the adoption of electrophysiologic guidance and non-fluoroscopic lead implantation are needed to make His-Purkinje pacing successful and effective at long term in a shorter procedure time; in the other way leadless stimulation needs to upgrade to a superior physiologic setting to mimic customary DDD pacing and possibly His-Purkinje pacing.
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Affiliation(s)
- Mauro Biffi
- Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
| | - Claudio Capobianco
- Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy.,Department of Experimental, Diagnostic and Specialty Medicine, Bologna, Italy
| | - Alberto Spadotto
- Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy.,Department of Experimental, Diagnostic and Specialty Medicine, Bologna, Italy
| | - Lorenzo Bartoli
- Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy.,Department of Experimental, Diagnostic and Specialty Medicine, Bologna, Italy
| | - Sergio Sorrentino
- Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy.,Department of Experimental, Diagnostic and Specialty Medicine, Bologna, Italy
| | - Alessandro Minguzzi
- Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy.,Department of Experimental, Diagnostic and Specialty Medicine, Bologna, Italy
| | - Giuseppe Pio Piemontese
- Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy.,Department of Experimental, Diagnostic and Specialty Medicine, Bologna, Italy
| | - Andrea Angeletti
- Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy.,Department of Experimental, Diagnostic and Specialty Medicine, Bologna, Italy
| | - Sebastiano Toniolo
- Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy.,Department of Experimental, Diagnostic and Specialty Medicine, Bologna, Italy
| | - Giovanni Statuto
- Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy.,Department of Experimental, Diagnostic and Specialty Medicine, Bologna, Italy
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10
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YALIM Z, ERSOY İ. Evaluation of the relationship between diastolic dysfunction and interatrial block. Journal of Health Sciences and Medicine 2020. [DOI: 10.32322/jhsm.770238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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11
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Bayes-Genis A, Bisbal F, Núñez J, Santas E, Lupón J, Rossignol P, Paulus W. Transitioning from Preclinical to Clinical Heart Failure with Preserved Ejection Fraction: A Mechanistic Approach. J Clin Med 2020; 9:E1110. [PMID: 32294958 DOI: 10.3390/jcm9041110] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 04/09/2020] [Accepted: 04/10/2020] [Indexed: 02/06/2023] Open
Abstract
To better understand heart failure with preserved ejection fraction (HFpEF), we need to better characterize the transition from asymptomatic pre-HFpEF to symptomatic HFpEF. The current emphasis on left ventricular diastolic dysfunction must be redirected to microvascular inflammation and endothelial dysfunction that leads to cardiomyocyte remodeling and enhanced interstitial collagen deposition. A pre-HFpEF patient lacks signs or symptoms of heart failure (HF), has preserved left ventricular ejection fraction (LVEF) with incipient structural changes similar to HFpEF, and possesses elevated biomarkers of cardiac dysfunction. The transition from pre-HFpEF to symptomatic HFpEF also involves left atrial failure, pulmonary hypertension and right ventricular dysfunction, and renal failure. This review focuses on the non-left ventricular mechanisms in this transition, involving the atria, right heart cavities, kidneys, and ultimately the currently accepted driver—systemic inflammation. Impaired atrial function may decrease ventricular hemodynamics and significantly increase left atrial and pulmonary pressure, leading to HF symptoms, irrespective of left ventricle (LV) systolic function. Pulmonary hypertension and low right-ventricular function are associated with the incidence of HF. Interstitial fibrosis in the heart, large arteries, and kidneys is key to the pathophysiology of the cardiorenal syndrome continuum. By understanding each of these processes, we may be able to halt disease progression and eventually extend the time a patient remains in the asymptomatic pre-HFpEF stage.
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Bisbal F, Baranchuk A, Braunwald E, Bayés de Luna A, Bayés-genís A. Atrial Failure as a Clinical Entity. J Am Coll Cardiol 2020; 75:222-32. [DOI: 10.1016/j.jacc.2019.11.013] [Citation(s) in RCA: 115] [Impact Index Per Article: 28.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 10/09/2019] [Accepted: 11/05/2019] [Indexed: 12/16/2022]
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13
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Nikolaidou T, Samuel NA, Marincowitz C, Fox DJ, Cleland JGF, Clark AL. Electrocardiographic characteristics in patients with heart failure and normal ejection fraction: A systematic review and meta-analysis. Ann Noninvasive Electrocardiol 2019; 25:e12710. [PMID: 31603593 PMCID: PMC7358891 DOI: 10.1111/anec.12710] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2019] [Revised: 09/03/2019] [Accepted: 09/11/2019] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Little is known about ECG abnormalities in patients with heart failure and normal ejection fraction (HeFNEF) and how they relate to different etiologies or outcomes. METHODS AND RESULTS We searched the literature for peer-reviewed studies describing ECG abnormalities in HeFNEF other than heart rhythm alone. Thirty five studies were identified and 32,006 participants. ECG abnormalities reported in patients with HeFNEF include atrial fibrillation (prevalence 12%-46%), long PR interval (11%-20%), left ventricular hypertrophy (LVH, 10%-30%), pathological Q waves (11%-18%), RBBB (6%-16%), LBBB (0%-8%), and long JTc (3%-4%). Atrial fibrillation is more common in patients with HeFNEF compared to those with heart failure and reduced ejection fraction (HeFREF). In contrast, long PR interval, LVH, Q waves, LBBB, and long JTc are more common in patients with HeFREF. A pooled effect estimate analysis showed that QRS duration ≥120 ms, although uncommon (13%-19%), is associated with worse outcomes in patients with HeFNEF. CONCLUSIONS There is high variability in the prevalence of ECG abnormalities in patients with HeFNEF. Atrial fibrillation is more common in patients with HeFNEF compared to those with HeFREF. QRS duration ≥120 ms is associated with worse outcomes in patients with HeFNEF. Further studies are needed to address whether ECG abnormalities correlate with different phenotypes in HeFNEF.
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Affiliation(s)
- Theodora Nikolaidou
- Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Nathan A Samuel
- Department of Academic Cardiology, Castle Hill Hospital, University of Hull, Hull, UK
| | - Carl Marincowitz
- Hull York Medical School, University of Hull, University of York, York, UK
| | - David J Fox
- Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - John G F Cleland
- Robertson Institute of Biostatistics and Clinical Trials Unit, University of Glasgow, Glasgow, UK.,National Heart & Lung Institute and National Institute of Health Research Cardiovascular Biomedical Research Unit, Imperial College, Royal Brompton & Harefield Hospitals, London, UK
| | - Andrew L Clark
- Department of Academic Cardiology, Castle Hill Hospital, University of Hull, Hull, UK
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14
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Salden FCWM, Kutyifa V, Stockburger M, Prinzen FW, Vernooy K. Atrioventricular dromotropathy: evidence for a distinctive entity in heart failure with prolonged PR interval? Europace 2019; 20:1067-1077. [PMID: 29186415 DOI: 10.1093/europace/eux207] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Accepted: 05/25/2017] [Indexed: 01/07/2023] Open
Abstract
Heart failure (HF) is often accompanied by atrioventricular (AV) conduction disturbance, represented by prolongation of the PR interval on the electrocardiogram. Studies suggest that PR prolongation exists in at least 10% of HF patients, and it seems more prevalent in the presence of prolonged QRS duration. A prolonged PR interval may result in elevated left ventricular (LV) end-diastolic pressure, diastolic mitral regurgitation, and reduced LV pump function. This seems especially the case in patients with heart disease, in whom it is associated with an increased risk for atrial fibrillation, advanced AV heart block, HF, and death. These findings point towards the importance of proper AV coupling in HF patients. A few studies, strongly differing in design, suggest that restoration of AV coupling in patients with PR prolongation by pacing improves cardiac function and clinical outcomes. These observations argue for AV-dromotropathy as a potential target for pacing therapy, but other studies show inconsistent results. Given its potential clinical implications, restoration of AV coupling by pacing warrants further investigation. Additional possible future research goals include assessing different techniques to measure compromised AV coupling, determine the best site(s) of ventricular pacing, and assess a potential influence of diastolic mitral regurgitation in the efficacy of such therapy.
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Affiliation(s)
- Floor C W M Salden
- Departments of Physiology and Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Universiteitssingel 50, ER Maastricht, The Netherlands
| | - Valentina Kutyifa
- Heart Research Follow-Up Program, University of Rochester Medical Center, 265 Crittenden Blvd, Rochester, NY, USA
| | - Martin Stockburger
- Department of Cardiology, Havelland Kliniken, Ketziner Straße 21, Nauen, Germany.,Department of Cardiology and Angiology, Charité - Universitaetsmedizin Berlin, Charitéplatz 1, Berlin, Germany
| | - Frits W Prinzen
- Departments of Physiology and Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Universiteitssingel 50, ER Maastricht, The Netherlands
| | - Kevin Vernooy
- Departments of Physiology and Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Universiteitssingel 50, ER Maastricht, The Netherlands
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15
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Burlacu A, Simion P, Nistor I, Covic A, Tinica G. Novel percutaneous interventional therapies in heart failure with preserved ejection fraction: an integrative review. Heart Fail Rev 2019; 24:793-803. [DOI: 10.1007/s10741-019-09787-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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16
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Park S, Kim H, Cho D, Kim M, Shim W. Impact of Left Bundle Branch Block on Left Atrial Dyssynchrony and Its Relationship to Left Ventricular Diastolic Function in Patients with Heart Failure and Dilated Cardiomyopathy. Int J Heart Fail 2019; 1:42. [PMID: 36262744 PMCID: PMC9536671 DOI: 10.36628/ijhf.2019.0001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 09/29/2019] [Accepted: 10/03/2019] [Indexed: 11/18/2022]
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17
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Miyazaki C. Left Atrial Dyssynchrony in Dilated Cardiomyopathy: Diastolic Dysfunction Matters but Left Bundle Branch Block Does Not. Int J Heart Fail 2019; 1:53. [PMID: 36262738 PMCID: PMC9536675 DOI: 10.36628/ijhf.2019.0011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 10/28/2019] [Indexed: 11/18/2022]
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18
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Johner N, Namdar M, Shah DC. Intra- and interatrial conduction abnormalities: hemodynamic and arrhythmic significance. J Interv Card Electrophysiol 2018; 52:293-302. [DOI: 10.1007/s10840-018-0413-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Accepted: 07/11/2018] [Indexed: 10/28/2022]
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Saksena S, Slee A, Saad M. Atrial resynchronization therapy in patients with atrial fibrillation and heart failure with and without systolic left ventricular dysfunction: a pilot study. J Interv Card Electrophysiol 2018; 53:9-17. [PMID: 29987682 DOI: 10.1007/s10840-018-0408-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 06/28/2018] [Indexed: 01/02/2023]
Abstract
BACKGROUND We examined the long-term (≥ 5 years) outcomes of dual-site atrial pacing (DAP) when added to background antiarrhythmic drugs (AADs) and/or ablation in patients with refractory atrial fibrillation (AF) and heart failure (HF). METHODS Seventy-three patients with HF (mean NYHA HF class of 2.5) and AF refractory to AADs and/or ablation were implanted with DAP systems to achieve biatrial electrical and mechanical resynchronization (ART) and rhythm control (RC). RESULTS Thirty-eight patients with refractory AF and HF with preserved ejection fraction (HFpEF) and 35 with reduced ejection fraction (HFrEF) were enrolled. HFpEF patients had higher left ventricular ejection fraction compared to HFrEF (53 ± 5 vs. 31 ± 10% p < 0.001). Median follow-up for survival was 9.3 years (mean 9.0 years, SE 0.63) and was similar across subgroups (p = 0.127). After DAP, 87% maintained RC with improvement in NYHA HF class (mean 1.8) at 3 years. RC was similar in HFpEF compared with HFrEF patients (89 vs. 85% respectively, p = NS) and in paroxysmal versus persistent AF (90 vs. 85% respectively, p = NS). Total survival was superior in HFpEF compared HFrEF patients (75% in HFpEF vs. 45% in HFrEF at 5 years, and 60% in HFpEF vs. 34% in HFrEF at 10 years, p = 0.036). Survival trended to be better in patients with RC than those without RC (75 vs. 54% respectively at 5 years, p = .13). CONCLUSIONS ART using DAP as add on therapy improved HF and established long-term RC in many patients with HFrEF and HFpEF with refractory AF. Long-term survival rates were superior in HFpEF than HFrEF.
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Affiliation(s)
- Sanjeev Saksena
- Electrophysiology Research Foundation, 161 Washington Valley Road, Suite 201, Warren, NJ, 07059, USA. .,Rutgers'- Robert Wood Johnson Medical School, Piscataway, NJ, USA.
| | - April Slee
- Electrophysiology Research Foundation, 161 Washington Valley Road, Suite 201, Warren, NJ, 07059, USA.,Rutgers'- Robert Wood Johnson Medical School, Piscataway, NJ, USA
| | - Marwan Saad
- Electrophysiology Research Foundation, 161 Washington Valley Road, Suite 201, Warren, NJ, 07059, USA.,Rutgers'- Robert Wood Johnson Medical School, Piscataway, NJ, USA
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20
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Galderisi M, Santoro C, Esposito R. Left atrial function and dyssynchrony: Main characters and not actor appearances in heart failure with preserved ejection fraction. Int J Cardiol 2018; 257:222-223. [DOI: 10.1016/j.ijcard.2018.01.060] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2018] [Accepted: 01/15/2018] [Indexed: 10/17/2022]
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21
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Liu S, Guan Z, Zheng X, Meng P, Wang Y, Li Y, Zhang Y, Yang J, Jia D, Ma C. Impaired left atrial systolic function and inter-atrial dyssynchrony may contribute to symptoms of heart failure with preserved left ventricular ejection fraction: A comprehensive assessment by echocardiography. Int J Cardiol 2018; 257:177-181. [DOI: 10.1016/j.ijcard.2017.12.042] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Revised: 11/24/2017] [Accepted: 12/13/2017] [Indexed: 11/26/2022]
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22
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Saksena S, Slee A. Atrial fibrillation and its pernicious role in heart failure with preserved ejection fraction: a new frontier in interventional electrophysiology. J Interv Card Electrophysiol 2018; 51:89-90. [PMID: 29480345 DOI: 10.1007/s10840-018-0341-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Sanjeev Saksena
- Rutgers' - Robert Wood Johnson Medical School, Piscataway, NJ, USA.
- Electrophysiology Research Foundation, 161 Washington Valley Road, Suite 201, Warren, NJ, 07059J, USA.
| | - April Slee
- Electrophysiology Research Foundation, 161 Washington Valley Road, Suite 201, Warren, NJ, 07059J, USA
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23
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Das A, Kahali D, Dutta S. Low interatrial septal pacing: A simple method. Indian Heart J 2017; 69:725-30. [PMID: 29174249 DOI: 10.1016/j.ihj.2017.06.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2016] [Revised: 12/17/2016] [Accepted: 06/05/2017] [Indexed: 11/20/2022] Open
Abstract
Background Sinus node disease is associated with widespread structural and electrophysiological changes in the atria in addition to abnormalities at the sinus node. The atrial conduction disorder in patients with atrial pacing results in higher incidence of atrial fibrillation. Studies have shown that low interatrial septal pacing is superior to right atrial appendage pacing in preventing persistent or permanent atrial fibrillation in these patients. However, implantation of active fixation lead in low interatrial septal position is difficult and time consuming with conventional stylet, inhibiting application of this method in routine practice. Method The technique of implanting atrial pacing lead in low interatrial septum with hand-made stylet is presented in this study with emphasis on fluoroscopic landmark and electrocardiographic P wave pattern. Results The results indicate acute and short-term success of low interatrial septal pacing in 10 patients out of 11 patients without major complications. Pacing parameters during implantation and 3 months post procedure were within normal limits. Conclusion The initial favorable results of this study indicate low interatrial septal pacing with conventional active fixation lead using fluoroscopic landmark and electrocardiographic characteristics is feasible and reproducible with a simple technique.
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Nanayakkara S, Kaye DM. Targets for Heart Failure With Preserved Ejection Fraction. Clin Pharmacol Ther 2017; 102:228-237. [PMID: 28466986 DOI: 10.1002/cpt.723] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Accepted: 04/21/2017] [Indexed: 12/19/2022]
Abstract
Heart failure (HF) with preserved ejection fraction (HFPEF) is responsible for half of all HF cases and will be the most common form of HF within the next 5 years. Previous studies of pharmacological agents in HFPEF have proved neutral or negative, in part due to phenotypic heterogeneity and complex underlying mechanisms. This review summarizes the key molecular and cellular pathways characterized in HFPEF as well as current and future therapies that target these mechanisms.
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Affiliation(s)
- S Nanayakkara
- Alfred Hospital and Baker Heart & Diabetes Institute, Melbourne, Australia
| | - D M Kaye
- Alfred Hospital and Baker Heart & Diabetes Institute, Melbourne, Australia
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25
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Abstract
BACKGROUND AND AIM Increased left atrial (LA) mass was introduced as a compensatory mechanism in heart failure (HF) patients. Furthermore, atrial conduction time and LA emptying fraction is are deteriorated in HF with preserved ejection fraction (HFpEF). The aim of this study was to assess the early LA changes in HFpEF patients. METHODS In 79 consecutive patients with HFpEF (age 61±8 years, NYHA class I-III, LV EF ≥45%), a complete 2-dimensional, M-mode, and Doppler echocardiographic study was performed. According to the diastolic dysfunction (DD), patients were divided into three groups: Group I-29 healthy subjects (control group); Group II-HFpEF patients with mild DD; and Group III-HFpEF patients with moderate DD. RESULTS The LV mass was increased (P<.05), septal s', lateral s', septal and lateral MAPSE were decreased (P<.05, for all), E/e' ratio was increased (P<.001), LA mass and minimal volume were increased (P<.001, P<.05), LA emptying fraction was decreased (P<.05), and LA dyssynchrony was deteriorated (P<.05) in patients with mild DD compared to controls. These changes were of the same nature in patients with moderate LV DD. CONCLUSIONS In early stage of DD, in patients with HFpEF, in addition to LV hypertrophy and compromised LV longitudinal systolic function, the LA emptying fraction is reduced, LA mass and LAV min are increased and LA dyssynchrony is significant, despite normal LA dimensions. These findings suggest early LA function deterioration irrespective of normal cavity measurements, hence a need for optimum therapy.
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Affiliation(s)
- Ibadete Bytyçi
- Clinic of Cardiology, University Clinical Centre of Kosova, Prishtina, Republic of Kosovo.
| | - Gani Bajraktari
- Clinic of Cardiology, University Clinical Centre of Kosova, Prishtina, Republic of Kosovo
- Medical Faculty, University of Prishtina, Prishtina, Republic of Kosovo
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26
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Das A, Banerjee S, Mandal S. A simple method for Bachmann's bundle pacing with indigenous modification of J-stylet. Indian Heart J 2016; 68:678-684. [PMID: 27773407 PMCID: PMC5079114 DOI: 10.1016/j.ihj.2015.10.299] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2015] [Revised: 10/02/2015] [Accepted: 10/06/2015] [Indexed: 11/26/2022] Open
Abstract
Background Pacing in the Bachmann's bundle (BB) area (upper atrial septum) appears superior to right atrial appendage or free wall stimulation for the prevention of paroxysmal atrial fibrillation in patients with atrial conduction delay. However, insertion of active fixation lead in the upper atrial septal position is difficult and time consuming with conventional stylet, inhibiting application of this pacing method in routine practice. Methods The technique of positioning the atrial lead in BB with hand-made stylet is presented with emphasis on electrocardiographic P-wave pattern and fluoroscopic landmarks. Results The results demonstrate an acute implantation and short-term success of BB pacing of 14 patients out of 15 patients without major complications. Pacing parameters at implantation and 3 months postprocedure were noted which were within normal limits. Conclusion These favorable initial results indicate that the positioning of active fixation atrial lead in BB with fluoroscopic landmarks is feasible and reproducible with a simple technique.
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Kelly JP, Daubert JP. Prolonged QRS in Heart Failure With Preserved Ejection Fraction: Risk Marker and Therapeutic Target? JACC Heart Fail 2016; 4:487-9. [PMID: 27256751 DOI: 10.1016/j.jchf.2016.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Accepted: 04/19/2016] [Indexed: 10/21/2022]
Affiliation(s)
- Jacob P Kelly
- Duke University Medical Center and Duke Clinical Research Institute, Durham, North Carolina.
| | - James P Daubert
- Duke University Medical Center and Duke Clinical Research Institute, Durham, North Carolina
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Abstract
In recent years, rapid technological advances have allowed the development of new electrophysiological procedures that would not have been possible without the parallel development of imaging techniques used to plan and guide these procedures and monitor their outcomes. Ablation of atrial fibrillation is among the interventions with the greatest need for imaging support. Echocardiography allows the appropriate selection of patients and the detection of thrombi that would contraindicate the intervention; cardiac magnetic resonance imaging and computed tomography are also essential in planning this procedure, by allowing a detailed anatomical study of the pulmonary veins. In addition, in cardiac resynchronization therapy, echocardiography plays a central role in both patient selection and, later, in device adjustment and in assessing the effectiveness of the technique. More recently, ablation of ventricular tachycardias has been established as a treatment option; this would not be possible without planning using an imaging study such as cardiac magnetic resonance imaging of myocardial scarring.
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Affiliation(s)
- Laura Sanchis
- Instituto Cardiovascular, Hospital Clínic, IDIBAPS, Universidad de Barcelona, IDIBAPS-Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
| | - Susanna Prat
- Instituto Cardiovascular, Hospital Clínic, IDIBAPS, Universidad de Barcelona, IDIBAPS-Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
| | - Marta Sitges
- Instituto Cardiovascular, Hospital Clínic, IDIBAPS, Universidad de Barcelona, IDIBAPS-Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain.
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30
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Bytyçi I, Haliti E, Berisha G, Tishukaj A, Shatri F, Bajraktari G. Left ventricular longitudinal systolic dysfunction is associated with right atrial dyssynchrony in heart failure with preserved ejection fraction. Revista Portuguesa de Cardiologia (English Edition) 2016; 35:207-214. [DOI: 10.1016/j.repce.2015.11.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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31
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Bytyçi I, Haliti E, Berisha G, Tishukaj A, Shatri F, Bajraktari G. Left ventricular longitudinal systolic dysfunction is associated with right atrial dyssynchrony in heart failure with preserved ejection fraction. Rev Port Cardiol 2016; 35:207-14. [PMID: 26992745 DOI: 10.1016/j.repc.2015.11.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2015] [Accepted: 11/21/2015] [Indexed: 02/08/2023] Open
Abstract
OBJECTIVE We aimed in this study to assess the role of longitudinal left ventricular (LV) systolic function in heart failure with preserved ejection fraction (HFpEF) in delayed intra- and interatrial conduction time. METHODS In 85 consecutive patients with HFpEF (age 60±11 years, ejection fraction [EF] ≥45%), a complete M-mode echocardiographic and tissue Doppler imaging (TDI) study was performed. The times from the onset of the P wave on the ECG to the beginning of the A' wave (PA) from the lateral and septal mitral and tricuspid annuli on TDI were recorded. The difference between these intervals gave the intra- and interatrial dyssynchrony. Based on mitral annular plane systolic excursion (MAPSE), patients were classified as having HFpEF with impaired (MAPSE ≤1.2 cm) or normal (MAPSE >1.2 cm) longitudinal systolic function. RESULTS Patients with impaired MAPSE were older (p<0.001), had higher LV mass index (p<0.001), greater left atrial (LA) minimum volume (p=0.007), reduced left atrial EF (p<0.001), higher E/e' ratio (p=0.002), reduced lateral and septal e' wave (p=0.005 and p=0.006, respectively), prolonged tricuspid PA' (p=0.03) and significantly increased right atrial (RA) dyssynchrony (p=0.001) compared with normal MAPSE. MAPSE correlated with RA dyssynchrony (r=-0.40, p<0.001) but not with interatrial and LA dyssynchrony. CONCLUSION In patients with HFpEF and impaired MAPSE, RA dyssynchrony is increased, compared to those with normal MAPSE. As patients with RA dyssynchrony are at higher risk for arrhythmia, assessment of this dyssynchrony may help to improve treatment, as well as to predict outcome in these patients.
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Affiliation(s)
- Ibadete Bytyçi
- Clinic of Cardiology, University Clinical Centre of Kosova, Prishtina, Kosovo.
| | - Edmond Haliti
- Clinic of Cardiology, University Clinical Centre of Kosova, Prishtina, Kosovo
| | - Gëzim Berisha
- Clinic of Cardiology, University Clinical Centre of Kosova, Prishtina, Kosovo
| | - Arbërie Tishukaj
- Clinic of Cardiology, University Clinical Centre of Kosova, Prishtina, Kosovo
| | - Faik Shatri
- Clinic of Cardiology, University Clinical Centre of Kosova, Prishtina, Kosovo
| | - Gani Bajraktari
- Clinic of Cardiology, University Clinical Centre of Kosova, Prishtina, Kosovo
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Kloosterman M, Rienstra M, Mulder BA, Van Gelder IC, Maass AH. Atrial reverse remodelling is associated with outcome of cardiac resynchronization therapy. Europace 2015; 18:1211-9. [DOI: 10.1093/europace/euv382] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Accepted: 10/25/2015] [Indexed: 12/21/2022] Open
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Donal E, Lund LH, Oger E, Hage C, Persson H, Reynaud A, Ennezat PV, Bauer F, Drouet E, Linde C, Daubert C. New echocardiographic predictors of clinical outcome in patients presenting with heart failure and a preserved left ventricular ejection fraction: a subanalysis of the Ka (Karolinska) Ren (Rennes) Study. Eur J Heart Fail 2015; 17:680-8. [PMID: 26033771 DOI: 10.1002/ejhf.291] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2014] [Revised: 02/23/2015] [Accepted: 03/19/2015] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVES To identify electrocardiographic and echocardiographic predictors of mortality and hospitalizations for heart failure (HF) in the KaRen study. BACKGROUND KaRen is a prospective, observational study of the long-term outcomes of patients presenting with heart failure and a preserved ejection fraction (HFpEF). METHOD We identified 538 patients who presented with acute cardiac decompensation, a >100 pg/mL serum b-type natriuretic peptide (BNP) or >300 pg/mL N-terminal pro-brain natriuretic peptide (NT-proBNP) concentration and a left ventricular ejection fraction (LVEF) >45%. After 4-8 weeks of standard treatment, 413 patients (mean age = 76 ± 9 years, 55.9% women) returned for analyses of their clinical status, laboratory screen, and detailed electrocardiographic and Doppler echocardiographic recordings. They were followed for a mean of 28 months thereafter. The primary study endpoint was time to death from all causes or first hospitalization for heart failure. RESULTS Mean LVEF was 62.4 ± 6.9% and median NT-proBNP 1410 pmol/L. PR interval >200 ms was present in 11.2% of patients and 14.9% had a >120 ms QRS duration, with left bundle branch block in only 6.3%. Over a mean follow-up of 28 months, 177 patients (42.9%) reached a primary study endpoint, including 61 deaths and 116 hospitalizations for heart failure. After adjustment for age, gender, New York Heart Association class, atrial fibrillation history, creatinine, sodium, BNP, ejection fraction, and right ventricular fractional shortening, only E/e' remained as a predictor, with a hazard ratio = 1.49 and P = 0.0012. CONCLUSION The incidence of hospitalizations for HF and deaths in KaRen was high and E/e' predicted adverse clinical outcomes. These observations should help in the risk stratification and therapy of HFpEF.
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Affiliation(s)
- Erwan Donal
- Cardiology department & CIC-IT U 804, Hôpital Pontchaillou-CHU Rennes, Rennes University Health Centre, rue Henri Le Guillou, 35000, Rennes, France.,LTSI, Rennes 1 University, INSERM 1099, Rennes, France
| | - Lars H Lund
- Department of Medicine, Karolinska Institutet and Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
| | - Emmanuel Oger
- Clinical Investigation Center INSERM CIC-1414, CHU Rennes, France
| | - Camilla Hage
- Department of Medicine, Karolinska Institutet and Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
| | - Hans Persson
- Karolinska Institutet, Department of Clinical Sciences, Danderyd Hospital, Stockholm, Sweden
| | | | | | - Fabrice Bauer
- Cardiology Department, Rouen University Health Centre, Rouen, France
| | | | - Cecilia Linde
- Department of Medicine, Karolinska Institutet and Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
| | - Claude Daubert
- Cardiology department & CIC-IT U 804, Hôpital Pontchaillou-CHU Rennes, Rennes University Health Centre, rue Henri Le Guillou, 35000, Rennes, France.,LTSI, Rennes 1 University, INSERM 1099, Rennes, France
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Abstract
PURPOSE OF REVIEW Left atrial structural and functional changes in heart failure are relatively ignored parts of cardiac assessment. This review illustrates the pathophysiological and functional changes in left atrium in heart failure as well as their prognostic value. RECENT FINDINGS Heart failure can be divided into those with systolic dysfunction and heart failure with preserved ejection fraction (HFPEF). Left atrial enlargement and dysfunction commonly occur in systolic heart failure, in particular, in idiopathic dilated cardiomyopathy. Atrial enlargement and dysfunction also carry important prognostic value in systolic heart failure, independently of known parameters such as left ventricular ejection fraction. In HFPEF, there is evidence of left atrial enlargement, impaired atrial compliance, and reduction of atrial pump function. This occurs not only at rest but also during exercise, indicating significant impairment of atrial contractile reserve. Furthermore, atrial dyssynchrony is common in HFPEF. These factors further contribute to the development of new onset or progression of atrial arrhythmias, in particular, atrial fibrillation. SUMMARY Left atrial function is an integral part of cardiac function and its structural and functional changes in heart failure are common. As changes of left atrial structure and function have different clinical implications in systolic heart failure and HFPEF, routine assessment is warranted.
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35
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Upadhya B, Taffet GE, Cheng CP, Kitzman DW. Heart failure with preserved ejection fraction in the elderly: scope of the problem. J Mol Cell Cardiol 2015; 83:73-87. [PMID: 25754674 DOI: 10.1016/j.yjmcc.2015.02.025] [Citation(s) in RCA: 98] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Revised: 02/25/2015] [Accepted: 02/26/2015] [Indexed: 12/13/2022]
Abstract
Heart failure with preserved ejection fraction (HFpEF) is the most common form of heart failure (HF) in older adults, particularly women, and is increasing in prevalence as the population ages. With morbidity and mortality on par with HF with reduced ejection fraction, it remains a most challenging clinical syndrome for the practicing clinician and basic research scientist. Originally considered to be predominantly caused by diastolic dysfunction, more recent insights indicate that HFpEF in older persons is typified by a broad range of cardiac and non-cardiac abnormalities and reduced reserve capacity in multiple organ systems. The globally reduced reserve capacity is driven by: 1) inherent age-related changes; 2) multiple, concomitant co-morbidities; 3) HFpEF itself, which is likely a systemic disorder. These insights help explain why: 1) co-morbidities are among the strongest predictors of outcomes; 2) approximately 50% of clinical events in HFpEF patients are non-cardiovascular; 3) clinical drug trials in HFpEF have been negative on their primary outcomes. Embracing HFpEF as a true geriatric syndrome, with complex, multi-factorial pathophysiology and clinical heterogeneity could provide new mechanistic insights and opportunities for progress in management. This article is part of a Special Issue entitled CV Aging.
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Affiliation(s)
- Bharathi Upadhya
- Cardiology Section, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - George E Taffet
- Geriatrics and Cardiovascular Sciences, Baylor College of Medicine, Houston Methodist Hospital, Houston, TX, USA
| | - Che Ping Cheng
- Cardiology Section, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Dalane W Kitzman
- Cardiology Section, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA.
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Sanchis L, Vannini L, Gabrielli L, Duchateau N, Falces C, Andrea R, Bijnens B, Sitges M. Interatrial Dyssynchrony May Contribute to Heart Failure Symptoms in Patients with Preserved Ejection Fraction. Echocardiography 2015; 32:1655-61. [DOI: 10.1111/echo.12927] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Affiliation(s)
- Laura Sanchis
- Cardiology Department; Thorax Institute; Hospital Clinic; IDIBAPS; University of Barcelona; Barcelona Spain
| | - Luca Vannini
- Cardiology Department; Thorax Institute; Hospital Clinic; IDIBAPS; University of Barcelona; Barcelona Spain
| | - Luigi Gabrielli
- Cardiology Department; Thorax Institute; Hospital Clinic; IDIBAPS; University of Barcelona; Barcelona Spain
- Advanced Center for Chronic Diseases; School of Medicine; Pontifical Catholic University of Chile; Santiago Chile
| | | | - Carles Falces
- Cardiology Department; Thorax Institute; Hospital Clinic; IDIBAPS; University of Barcelona; Barcelona Spain
| | - Rut Andrea
- Cardiology Department; Thorax Institute; Hospital Clinic; IDIBAPS; University of Barcelona; Barcelona Spain
| | - Bart Bijnens
- Pompeu Fabra University; Barcelona Spain
- Catalan Institution for Research and Advanced Studies; Barcelona Spain
| | - Marta Sitges
- Cardiology Department; Thorax Institute; Hospital Clinic; IDIBAPS; University of Barcelona; Barcelona Spain
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Kim IS, Kim TH, Shim CY, Mun HS, Uhm JS, Joung B, Hong GR, Lee MH, Pak HN. The ratio of early transmitral flow velocity (E) to early mitral annular velocity (Em) predicts improvement in left ventricular systolic and diastolic function 1 year after catheter ablation for atrial fibrillation. Europace 2015; 17:1051-8. [PMID: 25600764 DOI: 10.1093/europace/euu346] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Accepted: 11/08/2014] [Indexed: 01/01/2023] Open
Abstract
AIMS Successful rhythm control after atrial fibrillation catheter ablation is known to induce left atrial reverse remodelling and improve left ventricular (LV) function. We explored the clinical factors affecting LV systolic and diastolic function 1-year after catheter ablation for atrial fibrillation. METHODS AND RESULTS We compared pre-procedural and 1-year follow-up echocardiograms in 521 patients with atrial fibrillation who underwent catheter ablation. Left ventricular systolic function was estimated by the ejection fraction (EF); diastolic function was estimated by the ratio of early transmitral flow velocity (E) to early mitral annular velocity (Em). (i) Catheter ablation of atrial fibrillation significantly reduced left atrium volume index (P < 0.001) and improved LV EF both in patients with recurrent atrial fibrillation (n = 133, P = 0.008) and those without recurrence (n = 388, P < 0.001). (ii) Follow-up EF was significantly improved in patients with baseline E/Em < 15 (n = 454, P < 0.001), whereas E/Em was significantly reduced in patients with pre-procedural E/Em ≥ 15 (n = 67, P = 0.008). (iii) Baseline E/Em < 15 (β = -3.854, 95% CI -5.99 to -1.72, P < 0.001), baseline EF <50% (β = 10.586, 95% CI 7.55 to 13.63, P < 0.001), and female (β = -1.726, 95% CI -3.36 to -0.10, P = 0.038) were independently associated with improved EF. Baseline E/Em ≥ 15 (β = 4.896, 95% CI 3.45 to 6.34, P < 0.001) and younger age (β = -0.066, 95% CI -0.11 to -0.02, P = 0.003) were independent factors associated with improved E/Em. CONCLUSION Pre-procedural E/Em predicted improvement in LV systolic and diastolic functions 1 year after catheter ablation for atrial fibrillation. Low baseline E/Em was independently associated with improved EF, while high E/Em predicted improvement in LV diastolic function.
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Affiliation(s)
- In-Soo Kim
- Yonsei University Health System, 250 Seungsanno, Seodaemun-gu, Seoul 120-752, Republic of Korea
| | - Tae-Hoon Kim
- Yonsei University Health System, 250 Seungsanno, Seodaemun-gu, Seoul 120-752, Republic of Korea
| | - Chi-Young Shim
- Yonsei University Health System, 250 Seungsanno, Seodaemun-gu, Seoul 120-752, Republic of Korea
| | - Hee-Sun Mun
- Yonsei University Health System, 250 Seungsanno, Seodaemun-gu, Seoul 120-752, Republic of Korea
| | - Jae Sun Uhm
- Yonsei University Health System, 250 Seungsanno, Seodaemun-gu, Seoul 120-752, Republic of Korea
| | - Boyoung Joung
- Yonsei University Health System, 250 Seungsanno, Seodaemun-gu, Seoul 120-752, Republic of Korea
| | - Geu-Ru Hong
- Yonsei University Health System, 250 Seungsanno, Seodaemun-gu, Seoul 120-752, Republic of Korea
| | - Moon-Hyoung Lee
- Yonsei University Health System, 250 Seungsanno, Seodaemun-gu, Seoul 120-752, Republic of Korea
| | - Hui-Nam Pak
- Yonsei University Health System, 250 Seungsanno, Seodaemun-gu, Seoul 120-752, Republic of Korea
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Doltra A, Bijnens B, Tolosana JM, Borràs R, Khatib M, Penela D, De Caralt TM, Castel MÁ, Berruezo A, Brugada J, Mont L, Sitges M. Mechanical abnormalities detected with conventional echocardiography are associated with response and midterm survival in CRT. JACC Cardiovasc Imaging 2014; 7:969-79. [PMID: 25240452 DOI: 10.1016/j.jcmg.2014.03.022] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Revised: 03/05/2014] [Accepted: 03/06/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVES Our aim was to identify "correctable abnormalities" using conventional grayscale and blood-pool Doppler echocardiography and evaluate their ability to predict both response and midterm survival. BACKGROUND Identification of mechanical abnormalities that may be corrected with cardiac resynchronization therapy (CRT) is useful for predicting echocardiographic response at 1-year follow-up. METHODS A total of 200 CRT patients were included. Clinical evaluation and echocardiography were performed before and after CRT to assess the presence of the mechanical abnormalities of interest (septal flash, abnormal ventricular filling, or exaggerated interventricular dependence). Response to CRT was defined as a reduction in left ventricular (LV) end-systolic volume (ESV) ≥15%. Four subgroups of extent of response were defined: LVESV reduction >26.68% (extensive remodeling); LVESV reduction 6.8% to 26.68% (slight remodeling); LVESV reduction <6.8% (no remodeling) and clinical response; and LVESV reduction <6.8% without clinical response or the occurrence of death or heart transplantation. Midterm cardiovascular survival was evaluated (mean follow-up 38 ± 19 months). RESULTS The presence of a correctable abnormality was independently associated with a better rate (odds ratio: 0.03 [95% confidence interval (CI): 0.01 to 0.10], p < 0.001) and extent of response to CRT (n = 59 [96.7%] for the extensive remodeling subgroup vs. n = 53 [85.5%] for the slight remodeling subgroup vs. n = 19 [47.5%] for the no remodeling with clinical response subgroup vs. n = 17 [45.9%] for the no remodeling without clinical response subgroup, p = 0.0001), as well as with increased midterm survival (hazard ratio: 0.11 [95% CI: 0.2 to 0.6]). Other independent predictors included creatinine level and LV end-systolic diameter for response; New York Heart Association functional class IV, creatinine, LV end-systolic diameter, and transmurality index for extent of response; and New York Heart Association functional class IV for cardiovascular mortality. CONCLUSIONS The presence of a correctable abnormality evaluated by conventional echocardiography is associated with LV reverse remodeling and better survival at midterm follow-up. Clinical characteristics and myocardial viability also have an influence.
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Affiliation(s)
- Adelina Doltra
- Thorax Institute, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain.
| | - Bart Bijnens
- ICREA, Universitat Pompeu Fabra, Barcelona, Spain
| | - José M Tolosana
- Thorax Institute, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain
| | - Roger Borràs
- Thorax Institute, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain
| | - Malek Khatib
- Thorax Institute, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain
| | - Diego Penela
- Thorax Institute, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain
| | - Teresa Maria De Caralt
- Thorax Institute, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain
| | - María Ángeles Castel
- Thorax Institute, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain
| | - Antonio Berruezo
- Thorax Institute, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain
| | - Josep Brugada
- Thorax Institute, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain
| | - Lluís Mont
- Thorax Institute, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain
| | - Marta Sitges
- Thorax Institute, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain
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CHOUDHURI INDRAJIT, KRUM DAVID, AGARWAL ANUJ, HARE JOHN, BELOHLAVEK MAREK, AHMAD ABDUR, PINNINTI MAMATHA, KHANDHERIA BIJOYK. Bachmann's Bundle and Coronary Sinus Ostial Pacing Accentuate Left Atrial Electrical Dyssynchrony in an Acute Canine Model. J Cardiovasc Electrophysiol 2014; 25:1400-6. [DOI: 10.1111/jce.12511] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Revised: 05/28/2014] [Accepted: 07/06/2014] [Indexed: 11/27/2022]
Affiliation(s)
- INDRAJIT CHOUDHURI
- Aurora Cardiovascular Services; Aurora Sinai/Aurora St. Luke's Medical Centers; University of Wisconsin School of Medicine and Public Health; Milwaukee Wisconsin USA
| | - DAVID KRUM
- Aurora Cardiovascular Services; Aurora Sinai/Aurora St. Luke's Medical Centers; University of Wisconsin School of Medicine and Public Health; Milwaukee Wisconsin USA
| | - ANUJ AGARWAL
- Aurora Cardiovascular Services; Aurora Sinai/Aurora St. Luke's Medical Centers; University of Wisconsin School of Medicine and Public Health; Milwaukee Wisconsin USA
| | - JOHN HARE
- Aurora Cardiovascular Services; Aurora Sinai/Aurora St. Luke's Medical Centers; University of Wisconsin School of Medicine and Public Health; Milwaukee Wisconsin USA
| | - MAREK BELOHLAVEK
- Division of Cardiovascular Diseases; Mayo Clinic; Scottsdale Arizona USA
| | - ABDUR AHMAD
- Aurora Cardiovascular Services; Aurora Sinai/Aurora St. Luke's Medical Centers; University of Wisconsin School of Medicine and Public Health; Milwaukee Wisconsin USA
| | - MAMATHA PINNINTI
- Aurora Cardiovascular Services; Aurora Sinai/Aurora St. Luke's Medical Centers; University of Wisconsin School of Medicine and Public Health; Milwaukee Wisconsin USA
| | - BIJOY K. KHANDHERIA
- Aurora Cardiovascular Services; Aurora Sinai/Aurora St. Luke's Medical Centers; University of Wisconsin School of Medicine and Public Health; Milwaukee Wisconsin USA
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CHOUDHURI INDRAJIT, MACCARTER DEAN, SHAW RACHAEL, ANDERSON STEVE, ST. CYR JOHN, NIAZI IMRAN. Clinical Feasibility of Exercise-Based A-V Interval Optimization for Cardiac Resynchronization: A Pilot Study. Pacing and Clinical Electrophysiology 2014; 37:1499-509. [DOI: 10.1111/pace.12449] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Revised: 04/18/2014] [Accepted: 05/26/2014] [Indexed: 11/30/2022]
Affiliation(s)
- INDRAJIT CHOUDHURI
- Aurora Cardiovascular Services; Aurora Sinai/Aurora St. Luke's Medical Centers; University of Wisconsin School of Medicine and Public Health; Milwaukee Wisconsin
| | | | - RACHAEL SHAW
- Aurora Cardiovascular Services; Aurora Sinai/Aurora St. Luke's Medical Centers; University of Wisconsin School of Medicine and Public Health; Milwaukee Wisconsin
| | | | | | - IMRAN NIAZI
- Aurora Cardiovascular Services; Aurora Sinai/Aurora St. Luke's Medical Centers; University of Wisconsin School of Medicine and Public Health; Milwaukee Wisconsin
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Uhm J, Shim J, Wi J, Mun H, Park J, Park S, Joung B, Pak H, Lee M. First-degree atrioventricular block is associated with advanced atrioventricular block, atrial fibrillation and left ventricular dysfunction in patients with hypertension. J Hypertens 2014; 32:1115-20. [DOI: 10.1097/hjh.0000000000000141] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Gabrielli L, Sitges M, Mont L. Assessing reverse remodeling in heart failure patients treated with cardiac resynchronization therapy and its impact on prognosis. Expert Rev Cardiovasc Ther 2014; 10:1437-48. [DOI: 10.1586/erc.12.137] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Abstract
It is widely recognized that an effective cardiovascular system is based upon both a good ventricular-vascular interplay and a good ventricular-atrial interaction in all the phases of cardiac cycle. Moreover, left atrial dysfunction has been identified to be contributory in several common cardiovascular conditions, such as heart failure, atrial fibrillation and valvular heart disease; for instance, a good anatomical and functional assessment of this cardiac chamber is mandatory. For this purpose a multimodality imaging approach – including two-dimensional and three-dimensional echocardiography, speckle tracking technique, cardiac computed tomography (CT) and cardiac magnetic resonance (CMR) – is the most suitable one to achieve the best functional and anatomical evaluation of this cardiac chamber.
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Affiliation(s)
- Maria Chiara Todaro
- Cardiology Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Bijoy K Khandheria
- Aurora Cardiovascular Services, Aurora Sinai/Aurora St. Luke's Medical Centers, University of Wisconsin School of Medicine and Public Health, Wisconsin, USA
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Donal E, Lund LH, Oger E, Hage C, Persson H, Reynaud A, Ennezat PV, Bauer F, Sportouch-Dukhan C, Drouet E, Daubert JC, Linde C. Baseline characteristics of patients with heart failure and preserved ejection fraction included in the Karolinska Rennes (KaRen) study. Arch Cardiovasc Dis 2013; 107:112-21. [PMID: 24388161 DOI: 10.1016/j.acvd.2013.11.002] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2013] [Revised: 11/02/2013] [Accepted: 11/18/2013] [Indexed: 01/21/2023]
Abstract
BACKGROUND Karolinska Rennes (KaRen) is a prospective observational study to characterize heart failure patients with preserved ejection fraction (HFpEF) and to identify prognostic factors for long-term mortality and morbidity. AIMS To report characteristics and echocardiography at entry and after 4-8 weeks of follow-up. METHODS Patients were included following an acute heart failure presentation with B-type natriuretic peptide (BNP)>100 ng/L or N-terminal pro-BNP (NT-proBNP)>300 ng/L and left ventricular ejection fraction (LVEF)>45%. RESULTS The mean ± SD age of 539 included patients was 77 ± 9 years and 56% were women. Patient history included hypertension (78%), atrial tachyarrhythmia (44%), prior heart failure (40%) and anemia (37%), but left bundle branch block was rare (3.8%). Median NT-proBNP was 2448 ng/L (n=438), and median BNP 429 ng/L (n=101). Overall, 101 patients did not return for the follow-up visit, including 13 patients who died (2.4%). Apart from older age (80 ± 9 vs. 76 ± 9 years; P=0.006), there were no significant differences in baseline characteristics between patients who did and did not return for follow-up. Mean LVEF was lower at entry than follow-up (56% vs. 62%; P<0.001). At follow-up, mean E/e' was 12.9 ± 6.1, left atrial volume index 49.4±17.8mL/m(2). Mean global left ventricular longitudinal strain was -14.6 ± 3.9%; LV mass index was 126.6 ± 36.2g/m(2). CONCLUSIONS Patients in KaRen were old with slight female dominance and hypertension as the most prevalent etiological factor. LVEF was preserved, but with increased LV mass and depressed LV diastolic and longitudinal systolic functions. Few patients had signs of electrical dyssynchrony (ClinicalTrials.gov.- NCT00774709).
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Affiliation(s)
- Erwan Donal
- Département de Cardiologie & CIC-IT U 804, Hôpital Pontchaillou, CHU de Rennes, rue Henri-Le-Guillou, 35000 Rennes, France; LTSI, Université Rennes 1, INSERM 1099, Rennes, France; Société française de cardiologie, Paris, France.
| | - Lars H Lund
- Department of Medicine, Karolinska Institutet and Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden; Société française de cardiologie, Paris, France
| | - Emmanuel Oger
- Clinical Investigation Center INSERM CIC-0203, CHU de Rennes, Rennes, France; Société française de cardiologie, Paris, France
| | - Camilla Hage
- Department of Medicine, Karolinska Institutet and Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden; Société française de cardiologie, Paris, France
| | - Hans Persson
- Karolinska Institutet, Department of Clinical Sciences, Danderyd Hospital, Stockholm, Sweden; Société française de cardiologie, Paris, France
| | - Amélie Reynaud
- LTSI, Université Rennes 1, INSERM 1099, Rennes, France; Société française de cardiologie, Paris, France
| | - Pierre-Vladimir Ennezat
- Service de Cardiologie, CHU de Lille, Lille, France; Société française de cardiologie, Paris, France
| | - Fabrice Bauer
- Département de Cardiologie, CHU de Rouen, Rouen, France; Société française de cardiologie, Paris, France
| | - Catherine Sportouch-Dukhan
- Département de Cardiologie, CHU de Montpellier, Montpellier, France; Société française de cardiologie, Paris, France
| | - Elodie Drouet
- Département de Cardiologie, CHU de Montpellier, Montpellier, France; Société française de cardiologie, Paris, France
| | - Jean-Claude Daubert
- Département de Cardiologie & CIC-IT U 804, Hôpital Pontchaillou, CHU de Rennes, rue Henri-Le-Guillou, 35000 Rennes, France; LTSI, Université Rennes 1, INSERM 1099, Rennes, France; Société française de cardiologie, Paris, France
| | - Cecilia Linde
- Department of Medicine, Karolinska Institutet and Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden; Société française de cardiologie, Paris, France
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Liu LCY, Damman K, Lipsic E, Maass AH, Rienstra M, Westenbrink BD. Heart failure highlights in 2012-2013. Eur J Heart Fail 2013; 16:122-32. [PMID: 24464645 DOI: 10.1002/ejhf.43] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Revised: 11/04/2013] [Accepted: 11/08/2013] [Indexed: 01/10/2023] Open
Abstract
Heart failure has become the cardiovascular epidemic of the century. The European Journal of Heart Failure is dedicated to the advancement of knowledge in the field of heart failure management. In 2012 and 2013, several pioneering scientific discoveries and paradigm-shifting clinical trials have been published. In the current paper, we will discuss the most significant novel insights into the pathophysiology, diagnosis, and treatment of heart failure that were published during this period. All relevant research areas are discussed, including pathophysiology, co-morbidities, arrhythmias, biomarkers, clinical trials, and device therapy, including left ventricular assist devices.
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Affiliation(s)
- Licette C Y Liu
- The Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Abstract
Pre-clinical diastolic dysfunction (PDD) has been broadly defined as left ventricular diastolic dysfunction without the diagnosis of congestive heart failure (HF) and with normal systolic function. PDD is an entity that remains poorly understood, yet has definite clinical significance. Although few original studies have focused on PDD, it has been shown that PDD is prevalent, and that there is a clear progression from PDD to symptomatic HF including dyspnea, edema, and fatigue. In diabetic patients and in patients with coronary artery disease or hypertension, it has been shown that patients with PDD have a significantly higher risk of progression to heart failure and death compared with patients without PDD. Because of these findings and the increasing prevalence of the heart failure epidemic, it is clear that an understanding of PDD is essential to decreasing patients' morbidity and mortality. This review will focus on what is known concerning pre-clinical diastolic dysfunction, including definitions, staging, epidemiology, pathophysiology, and the natural history of the disease. In addition, given the paucity of trials focused on PDD treatment, studies targeting risk factors associated with the development of PDD and therapeutic trials for heart failure with preserved ejection fraction will be reviewed.
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Affiliation(s)
- Siu-Hin Wan
- Department of Internal Medicine, Mayo Clinic and Foundation, Rochester, Minnesota
| | - Mark W Vogel
- Division of Cardiovascular Diseases, Washington University, St. Louis, Missouri
| | - Horng H Chen
- Division of Cardiovascular Diseases, Mayo Clinic and Foundation, Rochester, Minnesota.
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Kosiuk J, Buchta P, Gaspar T, Arya A, Piorkowski C, Rolf S, Sommer P, Husser D, Hindricks G, Bollmann A. Prevalence and predictors of worsened left ventricular diastolic dysfunction after catheter ablation of atrial fibrillation. Int J Cardiol 2013; 168:3613-5. [DOI: 10.1016/j.ijcard.2013.05.047] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2013] [Accepted: 05/04/2013] [Indexed: 01/01/2023]
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