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Giannoni A, Gentile F, Buoncristiani F, Chubuchny V, Sciarrone P, Panichella G, Bazan L, Gasperini S, Fabiani I, Taddei C, Poggianti E, Petersen C, Pasanisi E, Passino C, Emdin M. Prognostic impact of echocardiographic derived precapillary wedge pressure and pulmonary vascular resistances in patients with heart failure. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
A reliable echocardiographic algorithm for the estimation of precapillary wedge pressure (PCWP) and pulmonary vascular resistances (PVR) has been recently validated by our group in a large cohort of patients undergoing right heart catheterization (RHC) (1). Those metrics may add relevant clinical and prognostic information in patients with heart failure (HF).
Objective
To assess the clinical/prognostic significance of echocardiographic derived PCWP and PVR in a large cohort of chronic HF patients on modern treatments.
Methods
Outpatients with chronic HF with either reduced (≤40%) or mildly reduced LVEF (41–49%) underwent a thorough clinical multiparametric assessment and were followed-up for a composite endpoint of cardiac death, appropriate ICD shock, or first HF hospitalization.
Results
Out of 1,483 patients prospectively enrolled (70±12 years, 73% males, 42% ischemic etiology, LVEF 35±8%), PCWP (16.4±5.8 mmHg) was elevated (>15 mmHg) in 53% of cases, while PVR (1.7±0.7) was elevated (>3 WU) in 6% of cases. Of the latter group, most (92%) had also elevated PCWP. Patients with increased PCWP were older, had a higher heart rate and lower cardiac output, showed a higher degree of left and right chamber remodeling, had a higher neurohormonal activation, worse renal function, worse functional capacity and ventilatory efficiency on effort (all p<0.001). Those patients with high PCWP and PVR showed higher heart rate and pulmonary pressures, lower cardiac output, and right ventricular function, higher neurohormonal activation, lower functional capacity and ventilatory efficiency on effort compared to patients with high PCWP but normal PVR (all p<0.01). The optimal prognostic cut-point was identified for both PCWP (16.2 mmHg) and PVR (2 WU) by log-rank maximal likelihood ratio. Over a median follow-up of 22 (8–37) months, both measures significantly stratified patients for the risk of the primary endpoint at Kaplan-Meier analysis (log-rank 92.9, p<0.001 for PCWP; log-rank 17.3, p<0.001 for PVR). At multivariable Cox regression analysis (adjusted for age, sex, ischemic HF etiology, renal function, LVEF, and NT-proBNP), PCWP (hazard ratio, HR 1.77 [95% CI 1.30–2.40], p<0.001) but not PVR (HR 1.15 [95% CI 0.88–1.51], p=0.31) remained an independent predictor of the primary outcome.
Conclusion
The estimation of PCWP and PVR by echocardiography add relevant clinical and prognostic information and may help in the decision making in patients with HF.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- A Giannoni
- Sant'Anna School of Advanced Studies , Pisa , Italy
| | - F Gentile
- Fondazione Toscana Gabriele Monasterio , Pisa , Italy
| | | | - V Chubuchny
- Fondazione Toscana Gabriele Monasterio , Pisa , Italy
| | - P Sciarrone
- Fondazione Toscana Gabriele Monasterio , Pisa , Italy
| | - G Panichella
- Sant'Anna School of Advanced Studies , Pisa , Italy
| | - L Bazan
- Sant'Anna School of Advanced Studies , Pisa , Italy
| | - S Gasperini
- Sant'Anna School of Advanced Studies , Pisa , Italy
| | - I Fabiani
- Fondazione Toscana Gabriele Monasterio , Pisa , Italy
| | - C Taddei
- Fondazione Toscana Gabriele Monasterio , Pisa , Italy
| | - E Poggianti
- Fondazione Toscana Gabriele Monasterio , Pisa , Italy
| | - C Petersen
- Fondazione Toscana Gabriele Monasterio , Pisa , Italy
| | - E Pasanisi
- Fondazione Toscana Gabriele Monasterio , Pisa , Italy
| | - C Passino
- Sant'Anna School of Advanced Studies , Pisa , Italy
| | - M Emdin
- Sant'Anna School of Advanced Studies , Pisa , Italy
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Gentile F, Buoncristiani F, Chubuchny V, Sciarrone P, Panichella G, Bazan L, Gasperini S, Fabiani I, Taddei C, Poggianti E, Petersen C, Pasanisi E, Passino C, Emdin M, Giannoni A. Clinical and prognostic significance of left ventricular outflow tract velocity time integral (LVOT-VTI) in patients with chronic heart failure. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
The echocardiographic evaluation of cardiac output relies on the product of the flow across the left ventricular outflow tract (LVOT), estimated through its velocity time integral (LVOT-VTI), and its cross-sectional area, estimated through the formula πr2. Considering the geometrical assumption behind such formula, LVOT-VTI has been proposed as a more reproducible surrogate of cardiac systolic function and showed prognostic value in the critical care setting. However, the role of such measure in patients with chronic heart failure (HF) remains unexplored.
Objective
To assess the clinical and prognostic significance of LVOT-VTI in a contemporary cohort of patients with chronic HF.
Methods
Outpatients with chronic HF with a LV ejection fraction <50% were prospectively enrolled to undergo a clinical, echocardiographic, and biohumoral assessment, and were followed-up for the endpoint of all-cause death.
Results
Finally, 971 patients were enrolled (71±12 years, 72% men, 50% ischemic etiology, LVEF 35±9%). Most patients showed a NYHA class I-II (74%) and were treated with ACE-inhibitors/ARBs or ARNI (81%), beta-blockers (95%), and mineralocorticoid receptor antagonists (71%). Patients were distinguished in three subgroups according to LVOT-VTI tertiles <19 (n=324), 19–24 (n=324), or ≥24 (n=323). Compared with the other two subgroups, patients with LVOT-VTI <19 showed worse NYHA class, lower LVEF and tricuspid annular plane systolic excursion (TAPSE), and higher E/e', left atrial volume index (LAVi), estimated systolic pulmonary arterial pressure (sPAP), and NT-proBNP concentration (all p<0.001). No differences were observed as for patients' age, HF etiology, and therapies (all p>0.05). Over a median follow-up of 22 (9–34) months, 103 (11%) patients met the primary endpoint. LVOT-VTI significantly stratified the risk of death, observing 65 (20%), 21 (7%), and 17 (5%) events across the subgroups with values <19, 19–24, or ≥24 (log-rank 33, p<0.001). At multivariable regression analysis, LVOT-VTI <19 (HR 2.06 [95% 1.21–3.49], p=0.008), but not LVEF <30% (p=0.614) was an independent predictor of all-cause death in a model adjusted for age, sex, ischemic etiology, renal function, hemoglobin, E/e', LAVi, TAPSE, sPAP, and NT-proBNP.
Conclusion
LVOT-VTI is associated with disease severity and is a strong predictor of all-cause death in patients with chronic HF.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
| | | | - V Chubuchny
- Fondazione Toscana Gabriele Monasterio , Pisa , Italy
| | | | - G Panichella
- Sant'Anna School of Advanced Studies , Pisa , Italy
| | - L Bazan
- Sant'Anna School of Advanced Studies , Pisa , Italy
| | - S Gasperini
- Sant'Anna School of Advanced Studies , Pisa , Italy
| | - I Fabiani
- Fondazione Toscana Gabriele Monasterio , Pisa , Italy
| | - C Taddei
- Fondazione Toscana Gabriele Monasterio , Pisa , Italy
| | - E Poggianti
- Fondazione Toscana Gabriele Monasterio , Pisa , Italy
| | - C Petersen
- Fondazione Toscana Gabriele Monasterio , Pisa , Italy
| | - E Pasanisi
- Fondazione Toscana Gabriele Monasterio , Pisa , Italy
| | - C Passino
- Sant'Anna School of Advanced Studies , Pisa , Italy
| | - M Emdin
- Sant'Anna School of Advanced Studies , Pisa , Italy
| | - A Giannoni
- Sant'Anna School of Advanced Studies , Pisa , Italy
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Liang E, Morris E, Vono J, Bazan L, Lu M, Modh A, Glide-Hurst C. Coupling Continuous Positive Airway Pressure (CPAP) and MR-guided Radiation Therapy. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.942] [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: 10/23/2022]
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Turanova OA, Volkov MY, Frolova EN, Bazan L, Garifzianova GG, Gafiyatullin LG, Ovchinnikov IV, Turanov AN. Publisher's Note: "Effect of the chemical structure of an equatorial ligand on the spin crossover properties of the Fe(III) complex with 4-styrylpyridine axial ligands" [J. Chem. Phys. 152, 014306 (2020)]. J Chem Phys 2020; 152:119902. [PMID: 32199426 DOI: 10.1063/5.0006432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- O A Turanova
- Zavoisky Physical-Technical Institute, FRC Kazan Scientific Center of RAS, Kazan, Russia
| | - M Yu Volkov
- Zavoisky Physical-Technical Institute, FRC Kazan Scientific Center of RAS, Kazan, Russia
| | - E N Frolova
- Zavoisky Physical-Technical Institute, FRC Kazan Scientific Center of RAS, Kazan, Russia
| | - L Bazan
- Zavoisky Physical-Technical Institute, FRC Kazan Scientific Center of RAS, Kazan, Russia
| | | | - L G Gafiyatullin
- Zavoisky Physical-Technical Institute, FRC Kazan Scientific Center of RAS, Kazan, Russia
| | - I V Ovchinnikov
- Zavoisky Physical-Technical Institute, FRC Kazan Scientific Center of RAS, Kazan, Russia
| | - A N Turanov
- Zavoisky Physical-Technical Institute, FRC Kazan Scientific Center of RAS, Kazan, Russia
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Turanova OA, Volkov MY, Frolova EN, Bazan L, Garifzianova GG, Gafiyatullin LG, Ovchinnikov IV, Turanov AN. Effect of the chemical structure of an equatorial ligand on the spin crossover properties of the Fe(III) complex with 4-styrylpyridine axial ligands. J Chem Phys 2020; 152:014306. [PMID: 31914761 DOI: 10.1063/1.5124369] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
In order to study the effect of the chemical structure of the equatorial ligand on the spin state of the Fe(iii) ion in complexes with invariable photoisomerizable 4-styrylpyridine axial ligands and different tetradentate Schiff bases, several new Fe(iii) complexes have been first synthesized, characterized, and studied by UV-vis, NMR, and EPR spectroscopies. The general chemical formula of the complexes is [Fe(SB)Sp2]BPh4·MeOH, where Sp is trans-4-styrylpyridine and SB are dianions of Schiff bases: salen, bzacen, and acen [salen = N,N'-ethylenebis(salicylaldimine) 1, acen = N,N'-ethylenebis(acetylacetonylideneimine) 2, and H2bzacen = N,N'-ethylenebis(benzoylacetonylideneimine) 3]. The results of the EPR and NMR measurements of the complexes both in the solid state and in solutions showed that the more methyl groups and less aromatic rings in the equatorial ligand, the more abrupt spin-crossover was observed in the complex. The dependence of the magnetic properties of the complexes on the state of matter and the presence of a solvent (powder, liquid solutions, and vitrified solutions) are noted.
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Affiliation(s)
- O A Turanova
- Zavoisky Physical-Technical Institute, FRC Kazan Scientific Center of RAS, Kazan, Russia
| | - M Yu Volkov
- Zavoisky Physical-Technical Institute, FRC Kazan Scientific Center of RAS, Kazan, Russia
| | - E N Frolova
- Zavoisky Physical-Technical Institute, FRC Kazan Scientific Center of RAS, Kazan, Russia
| | - L Bazan
- Zavoisky Physical-Technical Institute, FRC Kazan Scientific Center of RAS, Kazan, Russia
| | | | - L G Gafiyatullin
- Zavoisky Physical-Technical Institute, FRC Kazan Scientific Center of RAS, Kazan, Russia
| | - I V Ovchinnikov
- Zavoisky Physical-Technical Institute, FRC Kazan Scientific Center of RAS, Kazan, Russia
| | - A N Turanov
- Zavoisky Physical-Technical Institute, FRC Kazan Scientific Center of RAS, Kazan, Russia
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Assaad U, Bazan L. 1219 Post LVAD implantation related hypercapnia successfully treated with NIPPV: a case report. Sleep 2017. [DOI: 10.1093/sleepj/zsx052.009] [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: 11/14/2022] Open
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