Expression of uric acid and cystatin C in serum of older adult patients with diastolic heart failure and their correlation with ventricular remodeling / 中国基层医药

Objective:To investigate the expression of serum uric acid and cystatin C in older adult patients with diastolic heart failure and their correlation with ventricular remodeling.Methods:The clinical data of 173 older adult patients with diastolic heart failure (patient group) and 144 older adult patients who had normal heart function (control group) who received treatment in Liaoning Jinqiu Hospital from January 2018 to January 2020 were retrospectively analyzed. Left ventricular end-diastolic diameter, left ventricular mass index, serum uric acid and cystatin C levels were compared between the two groups. These indices were also compared between patients with different classes of heart failure. Serum uric acid and cystatin C levels were correlated with left ventricular end-diastolic diameter and left ventricular mass index.Results:Left ventricular end-diastolic diameter, left ventricular mass index, and serum uric acid and cystatin C levels in the patient group were (46.82 ± 4.56) mm, (117.45 ± 24.51) g/m 2, (380.23 ± 115.85) μmol/L, (1.41 ± 0.51) mg/L, respectively, which were significantly higher than (45.8 ± 3.96) mm, (111.19 ± 19.30) g/m 2, (333.65 ± 89.02) μmol/L, (1.06 ± 0.34) mg/L, respectively in the control group ( t = 2.10, 2.48, 3.95, 7.02, all P < 0.05). Serum uric acid level in patients with class IV heart failure was (432.48 ± 157.64) μmol/L, which was significantly higher than (355.22 ± 106.56) μmol/L and (379.89 ± 93.43) μmol/L in patients with class II and class III heart failure ( F = 5.18, P < 0.05). Pearson correlation analysis showed that serum uric acid level was positively correlated with left ventricular end-diastolic diameter ( r = 0.17, P < 0.05) and left ventricular mass index ( r = 0.18, P < 0.05) in older adult patients with diastolic heart failure. Conclusion:Serum uric acid plays an important role in the occurrence and development of diastolic heart failure in older adults. Serum uric acid level can help measure the degree of ventricular remodeling to some extent.

Factores asociados con mortalidad intrahospitalaria en falla cardíaca aguda: un estudio de cohorte retrospectiva / Factors Associated with in-hospital Mortality in Acute Heart Failure: A Retrospective Cohort Study / Fatores associados à mortalidade intra-hospitalar na insuficiência cardíaca aguda: estudo retrospectivo

Introducción: La falla cardiaca es una enfermedad de alta prevalencia mundial y de gran interés para la salud pública. En Colombia constituye una de las principales causas de mortalidad de origen cardiovascular, por lo cual es importante determinar los factores de riesgo asociados con la mortalidad intrahospitalaria en estos pacientes. Materiales y métodos: Estudio de cohorte retrospectiva que incluyó a 260 pacientes con diagnóstico de falla cardiaca aguda atendidos en el Hospital Universitario San Rafael de Tunja (Colombia) entre enero de 2019 y enero de 2022. Con un análisis univariado y bivariado se construyó un modelo de regresión de Cox para determinar los factores asociados con mortalidad intrahospitalaria, y como desenlaces secundarios se determinó la incidencia de mortalidad intrahospitalaria a 10 días, el reingreso y el tiempo de estancia hospitalaria. Resultados: La incidencia de mortalidad intrahospitalaria a los 10 días fue del 10 %, el reingreso hospitalario se presentó en el 21,2 % de los pacientes, la media de estancia hospitalaria fue de 9,31 días. Los factores de riesgo para mortalidad intrahospitalaria estadísticamente significativos fueron la clasificación clínica de Stevenson C o L (HR: 3,2; IC: 1,12-9,39; p = 0,03) y la clase funcional del paciente a su ingreso NYHA III o IV (HR: 2,76; IC: 1,02-7,53; p = 0,04). Conclusiones: La clasificación clínica de Stevenson C o L y la clase funcional según NYHA III o IV demostraron ser factores de riesgo independientes de mortalidad intrahospitalaria. Se sugiere identificar tempranamente a estos pacientes, ya que podría asegurar una mayor supervivencia

Introduction: Heart failure is an illness of high prevalence at world level, and therefore one of great interest for public health. In Colombia, it is one of the leading causes of death from cardiovascular cause. For this reason, it is important to determine the risk factors associated to intrahospital morta-lity in these patients. Materials and methods: Retrospective cohort study that included 260 patients diagnosed with acute heart failure treated in San Rafael University Hospital in Tunja between January 2019 and January 2022. A univariate and a bivariate analysis were carried out calculating Hazard Ratio and p values. With these results, a Cox regression model was made to determine the associated factors in intrahos-pital mortality; in addition, the incidence of intrahospital mortality 10 days after admission; readmis-sions; and length of hospital stay were determined as secondary outcomes. Results: The incidence of intrahospital mortality 10 days after admission was of 10%; hospital read-missions occurred for 21.2% of the patients; the mean in hospital stay was of 9.31 days; the statis-tically significant risk factors for intrahospital mortality were Stevenson's clinical classification C or L (HR: 3.2; IC: 1.12-9.39; p = 0.03] and the patient's functional class at the time of admission NYHA III or IV (HR: 2.76; IC: 1.02-7.53; p = 0.04]. Conclusion: Stevenson's clinical classification C or L and the functional class NYHA III or IV emerge as independent risk factors for intrahospital mortality. Early identification of these patients is suggested for an increased rate of survival.

Introdução: a insuficiência cardíaca é uma doença de elevada prevalência em todo o mundo e que suscita grades preocupações em termos de saúde pública. Na Colômbia, esta é uma das principais causas de mortalidade cardiovascular, pelo que é importante determinar os fatores de risco associados à mortalidade intra-hospitalar nestes pacientes. Materiais e métodos: Estudo retrospectivo que inclui 260 pacientes com diagnostico de insuficiência cardíaca aguda tratados no Hospital Universitário San Rafael da cidade de Tunja (Colômbia) entre janeiro de 2019 e janeiro de 2022. Foi construído um modelo de regressão de Cox utilizando análises univariada e bivariada para determinar os fatores associados à mortalidade intra-hospitalar. A inci-dência de mortalidade intra-hospitalar aos 10 dias, a readmissão e a duração do internamento foram determinados como resultados secundários. Resultados: A incidência de mortalidade intra-hospitalar aos 10 dias foi de 10%, a readmissão ocorreu em 21,2% dos pacientes e o tempo médio de internamento foi de 9,31 dias. Os fatores de risco estatis-ticamente significativos para a mortalidade intra-hospitalar foram a classificação clínica de Stevenson C ou L (HR: 3,2; IC: 1,12-9,39; p = 0,03) e a classe funcional do paciente na admissão NYHA III ou IV (HR: 2,76; IC: 1,02-7,53; p = 0,04). Conclusões: A classificação clínica C ou L de Stevenson e a classe funcional III ou IV da NYHA provaram ser fatores de risco independentes para a mortalidade intra-hospitalar. A identificação precoce destes pacientes é sugerida, uma vez que pode assegurar uma sobrevivência mais longa

Insuficiência Cardíaca com Fração de Ejeção Ventricular Esquerda Supranormal - Estado da Arte / Heart Failure with Supra-normal Left Ventricular Ejection Fraction - State of the Art

Resumo Em 2019, um artigo publicado no European Heart Journal reconheceu pela primeira vez a insuficiência cardíaca (IC) com fração de ejeção do ventrículo esquerdo (FEVE) ≥ 65% como um novo fenótipo de IC, ou a insuficiência cardíaca com fração de ejeção supranormal (ICFEsn), com o objetivo principal de promover a investigação desta nova categoria. Eles analisaram a mortalidade em pessoas com IC e descobriram que havia uma relação em forma de U entre a mortalidade e a FEVE. Sendo assim, os pacientes com ICFEsn tinham uma mortalidade geral mais alta em comparação com outros pacientes diagnosticados com IC com fração de ejeção preservada (ICFEp). Este artigo descreve a situação atual da ICFEsn e discute as perspectivas futuras com base nos resultados preliminares de nosso grupo. Para melhor tratar os pacientes com ICFEsn, é fundamental que cardiologistas e médicos entendam as diferenças e semelhanças desse novo fenótipo.

Abstract In 2019, an article published in the European Heart Journal recognized for the first time heart failure (HF) with left ventricular ejection fraction (LVEF)≥ 65% as a new HF phenotype, heart failure with supra-normal left ventricular ejection fraction (HFsnEF), with the main purpose of promoting research on this new category. They analyzed mortality in people with HF and found that there was a u-shaped relationship between mortality and LVEF. Accordingly, HFsnEF patients had a higher all-cause mortality compared with other patients diagnosed with HF with preserved ejection fraction (HFpEF). This article describes the current situation of HFsnEF and discusses future perspectives based on the preliminary results of our group. To better treat patients with HFsnEF, it is fundamental that cardiologists and physicians understand the differences and similarities of this new phenotype.

O Papel da Ecocardiografia sob Estresse na Detecção Precoce de Disfunção Diastólica em Pacientes com Doença Pulmonar Obstrutiva Crônica Não Grave / The Role of Stress Echocardiography in the Early Detection of Diastolic Dysfunction in Non-Severe Chronic Obstructive Pulmonary Disease Patients

Resumo Fundamento A dispneia por esforço é uma queixa comum de pacientes com insuficiência cardíaca com fração de ejeção preservada (ICFEP) e doença pulmonar obstrutiva crônica (DPOC). A ICFEP é comum na DPOC e é um fator de risco independente para a progressão e exacerbação da doença. A detecção precoce, portanto, tem grande relevância clínica. Objetivos O objetivo deste estudo foi detectar a frequência de ICFEP mascarada em pacientes com DPOC não grave com dispneia aos esforços, sem doença cardiovascular manifesta, e analisar a correlação entre ICFEP mascarada e os parâmetros do teste cardiopulmonar de exercício (TCPE). Métodos Aplicamos o TCPE em 104 pacientes com DPOC não grave com dispneia aos esforços, sem doença cardiovascular evidente. A ecocardiografia foi realizada antes e no pico do TCPE. Os valores de corte para disfunção diastólica ventricular esquerda e direita induzida por estresse (DDVE/DDVD) foram E/e' >15; E/e' >6, respectivamente. A análise de correlação foi feita entre os parâmetros do TCPE e o estresse E/d'. Valor de p<0,05 foi considerado significativo. Resultados 64% dos pacientes tinham DDVE induzida por estresse; 78% tinham DDVD induzida por estresse. Ambos os grupos com estresse DDVE e DDVD obtiveram carga menor, V'O2 e pulso de O2 mais baixos, além de apresentarem redução na eficiência ventilatória (maiores inclinações de VE/VCO2). Nenhum dos parâmetros do TCPE foram correlacionados com E/e' DDVE/DDVD induzida por estresse. Conclusão Há uma alta prevalência de disfunção diastólica induzida por estresse em pacientes com DPOC não grave com dispneia aos esforços, sem doença cardiovascular evidente. Nenhum dos parâmetros do TCPE se correlaciona com E/e' induzida por estresse. Isso demanda a realização de Ecocardiografia sob estresse por exercício (EES) e TCPE para detecção precoce e manejo adequado da ICFEP mascarada nesta população. (Arq Bras Cardiol. 2021; 116(2):259-265)

Abstract Background Exertional dyspnea is a common complaint of patients with heart failure with preserved ejection fraction (HFpEF) and chronic obstructive pulmonary disease (COPD). HFpEF is common in COPD and is an independent risk factor for disease progression and exacerbation. Early detection, therefore, has great clinical relevance. Objectives The aim of the study is to detect the frequency of masked HFpEF in non-severe COPD patients with exertional dyspnea, free of overt cardiovascular disease, and to analyze the correlation between masked HFpEF and the cardiopulmonary exercise testing (CPET) parameters. Methods We applied the CPET in 104 non-severe COPD patients with exertional dyspnea, free of overt cardiovascular disease. Echocardiography was performed before and at peak CPET. Cut-off values for stress-induced left and right ventricular diastolic dysfunction (LVDD/ RVDD) were E/e'>15; E/e'>6, respectively. Correlation analysis was done between CPET parameters and stress E/e'. A p-value <0.05 was considered significant. Results 64% of the patients had stress-induced LVDD; 78% had stress-induced RVDD. Both groups with stress LVDD and RVDD achieved lower load, lower V'O2 and O2-pulse, besides showing reduced ventilatory efficiency (higher VE/VCO2 slopes). None of the CPET parameters were correlated to stress-induced left or right E/e'. Conclusion There is a high prevalence of stress-induced diastolic dysfunction in non-severe COPD patients with exertional dyspnea, free of overt cardiovascular disease. None of the CPET parameters correlates to stress-induced E/e'. This demands the performance of Exercise stress echocardiography (ESE) and CPET for the early detection and proper management of masked HFpEF in this population. (Arq Bras Cardiol. 2021; 116(2):259-265)

Diastolic dysfunction for nephrologists: diagnosis at the point of care

SUMMARY Cardiovascular diseases are important causes of morbidity and mortality in the course of chronic kidney disease (CKD). Diastolic dysfunction (DD) may progress with the clinical manifestation of heart failure, known as heart failure with preserved ejection fraction, a condition that precedes systolic dysfunction. The early identification of DD by echocardiography at the point-of-care before the appearance of symptoms and signs of pulmonary congestion and the implementation of appropriate treatment can improve the prognosis of CKD. This review article briefly addresses DD in kidney disease and presents a practical approach to the echocardiographic diagnosis of DD at the point of care.

SUMÁRIO As doenças cardiovasculares são causa importante de morbidade e mortalidade no curso da doença renal crônica (DRC). A disfunção diastólica (DD) pode evoluir com insuficiência cardíaca manifesta clinicamente, denominada insuficiência cardíaca com fração de ejeção preservada, e precede a disfunção sistólica. A identificação precoce da DD pela ecocardiografia "point of care", antes do aparecimento dos sintomas e sinais de congestão pulmonar, e a implementação de tratamento adequado podem melhorar o prognóstico da DRC. Este artigo de revisão aborda brevemente a DD na doença renal e apresenta uma abordagem prática para o diagnóstico ecocardiográfico da DD à beira do leito

Echocardiographic Evaluation of Axial Spondyloarthritis in Korea: Data From the Catholic Axial Spondyloarthritis Cohort

OBJECTIVE: Axial spondyloarthritis (axSpA) is often accompanied by cardiac manifestations, such as valvular heart disease. In this prospective cohort study, we evaluated the incidence of cardiac abnormalities in Korean axSpA patients by echocardiography.METHODS: AxSpA patients were prospectively recruited from a single tertiary hospital. Baseline demographic, clinical, radiographic, and echocardiographic data were collected at the time of enrollment. Echocardiography evaluations were performed with a focus on valvular heart disease and systolic and diastolic function. Logistic regression analyses were used to identify factors associated with diastolic dysfunction in axSpA.RESULTS: A total of 357 axSpA patients were included in the analyses, of whom 78 (21.8%) exhibited diastolic dysfunction, with no reports of systolic dysfunction. Thirteen patients (3.6%) had valvular heart disease, and aortic valve regurgitation (n=5) and mitral valve regurgitation (n=6) were most common. Multivariable logistic regression analyses indicated that older age and higher body mass index (BMI) were positively associated with diastolic dysfunction, whereas human leukocyte antigen (HLA)-B27 positivity was negatively associated with diastolic dysfunction.CONCLUSION: Valvular heart disease is infrequent in Korean axSpA patients. However, diastolic dysfunction is common in axSpA patients, and is significantly associated with older age, higher BMI, and HLA-B27.

Expressions of plasma transforming growth factor β1 and brain natrium peptide in patients with diastolic heart failure and their relationship with diastolic function / 中华地方病学杂志

Objective To investigate the expressions of transforming growth factor β1 (TGF-β1) and brain natrium peptide (BNP) in patients with diastolic heart failure (DHF),and to explore the correlation between plasma levels of TGF-β1,BNP and TGF-β1/BNP with parameter of diastolic function,diastolic dysfunction and New York Heart Association (NYHA) classification of cardiac function.Methods Hospitalized patients with DHF from October 2016 to November 2017 in Beijing Chaoyang Hospital were selected as subjects.At the same time,the age-and gender-matched non-heart failure hospitalized patients were selected as the control.The diastolic function index (E/e') was measured using cardiac ultrasound spectral Doppler and tissue Doppler methods.The diastolic dysfunction classification was evaluated according to the American Society of Echocardiography guidelines.Cardiac function was evaluated with NYHA classification.The levels of plasma TGF-β1 and BNP were measured with method of enzyme linked immunosorbent assay (ELISA).The correlation between the indicators was analyzed and the receiver operating characteristic (ROC) curve was drawn.Results A total of 186 patients were enrolled,including 114 patients as DHF group [54 males and 60 females,mean age (70.75 ± 11.45) years old] and 72 cases as control group [41 males and 31 females,mean age (68.74 ± 10.86) years old].The levels of TGF-β1 [(77.68 ± 42.31) ng/L] and BNP [(1 153.84 ± 564.96) ng/L] in patients with DHF were significantly higher than those of the control group [(18.76 ± 13.70),(264.07 ± 179.43) ng/L,t =15.62,13.77,P ＜ 0.01].Pearson correlation analysis showed that level of plasma TGF-β1 had a significant liner correlation with index E/e' (r =0.582,P ＜ 0.01),level of plasma BNP had a low-degree liner correlation with index E/e' (r =0.261,P ＜ 0.01),and TGF-β1/BNP had no correlation with index E/e' (r =0.081,P ＞ 0.05).Spearman correlation analysis showed that the levels of TGF-β1 and BNP were significantly correlated with diastolic dysfunction grading (r =0.473,0.417,P ＜ 0.01),while TGF-β1/BNP had no correlation with diastolic dysfunction grading (r =0.062,P ＞ 0.05).Plasma TGF-β1 and BNP had low-degree correlation with NYHA classification of heart failure (r =0.309,0.326,P ＜ 0.01),TGF-β1/BNP had no correlation with NYHA classification of heart failure (r =0.011,P ＞ 0.05).Logistic analysis showed that both plasma TGF-β1 and BNP were independent predictors of DHF (OR =1.264,2.283,P ＜ 0.05 or ＜ 0.01).The area under ROC curve (AUC) of BNP for prediction of DHF was 0.937 ± 0.064,and TGF-β1 was 0.597 ± 0.042.AUC areas of BNP and TGF-β1 were significantly different (P ＜ 0.01).Conclusions The expressions of plasma TGF-β1 and BNP in patients with DHF are higher than those without DHF.The levels of plasma TGF-β1 and BNP are significantly correlated with index E/e',diastolic dysfunction grading and NYHA classification.Both elevated BNP and TGF-β1 levels are independent predictors of DHF.Both plasma BNP and TGF-β1 have auxiliary diagnostic value on DHF and the diagnostic value of plasma BNP is greater than plasma TGF-β1.

Evaluación de la disfunción diastólica y consideraciones perioperatorias / As assessment of diastolic dysfunction and its influence on perioperative considerations

Se revisó la importancia del hallazgo de disfunción diastólica en el peri-operatorio como predictor de morbimortalidad debido a eventos cardiovasculares mayores. Se realizó una búsqueda bibliográfica en las bases de datos de PubMed, Cochrane, Scielo, Bireme, Lilacs y Google Scholar. Se revisaron 250 artículos y se seleccionaron 55 que por criterio de los autores están relacionados directamente con el tema. Se observó que gran porcentaje de los pacientes con falla cardiaca tienen función sistólica preservada y que tener disfunción diastólica es un factor de riesgo independiente para presentar eventos cardiovasculares mayores en el perioperatorio. La disfunción diastólica ha demostrado ser un factor de riesgo independiente para eventos cardiovasculares mayores en cirugía no cardiaca. La importancia del uso de la ecocardiografía en el diagnóstico y seguimiento de la disfunción diastólica es cada vez mayor. La disfunción diastólica continúa siendo una entidad subdiagnosticada. El Manejo terapéutico debe ser estrecho y cauteloso evitando las variaciones hemodinámicas bruscas y adelantándose a la hipotensión con las medidas farmacológicas adecuadas y del manejo de líquidos, apoyados en un estricto control perioperatorio con medición de la presión arterial invasiva y ecocardiograma transesofágico

We assessed the presence of diastolic dysfunction during the perioperative period as a predictor of morbidity and mortality caused by major cardiovascular events. We did a literature search in specialized data bases (PubMed, Cochrane, Scielo, Bireme, Lilacs, and Google Scholar). Two hundred and fifty papers were found, and we chose 55 of them which complied with the selection criteria previously established by the authors. This review allowed us to find that a great proportion of patients with heart failure had preserved systolic function, and having diastolic dysfunction was an independent risk factor for developing major cardiovascular events in the perioperative period and in non-cardiac surgery; performing a cardiac ultrasonography is becoming more important for diagnosing and following diastolic dysfunction, being this still a misdiagnosed condition. Also, the therapy management should be well directed and cautious, avoiding sudden hemodynamic variations and preventing the occurrence of hypotension by using adequate pharmacological measures and proper fluid management, being supported by a strict perioperative control with invasive blood pressure monitoring and the use of transesophageal cardiac ultrasonography

Cardiac Amyloidosis and its New Clinical Phenotype: Heart Failure with Preserved Ejection Fraction / Amiloidose Cardíaca e seu Novo Fenótipo Clínico: Insuficiência Cardíaca com Fração de Ejeção Preservada

Abstract Heart failure with preserved ejection fraction (HFpEF) is now an emerging cardiovascular epidemic, being identified as the main phenotype observed in clinical practice. It is more associated with female gender, advanced age and comorbidities such as hypertension, diabetes, obesity and chronic kidney disease. Amyloidosis is a clinical disorder characterized by the deposition of aggregates of insoluble fibrils originating from proteins that exhibit anomalous folding. Recently, pictures of senile amyloidosis have been described in patients with HFpEF, demonstrating the need for clinical cardiologists to investigate this etiology in suspect cases. The clinical suspicion of amyloidosis should be increased in cases of HFPS where the cardio imaging methods are compatible with infiltrative cardiomyopathy. Advances in cardio imaging methods combined with the possibility of performing genetic tests and identification of the type of amyloid material allow the diagnosis to be made. The management of the diagnosed patients can be done in partnership with centers specialized in the study of amyloidosis, which, together with the new technologies, investigate the possibility of organ or bone marrow transplantation and also the involvement of patients in clinical studies that evaluate the action of the new emerging drugs.

Resumo A insuficiência cardíaca com fração de ejeção preservada (ICFEP) é hoje uma epidemia cardiovascular emergente, sendo identificada como o principal fenótipo observado na prática clínica. Está mais associado ao sexo feminino, idade avançada e a comorbidades como hipertensão arterial, diabetes, obesidade e doença renal crônica. A amiloidose é uma desordem clínica caracterizada pelo depósito de agregados de fibrilas insolúveis originadas de proteínas que apresentam dobramento anômalo. Recentemente, têm sido descritos quadros de amiloidose senil em pacientes com ICFEP, demonstrando a necessidade de os cardiologistas clínicos investigarem esta etiologia em casos suspeitos. Deve-se aumentar a suspeição clínica de amiloidose diante dos casos de ICFEP onde os métodos de cardioimagem sejam compatíveis com o quadro de cardiomiopatia infiltrativa. Os avanços nos métodos de cardioimagem aliados à possibilidade de realização de testes genéticos e identificação do tipo do material amiloide permitem a realização do diagnóstico. O manejo dos pacientes diagnosticados pode ser feito em parceria com centros especializados no estudo de amiloidose, que, aliados às novas tecnologias, investigam a possibilidade de transplante de órgãos ou medula óssea e também o envolvimento dos pacientes em estudos clínicos que avaliam a ação das novas drogas emergentes.

Two Distinct Responses of Left Ventricular End-Diastolic Pressure to Leg-Raise Exercise in Euvolemic Patients with Exertional Dyspnea

BACKGROUND AND OBJECTIVES: Few studies have invasively assessed diastolic functional reserve and serial changes in left ventricular hemodynamics in euvolemic patients with exertional dyspnea. In this study, sequential changes in left ventricular end-diastolic pressure (LVEDP) to leg-raise exercise were measured invasively in patients with early heart failure with preserved ejection fraction (HFpEF) to determine the association between these serial changes and echocardiographic results or clinical features. SUBJECTS AND METHODS: During their hospital stay, 181 patients with early HFpEF underwent left cardiac catheterization, coronary angiography, and transthoracic echocardiography (TTE). Leg-raise exercise was performed in two stages: during cardiac catheterization and again during TTE. RESULTS: Compared with the initial values, all the invasively measured LVEDP values increased significantly during the leg-raise exercise, whereas the septal e/e' ratio remained unchanged. Active leg-raise led to increased LVEDP, which caused dyspnea. The severity of symptoms correlated with the level and extent of changes in LVEDP. At the end of active leg-raise, LVEDP decreased in 40 patients (22.1%), who were younger and had significantly lower e/e' ratios. On multivariate analysis to predict the response of LVEDP to active leg-raise, age and the septal e/e' ratio remained significant predictors. CONCLUSION: Despite having similar LVEDP values at rest, patients may respond to exercise with different LVEDP levels and clinical manifestations, depending on their diastolic capacity. The leg-raise exercise in early HFpEF can elucidate individual diastolic profiles, and the LVEDP response to the leg-raise test may serve as a useful criterion in stratifying patients with early HFpEF with respect to functional reserve.

Hallazgos ecocardiográficos en pacientes con preeclampsia en la Unidad de alta dependencia obstétrica en el Hospital Universitario de San José, 2012-2014 / Echographic findings in patients with pre-eclampsia see at the critical obstetrics unit of the San Jose Children's Teaching Hospital, 2012-2014

Objetivo: describir las alteraciones ecocardiográficas encontradas en pacientes con diagnóstico de preeclampsia severa.Materiales y métodos: estudio de corte transversal. Se describen los hallazgos ecocardiográficos en las pacientes con preeclampsia severa (PS), de acuerdo con los criterios del Congreso Americano de Obstetras y Ginecólogos, atendidas en un hospital universitario de referencia ubicado en Bogotá (Colombia), entre enero 1 de 2012 y junio 30 de 2014. Se excluyeron las pacientes con control adecuado de tensión arterial o con patología cardiaca estructural previa conocida. Se describen las variables sociodemográficas, clínicas y los hallazgos ecocardiográficos más frecuentes, globalmente y por momento de aparición. Se presentan los datos mediante estadística descriptiva.Resultados: se diagnosticaron 228 pacientes con PS. A 124 se les realizó ecocardiograma: en 8 de ellas el informe de ecocardiografía fue no concluyente. Se hallaron 78 pacientes (67 %) con alguna alteración. Los principales hallazgos fueron: hipertensión pulmonar leve, n = 34 (29 %); hipertrofia del ventrículo izquierdo, n = 32 (27 %); hipertensión pulmonar moderada, n = 21 (18 %); disfunción diastólica, n = 16 (13 %). Las pacientes con PS pretérmino (69 %) presentaron alteraciones ecocardiográficas más frecuentes que las pacientes a término (20 %) y que las que comenzaron con PS en el puerperio (11 %). La disfunción diastólica se presentó más en pacientes con preeclampsia que comenzó en el puerperio.Conclusiones: la prevalencia de alteraciones ecocardiográficas en PS es del 67 %, con mayor frecuencia de hipertensión pulmonar e hipertrofia ventricular izquierda. Se requieren más estudios que validen estos hallazgos regionalmente.

Objective: To describe echographic abnormalities found in patients diagnosed with severe preeclampsia.Materials and methods: Cross-sectional study describing ultrasound findings in patients with severe preeclampsia (SP) in accordance with the criteria of the American Congress of Obstetricians and Gynecologists. The patients were seen in a referral teaching hospital in Bogota (Colombia), between January 1, 2012 and June 30, 2014. Patients with adequate blood pressure control or with known pre-existing structural heart disease were excluded. Social, demographic and clinical variables are described, as well as the most frequent global echographic findings, also by time of onset. The data are presented using descriptive statistics.Results: Overall, 228 patients were diagnosed with SP. An echographic examination was performed in 124 and in 8 of them the echographic report was non-conclusive. Some form of abnormality was found in 78 patients (67 %). Mild pulmonary hypertension [n=34 (29 %)], left-ventricular hypertrophy [n=32 (27 %)], moderate pulmonary hy per tension [n=21 (18 %)] and diastolic dysfunction [n= 16 (13 %)] were the main findings observed. Echographic abnormalities were found more frequently in patients with pre-term SP (69 %) than in term patients (20 %) or those who developed SP during the post-partum period (11 %). Diastolic dysfunction was found to occur more frequently in patients who developed preeclampsia in the post-partum period.Conclusions: The prevalence of echographic abnormalities in SP is 67 %, the most frequent being pulmonary hypertension and left ventricular hypertrophy. More studies are needed in order to validate these findings regionally.

Differences in clinical characteristics between patients with diastolic heart failure and systolic heart failure / 天津医药

Objective To analyze the differences in clinical characteristics and risk factors in patients with diastolic heart failure and systolic heart failure. Methods A total of 2 088 patients with heart failure were divided into two groups, diastolic heart failure group (EF≥0.45,n=1 356) and systolic heart failure group (EF<0.45,n=732), according to ejection fraction (EF). The clinical features and related factors affecting the two types of heart failure were compared between two groups. Results There were higher age, higher proportion of women and higher proportion of hypertensive patients in dia?stolic heart failure group than those of systolic heart failure group, but lower rates of hypoalbuminemia, anemia, renal insuffi?ciency and hyperuricimia. There was higher incidence of functional class I and II in diastolic heart failure group. And com?pared with systolic heart failure group, there were higher levels of systolic blood pressure, albumin, prealbumin, cholesterol, sodium and serum chloride in diastolic heart failure group, but lower levels of heart rates, creatinine, blood uric acid, potassi?um and brain natriuretic peptide. Compared with systolic heart failure group, there were lower left ventricular end diastolic volume (LVEDV) and left ventricular end systolic volume (LVESV) in diastolic heart failure group. And there were lower RAS blocker andβ-blocker usage, higher statin usage in diastolic heart failure group. Logistic regression analysis showed that gender and hypertension were significantly correlated with diastolic heart failure, and hypoalbuminemia and hyper?uricimia were significantly correlated with systolic heart failure. Conclusion Our results show that there are differences in clinical features and risk factors in patients with diastolic heart failure and systolic heart failure. We should take the differ?ent treatment and prevention programs for the two kinds of heart failures.

Therapeutic effect of erythropoietin combined adjuvant iron treatment on patients with diastolic heart failure complicated anemia / 心血管康复医学杂志

Objective:To observe the influence of erythropoietin (EPO)combined adjuvant iron treatment on cardiac function,exercise capacity and anemia in patients with diastolic heart failure (DHF)complicated anemia.Methods:A total of 94 DHF + anemia patients were randomly divided into routine treatment group (n=46)and combined treatment group (n=48,received EPO combined adjuvant iron treatment based on routine treatment).Patients re-ceived 6min walking test,levels of hemoglobin (Hb)and N-terminal pro brain natriuretic peptide (NT-proBNP), transmitral early diastolic peak velocity deceleration time (DT),early diastolic peak flow velocity (E),late diastolic peak flow velocity (A)and E/A etc.were measured and compared between two groups before and after six-month treatment.Results:Compared with before treatment,after treatment,NT-proBNP and DT significantly reduced, E/A and 6min walking distance significantly rose in both groups,P <0.05 or <0.01;compared with routine treat-ment group after treatment,there were significant reductions in NT-proBNP level [(368.4±110.7)pg/ml vs.(239 ±89.7)pg/ml]and DT [(257.5±73.4)ms vs.(208.9±59.1)ms],and significant rise in Hb level [(83.3±9.2) g/L vs.(122.1±13.6)g/L],E/A [(0.87±0.3)vs.(1.07±0.27)]and 6min walking distance [(367.54±21.08) m vs.(438.63±20.35)m]in combined treatment group,P <0.05 all.Conclusion:Erythropoietin combined iron treatment can better improve heart function and exercise capacity in patients with diastolic heart failure complicated anemia.

Influence of anemia on cardiac function in patients with diastolic heart failure / 心血管康复医学杂志

Objective: To explore change of hemoglobin (Hb) concentration, the relationship between anemia and left ventricular function and the influence of anemia on prognosis in patients with diastolic heart failure (DHF). Methods: According to NYHA classification, a total of 176 DHF patients were divided into class Ⅱ group (n=78), class Ⅲ group (n=50) and class Ⅳ group (n=48), then Hb level and morbidity rate of anemia were analyzed in each group. According to diagnostic standard of anemia, patients were divided into anemia group (n=58, , occupied 33.0%) and non anemia group (n=118, occupied 67.0% ). Left ventricular diastolic function, mortality rate and rehospitalization rate during follow-up were compared and analyzed between two groups. Results: Along with cardiac function class rose (from class Ⅱ to class Ⅳ), Hb level showed a decreasing trend [(130±6) g/L vs. (108±4) g/L vs. (96±12) g/L], while morbidity rate of anemia gradually rose (8.97% vs. 36.0% vs. 68.8%), P<0.05 all in anemia group；Compared with non-anemia group, there were significant rise in percentages of patients with coronary heart disease (55.1% vs. 65.5%), levels of creatinine [(87.6±39.2) μmol/L vs. (113.7±59.8) μmol/L] and N terminal pro B type natriuretic peptide [NT-proBNP, (578.0±136.7) pg/ml vs. (886.0±174.8) pg/ml], and early-diastolic peak velocity deceleration time [(137±15)ms vs. (196±13)ms], and significant reduction in mitral early/late diastolic peak flow velocity [E/A, (0.87±0.32) vs. (0.62±0.29)], P<0.05 all. Compared with non-anemia group, there were significant rise in mortality rate (9.3% vs. 20.7%) and rehospitalization rate (18.6% vs. 32.8%) in anemia group during follow-up, P<0.05 all. Conclusion: DHF patients often complicate with anemia. Along with heart failure aggravates, their morbidity rate of anemia rises, and anemia may aggravate cardiac diastolic dysfunction. Mortality rate and rehospitalization rate rise in DHF patients complicated with anemia.

Optimal Management of Heart Failure with Preserve Ejection Fraction / 대한내과학회지

More than 50% of patients who are diagnosed with heart failure have preserved ejection fraction (HFpEF), and they have an equally poor prognosis when compared to patients with heart failure with reduced ejection fraction (HFrEF). However, a comprehensive understanding and awareness of heart failure with preserved ejection fraction is still limited and there are currently no optimized treatments to improve morbidity and mortality in these patients. This review summarizes the differences in the epidemiology, pathophysiology, diagnosis, and prognosis between HFpEF and HFrEF. We also review current management strategies of HFpEF patients according to evidence-based treatment guidelines.

Predictive Value of Echocardiographic Parameters for Clinical Events in Patients Starting Hemodialysis

Echocardiographic parameters can predict cardiovascular events in several clinical settings. However, which echocardiographic parameter is most predictive of each cardiovascular or non-cardiovascular event in patients starting hemodialysis remains unresolved. Echocardiography was used in 189 patients at the time of starting hemodialysis. We established primary outcomes as follows: cardiovascular events (ischemic heart disease, cerebrovascular disease, peripheral artery disease, and acute heart failure), fatal non-cardiovascular events, all-cause mortality, and all combined events. The most predictable echocardiographic parameter was determined in the Cox hazard ratio model with a backward selection after the adjustment of multiple covariates. Among several echocardiographic parameters, the E/e' ratio and the left ventricular end-diastolic volume (LVEDV) were the strongest predictors of cardiovascular and non-cardiovascular events, respectively. After the adjustment of clinical and biochemical covariates, the predictability of E/e' remained consistent, but LVEDV did not. When clinical events were further analyzed, the significant echocardiographic parameters were as follows: s' for ischemic heart disease and peripheral artery disease, LVEDV and E/e' for acute heart failure, and E/e' for all-cause mortality and all combined events. However, no echocardiographic parameter independently predicted cerebrovascular disease or non-cardiovascular events. In conclusion, E/e', s', and LVEDV have independent predictive values for several cardiovascular and mortality events.

Efficacy and immune of gamma globulin in treatment of dilated cardiomyopathy complicating heart failure * / 重庆医学

Objective To observe the anti-cardiac myosin heavy chain IgG changes and efficacy of the antibody titration during the treatment of dilated cardiomyopathy (DCM ) complicating heart failure by a large number of gamma globulin .Methods 28 inpa-tients with dilated cardiomyopathy complicating heart failure were taken as the experimental group ,28 cases of healthy examination as the control group .The anti-cardiac myosin heavy chain IgG antibodies were detected by ELISA ;moreover ,among the patients with heart failure treated by the conventional therapy ,14 cases were selected and added large dose of gamma globulin for observing the curative effect .The remaining 14 cases were taken as the standard control group of this experiment .The anti-cardiac myosin heavy chain IgG antibodies were detected by ELISA .Results The anti-cardiac myosin heavy chain IgG antibodies before gamma globulin therapy in the DCM complicating heart failure group had statistical difference compared with the healthy examination goup (P<0 .05);in the 14 cases of heart failure treated by large dose of gamma globulin ,11 cases (78 .57% ) in the treatment group were improved ,while 5 cases(35 .71% ) in the standard control group were improved ,the anti-cardiac myosin heavy chain IgG antibody had no significant differences between the gamma globulin treatment group and the healthy examination group .The left ventricular ejection fraction(LVEF) in the gamma globulin treatment group was increased from (36 .12 ± 9 .98)% to (46 .15 ± 12 .18)% ,the left ventricular end-diastolic diameter was decreased from (59 .68 ± 9 .60) mm to (50 .05 ± 10 .20) mm ,the effects after gamma glob-ulin treatment were more significant than the conventional traditional control group .Conclusion Large dose of gamma globulin for treating dilated cardiomyopathy complicating heart failure has more significant effect than the traditional method ,reduces the titra-tion of in vivo anti-cardiac myosin heavy chain IgG antibody and contributes to explain the drug action mechanism from immune mechanism .

Disfunção diastólica e sua importância para o anestesiologista / Diastolic dysfunction and its importance to the anesthesiologist

O objetivo deste artigo é fazer uma revisão das alterações fisiopatológicas da disfunção diastólica (DD), além de indicar as causas que originam esta doença, mostrar a importância de se conhecerem as interações dos agentes anestésicos e as repercussões das alterações hemodinâmicas nos pacientes portadores de DD...

The aim of this paper is to review the pathophysiological changes of diastolic dysfunction (DD), besides pointing out the causes of this disease, showing the importance of knowing the interactions of anesthetics and the effects of hemodynamic changes in patients with DD...

Determination of Diastolic Dysfunction Cut-Off Value by Tissue Doppler Imaging in Adults 70 Years of Age or Older: A Comparative Analysis of Pulsed-Wave and Color-Coded Tissue Doppler Imaging

BACKGROUND AND OBJECTIVES: The cut-off value of diastolic dysfunction by tissue Doppler imaging (TDI) is affected by aging and modalities used (pulsed-wave vs. color-coded). The purpose of this study was to investigate the diastolic function of healthy elderly people and to determine the appropriate cut-off value of diastolic dysfunction in elderly individuals. SUBJECTS AND METHODS: Healthy volunteers (n=76) and patients with hypertension (n=51) aged > or =70 years underwent 2-dimensional and Doppler echocardiography. Mitral annulus velocities of TDI were measured at septal and lateral sites using the pulsed-wave and color-coded modalities. The appropriate cut-off value of diastolic dysfunction for healthy elderly individuals was defined as the lower limit of the 95% confidence interval for early diastolic mitral annulus velocity (Ea). RESULTS: The mean septal and lateral Ea were 6.5+/-1.5 and 8.3+/-1.7 cm/s, respectively, by pulsed-wave TDI, and 6.1+/-1.4 and 7.9+/-1.7 cm/s, respectively, by color-coded TDI. The cut-off values for diastolic dysfunction were as follows: septal and lateral Ea were 6.1 and 7.9 cm/s by pulsed-wave TDI, and 5.7 and 7.5 cm/s by color-coded TDI, respectively. When the group was stratified by gender, Ea was significantly lower in women than men. CONCLUSION: When interpreting diastolic function as measured by TDI in elderly subjects, different cut-off values should be considered based on the TDI modality, annulus site, and gender.