Central and Peripheral Determinants of Exercise Capacity in Heart Failure Patients With Preserved Ejection Fraction

This study sought to discern which central (e.g., heart rate, stroke volume [SV], filling pressure) and peripheral factors (e.g., oxygen use by skeletal muscle, body mass index [BMI]) during exercise were most strongly associated with the presence of heart failure and preserved ejection fraction (HFpEF) as compared with healthy control subjects exercising at the same workload.BackgroundThe underlying mechanisms limiting exercise capacity in patients with HFpEF are not fully understood.MethodsIn patients with HFpEF (n = 108), the hemodynamic response at peak exercise was measured using right-sided heart catheterization and was compared with that in healthy control subjects (n = 42) at matched workloads to reveal hemodynamic differences that were not attributable to the workload performed. The patients studied were prospectively included in the REDUCE-LAP HF (Reduce Elevated Left Atrial Pressure in Patients With Heart Failure) trials and HemReX (Effect of Age on the Hemodynamic Response During Rest and Exercise in Healthy Humans) study. Univariable and multivariable logistic regression models were used to analyze variables associated with HFpEF versus control subjects.ResultsCompared with healthy control subjects, pulmonary capillary wedge pressure (PCWP) and SV were the only independent hemodynamic variables that were associated with HFpEF, a finding explaining 66% (p 
Source: JACC: Heart Failure - Category: Cardiology Source Type: research

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ConclusionsA clear trend towards worse outcome with larger TRV or TR% was shown; however, the number of events was insufficient for significant outcome differences. Prognostic value of quantitative TR should be investigated in a larger multicentre cohort. Effective RV ejection fraction may be considered an improved measure of RV function in PAH.
Source: ESC Heart Failure - Category: Cardiology Authors: Tags: Original Research Article Source Type: research
AbstractAimsThe PREPARE ‐MVR study (PRediction of Early PostoperAtive Right vEntricular failure in Mitral Valve repair (MVR) and to explore the associations between/Repair patients) sought to investigate the alterations of right ventricular (RV) contraction pattern in patients undergoing mitral valve replacement/repair ( MVR) and to explore the associations between pre‐operative RV mechanics and early post‐operative RV dysfunction (RVD).Methods and resultsWe prospectively enrolled 42 patients (63  ± 11 years, 69% men) undergoing open‐heart MVR. Transthoracic three‐dimensional (3D) echocardio...
Source: ESC Heart Failure - Category: Cardiology Authors: Tags: Original Research Article Source Type: research
ConclusionsThe SV ‐INHIBITION study aims to answer the question whether PDE5 inhibitors should be prescribed in patients with an SV. This trial has been built focusing on the three levels of research defined by the World Health Organization: disability (exercise tolerance), deficit (SV function), and handicap (qual ity of life).
Source: ESC Heart Failure - Category: Cardiology Authors: Tags: Study Design Source Type: research
ConclusionsHVAD cannula coronal angle was associated with reduced right ventricular function and HRAE. Prospective studies evaluating surgical techniques to ensure optimal device positioning and its effects on HRAEs are warranted.
Source: The Annals of Thoracic Surgery - Category: Cardiovascular & Thoracic Surgery Source Type: research
CONCLUSIONS: HVAD cannula coronal angle was associated with reduced right ventricular function and HRAE. Prospective studies evaluating surgical techniques to ensure optimal device positioning and its effects on HRAEs are warranted. PMID: 32035046 [PubMed - as supplied by publisher]
Source: The Annals of Thoracic Surgery - Category: Cardiovascular & Thoracic Surgery Authors: Tags: Ann Thorac Surg Source Type: research
Authors: Toroghi HM, Lo KB, Ziccardi MR, Horn B, Kanjanahattakij N, Malik E, Penalver J, Rangaswami J, Gupta S, Amanullah A Abstract Worsening renal function in patients with heart failure with preserved ejection fraction is associated with poor outcomes. Pulmonary arterial capacitance is a novel right heart catheterization derived hemodynamic metric representing pulmonary arterial tree distensibility and right ventricle afterload. Given the strong association between heart failure, pulmonary hypertension, and kidney function, the goal of this study is to investigate the correlation between Pulmonary arterial capac...
Source: Reviews in Cardiovascular Medicine - Category: Cardiology Tags: Rev Cardiovasc Med Source Type: research
Authors: Milkas A, Tsioufis K, Koliastasis L, Tsiamis E, Tousoulis D, Bartunek J, Vanderheyden M Abstract Background: Right but not left ventricular hemodynamic parameters have been found to be independently associated with adverse renal outcomes in patients with acute decompensated heart failure (HF).Aim: To investigate the hemodynamic profile of patients without acute decompensated heart failure and left ventricular ejection fraction>50% referred for elective left and right heart catheterization and to correlate left and right filling pressures, stroke volume and arterial blood pressure to renal function param...
Source: Current Medical Research and Opinion - Category: Research Tags: Curr Med Res Opin Source Type: research
CONCLUSIONS: NFLG-AS was the most prevalent form of LG severe AS and was associated with adequate left ventricular compensation and good prognosis. On the other hand, CLFLG-AS represents the heart-failure with reduced ejection fraction (HFrEF) form of AS and was associated with the worst prognosis, whereas PLFLG-AS represents the heart-failure with preserved ejection fraction (HFpEF) form of AS with intermediary prognosis. Both groups showed early hemodynamic reverse response after TAVR. PMID: 31566569 [PubMed - as supplied by publisher]
Source: EuroIntervention - Category: Cardiovascular & Thoracic Surgery Tags: EuroIntervention Source Type: research
We present a case series of four patients with cardiog enic shock started on ivabradine who were unable to tolerate beta‐blockers.Methods and resultsFive patients identified with cardiogenic shock defined as a severe reduction in cardiac index (100] who were intolerant to beta ‐blockers. Each patient had a cardiac magnetic resonance imaging, echocardiogram, and coronary angiogram for determination of aetiology. Invasive haemodynamics via pulmonary artery catheterization were measured during initiation and titration of ivabradine (baseline, 6, 12, 24, and 48 h after iva bradine administration) with continuous telem...
Source: ESC Heart Failure - Category: Cardiology Authors: Tags: Short Communication Source Type: research
AbstractA growing body of evidence has demonstrated that pulmonary arterial capacitance (PAC) is the strongest hemodynamic predictor of clinical outcomes across a wide spectrum of cardiovascular disease, including pulmonary hypertension and heart failure. We hypothesized that a ratio of right ventricular stroke volume (RVOT VTI) to the associated peak arterial systolic pressure (PASP) could function as a reliable non-invasive surrogate for PAC. We performed a prospective study of patients undergoing simultaneous transthoracic echocardiography and right heart catheterization (RHC) for various clinical indications. Measureme...
Source: The International Journal of Cardiovascular Imaging - Category: Radiology Source Type: research
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