Aims
Right‐sided filling pressure is elevated in some patients with heart failure (HF) and preserved ejection fraction (HFpEF). We hypothesized that right atrial pressure (RAP) would represent the ...cumulative burden of abnormalities in the left heart, pulmonary vasculature, and the right heart.
Methods and results
Echocardiography was performed in 399 patients with HFpEF. RAP was estimated from inferior vena cava morphology and its respiratory change estimated right atrial pressure (eRAP), and patients were divided according to eRAP (3 or ≥8 mmHg). Patients with higher eRAP displayed more severe abnormalities in LV diastolic function as well as right heart structure and function than those with normal eRAP. Cardiac deaths or HF hospitalization occurred in 84 patients over a median follow‐up of 19.0 months (interquartile range 6.7–36.9). The presence of higher eRAP was independently associated with an increased risk of the composite outcome (adjusted hazard ratio 2.20 vs. normal eRAP group, 95% confidence interval 1.34–3.62, P = 0.002). Kaplan–Meier curves separating the patients into four groups based on eRAP and E/e' ratio showed that event‐free survival varied among the groups, providing an incremental prognostic value of eRAP over E/e' ratio. The classification and regression tree analysis demonstrated that eRAP was the strongest predictor of the outcome followed by right ventricular dimension, E/e' ratio, and estimated right ventricular systolic pressure, stratifying the patients into four risk groups (incident rate 8.8–72.2%).
Conclusions
These data may provide new insights into the prognostic role of RAP in the complex pathophysiology of HFpEF and suggest the utility of eRAP for the risk stratification in patients with HFpEF.
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FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
Anti-melanoma differentiation-associated gene 5 (MDA5) autoantibody-positive and age at onset ≥60 years are poor prognosis factors in polymyositis (PM) and dermatomyositis (DM) associated with ...interstitial lung disease (ILD) among Japanese patients. However, the influence of age on the clinical features of anti-MDA5 autoantibody-positive patients with DM remains unclear.
We retrospectively examined 40 patients with DM and anti-MDA5 autoantibodies according to age. We compared patients aged <60 and ≥60 years with respect to clinical features including laboratory test findings, high-resolution lung computed tomography data, treatment content, and complications such as infections and prognosis. We also examined clinical features between surviving and deceased patients in the older patient group.
Of 40 enrolled patients, 13 were classified as old and 27 as young. Older patients had significantly fewer clinical symptoms including arthralgia/arthritis (p < .01), skin ulceration (p = .02), and higher mortality than younger patients (p = .02) complicated with rapidly progressive ILD (RP-ILD), combination immunosuppressive therapy, and strictly controlled infections.
Clinical features and mortality of anti-MDA5 autoantibody-positive DM patients were influenced by age. Patients aged ≥60 years had a worse prognosis, and combination immunosuppressive therapy was often ineffective for RP-ILD in older patients.
Despite the obesity paradox, visceral adiposity is associated with poor clinical outcomes in patients with heart failure with preserved ejection fraction (HFpEF). However, it remains unclear whether ...a relationship between visceral fat and clinical outcomes exists in Asian patients with HFpEF, in whom obesity is rare.
Visceral and subcutaneous adipose tissue (VAT and SAT) volume and area were measured using computed tomography (CT) in 196 HFpEF patients. The primary endpoint was a composite of all-cause mortality or HF hospitalization.
Participants had a normal body mass index (BMI) (22.5 ± 4.4 kg/m2), and obesity (BMI > 30 kg/m2) was rare (4.6 %). The primary outcome was observed in 64 patients during a median follow-up of 11.6 months. Lower VAT and SAT volumes were associated with underweight and malnutrition. Composite outcomes increased as body weight, BMI, and height-indexed SAT volume and area decreased. Lower height-indexed VAT volume and area were also associated with the outcomes. The height-indexed SAT area provided independent and incremental prognostic value over age, BMI, blood pressure, and creatinine and albumin levels.
In lean East Asian patients with HFpEF, a lower VAT volume was associated with poorer clinical outcomes. CT-based assessments of adiposity may provide incremental prognostic value over simple anthropometric indices in lean HFpEF patients.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Abstract The purposes of this study were to investigate whether heart failure with reduced (HFrEF) and preserved ejection fraction (HFpEF) share echocardiographic predictors, and elucidate the E/(e' ...x s') predicts major adverse cardiovascular events (MACE) independent of other echocardiographic parameters in each HF group. We assessed tissue Doppler-derived parameters E/e', E/(e' x s'), and left ventricular (LV) and right ventricular (RV) longitudinal strains in HFrEF (n=340) and HFpEF (n=102). LV and RV longitudinal strains were significantly higher and E/(e' x s') was lower in HFpEF patients compared with those with HFrEF, while E/e' was similar between the groups. During a median follow-up of 342 days, MACE developed in 95 HFrEF and 29 HFpEF patients. The univariable analysis revealed similar echocardiographic predictors between the two groups, including E/e', E/(e' x s') and pulmonary artery systolic pressure. No 2D speckle tracking-derived parameter remained significant in multivariable models in each HF group. E/(e' x s') was an only independent predictor with an incremental prognostic value over the MAGGIC score, and was superior to the E/e' ratio in both HFrEF and HFpEF. In conclusion, despite differences in echocardiography-based cardiac function parameters between HFrEF and HFpEF, these HF phenotypes shared the same echocardiographic predictors of future MACE. E/(e' x s') was an only independent predictor for future cardiac events in both HF populations.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK, ZRSKP
Highlights • Approximately 50% of HFpEF patients developed EIPH. • Reduction in Ea/Ees was attenuated due to less Ees increases in HFpEF compared with HFrEF.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK, ZRSKP
Transesophageal echocardiography (TEE) detected the pulmonary valve (PV) and revealed subvalvular pulmonary stenosis (SubPS), rather than DCRV (Fig. 1d, e). LV: left ventricle, RV: right ventricle. c ...The apical three-chamber (A3C) view depicts a ventricular septal defect (VSD) just below the aortic valve, which was diagnosed as doubly committed subarterial VSD. d The midesophageal long-axis view illustrates 40-mm wall thickening just below the PV with lumen stenosis, which was diagnosed as subvalvular pulmonary stenosis (SubPS), rather than DCRV. e The midesophageal zoom view rotating multiplane from 99° to 64° clearly shows the PV in the diastolic phase Both SubPS and DCRV are phenotypes of congenital or acquired structural heart disease 1. Compliance with ethical standards Conflict of interest Toshimitsu Kato, Noriaki Takama, Tomonari Harada, Masaru Obokata, Koji Kurosawa, Masahiko Kurabayashi, and Masami Murakami declare that they have no conflicts of interest.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OBVAL, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
Anemia is common in patients with heart failure with preserved ejection fraction (HFpEF) and is associated with exercise intolerance. However, there are limited data on how anemia contributes to ...reduced exercise capacity in patients with HFpEF. We aimed to characterize exercise capacity, cardiovascular and ventilatory reserve, and the oxygen (O2) pathway in anemic patients with HFpEF.
A total of 238 patients with HFpEF and 248 dyspneic patients without HF underwent ergometry exercise stress echocardiography with simultaneous expired gas analysis. Patients with HFpEF were classified into two groups based on the presence of anemia (hemoglobin < 13.0 g/dL in men and < 12.0 g/dL in women).
Anemic HFpEF patients (n = 112) had worse nutritional status and renal function, lower iron levels, and greater left ventricular (LV) remodeling and plasma volume expansion than those without anemia (n = 126). Exercise capacity, assessed by peak oxygen consumption, exercise intensity, and exercise duration, was lower in the anemic HFpEF group than in the other groups. Despite a similar cardiac output during exercise, anemic patients with HFpEF demonstrated limitations in arterial O2 delivery, lower arteriovenous O2 content difference, and ventilatory inefficiency (higher minute ventilation vs. carbon dioxide production slope) during peak exercise.
Anemic HFpEF patients demonstrated unique pathophysiological features with greater LV remodeling and plasma volume expansion, limitations in arterial O2 delivery and peripheral O2 extraction, and ventilatory inefficiency, which may contribute to reduced exercise capacity. Further studies are needed to develop an optimal approach for treating anemia in patients with HFpEF.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Transthoracic echocardiography (TTE) was performed. Compliance with ethical standards Conflict of interest Toshimitsu Kato, Noriaki Takama, Yohei Ishibashi, Tomonari Harada, Masaru Obokata, Masahiko ...Kurabayashi, and Masami Murakami declare that they have no conflicts of interest. Ethical approval All procedures followed were in accordance with ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1964 and later versions.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OBVAL, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
...the detected MR jet is trivial. d The midesophageal two-chamber view shows prolapse of the anterior leaflet (A1) and a gap between A1 and the posterior leaflet (P1), which forms an MR jet orifice. ...e Continuous Doppler imaging shows an approximate MR acceleration flow velocity of 2.0 m/s. f MR jet is not observed in detail in the color Doppler midesophageal two-chamber view. g The three-dimensional (3D) transesophageal echocardiographic surgeon’s view clearly shows the mitral ring and suture. h–j MR jet is revealed to be rotating along the mitral ring in the color Doppler 3D transesophageal echocardiographic surgeon’s view The recurrence rate of mitral valve regurgitation after MVRep is 3.7% per year 1. The types of MR jet inducing hemolysis after mitral repair include collision (85%) with and fragmentation (8%) by a solid structure such as mitral ring with suture, acceleration (15%) from a small orifice, or a combination of these three types 4. Compliance with ethical standards Conflict of interest Toshimitsu Kato, Noriaki Takama, Tomonari Harada, Masaru Obokata, Koji Kurosawa, Masahiko Kurabayashi, and Masami Murakami declare that they have no conflicts of interest.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OBVAL, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
The inner margin of the mass is relatively rough. c In the zoom view of the Off-PSAX, color Doppler echocardiography reveals vortex blood flow in the mass (yellow arrow). d Continuous-wave Doppler ...echocardiography shows early diastolic blood flow into the mass. Ethical statement All procedures followed were in accordance with ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1964 and later versions. Giant left coronary artery aneurysms: review of the literature and report of a rare case diagnosed by transthoracic echocardiography.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OBVAL, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
