Yasushi Sakata 5 & osaka cardioVascular conference (ocVc) investigators † the index for a target that can lead to improved prognoses and more reliable therapy in each heterogeneous patient with heart failure with preserved ejection fraction (Hfpef) remains to be defined. We examined the heterogeneity in the cardiac performance of patients with HFpEF by clarifying the relationship between the indices of left atrial (LA) volume (LAV) overload and pressure overload with echocardiography. We enrolled patients with HFpEF (N = 105) who underwent transthoracic echocardiography during stable sinus rhythm. Relative LAV overload was evaluated using the LAV index or stroke volume (SV)/LAV ratio. Relative LA pressure overload was estimated using e/e' or the afterload-integrated index of left ventricular (LV) diastolic function: diastolic elastance (ed)/arterial elastance (ea) ratio = (E/e')/(0.9 × systolic blood pressure). The logarithmic value of the n-terminal pro-brain natriuretic peptide was associated with SV/LAV (r = −0.214, p = 0.033). The pulmonary capillary wedge pressure was positively correlated to ed/ea (r = 0.403, p = 0.005). SV/LAV was negatively correlated to ed/ea (r = −0.292, p = 0.002), with no observed between-sex differences. the correlations between the LAV index and e/e' and ed/ea and between SV/LAV and e/e' were less prominent than the abovementioned relationships. SV/LAV and Ed/Ea, showing relative LAV and LA pressure respectively, were significantly but modestly correlated in patients with HFpEF. There may be considerable scatter in the relationships between these indices, which could possibly affect the selection of medications or efforts to improve the prognoses of patients with HFpEF.

Higher afterload-related left ventricular diastolic elastance, Ed/Ea, in association with higher arterial elastance, Ea, accompanied by left atrioventricular volume mismatch was observed in elderly HFpEF women.

Aims Considerable variation in the relationships between the indices of left atrial (LA) volume and pressure could possibly affect the selection of medications or efforts to improve the prognoses of patients with heart failure and preserved ejection fraction (HFpEF). We aimed to clarify the association between the prognostic endpoint and LA overload indices in elderly patients with HFpEF. Methods and resultsWe analysed 898 patients with HFpEF hospitalized for acute decompensated heart failure (men/ women: 406/492). Blood tests and transthoracic echocardiography were performed before discharge. The primary endpoint was re-admission for heart failure or all-cause mortality. Stroke volume (SV)/left atrial volume (LAV), an index for LA volume overload, was a significant prognostic factor of re-admission for heart failure in the multivariable Cox hazard analysis adjusted for comorbidities [hazard ratio (HR) 0.616, 95% confidence interval (CI) 0.430-0.882, P = 0.008]. Additionally, the ratio of diastolic elastance (Ed) to arterial elastance (Ea), an index for LA pressure overload, was also significant (HR 1.444, 95% CI 1.014-2.058, P = 0.041). Furthermore, Ed/Ea, but not SV/LAV, was a significant prognostic factor of all-cause mortality (HR 1.594, 95% CI 1.102-2.306, P = 0.013). Conclusions The index of LA overload for prognosis may differ according to the different endpoints in elderly patients with HFpEF.

Patients with persistent atrial fibrillation (AF) and a large left atrium are at a high risk for thromboembolisms. Recently, direct oral anticoagulants (DOACs) have mainly been used for the prevention of cardiac embolisms caused by AF. Transesophageal echocardiography (TEE) is performed in order to exclude any left atrial appendage (LAA) thrombi. We herein report two cases of persistent AF, both of which were treated with rivaroxaban for more than two years. Since TEE identified mobile LAA thrombi with this treatment, we switched from rivaroxaban to the direct thrombin inhibitor dabigatran. Dabigatran resolved the LAA thrombi that had been refractory to rivaroxaban.

and hemoglobin levels among 3 age groups in men (both P<0.001) and women (both P<0.001) by analysis of variance. The eGFR and hemoglobin levels decreased with age in both men (r=−0.349, P<0.001, and r=−0.469, P<0.001, respectively) and women (r=−0.418, P<0.001, and r=−0.214, P=0.002, respectively). 9 The effective arterial elastance index (EaI=[0.9×systolic blood pressure (SBP)]/stroke volume index) and operant diastolic elastance index (EdI=E/e'/ stroke volume index) did not differ significantly between the sexes. However, the EdI indexed as EaI, EdI/EaI=E/e'/ (0.9×SBP), a new marker for diastolic function assessment, was significantly more impaired in women than in men only in patients ≥75 years old (Table 2, t-test). Furthermore, in the patients ≥75 years old, the coefficient of variation in EdI/EaI was larger in women and the variations of EdI/ EaI values were significantly different between the sexes (P=0.002, F-test), although no differences were observed in patients <75 years old. There were significant differences in left atrial volume index (LAVI), LV mass index (LVMI), and EdI/EaI between patients aged ≥75 and <75 years, but only among women ( Table 2). 9 Thus, impairment of diastolic function relative to arterial elasticity, EdI/EaI, occurred in elderly women with hypertension and was coincident with alterations in cardiac structure. Importantly, the changes in 2 indices, EdI/EaI and LAVI or LVMI, coincidentally occurred at different time points between the sexes. Because Arterial Elasticity-Related Diastolic FunctionRelative to Cardiac StructureHeart failure with preserved ejection fraction (HFpEF) is an important clinical condition that mainly occurs in elderly women. 1 Two major hypotheses may explain the pathophysiology of HFpEF: increased arterial stiffness 2,3 and left ventricular (LV) passive stiffness. 4-6 The pathophysiological base of HFpEF may be an extreme form of age-related deterioration with ventricular-arterial interrelation, possibly related to the prevalence of noncardiac comorbidities. 7 Regression modeling has identified that changes in cardiac structure, such as greater LV hypertrophy (LVH) and atrial dilation, best distinguish HFpEF from hypertensive LVH without HF. 8 However, the difference between elderly men and women in diastolic function relative to arterial elasticity, and its relation to alterations in the cardiac structure of hypertensive patients, remains unclear. We therefore sought to determine the age-and sex-related differences in diastolic function relative to arterial elasticity among hypertensive patients with preserved LVEF and no history of HF. 9 We enrolled hypertensive patients with LVEF ≥50% (Table 1), and their echocardiographic parameters regarding arterial elastance and LV performance were measured. There were significant differences in estimated glomerular filtration rate (eGFR) Received November 4, 2016; accepted January 12, 2017; released online January 28, 2017 Background: The mechanisms of heart failure with preserved ejection fraction (HFpEF) need ...