Arterial stiffness and elevated left ventricular filling pressure in patients at risk for the development or a previous diagnosis of HF—A subgroup analysis from the DIAST-CHF study

Lüers, Claus; Trippel, Tobias Daniel; Seeländer, Sebastian; Wachter, Rolf; Hasenfuß, Gerd; Lindhorst, Ruhdja; Bobenko, Anna; Nolte, Kathleen; Pieske, Burkert; Edelmann, Frank

doi:10.1016/j.jash.2017.03.006

Cited by 21 publications

(27 citation statements)

References 63 publications

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“…With regard to compounding effects of hypovolemia and arterial stiffness, experimental studies indicate that decreased BV impairs ventricular filling, stroke volume, and cardiac output specifically in the HFpEF phenotype, notably in the presence of exacerbated stiffening of the cardiovascular system (Nagano et al ). Loss of central arterial distensibility limits elastic recoil and contributes to ventricular diastolic dysfunction, limiting the gradient for venous return, further constrained by hypovolemia (Luers et al ). In addition, lower central BV unloads arterial and cardiopulmonary baroreceptors (Montero et al ), inducing a compensatory response that enhances sympathetic nerve activity and vasomotor tone (Ryan et al ) as well as activates the RAAS ultimately leading to increased arterial stiffness (Fig. )…”

Section: Discussionmentioning

confidence: 99%

Hypovolemia and reduced hemoglobin mass in patients with heart failure and preserved ejection fraction

et al. 2019

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A fundamental tenet of heart failure (HF) pathophysiology hinges on a propensity for fluid retention leading to blood volume (BV) expansion and hemodilution. Whether this can be applied to heart failure patients with preserved ejection fraction (HFpEF) remains uncertain. The present study sought to determine BV status and key hormones regulating fluid homeostasis and erythropoiesis in HFpEF patients. BV and hemoglobin mass (Hb mass ) were determined with high-precision, automated carbon monoxide (CO) rebreathing in 20 stable HFpEF patients (71.5 AE 7.3 years, left ventricular ejection fraction = 55.7 AE 4.0%) and 15 healthy age-and sex-matched control individuals. Additional measurements comprised key circulating BV-regulating hormones such as pro-atrial natriuretic peptide (proANP), copeptin, aldosterone and erythropoietin (EPO), as well as central hemodynamics and arterial stiffness via carotid-femoral pulse wave velocity (PWV). Carotid-femoral PWV was increased (+20%) in HFpEF patients versus control individuals. With respect to hematological variables, plasma volume (PV) did not differ between groups, whereas BV was decreased (À14%) in HFpEF patients. In consonance with the hypovolemic status, Hb mass was reduced (À27%) in HFpEF patients, despite they presented more than a twofold elevation of circulating EPO (+119%). Plasma concentrations of BV-regulating hormones, including proANP (+106%), copeptin (+99%), and aldosterone (+62%), were substantially augmented in HFpEF patients. HFpEF patients may present with hypovolemia and markedly reduced Hb mass , underpinned by a generalized overactivation of endocrine systems regulating fluid homeostasis and erythropoiesis. These findings provide a novel perspective on the pathophysiological basis of the HFpEF condition.

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Section: Discussionmentioning

confidence: 99%

Hypovolemia and reduced hemoglobin mass in patients with heart failure and preserved ejection fraction

et al. 2019

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“…32 BMI was high and comparable across all groups of total PA, which may explain the low values of natriuretic peptides. Since natriuretic peptides are valuable for identification of severe diastolic dysfunction, but not for mild or moderate diastolic dysfunction, 31,33 we may also conclude that the patients of our study did not present with severe diastolic dysfunction. This makes our results even more relevant since we analysed a study population with early-stage HFpEF where prevention strategies may still carry weight.…”

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confidence: 69%

Amount or intensity? Potential targets of exercise interventions in patients with heart failure with preserved ejection fraction

et al. 2017

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AimsHeart failure with preserved ejection fraction (HFpEF) remains a common condition with no pharmacological treatment. Physical activity (PA) improves symptoms and quality of life (QoL), but no clear recommendations exist on PA in HFpEF patients. We investigated the association of PA (amount/intensity) on clinical phenotype in HFpEF.Methods and resultsThe Aldosterone in Diastolic Heart Failure trial investigated spironolactone vs. placebo in stable HFpEF patients. At baseline, all patients underwent detailed phenotypization including echocardiography, cardiopulmonary exercise testing, 6 minute walking test (6MWT), and QoL assessment (36‐item Short‐Form questionnaire). PA was assessed by a self‐report questionnaire, classified in metabolic equivalents of task (MET) and analysed with regard to exercise capacity, diastolic function, and QoL. Four hundred twenty‐two patients (52% women, age 67 ± 8 years, New York Heart Association II and III) were classified by weekly MET hours into a low (<70), middle (70–140), or high (>140) level of PA. Total PA correlated positively with 6MWT distance (r = 0.17; P = 0.002) and physical function of QoL (r = 0.10; P = 0.05), but not with peak oxygen uptake (peakVO2). In contrast, both 6MWT distance and peakVO2 were significantly higher in patients who performed high‐intensity PA for >8 h/week (P < 0.001, P = 0.02, respectively). Time of high‐intensity PA was related to higher 6MWT distance (r = 0.21, P < 0.001), peakVO2, and better physical function of QoL (both r = 0.13, P = 0.01), whereas low‐intensity PA did not show significant associations. Interestingly, PA was not related to any measure of diastolic function.ConclusionsA higher amount of PA is related to higher submaximal exercise capacity and physical function of QoL. Regarding maximal exercise capacity, only high‐intensity PA showed significant association in HFpEF patients.

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“…This negative finding is important because an increase in preload predicts an increase in E/E′ and implicates the importance of a reduction in afterload post‐coupler . In addition, with increased right heart filling pressures and reduced arterial stiffness the E/E′ is expected to decrease …”

Section: Discussionmentioning

confidence: 95%

The hemodynamic effects of a central iliac arteriovenous anastomosis at 6 months in patients with resistant and uncontrolled hypertension

Eysenck

Zalen

Freemantle

et al. 2019

J of Clinical Hypertension

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A central iliac arteriovenous anastomosis, termed the "coupler" (ROX Medical), results in a significant reduction in blood pressure (BP) in hypertensive patients. This study assessed functional and hemodynamic changes induced by the device. Twenty-one patients with resistant and/or uncontrolled hypertension underwent stress echocardiography and cardiopulmonary exercise testing (CPET) at baseline and 6 months post-coupler implantation. End points were selected to best evaluate cardiac function including Doppler stroke volume (SV), septal and lateral E/E′, and right ventricular systolic velocity S′ (RV S′). CPET VO 2 peak demonstrated total cardiopulmonary performance. SV increased from 76.4 SD12.2 mL to 92.1 SD22.7 mL 6 months postcoupler insertion; P = .002. No changes in RV S′, septal or lateral E/E′, or VO 2 peak were observed. Five patients experienced increased diuretic requirement ≥3 times baseline. RV S′ fell from 19.0 SD1.87 cm/s to 16.80 SD3.43 cm/s in these patients (P > .05). A significant increase in SV 6 months post-coupler insertion was observed.In patients with increased diuretic requirement, the device was associated with a lower RV S′ suggesting occult RV dysfunction as the mechanism of this pre-specified adverse outcome. |EYSENCK Et al. changes and detailed assessment of these with CPET stress echo predicts patients at risk of increased diuretic requirement post-coupler insertion. | ME THODS | Study design and participantsThis study was performed at Eastbourne General Hospital, East Sussex Healthcare NHS Trust, UK, and was approved by the UK national ethics committee. Twenty-one consecutive participants with resistant and/or uncontrolled hypertension taking part in the ROX Control Hypertension Registry (RH-03) NCT01885390 were included. 10 The rationale and design of the RH-03 registry have been described previously. 10 Inclusion criteria were patients aged 18-85 years with a diagnosis of resistant or uncontrolled hypertension made on the basis of office and 24-hour BP monitoring, medical history, and physical examination. Resistant hypertension was defined as patients with established hypertension (diagnosed ≥12 months prior to baseline) on a guideline-based drug regimen at a stable and a fully tolerated dose, consisting of ≥3 hypertensive medications (including 1 diuretic). Uncontrolled hypertension was defined as patients with hypertension and drug intolerances to antihypertensive medications and unable to take a guideline-based drug regimen. Patients were excluded if they had any serious medical condition that might have adversely affected the patient's safety, limit the subject's ability to participate in the registry, comply with follow-up requirements, or impact the scientific integrity of the study. In addition, patients were excluded if found to have a baseline pulmonary capillary mean wedge pressure >15 mm Hg at right heart catheterization. Written informed consent was obtained from all participants. All 21 participants underwent baseline and 6 months post-coupler stress echo CPET ex...

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Arterial stiffness and elevated left ventricular filling pressure in patients at risk for the development or a previous diagnosis of HF—A subgroup analysis from the DIAST-CHF study

Cited by 21 publications

References 63 publications

Hypovolemia and reduced hemoglobin mass in patients with heart failure and preserved ejection fraction

Hypovolemia and reduced hemoglobin mass in patients with heart failure and preserved ejection fraction

Amount or intensity? Potential targets of exercise interventions in patients with heart failure with preserved ejection fraction

The hemodynamic effects of a central iliac arteriovenous anastomosis at 6 months in patients with resistant and uncontrolled hypertension

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