Diastolic Determinants of Excess Mortality in Heart Failure With Reduced Ejection Fraction

Benfari, Giovanni; Miller, Wayne L.; Antoine, Clémence; Rossi, Andrea; Lin, Grace; Oh, Jae K.; Roger, Véronique L.; Thapa, Prabin; Enríquez-Sarano, Maurice

doi:10.1016/j.jchf.2019.04.024

Cited by 43 publications

(45 citation statements)

References 37 publications

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“…However, E/e ′ and LA volumes did not increase, suggesting that such changes were not associated with an increase in cardiac filling pressures. Moreover contribute to morbidity in HFrEF, 19,20 treatment with a cardiac myosin activator that preserves relaxation may lead to enhanced clinical benefits. Consistent with the pre-clinical ex vivo and in vivo findings of direct atrial activation, danicamtiv had pronounced effects on LA volume and function, with concentration-dependent reductions in LA minimum volume and increases in LAEF and LAFI.…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, since forward flow (SV) remained enhanced, any effects of the potentially slowed relaxation on diastolic filling may have been offset by improved atrial systolic performance, in the setting of unaltered ventricular stiffness. Since diastolic dysfunction may contribute to morbidity in HFrEF, 19,20 treatment with a cardiac myosin activator that preserves relaxation may lead to enhanced clinical benefits.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Effects of danicamtiv, a novel cardiac myosin activator, in heart failure with reduced ejection fraction: experimental data and clinical results from a phase 2a trial

Voors

Tamby²,

Cleland

et al. 2020

European J of Heart Fail

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Effects of danicamtiv, a novel cardiac myosin activator, in heart failure with reduced ejection fraction: experimental data and clinical results from a phase 2a trial

Voors

Tamby²,

Cleland

et al. 2020

European J of Heart Fail

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show abstract

“…Noteworthy, when comparing DDF Grade II vs. Grade III, only the JOHANSEN algorithm yielded prognostic information. Moreover, in a recent cohort of HFrEF, guideline-based diastolic-grading algorithm independently predicted mortality but was undefinable in 30% of subjects implicating a better prognostic performance of elevated E/e′ ratio [ 35 ]. However, in patients with normal LVEF, the relationship of E/e’ with LVFP is modest, and hence, using E/e’ for estimating LVFP in routine clinical practice is of limited benefit [ 36 , 37 ].…”

Section: Discussionmentioning

confidence: 99%

Discrepancies in Assessing Diastolic Function in Pre-Clinical Heart Failure Using Different Algorithms—A Primary Care Study

et al. 2020

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Background: Current guidelines on diastolic function (DF) by the American Society of Echocardiography and the European Association of Cardiovascular Imaging (ASE/EACVI) have been disputed and two alternative algorithms have been proposed by Johansen et al. and Oh et al. We sought (a) to assess the concordance of ASE/EACVI guidelines on DF using these proposed alternative approaches and (b) to evaluate the prevalence of indeterminate diastolic dysfunction (DD) by each method, exploring means for reducing their number. Methods: We retrospectively analyzed the echocardiographic reports of 1158 outpatients including subjects at risk of heart failure without (n = 644) or with (n = 241) structural heart disease, and 273 healthy individuals. Concordance was calculated using the k coefficient and overall proportion of DD reclassification rate. The effectiveness of pulmonary vein flow (PVF), Valsalva maneuver, and left atrial volume index/late diastolic a’-ratio (LAVi/a’) over indeterminate grading was assessed. Results: The DD reclassification rate was 30.1% (k = 0.35) for ASE/EACVI and OH, 36.5% (k = 0.27) for ASE/EACVI and JOHANSEN and 31.1% (k = 0.37) for OH and JOHANSEN (p < 0.0001 for all comparisons). DF could not be graded only by ASE/EACVI and OH in 9% and 11% patients, respectively. The majority of patients could be reclassified using PVF or Valsalva maneuver or LAVi/a’, with the latter being the single most effective parameter. Conclusion: Inconsistencies between updated guidelines and independent approaches to assess and grade DF impede their interchangeable clinical use. The inconclusive diagnoses can be reconciled by conventional echocardiography in most patients, and LAVi/a’ emerges as a simple and effective approach to this aim.

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“…The filling indices can characterize the haemodynamic profile of patients with HFrEF for the purpose of prognostic stratification and a targeted therapeutic choice. 5 The most accurate and extensively applied indexes for identifying high values of the LV filling pressure are shown in Table 1 . The discriminating power of the individual parameters is conditioned by the level of cut-off used and by the respective potential methodological limitations or dependence on the LV load conditions.…”

Section: Conventional Echocardiographic Parameters (‘Old’) In Heart Fmentioning

confidence: 99%

New and old echographic parameters in heart failure

Canna

Scarfò

2020

European Heart Journal Supplements

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Echography (ECHO) is a first-line technology for diagnostic evaluation and prognostic stratification of patients with heart failure (HF). Recognizing specific diseases or conditions amenable to specific treatment is a crucial step in the work-up of patients with HF. Left ventricular ejection fraction (EF) measurement, despite its pathophysiological and methodological limitations, is the primary parameter for the HF classification, incorporating forms with reduced, moderately reduced, and preserved ejection fraction. The cardiac filling parameters could characterize the haemodynamic profile of the various forms of HF and guide different clinical therapeutic strategies. Besides the conventional parameters, widely validated by the clinical practice (old parameters), ECHO provides new information on cardiac function (deformation index), which prospectively could refine our phenotypic classification, beyond EF, thus opening new prospects in the pre-clinical identification, and in the selection of the appropriate treatment for HF patients Stemming from the recent technologic improvements, it is possible to analyse conventional parameters with innovative and automatic approaches, which are quickly available, and able to open new perspectives in the treatment of patients with HF.

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Diastolic Determinants of Excess Mortality in Heart Failure With Reduced Ejection Fraction

Cited by 43 publications

References 37 publications

Effects of danicamtiv, a novel cardiac myosin activator, in heart failure with reduced ejection fraction: experimental data and clinical results from a phase 2a trial

Effects of danicamtiv, a novel cardiac myosin activator, in heart failure with reduced ejection fraction: experimental data and clinical results from a phase 2a trial

Discrepancies in Assessing Diastolic Function in Pre-Clinical Heart Failure Using Different Algorithms—A Primary Care Study

New and old echographic parameters in heart failure

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