Etiology and pathophysiology of new-onset heart failure: Evaluation by myocardial perfusion imaging

Lahiri, Avijit; Mieres, Jennifer H.; Calnon, Dennis A.; Wolinsky, David G.; Sias, Tina; Burnham, Kenneth; Conway, Laurence; McCullough, Peter A.; Daher, Edouard; Walsh, Mary Norine; Wight, Joseph; Heller, Gary V.; Udelson, James E.

doi:10.1007/s12350-008-9010-8

Cited by 51 publications

(30 citation statements)

References 22 publications

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“…Similar to HF registries, prior CAD was more prevalent in those with systolic HF; however, the extent of active ischemia was similar between patients with systolic HF and patients with DHF [15]. This study consisted of subjects only with newonset HF, whereas previous studies were of sample groups with chronic HF.…”

Section: Introductionmentioning

confidence: 84%

“…A recent prospective study by Soman et al [15] used prospective myocardial perfusion imaging of patients diagnosed with new-onset HF who presented to an emergency department. Single photon emission CT myocardial perfusion imaging was performed on each participant and presence of prior myocardial infarction (fixed defects) or current myocardial ischemia (reversibility) were measured using an automated scoring technique.…”

Section: Introductionmentioning

confidence: 99%

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Myocardial Ischemia in Patients with Diastolic Dysfunction and Heart Failure

et al. 2010

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Coronary artery disease is present in 40-55% of patients with diastolic heart failure, and myocardial ischemia is both a cause and a precipitant of diastolic heart failure. Failure to recognize and treat acute and chronic ischemia in patients with this disorder results in rapid disease progression and poor outcomes. In diastolic heart failure patients without obstructive coronary artery disease, ischemia can be induced by other diseases that diminish perfusion gradient, cause myocardium to outgrow blood supply, or decrease diastolic filling time. In this article, we review the role of ischemia and development of fibrosis in the epidemiology, pathophysiology, and evaluation of patients with diastolic dysfunction and diastolic heart failure.

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Section: Introductionmentioning

confidence: 84%

Section: Introductionmentioning

confidence: 99%

Myocardial Ischemia in Patients with Diastolic Dysfunction and Heart Failure

et al. 2010

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“…This prognostic distinction between patients with ischemic LV dysfunction and patients with limited CAD co-existing with nonischemic LV dysfunction is important, since recent studies seem to indicate that the performance characteristics of MPS are excellent for the detection of extensive CAD (as defined in the Felker study) in new-onset heart failure patients, but only modest for limited CAD. 6 The Candell-Riera study adds further proof to the concept that gated SPECT MPS can reliably detect prognostically significant CAD in patients with heart failure. The study fell short of demonstrating a significant difference in outcome between patients who were treated medically and those who underwent revascularization.…”

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confidence: 93%

Gated SPECT myocardial perfusion scintigraphy: a multi-faceted tool for the evaluation of heart failure

Soman

2009

Journal of Nuclear Cardiology

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Compared to the large volume of data available on the prognostic utility of myocardial perfusion scanning (MPS) in unselected patients referred for stress testing and several subgroups therein, there is only a relatively scant amount of literature pertaining specifically to the use of MPS to determine prognosis in patients with heart failure. One could be excused for being surprised at this state of affairs, since heart failure is widely prevalent, and frequently encountered by cardiologists, internists, and specialists in cardiac imaging, and MPS is one of the most widely utilized cardiac assessment tools.In this issue of the Journal Candell-Riera and colleagues report on the prognostic value of clinically indicated Tc-99m gated SPECT MPS in a prospective cohort of patients with left ventricular ejection fraction (LVEF) B40%. Of 6114 patients referred to the authors' laboratory for MPS over a 6-year period, 365 had LVEF B40%. After excluding patients with nonischemic LV dysfunction and censuring patients who had early (with 60 days of MPS) revascularization, 167 patients with ischemic cardiomyopathy were followed up for an average of 2.3 ± 1.2 years to identify the variables associated with cardiac death. Thirty patients had stress testing precluded by severe heart failure and therefore, underwent only rest gated MPS. The mortality rate over this relatively short period of follow-up was substantial: 22% (36/167) all-cause mortality, of which 17% (29/ 167) were cardiac deaths. As expected, the majority of deaths in this population were from progressive heart failure (23), and most of the remaining were sudden cardiac deaths.MPS was read using a standard 17-segment LV model with visual, semi-quantitative scoring for perfusion and regional function. Residual myocardial viability was defined as preserved perfusion (normal to severe hypoperfusion) in C3 segments with severe dysfunction (severe hypokinesis, akinesis, or dyskinesis). For comparison with prior studies, this translates into an extent of viable but dysfunctional myocardium involving at least 18% of the LV myocardium, and approximates the threshold of critical mass that is generally accepted as clinically significant (i.e., predictive of recovery of function if revascularized, or of an adverse prognosis if not revascularized).1 Perfusion assessment however, was based on visual rather than the quantitative (albeit relative) methods previously established as most accurate for detection of viability, and nitrate-enhancement was not performed.2 On univariable analysis, patients who died from cardiac causes were older, less often able to undergo exercise testing, and had a greater prevalence of myocardial viability. Among patients who were able to undergo exercise testing, the survivors had greater exercise intensity and duration, with a lower prevalence of combined ischemia and viability, but not ischemia alone. Numerous other clinical and electrocardiographic criteria, and notably all coronary angiographic criteria, were similar between these groups. In a mu...

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“…HF is a leading cause of emergency room visits, hospitalizations, and death with five million cases in the US and another 500,000 diagnosed each year resulting in the forecasted prevalence to double by year 2040 [4,5]. Advancing age is a leading determinant of myocardial fibrosis, and thus, the incidence of HF nearly doubles for patients > 85 years of age compared to those < 75 years [4].…”

Section: Introductionmentioning

confidence: 99%

“…Approximately two thirds of HF patients have ischemic cardiomyopathy with zones of cardiac fibrosis in the form of a healed infarction [5,6]. The extent of coronary artery disease and prior infarction is associated with the severity of left ventricular dysfunction and clinical outcomes in those with both preserved and reduced ejection fraction [7,8].…”

Section: Introductionmentioning

confidence: 99%

Practical experience using galectin-3 in heart failure

McCullough¹

2014

Clinical Chemistry and Laboratory Medicine (CCLM)

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Heart failure is a complex mechanical and neurohormonal syndrome where the left ventricle fails as a pump, resulting in stasis of blood in the lungs and the periphery resulting in the cardial features of effort intolerance, fatigue, and peripheral edema. As part of the neurohormonal and local mechanical strain, tissue macrophages resident in the myocardium secrete galectin-3 which is a paracrine and endocrine factor which stimulates additional macrophages, pericytes, myofibroblasts, and fibroblasts to proliferate and secrete procollagen I which is irreversibly crosslinked resulting in myocardial fibrosis. In the general population, normal plasma concentrations of galectin-3 are < 11.0 ng/mL. Galectin-3 measured in blood has been shown to: 1) identify increased risk for new onset heart failure in healthy middle-aged adults; 2) predict cardiac failure in patients after acute coronary syndromes; 3) help establish the diagnosis of heart failure with preserved ejection fraction in patients presenting with exercise intolerance; and 4) aid in the prognosis of heart failure with preserved and reduced left ventricular ejection fraction. This manuscript will present practical real case management in these applications to highlight the importance of this new in vitro diagnostic test.

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Etiology and pathophysiology of new-onset heart failure: Evaluation by myocardial perfusion imaging

Abstract: These preliminary data derived from a non-randomized observational cohort suggest potential diagnostic utility of MPI for ischemic LV dysfunction in new-onset HF, and sets the stage for a prospective randomized study to confirm these findings.

Cited by 51 publications

References 22 publications

Myocardial Ischemia in Patients with Diastolic Dysfunction and Heart Failure

Myocardial Ischemia in Patients with Diastolic Dysfunction and Heart Failure

Gated SPECT myocardial perfusion scintigraphy: a multi-faceted tool for the evaluation of heart failure

Practical experience using galectin-3 in heart failure

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