Evolution of Myocardial Dysfunction in Asymptomatic Patients at Risk of Heart Failure

Halabi, Amera; Yang, Hilda; Wright, Leah; Potter, Elizabeth; Huynh, Quan; Negishi, Kazuaki; Marwick, Thomas H.

doi:10.1016/j.jcmg.2020.09.032

Cited by 11 publications

(6 citation statements)

References 41 publications

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“…This may be due to the fact that controls in the invasive arm were not truly normal, as they presented with exertional dyspnoea, and had other indicators of pre-clinical HFpEF, such as reduced GLS. 27,28 In agreement with Rosch et al, 10 we also observed that patients with HFpEF ≥65% displayed a leftward shifted EDPVR compared to patients with lower EF. However, the study from Rosch et al did not include a control group without HFpEF.…”

Section: Remodelling and Chamber Stiffening In Hfpef With Higher Ejec...supporting

confidence: 91%

“…In the community‐based sample, LV volumes were lower in HFpEF ≥65% compared to both HFpEF ≥65% and controls, whereas there was no difference in heart volumes compared to controls in the invasive cohort. This may be due to the fact that controls in the invasive arm were not truly normal, as they presented with exertional dyspnoea, and had other indicators of pre‐clinical HFpEF, such as reduced GLS 27,28 …”

Section: Discussionmentioning

confidence: 99%

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Ventricular stiffening and chamber contracture in heart failure with higher ejection fraction

Popović

Alogna

Omar

et al. 2023

European J of Heart Fail

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Aims Ancillary analyses from clinical trials have suggested reduced efficacy for neurohormonal antagonists among patients with heart failure and preserved ejection fraction (HFpEF) and higher ranges of ejection fraction (EF). Methods and results A total of 621 patients with HFpEF were grouped into those with low‐normal left ventricular EF (LVEF) (HFpEF<65%, n = 319, 50% ≤ LVEF <65%) or HFpEF≥65% (n = 302, LVEF ≥65%), and compared with 149 age‐matched controls undergoing comprehensive echocardiography and invasive cardiopulmonary exercise testing. A sensitivity analysis was performed in a second non‐invasive community‐based cohort of patients with HFpEF (n = 244) and healthy controls without cardiovascular disease (n = 617). Patients with HFpEF≥65% had smaller left ventricular (LV) end‐diastolic volume than HFpEF<65%, but LV systolic function assessed by preload recruitable stroke work and stroke work/end‐diastolic volume was similarly impaired. Patients with HFpEF≥65% displayed an end‐diastolic pressure–volume relationship (EDPVR) that was shifted leftward, with increased LV diastolic stiffness constant β, in both invasive and community‐based cohorts. Cardiac filling pressures and pulmonary artery pressures at rest and during exercise were similarly abnormal in all EF subgroups. While patients HFpEF≥57% displayed leftward shifted EDPVR, those with HFpEF<57% had a rightward shifted EDPVR more typical of heart failure with reduced EF. Conclusion Most pathophysiologic differences in patients with HFpEF and higher EF are related to smaller heart size, increased LV diastolic stiffness, and leftward shift in the EDPVR. These findings may help to explain the absence of efficacy for neurohormonal antagonists in this group and raise a new hypothesis, that interventions to stimulate eccentric LV remodelling and enhance diastolic capacitance may be beneficial for patients with HFpEF and EF in the higher range.

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Section: Remodelling and Chamber Stiffening In Hfpef With Higher Ejec...supporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Ventricular stiffening and chamber contracture in heart failure with higher ejection fraction

Popović

Alogna

Omar

et al. 2023

European J of Heart Fail

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“…Richard Lower FRCP (1631–1691) was the first to publish the twisting motion of the LV, in 1669, as “the wringing of a linen cloth to squeeze out the water”, which continues to intrigue the experts in their quest to understand cardiac function [ 13 , 14 , 15 ]. Apart from speckle tracking echocardiography (STE), magnetic resonance imaging (MRI) may be used to examine LV twist [ 15 , 16 ].…”

Section: Left Ventricular Twist As Function Of the Heartmentioning

confidence: 99%

High Exogenous Antioxidant, Restorative Treatment (Heart) for Prevention of the Six Stages of Heart Failure: The Heart Diet

Singh¹,

Fedačko

Pella

et al. 2022

Antioxidants

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The exact pathophysiology of heart failure (HF) is not yet known. Western diet, characterized by highly sweetened foods, as well as being rich in fat, fried foods, red meat and processed meat, eggs, and sweet beverages, may cause inflammation, leading to oxidative dysfunction in the cardiac ultra-structure. Oxidative function of the myocardium and how oxidative dysfunction causes physio-pathological remodeling, leading to HF, is not well known. Antioxidants, such as polyphenolics and flavonoids, omega-3 fatty acids, and other micronutrients that are rich in Indo-Mediterranean-type diets, could be protective in sustaining the oxidative functions of the heart. The cardiomyocytes use glucose and fatty acids for the physiological functions depending upon the metabolic requirements of the heart. Apart from toxicity due to glucose, lipotoxicity also adversely affects the cardiomyocytes, which worsen in the presence of deficiency of endogenous antioxidants and deficiency of exogenous antioxidant nutrients in the diet. The high-sugar-and-high-fat-induced production of ceramide, advanced glycation end products (AGE) and triamino-methyl-N-oxide (TMAO) can predispose individuals to oxidative dysfunction and Ca-overloading. The alteration in the biology may start with normal cardiac cell remodeling to biological remodeling due to inflammation. An increase in the fat content of a diet in combination with inducible nitric oxide synthase (NOSi) via N-arginine methyl ester has been found to preserve the ejection fraction in HF. It is proposed that a greater intake of high exogenous antioxidant restorative treatment (HEART) diet, polyphenolics and flavonoids, as well as cessation of red meat intake and egg, can cause improvement in the oxidative function of the heart, by inhibiting oxidative damage to lipids, proteins and DNA in the cell, resulting in beneficial effects in the early stage of the Six Stages of HF. There is an unmet need to conduct cohort studies and randomized, controlled studies to demonstrate the role of the HEART diet in the treatment of HF.

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“…91 The GLS also did not change in 982 diabetic patients in a large clinical trial conducted by Halabi A et al, although the authors observed improvement in the diastolic function and LV filling pressures after median 19 months of treatment with metformin. 92 Beyond the first-line agents for CHF treatment there is some sporadic data from experimental studies supporting the possible positive effect of ivabradine on longitudinal myocardial strain and strain rate in mouse models of acute myocardial infarction. 93 Unfortunately, the data on ivabradine impact on LV contractility are too scarce to make any conclusions; there are only some anecdotal clinical case presentations on this topic.…”

Section: Speckle Tracking Analysis Utility In Heart Failure With Pres...mentioning

confidence: 99%

“…Nevertheless, A. H. Larsen et al investigated the effect of metformin on LV function in 36 non‐diabetic patients with CHF with reduced EF and found improvement in myocardial efficiency, but no significant changes in GLS 91 . The GLS also did not change in 982 diabetic patients in a large clinical trial conducted by Halabi A et al, although the authors observed improvement in the diastolic function and LV filling pressures after median 19 months of treatment with metformin 92 …”

Section: Introductionmentioning

confidence: 99%

The impact of medical therapy on left ventricular strain: Current state and future perspectives

Karev

Вербило

Малев

et al. 2022

J of Clinical Ultrasound

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The speckle tracking strain is becoming a frequently used marker of subclinical left ventricular systolic dysfunction. Despite the wide range of data concerning left ventricular strain variability in the general population and its changes in various pathologic conditions, the information about the impact of medical therapy on left ventricle strain is limited. This article provides an analysis of published studies of left ventricle strain changes in response to different agents and combinations of medical therapies used for hypertension and congestive heart failure.

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Evolution of Myocardial Dysfunction in Asymptomatic Patients at Risk of Heart Failure

Cited by 11 publications

References 41 publications

Ventricular stiffening and chamber contracture in heart failure with higher ejection fraction

Ventricular stiffening and chamber contracture in heart failure with higher ejection fraction

High Exogenous Antioxidant, Restorative Treatment (Heart) for Prevention of the Six Stages of Heart Failure: The Heart Diet

The impact of medical therapy on left ventricular strain: Current state and future perspectives

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