Heart failure with mid-range ejection fraction and the effect of β-blockers after acute myocardial infarction

Song, Pil Sang; Kim, Mijoo; Seong, Seok-Woo; Park, Jae‐Hyeong; Choi, Si Wan; Hahn, Joo Yong; Gwon, Hyeon Cheol; Hur, Seung Ho; Rha, Seung Woon; Yoon, Chang Hwan; Jeong, Myung Ho; Seong, In Whan; Jeong, Jin Ok

doi:10.1007/s00380-021-01876-1

Cited by 4 publications

(4 citation statements)

References 31 publications

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“…In both studies, patients with reduced EF had a worse prognosis than patients with mildly reduced EF. Subsequent studies in cohorts from other countries have observed similar findings 25–27 . In our study, we did not observe a statistically significantly higher mortality in patients with reduced EF compared with patients with mildly reduced EF after adjustment for baseline covariates.…”

Section: Discussionsupporting

confidence: 87%

“…Subsequent studies in cohorts from other countries have observed similar findings. [25][26][27] In our study, we did not observe a statistically significantly higher mortality in patients with reduced EF compared with patients with mildly reduced EF after adjustment for baseline covariates. This finding might be explained by the different regions of the world where the studies were performed, or to the more complete adjustment in covariates and the longer follow-up in our study compared with the previous ones.…”

Section: Discussionmentioning

confidence: 73%

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Long‐term mortality after acute coronary syndromes among patients with normal, mildly reduced, or reduced ejection fraction

et al. 2022

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Aims Left ventricular ejection fraction (LVEF) ≤ 40% is a well-established risk factor for mortality after acute coronary syndromes (ACS). However, the long-term prognostic impact of mildly reduced ejection fraction (EF) (LVEF 41-49%) after ACS remains less clear. Methods and resultsThis was a retrospective study enrolling patients admitted with ACS included in a single-centre databank. LVEF was assessed by echocardiography during index hospitalization. Patients were divided in the following categories according to LVEF: normal (LVEF ≥ 50%), mildly reduced (LVEF 41-49%), and reduced (LVEF ≤ 40%). The endpoint of interest was all-cause death after hospital discharge. A multivariable Cox model was used to adjust for confounders. A total of 3200 patients were included (1952 with normal EF, 375 with mildly reduced EF, and 873 with reduced EF). The estimated cumulative incidence rates of mortality at 10 years for patients with normal, mildly reduced, and reduced EF were 24.8%, 33.5%, and 41.3%, respectively. After adjustments, the presence of reduced EF was associated with higher mortality compared with normal EF [adjusted hazard ratio (HR) 1.64; 95% confidence interval (CI) 1.36-1.96; P < 0.001], as was mildly reduced EF compared with normal EF (adjusted HR 1.33; 95% CI 1.05-1.68; P = 0.019). The presence of reduced EF was not associated with a statistically significantly higher mortality compared with mildly reduced EF (adjusted HR 1.23; 95% CI 0.96-1.57; P = 0.095). Conclusions In patients with ACS, mildly reduced EF measured in the acute phase was associated with higher long-term mortality compared with patients with normal EF. These data emphasize the importance of anti-remodelling therapies for ACS patients who have LVEF in the mildly reduced range.

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Section: Discussionsupporting

confidence: 87%

Section: Discussionmentioning

confidence: 73%

Long‐term mortality after acute coronary syndromes among patients with normal, mildly reduced, or reduced ejection fraction

et al. 2022

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“…Несмотря на то, что в последних руководствах ESC (European Society of Cardiology) была введена новая категория классификации СН, включающая пациентов с умеренно низкой ФВ (41-49%), этот подтип все еще недостаточно определен и плохо представлен в большинстве клинических исследований. Среди больных с ОКСпST доказана связь между тяжестью СН и смертностью [20], а в сравнительно недавнем исследовании Song PS, et al [21] определена эффективность назначения БАБ у больных с СНунФВ после острого инфаркта миокарда. Полагают, что одним из патогенетических механизмов прогрессирования СН является резкое снижение выработки оксида азота (NO), т.к.…”

Section: Discussionunclassified

Advantages of long-term combination pharmacotherapy with a beta-blocker and eplerenone in patients with ST-segment elevation acute coronary syndrome

Осипова

Михин

Головин

et al. 2022

Cardiovasc Ther Prev

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Aim. To conduct a comparative analysis of the effect of long-term pharmacotherapy (12 months) using a β-blocker (nebivolol) and its combination with eplerenone in patients after ST-segment elevation acute coronary syndrome (STE-ACS) with heart failure with mildly reduced ejection fraction (EF) (HFmrEF) on the structural and functional cardiac parameters.Material and methods. We examined 130 patients with STE-ACS and HFmrEF after successful myocardial revascularization by percutaneous coronary intervention. The mean age of patients was 53,6 [46;57] years. Ten patients withdrew from the study due to personal reasons. Subsequently, patients were randomly divided into 2 treatment groups as follows: 60 patients received nebivolol; 60 patients received nebivolol and eplerenone. Patients were examined at two stages: 1st day of the disease before PCI and 12 months later. All patients underwent a clinical examination, echocardiography, followed by assessment of left ventricular (LV) EF, LV end-diastolic volume index (EDVI), LV endsystolic volume index (ESVI), LV myocardial index (LVMI), LV wall motion score index (WMSI), the ratio of peak early diastolic flow over peak late diastolic flow (E/A), the ratio of early diastolic transmitral flow velocity to the mitral annular velocity (E/e´).Results. Twelve-month pharmacotherapy with nebivolol in patients after STE-ACS showed an increase in LVEF by 7,2% (p<0,05), a decrease in WMSI by 13,0% (p<0,05), an increase in the E/A ratio by 11,1% (р<0,05), decrease in the E/e’ ratio by 7,2% (р<0,05). LV EDVI increased by 4,6% (p>0,05). Twelve-month combined pharmacotherapy with nebivolol and eplerenone showed an increase in LVEF by 16,0% (p<0,01), a decrease in LV ESVI by 17,9% (p<0,05), and a decrease in WMSI by 26,7% (p<0,01), LVMI — by 23,8% (р<0,01). At the same time, LV EDVI decreased by 0,7% (p>0,05). The E/A ratio increased significantly by 22,2% (<0,01), E/e’ decreased by 29,6% (р<0,01). Comparative analysis also found that combination therapy had a more pronounced positive effect on LVEF (p<0,05), ESVI (p<0,05), WMSI (p<0,05), LVMI (p<0,01), as well as diastolic function in the form of a significant increase in E/A (p<0,05) and E/e’ (p<0,01), which recovered to normal values.Conclusion. The advantages of long-term combination pharmacotherapy of nebivolol and eplerenone in HFmrEF patients after STE-ACS on both structural and functional cardiac parameters were established.

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“…ՄԱՖՍԱ-ի բուժման տարբերակների վերաբերյալ հիմնական տարաձայնությունները վերաբերում են այն հարցերին, թե բուժական որ մոտեցումներն են լավագույնը, և ինչպես պետք է որոշվի ՄԱԱՖՍԱ հիվանդների հետագա վարումը [1,3,11,17,31,35]: CHARM հետազոտության արդյունքներով սարտանների կիրառումը, մասնավորապես կանդեսարտանի, կարող է նվազեցնել սիրտ-անոթային պատահարների և ՍԱ արտահայտվածության աստիճանը ՄԱԱՖՍԱ հիվանդների մոտ [15]։ Նմանատիպ արդյունքներ են ստացվել բետաադրենապաշարիչների կիրառմամբ կատարված հետազոտություններում, որոնց արդյունքում արձանագրվել է, որ սիրտ-անոթային մահացությունը պլացեբո խմբի համեմատ հավաստիորեն նվազել է սինուսային ռիթմ և 40-49% ՁՓ ԱՖ ունեցող հիվանդների մոտ [32]…”

unclassified

Ձախ Փորոքի Միջին Աստիճանի Արտամղման Ֆրակցիայով Սրտային Անբավարարություն. Առանձին Միավո՞ր, Թե՞ Անցումային Ֆենոտիպ

Թունյան¹,

Թումասյան²,

Հակոբյան³

et al. 2023

Medical Science of Armenia

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Сердечная недостаточность (СН) является важной проблемой современной кардиологии, для которой характерны высокие показатели заболеваемости и смертности, несмотря на темпы развития здравоохранения. Поскольку СН является синдромом, который обусловлен функциональными и структурными изменениями левого желудочка (ЛЖ), классификация СН, согласно фракции выброса ЛЖ, имеет важное значение, в частности при оценке патологического состояния и выборе лечебной тактики. Фракция выброса ЛЖ в пределах 40-49% зачастую называется «серой зоной», однако Европейская ассоциация кардиологов ведение больных с острой и хронической СН с умеренной сниженной фракцией выброса ЛЖ рассматривает как отдельную категорию. Heart failure (HF) is an important problem of modern cardiology with high morbidity and mortality rates, despite the pace of development of healthcare. Since HF is a syndrome that is caused by functional and structural changes of the left ventricle (LV), the classification of HF, according to the LV ejection fraction, is important, in particular, when assessing the pathological condition and making therapeutic decision. LV ejection fraction in the range of 40-49% is often referred to as the “gray zone”, but the European Heart Association considers the management of patients with acute and chronic HF with moderately reduced LV ejection fraction as a separate category.

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Heart failure with mid-range ejection fraction and the effect of β-blockers after acute myocardial infarction

Cited by 4 publications

References 31 publications

Long‐term mortality after acute coronary syndromes among patients with normal, mildly reduced, or reduced ejection fraction

Long‐term mortality after acute coronary syndromes among patients with normal, mildly reduced, or reduced ejection fraction

Advantages of long-term combination pharmacotherapy with a beta-blocker and eplerenone in patients with ST-segment elevation acute coronary syndrome

Ձախ Փորոքի Միջին Աստիճանի Արտամղման Ֆրակցիայով Սրտային Անբավարարություն. Առանձին Միավո՞ր, Թե՞ Անցումային Ֆենոտիպ

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