Heart Failure With Preserved Ejection Fraction: A Perioperative Review

Shillcutt, Sasha K.; Chacon, M. Megan; Brakke, Tara R.; Roberts, Ellen K.; Schulte, Thomas E.; Markin, Nicholas W.

doi:10.1053/j.jvca.2017.06.009

Cited by 8 publications

(6 citation statements)

References 78 publications

(112 reference statements)

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“…La valoración preanestésica debe incluir la descripción y optimización de las patologías concomitantes, pues es bien sabido que la enfermedad está asociada usualmente con la presencia de comorbilidades como la fibrilación auricular, anemia, diabetes mellitus, hipertensión arterial y obesidad (49,50). En aquellos pacientes con disfunción diastólica severa o sometidos a cirugía mayor, se debe considerar una evaluación detallada que puede incluir la realización de ecocardiografía de stress, resonancia magnética cardiaca, cateterismo cardiaco derecho e izquierdo, además del concepto especializado de cardiología (51). La valoración cardiovascular debe ser completa e incluir la capacidad funcional en equivalentes metabólicos (METs), y se ha demostrado que un hallazgo < 4 METs es un fuerte predictor de eventos cardiacos posoperatorios (52).…”

Section: Abordaje Perioperatoriounclassified

Falla cardiaca con fracción de eyección preservada: generalidades y aproximación en el perioperatorio

Garzón

Angel

2021

Rev. Med.

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La falla cardiaca con fracción de eyección preservada es frecuente y de difícil abordaje perioperatorio en población adulta. Es un síndrome clínico complejo con alteraciones estructurales y funcionales cardiacas con fracción de eyección del ventrículo izquierdo preservada (FEVI) > 50 %. Los biomarcadores, la ecocardiografía, el cateterismo cardiaco y otros métodos no invasivos confirman el diagnóstico. Actualmente no existe manejo específico efectivo comparado al de la falla con fevi reducida. Objetivo: elaborar una revisión de la literatura sobre la falla cardiaca con fracción de eyección preservada y sus implicaciones anestésicas. Métodos: se realizó una revisión no sistemática de la literatura en las siguientes bases de datos: Pubmed/Medline, LILACS, ScienceDirect. Resultados: la falla cardiaca con fracción de eyección preservada es una entidad común con una prevalencia entre 36,9 % y más del 50 % del total de pacientes. La fisiopatología incluye alteraciones diastólicas del ciclo cardiaco incluyendo las fases de relajación y de compliance ventricular. Desde el punto de vista anestésico se debe mantener el ritmo sinusal en arritmias, controlar la respuesta cronotrópica, evitar congestión pulmonar, manejar específicamente las etiologías-comorbilidades, conservar presiones de llenado ventricular y lograr estabilidad hemodinámica. Conclusión: los pacientes con este síndrome representan un reto anestésico. El manejo incluye tratamiento específico de las etiologías, comorbilidades y fenotipos. A diferencia de la falla cardiaca con fracción de eyección reducida, no existen terapias que disminuyan la mortalidad, por lo que se requieren nuevos fármacos y estudios clínicos que mejoren las perspectivas anestésicas y el abordaje terapéutico.

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Section: Abordaje Perioperatoriounclassified

Falla cardiaca con fracción de eyección preservada: generalidades y aproximación en el perioperatorio

Garzón

Angel

2021

Rev. Med.

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“…Almost half of the included studies (11/23) performed echocardiography or tissue Doppler under isoflurane (analogues) and it remains pivotal for obtaining accurate measurements. The general impact of anesthetics on perioperative LVDD and HFpEF remains unclear [71].…”

Section: Echocardiography and Tissue Doppler Parameters Of Lvdd And Hmentioning

confidence: 99%

Matrix Metalloproteinases and Tissue Inhibitors of Metalloproteinases in Extracellular Matrix Remodeling during Left Ventricular Diastolic Dysfunction and Heart Failure with Preserved Ejection Fraction: A Systematic Review and Meta-Analysis

Krebber

Dijk

Vernooij

et al. 2020

IJMS

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Matrix metalloproteinases (MMPs) and tissue inhibitors of metalloproteinases (TIMPs) are pivotal regulators of extracellular matrix (ECM) composition and could, due to their dynamic activity, function as prognostic tools for fibrosis and cardiac function in left ventricular diastolic dysfunction (LVDD) and heart failure with preserved ejection fraction (HFpEF). We conducted a systematic review on experimental animal models of LVDD and HFpEF published in MEDLINE or Embase. Twenty-three studies were included with a total of 36 comparisons that reported established LVDD, quantification of cardiac fibrosis and cardiac MMP or TIMP expression or activity. LVDD/HFpEF models were divided based on underlying pathology: hemodynamic overload (17 comparisons), metabolic alteration (16 comparisons) or ageing (3 comparisons). Meta-analysis showed that echocardiographic parameters were not consistently altered in LVDD/HFpEF with invasive hemodynamic measurements better representing LVDD. Increased myocardial fibrotic area indicated comparable characteristics between hemodynamic and metabolic models. Regarding MMPs and TIMPs; MMP2 and MMP9 activity and protein and TIMP1 protein levels were mainly enhanced in hemodynamic models. In most cases only mRNA was assessed and there were no correlations between cardiac tissue and plasma levels. Female gender, a known risk factor for LVDD and HFpEF, was underrepresented. Novel studies should detail relevant model characteristics and focus on MMP and TIMP protein expression and activity to identify predictive circulating markers in cardiac ECM remodeling.

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“…Авторы рекомендаций считают, что «определение СН-срФВ как отдельного показателя будет стимулировать исследования, касающиеся характеристики, патофизиологии и лечения этой группы населения» (Рекомендации Европейской ассоциации кардиологов, 2016, § 3) [7,8]. Хотя подразделение СН по критерию средней и сохраненной ФВ недостаточно обосновано (противоречиво), поскольку неизменная ФВ не может быть показателем изменяющейся тяжести СН [9,10].…”

Section: Introductionunclassified

“…Эти авторы также пишут, что ФВ может быть изменена прогрессированием заболевания или лечением [6,10]. Другие авторы высказывают сомнения в чувствительности и специфичности ФВ к клиническому состоянию [9,10]. Ведение больных с клинически выраженной СН при сохраненной ФВ представляет значительные проблемы для анестезиологов [9].…”

unclassified

“…Другие авторы высказывают сомнения в чувствительности и специфичности ФВ к клиническому состоянию [9,10]. Ведение больных с клинически выраженной СН при сохраненной ФВ представляет значительные проблемы для анестезиологов [9]. Исследуются механизмы сохранения ФВ при выраженном изменении циркулярного и продольного размера ЛЖ [13,14].…”

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Comparison of Ejection Fraction and End Volumes of the Left Ventricle as Indicators of the Severity of Heart Failure

Газизова

2019

Kuban. nauсh. med. vestnik

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Aim. To demonstrate that the end volumes are indicative of the severity of the left ventricle pathological condition not only under preserved, but also under reduced ejection fraction. Material and methods. 32 patients with dilated cardiomyopathy and severe heart failure, as well as with complete monitor and computer and echocardiographic control were examined. Results. The sensitivity of the ejection fraction and end volumes to the severity of heart failure (stroke index from 15.3 to 57.2, average 29.5±1.6; ejection fraction from 16.5 to 48.0, average 27.4±127; heart rate from 52 tо 113, average 81.8±2.4) was established. It is shown that the percentage change (sensitivity) of the ejection fraction (55%) is much lower than that of the end diastolic volume index (190%) and that of the end systolic volume index (438%) to the severity of heart failure. Conclusion. Indices of end-diastolic and end-systolic volumes of critical patients with dilated cardiomyopathy are more sensitive to the severity of heart failure than the ejection fraction. It is advisable to use end volumes as indicators of heart failure. An adequate quantitative assessment of the severity of heart failure should include the heart rate (duration of the cardiac cycle T).

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Heart Failure With Preserved Ejection Fraction: A Perioperative Review

Cited by 8 publications

References 78 publications

Falla cardiaca con fracción de eyección preservada: generalidades y aproximación en el perioperatorio

Falla cardiaca con fracción de eyección preservada: generalidades y aproximación en el perioperatorio

Matrix Metalloproteinases and Tissue Inhibitors of Metalloproteinases in Extracellular Matrix Remodeling during Left Ventricular Diastolic Dysfunction and Heart Failure with Preserved Ejection Fraction: A Systematic Review and Meta-Analysis

Comparison of Ejection Fraction and End Volumes of the Left Ventricle as Indicators of the Severity of Heart Failure

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