Phantom Systole: A Failed Ejection Phenomenon between Pulsus Alternans and Systolic Aortic Regurgitation

G, Germán Ramos; M, Juan Bulnes; C, Alejandro Paredes; N, Luigi Gabrielli

doi:10.1016/j.case.2020.08.010

Cited by 1 publication

(7 citation statements)

References 10 publications

(9 reference statements)

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“…This phenomenon is associated with pulsus alternans and ineffective contraction, which is common in severe left-side HF. 7 We found that simultaneous tricuspid regurgitation and PR at systolic phase in patients with acute decompensated HF , and systolic PR disappeared after discharge. The prevalence and clinical significance of systolic PR were not investigated before.…”

Section: Introductionmentioning

confidence: 68%

“…Like systolic AR, physicians are acquired to focus more on systolic PR. 1 , 2 , 3 , 4 , 5 , 6 , 7 Before elucidating systolic PR, systolic AR might provide some clues. Based on data, the prevalence of systolic AR is higher in HF population (5.9% vs. 2.1%).…”

Section: Discussionmentioning

confidence: 99%

“… 18 , 19 Transient systolic AR can be an ineffective ejection phenomenon, which is commonly associated with ventricular extrasystole and the use of LV assist devices in patients, being a consequence of artificial suction by the device from the LV apex rather than a spontaneous finding, in HF patients with pre‐existing AR. 7 Ineffective ejection responsible for generating pulsus alternans in HF cases could be explained by contractility variation as myocardial intracellular calcium availability during excitation–contraction coupling. It is also possible to observe sustained systolic AR in HF cases with sinus rhythm wherein rate of development of LV pressure is very slow and the aortic systolic pressure exceeds the LV systolic pressure during prolonged IVCT.…”

Section: Discussionmentioning

confidence: 99%

“…This phenomenon is associated with pulsus alternans and ineffective contraction, which is common in severe left‐side HF. 7 …”

Section: Introductionmentioning

confidence: 99%

“…Systolic AR was explained as the inability of the ventricular contraction to overcome the aortic pressure in patients with valvular incompetence. This phenomenon is associated with pulsus alternans and ineffective contraction, which is common in severe left‐side HF 7 …”

Section: Introductionmentioning

confidence: 99%

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Systolic pulmonary regurgitation affects the outcome of patients with severe systolic heart failure

Hsiao

Chiou

2021

ESC Heart Failure

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Aims Little is known of the impact of systolic pulmonary regurgitation (PR) on acute decompensated heart failure (HF). We assessed the prevalence and prognostic significance of systolic PR in patients with severe HF. Methods and results According to recent 10 year echocardiographic database of E‐Da Hospital, 533 patients admitted for first systolic heart failure (HF) and left ventricular ejection fraction <35% were under investigation. Systolic PR was defined as the presence of pulmonary backward flow persistent after QRS in electrocardiogram. Isovolumic contraction/relaxation time and myocardial performance index were derived by tissue Doppler imaging. Right ventricular (RV) function was assessed by RV fractional area change. Estimated pulmonary vascular resistance (PVR) was assessed by the ratio of peak tricuspid regurgitation velocity to the RV outflow tract time–velocity integral. The factors associated with systolic PR were assessed by multivariate logistic regression. Cox proportional regression analyses were used to estimate the impact of cardiovascular events including HF rehospitalization and cardiovascular death. For estimated prevalence of 5480 control subjects, echocardiographic screens in those with normal left ventricular ejection fraction were performed. Of 533 systolic HF cases, 143 (26.8%) had systolic PR during indexed hospitalization. Among 143 cases, 86% systolic PR disappeared during late follow‐up. In control subjects, 0.3% (18/5480) had systolic PR. Systolic PR correlated to RV dysfunction, estimated PVR, E/e′, sign of low cardiac output, and pulmonary oedema. Systolic PR was associated independently with further cardiovascular events (hazard ratio 2.266, 95% confidence interval 1.682–3.089, P < 0.0001) including cardiovascular death and HF rehospitalization. Conclusions Systolic PR is not uncommon in systolic HF and is associated with high PVR and RV dysfunction. Systolic PR significantly impacts cardiovascular outcome.

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Section: Introductionmentioning

confidence: 68%